scholarly journals T Scores, FRAX, Frailty Phenotype, Falls, and Its Relationship to Fractures in Patients on Maintenance Hemodialysis

2021 ◽  
Vol 8 ◽  
pp. 205435812110411
Author(s):  
Maryam Jafari ◽  
Salman Anwar ◽  
Kaval Kour ◽  
Shubrandu Sanjoy ◽  
Kunal Goyal ◽  
...  

Background: Despite the magnitude of fracture and the consequences in patients receiving hemodialysis, optimal risk assessment tools in this population are not well explored. Frailty and falls—known risk factors for fracture in chronic kidney disease (CKD) and non-CKD populations—are common in patients receiving hemodialysis (HD) therapy. While the relationship between T scores in relation to fractures in patients receiving HD is recognized, there is a paucity of data to the additional contributions of fracture assessment tool (FRAX), frailty status, and falls in its relationship with fracture. Objectives: To evaluate the clinical utility of adding FRAX, frailty status, and falls to T scores at the femoral neck to determine whether it enhances fracture discrimination in patients on maintenance HD. Design: A cross-sectional observational study. Setting: Two main dialysis units in Regina, Saskatchewan, Canada. Patients: A total of 109 patients on maintenance HD at two dialysis units from January 1, 2017, to December 31, 2018, were included in the study. Measurements: Fracture (the main outcome) was documented based on the review of medical charts, self-recall, and additionally vertebral fractures were identified by an x-ray. Areal bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). FRAX score was calculated using an online algorithm based on 11 clinical risk factors. We calculated the FRAX score for hip fracture and major osteoprotoic fracture with and without the inclusion of BMD. Frailty was assessed using the Fried criteria, which included assessments of unintentional weight loss, weakness (handgrip strength), slowness (walking speed), and questionnaires for physical activity and self-perceived exhaustion. Patients were enquired about the history and frequency of falls. Methods: A total of 131 patients underwent frailty assessments at the two dialysis units during the dialysis treatment. Following frailty assessments, they were referred for DXA scans and upon receipt of the results undertook FRAX questionnaires. They were additionally sent for lumbar x-rays and contacted for a history of falls. Association between the BMD-T score, FRAX, frailty status, falls, with fracture were examined with sequential multivariable logistic regression models. Differences were considered statistically significant at P values <.05. Results: A total of 109 patients were included in the data analysis. The composite of fracture occurred in 37.6% of patients. About 59.3% were identified as frail, and 29% of the participants had at least one fall in the last year. On multivariate regression analysis, each lower standard deviation (SD) in femoral neck T score was associated with 48% higher odds of fracture (odds ratio [OR] = 1.48; 95% confidence interval [CI] 1.20-1.68, P = .005). With the inclusion for FRAX scores (hip), the OR for fracture remained significant at 1.38 (OR = 1.38, 95% CI 1.04-1.63, P = .043). The addition of frailty status and history of falls did not further improve the model. Low T score and FRAX were both independent risk factors in patients on HD therapy. Limitations: This is a single-center study with a small sample size which limits the generalizability of the findings. Due to the cross-sectional study, associations identified may be difficult to interpret. Conclusions: Both BMD measurements by DXA and FRAX are useful tools to assess fracture in patients receiving HD. The addition of frailty status and history of falls is not associated with fractures in this population. Larger prospective studies are needed to determine whether the inclusion of frailty and falls to the conventional models will improve fracture assessment in the population receiving HD. Trial Registration: The study was not registered on a publicly accessible registry as it did not involve health care intervention on human participants.

2017 ◽  
Vol 18 (3) ◽  
pp. 239-243
Author(s):  
Dalibor Stajic ◽  
Sandra Zivanovic ◽  
Ana Miric ◽  
Marija Sekulic ◽  
Nela Djonovic

Abstract Osteoporosis is a progressive bone disorder that can be influenced by many different factors. A cross-sectional study has been conducted with the aim to assess the prevalence of risk factors as well as to identify the possible causes of improvement of the disease. Th e study population consisted of 97 women older than 35 who had previously been diagnosed with osteoporosis. Dualenergy X-ray Absorptiometry (DXA) scan was used to determine bone mineral density (BMD) in order to assess the current state of the disease. Th e participants were asked to complete a standardized IOF (International Osteoporosis Foundation) questionnaire. According to BMD measurements, 24.7% of women had normal bone density while 18.6% had T-score lower than -2.5. Th ere was a statistically significant correlation between T-score and the history of previous bone fractures. Besides, a relatively high prevalence of certain risk factors (such as underweight, early menopause, oophorectomy, thyroid and parathyroid disorders etc.) was observed in woman with osteoporosis


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 835.1-835
Author(s):  
Z. Batalov ◽  
M. Nikolov ◽  
N. Nikolov

Background:Radiofrequency echographic multi spectrometry (REMS) is an innovative radiation-free approach for the assessment of bone mineral density (BMD) at axial sites. The principle of this technology is based on the analysis of native raw unfiltered ultrasound signals, the so called radiofrequency ultrasound signals, acquired during an echographic scan of the lumbar spine and/or femoral neck. [1]. A previous published study showed a high degree of correlation between the T-score values provided by the two techniques-REMS and dual energy X-ray absorptiometry for both lumbar spine and femoral neck [2]. REMS software outputs information about BMD (g/cm2), T-scores, Z-scores [standard deviations (SD)], percentage of body fat and basal metabolic rate [BMR (kcal/daily)] [3].Objectives:The aim of the current study is to investigate the multivariate significant risk factors for reduced BMD through REMS technology.Methods:In this study, a total of 273 women with mean age 62 years (yrs.) ± 12 yrs. (range 25-88 yrs.) underwent REMS assessments. Subjects were divided into two groups after acquiring information about the spinal T-scores: 1st group with T-scores ≥-1 SD and 2nd group with T-scores <-1 SD. Age, weight, height, body mass index (BMI), basal metabolic rate (BMR), body fat and menopausal status were the risk factors included in the multivariate statistical analyses. Binary logistic regression was used to assess which are the significant risk factors for T-score <-1 SD. Youden’s indices were calculated for selecting the cut-off points for each risk factor.Results:273 women had mean weight of 70.5 kg. ± 15.7 kg. (range 39.4-127 kg.), mean height 157.1 cm. ± 8.8 cm. (range 100-182 cm.) and mean body mass index (BMI) 28.6 kg/cm2 ± 6.1 kg/cm2 (range 14.9-47.5 kg/cm2). The mean body fat of the subjects was 37.8% ± 8.8% (range 9-52%) and the mean BMR was 1274.01 kcal/daily ± 163.17 kcal/daily (range 929.7-1908.4 kcal/daily). 260 women (95.2%) were attributed to postmenopausal. Age (p=0.000), BMI (p=0.015), menopause (p=0.006) and BMR (p=0.000) were the multivariate significant risk factors for T-score <-1 SD. Odds ratio for the risk factor age was 1.16, so each added year of the women’s age increased the risk for T-score <-1 SD by 1.16%. Women over the age of 65 yrs. showed the highest risk for spinal T-score <-1 SD. The odds ratio of the menopause as a risk factor for spinal T-score <-1 SD was 9.54, so postmenopausal women showed about 9.5 times higher risk of T-score <-1 SD of the lumbar spine than women who still have their period. The increase of BMI by one kg/cm2 decreased the probability of spinal T-score <-1 SD by 0.15% and the increase of BMR by one kcal/daily decreased this probability by 0.02%. Women with BMI above 28.63 kg/cm2 and those with BMR >1331.75 kcal/daily were unlikely to develop spinal T-score <-1 SD.Conclusion:In the current study, multivariate regression analysis was used to develop a specific REMS-based risk prediction model for spinal BMD, corresponding to T-score <-1 SD. Postmenopausal women over age of 65 yrs. with BMI lower than 28.63 kg/cm2 and BMR <1331.75 kcal/daily were at the highest risk for T-score <-1 SD of the lumbar spine.References:[1]Pisani P, Renna MD, Conversano F, Casciaro E, Muratore M, et al. (2013) Screening and early diagnosis of osteoporosis through X-ray and ultrasound-based techniques. World J Radiol 5(11): 398-410.[2]Kirilov N. Analysis of dual-energy x-ray absorptiometry images using computer vision methods. (2020) Trakia Journal of Sciences, Vol. 18, Suppl. 1, pp 114-117.[3]Kirilova E, Kirilov N, Popov I, Vladeva S. (2019) Bone mineral density of lumbar spine and femoral neck assessed by novel echographic approach-Radiofrequency Echographic Multi Spectrometry (REMS). Clin. Cases Miner. Bone Metab., 16 (1), pp. 14-17.Disclosure of Interests:None declared.


2015 ◽  
pp. 50-58
Author(s):  
Thi Dung Nguyen ◽  
Tam Vo

Background: The patients on hemodialysis have a significantly decreased quality of life. One of many problems which reduce the quality of life and increase the mortality in these patients is osteoporosis and osteoporosis associated fractures. Objectives: To assess the bone density of those on hemodialysis by dual energy X ray absorptiometry and to examine the risk factors of bone density reduction in these patients. Patients and Method: This is a cross-sectional study, including 93 patients on chronic hemodialysis at the department of Hemodialysis at Cho Ray Hospital. Results: Mean bone densities at the region of interest (ROI) neck, trochanter, Ward triangle, intertrochanter and total neck are 0.603 ± 0.105; 0.583 ± 0.121; 0.811 ± 0.166; 0.489 ± 0.146; 0.723 ± 0.138 g/cm2 respectively. The prevalences of osteoporosis at those ROI are 39.8%, 15.1%; 28%; 38.7%; and 26.9% respectively. The prevalences of osteopenia at those ROI are 54.8%; 46.3%; 60.2%; 45.2% and 62.7% respectively. The prevalence of osteopososis in at least one ROI is 52.7% and the prevalence of osteopenia in at least one ROI is 47.3%. There are relations between the bone density at the neck and the gender of the patient and the albuminemia. Bone density at the trochanter is influenced by gender, albuminemia, calcemia and phosphoremia. Bone density at the intertrochanter is affected by the gender. Bone density at the Ward triangle is influenced by age and albuminemia. Total neck bone density is influenced by gender, albuminemia and phosphoremia. Conclusion: Osteoporosis in patients on chronic hemodialysis is an issue that requires our attention. There are many interventionable risk factors of bone density decrease in these patients. Key words: Osteoporosis, DEXA, chronic renal failure, chronic hemodialysis


Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Malika A Swar ◽  
Marwan Bukhari

Abstract Background/Aims  Osteoporosis (OP) is an extra-articular manifestation of rheumatoid arthritis (RA) that leads to increased fracture susceptibility due to a variety of reasons including immobility and cytokine driven bone loss. Bone loss in other populations has well documented risk factors. It is unknown whether bone loss in RA predominantly affects the femoral neck or the spine. This study aimed to identify independent predictors of low bone mineral density (BMD) in patients RA at the lumbar spine and the femoral neck. Methods  This was a retrospective observational cohort study using patients with Rheumatoid arthritis attending for a regional dual X-ray absorptiometry (DEXA) scan at the Royal Lancaster Infirmary between 2004 and 2014. BMD in L1-L4 in the spine and in the femoral neck were recorded. The risk factors investigated were steroid use, family history of osteoporosis, smoking, alcohol abuse, BMI, gender, previous fragility fracture, number of FRAX(tm) risk factors and age. Univariate and Multivariate regression analysis models were fitted to explore bone loss at these sites using BMD in g/cm2 as a dependant variable. . Results  1,527 patients were included in the analysis, 1,207 (79%) were female. Mean age was 64.34 years (SD11.6). mean BMI was 27.32kg/cm2 (SD 5.570) 858 (56.2%) had some steroid exposure . 169(11.1%) had family history of osteoporosis. fragility fracture history found in 406 (26.6%). 621 (40.7%) were current or ex smokers . There was a median of 3 OP risk factors (IQR 1,3) The performance of the models is shown in table one below. Different risk factors appeared to influence the BMD at different sites and the cumulative risk factors influenced BMD in the spine. None of the traditional risk factors predicted poor bone loss well in this cohort. P129 Table 1:result of the regression modelsCharacteristicB femoral neck95% CIpB spine95%CIpAge at scan-0.004-0.005,-0.003&lt;0.01-0.0005-0.002,0.00050.292Sex-0.094-0.113,-0.075&lt;0.01-0.101-0.129,-0.072&lt;0.01BMI (mg/m2)0.0080.008,0.0101&lt;0.010.01130.019,0.013&lt;0.01Fragility fracture-0.024-0.055,0.0060.12-0.0138-0.060,0.0320.559Smoking0.007-0.022,0.0350.650.0286-0.015,0.0720.20Alcohol0.011-0.033,0.0 5560.620.0544-0.013,0.1120.11Family history of OP0.012-0.021,0.0450.470.0158-0.034,0.0650.53Number of risk factors-0.015-0.039,0.0080.21-0.039-0.075,-0.0030.03steroids0.004-0.023,0.0320.030.027-0.015,0.0690.21 Conclusion  This study has shown that predictors of low BMD in the spine and hip are different and less influential than expected in this cohort with RA . As the FRAX(tm) tool only uses the femoral neck, this might underestimate the fracture risk in this population. Further work looking at individual areas is ongoing. Disclosure  M.A. Swar: None. M. Bukhari: None.


2021 ◽  
Vol 9 (1) ◽  
pp. e002099
Author(s):  
Yuji Komorita ◽  
Masae Minami ◽  
Yasutaka Maeda ◽  
Rie Yoshioka ◽  
Toshiaki Ohkuma ◽  
...  

IntroductionType 1 diabetes (T1D) is associated with higher fracture risk. However, few studies have investigated the relationship between severe hypoglycemia and fracture risk in patients with T1D, and the results are controversial. Besides, none has investigated the risk factors for fracture in Asian patients with T1D. The aim of the present study was to investigate the prevalence of bone fracture and its relationship between severe hypoglycemia and other risk factors in Japanese patients with T1D.Research design and methodsThe single-center cross-sectional study enrolled 388 Japanese patients with T1D (mean age, 45.2 years; women, 60.4%; mean duration of diabetes, 16.6 years) between October 2019 and April 2020. The occurrence and circumstances of any fracture after the diagnosis of T1D were identified using a self-administered questionnaire. The main outcomes were any anatomic site of fracture and fall-related fracture. Severe hypoglycemia was defined as an episode of hypoglycemia that required the assistance of others to achieve recovery.ResultsA total of 92 fractures occurred in 64 patients, and 59 fractures (64%) were fall-related. Only one participant experienced fracture within the 10 years following their diagnosis of diabetes. In logistic regression analysis, the multivariate-adjusted ORs (95% CIs) of a history of severe hypoglycemia were 2.11 (1.11 to 4.09) for any fracture and 1.91 (0.93 to 4.02) for fall-related fracture. Fourteen of 18 participants with multiple episodes of any type of fracture had a history of severe hypoglycemia (p<0.001 vs no fracture).ConclusionsWe have shown that a history of severe hypoglycemia is significantly associated with a higher risk of bone fracture in Japanese patients with T1D.


1970 ◽  
Vol 6 (1) ◽  
pp. 19-23 ◽  
Author(s):  
AM Hossain ◽  
NU Ahmed ◽  
M Rahman ◽  
MR Islam ◽  
G Sadhya ◽  
...  

A hospital based cross sectional study was carried out to analyze prevalence of risk factors for stroke in hospitalized patient in a medical college hospital. 100 patients were chosen using purposive sampling technique. Highest incidence of stroke was between the 6th and 7th decade. Patients came from both urban (54%) and rural (46%) areas and most of them belong to the low-income group (47%). In occupational category; service holder (28%) and retired person (21%) were the highest groups. Most of the study subjects were literate (63%). CT scan study revealed that the incidence of ischaemic stroke was 61% and haemorrhagic stroke 39%. Analysis indicated hypertension as major risk factor for stroke (63%) and major portion of the patients (42.85%) were on irregular or no treatment. Twenty four percent of the patients had heart diseases and out of 24 patients 45.83% were suffering from ischaemic heart disease. The present study detected diabetes in 21% patients. Fifty three percent of the study subjects were smoker, 39% patients had habit of betelnut chewing. Out of 26 female patients, only 23% had history of using oral contraceptives. Majority of the patients were sedentary workers (46%). Thirty seven percent of the stroke patients were obese. Among the stroke patients 9% had previous history of stroke and 3% had TIA respectively. Most of the patients (21%) were awake while they suffered from stroke and the time of occurrence was mostly in the afternoon (46%). This study found that hypertension, cigarette smoking, ischaemic heart disease and diabetes mellitus are the major risk factors prevalent in our community while other risk factors demand further study. Key words: stroke; risk factors; hospitalized patients; Bangladesh. DOI: 10.3329/fmcj.v6i1.7405 Faridpur Med. Coll. J. 2011;6(1): 19-23


2005 ◽  
Vol 38 (3) ◽  
pp. 304-326 ◽  
Author(s):  
Jason Sorens

This article analyzes the “risk factors” of secessionism at the substate, regional level. It seeks to answer the question, What regions are more likely to support more successful secessionist parties? Using new data in cross-sectional regression analysis, the author finds that secessionism involves unique factors not common to other kinds of ethnic conflict. Specifically, in addition to “identity” variables such as regional language and history of independence, the following variables explain secessionist strength: lack of irredentist potential, relative affluence, geographical noncontiguity, population, and multiparty political system. These factors generally serve as activators of ethnic identity rather than a substitute for the same, although there are important cases of nonethnic secessionism.


2016 ◽  
Vol 17 (2) ◽  
pp. 138-141
Author(s):  
Samira Sharmin ◽  
Mabubul Haque ◽  
Syedur Rahman Miah ◽  
Md Mahbub Ur Rahman ◽  
Jasmine Ara Haque ◽  
...  

Objectives: Low bone mass is a common disorder in elderly population which predisposes to fracture with minimal trauma. This study was performed to find out the association between the Body Mass Index (BMI) and Bone Mineral Density (BMD) in postmenopausal women.Materials and Methods: This cross sectional study was carried out at Institute of Nuclear Medicine and Allied Sciences Comilla and Mitford, Dhaka over a period of 12 months from January 2013 to December 2013. A total 93 postmenopausal women were enrolled for this study. All postmenopausal women underwent a BMD scan of femoral neck and lumbar vertebrae using a Dual Energy X-ray Absorptiometry (DEXA). Participants were categorized into three groups according to their age and BMI. BMD were expressed base on T-score according to WHO criteria. The relation among BMI, age and BMD were assessed.Results: The results of this study showed that the mean age of the study group was 57.13±7.49 years with range of 46 to 75 years. The most postmenopausal women were in age group 55-65years. The mean BMI of the study subjects were 24.18±5.08 kg/m2 with a range of 15.62 to 36.20 kg/m2. Among 93 subjects osteopenia was greater at lumbar spine (45.2%) with T-score mean±SD-1.83±0.33 and osteoporosis at femoral neck (51.6%) with T-score mean ±SD-3.36±-0.67. Pearson’s correlation coefficient test showed inverse relationship between age and BMD both lumbar spine (r = -0.301, p = 0.003) and femoral neck (r = -0.303, p=0.003) whereas the positive relation between BMI and BMD both at lumbar spine (r=0.338, p=0.001) and femoral neck (r =0.343, p=0.001). These showed that with advancing age, BMD decreases and the risk of osteoporosis increases and with increasing BMI, BMD increases and risk of osteoporosis decreases.Conclusion: The findings of this study portrait that aging and low BMI are risk factors associated with bone loss. So preventive measure should be taken for high risk post menopausal women.Bangladesh J. Nuclear Med. 17(2): 138-141, July 2014


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Thanaphum Laithaisong ◽  
Wichai Aekplakorn ◽  
Paibul Suriyawongpaisal ◽  
Chanunporn Tupthai ◽  
Chathaya Wongrathanandha

PurposeThis research aimed to explore the prevalence of musculoskeletal disorders (MSDs) and related factors among subcontracted cleaners in a teaching hospital in Thailand.Design/methodology/approachA cross-sectional study was conducted of 393 subcontracted cleaners in a teaching hospital, from May to June 2020. Face-to-face interviews were carried out using a standard questionnaire, consisting of four parts: (1) participant characteristics, (2) stress test, (3) work characteristics and (4) standardized Nordic questionnaire, Thai version, for MSDs outcome. Multiple logistic regression analyses were performed to determine the association between MSDs and related factors.FindingsThe prevalence of MSDs was 81.9%, involving mostly the lower back (57.7%), followed by the shoulder (52.6%). Factors significantly associated with MSDs were as follows: male gender (OR = 3.06, 95% CI [1.19, 7.87]), severe stress (OR = 2.72, 95% CI [1.13, 6.54]), history of injuries (OR = 4.37, 95% CI [1.27, 15.11]), mopping posture (OR = 2.81, 95% CI [1.43, 5.50]) and task duration (OR = 1.90, 95% CI [1.01, 3.57] for 2–4 h and OR = 3.39, 95% CI [1.17, 9.86] for more than 4 h). Sick leave due to MSDs was associated with history of injuries, Thai nationality and having another part-time job.Originality/valueThe study findings about MSDs in terms of prevalence and related factors contributed to limited pool of the knowledge among subcontracted hospital cleaners in Thailand and middle-income country settings. With growing popularity in outsourcing cleaning services among hospitals in these countries, the study findings could raise a concern and inform policymakers and hospital administrators the importance of the magnitude and risk factors for MSDs necessitating design of preventive strategies.


Sign in / Sign up

Export Citation Format

Share Document