scholarly journals Prevalence of subclinical contributors to low bone mineral density and/or fragility fracture

2013 ◽  
Vol 169 (2) ◽  
pp. 225-237 ◽  
Author(s):  
Cristina Eller-Vainicher ◽  
Elisa Cairoli ◽  
Volha V Zhukouskaya ◽  
Valentina Morelli ◽  
Serena Palmieri ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Fragility Fracture ◽  
Fragility Fractures ◽  
Hypovitaminosis D ◽  
Urinary Calcium ◽  
Idiopathic Hypercalciuria ◽  
Primary Osteoporosis ◽  
Mineral Density ◽  
Low Bone Mineral Density

ObjectiveThe prevalence of subclinical contributors to low bone mineral density (BMD) and/or fragility fracture is debated. We evaluated the prevalence of subclinical contributors to low BMD and/or fragility fracture in the presence of normal 25-hydroxyvitamin D (25OHVitD) levels.DesignProspective observational study.MethodsAmong 1095 consecutive outpatients evaluated for low BMD and/or fragility fractures, 602 (563 females, age 65.4±10.0 years) with apparent primary osteoporosis were enrolled. A general chemistry profile, phosphate, 25OHVitD, cortisol after 1-mg overnight dexamethasone suppression test, antitissue transglutaminase and endomysial antibodies and testosterone (in males) were performed. Serum and urinary calcium and parathyroid hormone levels were also evaluated after 25OHVitD levels normalization. Vertebral deformities were assessed by radiograph.ResultsIn total, 70.8% of patients had low 25OHVitD levels. Additional subclinical contributors to low BMD and/or fragility fracture were diagnosed in 45% of patients, with idiopathic hypercalciuria (IH, 34.1%) and primary hyperparathyroidism (PHPT, 4.5%) being the most frequent contributors, apart from hypovitaminosis D. Furthermore, 33.2% of IH and 18.5% of PHPT patients were diagnosed only after 25OHVitD levels normalization. The subclinical contributors to low BMD and/or fragility fracture besides hypovitaminosis D were associated inversely with age (odds ratio (OR) 1.02, 95% CI 1–1.04, P=0.04) and BMI (OR 1.1, 95% CI 1.05–1.17, P=0.0001) and directly with fragility fractures (OR 1.89, 95% CI 1.31–2.73, P=0.001), regardless of BMD.ConclusionsSubclinical contributors to low BMD and/or fragility fracture besides hypovitaminosis D are present in more than 40% of the subjects with apparent primary osteoporosis. Hypovitaminosis D masks a substantial proportion of IH and PHPT patients.

scholarly journals Impact of Thyroid Disease on Bone Mineral Density Preservation in Patients With Osteoporosis and Idiopathic Hypercalciuria

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A247-A248
Author(s):  
James W Chu
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Fragility Fracture ◽  
Thyroid Disease ◽  
Medication Use ◽  
Fragility Fractures ◽  
Idiopathic Hypercalciuria ◽  
Mineral Density ◽  
Urine Calcium ◽  
Thyroid Medication

Abstract Background: Idiopathic hypercalciuria (IHC) is associated with reduced bone mineral density (BMD) and increased risk of osteoporotic fractures. It is not known if thyroid disease impacts the degree of urine and bone mineral abnormalities in patients with IHC and osteoporosis (OPO). Methods: Retrospective chart review from a private endocrinology clinic identified 62 consecutive patients with OPO (fragility fracture and/or t-score ≤-2.5 on bone density scan) and concomitant diagnosis of IHC (urine calcium > 4.0 mg/kg weight/d when intaking low-moderate calcium amounts). Patients were classified into two groups: those with thyroid disease (Thy+, if presence of autoimmune thyroid disease [AITD] with high antibody titers and/or long-term thyroid medication use) and those without (Thy-). Comparisons were made between the two groups for severity of renal disease (urine calcium) and bone disease (number of fragility fractures, and BMD response to therapy). Results: Of 55 women and 7 men identified with both OPO and IHC, 30 were Thy+ (4 with Graves’, 11 with confirmed Hashimoto’s, 13 taking levothyroxine for presumed Hashimoto’s and 2 with thyroid cancer), and 32 were Thy- (including 2 with type 1 DM, 1 with vitiligo, and 6 with non-toxic nodular goiters requiring biopsies). Thy+ were compared to Thy- with respect to: mean age (70.7 ± 7.3 vs. 70.8 ± 9.3 y), sex (97% vs. 81% women), 24-hr urine calcium at diagnosis (317 ± 75 vs. 311 ± 68 mg), presence of fragility fracture (50% vs. 59%), use of thiazide (83% vs. 78%), and use of anti-fracture pharmacotherapy (73% vs. 84%). 50 patients had adequate comparative longitudinal BMD data. A (+) BMD response was based on consistent increases in BMD and/or t-scores across all spine and hip sites, and a (-) BMD response was classified by decreased BMD and/or t-scores across all sites. For Thy+ vs. Thy- patients, there were 25% vs. 69% (+) BMD response, 38% vs. 12% (-) BMD response, 21% vs. 4% with no significant BMD response, and 17% vs. 15% with mixed BMD responses. Conclusions: In this group at high risk for future fragility fractures, much lower rates of BMD preservation was seen in the Thy+ as compared to the Thy- patients. Overall, AITD and medical thyroid disease was very common (48%) in this cohort of patients with IHC and OP. However, this high rate may be confounded by the selective nature of the specialty clinic population. Further research needs to delineate the impact of AITD and thyroid medication use on the progression and treatment of patients with IHC and OPO.

Similarly high prevalence of hypovitaminosis D in HIV-infected subjects with and without low bone mineral density

2012 ◽  
Vol 7 (11) ◽  
pp. 1127-1134 ◽  
Author(s):  
Eugènia Negredo ◽  
Jordi Puig ◽  
Anna Bonjoch ◽  
Núria Pérez-Alvárez ◽  
Patricia Echeverría ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Hypovitaminosis D ◽  
Mineral Density ◽  
Low Bone Mineral Density ◽  
High Prevalence

scholarly journals Low Bone Mineral Density and Fragility Fractures in Permanent Vegetative State Patients

2014 ◽  
Vol 29 (5) ◽  
pp. 1096-1100 ◽  
Author(s):  
Bastian Oppl ◽  
Gabriele Michitsch ◽  
Barbara Misof ◽  
Stefan Kudlacek ◽  
Johann Donis ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Vegetative State ◽  
Fragility Fractures ◽  
Mineral Density ◽  
Low Bone Mineral Density ◽  
Permanent Vegetative State

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 = <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 > 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.

scholarly journals Dietary Calcium Intake in a Cohort of Individuals Evaluated for Low Bone Mineral Density: A Multicentre Italian Study

2020 ◽  
Author(s):  
Elisa Cairoli ◽  
Carmen Aresta ◽  
Luca Giovanelli ◽  
Cristina Eller-Vainicher ◽  
Silvia Migliaccio ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
At Risk ◽  
Bone Mineral ◽  
Calcium Intake ◽  
Dietary Calcium ◽  
Dietary Calcium Intake ◽  
Idiopathic Hypercalciuria ◽  
Mineral Density ◽  
Low Bone Mineral Density ◽  
Low Calcium

A low calcium intake is associated with an increased fracture risk. We assessed the dietary calcium intake in a cohort of Italian individuals evaluated for low bone mineral density (BMD). A 7-day food-frequency questionnaire was administered to 1793 individuals consecutively referred at a Centre of the Italian Society for Osteoporosis, Mineral Metabolism and Skeletal Diseases for low BMD. In 30.3% (544/1793) and 20.9% (374/1793) of subjects the calcium intake was inadequate ( <700 mg/day) and adequate (>1200 mg/day), respectively. Patients with calcium intake <700 mg/day showed a higher prevalence of diabetes mellitus, idiopathic hypercalciuria and food allergy/intolerance (8.1%, 5.1%, 7.2%, respectively) than patients with calcium intake >700 mg/day (5.3%, 3.0%, 4.1%, respectively, p<0.04 for all comparisons), also after adjusting for age, gender and BMI. In 30.3% of fractured subjects the calcium intake was <700 mg/day. In Italy, a low calcium intake is highly prevalent in individuals at risk for low BMD. Importantly, an inadequate calcium intake is highly prevalent even in patients with history of fragility fractures. Only about a fifth of patients at risk for low BMD reported an adequate calcium intake

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.

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