scholarly journals Glucocorticoids Increase Fracture Risk and Fracture Prevalence Independently from Bone Mineral Density and Clinical Risk Factors: Results from the Gliwice Osteoporosis (GO) Study

2022 ◽  
Vol 54 (01) ◽  
pp. 20-24
Author(s):  
Wojciech Pluskiewicz ◽  
Piotr Adamczyk ◽  
Bogna Drozdzowska
Keyword(s):  
Risk Factors ◽  
Fracture Risk ◽  
Fracture Probability ◽  
Clinical Risk Factors ◽  
Study Group ◽  
Mineral Density ◽  
Clinical Risk ◽  
Increase Fracture Risk ◽  
Risk Probability ◽  
Fracture Prevalence

AbstractThe aim of the study was to establish the influence of glucocorticoids (GC) on fracture risk, probability, and prevalence. A set of 1548 postmenopausal women were divided into study group – treated with GC (n=114, age 66.48±7.6 years) and controls (n=1434, age 66.46±6.83 years). Data on clinical risk factors for osteoporosis and fractures were collected. Hip bone densitometry was performed using a device Prodigy (GE, USA). Fracture probability was established by FRAX, and fracture risk by Garvan algorithm and POL-RISK. Fracture risk and fracture probability were significantly greater for GC-treated women in comparison to controls. In the study group, there were 24, 3, 24, and 6 fractures noted at spine, hip, forearm, and arm, respectively. The respective numbers of fractures reported in controls at those skeletal sites were: 186, 23, 240, and 25. The use of GCs increased significantly prevalence of all major, spine and arm fractures. Also the number of all fractures was affected by GC use. Following factors significantly increased fracture probability: age (OR 1.04 per each year; 95% CI: 1.03–1.06), GC use (OR 1.54; 95% CI: 1.03–2.31), falls (OR 2.09; 95% CI: 1.60–2.73), and FN T-score (OR 0.62 per each unit; 95% CI: 0.54–0.71). In conclusion, in patients treated with GCs the fracture risk, probability, and prevalence were increased. This effect was evident regardless of whether GC therapy is included in the algorithm as a risk factor (FRAX, POL-RISK) or not taken into consideration (Garvan nomogram).

scholarly journals Pelvic Organ Prolapse and Relationship with Skeletal Integrity

2009 ◽  
Vol 5 (3) ◽  
pp. 325-333 ◽  
Author(s):  
Lubna Pal
Keyword(s):  
Risk Factors ◽  
Pelvic Organ Prolapse ◽  
Fracture Risk ◽  
Postmenopausal Women ◽  
Pelvic Organ ◽  
Clinical Risk Factors ◽  
Mineral Density ◽  
Female Population ◽  
Clinical Risk ◽  
Age Related

Health burden related to osteoporotic fractures in an aging female population far exceeds that imposed by other chronic disorders such as cardiovascular disease and breast cancer. Bone mineral density assessment and clinical risk factors provide independent insights into fracture risk in individuals. A finite list of clinical risk factors are identified as prognostic of fracture risk, namely among aging women, including low body mass, compromised reproductive physiology (e.g., prolonged periods of amenorrhea and early menopause), parental and personal histories of fracture, and alcohol and tobacco use. Pelvic organ prolapse is a common gynecologic entity and a contributor to age-related morbidities. The purpose of this review is to communicate data identifying pelvic organ prolapse as another clinical risk factor for fracture risk in postmenopausal women and to increase the caregiver's vigilance in anticipating and instituting preventive care strategies to a population (i.e., postmenopausal women with clinically appreciable pelvic organ prolapse) that may be at an enhanced lifetime risk for skeletal fractures.

scholarly journals Redefining osteoporosis treatment: who to treat and how long to treat

2006 ◽  
Vol 50 (4) ◽  
pp. 694-704 ◽  
Author(s):  
E. Michael Lewiecki ◽  
Stuart L. Silverman
Keyword(s):  
Risk Factors ◽  
Fracture Risk ◽  
Weight Bearing ◽  
Pharmacological Therapy ◽  
Clinical Risk Factors ◽  
Common Disease ◽  
Mineral Density ◽  
Clinical Risk ◽  
Increased Risk ◽  
Bmd Testing

Osteoporosis is a common disease that is associated with increased risk of fractures and serious clinical consequences. Bone mineral density (BMD) testing is used to diagnose osteoporosis, estimate the risk of fracture, and monitor changes in BMD over time. Combining clinical risk factors for fracture with BMD is a better predictor of fracture risk than BMD or clinical risk factors alone. Methodologies are being developed to use BMD and validated risk factors to estimate the 10-year probability of fracture, and then combine fracture probability with country-specific economic assumptions to determine cost-effective intervention thresholds. The decision to treat is based on factors that also include availability of therapy, patient preferences, and co-morbidities. All patients benefit from nonpharmacological lifestyle treatments such a weight-bearing exercise, adequate intake of calcium and vitamin D, fall prevention, avoidance of cigarette smoking and bone-toxic drugs, and moderation of alcohol intake. Patients at high risk for fracture should be considered for pharmacological therapy, which can reduce fracture risk by about 50%.

scholarly journals Evaluation of fracture risk in osteoporosis

2011 ◽  
Vol 152 (33) ◽  
pp. 1304-1311 ◽  
Author(s):  
Miklós Szathmári
Keyword(s):  
Risk Factors ◽  
Fracture Risk ◽  
Absolute Risk ◽  
Treatment Options ◽  
Osteoporotic Fractures ◽  
Clinical Risk Factors ◽  
Mineral Density ◽  
High Fracture ◽  
Parental History ◽  
Clinical Risk

Osteoporotic fractures are associated with excess mortality. Effective treatment options are available, which reduce the risk of vertebral and non-vertebral fractures, but the identification of patients with high fracture risk is problematic. Low bone mineral density (BMD) – the basis for the diagnosis of osteoporosis – is an important, but not the only determinant of fracture risk. Several clinical risk factors are know that operate partially or completely independently of BMD, and affect the fracture risk. These include age, a prior fragility fracture, a parental history of hip fracture, use of corticosteroids, excess alcohol intake, rheumatoid arthritis, and different types of diseases which can cause secondary bone loss. The FRAX® tool integrates the weight of above mentioned clinical risk factors for fracture risk assessment with or without BMD value, and calculates the 10-year absolute risk of hip and major osteoporotic (hip, vertebral, humerus and forearm together) fracture probabilities. Although the use of data is not yet uniform, the FRAX® is a promising opportunity to identify individuals with high fracture risk. The accumulation of experience with FRAX® is going on and it can modify current diagnostic and therapeutic recommendations in Hungary as well. Orv. Hetil., 2011, 152, 1304–1311.

scholarly journals Association of Bone Mineral Density With Fractures Across the Spectrum of Chronic Kidney Disease: The Regina CKD-MBD Study

2019 ◽  
Vol 6 ◽  
pp. 205435811987053 ◽  
Author(s):  
Bhanu Prasad ◽  
Thomas Ferguson ◽  
Navdeep Tangri ◽  
Chee Yong Ng ◽  
Thomas L. Nickolas
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Biochemical Markers ◽  
Clinical Risk Factors ◽  
Mineral Density ◽  
Clinical Risk

Background: Recent studies have demonstrated that measurement of areal bone mineral density by dual-energy x-ray absorptiometry (DXA) predicts fractures in patients with chronic kidney disease (CKD). However, whether fracture risk prediction through bone mineral density (BMD) is enhanced due to the assessment of biochemical markers of chronic kidney disease and mineral and bone disease (CKD-MBD) or clinical risk factors is not clear. We hypothesized that in a select cohort of patients managed in a CKD clinic, that combining T-Scores with biochemical markers would optimize fracture discrimination than using DXA alone. Objective: To examine the relationships among BMD, biochemical markers of CKD-MBD, and fracture risk across Kidney Disease Improving Global Outcomes (KDIGO) glomerular filtration rate (GFR) categories G3a to G5. Design: Retrospective study. Setting: Patients were recruited from the multidisciplinary CKD clinic, Regina General Hospital, Canada. Patients: A total of 374 patients who received a DXA scan upon initial referral to Regina Multidisciplinary CKD Program from January 31, 2001 to January 31, 2010, were included in this study. The patients were followed for a total of 5 years. Methods: We conducted a retrospective review of 374 consecutive patients who underwent DXA imaging at the point of entry into our multidisciplinary CKD program. Areal BMD, T- and Z-Scores were obtained at the lumbar spine, total hip, mean of left and right femoral neck, and the one-third radius. We collected data on demographic, cross-sectional biochemical markers of mineral metabolism and fractures (identified through self-reported questionnaires, hospital electronic medical records, and physician billing records). We were able to gather data on 8/11 variables of Fracture Risk Assessment (FRAX) tool. Results: In our cohort, 14.3% of GFR categories G3a and G3b, 15.7% of GFR category G4, and 19.7% of GFR category G5 experienced a clinical fracture during the study period. On multivariate analysis, each decline of 1.0 SD in total hip BMD T-Score was associated with a significant increase in the risk of fracture (OR = 1.46, 95% confidence interval [CI], 1.12-1.89). Adding CKD-MBD markers and clinical risk factors did not further contribute to the model. Low BMD was the only independent risk factor for fracture in patients with CKD. Limitations: Self-reporting by patients and administrative records were used to identify fractures. We did not perform spine imaging to ascertain morphometric vertebral fractures. We were unable to gather all 11 variables of FRAX score and information on ethnicity. We were unable to capture site of fracture (hips, spine, etc) from billing records. Albumin excretion rates were not collected at baseline. Treatment of the underlying bone disease with pharmacotherapeutic agents may have attenuated patients’ fracture risk and thus underestimated the association between BMD and future fracture. Conclusions: Our findings confirm that BMD predicts fracture. The addition of cross-sectional CKD-MBD parameters and clinical risk factors to BMD did not add to fracture prediction. Prospective studies should investigate the utility of longitudinal biochemical markers on improving fracture risk assessment.

scholarly journals The timed up and go test predicts fracture risk in older women independently of clinical risk factors and bone mineral density

2020 ◽  
Vol 32 (1) ◽  
pp. 75-84
Author(s):  
B. A. M. Larsson ◽  
L. Johansson ◽  
H. Johansson ◽  
K. F. Axelsson ◽  
N. Harvey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Fracture Risk ◽  
Older Women ◽  
Bone Mineral ◽  
Clinical Risk Factors ◽  
Mineral Density ◽  
Timed Up And Go ◽  
Clinical Risk

scholarly journals SAT0082 FRAX AND DAS IN MOROCCAN RHEUMATOID ARTHRITIS PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 975.1-975
Author(s):  
H. Azzouzi ◽  
O. Lamkhanat ◽  
I. Linda
Keyword(s):  
Rheumatoid Arthritis ◽  
Fracture Risk ◽  
Disease Activity ◽  
Descriptive Analysis ◽  
Cross Sectional Study ◽  
Fracture Probability ◽  
Mineral Density ◽  
Cross Sectional ◽  
Risk Probability ◽  
Fracture Assessment

Background:Rheumatoid Arthritis (RA) is one of the risk factors for the calculation of the 10 years fracture probability assessed by the FRAX tool.Objectives:The aim was to study the association of disease activity and the 10 year fracture risk probability by the FRAX tool in our RA patients and their impact on fracture prevalence.Methods:Cross-sectional study of the association FRAX and disease activity score (DAS 28 CRP) was designed. Patients with RA were included. Mean DAS was calculated for each patient adjusted on his follow-up duration. Data about patients (demographic, disease characteristics and fracture assessment) were collected. The 10 year fracture risk probability for major osteoporotic fracture was calculated with and without BMD (bone mineral density) using the FRAX tool for Morocco. Descriptive analysis and regressions were performed with SPSS.20. p<0.05 was considered significant.Results:One hundred and ninety nine RA patients were included with mean age of 55.5±12 years. Women represented 91% and 40.1% had osteoporosis. Remission was observed in 86.4% with 95.5% taking methotrexate. 17.1% had vertebral fractures. FRAX and DAS were associated (p=0.03), and both explained vertebral fracture (VF) prevalence. When adjusted on disease parameters, FRAX with and without BMD explained the vertebral prevalence (p=0.02, OR=1.09[1.01-1.19]). However, age remains the only predictor of VF when adjusted on osteoporosis factors (DAS28CRP, menopause, BMI, smoking, diabetes, gender, steroid use, HAQ) and FRAX BMD.Conclusion:Persistent disease activity was associated to high 10 year fracture risk probability calculated by the FRAX tool in RA.Disclosure of Interests:None declared

scholarly journals WHO absolute fracture risk models (FRAX): Do clinical risk factors improve fracture prediction in older women without osteoporosis?

2011 ◽  
Vol 26 (8) ◽  
pp. 1774-1782 ◽  
Author(s):  
Teresa A Hillier ◽  
Jane A Cauley ◽  
Joanne H Rizzo ◽  
Kathryn L Pedula ◽  
Kristine E Ensrud ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fracture Risk ◽  
Older Women ◽  
Fracture Prediction ◽  
Clinical Risk Factors ◽  
Risk Models ◽  
Clinical Risk

scholarly journals Prognostic value of lower bone mineral density in predicting adverse cardiovascular disease in Asian women

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318764
Author(s):  
Jiesuck Park ◽  
Yeonyee Elizabeth Yoon ◽  
Kyoung Min Kim ◽  
In-Chang Hwang ◽  
Wonjae Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Cardiovascular Disease ◽  
Clinical Diagnosis ◽  
Bone Mineral ◽  
Prognostic Value ◽  
Clinical Risk Factors ◽  
Mineral Density ◽  
Clinical Risk ◽  
Incremental Prognostic Value

ObjectiveWe investigated whether the evaluation of bone mineral density (BMD) provides independent and incremental prognostic value for predicting atherosclerotic cardiovascular disease (ASCVD) in women.MethodsA total of 12 681 women aged 50–80 years (mean, 63.0±7.8 years) who underwent dual-energy X-ray absorptiometry were retrospectively analysed. We assessed the hazard ratio (HR) for ASCVD events (ASCVD death, non-fatal myocardial infarction and ischaemic stroke) according to the BMD or a clinical diagnosis of osteopenia or osteoporosis, with adjustment for clinical risk factors, including age, body mass index, hypertension, type 2 diabetes, hyperlipidaemia, current smoking and previous fracture. We also evaluated whether the addition of BMD or a clinical diagnosis of osteopenia or osteoporosis to clinical risk factors improved the prediction for ASCVD events.ResultsIn total, 468 women (3.7%) experienced ASCVD events during follow-up (median, 9.2 years). Lower BMD at the lumbar spine, femur neck and total hip was independently associated with higher risk for ASCVD events (adjusted HR per 1-standard deviation decrease in BMD: 1.16, p<0.001; 1.29, p<0.001; 1.38, p<0.001; respectively). A clinical diagnosis of osteoporosis was also independently associated with higher risk for ASCVD events (adjusted HR: 1.79, p<0.001). The addition of BMD or a clinical diagnosis of osteopenia or osteoporosis to clinical risk factors demonstrated significant incremental value in discriminating ASCVD events (addition of total hip BMD, p for difference <0.001).ConclusionThe evaluation of BMD provides independent and incremental prognostic value for ASCVD in women and thus may improve risk stratification in women.

scholarly journals Hip bone mineral density, bone turnover and risk of fracture in patients on long-term suppressive L-thyroxine therapy for differentiated thyroid carcinoma

2005 ◽  
Vol 153 (1) ◽  
pp. 23-29 ◽  
Author(s):  
A Caroline Heijckmann ◽  
Maya S P Huijberts ◽  
Piet Geusens ◽  
Jolanda de Vries ◽  
Paul P C A Menheere ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Vertebral Fracture ◽  
Thyroid Carcinoma ◽  
Differentiated Thyroid Carcinoma ◽  
Clinical Risk Factors ◽  
Type I ◽  
Mineral Density ◽  
Clinical Risk

Objective: Untreated hyperthyroidism and treatment with high doses of thyroid hormone are associated with osteoporosis. However, their effect on bone turnover, their contribution to bone mineral density (BMD) in the context of other clinical risk factors for osteoporosis and the prevalence of vertebral fractures is not well documented. Design: Cross-sectional study. Methods: We studied 59 patients receiving L-thyroxine suppressive therapy for differentiated thyroid carcinoma (DTC). BMD of the hip was measured by dual X-ray absorptiometry (DXA) and lateral DXA pictures of the lumbar and thoracic vertebrae were performed. Bone resorption was measured by C-telopeptides of type I collagen (ICTP) and bone formation by procollagen type I N-propeptide (PINP). Clinical risk factors for osteoporosis were evaluated using a questionnaire. Results: Z-scores of BMD were similar as the NHANES (National Health and Nutrition Examination Survey) III reference group in women and men, also after long-term (>10 years) suppression therapy. Patients in the lowest and highest quartile of BMD showed significant differences in the presence of clinical risk factors. ICTP levels were significantly higher than in age-matched controls, PINP levels were not different. We found four patients with a prevalent vertebral fracture. Conclusions: We conclude that patients with well-differentiated thyroid carcinoma are not at increased risk of developing low bone mass nor have a higher prevalence of vertebral fracture at least when treated with relatively low doses of l-thyroxine.

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