Osteoporosis

Osteoporosis is characterized by a reduction in bone mass and disruption of bone architecture, resulting in increased bone fragility and fracture risk, with fractures of the distal radius (Colles’ fracture), spine, and proximal femur being most characteristic. One in two women and one in five men over the age of 50 years will suffer an osteoporotic fracture during their remaining lifetime, with massive cost to healthcare services. Osteoporotic fractures are termed fragility fractures (defined as occurring after a fall from standing height or less). They may occur at several skeletal sites but fractures of the distal radius (Colles’ fracture), spine, and proximal femur are most characteristic. The incidence of osteoporotic fractures increases markedly with age; in women, the median age for Colles’ fractures is 65 years and for hip fracture, 80 years.

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Osteoporosis

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.2004_update_002 ◽

2010 ◽

pp. 3796-3801

Author(s):

Juliet Compston

Keyword(s):

Health Care ◽

Bone Mass ◽

Fracture Risk ◽

Osteoporotic Fracture ◽

Proximal Femur ◽

Health Care Services ◽

Bone Fragility ◽

Bone Architecture ◽

Care Services ◽

Colles Fracture

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Epidemiology of osteoporotic fractures in Brazil: what we have and what we need

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302010000200012 ◽

2010 ◽

Vol 54 (2) ◽

pp. 164-170 ◽

Cited By ~ 23

Author(s):

Marcelo de Medeiros Pinheiro ◽

Sérgio Ragi Eis

Keyword(s):

Femoral Fractures ◽

Public Health Problem ◽

Osteoporotic Fractures ◽

Fragility Fractures ◽

Healthcare Services ◽

Bone Fragility ◽

High Rate ◽

Physical Impairment ◽

Public Healthcare ◽

Major Public Health Problem

The epidemiology of osteoporotic fractures varies widely among countries and is primarily related to differences in the population and utilization of public healthcare services. Since 1994, over 200 studies about osteoporosis and fractures have been conducted in Brazil, among which 60 have described the current epidemiological status. This work is a compilation of studies published in scientific journals (PubMed, MedLine, Lilacs, SciELO Database) with the respective highlights. Overall, these studies show moderate incidence of hip fracture in subjects over 50 years old. However, the prevalence of all types of bone fragility fracture is higher, ranging from 11% to 23.8%. In addition, there is a high incidence of recurrent falls, which are the main extra-skeletal factor associated with these fractures. According to the national studies, 12 months after femoral fractures, the mortality rate ranged between 21.5% and 30%, and there was also a high rate of physical impairment, deterioration of the quality of life and excessive burden to the healthcare system. Considering its high prevalence and associated mortality and physical impairment, osteoporosis and its main consequence, bone fragility fractures, must be considered a major public health problem in our country.

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Is estrogen receptor alpha key to controlling bones' resistance to fracture?

Journal of Endocrinology ◽

10.1677/joe.0.1820183 ◽

2004 ◽

Vol 182 (2) ◽

pp. 183-191 ◽

Cited By ~ 45

Author(s):

L Lanyon ◽

V Armstrong ◽

D Ong ◽

G Zaman ◽

J Price

Keyword(s):

Estrogen Receptor ◽

Bone Mass ◽

Estrogen Receptor Alpha ◽

Bone Cells ◽

Fragility Fractures ◽

Bone Fragility ◽

Bone Architecture ◽

Rapid Loss ◽

Major Question ◽

Age Related

The ability of bones to withstand functional loading without damage depends upon their cell populations establishing and subsequently maintaining a mass and architecture that are appropriately robust for the purpose. In women, the rapid loss of bone associated with the menopause represents a steplike decline in the effectiveness of this process with consequent increase in bone fragility. In men, loss of bone tissue and reduction in bone strength are more gradual and the increased incidence of fragility fractures occurs later. In both sexes, bone mass is associated with levels of bioavailable estrogen. This poses the major question as to how the presence or concentration of the reproductive hormone estrogen influences the relationship between bone mass and bone loading. In this paper, we briefly review evidence of the mechanism(s) by which the mechanical strains engendered by loading influence bone cells to establish and maintain structurally competent bone architecture. We highlight the finding that at least one strain-related cascade responsible for adaptive control of bone architecture is mediated through estrogen receptor (ER) alpha, the number and activity of which are regulated by estrogen. We hypothesize that a major contributor to the rapid loss of bone mass that occurs in females, and the slower age-related fall in males and females, is reduced effectiveness of ER-mediated processing of strain-related information by resident bone cells.

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POS0163 INCIDENT FRACTURE RISK PREDICTION USING THE FRAGILITY SCORE CALCULATED BY LUMBAR SPINE RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS) SCANS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2311 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 294.2-294

Author(s):

D. Ciardo ◽

P. Pisani ◽

F. A. Lombardi ◽

R. Franchini ◽

F. Conversano ◽

...

Keyword(s):

Lumbar Spine ◽

Fracture Risk ◽

Fragility Fracture ◽

Osteoporotic Fractures ◽

Fragility Fractures ◽

Bone Fragility ◽

P Value ◽

T Score ◽

Caucasian Women

Background:The main consequence of osteoporosis is the occurrence of fractures due to bone fragility, with important sequelae in terms of disability and mortality. It has been already demonstrated that the information about bone mass density (BMD) alone is not sufficient to predict the risk of fragility fractures, since several fractures occur in patients with normal BMD [1].The Fragility Score is a parameter that allows to estimate skeletal fragility thanks to a trans-abdominal ultrasound scan performed with Radiofrequency Echographic Multi Spectrometry (REMS) technology. It is calculated by comparing the results of the spectral analysis of the patient’s raw ultrasound signals with reference models representative of fragile and non-fragile bones [2]. It is a dimensionless parameter, which can vary from 0 to 100, in proportion to the degree of fragility, independently from BMD.Objectives:This study aims to evaluate the effectiveness of Fragility Score, measured during a bone densitometry exam performed with REMS technology at lumbar spine, in identifying patients at risk of incident osteoporotic fractures at a follow-up period of 5 years.Methods:Caucasian women with age between 30 and 90 were scanned with spinal REMS and DXA. The incidence of osteoporotic fractures was assessed during a follow-up period of 5 years. The ability of the Fragility Score to discriminate between patients with and without incident fragility fractures was subsequently evaluated and compared with the discriminatory ability of the T-score calculated with DXA and with REMS.Results:Overall, 533 women (median age: 60 years; interquartile range [IQR]: 54-66 years) completed the follow-up (median 42 months; IQR: 35-56 months), during which 73 patients had sustained an incident fracture.Both median REMS and DXA measured T-score values were significantly lower in fractured patients than for non-fractured ones, conversely, REMS Fragility Score was significantly higher (Table 1).Table 1.Analysis of T-score values calculated with REMS and DXA and Fragility Score calculated with REMS. Median values and interquartile ranges (IQR) are reported. The p-value is derived from the Mann-Whitney test.Patients without incident fragility fracturePatients with incident fragility fracturep-valueT-score DXA[median (IQR)]-1.9 (-2.7 to -1.0)-2.6 (-3.3 to -1.7)0.0001T-score REMS[median (IQR)]-2.0 (-2.8 to -1.1)-2.7 (-3.5 to -1.9)<0.0001Fragility Score[median (IQR)]29.9 (25.7 to 36.2)53.0 (34.2 to 62.5)<0.0001By evaluating the capability to discriminate patients with/without fragility fractures, the Fragility Score obtained a value of the ROC area under the curve (AUC) of 0.80, higher than the AUC of the REMS T-score (0.66) and of the T-score DXA (0.64), and the difference was statistically significant (Figure 1).Figure 1.ROC curve comparison of Fragility Score, REMS and DXA T-score values in the classification of patients with incident fragility fractures.Furthermore, the correlation between the Fragility Score and the T-score values was low, with Pearson correlation coefficient r=-0.19 between Fragility Score and DXA T-score and -0.18 between the Fragility Score and the REMS T-score.Conclusion:The Fragility Score was found to be an effective tool for the prediction of fracture risk in a population of Caucasian women, with performances superior to those of the T-score values. Therefore, this tool presents a high potential as an effective diagnostic tool for the early identification and subsequent early treatment of bone fragility.References:[1]Diez Perez A et al. Aging Clin Exp Res 2019; 31(10):1375-1389.[2]Pisani P et al. Measurement 2017; 101:243–249.Disclosure of Interests:None declared

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Radiology of Osteoporosis

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2015.02.002 ◽

2016 ◽

Vol 67 (1) ◽

pp. 28-40 ◽

Cited By ~ 15

Author(s):

Thomas M. Link

Keyword(s):

Computed Tomography ◽

Fracture Risk ◽

New Technologies ◽

Assessment Tool ◽

Quantitative Computed Tomography ◽

Osteoporotic Fractures ◽

Fragility Fractures ◽

Bone Architecture ◽

Mineral Density ◽

Fracture Risk Assessment Tool

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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Distribution of bone density in the proximal femur and its association with hip fracture risk in older men: The osteoporotic fractures in men (MrOS) study

Journal of Bone and Mineral Research ◽

10.1002/jbmr.1693 ◽

2012 ◽

Vol 27 (11) ◽

pp. 2314-2324 ◽

Cited By ~ 40

Author(s):

Lang Yang ◽

Annabel C Burton ◽

Mike Bradburn ◽

Carrie M Nielson ◽

Eric S Orwoll ◽

...

Keyword(s):

Hip Fracture ◽

Bone Density ◽

Fracture Risk ◽

Proximal Femur ◽

Osteoporotic Fractures ◽

Older Men ◽

Hip Fracture Risk

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Aging of bone

Reviews in Clinical Gerontology ◽

10.1017/s0959259898008429 ◽

1998 ◽

Vol 8 (4) ◽

pp. 281-296 ◽

Cited By ~ 3

Author(s):

Lis Mosekilde

Keyword(s):

Vertebral Fracture ◽

Bone Mass ◽

Osteoporotic Fractures ◽

Bone Architecture ◽

Age Related ◽

Basic Understanding ◽

Vertebral Fracture Incidence ◽

Age Related Changes ◽

Shape And Size ◽

Do So

In Europe, vertebral fracture incidence has increased 300–400% for women and more than 400% for men during the last 30 years. These data are age-adjusted and therefore highlight that there is a decrease in bone mass or bone quality from generation to generation. To arrest or reverse the increases in osteoporotic fractures, effective general preventive regimens must be established. However, in order to do so, basic understanding of age-related changes in the material quality, 3D cancellous bone architecture, macrostructure (shape and size), and strength of human bone is crucial.

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EFFECT OF BETA-BLOCKERS ON BONE MINERAL DENSITY AND OSTEOPOROTIC FRACTURES

Osteoporosis and Bone Diseases ◽

10.14341/osteo2013135-38 ◽

2013 ◽

Vol 16 (1) ◽

pp. 35-38

Author(s):

K E Sobchenko ◽

I A Skripnikova ◽

E S Abirova ◽

P A Ptichkina

Keyword(s):

Bone Mineral Density ◽

Cardiovascular Disease ◽

Bone Mass ◽

Beta Blockers ◽

Osteoporotic Fractures ◽

Bone Fragility ◽

Mechanisms Of Action ◽

Current Data ◽

Mineral Density ◽

Fracture Development

This review presents the current data on the pleiotropic effects of beta-blockers in particular on the effect on bone mass and fracture development by means of increased bone fragility. In this article we discuss the mechanisms of action of beta-blockers on bone metabolism and their possible protective effect on bone tissue in the treatment of cardiovascular disease.

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Syndecan-3 enhances anabolic bone formation through WNT signalling

10.1101/846972 ◽

2019 ◽

Author(s):

Francesca Manuela Johnson de Sousa Brito ◽

Andrew Butcher ◽

Addolorata Pisconti ◽

Blandine Poulet ◽

Amanda Prior ◽

...

Keyword(s):

Bone Formation ◽

Bone Structure ◽

Fragility Fractures ◽

Bone Fragility ◽

Wnt Signalling ◽

Bone Architecture ◽

Age Related ◽

Metabolic Bone Disorder ◽

Metabolic Bone ◽

Canonical Wnt

ABSTRACTOsteoporosis is the most common age-related metabolic bone disorder, which is characterised by low bone mass and deterioration in bone architecture, with a propensity to fragility fractures. The best treatment for osteoporosis relies on stimulation of osteoblasts to form new bone and restore bone structure, however anabolic therapeutics are few and their use is time-restricted. Here we report that Syndecan-3 (SDC3) increases new bone formation through enhancement of WNT signalling. Young adult Sdc3−/− mice have a low bone volume phenotype associated with reduced bone formation, increased bone marrow adipose tissue (BMAT), increased bone fragility and a blunted anabolic bone formation response to mechanical loading. The premature osteoporosis-like phenotype of Sdc3−/− mice is primarily explained by delayed osteoblast maturation and impaired osteoblast function, with contributing increased osteoclast-mediated bone resorption. Mechanistically, SDC3 enhances canonical WNT signalling in osteoblasts through stabilisation of Frizzled 1, making SDC3 an attractive target for novel anabolic drug development.

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PROFILE OF OSTEOPOROTIC FRACTURES

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i9.1446 ◽

2020 ◽

Vol 4 (9) ◽

Author(s):

Gopal Yadav ◽

Chetan Laljibhai Rathod

Keyword(s):

Vitamin D ◽

Lumbar Spine ◽

Distal Radius ◽

Proximal Femur ◽

Proximal Humerus ◽

Osteoporotic Fractures ◽

High Energy ◽

World Health ◽

Risk Of Fracture ◽

Increased Risk

Introduction: Osteoporosis is a widespread global disorder characterized by decreased bone mass and altered bone architecture, resulting in increased fragility of the bone and an increased risk of fracture. The prevalence of osteoporosis is projected to rise dramatically in the future due to ageing of population. Leading to increased risk of fracture, osteoporosis is defined as a disorder of skeleton which is characterized by weak strength of bones according to National Institutes of Health Consensus Development Panel. According to the criteria laid by World Health Organization (WHO). There are various causes of osteoporosis which includes growing older with age, rheumatoid arthritis, lower body mass index, gender, premature ovarian failure, deficiency of vitamin D, alchohol abuse, poor consumption of calcium, medications. Osteoporosis sometimes may not be diagnosed until occurrence of fracture since it is a silent disease. Material and Methods: The study group which comprised of cases was subjects with osteoporotic fractures above 45 years of age having any one or combination of fractions mentioned below: Thoraco-lumbar spine, distal radius, proximal femur, proximal humerus, mechanism of low-energy trauma. Patients with high-energy trauma or fractures, road side accidents and/or below 45 years of age were not included in this study. The control group comprised of subjects above 45 years of age suffering from osteoarthritis. Results: Majority of females were observed in cases as well as controls in present studies with number of females in cases being 21 in cases while 18 in controls among 30 subjects belonging to each group. It is observed that among all fractures in cases which were included in present study, majority of fractures were proximal femur which accounted for 43% of total fractures followed by distal radius 30%, proximal humerus 20% and thoraco-lumbar spine 7%. Conclusion: Compromised by strength of bone leading to an increased fracture risk, osteoporosis is a skeletal disorder. Older patients, females, patients with higher BMI and weighed more had a greater proportion of osteoporotic fractures. Keywords: osteoporotic fractures, BMI, Vitamin D, alchohol abuse, calcium.

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