Bone Health Improvement Protocol

Introduction. Metabolic bone disease is a malady that causessignificant morbidity and mortality to a patient who has sustaineda fragility fracture. There is currently no protocol toprevent secondary fragility fracture at our institution. The objectiveof this study was to create an appropriate protocol forimplementing clinical pathways for physicians to diagnose andtreat osteoporosis and fragility fractures by educating patients. Methods. A multidisciplinary team created an appropriateprotocol that could be implemented in an inpatient setting.A thorough literature review was conducted to evaluatepotential barriers and efficacious methods of protocol design. Results. A bone health improvement protocol was developed.Any patient over the age of 50 who sustains a fracture from lowenergy trauma, such as a fall from standing or less, should beconsidered to place into this protocol. These patients receivededucation on metabolic bone disease, a prescription for highdose vitamin D therapy, and laboratory testing to determinethe etiology of their metabolic bone disease. Continuity of careof these patients with their primary care provider was providedfor further management of their metabolic bone disease andevaluation of their disease after discharged from the hospital. Conclusion. Comprehensive secondary prevention should consistof osteoporosis assessment and treatment together with afall risk assessment. With this protocol, secondary fragility fracturespotentially could be prevented. KS J Med 2017;10(3):62-66.

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PREVALENCE OF OSTEOPOROSIS AND HYPOVITAMINOSIS D AT SIRIRAJ METABOLIC BONE DISEASE CLINIC

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172506174133 ◽

2017 ◽

Vol 25 (6) ◽

pp. 262-265

Author(s):

AASIS UNNANUNTANA ◽

POJCHONG CHOTIYARNWONG

Keyword(s):

Bone Disease ◽

Metabolic Bone Disease ◽

Fragility Fractures ◽

Hypovitaminosis D ◽

Mineral Density ◽

Baseline Serum ◽

Metabolic Bone ◽

Vitamin D Levels ◽

History Of ◽

Prevalence Of Osteoporosis

ABSTRACT Objective: To identify the prevalence of osteoporosis and hypovitaminosis D among patients at the Siriraj Metabolic Bone Disease (MBD) Clinic, and to compare initial vitamin D levels in patients with and without a history of fragility fractures. Methods: Medical records of patients who attended our MBD clinic between 2012 and 2015 were retrospectively reviewed. Patient baseline demographic, clinical, bone mineral density (BMD), and laboratory data were collected and analyzed. Osteoporosis was diagnosed when patients had a BMD T-score <-2.5 or presented with fragility fractures. Results: There were 761 patients included in this study. Of these, 627 patients (82.4%) were diagnosed with osteoporosis and 508 patients (66.8%) had fragility fractures. Baseline serum 25-hydroxyvitamin D (25(OH)D) levels were available in 685 patients. Of these, 391 patients (57.1%) were diagnosed with hypovitaminosis D. When evaluated only in patients with fragility fractures, the average initial 25(OH)D level was 28.2±11.6 ng/mL, and the prevalence of hypovitaminosis D was 57.6%. Conclusion: A high prevalence of osteoporosis and hypovitaminosis D was found among patients at our clinic; two-thirds of patients had a history of fragility fractures, and no difference in initial 25(OH)D levels was seen between patients with and without fragility fractures. Level of Evidence III, Retrospective Study .

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Metabolic bone disease of prematurity: causes, recognition, prevention, treatment and long-term consequences

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2018-316330 ◽

2019 ◽

Vol 104 (5) ◽

pp. F560-F566 ◽

Cited By ~ 10

Author(s):

Amish Chinoy ◽

Mohamed Zulf Mughal ◽

Raja Padidela

Keyword(s):

Bone Disease ◽

Metabolic Bone Disease ◽

Diuretic Therapy ◽

Fragility Fractures ◽

Third Trimester ◽

Phosphate Homeostasis ◽

Metabolic Bone ◽

Routine Handling ◽

Postnatal Factors

Metabolic bone disease of prematurity (MBDP) is characterised by skeletal demineralisation, and in severe cases it can result in fragility fractures of long bones and ribs during routine handling. MBDP arises from prenatal and postnatal factors. Infants who are born preterm are deprived of fetal mineral accumulation, 80% of which occurs in the third trimester. Postnatally, it is difficult to maintain a comparable intake of minerals, and medications, such as corticosteroids and diuretic therapy, lead to bone resorption. With improvements in neonatal care and nutrition, the incidence of MBDP in preterm infants appears to have decreased, although the recent practice of administering phosphate supplements alone will result in secondary hyperparathyroidism and associated bone loss, worsening MBDP. Postnatal immobilisation and loss of placental supply of oestrogen also contribute to skeletal demineralisation. There is no single diagnostic or screening test for MBDP, with pitfalls existing for most radiological and biochemical investigations. By reviewing the pathophysiology of calcium and phosphate homeostasis, one can establish that plasma parathyroid hormone is important in determining the aetiology of MBDP – primarily calcipaenia or phosphopaenia. This will then direct treatment with the appropriate supplements while considering optimal physiological calcium to phosphate ratios.

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Teaching Bone Health: An Educational Quality Improvement Program to Create a Curriculum for Geriatric Medicine Fellows in Bone Densitometry and Metabolic Bone Disease

Journal of Clinical Densitometry ◽

10.1016/j.jocd.2014.04.034 ◽

2014 ◽

Vol 17 (3) ◽

pp. 407

Author(s):

Z. Rana ◽

B.-T. Ngo ◽

A. Dentino

Keyword(s):

Quality Improvement ◽

Bone Densitometry ◽

Bone Disease ◽

Bone Health ◽

Metabolic Bone Disease ◽

Geriatric Medicine ◽

Quality Improvement Program ◽

Educational Quality ◽

Improvement Program ◽

Metabolic Bone

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Findings of metabolic bone disease in infants with unexplained fractures in contested child abuse investigations: a case series of 75 infants

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0093 ◽

2019 ◽

Vol 32 (10) ◽

pp. 1103-1120 ◽

Cited By ~ 7

Author(s):

Marvin Miller ◽

Adrienne Stolfi ◽

David Ayoub

Keyword(s):

Risk Factors ◽

Child Abuse ◽

Bone Disease ◽

Metabolic Bone Disease ◽

Bone Mineralization ◽

Case Series ◽

Fragility Fractures ◽

Dihydroxyvitamin D ◽

Metabolic Bone ◽

Bone Loading

Abstract Background Infants who present with multiple unexplained fractures (MUF) are often diagnosed as victims of child abuse when parents deny wrongdoing and cannot provide a plausible alternative explanation. Herein we describe evidence of specific and commonly overlooked radiographic abnormalities and risk factors that suggest a medical explanation in such cases. Methods We evaluated such infants in which we reviewed the radiographs for signs of poor bone mineralization. We reviewed medical, pregnancy and family histories. Results Seventy-five of 78 cases showed poor bone mineralization with findings of healing rickets indicating susceptibility to fragility fractures that could result from a wide variety of causes other than child abuse. We found risk factors that could explain the poor bone mineralization: maternal and infant vitamin D deficiency (VDD), decreased fetal bone loading, prematurity and others. Most infants had more than one risk factor indicating that this bone disorder is a multifactorial disorder that we term metabolic bone disease of infancy (MBDI). Maternal and infant VDD were common. When tested, 1,25-dihydroxyvitamin D levels were often elevated, indicating metabolic bone disease. Conclusions Child abuse is sometimes incorrectly diagnosed in infants with MUF. Appreciation of the radiographic signs of MBDI (healing rickets), risk factors for MBDI and appropriate laboratory testing will improve diagnostic accuracy in these cases.

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HIV and Bone Health

Fundamentals of HIV Medicine 2019 ◽

10.1093/med/9780190942496.003.0046 ◽

2019 ◽

pp. 493-504

Author(s):

Edgar Turner Overton

Keyword(s):

Risk Factors ◽

Hiv Infection ◽

Bone Disease ◽

Bone Health ◽

Metabolic Bone Disease ◽

Risk Of Fracture ◽

Metabolic Bone ◽

Increased Risk ◽

Common Manifestation

Upon completion of this chapter, the reader should be able to • Familiar with the concept that metabolic bone disease is a common manifestation of HIV infection leading to an increased risk of fracture. • The reader should also recognize key risk factors for metabolic bone disease and strategies to mitigate this risk....

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