Bone microarchitecture phenotypes identified in older adults are associated with different levels of osteoporotic fracture risk

2021 ◽  
Author(s):  
Danielle E Whittier ◽  
Elizabeth J Samelson ◽  
Marian T Hannan ◽  
Lauren A Burt ◽  
David A Hanley ◽  
...  
Keyword(s):  
Older Adults ◽  
Fracture Risk ◽  
Osteoporotic Fracture ◽  
Bone Microarchitecture ◽  
Different Levels

scholarly journals Fractal lacunarity of trabecular bone in vertebral MRI to predict osteoporotic fracture risk in over-fifties women. The LOTO study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Annamaria Zaia ◽  
Roberto Rossi ◽  
Roberta Galeazzi ◽  
Manuela Sallei ◽  
Pierluigi Maponi ◽  
...  
Keyword(s):  
Fracture Risk ◽  
Trabecular Bone ◽  
Osteoporotic Fracture ◽  
Bone Microarchitecture ◽  
Spin Echo ◽  
Lumbar Vertebra ◽  
Operating Characteristics ◽  
Mineral Density ◽  
Cross Sectional

Abstract Background Osteoporotic fractures are a major cause of morbidity in the elderly. Menopausal women represent the population with the highest risk of early osteoporosis onset, often accompanied by vertebral fractures (VF). Bone mineral density (BMD) is commonly assessed by dual-energy X-ray absorptiometry (DXA) for osteoporosis diagnosis; however, BMD alone does not represent a significant predictor of fracture risk. Bone microarchitecture, instead, arises as a determinant of bone fragility independent of BMD. High-resolution magnetic resonance imaging (MRI) is an effective noninvasive/nonionizing tool for in vivo characterisation of trabecular bone microarchitecture (TBA). We have previously set up an MRI method able to characterise TBA changes in aging and osteoporosis by one parameter, trabecular bone lacunarity parameter β (TBLβ). Fractal lacunarity was used for TBA texture analysis as it describes discontinuity of bone network and size of bone marrow spaces, changes of which increase the risk of bone fracture. This study aims to assess the potential of TBLβ method as a tool for osteoporotic fracture risk. Methods An observational, cross-sectional, and prospective study on over-50s women at risk for VF was designed. TBLβ, our index of osteoporotic fracture risk, is the main outcome measure. It was calculated on lumbar vertebra axial images, acquired by 1.5 T MRI spin-echo technique, from 279 osteopenic/osteoporotic women with/without prior VF. Diagnostic power of TBLβ method, by Receiver Operating Characteristics (ROC) curve and other diagnostic accuracy measurements were compared with lumbar spine DXA-BMD. Results Baseline results show that TBLβ is able to discriminate patients with/without prevalent VF (p = 0.003). AUC (area under the curve from ROC) is 0.63 for TBLβ, statistically higher (p = 0.012) than BMD one (0.53). Contribution of TBLβ to prevalent VF is statistically higher (p < 0.001) than BMD (sensitivity: 66% vs. 52% respectively; OR: 3.20, p < 0.0001 for TBLβ vs. 1.31, p = 0.297 for BMD). Preliminary 1-year prospective results suggest that TBA contribution to incident VF is even higher (sensitivity: 73% for TBLβ vs. 55% for BMD; RR: 3.00, p = 0.002 for TBLβ vs. 1.31, p = 0.380 for BMD). Conclusion Results from this study further highlight the usefulness of TBLβ as a biomarker of TBA degeneration and an index of osteoporotic fracture risk.

Accelerated decline in quadriceps area and Timed Up and Go test performance are associated with hip fracture risk in older adults with impaired kidney function

2021 ◽  
pp. 111314
Author(s):  
Elisa A. Marques ◽  
Martine Elbejjani ◽  
João L. Viana ◽  
Vilmundur Gudnason ◽  
Gunnar Sigurdsson ◽  
...  
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Kidney Function ◽  
Test Performance ◽  
Timed Up And Go ◽  
Hip Fracture Risk

scholarly journals High osteoporotic fracture risk and CVD risk co-exist in postmenopausal women

Bone ◽  
2013 ◽  
Vol 52 (1) ◽  
pp. 120-125 ◽  
Author(s):  
Joanna Makovey ◽  
Monique Macara ◽  
Jian Sheng Chen ◽  
Christopher S. Hayward ◽  
Lyn March ◽  
...  
Keyword(s):  
Fracture Risk ◽  
Postmenopausal Women ◽  
Osteoporotic Fracture ◽  
Cvd Risk

scholarly journals Persistence with oral bisphosphonates and denosumab among older adults in primary care in Ireland

2020 ◽  
Author(s):  
Mary E. Walsh ◽  
Tom Fahey ◽  
Frank Moriarty
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Vitamin D ◽  
Fracture Risk ◽  
Bone Health ◽  
Pharmacological Treatment ◽  
Age Group ◽  
Oral Bisphosphonates ◽  
Factors Associated ◽  
Increase Fracture Risk

ABSTRACTPurposeGaps in pharmacological treatment for osteoporosis can reduce effectiveness. This study aimed to estimate persistence rates for oral bisphosphonates and denosumab in older primary care patients and identify factors associated with discontinuation.MethodsOlder patients newly prescribed oral bisphosphonates or denosumab between 2012 and 2017 were identified from 44 general practices (GP) in Ireland. Persistence without a coverage gap of >90 days was calculated for both medications from therapy initiation. Factors associated with time to discontinuation were explored using Cox regression analysis. Exposures included age-group, osteoporosis diagnosis, fracture history, calcium/vitamin D prescription, number of other medications, health cover, dosing frequency (bisphosphonates) and previous bone-health medication (denosumab).ResultsOf 41,901 patients, n=1,569 newly initiated on oral bisphosphonates and n=1,615 on denosumab. Two-year persistence was 49.4% for oral bisphosphonates and 53.8% for denosumab and <10% were switched to other medication. Having state-funded health cover was associated with a lower hazard of discontinuation for both oral bisphosphonates (HR=0.49, 95%CI=0.36-0.66, p<0.01) and denosumab (HR=0.71, 95%CI=0.57-0.89, p<0.01). Older age-group, number of medications and calcium/vitamin D prescription were also associated with better bisphosphonate persistence while having osteoporosis diagnosed was associated with better denosumab persistence.ConclusionPersistence for osteoporosis medications is sub-optimal. Of concern, few patients are switched to other bone-health treatments when denosumab is stopped which could increase fracture risk. Free access to GP services and medications may have resulted in better medication persistence in this cohort. Future research should explore prescribing choices in primary-care osteoporosis management and evaluate cost-effectiveness of interventions for improving persistence.SUMMARYGaps in pharmacological treatment for osteoporosis can reduce its effectiveness. This study found approximately half of older adults in primary care newly initiated on bisphosphonates or denosumab were still taking these after 2 years. Abrupt discontinuation of denosumab without switching to an alternative is concerning due to increased fracture risk.

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