scholarly journals Evaluation of Provider Screening Practices for Fracture Risk Assessment among Patients with HIV Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Faryal Mirza ◽  
Sabina Zawadzka ◽  
Anne Abbate ◽  
Michael Thompson ◽  
Dorothy Wakefield ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Fragility Fracture ◽  
People Living With Hiv ◽  
Mineral Density ◽  
Screening Practices ◽  
Low Bone Mineral Density ◽  
Increased Risk ◽  
Provider Survey

People living with HIV are known to have greater risk of low bone mineral density than HIV-negative peers. The reasons for this disparity are multifactorial. To address this increased risk, the Infectious Diseases Society of America (IDSA) released fracture risk screening recommendations in 2015, which differ significantly from recommendations that apply to the general population. A study was conducted at the University of Connecticut to assess for provider awareness and adherence to these recommendations. Electronic surveys were sent to providers, and patients were also surveyed for risk factors and prevalence of low bone mineral density. The results of the provider survey showed low rates of awareness of the IDSA screening recommendations. A substantial proportion of patients surveyed met criteria for low BMD screening but did not have dual-energy X-ray absorptiometry (DXA) ordered by their provider. As an intervention, providers were sent information via e-mail regarding current screening recommendations, as well as notifications if their patient met criteria for DXA screening. A twelve-month follow-up survey showed increased provider knowledge of screening recommendations and improved screening practices. Additionally, the results of a logistic regression analysis of patient factors showed that increasing age and male sex were positively associated with fragility fracture risk. Increased duration of antiretroviral therapy use was associated with a lower likelihood of fragility fracture.

Management of bone metabolism in epilepsy

2021 ◽  
Vol 74 (7-8) ◽  
pp. 257-265
Author(s):  
Firdevs Ezgi Uçan Tokuç ◽  
Fatma Genç ◽  
Abidin Erdal ◽  
Yasemin Biçer Gömceli
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Bone Metabolism ◽  
Bone Mineral ◽  
Outpatient Clinic ◽  
Bone Mineralization ◽  
Mineral Density ◽  
Low Bone Mineral Density ◽  
Increased Risk ◽  
Significant Difference

Many systemic problems arise due to the side effects of antiepileptic drugs (AEDs) used in epilepsy patients. Among these adverse effects are low bone mineral density and increased fracture risk due to long-term AED use. Although various studies have supported this association with increased risk in recent years, the length of this process has not been precisely defined and there is no clear consensus on bone density scanning, intervals of screening, and the subject of calcium and vitamin D supplementation. In this study, in accordance with the most current recommendations, our applications and data, including the detection of possible bone mineralization disorders, treatment methods, and recommendations to prevent bone mineralization disorders, were evaluated in epilepsy patients who were followed up at our outpatient clinic. It was aimed to draw attention to the significance of management of bone metabolism carried out with appropriate protocols. Epilepsy patients were followed up at the Antalya Training and Research Hospital Department of Neurology, Epilepsy Outpatient Clinic who were at high risk for osteoporosis (use of valproic acid [VPA] and enzyme-inducing drugs, using any AED for over 5 years, and postmenopausal women) and were evaluated using a screening protocol. According to this protocol, a total of 190 patients suspected of osteoporosis risk were retrospectively evaluated. Four patients were excluded from the study due to secondary osteoporosis. Of the 186 patients who were included in the study, 97 (52.2%) were women and 89 (47.8%) were men. Prevalence of low bone mineral density (BMD) was 42%, in which osteoporosis was detected in 11.8% and osteopenia in 30.6% of the patients. Osteoporosis rate was higher at the young age group (18-45) and this difference was statistically significant (p=0.018). There was no significant difference between male and female sexes according to osteoporosis and osteopenia rates. Patients receiving polytherapy had higher osteoporosis rate and lower BMD compared to patients receiving monotherapy. Comparison of separate drug groups according to osteoporosis rate revealed that osteoporosis rate was highest in patient groups using VPA+ carbamazepine (CBZ) (29.4%) and VPA polytherapy (19.4%). Total of osteopenia and osteoporosis, or low BMD, was highest in VPA polytherapy (VPA+ non-enzyme-inducing AED [NEID]) and CBZ polytherapy (CBZ+NEID) groups, with rates of 58.3% and 55.1%, respectively. In addition, there was no significant difference between drug groups according to bone metabolism markers, vitamin D levels, and osteopenia-osteoporosis rates. Assuming bone health will be affected at an early age in epilepsy patients, providing lifestyle and diet recommendations, avoiding polytherapy including VPA and CBZ when possible, and evaluating bone metabolism at regular intervals are actions that should be applied in routine practice.

scholarly journals Association Between moleculars and Osteoporotic Fracture Risk:A systematical review

2020 ◽  
Author(s):  
Jie-Yu Liu ◽  
Jia-Xiang Wang ◽  
Li Xu ◽  
Shu-Feng Lei ◽  
Fei-Yan Deng
Keyword(s):  
Bone Mineral Density ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Elderly Population ◽  
Early Recognition ◽  
Osteoporotic Fractures ◽  
Middle Aged ◽  
Mineral Density ◽  
Low Bone Mineral Density ◽  
Increased Risk

AbstractOsteoporosis is a systemic chronic skeletal disease, which is characterized by low bone mineral density (BMD) and increased risk to osteoporotic fractures (OFs). OFs are associated with high mortality and morbidity, and seriously affect the life quality of patients. Osteoporosis is prevalent in the middle-aged and elderly population, especially the postmenopausal women. With population aging, osteoporosis becomes a world-wide serious public health problem. Early recognition of the high-risk population followed by timely and efficient intervention and/or treatment is important for preventing OFs. In light of the high heritability and complex pathogenesis of OP, comprehensive consideration of significant biological/biochemical factors is necessary for accurate risk evaluation. For this purpose, we reviewed recent research progress on moleculars which are diagnostic and/or predictive of OFs risk. Future integrative analyses and systematic evaluation of these moleculars may facilitate developing novel methodologies and/or test strategies, i.e., biochips, for early recognition of osteoporosis, hence to contribute to preventing OFs in the world.Graphical AbstractOsteoporosis, which is characterized by low bone mineral density (BMD) and increased risk to osteoporotic fractures (OFs), is prevalent in the middle-aged and elderly population, especially in the postmenopausal women. We focused on several types of important molecules, including proteins/peptides, RNAs, lipids, to gain comprehensive understanding and to generate novel perspectives in predicting and diagnosing OFs.

scholarly journals Poor Vitamin K Status Is Associated With Low Bone Mineral Density and Increased Fracture Risk in End-Stage Renal Disease

2018 ◽  
Vol 34 (2) ◽  
pp. 262-269 ◽  
Author(s):  
Pieter Evenepoel ◽  
Kathleen Claes ◽  
Bjorn Meijers ◽  
Michaël Laurent ◽  
Bert Bammens ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Renal Disease ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Vitamin K ◽  
End Stage Renal Disease ◽  
Mineral Density ◽  
Low Bone Mineral Density ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Nutrients in the Prevention of Osteoporosis in Patients with Inflammatory Bowel Diseases

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1702
Author(s):  
Alicja Ewa Ratajczak ◽  
Anna Maria Rychter ◽  
Agnieszka Zawada ◽  
Agnieszka Dobrowolska ◽  
Iwona Krela-Kaźmierczak
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Inflammatory Bowel Diseases ◽  
Mineral Density ◽  
Low Bone Mineral Density ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Calcium Phosphorus ◽  
Prevention Of Osteoporosis ◽  
Inflammatory Bowel

The chronic character of inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, results in various complications. One of them is osteoporosis, manifested by low bone mineral density, which leads to an increased risk of fractures. The aetiology of low bone mineral density is multifactorial and includes both diet and nutritional status. Calcium and vitamin D are the most often discussed nutrients with regard to bone mineral density. Moreover, vitamins A, K, C, B12; folic acid; calcium; phosphorus; magnesium; sodium; zinc; copper; and selenium are also involved in the formation of bone mass. Patients suffering from inflammatory bowel diseases frequently consume inadequate amounts of the aforementioned minerals and vitamins or their absorption is disturbed, resulting innutritional deficiency and an increased risk of osteoporosis. Thus, nutritional guidelines for inflammatory bowel disease patients should comprise information concerning the prevention of osteoporosis.

scholarly journals Low Bone Mineral Density, Renal Dysfunction, and Fracture Risk in HIV Infection: A Cross‐Sectional Study

2009 ◽  
Vol 200 (11) ◽  
pp. 1746-1754 ◽  
Author(s):  
Alexandra Calmy ◽  
Christoph A. Fux ◽  
Richard Norris ◽  
Nathalie Vallier ◽  
Cécile Delhumeau ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Hiv Infection ◽  
Fracture Risk ◽  
Renal Dysfunction ◽  
Bone Mineral ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Mineral Density ◽  
Cross Sectional ◽  
Low Bone Mineral Density

scholarly journals Comparison of Bone Mineral Density, T-Scores and Serum Zinc between Diabetic and Non Diabetic Postmenopausal Women with Osteoporosis

2015 ◽  
Vol 7 (01) ◽  
pp. 043-048 ◽  
Author(s):  
Priyanka R Siddapur ◽  
Anuradha B Patil ◽  
Varsha S Borde
Keyword(s):  
Bone Mineral Density ◽  
Fracture Risk ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Mineral Density ◽  
T Score ◽  
Increased Risk ◽  
Serum Zn ◽  
Type 2 Diabetic

ABSTRACT Context: Postmenopausal osteoporosis is a public health problem. Diabetics are at increased risk of osteoporosis-related fractures. Zinc (Zn) has a role in collagen metabolism, and its levels are altered in diabetes. Aims: The aim was to compare bone mineral density (BMD), T-score and serum Zn between diabetic and nondiabetic postmenopausal women with osteoporosis to see if they influence increased fracture risk in diabetes. Settings and Design: It is a cross-sectional study conducted at Department of Biochemistry, Jawaharlal Nehru Medical College, Belgaum. Materials and Methods: Thirty type 2 diabetic and 30 age-matched (aged 45-75 years) nondiabetic Dual energy X-ray absorptiometry (DEXA) confirmed postmenopausal osteoporotics were included from January 2011 to March 2012. Serum Zn was analyzed by atomic absorption spectrophotometry. Statistical Analysis Used: Mean and standard deviation of the parameters of the two groups were computed and compared by unpaired Student's t-test. Relationship between variables was measured by Karl Pearson's correlation co-efficient. A statistical significance is set at 5% level of significance (P < 0.05). Results: T-score was significantly higher in diabetics compared with nondiabetics(−2.84 ± 0.42 vs. −3.22 ± 0.74) P < 0.05. BMD and serum Zn of diabetics showed a significant positive correlation with body mass index (BMI). Conclusions: Type 2 diabetic postmenopausal osteoporotics have a higher T-score than the nondiabetics. High BMI in type-2 diabetes mellitus (T2DM) may contribute to high BMD and may be a protective factor against zincuria. Increased fracture risk in T2DM could be due to other factors like poor bone quality due to hyperglycemia rather than BMD. Strict glycemic control is of paramount importance.

scholarly journals AB0913 PREDICTING PATIENTS AT RISK OF FRAGILITY FRACTURE WITH NORMAL BONE MINERAL DENSITY: AN OBSERVATIONAL STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1758.1-1758
Author(s):  
C. Saleh ◽  
M. Bukhari ◽  
S. M. Bilgrami
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Mineral Density ◽  
Logistic Regression ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Fat Mass ◽  
Fragility Fracture ◽  
Odds Ratio ◽  
Mineral Density ◽  
History Of

Background:There is an increased risk of low-trauma fracture as bone mineral density (BMD) decreases, however a large proportion of these fragility fractures occur in those without osteoporosis or osteopenia. The widely used FRAX tool uses femoral neck (FN) BMD, amongst other parameters, to predict fracture risk. In those with normal BMD, data is lacking on the weight these other parameters hold in predicting future risk. Indeed, FN BMD can be facultative in the estimation of risk when using FRAX.Objectives:To establish predictors of fragility fracture in a patient cohort referred for BMD estimation, subsequently found to have bilateral FN BMD of greater than 1.Methods:A cohort of patients in the North West of England referred between 2004 and 2014 for BMD estimation, with both left and right FN BMD of greater than 1 were identified. Patient parameters identified and analysed included age at scan, gender, BMD at left hip, body mass index (BMI), fat mass, family history of fracture, alcohol history of 3 or more units per day, smoking status, rheumatoid arthritis (RA), and steroid exposure. Patients with fragility fracture were compared with those without fracture. Chi-square test and T-test were applied to categorical and continuous data respectively. Further univariate and multivariate logistic regression models were fitted to determine parameters associated with future fracture risk.Results:619 patients with bilateral FN BMD of greater than 1 were identified and included in analysis. Mean age at scan was 54 years (SD 11.82) and 542 (87.56%) were female. 92 (14.86%) patients had a fragility fracture. Mean left FN BMD was 1.91 (SD 0.71), and mean right FN BMD was 1.92 (SD 0.68). Results of the univariate analysis are described in Table 1 below.Table 1.Logistic regression analysis of patient parameters with unadjusted and adjusted odds ratios for fragility fracturePredictorUnadjusted odds ratio (95% CI)Odds ratio adjusted for age (95% CI)Odds ratio adjusted for age and gender (95% CI)Age at scan (years)0.99 (0.98-1.01)--Gender1.37 (0.66, 2.84)1.34 (0.64, 2.80)-BMD at left hip0.34 (0.03, 4.05)0.37 (0.03, 4.37)0.50 (0.03, 7.67)BMI1.07 (1.03, 1.10)1.07 (1.03, 1.10)1.07 (1.03, 1.10)Fat mass1.00 (1.00, 1.00)1.00 (1.00, 1.01)1.00 (1.00, 1.01)Parent fractured hip0.99 (0.57, 1.70)0.97 (0.56, 1.68)0.94 (0.54, 1.64)Alcohol (3 or more units/day)1.16 (0.47, 2.86)1.16 (0.47, 2.87)1.16 (0.47, 2.89)Current smoker1.40 (0.89, 2.21)1.40 (0.89, 2.21)1.42 (0.90, 2.23)Rheumatoid arthritis0.83 (0.32, 2.19)0.85 (0.32, 2.24)0.86 (0.34, 2.27)Steroid exposure0.53 (0.30, 0.96)0.53 (0.30, 0.96)0.54 (0.30, 0.98)Conclusion:Steroid exposure and body composition parameters influence fracture risk in this group pf patients with normal BMD, further work will be done looking at the types of fractures and other parameters in this group of patients.Disclosure of Interests:Christopher Saleh: None declared, Marwan Bukhari Speakers bureau: Bristol-Myers Squib, UCB celltech, Roche/Chugai, Pfizer, Abbvie, Merck, Mennarini, Sanofi-aventis, Eli-Lilly, Janssen, Amgen and Novartis., Syed Mujtaba Bilgrami Speakers bureau: Pfizer

scholarly journals O41 Percentage body fat as a predictor for fragility fracture: an observational study

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Dominic T Beith ◽  
Marwan Bukhari
Keyword(s):  
Bone Mineral Density ◽  
Fracture Risk ◽  
Body Mass ◽  
Body Fat ◽  
Bone Mineral ◽  
Fragility Fracture ◽  
Statistical Significance ◽  
Fragility Fractures ◽  
Mineral Density ◽  
Percentage Body Fat

Abstract Background A body mass index (BMI) of less than 19 is a known risk factor for the development of osteoporosis and thus increases the propensity of one having a fragility fracture. Bone mineral density (BMD) referrals are aided by the FRAX™ tool, which contains BMI in order to calculate the ten-year fracture risk. We aimed to investigate the effect of percentage body fat on risk of fracture referred for BMD estimation. Methods Between June 2004 and October 2015, patients were referred for bone mineral density (BMD) estimation in a scanner in the North West of England. All patients were referred with all FRAX™ indications including rheumatoid arthritis, excess alcohol, steroids, family history of fracture and secondary osteoporosis. The cohort was divided into quintiles of ascending body mass percentage. Logistical regression was then applied before adjusting for age at scan, gender and total left BMD comparing patients with a fracture and those that had not. Results 35,759 patients were referred for scanning during the period. 22,765 (63.66%) were referred for BMD estimation and had body fat percentage measured. Mean age at scan was 63.16 (SD 12.86) and 18,961 (88.29%) of the cohort were females. 8,072 (35.46%) had a fracture. More fractures were seen in higher quintiles of percentage body fat, 1,693 (20.97%) compared to 1,580 (19.57%) in females (p = &lt;0.05). Predictors shown in the Table 1 below adjusted for age at scan, gender and total left BMD. Logistical regression of the quintiles after adjustment shows statistical significance in quintiles 3, 4 and 5 as well as for age at scan and total left BMD. Other predictors did not shows statistical significance p &gt; 0.05. Conclusion Our study of 22,765 patients referred for BMD estimations opposes current literature on the effect of BMI on fragility fractures. The data shows that increasing percentage body fat in associated with an increased propensity of fragility fractures in those with BMI as a FRAX™ indicator. Currently percentage body fact is not featured in the FRAX™ tool and further work needs to be done to show the relationship between fracture risk and percentage body fat. Disclosures D.T. Beith: None. M. Bukhari: None.

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