scholarly journals Screening, prevention and management of osteoporosis among Canadian adults

2018 ◽  
Vol 38 (12) ◽  
pp. 445-454 ◽  
Author(s):  
Siobhan O’Donnell ◽  
Keyword(s):  
Physical Activity ◽  
Vitamin D ◽  
Bone Density ◽  
Management Strategies ◽  
Osteoporosis Medication ◽  
Osteoporosis Screening ◽  
Calcium Supplements ◽  
Osteoporosis Diagnosis ◽  
Fracture History ◽  
Bone Density Testing

Introduction This study provides a benchmark for the nationwide use of osteoporosis screening, prevention and management strategies among Canadians aged 40 years and older (40+) using data collected one year prior to the release of Osteoporosis Canada’s latest (2010) clinical practice guidelines. Methods Data are from the 2009 Canadian Community Health Survey—Osteoporosis Rapid Response Component. The study sample (n = 5704) was divided into four risk subgroups: (1) osteoporosis diagnosis and major fracture; (2) osteoporosis diagnosis only; (3) major fracture only; or (4) neither osteoporosis diagnosis nor major fracture. We calculated descriptive statistics and performed multinomial multivariate logistic regression analyses to examine factors independently associated with osteoporosis screening, prevention and management strategies. Estimates were weighted to represent the Canadian household population (40+) living in the 10 provinces. Results Approximately 10.1% of the population or 1.5 million Canadians 40+ reported having been diagnosed with osteoporosis. The majority related taking vitamin D or calcium supplements and having been prescribed osteoporosis medication(s), while less than 40% reported regular physical activity. Among those without a reported osteoporosis diagnosis, an estimated 6.7% or 1 million reported having had a major fracture, of which one-third reported having had a bone density test and less than half reported taking vitamin D supplements, calcium supplements or engaging in regular physical activity. Major fracture history was not associated with bone density testing or osteoporosis medication use. Conclusion A large proportion of Canadians at risk for osteoporosis—those with a major fracture history—are not undergoing bone density testing nor are they engaging in lifestyle approaches known to help maintain healthy bones. This study provides the historical information required to evaluate whether the latest clinical practice guidelines have had an impact on osteoporosis care in Canada.

scholarly journals The relationship between iron deficiency and bone mineral density in young female athletes

Food Research ◽  
2020 ◽  
Vol 4 (S3) ◽  
pp. 99-108
Author(s):  
D.K. Pradita ◽  
F.F. Dieny ◽  
D.M. Kurniawati ◽  
A.F.A. Tsani ◽  
N. Widyastuti ◽  
...  
Keyword(s):  
Physical Activity ◽  
Vitamin D ◽  
Bone Density ◽  
Iron Deficiency ◽  
Muscle Mass ◽  
Female Athletes ◽  
Young Female ◽  
Bivariate Analysis ◽  
Mineral Density ◽  
The Relationship

The iron deficiency that occurs in young female athletes can cause a decrease in bone density in three mechanisms, through the process of hydrolysis of procollagen formation, metabolism along with vitamin D and hypoxia. The aimed of this study is to analyze the relationship of iron deficiency with bone density in young female athletes. A crosssectional study design with 70 athletes aged 12-21 years conducted at the BPPLOP Central Java, Salatiga Athletics Club and Athletics and Swimming Club Semarang State University. Iron deficiency was determined by levels of ferritin serum, bone density measured by Bone Densitometer Quantitative Ultrasound, body fat percentage and muscle mass measured by Body Composition Analyzer. Bone-specific Physical Activity Questionnaire was used for physical activity data. Nutrition intakes such as protein, calcium, vitamin D, phosphorus, iron, potassium, magnesium, and sodium was collected by Semi Quantitative-Food Frequency Questionnaire. This study used bivariate analysis with Pearson and Rank-Spearman Correlation Tests and multivariate analysis with Multiple Linear Regression Test. A young female athlete who suffers from iron deficiency is approximately 14.3%. All subjects had normal bone density. Significant relationships were observed between iron deficiency based on serum ferritin (p = 0.044) and muscle mass (p = 0.002) with bone density on young female athletes. The muscle mass variable had the strongest influence on bone density (p = 0.002; adjusted R2 = 0.117). This study showed that iron deficiency and muscle mass are related to bone density, but the other factors that might have an impact on bone density must be considered.

scholarly journals Calcium and/or Vitamin D Supplementation for the Prevention of Fragility Fractures: Who Needs It?

Nutrients ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 1011 ◽  
Author(s):  
Ian R Reid ◽  
Mark J Bolland
Keyword(s):  
Vitamin D ◽  
Bone Density ◽  
Vitamin D Deficiency ◽  
Nursing Home Residents ◽  
Fragility Fractures ◽  
Vitamin D Supplementation ◽  
Community Dwelling ◽  
Current Evidence ◽  
Calcium Supplements ◽  
Vitamin D Supplements

Vitamin D and calcium have different biological functions, so the need for supplementation, and its safety and efficacy, need to be evaluated for each separately. Vitamin D deficiency is usually the result of low sunlight exposure (e.g., in frail older people, those who are veiled, those with dark-skin living at higher latitudes) and is reversible with calciferol 400–800 IU/day. Calcium supplements produce a 1% increase in bone density in the first year of use, without further increases subsequently. Vitamin D supplements do not improve bone density in clinical trials except in analyses of subgroups with baseline levels of 25-hydroxyvitamin D <30 nmol/L. Supplementation with calcium, vitamin D, or their combination does not prevent fractures in community-dwelling adults, but a large study in vitamin D-deficient nursing home residents did demonstrate fracture prevention. When treating osteoporosis, co-administration of calcium with anti-resorptive drugs has not been shown to impact on treatment efficacy. Correction of severe vitamin D deficiency (<25 nmol/L) is necessary before use of potent anti-resorptive drugs to avoid hypocalcemia. Calcium supplements cause gastrointestinal side effects, particularly constipation, and increase the risk of kidney stones and, probably, heart attacks by about 20%. Low-dose vitamin D is safe, but doses >4000 IU/day have been associated with more falls and fractures. Current evidence does not support use of either calcium or vitamin D supplements in healthy community-dwelling adults.

scholarly journals Towards in silico prognosis using big data

2016 ◽  
Vol 2 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Nicholas Ohs ◽  
Fabian Keller ◽  
Ole Blank ◽  
Yuk-Wai Wayne Lee ◽  
Chun-Yiu Jack Cheng ◽  
...  
Keyword(s):  
Physical Activity ◽  
Vitamin D ◽  
Big Data ◽  
Bone Density ◽  
In Silico ◽  
Medical Images ◽  
Distal Tibia ◽  
Complex Diseases ◽  
Patient Specific ◽  
Element Analysis

AbstractClinical diagnosis and prognosis usually rely on few or even single measurements despite clinical big data being available. This limits the exploration of complex diseases such as adolescent idiopathic scoliosis (AIS) where the associated low bone mass remains unexplained. Observed low physical activity and increased RANKL/OPG, however, both indicate a mechanobiological cause. To deepen disease understanding, we propose an in silico prognosis approach using clinical big data, i.e. medical images, serum markers, questionnaires and live style data from mobile monitoring devices and explore the role of inadequate physical activity in a first AIS prototype. It employs a cellular automaton (CA) to represent the medical image, micro-finite element analysis to calculate loading, and a Boolean network to integrate the other biomarkers. Medical images of the distal tibia, physical activity scores, and vitamin D and PTH levels were integrated as measured clinically while the time development of bone density and RANKL/OPG was observed. Simulation of an AIS patient with normal physical activity and patient-specific vitamin D and PTH levels showed minor changes in bone density whereas the simulation of the same AIS patient but with reduced physical activity led to low density. Both showed unchanged RANKL/OPG and considerable cortical resorption. We conclude that our integrative in silico approach allows to account for a variety of clinical big data to study complex diseases.

scholarly journals AB0618 GLUCOCORTICOID INDUCED OSTEOPOROSIS PREVENTION IN THE OUTPATIENT RHEUMATOLOGY CLINIC

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1343.2-1344
Author(s):  
Z. Vaghaiwalla ◽  
G. Kaeley
Keyword(s):  
Vitamin D ◽  
Fracture Risk ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Osteoporosis Prevention ◽  
Osteoporosis Medication ◽  
Rheumatology Clinic ◽  
Dexa Scan ◽  
Audit Cycle

Background:Patients with rheumatic disease are at risk of developing glucocorticoid induced osteoporosis (GIOP) as many are prescribed systemic oral glucocorticoids as an adjunct to their maintenance therapy. Based on the 2017 ACR Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis, a good practice recommendation exists that “initial clinical fracture risk assessment should be performed as soon as possible, but at least within six months of the initiation of long term glucocorticoid treatment.1” Long-term glucocorticoid use is defined by duration of 3 months or greater. Fracture risk assessment should include dual energy-ray absorptiometry (DEXA) scan. Patients on greater than or equal to 2.5 mg of prednisone should be treated with an optimal dose of calcium and vitamin D and may benefit from oral bisphosphonate as primary prevention against GIOP if their fracture risk is moderate to high.1Objectives:The aim of this Quality Improvement Project is to assess the current status of provider implementation of GIOP recommendations in the rheumatology clinic. Ultimate goal is to improve osteoporosis prevention in the rheumatology clinic.Methods:We conducted a retrospective chart review of 60 patients in two outpatient rheumatology clinics. Clinic 1 follows patients with lower socioeconomic status and Clinic 2 follows patients with higher socioeconomics. Inclusion criteria were patients on long-term glucocorticoid use, defined as at least 3 months of corticosteroid use of at least 2.5 mg prednisone daily, as well as age less than 65. Females aged 65 or older were omitted to prevent overlap of the United States Preventative Taskforce recommendation for all women ≥ 65 years to be screened for osteoporosis with DEXA scans.2 DEXA scan orders, calcium and vitamin D prescriptions, and osteoporosis medication prescriptions were abstracted. After baseline data obtained, intervention of education of the rheumatology fellows and faculty, and internal medicine residents in the guidelines for GIOP prevention was implemented. In addition, a smartphrase in the electronic medical record was created for provider use when treating patients on chronic corticosteroids. Subsequently, two audit cycles were completed for retrospective chart review.Results:Upon completion of second audit cycle, there was no change in percentage of DEXA scan orders at Clinic 1, however there was a 10% overall improvement in DEXA scan orders in the Clinic 2.In terms of Calcium and Vitamin D prescriptions, there was an overall improvement in both clinics of 19.7% and 13.3% in Clinics 1 and 2 respectfully after the second audit cycle.Additionally, there was a 3.4% increase in osteoporosis medication prescriptions overall subsequent to the second audit cycle in Clinic 1. However in Clinic 2 there was an overall decrease in osteoporosis medication prescriptions of 6.6%.Clinic 1Prior to AuditAudit cycle 1Audit cycle 2Patient percentage without DEXA scan orders30%33.30%30%Patient percentage without Vitamin D/Calcium orders26.40%8.30%6.70%Patient percentage with osteoporosis medication orders23.30%8.30%26.70%Clinic 2Patient percentage without DEXA scan orders50%37.00%40%Patient percentage without Vitamin D/Calcium orders30%26.00%16.70%Patient percentage with osteoporosis medication orders23.30%11.10%16.70%Conclusion:Overall, the results of the intervention were strongest for improvements in Vitamin D and Calcium orders in both clinics. Improvements in DEXA scan orders and osteoporosis medications were present in Clinic 2 and not present in Clinic 1. This reveals continued efforts and education of providers need to be made for improvement in bone health monitoring.References:[1]Buckley, Lenore, et al. “2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.” Arthritis & Rheumatology, vol. 69, no. 8, June 2017, pp. 1521–1537., doi:10.1002/art.40137.[2]Final Recommendation Statement: Osteoporosis to Prevent Fractures: Screening. U.S. Preventive Services Task Force. July 2019.Disclosure of Interests:None declared.

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