Prevalence of osteoporosis and osteopenia in elderly patients scheduled for total knee arthroplasty

Introduction Osteoporosis is a common comorbidity in elderly patients with osteoarthritis (OA) and may increase perioperative complications in orthopedic surgery (e.g., component migration, periprosthetic fractures). As there is no investigation of bone mineral density (BMD) in elderly patients prior to total knee arthroplasty (TKA) in Europe, we investigated this issue with a particular focus on a potential treatment gap. Materials and methods We assessed the BMD by dual-energy X-ray absorptiometry (DXA) in 109 consecutive elderly patients (age ≥ 70 years) scheduled for TKA. In addition to a detailed assessment of osteoporosis and osteopenia, the influence of clinical risk factors and radiological OA severity on BMD was evaluated using group comparisons and linear regression models. In addition, we analyzed differences in BMD between patients scheduled for TKA vs. total hip arthroplasty (THA). Results Of the included 109 patients, 19 patients (17.4%) were diagnosed with osteoporosis and 50 (45.9%) with osteopenia. In the osteoporotic patients, a clinically relevant underdiagnosis concomitant with a serious treatment gap was observed in 95.0% of the patients. Body mass index, OA grade, and glucocorticoid use were identified as independent factors associated with BMD. No differences in BMD were found between the patients scheduled for TKA vs. THA. Conclusions Considering the high prevalence of osteoporosis and osteopenia in elderly patients, DXA screening should be recommended for patients ≥ 70 years indicated for TKA.

Osteoporosis in rheumatic diseases

The article presents a review of studies that have examined osteoporosis in rheumatic diseases, including rheumatoid arthritis, spondylarthritis, psoriatic arthritis, systemic connective tissue diseases, and systemic vasculitis. The review discusses the pathogenesis, diagnosis and treatment of osteoporosis in these diseases, presents the results of epidemiological studies assessing the risk factors and the prevalence of osteoporosis in rheumatic diseases. There was a high prevalence of osteoporosis and fractures in rheumatic diseases, exceeding the population, associated primarily with systemic and local inflammation, as well as with the intake of glucocorticoids. It is indicated that the existing strategies for the treatment of rheumatic diseases may partially reduce bone loss, but long-term administration of glucocorticoids, on the contrary, increase bone resorption. The review presents data on the medications for the treatment of osteoporosis and approaches to the treatment of glucocorticoid osteoporosis.

Global prevalence of osteoporosis among the world older adults: a comprehensive systematic review and meta-analysis

Background Osteoporosis is one of the most common bone system diseases that is associated with an increased risk of bone fractures and causes many complications for patients. With age, the prevalence of this disease increases so that it has become a serious problem among the elders. In this study, the prevalence of osteoporosis among elders around the world is examined to gain an understanding of its prevalence pattern. Methods In this systematic review and meta-analysis, articles that have focused on prevalence of osteoporosis in the world’s elders were searched with these key words, such as Prevalence, Osteoporosis, Elders, Older adult in the Science Direct, Embase, Scopus, PubMed, Web of Science (WoS) databases and Google Scholar search engine, and extracted without time limit until March 2020 and transferred to information management software (EndNote). Then, duplicate studies were eliminated and the remaining studies were evaluated in terms of screening, competence and qualitative evaluation based on inclusion and exclusion criteria. Data analysis was performed with Comprehensive Meta-Analysis software (Version 2) and Begg and Mazumdar test was used to check the publication bias and I2 test was used to check the heterogeneity. Results In a review of 40 studies (31 studies related to Asia, 5 studies related to Europe and 4 studies related to America) with a total sample size of 79,127 people, the prevalence of osteoporosis in the elders of the world; 21.7% (95% confidence interval: 18.8–25%) and the overall prevalence of osteoporosis in older men and women in the world, 35.3% (95% confidence interval: 27.9–43.4%), 12.5% (95% confidence interval: 9.3–16.7%) was reported. Also, the highest prevalence of osteoporosis in the elders was reported in Asia with; 24.3% (95% confidence interval: 20.9–28.1%). Conclusion The results of the present study showed that the prevalence of osteoporosis in the elders and especially elders' women is very high. Osteoporosis was once thought to be an inseparable part of elders’ lives. Nowadays, Osteoporosis can be prevented due to significant scientific advances in its causes, diagnosis, and treatment. Regarding the growing number of elderly people in the world, it is necessary for health policy-makers to think of measures to prevent and treat osteoporosis among the elders.

The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis

Background Osteoporosis affects all sections of society, including families with people affected by osteoporosis, government agencies and medical institutes in various fields. For example, it involves the patient and his/her family members, and government agencies in terms of the cost of treatment and medical care. Providing a comprehensive picture of the prevalence of osteoporosis globally is important for health policymakers to make appropriate decisions. Therefore, this study was conducted to investigate the prevalence of osteoporosis worldwide. Methods A systematic review and meta-analysis were conducted in accordance with the PRISMA criteria. The PubMed, Science Direct, Web of Science, Scopus, Magiran, and Google Scholar databases were searched with no lower time limit up till 26 August 2020. The heterogeneity of the studies was measured using the I2 test, and the publication bias was assessed by the Begg and Mazumdar’s test at the significance level of 0.1. Results After following the systematic review processes, 86 studies were selected for meta-analysis. The sample size of the study was 103,334,579 people in the age range of 15–105 years. Using meta-analysis, the prevalence of osteoporosis in the world was reported to be 18.3 (95% CI 16.2–20.7). Based on 70 studies and sample size of 800,457 women, and heterogenicity I2: 99.8, the prevalence of osteoporosis in women of the world was reported to be 23.1 (95% CI 19.8–26.9), while the prevalence of osteoporosis among men of the world was found to be 11.7 (95% CI 9.6–14.1 which was based on 40 studies and sample size of 453,964 men.). The highest prevalence of osteoporosis was reported in Africa with 39.5% (95% CI 22.3–59.7) and a sample size of 2989 people with the age range 18–95 years. Conclusion According to the medical, economic, and social burden of osteoporosis, providing a robust and comprehensive estimate of the prevalence of osteoporosis in the world can facilitate decisions in health system planning and policymaking, including an overview of the current and outlook for the future; provide the necessary facilities for the treatment of people with osteoporosis; reduce the severe risks that lead to death by preventing fractures; and, finally, monitor the overall state of osteoporosis in the world. This study is the first to report a structured review and meta-analysis of the prevalence of osteoporosis worldwide.

The Relationship between Dietary Patterns and Bone Mineral Density of 476 Middle-Aged and Aged People

Background: To investigate the relationship between different dietary patterns and the levels of bone mineral density (BMD) in middle-aged and aged people, and to provide references for the nutritional prevention of osteoporosis. Methods: A total of 476 residents aged 45 yr or more in Qiqihar City were enrolled from Aug 2018 to Feb 2019. They took a Food Frequency Questionnaire for dietary survey. Their dietary patterns were analyzed using the factor analysis method, and BMD were detected using ultrasound bone densitometer, to explore the relationship between different dietary patterns and BMD levels. Results: Four dietary patterns were obtained in the survey: relatively balanced, oil-salt, milk-tuber, and aquatic. Among them, the prevalence of osteoporosis reached 21.8%. High-level relatively balanced dietary pattern (OR=0.588, 95%CI= 0.363-0.951) and high-level dairy-potato food dietary pattern (OR=0.668, 95%CI= 0.370-0.983) were associated with lower risk of osteoporosis. Conclusion: A balanced diet and a high intake of dairy-potato food dietary pattern were associated with a lower prevalence of osteoporosis. It is recommended that middle-aged and aged people should have a balanced diet with more dairy products and potatoes to protect bone health.

Study of The Relationship Between Psoriasis of Different Clinical Varieties and Osteoporosis

Background Psoriasis is considered as a systemic disease since it is an inflammatory skin disorder associated with increased level of many inflammatory cytokines, which can result in many comorbidities. It was hypothesized that there is an association between psoriasis and osteoporosis and many studies investigated this association, but the majority of them focused on the association between psoriatic arthritis and osteoporosis, while this study excluded psoriatic arthritis and investigated the association between psoriasis of different clinical varieties and osteoporosis. Objective to assess the associated relationship between psoriasis and osteoporosis in psoriatic patients of different clinical varieties, by measuring the prevalence of osteoporosis in a sample of these patients. Subjects and methods Our cross-sectional study included 42 psoriatic male and female patients with non specific ages, 48% of them were males (20 patients) and 52% of them were females (22 patients), and it excluded any patients with endocrinal disorders, chronic renal failure, liver cell failure, other chronic inflammatory disoredres, malabsorption, history of alcohol misuse, history of intake of steroids for longer than 6 months, pregnant women and psoriatic arthritis. All patients were subjected to a questionnaire for detailed history taking, complete general and dermatological examinations, evaluation of psoriasis severity by Psoriasis Area and Severity Index (PASI) score and bone mineral density (BMD) measurement using the DEXA method of the lumbar spine (L1L4) and femoral neck. Results The prevalence of osteoporosis among psoriatic patients was (9.5%), (10%) in males and (9%) in females, which was lower than the prevalence of osteoporosis in the population. While the prevalence of osteopenia was 50%, (45%) in males and (54.5%) in females, which was higher than the prevalence of osteopenia in the population. Additionally this study showed a statistically significant negative correlation between the age of the patients and BMD, and a highly significant positive correlation between the BMI of the patients and BMD, while there were non significant negative correlations between both (duration of psoriasis and PASI score) and BMD, and no significant correlations between clinical variants of psoriasis and BMD. Conclusion Psoriasis is associated with a decrease in the bone mineral density more in males, with higher incidence of osteopenia rather than osteoporosis. The decrease in BMD increases with increasing age, duration of psoriasis and PASI score, decreases with increasing BMI, while the clinical variants of psoriasis didn’t seem to affect the BMD of psoriatic patients.

Sex Difference in the Socioeconomic Burden of Osteoporosis among South Koreans

Background: The prevalence of osteoporosis is increasing with the aging of the population and the socioeconomic burden. The purpose of this study was to determine the socioeconomic burden of osteoporosis in Korea. Methods: The prevalence of osteoporosis was analyzed using 2017 National Patients Sample and Korea National Health and Nutrition Examination Survey data. Direct costs were divided into healthcare and non-healthcare costs, and indirect costs were calculated by assessing the cost of loss of productivity for labor loss due to disease. Results: The prevalence of osteoporosis diagnosis was 1.91% in total, which was 13 times higher in women than in men (3.57% vs. 0.26%). The socioeconomic cost of osteoporosis was 299.1 million USD based on main diagnosis, and the cost was 13 times higher in women than in men (277.6 vs. 21.5 million USD). The total cost based on main and secondary diagnosis was 981.8 million USD. Similarly, the cost was seven times higher in women than in men (862.4 vs. 119.4 million USD). Conclusions: Osteoporosis increases the socioeconomic burden of disease, and it is significantly higher in women than in men. The policy support for the implementation of prevention and management programs would be necessary to reduce the burden of osteoporosis.

Prevalence of osteoporosis and osteoporotic fractures in postmenopausal women with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) and osteoporosis are chronic diseases with increasing prevalence. The aim of this study was to determine the prevalence of osteoporosis and osteoporotic fracture in women with T2DM and to identify predictive factors of fracture occurrence. The prevalence of osteoporosis and fractures in postmenopausal women with T2DM was 23.1% and 16.9%, respectively. 46.2% of T2DM patients had normal bone mineral density (BMD) (P<0.01) and 58.5% of control subjects had osteopenia (P<0.01). Incidence of fracture in T2DM patients with osteopenia was significantly increased versus control subjects when stratified according the BMD (P=0.009). By stratifying T2DM patients according to fractures, factors that were significantly associated with occurrence included T2DM duration (P=0.038), use of insulin (P=0.017), and lower BMD (P=0.048). Our study suggests that there was a higher prevalence of fracture in T2DM patients compared to control subjects and a significant difference in BMD was found between the groups. We also showed that insulin use, low BMD, and long duration of T2DM are factors associated with an increased risk of bone fracture.