DIAGNOSTIC POSSIBILITIES OF THE VARIOUS METHODS FOR THE IDENTIFICATION OF HIGH FRACTURE RISK POPULATIONS (FRAX®, DENSITOMETRY)

Abstract Background Adults at high risk of fragility fracture should be offered pharmacological treatment when not contraindicated, however, under-treatment is common. Objective This study aimed to investigate factors associated with bone-health medication initiation in older patients attending primary care. Design This was a retrospective cohort study. Setting The study used data from forty-four general practices in Ireland from 2011–2017. Subjects The study included adults aged ≥ 65 years who were naïve to bone-health medication for 12 months. Methods Overall fracture-risk (based on QFracture) and individual fracture-risk factors were described for patients initiated and not initiated onto medication and compared using generalised linear model regression with the Poisson distribution. Results Of 36,799 patients (51% female, mean age 75.4 (SD = 8.4)) included, 8% (n = 2,992) were observed to initiate bone-health medication during the study. One-fifth of all patients (n = 8,193) had osteoporosis or had high fracture-risk but only 21% of them (n = 1,687) initiated on medication. Female sex, older age, state-funded health cover and osteoporosis were associated with initiation. Independently of osteoporosis and co-variates, high 5-year QFracture risk for hip (IRR = 1.33 (95% CI = 1.17–1.50), P < 0.01) and all fractures (IRR = 1.30 (95% CI = 1.17–1.44), P < 0.01) were associated with medication initiation. Previous fracture, rheumatoid arthritis and corticosteroid use were associated with initiation, while liver, kidney, cardiovascular disease, diabetes and oestrogen-only hormone replacement therapy showed an inverse association. Conclusions Bone-health medication initiation is targeted at patients at higher fracture-risk but much potential under-treatment remains, particularly in those >80 years and with co-morbidities. This may reflect clinical uncertainty in older multimorbid patients, and further research should explore decision-making in preventive bone medication prescribing.

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Pharmacologic treatment of osteoporosis – 2011

Orvosi Hetilap ◽

10.1556/oh.2011.29111 ◽

2011 ◽

Vol 152 (33) ◽

pp. 1320-1326 ◽

Cited By ~ 2

Author(s):

Péter Lakatos

Keyword(s):

Bone Loss ◽

Fracture Risk ◽

Hormone Replacement ◽

Treatment Options ◽

Osteoporotic Fractures ◽

Cost Effective ◽

Similar Efficacy ◽

High Fracture ◽

Efficient Treatment ◽

Treatment Of Osteoporosis

Osteoporosis affects approximately 9% of the population in Hungary resulting in about 100 000 osteoporotic fractures annually. Thirty-five percent of patients with hip fractures due to osteoporosis will die within 1 year. Direct costs of osteoporosis exceed 25 billion forints per year. Apparently, cost-effective reduction of bone loss and consequent fracture risk will add up to not only financial savings but improvement in quality of life, as well. A number of pharmacological modalities are available for this purpose. The mainstay of the treatment of osteoporosis is the bisphosphonate group that includes effective anti-resorptive compounds mitigating bone loss and fragility. The recently registered denosumab exhibits similar efficacy by neutralizing RANK ligand, however, marked differences can be observed between the two drug classes. Strontium has a unique mechanism of action by rebalancing bone turnover, and thus, providing an efficient treatment option for the not fast bone losers who are at high fracture risk. The purely anabolic teriparatide is available for the extremely severe osteoporotic patients and for those who do not respond to other types of therapy. Older treatment options such as hormone replacement therapy, raloxifene, tibolone or calcitonin may also have a restricted place in the management of osteoporosis. Orv. Hetil., 2011, 152, 1320–1326.

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Cluster Analysis of Finite Element Analysis and Bone Microarchitectural Parameters Identifies Phenotypes with High Fracture Risk

Calcified Tissue International ◽

10.1007/s00223-019-00564-7 ◽

2019 ◽

Vol 105 (3) ◽

pp. 252-262 ◽

Cited By ~ 3

Author(s):

Leo D. Westbury ◽

Clare Shere ◽

Mark H. Edwards ◽

Cyrus Cooper ◽

Elaine M. Dennison ◽

...

Keyword(s):

Finite Element Analysis ◽

Cluster Analysis ◽

Finite Element ◽

Fracture Risk ◽

High Fracture ◽

Element Analysis

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Osteoporosis drugs most effective in women at high fracture risk

BoneKEy Reports ◽

10.1038/bonekey.2012.124 ◽

2012 ◽

Vol 1 (6) ◽

Keyword(s):

Fracture Risk ◽

High Fracture

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Secondary Osteoporosis in Men and Women: Clinical Challenge of an Unresolved Issue

The Journal of Rheumatology ◽

10.3899/jrheum.110030 ◽

2011 ◽

Vol 38 (8) ◽

pp. 1671-1679 ◽

Cited By ~ 11

Author(s):

ELISABETTA ROMAGNOLI ◽

ROMANO DEL FIACCO ◽

STEFANIA RUSSO ◽

SARA PIEMONTE ◽

FRANCESCA FIDANZA ◽

...

Keyword(s):

Fracture Risk ◽

Clinical Symptoms ◽

Bone Fragility ◽

Secondary Osteoporosis ◽

Primary Osteoporosis ◽

High Fracture ◽

Men And Women ◽

Osteoporosis In Men ◽

Prevention Of Osteoporosis ◽

A Prospective Study

Objective.To evaluate the clinical and etiological factors of osteoporosis. We also tested the FRAX algorithm to compare the assessment of fracture risk in patients with primary or secondary osteoporosis.Methods.A prospective study carried out in a large sample of 123 men and 246 women. All subjects had a biochemical, densitometric, and radiological examination of thoracic and lumbar spine.Results.The prevalence of primary (men 52.9% vs women 50%; p = nonsignificant) and secondary (men 21.1% vs women 17.5%; p = nonsignificant) osteoporosis did not differ between the sexes. In contrast, the prevalence of primary osteoporosis was significantly higher than secondary causes (p < 0.0001) in both men and women. While women came to our attention for prevention of osteoporosis, men sought help because of clinical symptoms or disease-related complications, such as fractures. As evaluated by the FRAX tool, patients with osteopenia do not need treatment, in agreement with Italian guidelines. The estimated risk of major osteoporotic and hip fractures was significantly higher in women with secondary osteoporosis compared to men and also compared to women with primary osteoporosis.Conclusion.The prevalence of secondary osteoporosis in men is similar to that in women and it is less frequent than commonly reported. In patients with secondary osteoporosis, FRAX calculation may provide an estimate of a particularly high fracture risk in patients whose bone fragility is usually attributed to another disease.

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