Progress of osteoporosis: stratification of fracture risk

2018 ◽  
Vol 21 (1) ◽  
pp. 4-9 ◽  
Author(s):  
Oksana A. Nikitinskaya ◽  
Natalya V. Toroptsova
Keyword(s):  
Diagnostic Accuracy ◽  
Osteoporotic Fracture ◽  
Osteoporotic Fractures ◽  
Osteoporosis Treatment ◽  
Axial Skeleton ◽  
Mineral Density ◽  
Major Osteoporotic Fractures ◽  
Age Dependent ◽  
Probability Of Fracture

Background: There are two approaches to identify candidates for the prescription of osteoporosis treatment: identification of patients with low bone mineral density using DEXA of the axial skeleton and calculation of the 10-year probability of major osteoporotic fractures using FRAX®. Aims: to assess the diagnostic accuracy of different FRAX® thresholds in the Russian population. Materials and methods: the value of individual 10-year probability of osteoporotic fracture by FRAX® at the time of inclusion in the study was retrospectively estimated in 224 postmenopausal women, whom the major osteoporotic fractures were recorded over 10 years of prospective observation. The diagnostic accuracy of different thresholds were compared: "European" and Russian age-dependent thresholds, fixed 20% threshold, the average FRAX® of patients who had a major osteoporotic fracture during follow-up (16%), FRAX® value corresponding to the "cut-off point" (12,5%). Results: The Russian FRAX model showed the acceptable diagnostic accuracy of the method (AUC=0.665±0.036; 95% CI 0.595; 0.736). The "European" threshold of therapeutic intervention demonstrated 72% sensitivity and 38% specificity, 20% threshold – 27% and 87%, the Russian threshold – 41% and 77%, 12.5% threshold – 68% and 58%, 16% threshold – 57% and 73%, respectively. The diagnostic precision of the specified thresholds was 54%, 58%, 60%, 63% and 65%, respectively. Conclusions: the Russian age-dependent threshold remains the optimal way to decide whether to initiate anti-osteoporotic therapy based on an assessment of the 10-year probability of fracture by the Russian model for FRAX®.

scholarly journals Natto Intake is Inversely Associated with Osteoporotic Fracture Risk in Postmenopausal Japanese Women

2019 ◽  
Vol 150 (3) ◽  
pp. 599-605 ◽  
Author(s):  
Akane Kojima ◽  
Satoyo Ikehara ◽  
Kuniyasu Kamiya ◽  
Etsuko Kajita ◽  
Yuho Sato ◽  
...  
Keyword(s):  
Cohort Study ◽  
Osteoporotic Fracture ◽  
Osteoporotic Fractures ◽  
Population Based ◽  
Japanese Women ◽  
Dietary Calcium Intake ◽  
Mineral Density ◽  
Soybean Product ◽  
History Of

ABSTRACT Background The direct association between intake of Japanese fermented soybeans, namely natto, and bone mineral density (BMD) is known. However, the association with osteoporotic fractures has not been studied. Objective This study aimed to investigate whether habitual natto intake is associated with a risk of osteoporotic fractures. Methods This prospective cohort study included 1417 postmenopausal Japanese women who were enrolled in the Japanese Population-Based Osteoporosis cohort study in 1996, 1999, 2002, and 2006 and were aged ≥45 y at baseline. The intake of natto, tofu, and other soybean products was surveyed with use of a FFQ at baseline. Fractures were ascertained in follow-up surveys conducted in 1999, 2002, 2006, and 2011/2012. Osteoporotic fracture was the primary outcome and was defined as a clinical fracture occurring without strong external force, diagnosed with radiographs by a medical doctor. HRs with 95% CIs were estimated with Cox proportional hazard models. Results During the 17,699 person-years of follow-up (median, 15.2 y), 172 women experienced osteoporotic fractures. After adjustment for age and BMD at the total hip, the HRs compared with those of < 1 pack (approximately 40 g)/wk natto intake were 0.72 (95% CI: 0.52, 0.98) and 0.51 (95% CI: 0.30, 0.87) for 1–6 and ≥7 packs/wk, respectively. After further adjustment for BMI, history of osteoporotic fractures, history of myocardial infarction or stroke, diabetes mellitus, current smoking, alcohol intake, frequency of tofu and other soybean product intakes, and dietary calcium intake, the HRs were 0.79 (95% CI: 0.56, 1.10) and 0.56 (95% CI: 0.32, 0.99) for 1–6 and ≥7 packs/wk, respectively. Frequency of tofu or other soybean product intakes had no association with the risk of osteoporotic fractures. Conclusions Habitual natto intake may be associated with a reduced risk of osteoporotic fractures independent of confounding factors, including BMD, in Japanese postmenopausal women. This trial was registered at umin.ac.jp as UMIN 000032869.

scholarly journals Effect of Statin Use on the Risk of Osteoporotic Fracture in Patients With Metabolic Syndrome: A Nested Case-Control Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A244-A245
Author(s):  
Kyoung Jin Kim ◽  
Jimi Choi ◽  
Ji Yoon Kim ◽  
Jae Hyun Bae ◽  
Kyeong Jin Kim ◽  
...  
Keyword(s):  
Vertebral Fracture ◽  
Osteoporotic Fracture ◽  
Osteoporotic Fractures ◽  
Defined Daily Dose ◽  
Major Osteoporotic Fracture ◽  
Major Osteoporotic Fractures ◽  
Nested Case Control ◽  
Control Study ◽  
Statin Use

Abstract Statins may have advantageous pleiotropic effects on bone metabolism, however, the clinical evidence about the association is still unclear. Although many studies have already evaluated this association, they have performed mostly in a general population with limitation of between-study heterogeneity. Statin may not be equally effective for bone metabolism to every patient, but it can give some benefits for some patients especially with metabolic syndrome (MetS). However, no recent study assessing this relationship, to best our knowledge, has evaluated specifically on patients with MetS. It is also unclear whether the association between statin and osteoporotic fracture differ by statin intensity, dose (cumulative defined daily dose), and duration. This study aimed to investigate the association of statin use with the risk of major osteoporotic fracture in MetS patients from a population-based cohort (NHIS-HEALS, 2002–2015). A nested case-control study was performed in patients with MetS (≥50 years) who had no history of previous osteoporotic fracture. This study included 17,041 cases diagnosed as new-onset osteoporotic fractures and controls matched in a 1:1 ratio by age, sex, body mass index, cohort entry date, and follow-up duration. Conditional logistic regression analysis was used to evaluate covariate-adjusted odds ratio (OR) and 95% confidence interval (CI). During the 4-year follow up period, statin users had a significantly lower risk of major osteoporotic fractures by 9% (OR, 0.91; 95% CI, 0.85 to 0.97) compared with non-users. Among subtypes of major osteoporotic fracture, a risk reduction of vertebral fracture was significant (OR, 0.86; 95% CI, 0.79 to 0.94), but not non-vertebral fracture (OR, 0.97; 95% CI, 0.88 to 1.06) with statin use. Longer duration (OR, 0.97 per 1 year) and cumulative dose (OR, 0.97 per 365 defined daily dose) of statin was negatively associated with the risk of major osteoporotic fracture. There was no difference in risk of major osteoporotic fractures among groups according to statin intensity. In conclusion, this study supports the hypothesis that statin treatment has a beneficial effect on major osteoporotic fracture, especially for vertebral fracture, in patients with MetS with a possibly dose-effect relationship.

scholarly journals Anxiety Levels Predict Bone Mineral Density in Postmenopausal Women Undergoing Oral Bisphosphonates: A Two-Year Follow-Up

2021 ◽  
Vol 18 (15) ◽  
pp. 8144
Author(s):  
Gabriella Martino ◽  
Federica Bellone ◽  
Carmelo M. Vicario ◽  
Agostino Gaudio ◽  
Andrea Caputo ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Rating Scale ◽  
Osteoporotic Fractures ◽  
Oral Bisphosphonates ◽  
Mineral Density ◽  
X Ray ◽  
Hamilton Anxiety Rating Scale ◽  
Anxiety Levels

Clinical psychological factors may predict medical diseases. Anxiety level has been associated with osteoporosis, but its role on bone mineral density (BMD) change is still unknown. This study aimed to investigate the association between anxiety levels and both adherence and treatment response to oral bisphosphonates (BPs) in postmenopausal osteoporosis. BMD and anxiety levels were evaluated trough dual-energy X-ray absorptiometry and the Hamilton Anxiety Rating Scale (HAM-A), respectively. Participants received weekly medication with alendronate or risedronate and were grouped according to the HAM-A scores into tertiles (HAM-A 3 > HAM-A 2 > HAM-A 1). After 24 months, BMD changes were different among the HAM-A tertiles. The median lumbar BMD change was significantly greater in both the HAM-A 2 and HAM-A 3 in comparison with the HAM-A 1. The same trend was observed for femoral BMD change. Adherence to BPs was >75% in 68% of patients in the HAM-A 1, 79% of patients in the HAM-A 2, and 89% of patients in the HAM-A 3 (p = 0.0014). After correcting for age, body mass index, depressive symptoms, and the 10-yr. probability of osteoporotic fractures, anxiety levels independently predicted lumbar BMD change (β = 0.3417, SE 0.145, p = 0.02). In conclusion, women with higher anxiety levels reported greater BMD improvement, highlighting that anxiety was associated with adherence and response to osteoporosis medical treatment, although further research on this topic is needed.

scholarly journals Under-Recognition of Fractures as Osteoporosis Indicators

Geriatrics ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 9 ◽  
Author(s):  
Violet S. Lagari ◽  
Fatima Al-Yatama ◽  
Gracielena Rodriguez ◽  
Hara R. Berger ◽  
Silvina Levis
Keyword(s):  
Older Adults ◽  
Osteoporotic Fractures ◽  
Osteoporosis Treatment ◽  
Mineral Density ◽  
Osteoporosis Therapy ◽  
Diagnosis Of Osteoporosis ◽  
International Classification Of Disease ◽  
T Score ◽  
Traumatic Fracture ◽  
Receive Treatment

After the first fracture, the risk of subsequent fractures increases significantly. Medical treatment can reduce the risk of a second fracture by about 50%, but many older adults do not receive osteoporosis medication following their first fracture. This observational study aimed to understand primary care management patterns of older adults after osteoporotic fractures at the Miami Veterans Affairs (VA) Healthcare System. A retrospective review of 219 fracture cases selected by International Classification of Disease (ICD-9) codes between October 2015 and September 2016 identified 114 individuals age ≥50 years who had a non-traumatic fracture code entered in their medical record for the first time. Among them, 72 (63%) did not undergo a bone mineral density (BMD) test or receive treatment in the 12 months following their fracture. Of the 40 individuals who had a BMD test post-fracture, 17 (100%) received or were considered for anti-osteoporosis treatment if their T-score indicated osteoporosis (T-score ≤−2.5), but only 8/23 (35%) if the T-score was >−2.5. Physicians are more likely to prescribe osteoporosis therapy based on a BMD T-score diagnosis of osteoporosis, rather than a clinical diagnosis of osteoporosis based on a low-trauma fracture. A change in practice patterns is necessary to decrease the incidence of fractures.

scholarly journals Incidence and Risk of Venous Thromboembolism Among Taiwan Osteoporotic Fracture Population under Osteoporosis Pharmacological Treatments

2014 ◽  
Vol 99 (5) ◽  
pp. 1599-1607 ◽  
Author(s):  
Tzu-Chieh Lin ◽  
Cheng-Han Lee ◽  
Chyun-Yu Yang ◽  
Yea-Huei Kao Yang ◽  
Swu-Jane Lin
Keyword(s):  
Venous Thromboembolism ◽  
Confidence Interval ◽  
Osteoporotic Fracture ◽  
Osteoporotic Fractures ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Osteoporosis Therapy ◽  
Treatment Scenario ◽  
Fracture Population

Context: There was no clear evidence for the association between oral bisphosphonates or raloxifene and venous thromboembolism (VTE). There might also be ethnic differences in VTE risk. Objective: The purpose of this study was to compare the incidence and risk of VTEs for different classes of osteoporosis drugs in the Taiwanese osteoporotic fracture population. Design: This was a retrospective cohort study from 2003 to 2007, with up to 6 years follow-up. Setting: Enrollees were participants in Taiwan National Health Insurance. Patients: Patients older than 50 years who had vertebral or hip fractures and were new to osteoporosis therapy were recruited. Intervention: Patients were classified into the alendronate, calcitonin, or raloxifene group according to exposure after follow-up. Main Outcome Measure: The primary outcome of our study was all incident VTEs, including deep vein thrombosis and pulmonary embolism. Cox proportional hazard models were used to compare the relative VTE risk among alendronate, raloxifene, and calcitonin groups under an on-treatment scenario. Results: There were 25 443, 9642, and 31 900 patients in the alendronate, raloxifene, and calcitonin groups, and the mean age was 74.5 years (SD, 9.6). The incidence of VTE in the alendronate, raloxifene, and calcitonin groups was 11.2, 8.5, and 18.8 per 10 000 person-years. Results from Cox analyses showed that alendronate or raloxifene recipients did not have a higher risk for VTE than calcitonin recipients (adjusted hazard ratio for alendronate, 0.84; 95% confidence interval, 0.47–1.51; adjusted hazard ratio for raloxifene, 0.64; 95% confidence interval, 0.33–1.28). Conclusion: This retrospective analysis found that the incidence of VTE in Taiwanese patients with osteoporosis was low, and the risk of VTE was similar across alendronate, raloxifene, and calcitonin recipients in patients with osteoporotic fractures who were new to osteoporosis therapy.

scholarly journals Glucocorticoid-induced osteoporosis: presentation and comments on the new American College of Rheumatology guidelines

2018 ◽  
Vol 20 (3) ◽  
pp. 114-120
Author(s):  
Natalia V. Toroptsova
Keyword(s):  
Age Groups ◽  
Organ Transplant ◽  
Osteoporotic Fractures ◽  
High Dose ◽  
Mineral Density ◽  
First Line ◽  
American College Of Rheumatology ◽  
Over 40 Years ◽  
Very High

The article presents a review of the clinical guidelines of 2017 American College of Rheumatology for prevention and treatment of glucocorticoid-induced osteoporosis. The guidelines i contain fracture risk gradation not only for people over 40 years , based on the measurement of bone mineral density, 10-year probability of fractures by FRAX and prior osteoporotic fractures, but also for people under 40 years. The guidelines present , recommendations for initial and follow-up treatment for prevention of glucocorticoid-induced osteoporosis according the level of risk of fractures in different age groups of adults, and in children from 4 years of age, in patients with organ transplant and patients older than 30 years, receiving very high-dose of glucocorticoids . Oral bisphosphonates were recommended as first line treatment due to safety, cost, and because of lack of evidence for superior antifracture benefits from other OP medications. Oral bisohosphonates could be switched to another medication in case of intolerance. The issues of applicability of these recommendations in national clinical practice are being discussed.

scholarly journals Analysis of the clinical risk factors of re-fracture after osteoporotic fracture

2020 ◽  
Author(s):  
Lin Wang ◽  
Guo-Zheng Ding ◽  
Min Yang
Keyword(s):  
Risk Factors ◽  
Osteoporotic Fracture ◽  
Preventive Measures ◽  
Osteoporotic Fractures ◽  
Clinical Situation ◽  
Clinical Risk Factors ◽  
Early Investigation ◽  
Mineral Density ◽  
Clinical Risk ◽  
Research Objects

Abstract Background To investigate the clinical risk factors of patients with osteoporotic fracture and re-fracture. Methods A total of 96 patients with osteoporotic fractures and re-fractures who were treated in the relevant department of our hospital from January 2017 to December 2018 were selected as the research objects. By comparing the basic clinical situation of these two groups Analysis to explore the main risk factors after refracture. Results Through statistical analysis of clinical data, it was found that gender, age, the time from lying down to standing, and the bone mineral density T value were all clinical risk factors for refracture. Women who lie prolonged to stand have a higher risk of re-fracture. Conclusions The risk factors of re-fracture after treatment in elderly patients with osteoporotic fractures are many and complex. Early investigation and targeted preventive measures can be of great significance to reduce the incidence of re-fractures.

scholarly journals P1389MAJOR OSTEOPOROTIC FRACTURES AFTER INITIATION OF DIALYSIS: INCIDENCE, PREDICTORS AND ASSOCIATION WITH MORTALITY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ken Iseri ◽  
Juan Jesus Carrero ◽  
Marie Evans ◽  
Li Felländer-Tsai ◽  
Hans Berg ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Hip Fractures ◽  
Osteoporotic Fractures ◽  
Fracture Incidence ◽  
Dialysis Initiation ◽  
Dialysis Patients ◽  
Increased Risk ◽  
Major Osteoporotic Fractures ◽  
Initiation Of Dialysis

Abstract Background and Aims Major osteoporotic fractures (MOF) are common in dialysis patients. We investigated incidence, predictors and clinical outcomes associated with first MOF occurring after initiation of dialysis (MOFfirst). Method In Swedish Renal Registry of 9714 incident (2005 -2016) dialysis patients (median age 68 years, 67% men), we identified all MOFfirst in hip, spine, humerus and forearm. Using flexible parametric hazard models and Fine-Gray analysis, we estimated incidence, mortality rates and predictors of MOFfirst, and, in time-dependent analysis, risk of all-cause and cardiovascular disease (CVD) mortality following MOFfirst. Results During median follow-up of 2.2 years, the crude incidence rate of MOFfirst (n=835) was 24/1000 patient-years (pt-yrs) and that of hip fractures (n=470) 13/1000 pt-yrs. The multivariate-adjusted fracture incidence rates increased gradually after dialysis initiation and were 47% higher among women. Female sex, higher age, presence of comorbidities, and previous history of MOF (MOFprevious) were associated with increased risk for MOFfirst, whereas peritoneal dialysis as compared to hemodialysis was associated with decreased fracture risk. The adjusted fracture incidence rate of MOFfirst during the first 90 days following dialysis initiation was higher in patients with MOFprevious than in those without MOFprevious. MOFfirst independently predicted increased all-cause mortality (sub-distribution hazard ratio, sHR, 1.67(95%CI 1.47-1.91) and CVD-related mortality (sHR 1.49 (95%CI 1.22-1.84). Adjusted mortality rate following hip fractures was higher than for other types of MOF. Spline curves showed that mortality following MOFfirst was highest during the first 6 months of follow-up. Conclusion Major osteoporotic fractures are common and associated with increased mortality in incident dialysis patients.

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