scholarly journals High prevalence of osteoporosis in patients undergoing spine surgery in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaoyi Mo ◽  
Shengli Zhao ◽  
Zhenxing Wen ◽  
Wei Lin ◽  
Zhipeng Chen ◽  
...  
Keyword(s):  
Vertebral Fracture ◽  
Spine Surgery ◽  
Southern China ◽  
Chinese Patients ◽  
Fracture Rate ◽  
Mineral Density ◽  
Degenerative Scoliosis ◽  
Number Of Patients ◽  
Significant Difference ◽  
High Prevalence

Abstract Background With the increase in life expectancy, a large number of patients with osteoporosis (OP) are undergoing spine surgery, which may adversely affect the surgical success rate. The prevalence of OP varies in different regions, and no data are available that represent the prevalence of OP among Chinese patients over 50 years of age who are undergoing spine surgery. It was the first multicenter study to assess OP in these patients. Aiming to obtain comprehensive data, this study combined bone mineral density (BMD) measurements and visual radiography assessment (VRA) to analyze the prevalence of OP in patients aged > 50 years who underwent spine surgery. Methods Data from 1,856 patients aged over 50 years undergoing spine surgery who resided in northern, central, and southern China were reviewed between 2018 and 2019. Based on the perioperative BMD and X-ray data, we calculated the prevalence of OP in this special population according to sex, age, and spine degenerative disease. Results A total of 1,245 patients (678 females and 567 males) were included in the study. The prevalence of OP diagnosed by BMD was 52.8 % in females and 18.7 % in males. When we combined with BMD and VRA, the prevalence of OP increased from 52.8 to 65.9 % in females and from 18.7 to 40.6 % in males. Although OP was more severe in females than in males, a significant difference in the rate of vertebral fracture (VF) was not observed between females and males with a normal BMD and osteopenia (females vs. males: aged 50–59 years, P = 0.977; 60–69 years, P = 0.302; >70 years, P = 0.172). Similarly, no significant difference in the vertebral fracture rate was observed within different age groups of patients with a normal BMD and osteopenia (females: P = 0.210; males, P = 0.895). The incidence of OP in patients with degenerative scoliosis was higher than that in the remaining patients (females: 63.6 % vs. 42.4 %, P = 0.018; males: 38.9 % vs. 13.8 %, P = 0.004). Conclusions A high prevalence of OP was identified in patients aged > 50 years undergoing spine surgery, especially in patients whose primary diagnosis was degenerative scoliosis. BMD and VRA evaluations should be included in the clinical routine for these patients prior to surgery.

scholarly journals Comparative assessment of sarcopenia using the JSH, AWGS, and EWGSOP2 criteria and the relationship between sarcopenia, osteoporosis, and osteosarcopenia in patients with liver cirrhosis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Chisato Saeki ◽  
Keiko Takano ◽  
Tsunekazu Oikawa ◽  
Yuma Aoki ◽  
Tomoya Kanai ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Vertebral Fracture ◽  
Working Group ◽  
Close Association ◽  
Handgrip Strength ◽  
X Rays ◽  
Mineral Density ◽  
Number Of Patients ◽  
European Working ◽  
The Relationship

Abstract Background Sarcopenia and osteoporosis reduce life quality and worsen prognosis in patients with liver cirrhosis (LC). When these two complications coexist, a diagnosis of osteosarcopenia is made. We aimed to investigate the actual situations of sarcopenia, osteoporosis, osteosarcopenia, and vertebral fracture, and to clarify the relationship among these events in patients with LC. Methods We describe a cross-sectional study of 142 patients with LC. Sarcopenia was defined according to the Japan Society of Hepatology (JSH) criteria, Asian Working Group for Sarcopenia (AWGS) criteria, and European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. The skeletal muscle mass index (SMI) and handgrip strength were assessed using bioelectrical impedance analysis and a digital grip strength dynamometer, respectively. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry, and vertebral fracture was evaluated using spinal lateral X-rays. The severity of LC was assessed using the Child-Pugh classification. Results Among the 142 patients, the prevalence of sarcopenia was 33.8% (48/142) according to the JSH and AWGS criteria and 28.2% (40/142) according to the EWGSOP2 criteria. The number of patients with osteoporosis, osteosarcopenia, and vertebral fracture was 49 (34.5%), 31 (21.8%), and 41 (28.9%), respectively. Multivariate analysis revealed a close association between sarcopenia and osteoporosis. Osteoporosis was independently associated with sarcopenia [odds ratio (OR) = 3.923, P = 0.010]. Conversely, sarcopenia was independently associated with osteoporosis (OR = 5.722, P < 0.001). Vertebral fracture occurred most frequently in patients with osteosarcopenia (19/31; 61.3%) and least frequently in those without both sarcopenia and osteoporosis (12/76; 15.8%). The SMI and handgrip strength values were significantly correlated with the BMD of the lumbar spine (r = 0.55 and 0.51, respectively; P < 0.001 for both), femoral neck, (r = 0.67 and 0.62, respectively; P < 0.001 for both), and total hip (r = 0.67 and 0.61, respectively; P < 0.001 for both). Conclusions Sarcopenia, osteoporosis, osteosarcopenia, and vertebral fracture were highly prevalent and closely associated with one another in patients with LC. Specifically, patients with osteosarcopenia had the highest risk of vertebral fractures. Early diagnosis of these complications is essential for treatment intervention.

scholarly journals Investigation of osteoporosis and its influencing factors in a group of Chinese patients with Interstitial Lung Disease

2021 ◽  
Author(s):  
Hui Zhang ◽  
Xiao-Wen Sheng ◽  
Fan Zhang ◽  
Yu-Qi Hu ◽  
Li-Ru Huang ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Chinese Patients ◽  
Mineral Density ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Multiple Factors ◽  
Lung Structure ◽  
High Prevalence

Abstract Background Interstitial lung disease (ILD) seriously influences patient’s quality of life (QOL) due to an abnormally repaired lung structure and damaged lung function, as well as its many complications. Osteoporosis is a systemic bone disease characterized by low bone mineral density (BMD) and may impair QOL and increase mortality in ILD patients. We conducted this study to investigate osteoporosis in Chinese ILD patients. Methods We performed a cross-sectional survey of 179 Chinese ILD patients. BMD levels were evaluated, and the clinical variables of the patients were recorded. The physical activity and QOL of patients were evaluated by a questionnaire when enrolled. Regression analysis was used to identify factors affecting BMD in ILD patients. Results In total, 68.2% of the included patients had an abnormal BMD, 24.6% had osteoporosis, and 43.6% had osteopenia. Decreased of BMD in ILD patients was associated with multiple factors, of which sex, height, weight, ILD subtypes and serum parathyroid hormone (PTH) were most significantly. The QOL of ILD patients with osteoporosis is dramatically declining. Conclusions Osteoporosis and osteopenia have high prevalence rates in ILD patients and seriously affect patients’ QOL. The development of osteoporosis and low BMD in ILD patients are influenced by multiple factors. Early identification and interventions are expected to benefit the QOL of ILD patients.

scholarly journals Aromatase Inhibitor Induced Bone Loss: Do International Guidelines Accurately Stratify Fracture Risk and Selection of Anti-Osteoporosis Treatment?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A242-A242
Author(s):  
Shriya Gandhi ◽  
Cydney A Bullock ◽  
Ethan M Ritz ◽  
Todd Beck ◽  
Sanford Baim
Keyword(s):  
Breast Cancer ◽  
Bone Resorption ◽  
Bone Loss ◽  
Fracture Risk ◽  
Academic Medical Center ◽  
Untreated Group ◽  
Fracture Rate ◽  
Mineral Density ◽  
Peripheral Tissues ◽  
Significant Difference

Abstract Introduction: Aromatase inhibitors (AI) are used for adjunctive treatment of estrogen receptor-positive (ER+) breast cancer. Aromatase converts androgens to estrogens in the ovaries and peripheral tissues such as adipose, liver, muscle, and breast. In breast, estrogens increase cell proliferation in both normal and ER+ malignant tissue. AIs globally suppress estrogen production, and thereby can decrease tumor progression. However, in bone, estrogens suppress osteoclast activity and decrease bone resorption so AI use results in increased bone resorption and decreased bone mineral density (BMD). Several guidelines exist to direct management of AI-associated bone loss, but it is unclear whether adherence to these guidelines translates to decreased fracture risk. The International Osteoporosis Foundation (IOF) et al 2017 guidelines for the prevention of osteoporotic fractures in patients treated with AI recommended BMD measurement at the onset of AI use and use of anti-osteoporosis therapy (anti-OP) in those who met T-score and clinical risk factor (CRF) criteria. Hypothesis: We explored application of these guidelines and whether they were able to stratify patients according to risk, initiation of treatment, and fracture outcomes. Methods: 1517 charts were extracted from the electronic medical record (EMR) of a tertiary academic medical center based on history of breast cancer and use of AIs between 2008 and 2017. Charts were retrospectively analyzed to determine baseline BMD, osteoporosis risk factors, duration of AI use, duration of anti-OP therapy, and fractures. The IOF criteria were applied to each patient to determine applicability of anti-OP therapy. Fracture rates were compared using chi square test or Fisher’s exact test. Results: 1517 patients were included in the analysis. Regardless of whether criteria were met for treatment based on baseline BMD and CRF, the fracture rate was significantly higher in the treated versus the untreated group, 13.78% (CI: 9.56–18.99) versus 2.24% (p &lt; 0.0001, CI: 1.51–3.21). Similarly, among those that met criteria, the fracture rate was significantly higher in the treated versus the untreated group, 10.24% (CI: 5.56–16.87) versus 2.61% (p = 0.0005, CI: 1.20–4.89). There was no significant difference in fractures between those who did versus did not meet treatment criteria, 4.66% (CI: 2.94–6.97) versus 3.64% (p = 0.34, CI 2.59–4.96). Conclusions: This retrospective EMR analysis of 1517 breast cancer patients on AIs between 2008 and 2017 observed a higher fracture incidence in patients who received anti-OP treatment compared to those who did not, regardless of meeting criteria for treatment per the IOF guidelines. It is possible that patients who initiated anti-OP therapy had additional CRFs not captured in the EMR and not factored into our analyses.

scholarly journals Effect of general and sub-arachnoid anesthesia on the incidence of postoperative delirium and cognitive impairments in elderly Chinese patients

2022 ◽  
Vol 20 (2) ◽  
pp. 433-439
Author(s):  
Wei-Xia Ren ◽  
Ran-Ran Wu
Keyword(s):  
Spinal Anesthesia ◽  
Femoral Fracture ◽  
Postoperative Delirium ◽  
Cognitive Impairments ◽  
Proximal Femoral Fracture ◽  
Chinese Patients ◽  
Number Of Patients ◽  
Significant Difference ◽  
Elderly Chinese ◽  
Fracture Surgery

Purpose: To investigate the effect of general and subarachnoid (spinal) anesthesia on the incidence of postoperative delirium and cognitive impairments in elderly Chinese patients. Methods: Elderly Chinese patients (n = 281) aged 65 – 79 years (mean age = 74.12 ± 4.15 years) who underwent proximal femoral fracture surgery were recruited over a 1-year period for this study. The patients were evaluated using neuropsychological assessment battery (NAB) 24 h before surgery, and on the first day 1 month after surgery. Data on activity of daily living (ADL) (in this case toileting at the time of discharge) were recorded and analyzed. Results: There was no significant difference in the number of patients that developed postoperative delirium between the two anesthesia groups (p > 0.05). Although the trail making test (TMT) scores (parts A and B) were increased on the first day 1 month after surgery, there were no significant differences in NAB results between the two groups (p > 0.05). Patients who received subarachnoid (spinal) anesthesia had significantly higher dependency for toileting at the time of discharge than those who received general anesthesia (p < 0.05). Conclusion: These results show that general and subarachnoid (spinal) anesthesia do not cause postoperative delirium and cognitive dysfunction in elderly Chinese patients who underwent proximal femoral fracture surgery.

scholarly journals Performance of HR-pQCT, DXA, and FRAX in the discrimination of asymptomatic vertebral fracture in postmenopausal Chinese women

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Meiling Huang ◽  
Vivian Wing-yin Hung ◽  
Tsz Kiu Li ◽  
Sheung Wai Law ◽  
Yulong Wang ◽  
...  
Keyword(s):  
Vertebral Fracture ◽  
Fracture Risk ◽  
Postmenopausal Women ◽  
Bone Quality ◽  
Assessment Tool ◽  
Chinese Women ◽  
Quantitative Computed Tomography ◽  
Areal Bone Mineral Density ◽  
Mineral Density ◽  
Significant Difference

Abstract Summary Volumetric bone density (vBMD) and trabecular microarchitecture measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) can discriminate the patients with high risk of asymptomatic vertebral fracture (VF) in postmenopausal Chinese women. These findings suggested that HR-pQCT could provide additional information on bone quality of the patients with asymptomatic VF. Introduction Although there were several studies using HR-pQCT to investigate asymptomatic VF, it remains uncertain if HR-pQCT parameters can discriminate asymptomatic VF patients, especially in Chinese population. The purpose of this study was to investigate whether bone quality measured by HR-pQCT could discriminate asymptomatic VF independent of hip areal bone mineral density (aBMD) measured by dual-energy x-ray absorptiometry (DXA) and fracture risks evaluated using built-in Fracture Risk Assessment Tool (FRAXBMD). Methods This is a nested case–control study. One hundred seventy-five ambulatory Chinese postmenopausal women aged 60–79 years were retrieved from Normative Reference Standards (NRS) cohort in Hong Kong. DXA was used to identify VF from lateral spine images (VFA) using Genant’s semi-quantitative method. Major osteoporotic fracture risk was calculated using FRAX tool. HR-pQCT was used to assess vBMD, microarchitecture, and estimated strength at both distal radius and tibia. Comparison of HR-pQCT parameters between asymptomatic VF and control was performed using covariance analysis. Logistic regression analysis was performed for calculating the adjusted odds ratio (OR) with 95% confidence intervals (CI) of fracture status as per SD decrease in HR-pQCT parameters. Results Women with asymptomatic VF were older than those of the control in our NRS cohort. Nevertheless, after adjusted for covariance, asymptomatic VF showed significantly lower trabecular vBMD (Tb.vBMD) at radius but higher SMI at tibia as compared with those of the control. Tb.vBMD at radius yielded the highest value of area under the curve (AUC) as compared with total hip aBMD and FRAXBMD. However, no significant difference was found among each other. Conclusion Tb.vBMD at the radius and SMI at the tibia provided by HR-pQCT can discriminate asymptomatic VF independent of hip aBMD and FRAXBMD by DXA in postmenopausal women.

Bone mineral density in postmenopausal women with osteoarthritis of knee joint

2021 ◽  
pp. 53-58
Author(s):  
E. V. Usova ◽  
Yu. V. Averkieva ◽  
T. A. Raskina ◽  
M. V. Letaeva ◽  
O. S. Malyshenko ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Femoral Neck ◽  
Knee Joint ◽  
Postmenopausal Women ◽  
Mineral Density ◽  
X Ray ◽  
Femur Neck ◽  
American College Of Rheumatology ◽  
Number Of Patients ◽  
Significant Difference

Objective. Study the state of mineral bone density (BMD) in postmenopausal women with osteoarthritis (OA) of the knee joint depending on the X-ray stage.Materials and methods. The study included 56 women between 44 and 75 years of age. The diagnosis of OA is established according to the diagnostic criteria of the American College of Rheumatology (ACR, 1991). For comparative analysis, patients were divided into two groups, taking into account the radiological stage: the 1st with 38 women with I–II radiology stage, the 2nd with 18 patients with III–IV radiology stage. The X-ray of the knee joint in the anterior projection is performed in a fixed bending position using a special frame (SynaFlexer TM Plexiglass positioning frame, Synarc Inc., USA). The BMD is estimated by a two-energy X-ray absorption technique in the femoral neck and lumbar spine.Results. Osteopenic syndrome is diagnosed in 52 (92.8%) of the total number of patients, 27 (48.2%) have osteopenia and 25 (44.6%) have osteoporosis. Four women (7.1%) have a normal BMD. There is no statistically significant difference in the frequency of detection of the osteopenic syndrome between the groups studied (p > 0.050). Statistically significant increases in BMD and T-criteria have been found as the OA progresses in both the femoral neck and the lumbar spine. The correlation analysis results show a significant positive correlation between the BMD femoral neck and the OA X-ray stage (r = 501; p < 0.001).Conclusions. The data show the presence of the osteopenic syndrome in the vast majority in postmenopausal women with OA of the knee joint. The high BMD values of the femur neck and lumbar spine are associated with the late X-ray stages of the OA of the knee joint.

scholarly journals Fracture Rates in Men With Non-Metastatic Prostate Cancer on Androgen Deprivation Therapy With or Without Anti-Osteoporosis Treatment

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A246-A247
Author(s):  
Hajerah Sonnabend ◽  
Vishnu Priya Pulipati ◽  
Sanford Baim ◽  
Todd Beck ◽  
Ethan M Ritz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Therapy ◽  
Androgen Deprivation Therapy ◽  
Statistical Significance ◽  
Osteoporotic Fractures ◽  
Osteoporosis Treatment ◽  
Androgen Deprivation ◽  
Fracture Rate ◽  
Mineral Density ◽  
Significant Difference

Abstract Introduction: Androgen deprivation therapy (ADT) decreases bone mineral density and increases osteoporotic fracture (OsteoFx) risk. Hypothesis: To assess OsteoFx incidence most predictive of future OsteoFx among men with prostate cancer on ADT. Methods: 4370 electronic medical records were reviewed of adult men with prostate cancer on cancer therapy +/- anti-osteoporotic therapy (Anti-OsteoRx) from 2011–2019. Cancer therapy included ADT (anti-androgens, GnRH agonists & antagonists, orchiectomy) and supplemental cancer therapy (SupplRx) (prostatectomy, brachytherapy, radiation, immunotherapy, and chemotherapy). Anti-OsteoRx included bisphosphonates, denosumab, and parathyroid hormone analogs. Patients with other cancers within 5 years of initial visit, metastasis or traumatic fractures were excluded. Retrospective analysis was done to determine baseline characteristics, type and duration of ADT, Anti-OsteoRx, SupplRx, and OsteoFx incidence. Results: Fracture rate subgroups: • ADT only - Anti-OsteoRx 37/ 374 fractured (9.89%) • ADT only + Anti-OsteoRx 10/52 fractured (19.23%) • ADT + SupplRx + Anti-OsteoRx 2/19 fractured (10.53%) • ADT + SupplRx + Anti-OsteoRx 13/170 fractured (7.65%) Comparing fracture rates between subgroups: • Comparing ADT only +/- Anti-OsteoRx, statistical significance was observed with higher fracture rate in patients taking Anti-OsteoRx (19.23% vs. 9.89%, p &lt; 0.044) • Comparing ADT + SupplRx +/- Anti-OsteoRx, no significant difference in fracture rates due to small number of fractures Comparing combined subgroups: • ADT +/- SupplRx + Anti-OsteoRx 12/71 (16.9%) fractured • ADT +/- SupplRx - Anti-OsteoRx 50/544 (9.19%) fractured • Statistically significant between groups fracture rates was observed (p= 0.042) in patients treated with Anti-OsteoRX. Discussion: Patients receiving Anti-OsteoRx, regardless of their prostate cancer therapies, had higher rates of fractures (16.9 vs. 9.19%, p= 0.042) due to their being selected for therapy based on greater clinical risks. The Anti-OsteoRx group had a higher percentage of glucocorticoid listed as a historical medication (26.8 vs.15.3% vs, p= 0.023), glucocorticoids administered (50.7 vs. 30.3% p=0.001), and anticonvulsants and proton-pump inhibitor use (45.1 vs. 26.5%, p= 0.002). Conclusion: Higher fracture rates were observed in patients on Anti-OsteoRx that could be related to their being selected for treatment based on risk factors known to be associated with osteoporosis. Limited Anti-OsteoRx use in our study is possibly related to lack of standardized guidelines for prevention of osteoporotic fractures in prostate cancer patients. OsteoFx risk assessment utilizing CRF, DXA, and FRAX may prevent fractures in these high-risk patients. Further long-term prospective studies to address these unresolved queries are warranted.

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