Journal articles on the topic 'Osteoporosic fractures'
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Baccichetti, A., P. L. Nguyen-Thi, A. Blum, D. Mainard, F. Sirveaux, L. Nace, A. Valance, et al. "SAT0459 EVALUATION OF THE PREVALENCE AND THE MANAGEMENT OF OSTEOPOROTIC FRACTURES IN PATIENTS HOSPITALIZED AT NANCY UNIVERSITY HOSPITAL (FRANCE) IN 2017." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1187.1–1187. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3366.
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Background:Osteoporotic fractures are a major public health concern because of their consequences in morbidity, costs and mortality. In the meantime, historically postfracture osteoporosis medication use rates have been poor.Objectives:The aim is to analyze the management of osteoporosis in patients hospitalized for osteoporotic fractures (OF) at Nancy University Hospital (France) in 2017.Methods:Total number of hospitalized patients and hospital stays were extracted by the Department of Medical Information (DIM) which selected departments with at least forty hospitalizations with Medical Unit Summary related to a diagnosis of fracture or osteoporosis. Hospitalizations not concerned by a recent OF were excluded. Data on fractures, patient characteristics, risk factors for OF and fall, management of osteoporosis, discharge status, stay duration, were studied from patient medical records. Prevalence of OF stays, management of osteoporosis and factors associated with duration of stay were analyzed.Results:Out of a total of 153,840 hospitalizations, 918 hospitalizations (844 patients, mean age 74.5 years ± 13.6, 74.5% women) concern an OF. The prevalence of hospitalizations for OF was 0.6% of total hospitalizations and 17.9% of total hospitalizations for fractures. Among the 844 patients, 85.7% had a severe fracture (vertebral fracture: 56.2%, hip fracture: 24.1%), 16.5% had a non-severe fracture, and 8.5% had a fracture cascade in the year. At discharge from hospital, 11.7% of patients received a specific treatment for osteoporosis. Longer stay duration was associated with age, severe fractures, Groll index and discharge status.Conclusion:Nearly one hospitalized fracture in five is osteoporotic, while only one in ten patients is treated for osteoporosis. Stay duration increased with age and comorbidities. This encourages the development of early prevention, screening and treatment strategies for osteoporosis.References:[1]Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8:136.[2]Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006 Oct 19;17(12):1726–33.[3]Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD. Fragility Fractures and the Osteoporosis Care Gap: An International Phenomenon. Semin Arthritis Rheum. 2006 Apr;35(5):293–305.Disclosure of Interests:None declared
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Murillo, Bernardo, Christian Antonio Allende Nores, and Orlando Rodríguez. "Incidencia de diagnóstico y tratamiento de la osteoporosis en pacientes con fractura de radio distal. [Diagnosis and treatment incidence of osteoporosis in patients with distal radius fractures]." Revista de la Asociación Argentina de Ortopedia y Traumatología 84, no. 2 (May 2, 2019): 99–104. http://dx.doi.org/10.15417/issn.1852-7434.2019.84.2.664.
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Introducción: Las fracturas de radio distal en pacientes mayores son un indicador de osteoporosis. El objetivo de este estudio fue determinar el diagnóstico y el tratamiento de la osteoporosis en pacientes con fractura de radio distal, operados en nuestra institución, entre 2012 y 2014.Materiales y Métodos: Los datos se obtuvieron de entrevistas telefónicas a 41 pacientes mayores, operados por fracturas de radio distal. Las variables evaluadas fueron: sexo, edad, enfermedades asociadas, tabaquismo, fracturas previas, tratamiento antiosteoporótico previo o posterior a la fractura en cuestión, especialidad del médico que solicitó el tratamiento y realización o no de densitometría mineral ósea.Resultados: La muestra incluyó a 41 pacientes (32 mujeres). Veintiséis contaban con una densitometría antes de la fractura (15 con osteoporosis), 11 habían sufrido una fractura por osteoporosis, y sólo 7 recibían tratamiento antiosteoporótico cuando ocurrió la fractura. Luego de la cirugía, solo 4 de ellos continuó con el tratamiento. Se encontró cierta asociación entre una densitometría patológica y la presencia de diabetes tipo 2, no así con otras comorbilidades. La tasa de incidencia anual de osteoporosis, calculada entre todos los pacientes que se atendieron en nuestra institución, en 2014, fue alrededor del 1%. Los traumatólogos solicitaron el 1,5% de todas las densitometrías prescritas dicho año.Conclusiones: Este estudio sugiere que los traumatólogos que se desempeñan en nuestra institución tienen nula o poca participación en la prevención secundaria de la osteoporosis; por esta razón, se consideraría necesario un protocolo de prevención de fracturas secundarias a la osteoporosis. Abstract Introduction: Distal radius fractures in elderly patients are an indicator of osteoporosis. The aim of this study was to determine osteoporosis diagnosis and treatment in patients with distal radius fractures treated surgically at our institution between 2012 and 2014.Methods:Information of 41 patients who had surgical intervention for distal radius fracture was obtained through telephones interviews. Several variables evaluated: age, sex, smoking, associated pathologies, previous fractures, preoperative and postoperative anti-osteoporotic treatments, specialty of the physicians that indicated antiosteoporotic treatment, and bone mineral density (BMD) studies performed.Results: The study included 41 patients (32 female).Twenty-six had a BMD performed before the fracture (15 evidenced osteoporosis), 11 had had previous fractures secondary to osteoporosis. Only 7patients were under anti-osteoporotic treatment to the moment of the fracture. After surgery, only 4 of the patients continued with the treatment. Pathological BMD had certain degree of associationwith the presence of Diabetes (type 2), but not with other comorbidities. The annual incidence rate of osteoporosis, calculated using all patients attended at our institution in 2014, was about 1%. Orthopedic surgeons indicated only 1.5% of the total number of BMDs prescribed that year.Conclusion: Our study suggests that there is poor prevention by orthopedic surgeons of secondary osteoporotic fractures, which is why a national prevention protocol for fractures secondary to osteoporosis would be considered necessary.
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Lyalina, V. V., I. A. Borshenko, S. V. Borisovskaya, E. A. Skripnichenko, R. V. Binyakovskiy, V. V. Trishina, and I. G. Nikitin. "Acute Osteoporotic Vertebral Fracture. Part 1. Definitions, Clinical Presentation, Pain Assessment, Diagnostic Imaging, Introduction to Differential Diagnosis." Russian Archives of Internal Medicine 12, no. 4 (July 30, 2022): 254–66. http://dx.doi.org/10.20514/2226-6704-2022-12-4-254-266.
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Osteoporosis is a widespread metabolic disease of the skeleton among the elderly. Osteoporotic fractures are significant manifestation of the disease, which can substantially affect the quality of life. The purpose of this article is to review approaches to the management of patients with acute osteoporotic fracture. This article consists of two parts. The first part reviews general information about osteoporosis, clinical course of osteoporotic fracture, differential diagnosis of pain syndrome, methods of visualization of fractures, differential diagnosis of osteoporosis. In the second part, we discuss differential diagnosis of osteoporotic fracture according to the data of imaging methods, non-pharmacologic, pharmacologic and surgical methods of treatment.
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Lyalina, V. V., I. A. Borshenko, S. V. Borisovskaya, E. A. Skripnichenko, R. V. Binyakovskiy, V. D. Solomin, V. V. Trishina, and I. G. Nikitin. "Acute Osteoporotic Vertebral Fracture. Part 2. Differential Diagnostics According to the Data of Imaging Methods. Conservative and Surgical Treatment." Russian Archives of Internal Medicine 12, no. 6 (November 29, 2022): 438–49. http://dx.doi.org/10.20514/2226-6704-2022-12-6-438-449.
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Osteoporosis is a widespread metabolic disease of the skeleton among the elderly. Osteoporotic fractures are significant manifestation of the disease, which can substantially affect the quality of life. The purpose of this article is to review approaches to the management of patients with acute osteoporotic fracture. This article consists of two parts. The first part reviews general information about osteoporosis, clinical course of osteoporotic fracture, differential diagnosis of pain syndrome, methods of visualization of fractures, differential diagnosis of osteoporosis. In the second part, we discuss differential diagnosis of osteoporotic fracture according to the data of imaging methods, non-pharmacologic, pharmacologic and surgical methods of treatment.
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Laffaire, M., M. Caroline, E. Allado, E. Bauer, I. Chary Valckenaere, and D. Loeuille. "AB0948 Osteoporotic screening and prevalence of severe osteoporotic fractures in a population of psoriatic arthritis initiating a biologic treatment." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1602.2–1603. http://dx.doi.org/10.1136/annrheumdis-2022-eular.3871.
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BackgroundOsteoporosis is a common complication of Rheumatic diseases. The association between osteoporosis and rheumatoid arthritis is clearly demonstrated while this association is still debated as well as for the screening of osteoporosis by Dual-Energy X-Ray Absorptiometry (DEXA) or to demonstrate an increased risk of fracture on radiography in a population of Psoriatic Arthritis (PsA). The prevalence of fragility fractures reported on medical reports ranged between 12% and 40% in PsA patients. Only a few studies evaluated the prevalence of vertebral fracture (VF) on spine radiographs. To our knowledge no study has evaluated the contribution of radiographic or CT assessment of the spine on the prevalence of fragility fracture reported in medical records.ObjectivesTo determine Psoriatic Arthritis patient’s characteristics screened for osteoporosis by DEXA in a population initiating a biologic treatment (bDMARD) and to estimate the prevalence of severe osteoporotic fractures on medical reports and after imaging modalities scoring (X-ray or CT-scan).MethodsPatients with psoriasis should satisfy the CASPAR or ASAS criteria and have been screened during their follow up for a bDMARD. Osteoporotic screening was defined by a BMD testing (DEXA). Vertebral fractures were scored according to Genant’s method on spine X-ray or sagittal CT-scan images. Clinical and demographic data and the presence of previous severe osteoporotic fracture reported in the medical records were collected.ResultsOn 417 PsA patients screened for bDMARDs during 2008-2019, 89 patients (21.3%) were assessed for osteoporosis by DEXA. Increased age, female sex, menopause, previous severe fracture, disease duration, presence of inflammatory bowel disease, current and previous corticosteroid and bDMARDs uses were significantly associated with osteoporotic screening. On DEXA, 7 patients (7.9%) were classified as osteoporotic. The prevalence of severe osteoporotic fracture was 6.7% in medical reports and increased to 23.6% after scoring spine radiographies or TAP-CT images. In univariate analysis the presence of severe osteoporotic fractures was associated with age (p=0.013), scanographic bone attenuation coefficient (p=0.005) and Lumbar T-score (p=0.039).ConclusionLess than a quarter of PsA patients initiating a bDMARD is screened for osteoporosis. The prevalence of osteoporosis on DEXA and severe osteoporotic fractures on medical records are inferior to 10%. After systematic imaging evaluation, this prevalence increases at 23.6%.References[1]Chandran S, Aldei A, Johnson SR, Cheung AM, Salonen D, Gladman DD. Prevalence and risk factors of low bone mineral density in psoriatic arthritis: A systematic review. Seminars in Arthritis and Rheumatism. oct 2016[2]Riesco M, Manzano F, Font P, García A, Nolla JM. Osteoporosis in psoriatic arthritis: an assessment of densitometry and fragility fractures. Clinical Rheumatology. déc 2013[3]Pedreira PG, Pinheiro MM, Szejnfeld VL. Bone mineral density and body composition in postmenopausal women with psoriasis and psoriatic arthritis. Arthritis Res Ther. févr 2011[4]Del Puente A, Esposito A, Costa L, Benigno C, Del Puente A, Foglia F, et al. Fragility Fractures in Patients with Psoriatic Arthritis. The Journal of Rheumatology Supplement. 1 nov 2015[5]van der Weijden MAC, van der Horst-Bruinsma IE, van Denderen JC, Dijkmans BAC, Heymans MW, Lems WF. High frequency of vertebral fractures in early spondylarthropathies. Osteoporos Int. juin 2012[6]Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N. Opportunistic Screening for Osteoporosis Using Abdominal Computed Tomography Scans Obtained for Other Indications. Ann Intern Med. 16 avr 2013[7]Kwok TSH, Sutton M, Yang Ye J, Pereira D, Chandran V, Gladman DD. Prevalence and factors associated with osteoporosis and bone mineral density testing in psoriatic arthritis. Arthritis Care & Research. 16 déc 2020[8]Gulati AM et al. Osteoporosis in psoriatic arthritis: a cross-sectional study of an outpatient clinic population. RMD Open. juin 2018Disclosure of InterestsNone declared
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Ahn, Seong Hee, Seongbin Hong, Young J. Suh, Da Hea Seo, Yujin Jeong, Yongin Cho, and So Hun Kim. "ODP087 Dose-dependent effect of long-term statin use on risk of osteoporotic fracture in elderly patients." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A162. http://dx.doi.org/10.1210/jendso/bvac150.331.
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Abstract Introduction Studies have been conducted to assess the association between the use of statin and risk of new onset osteoporosis or osteoporotic fractures, however, they have shown conflicting results. We aimed to investigate the association between statin use and the risk of major osteoporotic fractures in elderly population. Methods In this population cohort study with Korean National Health Insurance Service-Senior Cohort database, a total of 365,656 elderly (≥60 years) without previous history of osteoporosis were included. The patients who did not have a history of statin use in year 2003 were followed from January 2004 to December 2012. Incidences of major osteoporotic fractures and site specific fractures were compared using the Cox proportional hazards model with use the inverse probability weighting method. Results During years follow-up period, 54,959 major osteoporotic fractures occurred; the risk of major osteoporotic fractures was significantly reduced (OR,0.769; 95% CI,0.716-0.826) in statin users compared with that in non-users. Among subtypes of major osteoporotic fracture, a risk reduction with statin therapy was significant for both vertebral fracture (OR,0.701; 95% CI,0.641-0.767) and non-vertebral fracture (OR,0.807; 95% CI,0.726-0.898). Longer duration and higher cumulative dose of statin, defined by cumulative daily defined dose, were negatively associated with the risk of major osteoporotic fracture. Conclusion In this population-based cohort study, the use of statin was associated with significant reduction in the risk of osteoporotic fractures in elderly patients without previous history of osteoporosis. Presentation: No date and time listed
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Dionyssiotis, Yannis, Grigorios Skarantavos, and Panayiotis Papagelopoulos. "Modern Rehabilitation in Osteoporosis, Falls, and Fractures." Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders 7 (January 2014): CMAMD.S14077. http://dx.doi.org/10.4137/cmamd.s14077.
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In prevention and management of osteoporosis, modern rehabilitation should focus on how to increase muscular and bone strength. Resistance exercises are beneficial for muscle and bone strength, and weight-bearing exercises help maintain fitness and bone mass. In subjects at higher risk for osteoporotic fractures, particular attention should be paid to improving balance – the most important element in falls prevention. Given the close interaction between osteoporosis and falls, prevention of fractures should be based on factors related to bone strength and risk factors for falls. Fractures are the most serious complication of osteoporosis and may be prevented. The use of modern spinal orthosis helps to reduce pain and improve posture. Vibration platforms are used in rehabilitation of osteoporosis, based on the concept that noninvasive, short-duration, mechanical stimulation could have an impact on osteoporosis risk. Pharmacologic therapy should be added for those at high risk of fracture, and vitamin D/calcium supplementation is essential in all prevention strategies. Success of rehabilitation in osteoporotic and fractured subjects through an individualized educational approach optimizes function to the highest level of independence while improving the overall quality of life.
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Kerschan-Schindl, K., M. Hackl, E. Boschitsch, U. Föger-Samwald, O. Nägele, S. Skalicky, M. Weigl, J. Grillari, and P. Pietschmann. "Diagnostic Performance of a Panel of miRNAs (OsteomiR) for Osteoporosis in a Cohort of Postmenopausal Women." Calcified Tissue International 108, no. 6 (January 11, 2021): 725–37. http://dx.doi.org/10.1007/s00223-020-00802-3.
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AbstractA specific signature of 19 circulating miRNAs (osteomiRs) has been reported to be associated with fragility fractures due to postmenopausal osteoporosis. However, it is unknown whether osteoporotic fractures or low BMD phenotypes are independently contributing to changes in osteomiR serum levels. The first aim was to characterize the abundance, sensitivity to hemolysis, and correlation of osteomiR serum levels, the second objective to evaluate the diagnostic accuracy of osteomiRs for osteoporosis according to the WHO criteria and on basis of major osteoporotic fracture history. Fifty postmenopausal women with osteoporosis (with or without fragility fracture) and 50 non-osteoporotic women were included in this cross-sectional study. The diagnostic performance of osteomiRs for osteoporosis based on the WHO definition or fracture history was evaluated using multiple logistic regression and receiver-operator curve (AUC) analysis. The osteomiR® signature is composed of four clusters of miRNAs providing good performance for the diagnosis of osteoporosis in postmenopausal women defined by WHO criteria (AUC = 0.830) and based on history of major osteoporotic fractures (AUC = 0.834). The classification performance for the WHO criteria and for fracture risk is driven by miR-375 and miR-203a, respectively. OsteomiRs, a signature of 19 emerging miRNA bone biomarkers, are measurable in human serum samples. They constitute a panel of independent bone and muscle biomarkers, which in combination could serve as diagnostic biomarkers for osteoporosis in postmenopausal women.
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Belova, K. Yu, O. B. Yershova, A. A. Degtyarev, M. V. Belov, V. O. Gerasimov, and S. Yu Fedotov. "REFRACTURE PREVENTION SYSTEM: FIRST RESULTS OF A PILOT PROGRAM WITHIN THE PROJECT «PROMETHEUS» IN YAROSLAVL." Osteoporosis and Bone Diseases 17, no. 2 (December 15, 2014): 3–6. http://dx.doi.org/10.14341/osteo201423-6.
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In order to reduce the incidence of recurrent fractures in patients that had already experienced low-energy (osteoporotic) fracture, the International Osteoporosis Foundation initiated the program «Capture the fracture». Established Best Practice Framework represents 13 standards to evaluate the effectiveness of the centers for the prevention of recurrent fractures, organized in different countries. In 2012 the Russian Association on Osteoporosis started the project PROMETHEUS [Creation the system to prevent recurrence of fractures in patients with osteoporosis]. In order to implement this program in the city of Yaroslavl we conducted a pilot project to establish a center for the prevention of recurrent fractures in patients who have received osteoporotic fracture. In this article we assess the effectiveness of the work of this center with the use of international standards, identify key problems and propose solutions.
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Tile, Lianne, and Angela M. Cheung. "Atypical femur fractures: current understanding and approach to management." Therapeutic Advances in Musculoskeletal Disease 12 (January 2020): 1759720X2091698. http://dx.doi.org/10.1177/1759720x20916983.
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Osteoporosis and resulting osteoporotic fractures are responsible for significant morbidity, excess mortality, and health care costs in the developed world. Medical therapy for osteoporosis has been shown in multiple randomized controlled trials to reduce the risk of vertebral and non-vertebral fractures and hip fractures, and in some studies bisphosphonate medications have been associated with improved survival. Although the overall benefit to risk ratio of osteoporosis medications remains favorable, there have been concerns raised about the long-term safety of these treatments. Atypical femur fracture, which is a rare type of fracture that has been associated with the long-term use of potent antiresorptive bone medications, is a potentially devastating consequence of osteoporosis treatment. This paper reviews our current understanding of atypical femur fractures, their relationship to antiresorptive osteoporosis medications, and proposed strategies for management, in order to inform clinical decision making about the optimal use and duration of medical therapy for the treatment of patients with osteoporosis or at high risk for osteoporotic fractures.
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Romanov, G. N., N. F. Chernova, T. I. Moskvicheva, and E. V. Rudenko. "CLINICAL AND INSTRUMENTAL CHARACTERISTICS OF REPEATED OSTEOPOROTIC FRACTURES IN PATIENTS OF GOMEL REGION OF BELORUSSIA AND MODERN THERAPEUTIC STRATEGY." Osteoporosis and Bone Diseases 17, no. 2 (December 15, 2014): 22–25. http://dx.doi.org/10.14341/osteo2014222-25.
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Introduction. Experienced osteoporotic fractures are a significant predictor of repeated, more severe fractures, entailing reduced quality of life and its expectancy. Objectives. To study the clinical and instrumental data of patients with single and repeated osteoporotic fractures of the forearm, proximal femur and spine, as well as the frequency of their occurrence in women of Gomel region of Belorussia. Materials and methods. The study included 2356 women aged over 50 years. Protocol included questionnaire with the assessment of detailed fracture data, medical history and Charlson comorbidity index calculation, quantitative assessment of bone mineral density (BMD) by dual-energy X-ray absorptiometry (LUNAR Prodigy, GE, USA). Results. Osteoporotic fractures of the forearm, spine and proximal femur were found in 523 (22%) of women. More than one fracture was revealed in 106 patients of the total number of patients with fractures (20%). The average age of first fracture in patients with multiple fractures was 59.9 years, for second fracture - 63.3 years and for the third fracture - 66.6 years. Most repeated fractures (67%) occurred within the first three years from the time of initial fracture and were not associated with the densitometry data. Despite the presence of multiple osteoporotic fractures, adequate specific therapy of severe osteoporosis was recommended to only every third patient in need of treatment. Conclusions. Every fifth woman over the age of 50 years had experienced an osteoporotic fracture, with the highest risk of re-fracture occurring during the first three years. Mandatory antiosteoporotic therapy is the only effective method of secondary prevention of complications of osteoporosis.
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Oh, Ho-Seok, Sung-Kyu Kim, and Hyoung-Yeon Seo. "Characteristics of Osteoporosis & Osteoporotic Fractures in Korea Based on Health Insurance Review and Assessment (HIRA) Database: 2009–2017." Healthcare 9, no. 3 (March 14, 2021): 324. http://dx.doi.org/10.3390/healthcare9030324.
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To investigate the incidence and characteristics of osteoporosis and osteoporotic fractures in Korea, we used the Health Insurance Review and Assessment Service (HIRA) database. Patients over 50 years old, who were diagnosed or treated for osteoporosis and osteoporotic fractures in all hospitals and clinics, were analyzed between 1 January 2009 and 31 December 2017 by using the HIRA database that contains prescription data and diagnostic codes. These data were retrospectively analyzed by decade and age-specific and gender-specific incidents in each year. We also evaluated other characteristics of patients including medication state of osteoporosis, primary used medical institution, regional-specific incidence of osteoporosis, and incidence of site-specific osteoporotic fractures. The number of osteoporosis patients over 50 years old, as diagnosed by a doctor, steadily increased from 2009 to 2017. The number of osteoporosis patients was notably greatest in the 60′s and 70′s age groups in every study period. Patients undergoing treatment for osteoporosis increased significantly (96%) from 2009 to 2017. Among the patients diagnosed with osteoporosis, the proportion who experienced osteoporotic fracture increased gradually (60%) from 2009 to 2017. The number of patients with osteoporotic fractures of the spine and hip was highest in the 70 to 90 age range, and the number of patients with osteoporotic fractures in the upper and lower extremities was highest in the 50 to 70 age range. Understanding the trends of osteoporosis in Korea will contribute to manage the increased number of patients with osteoporosis and osteoporotic fractures.
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Lems, Willem F., and Hennie G. Raterman. "Critical issues and current challenges in osteoporosis and fracture prevention. An overview of unmet needs." Therapeutic Advances in Musculoskeletal Disease 9, no. 12 (October 27, 2017): 299–316. http://dx.doi.org/10.1177/1759720x17732562.
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Osteoporosis is a silent disease with increasing prevalence due to the global ageing population. Decreased bone strength and bone quality is the hallmark of osteoporosis which leads to an increased risk of fragility fractures in elderly. It has been estimated that approximately ~50% of women will suffer during their lifetime from an osteoporotic fracture. This must be considered as a major health concern, as it has previously been established that fragility fracture has been associated with decreased quality of life due to increased disability, more frequent hospital admission and most importantly, osteoporotic fractures have been related to an augmented mortality risk. Anti-osteoporotic drugs are available for improving bone quality. Although there is access to these therapeutic options, there remain multiple unmet needs in the field of osteoporosis and fracture care, for example, the primary prevention of osteoporosis in young individuals (to reach a high peak bone mass), the optimization of the use of imaging techniques [dual-energy X-ray absorptiometry (DXA), vertebral fracture assessment (VFA) and new techniques measuring bone quality], the use of nonmedical treatment options and surgical techniques of fracture healing. In this review, we will discuss topics that play a role in the occurrence and prevention of fractures, and we give an overview of and insight into the critical issues and challenges around osteoporosis and fracture prevention.
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Marchenkova, L. "POS1469-HPR THE ASSESSMENT OF FRACTURE RISK AND OSTEOPOROSIS RATE AMONG PATIENTS OVER 50 YEARS OLD UNDERGOING MEDICAL REHABILITATION." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1020.2–1020. http://dx.doi.org/10.1136/annrheumdis-2021-eular.4258.
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Background:Taking a course of physical rehabilitation creates the prerequisites for falls and injuries in patients at high risk of fractures. Data on fracture risk and prevalence of osteoporosis in older patients starting medical rehabilitation can change the approach of doctors to the development of rehabilitation programs and the management of such patients.Objectives:To assess the prevalence of osteoporosis, individual risk factors for osteoporosis as well as the proportion of people with high risk of osteoporotic low-energy fractures among patients over 50 years old undergoing treatment according to the “medical rehabilitation” profile.Methods:The study group comprised of 600 patients (426 women and 174 men) aged 50 to 84 years, average age 64.25 ± 10.17 years, undergoing treatment in a rehabilitation department. This was a cross-sectional study in the form of unified questionnaire, including data concerning age, weight, height, BMI, clinical and rehabilitation diagnosis, anamnesis of the main disease, anamnesis vitae, presence of osteoporosis diagnosis in the anamnesis, its treatment, osteoporosis risk factors estimation. An assessment of 10-year probability of osteoporotic fractures was carried out using Russian model of online FRAX® calculator.Results:41.8% patients in the study sample had osteoporosis risk factors, including 31.2% of subjects had 3 risk factors or more. 38.0% patients showed a high fracture risk according to the FRAX calculator. 34.1% had a diagnosis of osteoporosis, and 45.8% already had osteoporotic fractures. Among those who did not undergo densitometry examination, 69.9% had a history of low-traumatic fractures, and only 58.5% of patients with an established diagnosis of osteoporosis and 26.8% of those at high risk of fractures received effective therapy for osteoporosis.Conclusion:Population of patients over 50 years old undergoing rehabilitation is characterized by high frequency of osteoporosis and probability of fractures, and insufficient quality of osteoporosis verification and anti-osteoporotic therapy administration at the same time.Disclosure of Interests:None declared
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Mok, Chi Chiu, Sau Mei Tse, Kar Li Chan, and Ling Yin Ho. "Estimation of fracture risk by the FRAX tool in patients with systemic lupus erythematosus: a 10-year longitudinal validation study." Therapeutic Advances in Musculoskeletal Disease 14 (January 2022): 1759720X2210744. http://dx.doi.org/10.1177/1759720x221074451.
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Background: The fracture risk assessment tool has been widely used to stratify the 10-year fracture risk to guide therapy. Using the actual fracture data of a 10-year longitudinal cohort of older patients with systemic lupus erythematosus, we reported an underestimation of the tool in predicting major symptomatic osteoporotic fractures. Treatment of osteoporosis in systemic lupus erythematosus should not be based on fracture risk estimation alone. Relevant time-dependent risk factors should be taken into account for an individualized decision. Objective: To compare the observed fracture incidence in a 10-year longitudinal cohort of patients with systemic lupus erythematosus (SLE) with the fracture risk prediction from the fracture risk assessment (FRAX) tool. Methods: Adult patients (⩾40 years) with SLE who had a first DEXA scan performed in 2005–2009 were studied. The 10-year rates of major osteoporotic and hip fractures were estimated by FRAX using clinical data at DEXA with adjustment for prednisolone dosage. The actual incidence of clinical fractures at 10 years was compared with the estimated rates. Factors associated with new fractures were studied by logistic regression. Results: A total of 229 SLE patients were studied (age: 50.2 ± 6.6 years, 93% women). Glucocorticoid was used in 148 (65%) patients at baseline (mean dose: 7.3 ± 6.9 mg/day; 34% ⩾ 7.5 mg/day). Osteoporosis (bone mineral density T score ⩽ –2.5) at the hip, femoral neck, or spine was present in 61 (27%) patients. The estimated 10-year risk of major osteoporotic and hip fractures by FRAX was 3.4 ± 4.5% and 0.95 ± 2.3%, respectively. After 10 years, three patients developed hip fracture, 6 patients had limb fractures and 20 patients had symptomatic vertebral fractures (major osteoporotic fracture 12.7%, hip fracture 1.3%). The actual major osteoporotic fracture rate was significantly higher than the FRAX estimation (12.7% vs 3.4%; p < 0.001). Logistic regression revealed that osteoporosis (odds ratio (OR): 4.07 [1.51–10.9]), previous fragility fracture (OR: 3.18 [1.02–9.90]), and a parental history of fracture (OR: 4.44 [1.16–17.0]) were independently associated with new clinical fractures at 10 years. Conclusion: The FRAX tool underestimates the major clinical fracture risk at 10 years in patients with SLE.
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Povoroznyuk, V. V., H. Johansson, N. V. Grygorieva, J. A. Kanis, А. S. Musiіenko, M. Lorentzon, N. C. Harvey, E. V. McCloskey, and E. Liu. "Ukrainian FRAX version in the male osteoporosis management." PAIN, JOINTS, SPINE 11, no. 2 (July 20, 2021): 53–61. http://dx.doi.org/10.22141/2224-1507.11.2.2021.236563.
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Background. At present, FRAX is a well-known and widely-used risk assessment tool for major osteoporotic fractures. The Ukrainian version of the FRAX algorithm was presented in 2016; with the “intervention threshold” for additional DXA examination and antiosteoporotic treatment of the Ukrainian women published in 2019. However, the data on its possible uses in men are limited. The purpose of the study was to evaluate the possibilities of using the previously developed criteria of the Ukrainian FRAX algorithm in Ukrainian men. Materials and methods. We examined 653 outpatients aged 40–88 years (mean age (M ± SD) — 60.5 ± 11.8 years). We analyzed the results both in the general group and in the age subgroups; in particular, with an account of low-trauma fractures, included in the FRAX calculation, and compared them with the corresponding indices of the Ukrainian women. Results. The most frequent (26.6 %) risk factor for osteoporotic fractures in the group of Ukrainian men was a history of low-trauma fracture (the corresponding index in women was 51.3 %), its presence being the reason for antiosteoporotic treatment initiating. Following upon the risk of major osteoporotic fractures calculated by FRAX, only 6.7 % of men without previous fractures were found to require additional DXA examination in order to re-evaluate the osteoporotic fracture risk, and none had a high fracture risk. 73 % of men without fractures did not have any risk factor included in the FRAX algorithm. Conclusions. This study showed a greater need for both antiosteoporotic treatment without DXA assessment and additional densitometric examination for the osteoporotic fracture risk assessment for the Ukrainian women rather than men, along with a special attention to the presence of previous fractures in men, and consideration of other risk factors for osteoporosis, even those not included in this FRAX algorithm.
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Issayeva, Samal M., Olga M. Lesnyak, Bakytsholpan G. Issayeva, Dina S. Dilmanova, Meruyert A. Bissembay, and Gaukhar A. Burakhanova. "Comparative analysis of risk factors for hip fracture in patients of different nationalities living in Kazakhstan." Russian Family Doctor 26, no. 2 (August 26, 2022): 13–22. http://dx.doi.org/10.17816/rfd108304.
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BACKGROUND: Osteoporosis is a multifactorial systemic skeletal disease characterized by a decrease in bone strength leading to an increased risk of fractures. Hip fracture is a serious complication of osteoporosis. It is expected in Kazakhstan by 2050 the annual number of hip fracture will increase by 140% compared to 2015 data and will amount to 28,048 cases. There are differences in the incidence of fractures and low bone mineral density in different ethnic groups. However, low bone mineral density is only one of many risk factors for osteoporotic fractures.
AIM: To study the risk factors of osteoporosis and related osteoporotic fractures in patients with hip fracture living in Kazakhstan.
MATERIALS AND METHODS: The case-control study included 98 patients with hip fracture of Kazakh (main group, n = 49) and other nationalities (control group, n = 49). In the registration card, risk factors for osteoporosis and osteoporotic fractures from the Fracture Risk Assessment (FRAX) model were distinguished, and the Find cases Assess Confirm Severity algorithm (2019) was used to diagnose sarcopenia. Statistical analysis was carried out using the Statistics 26 (IBM SPSS, США).
RESULTS: The groups were comparable in terms of gender, disability, fracture location and functional activity, surgical treatment. An increase in cases of hip fracture at an older age was found in the main group than in the control group (р = 0.035).
There were no differences in the groups for clinical risk factors for osteoporotic fractures (body weight, height, history of fractures, family history of fractures, medication, comorbidity), except for smoking (lower in Kazakhs than in the other group) (р = 0.033). Differences in 10-year probability of major osteoporotic fracture and hip fracture between groups (р = 0.34 and р = 0.74) were not found. The proportion of patients who entered the intervention threshold and at low risk did not differ in the groups (р = 0.623).
The average SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls) score was lower among Kazakhs (р = 0.011), there is a difference between the groups when walking (р = 0.044), climbing stairs (р = 0.003). A decrease of grip strength was noted in the main group (р = 0.008), especially in men (р = 0.011), but low grip strength (р 0.001) and signs of sarcopenia (р 0.001) were determined only by age, not nationality.
CONCLUSIONS: The Fracture Risk Assessment (FRAX) model and intervention threshold can be applied to all residents of Kazakhstan.
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Abdel-Wanis, Mohamed El-Sayed, Mohamed Tharwat Mahmoud Solyman, and Nahla Mohamed Ali Hasan. "MRI PATTERN OF VERTEBRAL FRACTURES DUE TO OSTEOPOROSIS, INFECTION, AND MALIGNANT TUMORS." Journal of Musculoskeletal Research 13, no. 02 (June 2010): 57–63. http://dx.doi.org/10.1142/s0218957710002491.
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No previous studies discussed the significance of the MRI pattern of vertebral collapse in differentiation between vertebral compression fractures due to malignancy, osteoporosis, and infections. MRI was used in the evaluation of 152 atraumatic vertebral compression fractures in 80 patients: 85 malignant, 34 osteoporotic, and 33 infective. Central collapse of the fractured vertebral body was the commonest pattern in malignant fractures (57 vertebrae, 67%), followed by uniform collapse (21 vertebrae, 24.7%), then anterior wedging (5 vertebrae, 5.9%), and finally posterior wedging (2 vertebrae, 2.4%). In osteoporotic fractures, anterior wedging was the commonest pattern (18 vertebrae, 53%), followed by central collapse (11 vertebrae, 32.3%), then uniform collapse (4 vertebrae, 11.8%), and finally posterior wedging (1 vertebra, 2.9%). In vertebral compression fractures due to spinal infection, anterior wedging was the commonest pattern (20 vertebrae, 60.6%), followed by uniform collapse (12 vertebrae, 36.4%), while only one vertebra (3%) was centrally collapsed. Central collapse of the vertebral body is highly suggestive of malignant compression fracture while anterior vertebral wedging is highly suggestive of a benign compression fracture.
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Link, Thomas M. "Radiology of Osteoporosis." Canadian Association of Radiologists Journal 67, no. 1 (February 2016): 28–40. http://dx.doi.org/10.1016/j.carj.2015.02.002.
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The radiologist has a number of roles not only in diagnosing but also in treating osteoporosis. Radiologists diagnose fragility fractures with all imaging modalities, which includes magnetic resonance imaging (MRI) demonstrating radiologically occult insufficiency fractures, but also lateral chest radiographs showing asymptomatic vertebral fractures. In particular MRI fragility fractures may have a nonspecific appearance and the radiologists needs to be familiar with the typical locations and findings, to differentiate these fractures from neoplastic lesions. It should be noted that radiologists do not simply need to diagnose fractures related to osteoporosis but also to diagnose those fractures which are complications of osteoporosis related pharmacotherapy. In addition to using standard radiological techniques radiologists also use dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT) to quantitatively assess bone mineral density for diagnosing osteoporosis or osteopenia as well as to monitor therapy. DXA measurements of the femoral neck are also used to calculate osteoporotic fracture risk based on the Fracture Risk Assessment Tool (FRAX) score, which is universally available. Some of the new technologies such as high-resolution peripheral computed tomography (HR-pQCT) and MR spectroscopy allow assessment of bone architecture and bone marrow composition to characterize fracture risk. Finally radiologists are also involved in the therapy of osteoporotic fractures by using vertebroplasty, kyphoplasty, and sacroplasty. This review article will focus on standard techniques and new concepts in diagnosing and managing osteoporosis.
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Sonnabend, Hajerah, Vishnu Priya Pulipati, Sanford Baim, Todd Beck, Ethan M. Ritz, and J. Alan Simmons. "Fracture Rates in Men With Non-Metastatic Prostate Cancer on Androgen Deprivation Therapy With or Without Anti-Osteoporosis Treatment." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A246—A247. http://dx.doi.org/10.1210/jendso/bvab048.501.
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Abstract Introduction: Androgen deprivation therapy (ADT) decreases bone mineral density and increases osteoporotic fracture (OsteoFx) risk. Hypothesis: To assess OsteoFx incidence most predictive of future OsteoFx among men with prostate cancer on ADT. Methods: 4370 electronic medical records were reviewed of adult men with prostate cancer on cancer therapy +/- anti-osteoporotic therapy (Anti-OsteoRx) from 2011–2019. Cancer therapy included ADT (anti-androgens, GnRH agonists & antagonists, orchiectomy) and supplemental cancer therapy (SupplRx) (prostatectomy, brachytherapy, radiation, immunotherapy, and chemotherapy). Anti-OsteoRx included bisphosphonates, denosumab, and parathyroid hormone analogs. Patients with other cancers within 5 years of initial visit, metastasis or traumatic fractures were excluded. Retrospective analysis was done to determine baseline characteristics, type and duration of ADT, Anti-OsteoRx, SupplRx, and OsteoFx incidence. Results: Fracture rate subgroups: • ADT only - Anti-OsteoRx 37/ 374 fractured (9.89%) • ADT only + Anti-OsteoRx 10/52 fractured (19.23%) • ADT + SupplRx + Anti-OsteoRx 2/19 fractured (10.53%) • ADT + SupplRx + Anti-OsteoRx 13/170 fractured (7.65%) Comparing fracture rates between subgroups: • Comparing ADT only +/- Anti-OsteoRx, statistical significance was observed with higher fracture rate in patients taking Anti-OsteoRx (19.23% vs. 9.89%, p < 0.044) • Comparing ADT + SupplRx +/- Anti-OsteoRx, no significant difference in fracture rates due to small number of fractures Comparing combined subgroups: • ADT +/- SupplRx + Anti-OsteoRx 12/71 (16.9%) fractured • ADT +/- SupplRx - Anti-OsteoRx 50/544 (9.19%) fractured • Statistically significant between groups fracture rates was observed (p= 0.042) in patients treated with Anti-OsteoRX. Discussion: Patients receiving Anti-OsteoRx, regardless of their prostate cancer therapies, had higher rates of fractures (16.9 vs. 9.19%, p= 0.042) due to their being selected for therapy based on greater clinical risks. The Anti-OsteoRx group had a higher percentage of glucocorticoid listed as a historical medication (26.8 vs.15.3% vs, p= 0.023), glucocorticoids administered (50.7 vs. 30.3% p=0.001), and anticonvulsants and proton-pump inhibitor use (45.1 vs. 26.5%, p= 0.002). Conclusion: Higher fracture rates were observed in patients on Anti-OsteoRx that could be related to their being selected for treatment based on risk factors known to be associated with osteoporosis. Limited Anti-OsteoRx use in our study is possibly related to lack of standardized guidelines for prevention of osteoporotic fractures in prostate cancer patients. OsteoFx risk assessment utilizing CRF, DXA, and FRAX may prevent fractures in these high-risk patients. Further long-term prospective studies to address these unresolved queries are warranted.
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Binkley, Neil. "Osteoporosis in men." Arquivos Brasileiros de Endocrinologia & Metabologia 50, no. 4 (August 2006): 764–74. http://dx.doi.org/10.1590/s0004-27302006000400021.
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Osteoporosis is defined as "a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture". Approximately 4050% of women sustain osteoporotic fractures in their lifetime; as such, it is appropriate that studies initially focused upon females. Despite an increased recognition of osteoporotic fractures in men, there continues to be neglect of this disease in males. This ongoing neglect is inappropriate as 2533% of men in some populations will sustain osteoporotic fractures in their lifetime. Testosterone plays an important role in male skeletal health. However, recent data suggest that estrogen may in fact be the dominant hormone regulating skeletal status in both men and women. BMD measurement may be utilized for osteoporosis diagnosis and to assist with fracture risk prediction in men prior to their sustaining a fracture. Recognizing this need, the International Society for Clinical Densitometry (ISCD) recommended and recently reaffirmed use of a BMD T-score of -2.5 or below be utilized to diagnose osteoporosis in men. Androgen therapy of hypogonadal men may be considered with the caveat that data do not exist to document that this treatment reduces fracture risk. At this time, the data is inadequate to support use of androgen treatment in eugonadal men with osteoporosis. Parathyroid hormone treatment does increase BMD; existing studies have not been of adequate size or duration to document fracture reduction efficacy. Bisphosphonate therapy increases BMD, reduces vertebral fracture risk and is considered the standard of care for osteoporotic men at this point in time.
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Schulz, Karoline, Hannes Kalscheuer, and Hendrik Lehnert. "Personalisierte Osteoporose-Therapie." DMW - Deutsche Medizinische Wochenschrift 144, no. 16 (August 2019): 1111–19. http://dx.doi.org/10.1055/a-0841-8336.
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AbstractIn Germany, over six million people suffer from osteoporosis. Nearly half of the women over 70 years and nearly 20 % of men at the same age are affected. The clinical and socioeconomical relevance of the disease lies in osteoporotic fractures leading to extensive bone-associated morbidity, increased mortality and health care costs. Fracture risk algorithms and guidelines for the diagnosis and treatment of osteoporosis help to assess the individual fracture risk. By calculating the individual fracture risk, the indication for specific osteoporosis treatment can objectively be determined. A consequent specific osteoporosis therapy is required for patients with a high fracture risk and is essential to prevent osteoporotic fractures and their consequences. As first-line therapy a drug with a proven fracture-reducing effect should be taken. However, for successful osteoporosis therapy, many individual factors have to be considered. A personalized treatment approach should be established according to the severity of the disease, the patient’s sex and comorbidities as well as the possible additive and side effects of the drug.
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Usova, E., O. Malyshenko, M. Letaeva, J. Averkieva, M. Koroleva, and T. Raskina. "POS0131 10-YEAR PROBABILITY OF A MAJOR OSTEOPOROTIC FRACTURES IN WOMEN WITH OSTEOARTHRITIS OF THE KNEE JOINT." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 277.2–277. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3446.
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Background:The relationship between osteoporosis and osteoarthritis (OA) is complex and contradictory. Some studies suggest a protective effect of OA in osteoporosis [1-2]. However, other studies show that increased bone mineral density (BMD) in OA not only does not reduce the risk of fractures, but can also increase it [3-4].Objectives:To assess the 10-year probability of osteoporotic fractures using the FRAX calculator in women with OA of the knee joint.Methods:The study included 22 women (average age 63.7±1.01 years) diagnosed with ACP of the knee joint according to the ACR criteria (1991). The Control Group included 24 conditionally healthy women without OA knee joint, with an average age of 63.6±1.37 years.The BMD (g/cm2) and the T-criterion (standard deviation, SD) of the neck of the femur and lumbar spine (LI-LIV) were evaluated by the method of two-power X-ray absorption (DXA) (apparatus «Lunar Prodigy Primo», USA). 10-year probability of major osteoporotic fractures (clinically significant fracture of the spine, distal fracture of the forearm, fracture of the proximal femur, or fracture of the shoulder) and fracture of the proximal thigh with the FRAX calculator (version 3.5 for Russian population).Results:An osteopenic syndrome in the cohort under investigation was found in 42 (91.3%) patients, of whom osteopenia in 24 (52.2%) women and osteoporosis in 18 (39.1%). A normal BMD is registered in 4 (8.7%) patients.In the group of patients with knee joint OA, only 2 (9.1%) of women had a normal BMD, 11 (50.0%) of osteoporosis, and 9 (40.9%). Osteopenic syndrome is generally found in 20 (90,9%) patients.In the control group, osteopenic syndrome has been diagnosed in 22 (91,7%) of whom: osteopenia in 13 (54.2%), osteoporosis in 9 (37.5%) patients. Two (8.3%) women had a normal BMD. There were no statistically significant differences in the structure of the osteopenic syndrome among the studied groups (p=0.961).An analysis of the 10-year probability of major osteoporotic fractures found that women with OA knee joint had the above probability of 12.3±0.91, and in the control group 14.2±1.06 (p=0.085).The 10-year probability of fracture of the proximal femur in women with OA was statistically less significant than in the control group: 1.55 (0.70;1.98) and 2.10 (1.20;2.95), (p=0.031), respectively.Conclusion:The total incidence of the osteopenic syndrome in the cohort under investigation was 91.3% (90.9% in women with OA, 91.7% in the control group). The frequency of registration of osteopenia and osteoporosis in women with OA did not differ statistically significantly from the control group. The probability of major osteoporotic fractures within 10 years was comparable in these groups. The probability of a proximal femur fracture in women with OA was statistically significant, but not clinically significant, compared to the control group.References:[1]Yamamoto Y, Turkiewicz A, Wingstrand H, et al. Fragility Fractures in Patients with Rheumatoid Arthritis and Osteoarthritis Compared with the General Population. J Rheumatol. 2015 Nov;42(11):2055-8.[2]Vala CH, Kärrholm J, Kanis JA, et al. Risk for hip fracture before and after total knee replacement in Sweden. Osteoporos Int. 2020 May;31(5):887-895.[3]Kim BY, Kim HA, Jung JY, et al. Clinical Impact of the Fracture Risk Assessment Tool on the Treatment Decision for Osteoporosis in Patients with Knee Osteoarthritis: A Multicenter Comparative Study of the Fracture Risk Assessment Tool and World Health Organization Criteria. J Clin Med. 2019 Jun 26;8(7):918.[4]Soh SE, Barker AL, Morello RT, et al. Applying the International Classification of Functioning, Disability and Health framework to determine the predictors of falls and fractures in people with osteoarthritis or at high risk of developing osteoarthritis: data from the Osteoarthritis Initiative. BMC Musculoskelet Disord. 2020 Feb 29;21(1):138.Disclosure of Interests:None declared
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Kim, Gyu Lee, Yu Hyeon Yi, Hye Rim Hwang, Jinmi Kim, Youngmin Park, Yun Jin Kim, Jeong Gyu Lee, et al. "The Risk of Osteoporosis and Osteoporotic Fracture Following the Use of Irritable Bowel Syndrome Medical Treatment: An Analysis Using the OMOP CDM Database." Journal of Clinical Medicine 10, no. 9 (May 10, 2021): 2044. http://dx.doi.org/10.3390/jcm10092044.
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Patients with irritable bowel syndrome (IBS) are at increased risk of osteoporosis and osteoporotic fracture. This study investigated whether IBS medication attenuated the rate of osteoporosis and osteoporotic fracture risk. We conducted a retrospective large-scale multicenter study across eight hospital databases encoded in the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). The primary outcome was the incidence of osteoporosis, whereas secondary outcomes were osteoporotic fractures. After 1:4 matching, 24,723 IBS patients, 78,318 non-IBS patients, 427,640 non-IBS patients with IBS medication, and 827,954 non-IBS patients without IBS medication were selected. The risk of osteoporosis was significantly increased in the IBS group compared to the non-IBS group (hazard ratio (HR) 1.33; confidence interval (CI) 1.17~1.51). Even in patients who were not diagnosed with IBS, the risk of osteoporosis was significantly increased in those with IBS medication compared to those without (HR 1.77, CI 1.62~1.93). The risk of osteoporotic fracture was significantly increased in the IBS medication group (HR 1.69, CI 1.55~1.84). Patients exposed to IBS treatment even without IBS diagnosis were at increased risk of osteoporosis and osteoporotic fracture. Early diagnosis and treatment of osteoporosis should be considered in patients who have received medication for IBS symptoms.
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Hollensteiner, Marianne, Sabrina Sandriesser, Emily Bliven, Christian von Rüden, and Peter Augat. "Biomechanics of Osteoporotic Fracture Fixation." Current Osteoporosis Reports 17, no. 6 (November 21, 2019): 363–74. http://dx.doi.org/10.1007/s11914-019-00535-9.
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Abstract Purpose of Review Fractures of osteoporotic bone in elderly individuals need special attention. This manuscript reviews the current strategies to provide sufficient fracture fixation stability with a particular focus on fractures that frequently occur in elderly individuals with osteoporosis and require full load-bearing capacity, i.e., pelvis, hip, ankle, and peri-implant fractures. Recent Findings Elderly individuals benefit immensely from immediate mobilization after fracture and thus require stable fracture fixation that allows immediate post-operative weight-bearing. However, osteoporotic bone has decreased holding capacity for metallic implants and is thus associated with a considerable fracture fixation failure rate both short term and long term. Modern implant technologies with dedicated modifications provide sufficient mechanical stability to allow immediate weight-bearing for elderly individuals. Depending on fracture location and fracture severity, various options are available to reinforce or augment standard fracture fixation systems. Summary Correct application of the basic principles of fracture fixation and the use of modern implant technologies enables mechanically stable fracture fixation that allows early weight-bearing and results in timely fracture healing even in patients with osteoporosis.
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Kraus, Moritz, Carl Neuerburg, Nicole Thomasser, Ulla Cordula Stumpf, Matthias Blaschke, Werner Plötz, Maximilian Michael Saller, Wolfgang Böcker, and Alexander Martin Keppler. "Reduced Awareness for Osteoporosis in Hip Fracture Patients Compared to Elderly Patients Undergoing Elective Hip Replacement." Medicina 58, no. 11 (October 31, 2022): 1564. http://dx.doi.org/10.3390/medicina58111564.
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Background: Osteoporotic fractures are associated with a loss of quality of life, but only few patients receive an appropriate therapy. Therefore, the present study aims to investigate the awareness of musculoskeletal patients to participate in osteoporosis assessment and to evaluate whether there are significant differences between acute care patients treated for major fractures of the hip compared to elective patients treated for hip joint replacement.; Methods: From May 2015 to December 2016 patients who were undergoing surgical treatment for proximal femur fracture or total hip replacement due to osteoarthritis and were at risk for an underlying osteoporosis (female > 60 and male > 70 years) were included in the study and asked to complete a questionnaire assessing the awareness for an underlying osteoporosis. ASA Score, FRAX Score, and demographic information have also been examined. Results: In total 268 patients (female = 194 (72.0%)/male = 74 (28%)), mean age 77.7 years (±7.7) undergoing hip surgery were included. Of these, 118 were treated for fracture-related etiology and 150 underwent total hip arthroplasty in an elective care setting. Patients were interviewed about their need for osteoporosis examination during hospitalization. Overall, 76 of 150 patients receiving elective care (50.7%) considered that an examination was necessary, whereas in proximal femur fracture patients the awareness was lower, and the disease osteoporosis was assessed as threatening by significantly fewer newly fractured patients. By comparison, patients undergoing trauma surgery had a considerably greater risk of developing another osteoporotic fracture than patients undergoing elective surgery determined by the FRAX® Score (p ≤ 0.001).; Conclusions: The patients’ motivation to endure additional osteoporosis diagnostic testing is notoriously low and needs to be increased. Patients who underwent acute care surgery for a fragility proximal femur fracture, although acutely affected by the potential consequences of underlying osteoporosis, showed lower awareness than the elective comparison population that was also on average 6.1 years younger. Although elective patients were younger and at a lower risk, they seemed to be much more willing to undergo further osteoporosis assessment. In order to better identify and care for patients at risk, interventions such as effective screening, early initiation of osteoporosis therapy in the inpatient setting and a fracture liaison service are important measures.
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Jehn, Ulrich, Anja Kortenhorn, Katharina Schütte-Nütgen, Gerold Thölking, Florian Westphal, Markus Strauss, Dirk-Oliver Wennmann, et al. "The Influence of Parathyroidectomy on Osteoporotic Fractures in Kidney Transplant Recipients: Results from a Retrospective Single-Center Trial." Journal of Clinical Medicine 11, no. 3 (January 27, 2022): 654. http://dx.doi.org/10.3390/jcm11030654.
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Kidney transplant (KTx) recipients are a high-risk population for osteoporotic fractures. We herein aim to identify the role of pre-transplant parathyroidectomy (PTX) and other modifiable factors associated with osteoporotic fractures in KTx recipients. We conducted a retrospective study involving 711 adult patients (4608 patient-years) who were transplanted at our center between January 2007 and June 2015. Clinical data were extracted from patients’ electronic medical records. Different laboratory and clinical parameters for mineral bone disease (MBD) and osteoporosis, including medication, were evaluated. We chose fracture events unrelated to malignancies or adequate trauma as the primary endpoint. Osteoporotic fractures occurred in 47 (6.6%) patients (median 36.7 months, IQR 45.9) after KTx (fracture incidence of 10 per 1000 person-years). Prior to KTx, subtotal PTX was performed in 116 patients (16.3%, median time 4.2 years before KTx, IQR 5.0). Of the patients with fracture (n = 47), only one (2.2%) patient had previously undergone PTX. After adjusting for the known fracture risk factors MBD and osteoporosis, PTX remained a protective factor against fractures (HR 0.134, CI 0.018–0.991, p = 0.049). We observed a reduced risk for pathological fractures in KTx patients who underwent PTX, independent from elevated parathyroid hormone at the time of KTx or afterwards.
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Nowakowska-Płaza, Anna, Jakub Wroński, Iwona Sudoł-Szopińska, and Piotr Głuszko. "Clinical Utility of Trabecular Bone Score (TBS) in Fracture Risk Assessment of Patients with Rheumatic Diseases Treated with Glucocorticoids." Hormone and Metabolic Research 53, no. 08 (August 2021): 499–503. http://dx.doi.org/10.1055/a-1528-7261.
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AbstractChronic glucocorticoid therapy is associated with osteoporosis and can cause fractures in up to 50% of patients. Increased risk of fractures in patients with glucocorticoid-induced osteoporosis does not result only from the decreased bone mineral density (BMD) but also bone microarchitecture deterioration. Trabecular bone score (TBS) is a method complementary to DXA, providing additional information about trabecular bone structure. The aim of this study was to assess the clinical utility of TBS in fracture risk assessment of patients treated with glucocorticoids. Patients with rheumatic diseases treated with glucocorticoids for at least 3 months were enrolled. All recruited patients underwent DXA with additional TBS assessment. We analyzed the frequency of osteoporosis and osteoporotic fractures and assessed factors that might be associated with the risk of osteoporotic fractures. A total of 64 patients were enrolled. TBS and TBS T-score values were significantly lower in patients with osteoporosis compared to patients without osteoporosis. Low energy fractures occurred in 19 patients. The disturbed bone microarchitecture was found in 30% of patients with fractures without osteoporosis diagnosis based on BMD. In the multivariate analysis, only TBS and age were significantly associated with the occurrence of osteoporotic fractures. TBS reflects the influence of glucocorticoid therapy on bone quality better than DXA measured BMD and provides an added value to DXA in identifying the group of patients particularly prone to fractures.
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Kwon, Mi Jung, Jae Yong Park, Sung Gyun Kim, Jwa-Kyung Kim, Hyun Lim, Joo-Hee Kim, Ji Hee Kim, et al. "Potential Association of Osteoporosis and Not Osteoporotic Fractures in Patients with Gout: A Longitudinal Follow-Up Study." Nutrients 15, no. 1 (December 28, 2022): 134. http://dx.doi.org/10.3390/nu15010134.
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Health issues associated with gout and increased occurrence of osteoporosis or fractures have been raised; however, the results are elusive. Herein, we explored the possible link between gout and incident osteoporosis/osteoporotic fractures based on long-term follow-up nationwide data. This study enrolled 16,305 patients with gout and 65,220 controls who were matched by propensity score at a 1:4 ratio on the basis of sex, age, income, and residence from the Korean National Health Insurance Service-Health Screening Cohort database (2002–2015). A Cox proportional hazard model was employed to identify the relevance between gout and incident osteoporosis/fractures, following adjustment for various covariates. In the follow-up period, osteoporosis developed in 761 individuals with gout and 2805 controls (incidence rates: 8.0 and 7.3/1000 person-years, respectively), and each osteoporotic fracture in the distal radius (2.8 vs. 2.7/1000 person-years), hip (1.3 vs. 1.3/1000 person-years), and spine (4.5 vs. 4.5/1000 person-years) occurred in gout and control groups, respectively. After adjustment, the gout group presented an 11% higher development of osteoporosis (95% confidence interval = 1.02–1.20) than the controls (p = 0.011). Subgroup analyses maintained the augment of incident osteoporosis in sufferers with gout, particularly in either men or <60 years. However, no such relevance was identified between gout and incident osteoporotic fractures at any site. In conclusion, gout may result in a slightly elevated likelihood of developing osteoporosis, and not osteoporotic fractures, in the Korean population.
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Kim, Hyojune, Wonhee Lee, SeungHyun Choi, Erica Kholinne, Euisop Lee, Wael Mohammed Alzahrani, Kyoung Hwan Koh, In-Ho Jeon, and Shinseok Kim. "Role of Additional Inferomedial Supporting Screws in Osteoporotic 3-Part Proximal Humerus Fracture: Finite Element Analysis." Geriatric Orthopaedic Surgery & Rehabilitation 11 (January 1, 2020): 215145932095695. http://dx.doi.org/10.1177/2151459320956958.
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Introduction: Importance of inferomedial supporting screws in preventing varus collapse has been investigated for the proximal humerus fracture. However, few studies reported the results of osteoporotic complex fracture. This study aimed to demonstrate the stress distribution pattern, particularly in osteoporotic 3-part proximal humerus fractures involving greater tuberosity (GT) with different screw configurations. Materials and methods: Using the computed tomography (CT) images of 2 patients, who had osteoporosis and the other had normal bone density, 3-part fractures involving the GT, without medial support were reconstructed. To reflect the osteoporosis or real bone density, Hounsfield unit of CT scans were utilized. A force of 200 N was applied in 30° varus direction. The proximal screws were set in 2 ways: 6 screws without inferomedial supporting screws and 9 screws with inferomedial supporting screws. Qualitative and quantitative analysis of internal stress distribution were performed. Results: The most proximal part area near humeral head vertex and near the 1st screw’s passage and tip had more stress concentrated in osteoporotic 3-part fractures. The stress distribution around the proximal screws was found near the GT fracture line and its lateral side, where the local max values located. Inferomedial supporting screws decreased these effects by changing the points to medial side from the GT. The ratio in osteoporotic bone model decreased to that in normal bone model when inferomedial supporting screws were applied (normal bone, 2.97%–1.30%; osteoporosis bone, 4.76%–1.71%). Conclusions: In osteoporotic 3-part proximal humerus fracture, the stress distribution was concentrated on the area near the humeral vertex, 1st row screw tips, and lateral side region from the GT fracture line. Moreover, inferomedial supporting screws ensured that the stress distribution is similar to that in normal bone setting, particularly in osteoporotic condition.
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Lukianets, Yevheniia. "Assessment of the use of different risk algorithms for osteoporotic fractures in women in the practice of a family doctor." ScienceRise, no. 3 (June 30, 2021): 34–39. http://dx.doi.org/10.21303/2313-8416.2021.001921.
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Object of research: Women in whom the risk of osteoporotic fractures was assessed using the FRAX, Q-Fracture algorithms, and the risk factors for osteoporosis and their role in the development of osteoporotic fractures were studied.
Investigated problem: the use of various algorithms in the practice of a family doctor to assess the 10-year risk of osteoporotic fractures.
Main scientific results: A decrease in bone mineral density was found in 51.4 % of the surveyed women, of whom osteopenia was in 48.7 %, osteoporosis in 2.9 % of women. The risk of fractures according to all algorithms was higher in women of the age group 70–79 years: FRAX Total – 8.87±3.2, FRAX Hip – 4.03±3.1, Q fracture total – 12.87±1.5, Q fracture Hip – 7.97±2.7, FRAX Total without BMD – 11.9±5.5, FRAX Hip without BMD – 6.3±4.8. Age correlates negatively with the T score (r=–0.47, p=0.007) and positively with the FRAX Total algorithms without BMD (r=–0.47, p=0.003), FRAX Hip without BMD (r=0.78, p=0.006), Q fracture total (r=0.86, p=0.007), Q fracture Hip (r=0.92, p=0.008), FRAX Hip with BMD (r=0.55, p=0.009). No statistically significant difference was found with FRAX Total with BMD (r=0.21, p=0.345).
Risk factors: 14.3 % of women had fractures of various localization; fractures in parents were noted by 37.1 % of respondents; a decrease in height by 3 cm during life occurred in 13.3 %. Early menopause (up to 45 years old) occurred in 11.4 % of women. Physical activity less than 30 minutes a day was noted by 68.6 %.
The area of practical use of the research results: the primary level of medical care.
Innovative technological product: early identification of risk factors for osteoporosis and calculation of the risk of fractures will reduce the medical and social consequences of complications in osteoporosis.
Scope of application of the innovative technological product: in the clinical practice of general practitioners.
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Watts, Nelson B. "Osteoporotic vertebral fractures." Neurosurgical Focus 10, no. 4 (April 2001): 1–3. http://dx.doi.org/10.3171/foc.2001.10.4.13.
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Osteoporosis is a significant public health problem. Vertebral fractures are the most common fracture in patients with osteoporosis, occurring in approximately 750,000 cases each year. The fractures may cause acute or chronic pain, reduce the quality of life, and shorten life expectancy. Several medications are available that reduce the risk of fracture. Vertebroplasty and kyphoplasty (balloon-inflated expansion of collapsed vertebrae followed by injection of bone cement) may reduce or relieve pain in selected patients. Although surgery is rarely necessary for the management of osteoporotic vertebral fractures, it may be indicated for other reasons. No studies have been conducted to determine if the outcome of spinal fusion is different in patients with osteoporosis and, if it is, whether management of the patient's osteoporosis will improve the outcome.
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Chung, Marvin MT, Dennis KH Yee, Evan Fang, Frankie Leung, and Christian Fang. "Distal radius fracture: An opportunity for osteoporosis intervention." Journal of Orthopaedics, Trauma and Rehabilitation 28 (January 2021): 221049172110355. http://dx.doi.org/10.1177/22104917211035549.
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Background Distal radius fractures have been reported as a predictor of subsequent osteoporotic fragility fractures. This retrospective study evaluated the proportion of patients with distal radius fractures at a government hospital in Hong Kong who received diagnostic evaluation or treatment for osteoporosis within 1 year. Methods Five hundred sixty-one postmenopausal women aged >50 years admitted to a public hospital between 2013 and 2017 for a low-energy distal radius fracture were analysed for initiation of osteoporosis medications and/or arrangement of dual-energy X-ray absorptiometry screening within 1 year of injury. Results Within 1 year, 8.4% of patients were prescribed osteoporosis medication and 6.1% of patients had dual-energy X-ray absorptiometry arranged. Patients with a previous fracture were more likely to receive osteoporosis medication (18.6% vs 7.5%, P = 0.012) and either intervention (screening or medication) overall (23.3% vs 10.4%, P = 0.011). Conclusions Few postmenopausal women who suffered a distal radius fracture received osteoporosis intervention within 1 year. Orthopaedic surgeons should be aware of the possibility of underlying osteoporosis and opportunity for intervention when managing fragility distal radius fractures.
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Ulivieri, Fabio Massimo, and Luca Rinaudo. "The Bone Strain Index: An Innovative Dual X-ray Absorptiometry Bone Strength Index and Its Helpfulness in Clinical Medicine." Journal of Clinical Medicine 11, no. 9 (April 20, 2022): 2284. http://dx.doi.org/10.3390/jcm11092284.
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Bone strain Index (BSI) is an innovative index of bone strength that provides information about skeletal resistance to loads not considered by existing indexes (Bone Mineral Density, BMD. Trabecular Bone Score, TBS. Hip Structural Analysis, HSA. Hip Axis Length, HAL), and, thus, improves the predictability of fragility fractures in osteoporotic patients. This improved predictability of fracture facilitates the possibility of timely intervention with appropriate therapies to reduce the risk of fracture. The development of the index was the result of combining clinical, radiographical and construction-engineering skills. In fact, from a physical point of view, primary and secondary osteoporosis, leading to bone fracture, are determined by an impairment of the physical properties of bone strength: density, internal structure, deformation and fatigue. Dual X-ray absorptiometry (DXA) is the gold standard for assessing bone properties, and it allows measurement of the BMD, which is reduced mainly in primary osteoporosis, the structural texture TBS, which can be particularly degraded in secondary osteoporosis, and the bone geometry (HSA, HAL). The authors recently conceived and developed a new bone deformation index named Bone Strain Index (BSI) that assesses the resistance of bone to loads. If the skeletal structure is equated to engineering construction, these three indexes are all considered to determine the load resistance of the construct. In particular, BSI allows clinicians to detect critical information that BMD and TBS cannot explain, and this information is essential for an accurate definition of a patient’s fracture risk. The literature demonstrates that both lumbar and femoral BSI discriminate fractured osteoporotic people, that they predict the first fragility fracture, and further fragility fractures, monitor anabolic treatment efficacy and detect patients affected by secondary osteoporosis. BSI is a new diagnostic tool that offers a unique perspective to clinical medicine to identify patients affected by primary and, specially, secondary osteoporosis. This literature review illustrates BSI’s state of the art and its ratio in clinical medicine.
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Pinheiro, Marcelo M., Edgard T. dos Reis Neto, Flávia S. Machado, Felipe Omura, Jeane H. K. Yang, Jacob Szejnfeld, and Vera L. Szejnfeld. "Risk factors for osteoporotic fractures and low bone density in pre and postmenopausal women." Revista de Saúde Pública 44, no. 3 (June 2010): 479–85. http://dx.doi.org/10.1590/s0034-89102010000300011.
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OBJECTIVE: To estimate the prevalence and analyze risk factors associated to osteoporosis and low-trauma fracture in women. METHODS: Cross-sectional study including a total of 4,332 women older than 40 attending primary care services in the Greater São Paulo, Southeastern Brazil, between 2004 and 2007. Anthropometrical and gynecological data and information about lifestyle habits, previous fracture, medical history, food intake and physical activity were obtained through individual quantitative interviews. Low-trauma fracture was defined as that resulting from a fall from standing height or less in individuals 50 years or older. Multiple logistic regression models were designed having osteoporotic fracture and bone mineral density (BMD) as the dependent variables and all other parameters as the independent ones. The significance level was set at p<0.05. RESULTS: The prevalence of osteoporosis and osteoporotic fractures was 33% and 11.5%, respectively. The main risk factors associated with low bone mass were age (OR=1.07; 95% CI: 1.06;1.08), time since menopause (OR=2.16; 95% CI: 1.49;3.14), previous fracture (OR=2.62; 95% CI: 2.08;3.29) and current smoking (OR=1.45; 95% CI: 1.13;1.85). BMI (OR=0.88; 95% CI: 0.86;0.89), regular physical activity (OR=0.78; 95% CI: 0.65;0.94) and hormone replacement therapy (OR=0.43; 95% CI: 0.33;0.56) had a protective effect on bone mass. Risk factors significantly associated with osteoporotic fractures were age (OR=1.05; 95% CI: 1.04;1.06), time since menopause (OR=4.12; 95% CI: 1.79;9.48), familial history of hip fracture (OR=3.59; 95% CI: 2.88;4.47) and low BMD (OR=2.28; 95% CI: 1.85;2.82). CONCLUSIONS: Advanced age, menopause, low-trauma fracture and current smoking are major risk factors associated with low BMD and osteoporotic fracture. The clinical use of these parameters to identify women at higher risk for fractures might be a reasonable strategy to improve the management of osteoporosis.
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Choi, Sang, Seong-Ryul Kwon, Ju-Yang Jung, Hyoun-Ah Kim, Sung-Soo Kim, Sang Kim, Ji-Min Kim, Ji-Ho Park, and Chang-Hee Suh. "Prevalence and Fracture Risk of Osteoporosis in Patients with Rheumatoid Arthritis: A Multicenter Comparative Study of the FRAX and WHO Criteria." Journal of Clinical Medicine 7, no. 12 (December 2, 2018): 507. http://dx.doi.org/10.3390/jcm7120507.
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(1) Background: We evaluated the prevalence and fracture risk of osteoporosis in patients with rheumatoid arthritis (RA), and compared the fracture risk assessment tool (FRAX) criteria and bone mineral density (BMD) criteria established by the World Health Organization (WHO). (2) Methods: This retrospective cross-sectional study, which included 479 RA patients in 5 hospitals, was conducted between January 2012 and December 2016. The FRAX criteria for high-risk osteoporotic fractures were calculated including and excluding the BMD values, respectively. The definition of high risk for fracture by FRAX criteria and BMD criteria by WHO was 10-year probability of ≥ 20% for major osteoporotic fracture or ≥ 3% for hip fracture, and T score ≤ −2.5 or Z score ≤ −2.0, respectively. (3) Results: The mean age was 61.7 ± 11.9 years. The study included 426 female patients (88.9%), 353 (82.9%) of whom were postmenopausal. Osteoporotic fractures were detected in 81 (16.9%) patients. The numbers of candidates for pharmacological intervention using the FRAX criteria with and without BMD and the WHO criteria were 226 (47.2%), 292 (61%), and 160 (33.4%), respectively. Only 69.2%–77% of the patients in the high-risk group using the FRAX criteria were receiving osteoporosis treatments. The following were significant using the WHO criteria: female (OR 3.55, 95% CI 1.46–8.63), age (OR 1.1, 95% CI 1.08–1.13), and BMI (OR 0.8, 95% CI 0.75–0.87). Glucocorticoid dose (OR 1.09, 95% CI 1.01–1.17), age (OR 1.09, 95% CI 1.06–1.12), and disease duration (OR 1.01, 95% CI 1–1.01) were independent risk factors for fracture. (4) Conclusions: The proportion of RA patients with a high risk of osteoporotic fractures was 33.4%–61%. Only 69.2%–77% of candidate patients were receiving osteoporotic treatments while applying FRAX criteria. Independent risk factors for osteoporotic fractures in RA patients were age, the dose of glucocorticoid, and disease duration.
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Lagari, Violet S., Fatima Al-Yatama, Gracielena Rodriguez, Hara R. Berger, and Silvina Levis. "Under-Recognition of Fractures as Osteoporosis Indicators." Geriatrics 4, no. 1 (January 9, 2019): 9. http://dx.doi.org/10.3390/geriatrics4010009.
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After the first fracture, the risk of subsequent fractures increases significantly. Medical treatment can reduce the risk of a second fracture by about 50%, but many older adults do not receive osteoporosis medication following their first fracture. This observational study aimed to understand primary care management patterns of older adults after osteoporotic fractures at the Miami Veterans Affairs (VA) Healthcare System. A retrospective review of 219 fracture cases selected by International Classification of Disease (ICD-9) codes between October 2015 and September 2016 identified 114 individuals age ≥50 years who had a non-traumatic fracture code entered in their medical record for the first time. Among them, 72 (63%) did not undergo a bone mineral density (BMD) test or receive treatment in the 12 months following their fracture. Of the 40 individuals who had a BMD test post-fracture, 17 (100%) received or were considered for anti-osteoporosis treatment if their T-score indicated osteoporosis (T-score ≤−2.5), but only 8/23 (35%) if the T-score was >−2.5. Physicians are more likely to prescribe osteoporosis therapy based on a BMD T-score diagnosis of osteoporosis, rather than a clinical diagnosis of osteoporosis based on a low-trauma fracture. A change in practice patterns is necessary to decrease the incidence of fractures.
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Chewakidakarn, Chulin, and Varah Yuenyongviwat. "Comparison of Bone Mineral Density at Hip and Lumbar Spine in Patients with Femoral Neck Fractures and Pertrochanteric Fractures." Ortopedia Traumatologia Rehabilitacja 23, no. 1 (February 28, 2021): 45–49. http://dx.doi.org/10.5604/01.3001.0014.7567.
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Background. Geriatric hip fractures, including femoral neck and pertrochanteric fractures, are common nowadays, which is related to increasing numbers of elderly people worldwide. Osteoporosis is an important risk factor associated with hip fractures. This study aimed to describe the association of hip fractures and osteoporosis at different BMD measurement sites and determine any differences between these two types of hip fracture. Material and methods. A retrospective study conducted in a university hospital in the south of Thailand enrolled 223 patients aged over 50 years with low-energy trauma hip fractures. Each patient had undergone dual energy x-ray absorptiometry (DXA) within 2 weeks of injury. T-scores were recorded for the total hip, femoral neck and lumbar spine areas and classified as normal, osteopenia and osteoporosis according to WHO osteoporosis diagnostic criteria. Results. The highest proportion of T-scores in the osteoporotic range were registered at the femoral neck (68.6%) compared to total hip (52.9%) and lumbar spine (47.7%). At least 31.4% of patients were in the non-osteoporotic range. No significant differences were found at all sites of BMD measurement between the two types of fracture. Conclusions. 1. At least 1/3 of patients with geriatric hip fractures had their T-scores in the normal to osteopenic range. 2. BMD in different areas is not different between types of hip fractures.
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Widjaja, Sry Suryani, Rusdiana Rusdiana, and Vito Filbert Jayalie. "Homocysteine Levels and Osteoporotic Fracture in a Population Aged 55 Years Over in Medan District Indonesia." Open Access Macedonian Journal of Medical Sciences 10, A (January 8, 2022): 45–48. http://dx.doi.org/10.3889/oamjms.2022.7901.
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BACKGROUND: Osteoporosis is a chronic, progressive, systemic, skeletal, multifactorial disorder characterized by low bone mass, microarchitectural deterioration of bone tissues that increased the risk of fragility fracture. The increased prevalence of early osteoporosis in homocystinuria illustrates that homocysteine metabolism is involved in the process of osteoporosis. AIM: This study was aimed to look for the relationship between homocysteine levels in the blood and the occurrence of osteoporotic fractures in the population above 55 years old. METHODS: This is a descriptive study with cross-sectional approach, total sixty-five patients aged 55 years or older with osteoporotic fracture and as a control group without osteoporotic fracture. Blood pressure, heart rate, and body weight were recorded, bone density was measured using central dual-energy x-ray absorptiometry (DXA) machine/DXA and homocysteine plasma levels were measured using the enzyme-linked immunoassay method. RESULTS: Total of 65 samples with age range between 55 and 88 years, they were 38 peoples with osteoporosis, which 12 got the osteoporotic fracture. Among the 16 samples in osteopenia group, two got the fracture, among 11 samples with normal bone density, one got the osteoporotic fracture. There was statistical significant between fracture and bone mineral density (p = 0.00) and no statistical significant between bone density and gender (p = 0.08), bone density and body mass index (BMI) (p = 0.11). There was statistical significant correlation between homocysteine and age (p = 0.02), age and bone density (p = 0.002) but no statistical significant correlation between homocysteine and BMI (p = 0.07), homocysteine and osteoporotic fracture (p = 0.87). CONCLUSIONS: Homocysteine level did not increased the incidence of osteoporotic fracture, however homocysteine increased with aging and correlated with bone mineral density.
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Xu, Jixi, Mingbo Li, Wei Pei, Jinyong Ding, Yueran Pan, Huifeng Peng, Shiman Lin, and Yanbo Huang. "Reduced Circulating Levels of miR-491-5p and miR-485-3p Are Associated with the Occurrence of Vertebral Fractures in Postmenopausal Women with Osteoporosis." Genetics Research 2022 (March 7, 2022): 1–8. http://dx.doi.org/10.1155/2022/3838126.
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Objective. Postmenopausal women experiences osteoporotic structural damage and bone fragility resulting from reduced bone formation and increased bone resorption. Osteoporosis frequently affects the vertebral column and causes compression fractures. This study aims to characterize roles of miRNAs in osteoporosis and subsequent incidence risk of vertebral fractures for postmenopausal women. Methods. Differentially expressed miRNAs between osteoporotic patients with vertebral fractures and osteoporotic patients without fracture were identified. This retrospective study included 78 osteoporotic patients with vertebral fractures and 82 osteoporotic patients without vertebral fractures. The plasma levels of bone metabolic markers, 25-hydroxyvitamin D (25-(OH)VitD), propeptide of type I procollagen (PINP), and β-Carboxyl terminal peptide (β-CTx), were detected using the patented electro-chemiluminescence (ECLIA) method. The expression levels of miR-491-5p and miR-485-3p were determined by qRT-PCR. Pearson correlation analysis was carried out to assess the relationship between miR-491-5p, miR-485-3p, and bone metabolic markers. Receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) were used to evaluate the performance of miR-491-5p and miR-485-3p in diagnosing the occurrence of vertebral fractures in osteoporotic patients.Results: The plasma levels of PINP and β-CTx were elevated but the plasma level of 25-(OH)VitD was declined in osteoporotic patients with vertebral fractures when comparable to those without (< 0.05). The plasma expression levels of miR-491-5p and miR-485-3p were declined osteoporotic patients with vertebral fractures when comparable to those without (< 0.001). Pearson correlation analysis revealed that the relative expression level of miR-491-5p was negatively correlated with the level of 25-(OH)VitD (r = -0.518, < 0.001) but positively correlated with the levels of PINP (r = 0.547, < 0.001) and β-CTx (r = 0.380, < 0.001). We also observed a negative correlation between the relative expression level of miR-485-3p and 25-(OH)VitD (r = -0.388, < 0.001), a positive correlation between miR-485-3p and PINP (r = 0.422,< 0.001). ROC curves for prediction of vertebral fracture following osteoporosis in postmenopausal women by miR-491-5p expression yielded 0.866 AUC and by miR-485-3p expression produced 0.848 AUC. Conclusion. The data suggest that downregulated expressions of miR-491-5p and miR-485-3p may be involved in the occurrence of vertebral fractures in postmenopausal women with osteoporosis.
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Akter, Nazma, Nazmul Kabir Qureshi, and Zafar Ahmed Latif. "Can FRAX Tool be Used for Determination of Risk Score for Osteoporosis Fractures in a Financially Constrained Society Like Bangladesh?" BIRDEM Medical Journal 8, no. 1 (December 27, 2017): 9–15. http://dx.doi.org/10.3329/birdem.v8i1.35031.
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Background: This study was designed to assess the effectiveness of use of the fracture risk assessment system (FRAX) as risk assessment tool for osteoporosis risk score scale in Bangladeshi subjects and to assess how the results of the tools correlate with each other.Methods: This cross-sectional study was conducted between January 2016 to August 2016. The study population was randomly collected 600 Bangladeshi subjects; who attended outpatient department (OPD) of MARKS Medical College & Hospital, Dhaka, Bangladesh. The age range of the subjects was between 40 to 75 years. The subjects had not done a bone mineral density (BMD) score. None of them were previously diagnosed or got treatment for osteoporosis. A questionnaire was designed to complete the osteoporosis specific risk score sheet. Major osteoporotic and hip fracture incidence to 10-years as a function of the FRAX probability was calculated by using fracture risk assessment system.Results: A total of 600 subjects were included. Among them, 59.2% and 40.8%were male and female respectively. Mean age (Mean ± SD) of the study, subjects were 52.16±7.96 years. Among study subjects, mean BMI was more in females in comparison to males (p<0.05). The FRAX predicted 10-year risk assessment scores of major osteoporotic fractures were significantly more in females than males (p<0.02). Risk assessment scores of both major osteoporotic fractures and hip fractures showed significant association in post-menopausal women when compared with there who were not menopausal (p<0.05). Risk assessment factors for risk scores did differ significantly among male and female subjects and among postmenopausal and non-menopausal women. Among risk assessment factors, subjects having finally history of fracture hip, glucocorticoids, rheumatoid arthritis showed strong association with presence of ≥20% risk scores for major osteoporotic fracture (p<0.05) and ≥ 3% for hip fracture (p<0.05). Subjects having history of previous fracture and secondary osteoporosis showed only significant association with ≥3% risk scores for hip fracture (p<0.05).Conclusion: The public health burden of fractures will fail to compromise unless the subset of patients who are at increased risk for fracture are identified and treated. Ten-year fracture risk assessment with the fracture risk assessment system is increasingly used to guide for treatment decisions. It is an effective tool to predict fracture probability, particularly in developing countries like Bangladesh, where most of the patients cannot afford expensive dual energy x-ray absorptiometry scans.Birdem Med J 2018; 8(1): 9-15
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Mai, Ha T., Thach S. Tran, Thao P. Ho-Le, Jacqueline R. Center, John A. Eisman, and Tuan V. Nguyen. "Two-Thirds of All Fractures Are Not Attributable to Osteoporosis and Advancing Age: Implications for Fracture Prevention." Journal of Clinical Endocrinology & Metabolism 104, no. 8 (April 5, 2019): 3514–20. http://dx.doi.org/10.1210/jc.2018-02614.
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Abstract Context Although bone mineral density (BMD) is strongly associated with fracture and postfracture mortality, the burden of fractures attributable to low BMD has not been investigated. Objectives We sought to estimate the population attributable fraction of fractures and fracture-related mortality that can be attributed to low BMD. Design and Setting This study is a part of an ongoing population-based prospective cohort study, the Dubbo Osteoporosis Epidemiology study. In total, 3700 participants aged ≥50 years participated in the study. Low-trauma fracture was ascertained by X-ray reports, and mortality was ascertained from the Birth, Death and Marriage Registry. Results Overall, 21% of women and 11% of men had osteoporotic BMD. In univariable analysis, 21% and 16% of total fractures in women and men, respectively, were attributable to osteoporosis. Osteoporosis combined with advancing age (>70 years) accounted for 34% and 35% of fractures in women and men, respectively. However, these two factors accounted for ∼60% of hip fractures. About 99% and 66% of postfracture mortality in women and men, respectively, were attributable to advancing age, osteoporosis, and fracture; however, most of the attributable proportion was accounted for by advancing age. Conclusions A substantial health care burden of fracture is on people aged <70 years or nonosteoporosis, suggesting that treatment of people with osteoporosis is unlikely to reduce a large number of fractures in the general population.
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Czerwiński, Edward, Jarosław Czubak, Marek Synder, Maja Warzecha, and Małgorzata Berwecka. "Contemporary Management of Osteoporotic Fractures." Ortopedia Traumatologia Rehabilitacja 20, no. 2 (April 16, 2018): 91–102. http://dx.doi.org/10.5604/01.3001.0011.7665.
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With aging of the population, osteoporotic fractures are becoming an increasing medical problem worldwide. It has been estimated that 2,700,000 patients experienced a low energy fracture in the Polish population in 2010. On the basis of contemporary world standards and publications in the field of orthopaedics and traumatic surgery, a summary of the principles of management of osteoporotic fractures is presented. Both general problems of fracture treatment in elderly patients as well as difficulties in surgical and conservative treatment resulting from osteoporotic bone abnormalities are discussed. Special attention is paid to preoperative and postoperative procedures in patients with proximal femur fractures. Also presented is a contemporary strategy for the treatment of fractures of the distal forearm, proximal humerus and vertebrae. General principles of diagnosis and treatment of osteoporosis are discussed.
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Jiang, Nathan S., Byron Newton, and Xuezhi Jiang. "An Overview of Osteoporosis Management." OBM Geriatrics 05, no. 04 (June 28, 2021): 1. http://dx.doi.org/10.21926/obm.geriatr.2104181.
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Osteoporosis is one of the most common disorders around the world. Osteoporotic fracture especially hip fracture are associated with an increased mortality rate in elders. However, elders with osteoporosis or at high risk of fractures remain largely underdiagnosed and undertreated. The screening, diagnosis, and treatment of osteoporosis must be improved to maintain pace with its fast-growing prevalence. This review will cover risk factors of osteoporosis, screening and diagnosis tools, newfound advancements, current medical treatments including options for special populations of concern, and future research directions.
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Muratore, Maurizio, Francesco Conversano, Maria Daniela Renna, Paola Pisani, Valeria Villani, and Sergio Casciaro. "Social Impact of Osteoporotic Fractures." International Journal of Measurement Technologies and Instrumentation Engineering 4, no. 2 (April 2014): 39–53. http://dx.doi.org/10.4018/ijmtie.2014040104.
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Osteoporosis affects about 200 million subjects in the world and is responsible for 8.9 million fractures each year. The frequency of osteoporotic fractures is rising in many countries, due to the increased longevity of the population. In Europe, the annual cost of all osteoporotic fractures has been estimated to be 30 billion of Euros. In this paper, after an overview of the socioeconomic impact of osteoporosis in the world and in Italy, with particular focus on Apulia region, the most important techniques used to assess the fracture risk are briefly described. Moreover, the most commonly used pharmacological agents for the treatment of osteoporosis are reported. The aim of this review is to analyze the main factors causing the huge impact of osteoporosis on healthcare system, in terms of diagnosis and therapies, and to illustrate recent advances for treatment and prevention of this “silent disease”.
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Zamboni, Caio, Marina Sousa Carvalho, Eduardo Araujo Pires, Jorge Rafael Durigan, Patrícia Maria de Moraes Barros Fucs, and Marcelo Tomanik Mercadante. "ARE TRAUMATOLOGISTS TREATING OSTEOPOROSIS TO PREVENT NEW FRACTURES IN BRAZIL?" Acta Ortopédica Brasileira 26, no. 6 (December 2018): 384–87. http://dx.doi.org/10.1590/1413-785220182606202125.
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ABSTRACT Objectives: To determine the proportion of traumatologists who investigate osteoporosis in elderly patients with fractures and recommend secondary prevention of osteoporotic fractures. Methods: We distributed questionnaires to 244 physicians attending the 2015 Brazilian Congress of Orthopedic Trauma. We determined the respondents’ profiles and assessed how they investigated and treated osteoporosis in elderly patients with fractures. Results: Overall, 32% of the respondents reported that their knowledge level regarding osteoporosis ranged from 0-5 (out of 0-10). In total, 42% of the participants reported that they usually requested DXA for elderly patients with fractures and less than 30% reported prescribing supplemental calcium and/or vitamin D. We considered physicians conducting a complete treatment for the patient as those who in addition to requesting DXA prescribed supplemental calcium, vitamin D, and specific medications for their elderly patients, and recommended non-pharmacological measures. Only 0.8% of the participants fulfilled all these criteria. In addition, 47% of the traumatologists reported that they did not treat osteoporosis directly but instead, referred osteoporotic patients to a qualified physician. Conclusion: Less than 50% of the surveyed traumatologists investigated and performed secondary prevention against osteoporotic fractures after treating an elderly patient with a fracture. Level of evidence III, Economic and Decision Analyses - Developing an Economic or Decisions Model.
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Möckel, Luis. "Number and Impact of Osteoporotic Forearm Fractures: An Analysis of German Hospital Data." Osteologie 29, no. 02 (May 2020): 150–56. http://dx.doi.org/10.1055/a-1023-4859.
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Abstract Introduction Osteoporosis is a burden for Germany, however recent data on osteoporotic forearm fractures is missing. Methods Numbers of hospital diagnosed forearm fractures based on ICD-10 code S52.- for 2000 to 2017 were taken from GBE database. From this dataset, number of osteoporotic forearm fractures in patients aged 50+ years were calculated using age- and gender specific weighting factors. In addition, fracture rates per 100,000 people, total days in hospital and quality-adjusted life years (QALYs) lost due to osteoporotic forearm fractures were calculated. Results In 2017, a total of 69,046 osteoporotic forearm fractures were diagnosed in hospitals in patients aged 50+ years in Germany, which represents an increase of 48.8% since 2000. Age-adjusted fracture rates in women were 300/100,000 (standard error [SE] 1.25) in 2017 compared to 248/100,000 (SE 1.25) in 2000 (Odds ratio [OR]: 1.21 [95% confidence interval [CI]: 1.02; 1.43]; p = 0.026). In male patients fracture rates were 62/100,000 (SE 0.61) in 2017 and 53/100,000 (SE 0.65) in 2000 (OR: 1.17 [95% CI: 0.81; 1.69]; p = 0.401). However, highest numbers and rates of osteoporotic forearm fractures were seen in 2010.Osteoporotic forearm fractures resulted in 276,185 hospital days and 2,259 lost QALYs in patients aged 50+ years in 2017. Conclusion Number of osteoporotic forearm fractures increased from 2000 to 2017 in Germany and indicate a high burden of disease for patients and healthcare system.
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Alshaali, Anood Jamal, Soha Abd El Aziz Abd El Aal, Amal Mohamad AlJaziri, Tamer Mohamed Farid Abdellatif, Manal Mohammad Omran Taryam, and Nahed AbdulKhaleq Monsef. "Vertebral Fractures among Patients Referred for Bone Densitometry Screening in Dubai Primary Health Care Facilities." International Journal of Rheumatology 2019 (March 6, 2019): 1–5. http://dx.doi.org/10.1155/2019/7974534.
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Vertebral fractures are one of the most common fractures associated with low bone mineral density. However two-thirds to three-fourths of patients with vertebral fractures are not clinically recognized. The objective of this study was to determine the prevalence of vertebral fractures in patients referred for bone densitometry and the most common site of fracture. The study was carried out in the osteoporosis clinic in Dubai primary health care center. A total of 120 patients were examined using the dual energy X-ray absorptiometry. Of all the patients, 48.3% were osteoporotic and 40.9% were osteopenic. The overall prevalence of vertebral fracture was 14.2%. The result showed that the prevalence of vertebral fracture was higher in female compared to male (15.7% and 9.7%, respectively). It was found that patients aged 80 and above had the highest prevalence of vertebral fracture (54.5%). Undiagnosed vertebral fractures were common. Therefore, it is crucial to prevent vertebral fracture through early diagnosis and appropriate treatment of osteoporosis.
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Feng, Fen, CiLa Zhou, Ping Huang, QiaoLin Zhu, Gang Wang, and Bin Zhou. "Value of Biochemical Indexes of Bone Metabolism in Predicting Osteoporotic Lumbar Fractures." Applied Bionics and Biomechanics 2022 (June 23, 2022): 1–5. http://dx.doi.org/10.1155/2022/7348884.
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Objective. To investigate the value of bone metabolism indexes such as type I procollagen N-terminal propeptide (P1NP), 25-hydroxyvitamin D (25(OH)D), osteocalcin (OSTEOC), and parathyroid hormone (PTH) in predicting osteoporotic lumbar fractures. Methods. 120 female patients with osteoporosis treated in our hospital were selected as research objects. There were 76 cases in the fracture group and 44 cases in the nonfracture group. The relationship between the levels of P1NP, 25(OH)D, OSTEOC, and PTH and the incidence of osteoporotic lumbar fractures were detected and compared between the two groups. The predictive value of biochemical indexes of bone metabolism in patients with osteoporosis was analyzed by ROC curve. Results. The levels of P1NP and PTH in the fracture group were significantly higher than those in the nonfracture group, while 25(OH)D and OSTEOC levels were lower than those in the nonfracture group. Moreover, the levels of P1NP, 25(OH)D, OSTEOC, and PTH are important factors affecting the pathogenesis of osteoporosis. The area under the curve (AUC) of fracture in patients with osteoporosis predicted by the combination of P1NP, 25(OH)D, OSTEOC, and PTH levels was 0.886, which was greater than the AUC predicted by each index (0.796, 0.753, 0.670, and 0.824). The best sensitivity and specificity of comprehensive prediction of each index were 78.95% and 79.10%, respectively. Conclusion. The abnormal changes of P1NP, 25(OH)D, OSTEOC, and PTH in female patients with osteoporotic lumbar fracture are closely related to the occurrence of the disease. The combination of these indicators has relatively significant application value in predicting the occurrence of fracture, which is helpful to formulate and guide relevant preventive measures for female patients with osteoporotic lumbar fracture and improve the prognosis.
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Pai, Yuan-Yi, Jiaan-Der Wang, Hsin-En Ho, Yi-Jung Chou, Wen-Chao Ho, Wei-Cheng Chan, Wei-Min Chu, and Yu-Tse Tsan. "Risk of Fractures, Repeated Fractures and Osteoporotic Fractures among Patients with Hemophilia in Taiwan: A 14-Year Population-Based Cohort Study." International Journal of Environmental Research and Public Health 20, no. 1 (December 28, 2022): 525. http://dx.doi.org/10.3390/ijerph20010525.
Full textAbstract:
The world is aging, and hemophilia patients are as well. The association between patients with hemophilia (PWH) and low bone mineral density is clear. However, the incidence of fractures in patients with hemophilia is inconclusive, and no research has yet explored repeated fractures among PWH. In this study, we investigated the incidence of all-site fractures, repeated fractures and osteoporotic fractures amongst PWH. The study compared the incidence of all-site fractures, repeated fractures and osteoporotic fractures occurring in all PWH who were enrolled in Taiwan’s National Health Insurance Research Database between 1997 and 2013 with an age- and gender-matched group from the general population. Eight-hundred thirty-two PWH, along with 8320 members of the general population, were included in the final analysis. After multivariate COX regression analysis with an adjustment for confounding factors, it was found that PWH experienced a higher risk of osteoporotic fracture (HR: 1.25 with 95% CI of 1.03–2.52) but only saw a neutral effect with regards to both all-sites of fracture (HR: 1.00 with 95% CI of 0.92–1.09) and repeated fractures (HR: 1.01 with 95% CI of 0.92–1.10), when compared with the general population. This 14-year population-based cohort study showed that PWH had a higher risk of osteoporotic fracture, but that hemophilia only had a neutral effect in all-sites of fracture and repeated fractures. Screening, prevention and treatment for osteoporosis and further osteoporotic fractures among PWH, in order to improve quality of life and achieve healthy aging in this particular population, remain essential.