Fragility fractures in postmenopausal women: development of 5-year prediction models using the FRISBEE study

Background As the aging population increases in the United States, so has the prevalence of osteoporosis (10.2 million adults aged 50 years and older in 2010). Programs to manage the increased incidence of fragility fractures in such patients particularly the postmenopausal women are the priority. Programs such as the Fracture Liaison Service (FLS) might be the answer. Methods Data of 256 postmenopausal women with vertebral compression fractures treated with vertebroplasty between 2012 and 2017 were divided into 2 groups. Group A were patients seen between 2012 and 2014 before the establishment of the FLS program at the clinic. Group B were patients seen between 2015 and 2017 who presented to the FLS program in our clinic. Data collected included demographics, refracture rates, dual-energy X-ray absorptiometry (DEXA) scan T-scores, fracture risk score (FRAX), serum calcium and vitamin D levels, and comorbid conditions. Results There were 103 female patients with a mean age of 79.75 years (standard deviation [SD] ± 10.86) in group A, while group B had 153 patients with a mean age of 75.66 years (SD ± 10.78). There was no significant difference in the DEXA scan T-scores, FRAX scores, and mean serum calcium and vitamin D levels; however, there was a significant reduction in the refracture rate for vertebral compression fractures ( P = .003). Conclusion FLS programs, when implemented, will have a beneficial effect in reducing refracture rates of postmenopausal women with osteoporotic fragility fractures.

Download Full-text

Cortisol Secretion, Sensitivity, and Activity Are Associated With Hypertension in Postmenopausal Eucortisolemic Women

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2019-00037 ◽

2019 ◽

Vol 104 (10) ◽

pp. 4441-4448 ◽

Cited By ~ 10

Author(s):

Iacopo Chiodini ◽

Agostino Gaudio ◽

Cristina Eller-Vainicher ◽

Valentina Morelli ◽

Carmen Aresta ◽

...

Keyword(s):

Single Nucleotide Polymorphism ◽

Postmenopausal Women ◽

Fragility Fractures ◽

Urinary Free Cortisol ◽

Progressive Increase ◽

Nucleotide Polymorphism ◽

Single Nucleotide ◽

Heterozygous Variant ◽

Free Cortisol ◽

Peripheral Activation

Abstract Context Previous data suggest a possible association between type 2 diabetes (T2D) and fragility fractures (FX) with the degree of glucocorticoid suppressibility (GCS) and peripheral activation or sensitivity even in persons without hypercortisolemia. Objective To investigate whether the degree of GCS, GC sensitivity, and peripheral activation in persons without overt or mild hypercortisolism are associated with hypertension and with the number of the possible consequences of cortisol excess among patients with T2D, fragility FX, and hypertension. Design Case-control study. Setting Outpatient clinic. Patients A total of 216 postmenopausal women without hypercortisolemia (age, 50 to 80 years; 108 with hypertension); 68 and 99 patients had fragility FX and T2D, respectively Main outcome measures We assessed 24-hour urinary free cortisol (UFF), cortisone (UFE), their ratio (R-UFF/UFE), (F-1mgDST), and the GC receptor N363S single-nucleotide polymorphism (N363S-SNP). Results Hypertension was associated with F-1 mgDST [odds ratio (OR), 3.3; 95% CI, 1.5 to 7.5; P = 0.004) and R-UFF/UFE (OR, 101.7; 95% CI, 2.6 to 4004.1; P = 0.014), regardless of age, body mass index, and presence of the N363S single nucleotide polymorphism and of T2D. The progressive increase in the number of possible consequences of cortisol excess was significantly associated with F-1mgDST levels (R2 = 0.125; P = 0.04), R-UFF/UFE (R2 = 0.46; P = 0.02), and the prevalence of N363S heterozygous variant (T = 0.46; P = 0.015), after adjustment for age. Conclusions In postmenopausal women without hypercortisolemia, hypertension is associated with GCS and GC peripheral activation. The number of possible consequences of cortisol excess (among patients with hypertension, T2D, and fragility FX) is associated with GCS, GC peripheral activation, and the prevalence of the N363S heterozygous variant.

Download Full-text

An evaluation of the NICE guidance for the prevention of osteoporotic fragility fractures in postmenopausal women

Archives of Osteoporosis ◽

10.1007/s11657-010-0045-5 ◽

2010 ◽

Vol 5 (1-2) ◽

pp. 19-48 ◽

Cited By ~ 16

Author(s):

John A. Kanis ◽

Eugene V. McCloskey ◽

Bengt Jonsson ◽

Alun Cooper ◽

Oskar Ström ◽

...

Keyword(s):

Postmenopausal Women ◽

Fragility Fractures ◽

Nice Guidance

Download Full-text

In older postmenopausal women with osteopenia, zoledronate reduced fragility fractures at 6 years

Annals of Internal Medicine ◽

10.7326/acpj201904160-042 ◽

2019 ◽

Vol 170 (8) ◽

pp. JC42

Author(s):

Kristine E. Ensrud ◽

Carolyn J. Crandall

Keyword(s):

Postmenopausal Women ◽

Fragility Fractures

Download Full-text

SUN-395 Pelvic Bone Density Is Lower Than Bone Density of Hip and Femoral Neck in Postmenopausal Women

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1556 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Mahshid Mohseni ◽

Roberto Civitelli ◽

Shannon Stum ◽

Bridgett Toennies ◽

Seth Eisen

Keyword(s):

Bone Density ◽

Femoral Neck ◽

Postmenopausal Women ◽

Fragility Fractures ◽

Measurement Precision ◽

Pelvic Fractures ◽

Pelvic Bone ◽

Pubic Ramus ◽

Precision Error ◽

Total Hip

Abstract Pelvic fractures represent 7% of all fragility fractures; they account for 5% of the cost of osteoporotic fracture care, and are commonly (> 50%) associated with loss of independence in the elderly. The incidence of pelvic fractures has increased significantly over the past 3 decades. However, little is known about the relationship between bone mineral density (BMD) and pelvic fractures. We have conducted a pilot cross-sectional study to establish a method of measuring pelvic BMD and to correlate BMD of the pelvis with BMD at other skeletal sites. Postmenopausal women without a history of pelvis and hip fragility fractures were enrolled. Hip, spine, and pelvis DXA scans were obtained using a Hologic DXA machine. Pelvic BMD was calculated using Hologic Research Software from 3 areas of the pelvis (R1: public symphysis, R2: inferior pubic ramus, and R3: superior pubic ramus), corresponding to common fracture locations. Pelvis BMD was the average of the 3 pelvis sites. Pelvic BMD measurement precision error was calculated using the root mean square method (Recommended by International Society of Clinical Densitometry (ISCD)). Statistical analysis was used to compare BMD at different sites. Alpha error was set at 0.05. Of 73 postmenopausal women who were enrolled in the study (average age 64 years, average 15 years postmenopausal), 3% had chronic kidney disease, 7% had type 2 DM, 3% were on corticosteroids and none were smokers. BMD of femoral neck assessed on pelvic DXA was not significantly different from femoral neck BMD measured on standard DXA (P=0.09). To assess pelvis BMD measurement precision, 15 patients underwent 3 separate pelvic DXA images after repositioning. BMD precision error was 0.011g/cm2 which is slightly lower than the precision total hip BMD at our center (0.007 g/cm2). BMD of R1, R2, and R3 pelvic areas were measured as 0.44±0.15, 0.41± 0.15, and 0.62 ±0.19 g/cm2, respectively. Notably, BMD of R3 was significantly higher than the other 2 areas (P<0.001, ANOVA). Average BMD (0.49±0.14 g/cm2) of pelvis was significantly lower than BMD of femoral neck (0.72± 0.16 g/cm2), total hip (0.86±17 g/cm2) and spine (0.97± 19 g/cm2)(P <0.001). Average BMD of pelvis was significantly lower in participants with osteopenia and osteoporosis of the hip and femoral neck compared to participants with normal BMD in those locations. In summary, we report a precise method of measuring BMD of commonly fractured areas of the pelvis. Pelvis BMD is lower than hip, femoral neck, and spine. Bone density of the pelvis correlates with hip and femoral neck bone density. The results of this pilot study can be used for future studies looking at pelvic low bone density in patients with pelvic fragility fractures which could help identify patients at risk for pelvic fragility fractures and change how osteoporosis is defined based on DXA images.

Download Full-text

Health-related quality of life in Romanian postmenopausal women with osteoporosis and fragility fractures

Clinical Interventions in Aging ◽

10.2147/cia.s190440 ◽

2018 ◽

Vol Volume 13 ◽

pp. 2465-2472 ◽

Cited By ~ 9

Author(s):

Alina Deniza Ciubean ◽

Rodica Ana Ungur ◽

Laszlo Irsay ◽

Viorela Mihaela Ciortea ◽

Ileana Monica Borda ◽

...

Keyword(s):

Quality Of Life ◽

Postmenopausal Women ◽

Fragility Fractures ◽

Health Related Quality ◽

Related Quality ◽

Health Related

Download Full-text

Development and validation of circulating CA125 prediction models in postmenopausal women

Journal of Ovarian Research ◽

10.1186/s13048-019-0591-4 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 2

Author(s):

Naoko Sasamoto ◽

Ana Babic ◽

Bernard A. Rosner ◽

Renée T. Fortner ◽

Allison F. Vitonis ◽

...

Keyword(s):

Ovarian Cancer ◽

Cancer Screening ◽

Prediction Model ◽

Postmenopausal Women ◽

Prediction Models ◽

Smoking Status ◽

Large Population ◽

External Validation ◽

Validation Dataset ◽

Ovarian Cancer Screening

Abstract Background Cancer Antigen 125 (CA125) is currently the best available ovarian cancer screening biomarker. However, CA125 has been limited by low sensitivity and specificity in part due to normal variation between individuals. Personal characteristics that influence CA125 could be used to improve its performance as screening biomarker. Methods We developed and validated linear and dichotomous (≥35 U/mL) circulating CA125 prediction models in postmenopausal women without ovarian cancer who participated in one of five large population-based studies: Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO, n = 26,981), European Prospective Investigation into Cancer and Nutrition (EPIC, n = 861), the Nurses’ Health Studies (NHS/NHSII, n = 81), and the New England Case Control Study (NEC, n = 923). The prediction models were developed using stepwise regression in PLCO and validated in EPIC, NHS/NHSII and NEC. Result The linear CA125 prediction model, which included age, race, body mass index (BMI), smoking status and duration, parity, hysterectomy, age at menopause, and duration of hormone therapy (HT), explained 5% of the total variance of CA125. The correlation between measured and predicted CA125 was comparable in PLCO testing dataset (r = 0.18) and external validation datasets (r = 0.14). The dichotomous CA125 prediction model included age, race, BMI, smoking status and duration, hysterectomy, time since menopause, and duration of HT with AUC of 0.64 in PLCO and 0.80 in validation dataset. Conclusions The linear prediction model explained a small portion of the total variability of CA125, suggesting the need to identify novel predictors of CA125. The dichotomous prediction model showed moderate discriminatory performance which validated well in independent dataset. Our dichotomous model could be valuable in identifying healthy women who may have elevated CA125 levels, which may contribute to reducing false positive tests using CA125 as screening biomarker.

Download Full-text