Organization of primary medical care for patients with osteoporosis

2021 ◽  
Vol 25 (2) ◽  
pp. 7-17
Author(s):  
Elena N. Gladkova
Keyword(s):  
High Risk ◽  
Medical Care ◽  
Hip Fractures ◽  
Osteoporotic Fractures ◽  
Population Based ◽  
Subsequent Treatment ◽  
Primary Medical Care ◽  
Screening Programs ◽  
Active Identification ◽  
The World

The author revises the latest evidence in the literature regarding of organizing medical care for patients with osteoporosis in primary medical care. In the world, there is an increase in the group of older people (60 years and older), therefore, the problem of osteoporosis and osteoporotic fractures becomes very urgent. In Russia, the number of hip fractures will increase by 70% by 2050 compared to 2015. The article provides an overview of studies demonstrating the clinical and cost-effectiveness of population-based screening programs for the identification and subsequent treatment of patients at high risk of fractures, and discusses the issues of secondary prevention of fractures. With the active identification of patients at high risk of fractures and the initiation of antiosteoporotic therapy, a decrease in the incidence of osteoporotic fractures, including hip fractures, is expected.

Increased risk of osteoporotic fractures in patients with systemic sclerosis: a nationwide population-based study

2014 ◽  
Vol 74 (7) ◽  
pp. 1347-1352 ◽  
Author(s):  
Chien-Chih Lai ◽  
Shu-Hung Wang ◽  
Wei-Sheng Chen ◽  
Chia-Jen Liu ◽  
Tzeng-Ji Chen ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Incidence Rate ◽  
Hip Fractures ◽  
Vertebral Fractures ◽  
Cox Regression ◽  
Osteoporotic Fractures ◽  
Population Based ◽  
High Dose ◽  
Increased Risk ◽  
Rate Ratios

ObjectivesTo identify the incidence rate (IR) and risk factors of osteoporotic fractures (OFs) among systemic sclerosis (SSc) patients.MethodsA cohort study was conducted using the Taiwan National Health Insurance database. Patients with SSc and respective age- and gender-matched controls without SSc were enrolled. The primary endpoint was the first occurrence of OF. The Cox proportional hazard model was used to investigate the risk factor of OFs in the SSc cohort.ResultsAmong 1712 SSc patients (77.8% female, mean age 50.3 years) with a median follow-up of 5.2 years, 54 patients developed vertebral fractures, 17 patients developed hip fractures, and 7 patients developed radius fractures (IR: 6.99, 2.18 and 0.90 per 1000 person-years, respectively). Compared with the controls, the incidence rate ratios (IRRs) (95% CIs) among SSc patients were 1.78 (1.30 to 2.39, p<0.001) for vertebral fractures and 1.89 (1.05 to 3.22, p=0.026) for hip fractures. The IRRs for overall OFs were 1.74 (1.32 to 2.27, p<0.001) for women and 1.06 (0.33 to 2.66, p=0.856) for men. The SSc patients experienced hip fractures at a younger age (67.2 vs 75.2 years, p=0.005), and had a higher 1-year mortality rate (13% vs 3%, p=0.006) of vertebral fractures than did the controls. Multivariable Cox regression analyses indicated that older age, being female, using daily prednisolone equivalent to >7.5 mg, and bowel dysmotility treated with intravenous metoclopramide are associated with OF.ConclusionsSSc patients had a high IR of vertebral and hip fractures, especially those who were female, older, used a high dose of corticosteroid or experienced bowel dysmotility.

Potential role of FRAX analysis in postmenopausal women with osteopenia

Open Medicine ◽  
2011 ◽  
Vol 6 (2) ◽  
pp. 185-189
Author(s):  
Aleksandar Dimić ◽  
Stojanovic Sonja ◽  
Nedovic Jovan ◽  
Stankovic Aleksandra ◽  
Stamenkovic Bojana ◽  
...  
Keyword(s):  
Hip Fracture ◽  
High Risk ◽  
Postmenopausal Women ◽  
Hip Fractures ◽  
Potential Role ◽  
Osteoporotic Fractures ◽  
Significant Negative Correlation ◽  
Mineral Density ◽  
Fracture Development

AbstractEarly diagnosis of osteoporosis and estimation of subjects that are at high risk for fracture, is neccesary for osteoporosis treatment. Dual-energy X-ray absorptometry (DXA) is a modern method for bone mineral density (BMD) evaluation. However, along BMD, clinical risk factors may significantly influence fracture development. Therefore, FRAX algorithm was designed for the assessment of a ten-year risk for serious osteoporotic fractures (SOF), as well as hip fractures. In the current study, we tried to evaluate the possible lumbal spine and hip BMD influence on ten year risk for SOF and hip fractures and potential role of FRAX in predicting the therapy in postmenopausal women with osteopenia. We performed the study on 385 postmenopausal women. According to the DXA measurements, at the lumbal (L) spine (L1–L4) and hip (femor neck), patients were then classified as normal, osteopenic, or osteoporotic. BMD evaluation included the L spine and the hip (subgroup 1), and only on the L spine (subgroup 2). By filling up the FRAX questionnaire, a ten-year risk for SOF fracture and hip fracture was calculated. BMD evaluation, in complete patient’s group and in subgroup 1, resulted in the highest number of osteoporosis (61.04%, 48.08%, retrospectively), while ospeopenia was a main finding in subgroup 2. In the subgroup 1, a high risk for SOF and hip fracture was detected in 16.45% and with high risk for hip fracture in 11.38% subjects. In subgroup 2, only high risk for hip fracture was observed in 3.16% subjects, indicating the active medicament treatment. Simultaneously, correlation of BMD results with FRAX values for SOF and hip fracture, showed significant negative correlation (p<0.001). Obtained results showed significant role of femur neck BMD evaluation in predicting the future factors, which may, together with FRAX analysis, improve the therapy approach in postmenopausal women with ospeopenia.

scholarly journals Bisphosphonate Use and Hospitalization for Hip Fractures in Women: An Observational Population-Based Study in France

2021 ◽  
Vol 18 (16) ◽  
pp. 8780
Author(s):  
Bastien Bourrion ◽  
Cécile Souty ◽  
Lucie Fournier ◽  
Ana-Maria Vilcu ◽  
Thierry Blanchon ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Primary Outcome ◽  
Real Life ◽  
Osteoporotic Fractures ◽  
Population Based ◽  
Medication Persistence ◽  
Population Based Study ◽  
Osteoporotic Hip Fracture ◽  
Overall Effectiveness

Bisphosphonates are widely used in the treatment of women at risk of osteoporotic hip fracture; however, the overall effectiveness of bisphosphonates in the prevention of osteoporotic fractures has not been studied in real life. To investigate whether the use of bisphosphonates in women aged 50 years and over is associated with a decrease in hospitalization for osteoporotic hip fractures, a historical prospective cohort study was conducted between 2009 and 2016 from a permanent representative sample consisting of 1/97 of the French health insurance beneficiaries. Bisphosphonate use was defined according to medication persistence and adherence regarding bisphosphonate dispensations. The primary outcome was the hospitalization rate for osteoporotic hip fracture. Among the 81,268 women included, 2005 were exposed to bisphosphonates. The median time of bisphosphonate exposure was 12 (IQR, 3–29) and 17 (IQR, 5–42) months for the persistence and adherence definitions, respectively. Exposure to bisphosphonates was not associated with a decrease in hospitalization for hip fracture: weighted HRadherence = 0.66 (95% CI, 0.33 to 1.33); HRpersistance = 0.77 (95% CI, 0.38 to 1.57). In real life, bisphosphonate use does not appear to reduce hospitalization for hip fractures, as to date, it is probably prescribed as primary prevention and for a duration too short to be effective.

scholarly journals Annual incidence of osteoporotic hip fractures in Iran: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kiarash Tanha ◽  
Noushin Fahimfar ◽  
Shahrzad Nematollahi ◽  
Sayed Mahmoud Sajjadi-Jazi ◽  
Safoora Gharibzadeh ◽  
...  
Keyword(s):  
Hip Fractures ◽  
Financial Burden ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Population Based ◽  
Annual Incidence ◽  
Language Restriction

Abstract Background Osteoporosis (OP) is progressively becoming a global concern with the aging of the world’s populations. Osteoporotic fractures are associated with significantly increased mortality rates and a financial burden to health systems. This Meta-analysis aims to estimate the annual incidence of osteoporotic fractures in Iran. Methods A comprehensive systematic literature search was performed through Medline (PubMed), Embase, Scopus, Web of Science, and Google Scholar to identify studies which contain an investigation of the incidence of osteoporotic fractures in Iran up to December 3rd 2020, with no time and language restriction. For the risk of bias assessments of studies, the Joanna Briggs Institute (JBI) critical appraisal checklist for studies reporting prevalence data was used. The pooled estimation of the incidence of osteoporotic fractures in population aged≥50 years was calculated using random-effects meta-analysis, and the heterogeneity of included studies was quantified with the I2 statistic. Results In all, 6708 papers were initially retrieved from the electronic databases, among which seven studies were included in the meta-analysis. The pooled standardized annual cumulative incidence of hip fractures was estimated as 138.26 (95% CI: 98.71–193.65) per 100,000 population and 157.52 (95% CI: 124.29–199.64) per 100,000 population in men and women, respectively. Conclusion This study showed a high incidence rate of osteoporotic hip fractures in Iran. Early detection and treatment of individuals with higher risks of primary fragility fractures at primary health care as well as implementing fracture liaison services to prevent secondary fractures are highly recommended. The results suffer from the following limitations: first, a low number of studies that were eligible for inclusion; second, the lack of population-based studies; and presence of highly heterogeneous studies despite the use of a random effect model.

Burden of high-risk oral HPV infection in men in the United States and implications for oropharyngeal cancer screening: NHANES (1999-2012).

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 55-55
Author(s):  
Erin Dunn ◽  
Kevin J. Moore ◽  
Tulay Koru-Sengul
Keyword(s):  
Cancer Screening ◽  
High Risk ◽  
Oropharyngeal Cancer ◽  
The United States ◽  
Hpv Infection ◽  
Population Based ◽  
Infection Prevalence ◽  
Hpv 16 ◽  
Screening Programs ◽  
High Risk Hpv

55 Background: In men high-risk human papilloma viruses (HPVs) have been implicated in causing cancer of the penis, anus, and oropharynx. HPV infection, specifically HPV 16, is currently one of the most common causes of oropharyngeal cancer. National population-based surveys provide estimates of population-specific prevalence, trend, and determinants to identify the burden of high-risk HPV in the oropharynx of men. Methods: We calculated HPV infection prevalence by oral testing in the US from 1999-2012 National Health and Nutrition Examination Survey (NHANES) to obtain a representative sample of non-institutionalized civilian population. We provided epidemiology of HPV infection for both females and males with prevalence estimates, unadjusted odds ratio (OR) with 95% confidence interval (95%CI). Analysis was performed by SAS v9.3 with complex sampling design. Results: Among HPV-positive persons, high-risk HPV infection (16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 73, 82) was more prevalent for men (79.4%) than for women (20.6%). Men also had the highest prevalence for each high-risk type tested. Notably, men held 84.9% of the HPV 16 burden, which has the highest risk for orophargyngeal cancer. Mexican-American men had lower odds of high-risk HPV infection than White men (OR=0.47; 95%CI=0.261, 0.86). Further, divorced/separated/widowed men had lower (0.48; 0.26, 0.88) and never married men had greater (1.76; 1.01, 3.07) odds of high-risk HPV compared to men who are married/living with partner. Conclusions: Using a large population-based survey, our results show increased prevalence of high-risk HPV infection in men. Stratification by ethnicity and marital status will increase understanding and awareness of the burden and demographic disparities of potentially oncogenic HPV infections in men and may provide a base for culturally and gender competent oropharyngeal cancer screening programs. Recognizing demographic disparities and behaviors could guide further research into risk factors and conditions that guide the prevalence of HPV infection and oropharyngeal cancer in specific male populations.

scholarly journals Epidemiology of osteoporotic fracture in Kazakhstan and development of a country specific FRAX model

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
S. Issayeva ◽  
O. Lesnyak ◽  
A. Zakroyeva ◽  
B. Issayeva ◽  
D. Dilmanova ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Osteoporotic Fractures ◽  
Population Based ◽  
Trauma Centre ◽  
Fracture Incidence ◽  
Hip Fracture Incidence ◽  
The Republic ◽  
Country Specific ◽  
Population Based Survey

Abstract Summary Retrospective and prospective population-based survey in a region of the Republic of Kazakhstan determined the incidence of fractures at the hip, proximal humerus and distal forearm. The hip fracture rates were used to create a FRAX® model to enhance fracture risk assessment in Kazakhstan. Objective This paper describes the epidemiology of osteoporotic fractures in the Republic of Kazakhstan that was used to develop a country specific FRAX® tool for fracture prediction. Methods We carried out a retrospective population-based survey in Taldykorgan in the Republic of Kazakhstan representing approximately 1% of the country’s population. Hip, forearm and humerus fractures were identified retrospectively in 2015 and 2016 from hospital registers and the trauma centre. Hip fractures were prospectively identified in 2017 from the same sources and additionally from primary care data. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Kazakhstan. Fracture probabilities were compared with those from neighbouring countries having FRAX models. Results The difference in hip fracture incidence between the retrospective and prospective survey indicated that approximately 25% of hip fracture cases did not come to hospital attention. The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 11,690 and is predicted to increase by 140% to 28,000 in 2050. Hip fracture incidence was a good predictor of forearm and humeral fractures in men but not in women. Conclusion The FRAX model should enhance accuracy of determining fracture probability among the Kazakh population and help guide decisions about treatment.

The Place of General Practice

1972 ◽  
Vol 2 (2) ◽  
pp. 165-169 ◽  
Author(s):  
J. Fry
Keyword(s):  
Health Care ◽  
General Practice ◽  
Medical Care ◽  
Primary Medical Care ◽  
The World

The editor of this issue sets out the place of primary medical care or general practice in any system of health care and shows that the features and problems are common to all forms of care throughout the world.

scholarly journals EPIDEMIOLOGY OF FRACTURES OF THE PROXIMAL FEMUR IN ELDERLY RESIDENTS OF YAKUTSK

2015 ◽  
Vol 18 (3) ◽  
pp. 9-12
Author(s):  
V V Epanov ◽  
A K Lebedev ◽  
A A Epanova ◽  
I P Semenov ◽  
G A Palshin ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Bone Fractures ◽  
Osteoporotic Fractures ◽  
Population Based ◽  
Incidence Rates ◽  
Fracture Incidence ◽  
Hip Fracture Incidence ◽  
The Republic ◽  
A Minor

Bone fractures of the skeleton with a minor injury is a clinical manifestation of osteoporosis and its population-based marker. The incidence of hip fracture varies in different geographic areas and ethnic groups. The aim was to study incidence of hip fractures in patients older than 40 years in the Republic of Sakha (Yakutia, Russian federation) in 2011-2013 and to compare the data with the previous study at the same region performed in 1997-2003. Material and methods. The study is a part of a multi-center international project «Epidemiological study of osteoporotic fractures in Eurasia (EVA).» It was a retrospective study followed by a prospective one. In the retrospective part the information on hip fracture cases registered in the official documents of the orthopedic service in 2011-2012 was collected. The prospective part was conducted in 2013, it was aimed at the identification of the patients with a hip fracture, applied not only in orthopedic department but also to other medical professionals, such as general practitioners. Results. Overall, in three years 426 hip fractures were reported in the city of Yakutsk. The total number of fractures in women was 286 (67.1%), in men - 140 (32.9%). We observed the increase in hip fracture incidence in 2013 (192 cases per 100,000 population in men and 283 per 100,000 in women 50 years old and older) which was 12% higher than in 2011 and 2012. We owe it to improved registration of hip fractures in the group of women 85 years old and older. The hip fracture incidence in this study significantly exceed the data of previous study 15 years ago. Conclusion. In recent years, there is an increase in incidence rates of hip fracture in Yakutsk due to improved hospitalization rates in orthopedic service.

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