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Chen Y, Cao Z, Zhang L, Xu X, Chen Y, Chen Y. Low level laser can be a novel adjuvant method for orthodontic tooth movement on postmenopausal women. Med Hypotheses 2011; 76:479-81. [DOI: 10.1016/j.mehy.2010.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Revised: 11/18/2010] [Accepted: 11/21/2010] [Indexed: 10/18/2022]
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Samelson EJ, Christiansen BA, Demissie S, Broe KE, Zhou Y, Meng CA, Yu W, Cheng X, O'Donnell CJ, Hoffmann U, Genant HK, Kiel DP, Bouxsein ML. Reliability of vertebral fracture assessment using multidetector CT lateral scout views: the Framingham Osteoporosis Study. Osteoporos Int 2011; 22:1123-31. [PMID: 20495902 PMCID: PMC2964444 DOI: 10.1007/s00198-010-1290-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 04/27/2010] [Indexed: 11/27/2022]
Abstract
UNLABELLED Two radiologists evaluated images of the spine from computed tomography (CT) scans on two occasions to diagnose vertebral fracture in 100 individuals. Agreement was fair to good for mild fractures, and agreement was good to excellent for more severe fractures. CT scout views are useful to assess vertebral fracture. INTRODUCTION We investigated inter-reader agreement between two radiologists and intra-reader agreement between duplicate readings for each radiologist, in assessment of vertebral fracture using a semi-quantitative method from lateral scout views obtained by CT. METHODS Participants included 50 women and 50 men (age 50-87 years, mean 70 years) in the Framingham Study. T4-L4 vertebrae were assessed independently by two radiologists on two occasions using a semi-quantitative scale as normal, mild, moderate, or severe fracture. RESULTS Vertebra-specific prevalence of grade ≥ 1 (mild) fracture ranged from 3% to 5%. We found fair (κ = 56-59%) inter-reader agreement for grade ≥ 1 vertebral fractures and good (κ = 68-72%) inter-reader agreement for grade ≥ 2 fractures. Intra-reader agreement for grade ≥ 1 vertebral fracture was fair (κ = 55%) for one reader and excellent for another reader (κ = 77%), whereas intra-reader agreement for grade ≥ 2 vertebral fracture was excellent for both readers (κ = 76% and 98%). Thoracic vertebrae were more difficult to evaluate than the lumbar region, and agreement was lowest (inter-reader κ = 43%) for fracture at the upper (T4-T9) thoracic levels and highest (inter-reader κ = 76-78%) for the lumbar spine (L1-L4). CONCLUSIONS Based on a semi-quantitative method to classify vertebral fractures using CT scout views, agreement within and between readers was fair to good, with the greatest source of variation occurring for fractures of mild severity and for the upper thoracic region. Agreement was good to excellent for fractures of at least moderate severity. Lateral CT scout views can be useful in clinical research settings to assess vertebral fracture.
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Affiliation(s)
- E J Samelson
- Hebrew SeniorLife, Institute for Aging Research Boston, Boston, MA, USA.
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103
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Tsang SWY, Bow CH, Chu EYW, Yeung SC, Soong CC, Kung AWC. Clinical risk factor assessment had better discriminative ability than bone mineral density in identifying subjects with vertebral fracture. Osteoporos Int 2011; 22:667-74. [PMID: 20503038 PMCID: PMC3020297 DOI: 10.1007/s00198-010-1260-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 03/30/2010] [Indexed: 11/30/2022]
Abstract
UNLABELLED This study evaluated the characteristics of patients with vertebral fractures and examined the discriminative ability of clinical risk factors. The findings provide further insights into possible development of a simple, cost-effective scheme for fracture risk assessment using clinical risk factors to identify high-risk patients for further evaluation. INTRODUCTION Vertebral fractures are the most common complication of osteoporosis. The aim of this study was to evaluate the characteristics of patients with vertebral fractures and to determine the discriminative ability of bone mineral density (BMD) and other clinical risk factors. METHODS Postmenopausal Southern Chinese women (2,178) enrolled in the Hong Kong Osteoporosis Study since 1995 were prospectively followed up for fracture outcome. Subjects (1,372) with lateral spine radiographs were included in this study. Baseline demographic, BMD, and clinical risk factor information were obtained from a structured questionnaire. RESULTS Subjects (299; 22%) had prevalent vertebral fractures. The prevalence of vertebral fractures increased with increasing age, number of clinical risk factors, and decreasing BMD. The odds of having a prevalent vertebral fracture per SD reduction in BMD after adjustment for age in Hong Kong Southern Chinese postmenopausal women was 1.5 for the lumbar spine and femoral neck. Analysis of the receiver operating characteristic curve revealed that bone mineral apparent density did not enhance fracture risk prediction. Subjects with ≥ 4 clinical risk factors had 2.3-fold higher odds of having a prevalent vertebral fracture while subjects with ≥ 4 clinical risk factors plus a low BMD (i.e., femoral neck T-score < -2.5) had 2.6-fold. Addition of BMD to clinical risk factors did not enhance the discriminative ability to identify subjects with vertebral fracture. CONCLUSIONS Based on these findings, we recommend that screening efforts should focus on older postmenopausal women with multiple risk factors to identify women who are likely to have a prevalent vertebral fracture.
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Affiliation(s)
- S. W. Y. Tsang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
| | - C. H. Bow
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
| | - E. Y. W. Chu
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
| | - S. C. Yeung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
| | - C. C. Soong
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
| | - A. W. C. Kung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
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104
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The prevalence of vertebral fractures and health-related quality of life in postmenopausal women. Rheumatol Int 2011; 32:971-80. [DOI: 10.1007/s00296-010-1734-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 12/30/2010] [Indexed: 10/18/2022]
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105
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Holroyd C, Dennison E, Cooper C. Epidemiology and classification of metabolic bone disease. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00193-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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106
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Clinical course of pain in acute osteoporotic vertebral compression fractures. J Vasc Interv Radiol 2010; 21:1405-9. [PMID: 20800779 DOI: 10.1016/j.jvir.2010.05.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 04/18/2010] [Accepted: 05/10/2010] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The authors prospectively determined the natural course of pain in patients with conservatively treated acute osteoporotic vertebral compression fractures (VCF). In addition, the type of conservative therapy that these patients received was assessed. MATERIALS AND METHODS Patients older than 50 years, referred for spine radiography for acute back pain, were asked to complete a baseline clinical questionnaire. Patients with an acute VCF were followed up at 6 and 23 months with a questionnaire that included a Visual Analog Score (VAS) and type of pain medication and other conservative treatment. Significant pain relief was defined as a decrease in VAS of 50% or more. RESULTS Forty-nine patients (mean age, 78 years; range, 51-95) with acute VCF were followed up for almost 2 years. Significant pain relief was noted in 22 of 35 patients (63%) at 6 months and in 25 of 36 (69%) at 23 months. In patients with persisting pain at 23 months (mean VAS 6.4), some decrease in VAS was apparent at 6 months but not in the 6-23 months interval. No predictors for significant pain relief could be identified. Patients with significant pain relief used less pain medication and had less physical therapy. CONCLUSIONS In most patients with an acute VCF, pain decreases significantly with conservative therapy, predominantly in the first 6 months. However, almost 2 years after an acute VCF, a third of patients still had severe pain necessitating pain medication and physical therapy in the majority. No predictors for transition from acute to chronic pain could be identified.
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Abstract
Vertebral fractures (VFxs) are the most common osteoporotic fracture, and are a strong risk factor for future fracture. The presence of a VFx greatly increases the risk of sustaining subsequent VFxs-a phenomenon often referred to as the "vertebral fracture cascade." VFxs do not occur uniformly along the spine, but occur more often at the mid-thoracic and thoracolumbar regions than elsewhere. It is likely that both the vertebral fracture cascade and the bimodal distribution of VFx along the spine are attributable to biomechanical factors. VFxs occur when the forces applied to the vertebral body exceed its strength. Loading on the spine is primarily determined by a person's height, weight, muscle forces, and the task or movement performed, but can also be affected by other factors, such as spinal curvature and invertebral disk deterioration. Vertebral strength is determined mainly by bone size, shape, and bone mineral density, and secondarily by bone microarchitecture, collagen characteristics, and microdamage. Better understanding of VFx etiology is hampered by the fact that most VFxs do not come to clinical attention; therefore, the factors and activities that cause VFxs remain ill defined, including possible differences in the etiology of acute fractures versus those of slow onset. Additional research is needed to elucidate the precise mechanical, morphologic, and biological mechanisms that underlie VFx to improve strategies for assessing VFx risk and preventing the vertebral fracture cascade.
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108
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de Felipe R, Cáceres C, Cimas M, Dávila G, Fernández S, Ruiz T. [Clinical characteristics of patients under treatment for osteoporosis in a Primary Care Centre. Who do we treat?]. Aten Primaria 2010; 42:559-63. [PMID: 20129712 PMCID: PMC7024519 DOI: 10.1016/j.aprim.2009.10.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 10/21/2009] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To find out the clinical and demographic features of patients in treatment for osteoporosis, look for risk factors for osteoporosis and bone fractures, and assess whether treatment is indicated. DESIGN Descriptive study of a series of cases. LOCATION Primary Care Centre, Madrid. PARTICIPANTS 216 patients on treatment for osteoporosis during 2007. PRINCIPAL MEASURES Sociodemographic variables, osteoporosis risk factors, risk of falling, prescription and treatment related information. To evaluate if treatment is indicated we have used principal medical guidelines. RESULTS Most of our patients were Caucasian women with a mean age of 66.14 years. A total of 39.5% had suffered an osteoporotic fracture and 16.12% had family history of osteoporotic fracture. The majority of our registers,73.15%, do not report information on Dual-Energy X-ray Absorptiometry (DEXA), and 73.13% do not make any reference to bone mineral density. Risk factors are not recorded in most of the clinical histories. Only 51.85% of the treatments were well indicated, and 44% of them began at a primary health care centre. CONCLUSIONS Nearly 50% of treatments are not well indicated and a high percentage of our clinical histories do not record risk factors correctly. We should improve our clinical histories, as we are responsible for identifying, studying, evaluating, treating and controlling the progress of osteoporosis.
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109
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Watts NB, Bilezikian JP, Camacho PM, Greenspan SL, Harris ST, Hodgson SF, Kleerekoper M, Luckey MM, McClung MR, Pollack RP, Petak SM. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of postmenopausal osteoporosis. Endocr Pract 2010; 16 Suppl 3:1-37. [PMID: 21224201 PMCID: PMC4876714 DOI: 10.4158/ep.16.s3.1] [Citation(s) in RCA: 278] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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110
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Iyer S, Christiansen BA, Roberts BJ, Valentine MJ, Manoharan RK, Bouxsein ML. A biomechanical model for estimating loads on thoracic and lumbar vertebrae. Clin Biomech (Bristol, Avon) 2010; 25:853-8. [PMID: 20655634 PMCID: PMC2949493 DOI: 10.1016/j.clinbiomech.2010.06.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 06/12/2010] [Accepted: 06/14/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Biomechanical models are commonly used to estimate loads on the spine. Current models have focused on understanding the etiology of low back pain and have not included thoracic vertebral levels. Using experimental data on the stiffness of the thoracic spine, ribcage, and sternum, we developed a new quasi-static stiffness-based biomechanical model to calculate loads on the thoracic and lumbar spine during bending or lifting tasks. METHODS To assess the sensitivity of the model to our key assumptions, we determined the effect of varying ribcage and sternal stiffness, maximum muscle stress, and objective function on predicted spinal loads. We compared estimates of spinal loading obtained with our model to previously reported in vivo intradiscal pressures and muscle activation patterns. FINDINGS Inclusion of the ribs and sternum caused an average decrease in vertebral compressive force of 33% for forward flexion and 18% in a lateral moment task. The impact of maximum muscle stress on vertebral force was limited to a narrow range of values. Compressive forces predicted by our model were strongly correlated to in vivo intradiscal pressure measurements in the thoracic (r=0.95) and lumbar (r=1) spine. Predicted trunk muscle activity was also strongly correlated (r=0.95) with previously published EMG data from the lumbar spine. INTERPRETATION The consistency and accuracy of the model predictions appear to be sufficient to justify the use of this model for investigating the relationships between applied loads and injury to the thoracic spine during quasi-static loading activities.
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Affiliation(s)
- Sravisht Iyer
- Harvard-MIT Health Sciences and Technology Program, Cambridge, MA,Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA
| | - Blaine A. Christiansen
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA,Department of Orthopedic Surgery, Harvard Medical School, Boston, MA
| | - Benjamin J. Roberts
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michael J. Valentine
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA
| | - Rajaram K. Manoharan
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA
| | - Mary L. Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA,Department of Orthopedic Surgery, Harvard Medical School, Boston, MA
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Watts NB, Bilezikian JP, Camacho PM, Greenspan SL, Harris ST, Hodgson SF, Kleerekoper M, Luckey MM, McClung MR, Pollack RP, Petak SM. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of postmenopausal osteoporosis: executive summary of recommendations. Endocr Pract 2010; 16:1016-9. [PMID: 21216723 PMCID: PMC4890158 DOI: 10.4158/ep.16.6.1016] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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112
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Nekkanty S, Yerramshetty J, Kim DG, Zauel R, Johnson E, Cody DD, Yeni YN. Stiffness of the endplate boundary layer and endplate surface topography are associated with brittleness of human whole vertebral bodies. Bone 2010; 47:783-9. [PMID: 20633709 PMCID: PMC3710658 DOI: 10.1016/j.bone.2010.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 06/14/2010] [Accepted: 07/06/2010] [Indexed: 10/19/2022]
Abstract
Stress magnitude and variability as estimated from large scale finite element (FE) analyses have been associated with compressive strength of human vertebral cancellous cores but these relationships have not been explored for whole vertebral bodies. In this study, the objectives were to investigate the relationship of FE-calculated stress distribution parameters with experimentally determined strength, stiffness, and displacement based ductility measures in human whole vertebral bodies, investigate the effect of endplate loading conditions on vertebral stiffness, strength, and ductility and test the hypothesis that endplate topography affects vertebral ductility and stress distributions. Eighteen vertebral bodies (T6-L3 levels; 4 female and 5 male cadavers, aged 40-98 years) were scanned using a flat-panel CT system and followed with axial compression testing with Wood's metal as filler material to maintain flat boundaries between load plates and specimens. FE models were constructed using reconstructed CT images and filler material was added digitally. Two different FE models with different filler material modulus simulating Wood's metal and intervertebral disc (W-layer and D-layer models) were used. Element material modulus to cancellous bone was based on image gray value. Average, standard deviation, and coefficient of variation of von Mises stress in vertebral bone for W-layer and D-layer models and also the ratios of FE parameters from the two models (W/D) were calculated. Inferior and superior endplate surface topographical distribution parameters were calculated. Experimental stiffness, maximum load and work to fracture had the highest correlation with FE-calculated stiffness while experimental ductility measures had highest correlations with FE-calculated average von Mises stress and W-layer to D-layer stiffness ratio. Endplate topography of the vertebra was also associated with its structural ductility and the distribution parameter that best explained this association was kurtosis of inferior endplate topography. Our results indicate that endplate topography variations may provide insight into the mechanisms responsible for vertebral fractures.
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Affiliation(s)
- Srikant Nekkanty
- Bone and Joint Research Center, Department of Orthopaedics, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202, USA.
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113
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Affiliation(s)
- Ralph Hasserius
- Departments of Clinical Sciences, Lund University and Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Acke Ohlin
- Departments of Clinical Sciences, Lund University and Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Magnus K Karlsson
- Departments of Clinical Sciences, Lund University and Orthopedics, Skåne University Hospital, Malmö, Sweden
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114
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Sanfélix-Genovés J, Reig-Molla B, Sanfélix-Gimeno G, Peiró S, Graells-Ferrer M, Vega-Martínez M, Giner V. The population-based prevalence of osteoporotic vertebral fracture and densitometric osteoporosis in postmenopausal women over 50 in Valencia, Spain (the FRAVO study). Bone 2010; 47:610-6. [PMID: 20601286 DOI: 10.1016/j.bone.2010.06.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 06/10/2010] [Accepted: 06/11/2010] [Indexed: 11/21/2022]
Abstract
PURPOSE To estimate the prevalence of vertebral fracture and densitometric osteoporosis in postmenopausal women over the age of 50 in Valencia, Spain. METHODS This cross-sectional study was conducted in 2006-2007. An age-stratified population-based random sample of 824 postmenopausal women over the age of 50 answered a questionnaire and received a densitometric examination of the lumbar spine and hip with dual-energy X-ray absorptiometry and a lateral X-ray of the thoracic spine and lumbar regions. Osteoporosis was defined as a T-score less than or equal to -2.5 compared to a population of young women, and the presence of vertebral fractures was classified according to Genant's semiquantitative method. RESULTS The average age of the women was 64 years (range 50-87 years). The prevalence for all vertebral fractures was 21.4% (95% CI: 17.7%-25.1%) and 9.7% (95% CI: 6.7%-12.7%) for moderate-severe fractures. In women over the age of 75, the respective values were 46.3% (95% CI: 34.2%-58.3%) and 23.9% (95% CI:13.6%-34.2%). Only 1.5% of the women with vertebral fractures were aware of their condition. The prevalence of osteoporosis was estimated as 27.0% (95% CI:23.1%-30.8%) for the lumbar spine, 15.1% (95% CI:11.7%-18.5%) in the femoral neck, and 31.8% (95% CI:27.8%-35.7%) at either sites. CONCLUSIONS The study confirms that osteoporosis (1 in 3 women over the age of 50) and vertebral fracture (1 in 5 for all fractures and 1 in 10 for moderate-severe fractures) constitute a major public health and healthcare challenge; measuring their real impact will depend in part on the criteria used to define a fracture.
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Affiliation(s)
- José Sanfélix-Genovés
- Centro Superior de Investigación en Salud Pública (CSISP), Health Services Research Unit, Valencia, Spain.
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115
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Russo LAT, Gregório LHD, Lacativa PGS, Marinheiro LPF. [Concentration of 25-hydroxyvitamin D in postmenopausal women with low bone mineral density]. ACTA ACUST UNITED AC 2010; 53:1079-87. [PMID: 20126865 DOI: 10.1590/s0004-27302009000900004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 09/21/2009] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study was designed to determine mean serum concentrations of 25-hydroxyvitamin D (25OHD) in postmenopausal women with low bone mineral density (BMD), to find the cutoff of parathormone (PTH) elevation, and to evaluate the correlation 25OHD with BMD, biochemical parameters and vertebral fracture presence. METHODS Transversal study, with collection of 25OHD and PTH, and determination of DMO and column radiograph. RESULTS A high incidence of inadequate serum concentrations of 25OHD (68.3%) was found and 8% of secondary hyperparathyreoidism. No significant differences were found between 25OHD serum concentrations and the evaluated parameters, except for PTH, which showed a negative association. The established cutoff was 61.5 nmol/L. CONCLUSIONS The elevated incidence of hipovitaminosis D in elderly women with low BMD suggests that a systematic evaluation of 25OHD serum concentrations must be done for this population.The use of 61.5 nmol/L as a cutoff is recommended until the realization of an epidemiologic study that represents all Rio de Janeiro city (RJ, Brazil).
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116
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Abstract
Visual semiquantitative (SQ) assessment of the radiographs by a trained and experienced observer is the "gold standard" method to detect vertebral fractures. Vertebral morphometry is a quantitative method to identify osteoporotic vertebral fractures based on the measurement of vertebral heights. Vertebral morphometry may be performed on conventional spinal radiographs (MRX: morphometric x-ray radiography) or on images obtained from dual x-ray absorptiometry (DXA) scans (MXA: morphometric x-ray absorptiometry). Vertebral fracture assessment (VFA) indicates the method for identification of the vertebral fractures using lateral spine views acquired by DXA, with low-dose exposition. For epidemiologic studies and clinical drug trials in osteoporosis research but also in clinical practice, the preferred method is radiographic SQ assessment., because an expert eye can better distinguish between true fractures and vertebral anomalies than can quantitative morphometry. However, vertebral morphometry, calculating the deformity of overall thoracic and lumbar spine, may supply useful data about the vertebral fracture risk. VFA performed during routine densitometry allows identification, by visual or morphometric methods, of most osteoporotic vertebral fractures, even those that are asymptomatic.
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Affiliation(s)
- Daniele Diacinti
- Department of Radiology, University Sapienza, Policlinico Umberto I, Viale Regina Elena 324, Rome, Italy
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117
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Abstract
The epidemiology of osteoporosis is reviewed, with a discussion of secular changes in incidence, geographical variation, and economic costs. The morbidity and mortality associated with hip, vertebral, and forearm fractures are outlined. The main pathogenetic factors contributing to age-related bone loss and osteoporosis are reviewed. Finally, there is a discussion of the recent advances in fracture risk prediction and the use of independent clinical risk factors to improve bone mineral density-based prediction.
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Affiliation(s)
- Juliet Compston
- Department of Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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118
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Rossini M, Viapiana O, Gatti D, de Terlizzi F, Adami S. Capacitively coupled electric field for pain relief in patients with vertebral fractures and chronic pain. Clin Orthop Relat Res 2010; 468:735-40. [PMID: 19756902 PMCID: PMC2816769 DOI: 10.1007/s11999-009-1088-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 08/27/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Fragility vertebral fractures often are associated with chronic back pain controlled by analgesic compounds. Capacitive coupling electrical stimulation is a type of electrical stimulation technology approved by the US FDA to noninvasively enhance fracture repair and spinal fusion. These uses suggest it would be a possible treatment for patients with back pain attributable to vertebral fractures. We therefore randomized 51 postmenopausal women with multiple fractures and chronic pain to the use of one of two indistinguishable devices delivering either the standard capacitive coupling electrical stimulation by Osteospine (active group) or low intensity pulse (control group). Twenty patients of the active group and 21 of the control group (80%) completed the study for a total duration of 3 months. The mean visual analog scale values for pain and the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) scores improved in both groups. We observed a relationship between hours of treatments and reductions in pain intensity only in the active group. Capacitive coupling electrical stimulation was not more effective than control treatment when comparing mean visual analog scale pain and QALEFFO scores in the two groups and when adjusting for the hours of treatment. However, the proportion of patients able to discontinue NSAIDs owing to elimination or reduction of pain was greater in the active group than in the control group. We interpret these findings as suggesting capacitive coupling electrical stimulation controls pain in some patients and reduces the use of NSAIDs. LEVEL OF EVIDENCE Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Maurizio Rossini
- Rheumatology Unit, Department of Biomedical and Surgical Sciences, University of Verona, OCM Borgo Trento, P le Stefani, 1, 37126 Verona, Italy
| | - Ombretta Viapiana
- Rheumatology Unit, Department of Biomedical and Surgical Sciences, University of Verona, OCM Borgo Trento, P le Stefani, 1, 37126 Verona, Italy
| | - Davide Gatti
- Rheumatology Unit, Department of Biomedical and Surgical Sciences, University of Verona, OCM Borgo Trento, P le Stefani, 1, 37126 Verona, Italy
| | | | - Silvano Adami
- Rheumatology Unit, Department of Biomedical and Surgical Sciences, University of Verona, OCM Borgo Trento, P le Stefani, 1, 37126 Verona, Italy
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Diacinti D, Pisani D, Barone-Adesi F, Del Fiacco R, Minisola S, David V, Aliberti G, Mazzuoli GF. A new predictive index for vertebral fractures: the sum of the anterior vertebral body heights. Bone 2010; 46:768-73. [PMID: 19895914 DOI: 10.1016/j.bone.2009.10.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 10/13/2009] [Accepted: 10/28/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Evaluation of osteoporotic vertebral fracture risk is currently based on measurement of bone mineral density (BMD), but bone strength depends also on bone quality parameters. Aim of this study was to evaluate the validity of a new vertebral morphometric index, the Anterior Vertebral Heights sum (AHs) in discriminating women at high risk of vertebral fracture, comparing its diagnostic accuracy with that of BMD measured at lumbar spine (LS-BMD) and femoral neck (FN-BMD). MATERIALS AND METHODS A total of 163 Caucasian post-menopausal women (age range 46-74 years, mean age+/-SD=63.8+/-7.1 years), who did not present prevalent fractures at baseline evaluation, were observed at longitudinal follow-up. X-ray of the thoracic and lumbar spine, LS-BMD and FN-BMD measurements were obtained in all patients at baseline and repeated at the second follow-up visit 18-24 months later (mean 21+/-1.7 months). Radiographs of spine were analysed in order to identify vertebral fractures using a visual semiquantitative method (SQ) and vertebral morphometry as well as by calculating the AHs morphometric index. RESULTS During follow-up, 21/163 patients (12.9%) sustained a new vertebral fracture; 95.2% (20/21) of fractured patients but only 4.9% (7/142) of non-fractured women had reduced AHs values. As regarding BMD, 66.6% (14/21) and 61.9% (13/21) of women with incident fracture were osteoporotic at lumbar spine and femoral neck baseline evaluation , whereas among non-fractured women, 38% (54/142) at LS-BMD and 33.1% (47/142) at FN-BMD were osteoporotic . Analyses of Receiver Operating Characteristic (ROC) curves showed that AHs discriminated vertebral fractures almost perfectly (AUC 0.97; 95% CI 0.95-0.99). On the other hand, the AUC for LS-BMD was only 0.73 (95% CI 0.64-0.81) and for FN-BMD was 0.72 (95%CI 0.63-0.80), showing that the diagnostic accuracy of AHs was significantly higher compared to that of LS-BMD (p<0.001) or FN-BMD (p<0.001). A modified Poisson regression model for binary data was used to assess the independent role of AHs in predicting vertebral fracture. The effect of AHs remained statistically significant (p<0.001) after adjusting by FN-BMD, age, weight and body height. CONCLUSIONS Results of this study indicate the validity of this new morphometric index in evaluating the risk of osteoporotic vertebral fractures thus suggesting that AHs should be considered a valid parameter in clinical practice to assess the need for primary prevention of vertebral fractures.
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Affiliation(s)
- D Diacinti
- Department of Radiology, University La Sapienza, Rome, Italy
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Gao L, Fan T, Chen Y, Qiu S. Reference values for vertebral shape in young Chinese women: implication for assessment of vertebral deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:1162-8. [PMID: 20186444 DOI: 10.1007/s00586-010-1317-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 01/13/2010] [Accepted: 01/31/2010] [Indexed: 11/25/2022]
Abstract
The race- and sex-specific reference values for vertebral shape are important to determine the prevalence of osteoporotic vertebral fracture. However, these reference values are absent in Chinese women. In the present study, the anterior, middle and posterior heights and the ratios of these heights were measured from 14 vertebral bodies (T4-L5) in 60 premenopausal Chinese women (aged 19-25 years). Cutoff values were set as standard deviations (3 and 3.5 SD) and percentages (15 and 20%) below the means of vertebral height (VH) ratios to define vertebral deformities. The number of subjects with a VH ratio lower than -15% cutoff were significantly more than those with a VH ratio lower than -3 SD cutoff (p < 0.05), but this difference did not occur when a -20% cutoff was selected. A few VH ratios were distributed below -20% and -3 SD cutoffs, and none was below -3.5 SD. The vertebral shape defined by VH ratios was different between Chinese and European women. We conclude that 3.5 SD below the reference mean is an ideal cutoff value for the definition of prevalent vertebral fractures in Chinese women, and reference data should be obtained from young premenopausal women.
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Affiliation(s)
- Lingjun Gao
- Department of Orthopaedic Surgery, Shanghai Traditional Chinese Medicine Hospital, Shanghai University of Traditional Chinese Medicine, 274 Middle Zhi-Jiang Road, Shanghai, 200071, People's Republic of China
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Boonen S, Black DM, Colón-Emeric CS, Eastell R, Magaziner JS, Eriksen EF, Mesenbrink P, Haentjens P, Lyles KW. Efficacy and safety of a once-yearly intravenous zoledronic acid 5 mg for fracture prevention in elderly postmenopausal women with osteoporosis aged 75 and older. J Am Geriatr Soc 2010; 58:292-9. [PMID: 20070415 DOI: 10.1111/j.1532-5415.2009.02673.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the efficacy of once-yearly intravenous zoledronic acid (ZOL) 5 mg in reducing risk of clinical vertebral, nonvertebral, and any clinical fractures in elderly osteoporotic postmenopausal women. DESIGN A post hoc subgroup analysis of pooled data from the Health Outcome and Reduced Incidence with Zoledronic Acid One Yearly (HORIZON) Pivotal Fracture Trial and the HORIZON Recurrent Fracture Trial. SETTING Multicenter, randomized, double-blind, placebo-controlled trials. PARTICIPANTS Postmenopausal women (aged > or =75) with documented osteoporosis (T-score < or =-2.5 at femoral neck or >/=1 prevalent vertebral or hip fracture) or a recent hip fracture. INTERVENTION Patients were randomized to receive an intravenous infusion of ZOL 5 mg (n=1,961) or placebo (n=1,926) at baseline and 12 and 24 months. MEASUREMENTS Primary endpoints were incidence of clinical vertebral and nonvertebral and any clinical fracture after treatment. RESULTS At 3 years, incidence of any clinical, clinical vertebral, and nonvertebral fracture were significantly lower in the ZOL group than in the placebo group (10.8% vs 16.6%, 1.1% vs 3.7%, and 9.9% vs 13.7%, respectively) (hazard ratio (HR)=0.65, 95% confidence interval (CI)=0.54-0.78, P<.001; HR=0.34, 95% CI=0.21-0.55, P<.001; and HR=0.73, 95% CI=0.60-0.90, P=.002, respectively). The incidence of hip fracture was lower with ZOL but did not reach statistical significance. The incidence rate of postdose adverse events were higher with ZOL, although the rate of serious adverse events and deaths was comparable between the two groups. CONCLUSION Once-yearly intravenous ZOL 5 mg was associated with a significant reduction in the risk of new clinical fractures (vertebral and nonvertebral) in elderly postmenopausal women with osteroporosis.
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Affiliation(s)
- Steven Boonen
- Leuven University Centre for Metabolic Bone Diseases and Division of Geriatric Medicine, University of Leuven, Leuven, Belgium.
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Abstract
Fractures in older people are important medical problems. Knowledge of risk factors is essential for successful preventive measures, but when fracture sites of diverse etiology are combined, risk factors for any one site are difficult to identify and may be missed entirely. Among older people, incidence rates of hip, proximal humerus, and vertebral fractures increase with age, but not rates of distal forearm and foot fractures. Low bone mineral density is strongly associated with hip, distal forearm, vertebral, and proximal humerus fractures, but not foot fracture. Most fractures of the hip, distal forearm, and proximal humerus result from a fall, whereas smaller proportions of fractures of the foot and vertebrae follow a fall. Frail people are likely to fracture their hip or proximal humerus, while healthy, active people tend to fracture their distal forearm. We strongly recommend that studies identify risk factors on a site-specific basis.
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Affiliation(s)
- Jennifer L Kelsey
- University of Massachusetts Medical School, Department of Medicine, Division of Preventive and Behavior Medicine, and Department of Family Medicine and Community Health, 55 Lake Place North, Shaw Building, Worcester MA 01655, USA.
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Masud T, McClung M, Geusens P. Reducing hip fracture risk with risedronate in elderly women with established osteoporosis. Clin Interv Aging 2009; 4:445-9. [PMID: 19966913 PMCID: PMC2785868 DOI: 10.2147/cia.s8200] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There is limited evidence to support the efficacy of current pharmaceutical agents in reducing the risk of hip fracture in older postmenopausal women with established osteoporosis. OBJECTIVE To clarify the efficacy of risedronate in reducing the risk of hip fracture in elderly postmenopausal women aged > or = 70 years with established osteoporosis, i.e., those with bone mineral density-defined osteoporosis and a prevalent vertebral fracture. METHODS Post hoc analysis of the Hip Intervention Program (HIP) study, a randomized controlled trial comparing risedronate with placebo for reducing the risk of hip fracture in elderly women. Women aged 70 to 100 years with established osteoporosis (baseline femoral neck T-score < or = -2.5 and > or =1 prior vertebral fracture) were included. The main outcome measure was 3-year hip fracture incidence in the risedronate and placebo groups. RESULTS A total of 1656 women met the inclusion criteria. After 3 years, hip fracture had occurred in 3.8% of risedronate-treated patients and 7.4% of placebo-treated patients (relative risk 0.54; 95% confidence interval 0.32-0.91; P = 0.019). CONCLUSION Risedronate significantly reduced the risk of hip fracture in women aged up to 100 years with established osteoporosis.
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Affiliation(s)
- Tahir Masud
- Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Adachi JD, Kennedy CC, Papaioannou A, Ioannidis G, Leslie WD, Walker V. Treating osteoporosis in Canada: what clinical efficacy data should be considered by policy decision makers? Osteoporos Int 2009; 20:1785-93. [PMID: 19277810 PMCID: PMC5101050 DOI: 10.1007/s00198-009-0870-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 01/09/2009] [Indexed: 10/21/2022]
Abstract
UNLABELLED SAUMMARY: Using a Markov state-transition model, we estimated fractures averted with risedronate using two different types of clinical efficacy data. Summary data, as opposed to individual patient data (IPD), underestimated the number of fractures averted when applied in a specified high risk population. The choice of clinical efficacy data is an important consideration in health economic models evaluating osteoporosis therapies. INTRODUCTION This paper contrasts fracture reduction estimates for risedronate utilizing efficacy data from two approaches to meta-analysis: summary data versus individual patient data. We also examined differences in fracture reduction explained by varied cohort selection, especially the inclusion of low- versus high-risk populations. METHODS Using a Markov state-transition model, we compared fractures averted over 3 years in a hypothetical cohort by inputting fracture risk reduction estimates (risedronate versus placebo) from two data sources (summary data versus IPD). The cohort consisted of 100,000 Canadian women, age > or =65 years with osteoporosis (WHO criteria T-score < or = -2.5) and prevalent morphometric vertebral fracture. RESULTS Non-vertebral fractures averted with risedronate were: 3,571 and 6,584 per 100,000 women for summary data and IPD, respectively. For vertebral fractures, the numbers were 8,552 and 10,127. When IPD versus summary data was used, an additional 3,013 more non-vertebral fractures and 1,575 vertebral fractures were averted. DISCUSSION Relative risk estimates from IPD analyses were the best choice for modelling fracture outcomes when applied in a specified high-risk population. In addition to superior statistical methodology, they utilized RCT cohorts that are more representative of higher risk patients requiring treatment (osteoporotic women > or =65 years with a prevalent vertebral fracture).
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Affiliation(s)
- J D Adachi
- Department of Medicine, St Joseph's, Healthcare-McMaster University, 25 Charlton Avenue East, Suite 501, Hamilton, Ontario, L8N 1Y2, Canada.
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125
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van Schoor NM, Yu H, Bobula J, Lips P. Cross-geographic region differences in quality of life in women with and without vertebral fracture. Osteoporos Int 2009; 20:1759-66. [PMID: 19238305 DOI: 10.1007/s00198-009-0853-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 01/29/2009] [Indexed: 12/21/2022]
Abstract
SUMMARY Not much is known about cross-geographic region differences in quality of life (QoL) in women with and without prevalent vertebral fractures (VFX). QoL differed between continents, countries, and ethnicities. The observed differences in QoL mostly appeared larger than the difference in QoL between women with or without mild to moderate VFX. INTRODUCTION Quality of life (QoL) is an increasingly important outcome measure in randomized controlled trials and cost-utility studies. However, not much is known about cross-geographic region differences in QoL. The objective of this study was to describe the cross-geographic region differences in QoL in women with and without mild to moderate prevalent vertebral fractures (VFX). METHODS The study was performed using baseline data of the bazedoxifene study. The study was carried out in 25 countries in six continents (n = 7117). QoL was assessed using the index and Visual Analogue Scale (VAS) scores of the EQ-5D, Qualeffo-41, and Women's Health Questionnaire (WHQ). VFX were assessed using semi-quantitative and quantitative morphometric methods. RESULTS In general, all four instruments followed more or less the same pattern. In most analyses, the reported QoL was lowest in Asia and Europe and highest in North America and Oceania. To examine the influence of ethnicity, North and South America were stratified on race. In both continents, a lower QoL was observed in Hispanic people. CONCLUSIONS QoL differed between continents, countries, and ethnicities. The observed differences in QoL appeared larger between most continents and countries than the difference in QoL between women with or without mild to moderate VFX.
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Affiliation(s)
- N M van Schoor
- EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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Middleton ET, Gardiner ED, Steel SA. Which women should be selected for vertebral fracture assessment? Comparing different methods of targeting VFA. Calcif Tissue Int 2009; 85:203-10. [PMID: 19609737 DOI: 10.1007/s00223-009-9268-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 06/04/2009] [Indexed: 10/20/2022]
Abstract
Vertebral fracture assessment (VFA) is a potential screening tool for vertebral fractures, but it is uncertain how to optimize the selection of women for VFA. We investigate the use of a probability score (VFscore) to select women for VFA screening and compare this to other means of targeting VFA. We identified 1,572 treatment-naive women over age 65 who had undergone routine VFA screening. Risk factors for fracture on VFA were identified using multivariate logistic regression, and a VFscore was created. Different thresholds of VFscore were examined and compared to using BMD as a means of targeting screening. After multivariate logistic regression, the risk factors significantly associated with the presence of a fracture on VFA were age, femoral neck BMD, prior clinical fracture, and height loss/kyphosis. The VFscore derived from these factors had a 65.5% sensitivity and a 65.5% specificity for determining vertebral fracture status. For equal resource requirements, the VFscore identified more women with fracture than using BMD category to target VFA. Compared to routinely screening all women, VFscore enabled a 30% reduction in the number of women undergoing VFA while still identifying >90% of women with a vertebral fracture. Overall, a large proportion of the population is required to undergo VFA in order to ensure that the majority of women with a vertebral fracture are selected for screening. The VFscore increased the efficiency of VFA screening to a modest degree compared to screening routinely or according to BMD category.
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Affiliation(s)
- Edward T Middleton
- Centre for Metabolic Bone Disease, Hull Royal Infirmary, Brocklehurst Building, 220-236 Anlaby Road, Hull, HU3 2RW, UK.
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127
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Kerkeni S, Kolta S, Fechtenbaum J, Roux C. Spinal deformity index (SDI) is a good predictor of incident vertebral fractures. Osteoporos Int 2009; 20:1547-52. [PMID: 19137350 DOI: 10.1007/s00198-008-0832-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 12/12/2008] [Indexed: 01/02/2023]
Abstract
UNLABELLED The spinal deformity index is a convenient tool to quantify the number and the severity of prevalent vertebral fractures. It is a predictor of the risk of sustaining incident vertebral fracture. This quantification must be taken into account to improve management of patients. INTRODUCTION Prevalent fractures are strong risk factors for subsequent fractures. METHODS The study subjects were women from the placebo groups of two studies of strontium ranelate in postmenopausal osteoporosis (N = 723 and 637 patients, respectively). Three lateral radiographs of the spine were obtained at baseline and annually over 3 years, according to standardized procedures. The semiquantitative visual assessment of each vertebra from T4 to L4 was performed by the same reader throughout the study. A spinal deformity index (SDI) was calculated by summing for each patient the grade of each vertebra from T4 to L4. RESULTS There was a linear relationship between baseline SDI and the 3-year incidence of vertebral fracture (adjusted R(2) = 0.76). The 3-year incidence of vertebral fractures was different among the tertiles of baseline SDI: 17.3 +/- 3.6%, 25.4 +/- 2.6%, and 47.6 +/- 3.1% from the lowest to the highest, respectively. There was no relationship between SDI and non-vertebral fractures incidence. CONCLUSION SDI is a good predictor of incident vertebral fractures. Patients with highest SDI should receive highest priority to treatment.
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Affiliation(s)
- S Kerkeni
- Cochin Hospital, Rheumatology Department, Paris Descartes University, Paris, France
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128
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Abstract
Vertebral fractures resulting from osteoporosis are a significant cause of morbidity and mortality in the aging population and are commonly seen in the hospital setting. Appropriately assessing and treating these conditions continues to be a challenge. This article is an evidence-based clinical update on the evaluation and management options of acute vertebral fractures, ranging from conservative treatment to surgical intervention. Hospitalists can play an influential role in the management of osteoporosis.
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Affiliation(s)
- Abby N Agulnek
- Division of Hospital Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
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129
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Buckley JM, Parmeshwar R, Deviren V, Ames CP. An improved metric for quantifying the stiffnesses of intact human vertebrae. Proc Inst Mech Eng H 2009; 223:537-43. [PMID: 19623907 DOI: 10.1243/09544119jeim524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Accurately quantifying the compressive stiffnesses of whole human vertebrae is important in the development of new treatment regimes for fractures due to osteoporosis or metastatic involvement. Two methods are commonly used to quantify compressive stiffnesses of whole vertebrae: first, the maximum slope of the force-deformation curve over a 0.2 per cent strain window; second, the slope of the best-fit line to the load-deflection curve over a specified loading range. Because the whole bone load-displacement response is non-linear, these two measurement systems yield different stiffness values for the same set of experimental data. Thus, the goal of this study was to develop and validate a standard method for deriving the whole bone stiffnesses of human vertebrae. Data from uniaxial compression tests on isolated human thoracic vertebrae (N=30 from 24 donors; T7-T10; age, 84 +/- 10, seven male, and 17 female) were analysed using the two aforementioned stiffness measurement techniques. A sensitivity analysis was also conducted whereby stiffness values were calculated for strain windows ranging from 0.05 per cent to 10 per cent. The results showed that the whole vertebra stiffness was sensitive to the calculation method. Using strain window approaches, the calculated stiffness was erratic at small strain ranges (less than 0.75 per cent), but it began to stabilize at 1 per cent strain. Comparing the historical measurement techniques versus the new standard, it was found that the 1 per cent and 0.2 per cent strain window techniques were well correlated (R2 = 0.91; p < 0.01); however, compared with the 1 per cent strain window method, the 0.2 per cent technique consistently overestimated stiffness and had five times the sensitivity to small changes in strain window magnitude. In conclusion, it is recommended that the 1 per cent strain window technique is adopted as a new standard for measuring the whole bone compressive stiffnesses of human vertebrae based on this method's superior level of accuracy and repeatability when compared with current techniques. The adoption of such a standard in the biomechanics field is important because it allows for inter-study comparisons of new orthopaedic treatments, such as vertebroplasty products.
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Affiliation(s)
- J M Buckley
- Biomedical Testing Facility, UCSF/SFGH Orthopaedic Trauma Institute, University of California, San Fransisco, CA 94143, USA
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130
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Mermerci Başkan B, Pekin Doğan Y, Sivas F, Bodur H, Ozoran K. The relation between osteoporosis and vitamin D levels and disease activity in ankylosing spondylitis. Rheumatol Int 2009; 30:375-81. [PMID: 19685057 DOI: 10.1007/s00296-009-0975-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Accepted: 05/20/2009] [Indexed: 01/22/2023]
Abstract
In this study, the relation between osteoporosis and vitamin D and the disease activity in patients with ankylosing spondylitis (AS) was investigated. A hundred patients with AS and 58 healthy individuals were included in the study. In addition to the routine blood and urine tests, serum 25-(OH)D3, parathormone (PTH), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total calcium, ionized calcium, and phosphorous levels of all participants were also measured. Bone mineral density (BMD) measurements were performed at the anterior-posterior and lateral lumbar and femur regions. Anterior-posterior and lateral thoracic and lumbosacral radiography was performed on all participants. The disease activity was evaluated by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional status by Bath Ankylosing Spondylitis Functional Index (BASFI), and mobility by Bath Ankylosing Spondylitis Metrology Index (BASMI). In the patient group, BMD values obtained from the lateral lumbar and femur regions and serum vitamin D levels were lower than the control group. A negative relation was determined between the lateral lumbar BMD values and ESR, CRP, and BASDAI scores of patients with AS. The ESR, CRP levels, and BASMI scores of the AS patients with osteoporosis were significantly higher, when compared to patients without osteoporosis. The negative correlation between serum 25-(OH)D3 level and ESR, CRP levels did not reach a statistically significant level in patients with AS; the positive correlation between PTH levels and ESR, and the negative correlation between CRP and BASDAI also did not reach a statistically significant level. Vitamin D deficiency in AS may indirectly lead to osteoporosis by causing an increase in the inflammatory activity. The present authors believe that it would be beneficial to monitorize vitamin D levels together with BMD measurements in order to determine the patients under osteoporosis risk.
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Affiliation(s)
- Bedriye Mermerci Başkan
- Department of Physical Therapy, Ankara Numune Education and Research Hospital, 86 Sokak, 9/16 Emek, Ankara, Turkey.
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Greendale GA, Huang MH, Karlamangla AS, Seeger L, Crawford S. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: results of a randomized controlled trial. J Am Geriatr Soc 2009; 57:1569-79. [PMID: 19682114 DOI: 10.1111/j.1532-5415.2009.02391.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To assess whether a specifically designed yoga intervention can reduce hyperkyphosis. DESIGN A 6-month, two-group, randomized, controlled, single-masked trial. SETTING Community research unit. PARTICIPANTS One hundred eighteen women and men aged 60 and older with a kyphosis angle of 40 degrees or greater. Major exclusions were serious medical comorbidity, use of assistive device, inability to hear or see adequately for participation, and inability to pass a physical safety screen. INTERVENTION The active treatment group attended hour-long yoga classes 3 days per week for 24 weeks. The control group attended a monthly luncheon and seminar and received mailings. MEASUREMENTS Primary outcomes were change (baseline to 6 months) in Debrunner kyphometer-assessed kyphosis angle, standing height, timed chair stands, functional reach, and walking speed. Secondary outcomes were change in kyphosis index, flexicurve kyphosis angle, Rancho Bernardo Blocks posture assessment, and health-related quality of life (HRQOL). RESULTS Compared with control participants, participants randomized to yoga experienced a 4.4% improvement in flexicurve kyphosis angle (P=.006) and a 5% improvement in kyphosis index (P=.004). The intervention did not result in statistically significant improvement in Debrunner kyphometer angle, measured physical performance, or self-assessed HRQOL (each P>.1). CONCLUSION The decrease in flexicurve kyphosis angle in the yoga treatment group shows that hyperkyphosis is remediable, a critical first step in the pathway to treating or preventing this condition. Larger, more-definitive studies of yoga or other interventions for hyperkyphosis should be considered. Targeting individuals with more-malleable spines and using longitudinally precise measures of kyphosis could strengthen the treatment effect.
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Affiliation(s)
- Gail A Greendale
- Division of Geriatrics, Geffen School of Medicine, University of California at Los Angeles, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095, USA.
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132
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Kelton CML, Pasquale MK. Evaluating the Claim of Enhanced Persistence: The Case of Osteoporosis and Implications for Payers. Med Decis Making 2009; 29:690-706. [DOI: 10.1177/0272989x09336143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cost-effectiveness analysis (CEA) has been widely used in evaluating treatments for osteoporosis. To study the claim of enhanced persistence, this research determined the effects of persistence (the proportion of individuals who remain on treatment) and efficacy on incremental cost-effectiveness ratios (ICERs) for bisphosphonate treatment relative to no bisphosphonate treatment in the United States. For 2 age groups, 55 to 59 and 75 to 79, the authors relied on published fracture rates and applied them to 1000 postmenopausal osteoporotic patients with bone mineral density (BMD) T score ≤−2.5 during 3 years of treatment. After developing an algebraic ICER, with effectiveness measured by either quality-adjusted life years (QALYs) gained or number of fractures averted, they determined the effects of persistence and efficacy and then calibrated the model to variable estimates from the literature. For the younger (older) cohort, the cost per fracture averted was $66,606 ($18,256), consistent with a validated Markov simulation model. The effect of a 1 percentage point change in vertebral efficacy was 24 (5) times the effect of a 1 percentage point change in persistence for the younger cohort when QALYs (fractures) were involved. Nonvertebral efficacy had approximately 27 (9) times the effect of persistence. For the older cohort, the ratios were 15 (4.5) and 33 (10) for vertebral and nonvertebral fractures, respectively. In evaluating the claim of enhanced persistence, formulary decision makers need to exercise caution to ensure that efficacy is not compromised. Two drugs would have to be virtually identical in efficacy for better persistence to improve cost-effectiveness.
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Prediction of vertebral strength under loading conditions occurring in activities of daily living using a computed tomography-based nonlinear finite element method. Spine (Phila Pa 1976) 2009; 34:1464-9. [PMID: 19525837 DOI: 10.1097/brs.0b013e3181a55636] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A clinical study on osteoporotic vertebral strength in daily living using a computed tomography (CT)-based nonlinear finite element (FE) model. OBJECTIVE To evaluate the differences in predicted fracture strength of osteoporotic vertebral bodies among the different loading conditions that are occurring in the activities of daily living. SUMMARY OF BACKGROUND DATA FE model has been reported to predict vertebral strength in uniaxial loading, but forward bending load plays an important role in osteoporotic vertebral fractures. METHODS Strengths of the second lumbar vertebra in 41 female patients with postmenopausal osteoporosis were analyzed using a nonlinear CT-based FE method. Three different loading conditions were adopted uniaxial compression, forward bending, and erect standing. The same boundary condition was used for all loading conditions. Predicted strengths under forward bending and erect standing were compared with that under uniaxial compression and differences in strength were statistically analyzed. RESULTS The regression equation relating strength under uniaxial compression to that under erect standing was expressed as y = 0.8912x + 19.332 (R = 0.9522), whereas the equation relating uniaxial compression to forward bending was y = 0.7033x + 55.071 (R = 0.8342). Both relationships were significant, but the correlation between forward bending and uniaxial compression was not strong, while strength was lower under forward bending than under uniaxial compression according to the Friedman multiple comparison test (P = 0.00017). CONCLUSION Strength under forward bending correlated significantly to that under uniaxial compression, but the correlation was not strong. Therefore, in osteoporotic patients, both uniaxial compression and forward bending should be assessed to evaluate fracture risk in daily living using a CT-based FE method.
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Bouxsein ML, Chen P, Glass EV, Kallmes DF, Delmas PD, Mitlak BH. Teriparatide and raloxifene reduce the risk of new adjacent vertebral fractures in postmenopausal women with osteoporosis. Results from two randomized controlled trials. J Bone Joint Surg Am 2009; 91:1329-38. [PMID: 19487509 DOI: 10.2106/jbjs.h.01030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vertebral fractures increase the risk of new vertebral fractures; however, we are not aware of any study addressing the risk of new vertebral fractures adjacent to existing vertebral fractures. Therefore, we sought to determine the influence of the number and severity of prevalent (preexisting) vertebral fractures on the risk of new adjacent vertebral fractures and to determine whether teriparatide (rhPTH [recombinant human parathyroid hormone] [1-34]) or raloxifene treatment reduces the incidence of adjacent vertebral fractures in postmenopausal women with osteoporosis. METHODS Data from the Fracture Prevention Trial and the Multiple Outcomes of Raloxifene Evaluation trial were analyzed to determine the incidences of new adjacent and new nonadjacent vertebral fractures in the placebo groups and the effect of treatment with raloxifene and teriparatide on the incidence of new adjacent vertebral fractures as compared with that of new nonadjacent vertebral fractures. RESULTS Of 1226 untreated postmenopausal women with one or more prevalent vertebral fractures at baseline, 196 (16.0%) had a total of 292 new vertebral fractures during the two-year follow-up period, with 108 (8.8%) of the 1226 women having at least one new fracture adjacent to a prevalent fracture. Of the 292 new vertebral fractures, 136 (47%) were adjacent to a previously existing vertebral fracture. The risk of a new adjacent vertebral fracture was 2.5-fold higher than the risk of a new nonadjacent vertebral fracture (4.03% compared with 1.59%). The incidence of new adjacent vertebral fractures increased with both the number and the severity of prevalent vertebral fractures. Teriparatide reduced the risk of any new, new adjacent, and new nonadjacent vertebral fractures by 72%, 75%, and 70%, respectively, compared with the rates in the placebo group. Similarly, compared with the placebo, raloxifene treatment reduced the risk of any new vertebral fracture, new adjacent vertebral fracture, and new nonadjacent vertebral fracture by 54%, 54%, and 53%, respectively. CONCLUSIONS In untreated postmenopausal women with osteoporosis, nearly half of the incident vertebral fractures occur adjacent to an existing vertebral fracture. Both teriparatide and raloxifene can significantly reduce the occurrence of new adjacent and nonadjacent vertebral fractures.
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Inderjeeth CA, Foo ACH, Lai MMY, Glendenning P. Efficacy and safety of pharmacological agents in managing osteoporosis in the old old: review of the evidence. Bone 2009; 44:744-51. [PMID: 19130909 DOI: 10.1016/j.bone.2008.12.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 10/31/2008] [Accepted: 12/08/2008] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Osteoporosis and fracture risk increase exponentially in postmenopausal females. This places a significant burden in terms of morbidity, mortality and costs that are likely to increase with an ageing population. Despite this there is very limited data on pharmacological management of osteoporosis in this high risk group. OBJECTIVES OF THIS REVIEW: To review the published literature on the clinical efficacy and safety of specific anti osteoporosis treatments in the reduction in fracture risk in females >or=75 years of age. The following major endpoints were used in this review: SEARCH METHODS FOR IDENTIFICATION OF STUDIES: We performed an electronic search of Medline (1970 to June 2007) and the Cochrane Library (1996 to June 2007). Our search strategy included MeSH terms for osteoporosis and treatments. We reviewed the reference list of identified articles for additional relevant published trials. RESULTS Two hundred and fifty-two potentially relevant abstracts were identified. Only six publications were deemed to meet full eligibility criteria and one met most criteria. There is evidence for significant vertebral fracture relative risk reduction(RR) at 1 year for Risedronate (RR 81%; p<0.001), Teriparatide (RR 65%; p<0.05) and Strontium Ranelate (RR 59%; p=0.002) and 3 years for Risedronate (RR 44%; p=0.003), Alendronate (RR 38%; p<0.05) and Strontium Ranelate (RR 32%; p=0.013). There is evidence for significant non-vertebral fracture relative risk reduction at 1 year for Strontium Ranelate (RR 41%; p=0.027) but not Teriparatide (p=0.66) and 3 years for Strontium Ranelate (RR 31%; p=0.011) but not Risedronate (p=0.66). The only study to report a reduction in hip fracture at 3 years is the TROPOS study with Strontium Ranelate (RR 36%; p=0.046). DISCUSSION This review reinforces the irony that the least evidence is available for fragility fracture reduction in the group at greatest risk; the old old and those with non vertebral and hip fracture. Although there is good evidence for the benefit of the bisphosphonates (Alendronate and Risedronate), Teriparatide and Strontium Ranelate in vertebral fracture reduction, there are very limited data for non vertebral and hip fracture reduction. Strontium Ranelate is the only agent to date that has demonstrated a reduction in non vertebral and hip fracture events in this high risk elderly female population. Perhaps we need to adopt different strategies in managing older patients with osteoporosis as their fracture risks and treatment strategies may be quite different from younger populations.
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Koduganti RR, Gorthi C, Reddy PV, Sandeep N. Osteoporosis: "A risk factor for periodontitis". J Indian Soc Periodontol 2009; 13:90-6. [PMID: 20407657 PMCID: PMC2847131 DOI: 10.4103/0972-124x.55841] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2009] [Accepted: 05/22/2009] [Indexed: 01/05/2023] Open
Abstract
Aging is one of the major health challenges today. Most of the diseases related to aging, lead to significantly increased morbidity and mortality and higher public expenditure of funds. The interconnection between socio-economic conditions and social vulnerability is reflected in precarious states of health with prominence of high rates of osteoporosis and periodontal disease.Both these diseases have been highlighted in public health because of the impact caused by bone fracture and tooth loss. Thus, the elderly could help live a healthier and more meaningful life with the prevention of these diseases.
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Affiliation(s)
- Rekha Rani Koduganti
- Professor and H.O.D, Department of Periodontics, Panineeya Mahavidhyalaya Institute of Dental Sciences and Research, Kamala Nagar, Dilsukhnagar, Hyderabad - 500 060, India
| | - Chandana Gorthi
- Sr. Lecturer, Department of Periodontics, Panineeya Mahavidhyalaya Institute of Dental Sciences and Research, Kamala Nagar, Dilsukhnagar, Hyderabad - 500 060, India
| | - P. Veerendranath Reddy
- Sr. Lecturer, Department of Periodontics, Panineeya Mahavidhyalaya Institute of Dental Sciences and Research, Kamala Nagar, Dilsukhnagar, Hyderabad - 500 060, India
| | - N. Sandeep
- Reader, Department of Periodontics, Panineeya Mahavidhyalaya Institute of Dental Sciences and Research, Kamala Nagar, Dilsukhnagar, Hyderabad - 500 060, India
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Reid DM, Devogelaer JP, Saag K, Roux C, Lau CS, Reginster JY, Papanastasiou P, Ferreira A, Hartl F, Fashola T, Mesenbrink P, Sambrook PN. Zoledronic acid and risedronate in the prevention and treatment of glucocorticoid-induced osteoporosis (HORIZON): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet 2009; 373:1253-63. [PMID: 19362675 DOI: 10.1016/s0140-6736(09)60250-6] [Citation(s) in RCA: 311] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Persistent use of glucocorticoid drugs is associated with bone loss and increased fracture risk. Concurrent oral bisphosphonates increase bone mineral density and reduce frequency of vertebral fractures, but are associated with poor compliance and adherence. We aimed to assess whether one intravenous infusion of zoledronic acid was non-inferior to daily oral risedronate for prevention and treatment of glucocorticoid-induced osteoporosis. METHODS This 1-year randomised, double-blind, double-dummy, non-inferiority study of 54 centres in 12 European countries, Australia, Hong Kong, Israel, and the USA, tested the effectiveness of 5 mg intravenous infusion of zoledronic acid versus 5 mg oral risedronate for prevention and treatment of glucocorticoid-induced osteoporosis. 833 patients were randomised 1:1 to receive zoledronic acid (n=416) or risedronate (n=417). Patients were stratified by sex, and allocated to prevention or treatment subgroups dependent on duration of glucocorticoid use immediately preceding the study. The treatment subgroup consisted of those treated for more than 3 months (272 patients on zoledronic acid and 273 on risedronate), and the prevention subgroup of those treated for less than 3 months (144 patients on each drug). 62 patients did not complete the study because of adverse events, withdrawal of consent, loss to follow-up, death, misrandomisation, or protocol deviation. The primary endpoint was percentage change from baseline in lumbar spine bone mineral density. Drug efficacy was assessed on a modified intention-to-treat basis and safety was assessed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT00100620. FINDINGS Zoledronic acid was non-inferior and superior to risedronate for increase of lumbar spine bone mineral density in both the treatment (least-squares mean 4.06% [SE 0.28] vs 2.71% [SE 0.28], mean difference 1.36% [95% CI 0.67-2.05], p=0.0001) and prevention (2.60% [0.45] vs 0.64% [0.46], 1.96% [1.04-2.88], p<0.0001) subgroups at 12 months. Adverse events were more frequent in patients given zoledronic acid than in those on risedronate, largely as a result of transient symptoms during the first 3 days after infusion. Serious adverse events were worsening rheumatoid arthritis for the treatment subgroup and pyrexia for the prevention subgroup. INTERPRETATION A single 5 mg intravenous infusion of zoledronic acid is non-inferior, possibly more effective, and more acceptable to patients than is 5 mg of oral risedronate daily for prevention and treatment of bone loss that is associated with glucocorticoid use.
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Prevrhal S, Krege JH, Chen P, Genant H, Black DM. Teriparatide vertebral fracture risk reduction determined by quantitative and qualitative radiographic assessment. Curr Med Res Opin 2009; 25:921-8. [PMID: 19250060 DOI: 10.1185/03007990902790993] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Most registration studies for new osteoporosis drugs have used a combination of quantitative morphometry (QM) and visual semiquantitative reading (SQ) to define vertebral fractures. However, in the pivotal teriparatide Fracture Prevention Trial (ClinicalTrials.gov Identifier: NCT00670501), vertebral fractures were previously defined only by the SQ methodology. The objective of this study was to define the effect of teriparatide on the incidence of vertebral fractures defined by QM plus SQ assessment. RESEARCH DESIGN AND METHODS Radiographs from the Fracture Prevention Trial placebo- and teriparatide 20 microg/day groups were re-assessed in blinded fashion, defining incident vertebral fractures for vertebrae meeting all of the following requirements: (a) 20% decrease in height by QM, (b) a corresponding 4 mm decrease in height (c) an increase of at least one grade by visual SQ assessment by a radiologist. RESULTS By this methodology, vertebral fracture risk was reduced in the teriparatide versus placebo group by 84% (RR = 0.16, p < 0.001). The risk of two or more vertebral fractures was also significantly reduced by 94% (RR = 0.06, p < 0.001). The fractures in the teriparatide group were of lesser severity than the fractures in the placebo group. The absolute benefit of teriparatide was greatest in those patients with the highest number and severity of prevalent vertebral fractures. CONCLUSIONS As assessed by QM plus SQ, teriparatide reduced the incidence of vertebral fractures.
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Affiliation(s)
- Sven Prevrhal
- Department of Epidemiology and Biostatistics, University of California-San Francisco, 185 Berry St., San Francisco, CA 94107, USA
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Yeni YN, Kim DG, Divine GW, Johnson EM, Cody DD. Human cancellous bone from T12-L1 vertebrae has unique microstructural and trabecular shear stress properties. Bone 2009; 44:130-6. [PMID: 18848654 PMCID: PMC2667817 DOI: 10.1016/j.bone.2008.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 09/04/2008] [Accepted: 09/08/2008] [Indexed: 11/27/2022]
Abstract
Increase of trabecular stress variability with loss of bone mass has been implicated as a mechanism for increased cancellous bone fragility with age and disease. In the current study, a previous observation that trabecular shear stress estimates vary along the human spine such that the cancellous tissue from the thoracic 12 (T12)-lumbar 1 (L1) junction experiences the highest trabecular stresses for a given load was tested as a formal hypothesis using multiple human spines. Thoracic 4, T5, T7, T9, T10, T12, L1, L2, L4 and L5 vertebrae from 10 human cadaver spines were examined. One specimen in the central anterior region was cored in the supero-inferior (SI) direction and another in the postero-lateral region was cored in the transverse (TR) direction from each vertebra. Micro-CT-based large-scale finite element models were constructed for each specimen and compression in the long axis of the cylindrical specimens was simulated. Cancellous bone modulus and the mean, the standard deviation, variability and amplification of trabecular von Mises stresses were computed. Bone volume fraction, trabecular number, trabecular thickness, trabecular separation, connectivity density and degree of anisotropy were calculated using 3D stereology. The results were analyzed using a mixed model in which spine level was modeled using a quadratic polynomial. The maximum of trabecular shear stress amplification and minimum of bone volume fraction were found in the cancellous tissue from the T12-L1 location when results from the samples of the same vertebra were averaged. When groups were separated, microstructure and trabecular stresses varied with spine level, extrema being at the T12-L1 levels, for the TR specimens only. SI/TR ratio of measured parameters also had quadratic relationships with spine level, the extrema being located at T12-L1 levels for most parameters. For microstructural parameters, these ratios approached to a value of one at the T12-L1 level, suggesting that T12-L1 vertebrae have more uniform cancellous tissue properties than other levels. The mean intercept length in the secondary principal direction of trabecular orientation could account for the variation of all mechanical parameters with spine level. Our results support that cancellous tissue from T12-L1 levels is unique and may explain, in part, the higher incidence of vertebral fractures at these levels.
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Affiliation(s)
- Yener N. Yeni
- For Correspondence: Yener N. Yeni, Ph.D., Head, Section of Biomechanics, Bone and Joint Center, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI, 48202, USA, Phone: 313-916-7592, Fax: 313-916-8064,
| | | | - George W. Divine
- Biostatistics & Research Epidemiology, Henry Ford Hospital, Detroit, MI,
| | - Evan M. Johnson
- Department of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX,
| | - Dianna D. Cody
- Department of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX,
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Guglielmi G, Muscarella S, Leone A, Peh WCG. Imaging of metabolic bone diseases. Radiol Clin North Am 2008; 46:735-54, vi. [PMID: 18922290 DOI: 10.1016/j.rcl.2008.04.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Osteoporosis is a serious public health problem. The incidence of osteoporotic fractures increases with age. As life expectancy increases, social costs associated with osteoporotic fractures will multiply exponentially. The early diagnosis of osteoporosis, thanks to evermore precise devices, becomes, therefore, fundamental to prevent complications of disease and unnecessary suffering.
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Affiliation(s)
- Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale L. Pinto 1, 71100 Foggia, Italy.
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141
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Burge RT, Worley D, Johansen A, Bhattacharyya S, Bose U. The cost of osteoporotic fractures in the UK: projections for 2000–2020. J Med Econ 2008. [DOI: 10.3111/200104051062] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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142
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Prevalence of risk factors for referring post-menopausal women for bone densitometry. The INSTANT study. Joint Bone Spine 2008; 75:702-7. [DOI: 10.1016/j.jbspin.2007.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 12/12/2007] [Indexed: 12/17/2022]
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Affiliation(s)
- B E Christopher Nordin
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, North Terrace, Adelaide, 5000, SA, Australia.
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Lau AN, Ali SH, Sawka AM, Thabane L, Papaioannou A, Gafni A, Adachi JD. Improvement in health-related quality of life in osteoporosis patients treated with teriparatide. BMC Musculoskelet Disord 2008; 9:151. [PMID: 18990249 PMCID: PMC2588585 DOI: 10.1186/1471-2474-9-151] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 11/07/2008] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Individuals with osteoporosis and recent vertebral fractures suffer from pain and impaired health-related quality of life (HRQL). To determine whether patients with osteoporosis treated with teriparatide experienced improvement in HRQL and pain symptoms after several months of therapy. METHODS We retrospectively studied a sample of osteoporosis patients treated with teriparatide in a Canadian rheumatology practice. We included patients that received teriparatide therapy with baseline and follow-up Mini-Osteoporosis Quality of Life Questionnaire (OQLQ) data. Follow-up data was measured at three or six months. We used a paired Student's t-test to compare baseline and follow-up measurements for each of the questionnaire's ten questions (five domains). Statistical analysis was also repeated to only include patients who suffered a prior vertebral fracture. RESULTS 57 patients were included in the study, including 47 women. The mean age was 63.8 years (standard deviation 12.1 years). About sixty five percent (37/57) had previously sustained one or more osteoporotic fractures and about 38.6% (22/57) had suffered a prior vertebral fracture. About 44% (25/57) of individuals were taking one or more types of pain medications regularly prior to starting therapy. At follow-up, significant improvements were observed in the OQLQ domains of pain symptoms. This was seen when all patients on teriparatide were included, and also when only patients with prior vertebral fractures were included. There was also an improvement in emotional functioning, relating to fear of falling at 3 months follow-up (p = 0.019). Respondents also reported improvement in the domain of activities of daily living, relating to vacuuming at 6 months follow-up (p = 0.036), and an improvement in the leisure domain, relating to ease of traveling in the prior vertebral fracture population at 3 months follow-up (p = 0.012). However, there was no significant improvement observed in the domains of physical functioning. Participants also reported a decrease in need for pain medications, with 26% (15/57) requiring analgesics at the time of follow-up. CONCLUSION Teriparatide use may be associated with improvements in HRQL in osteoporosis patients, in particular alleviation of pain symptoms. These results were especially evident in patients with a history of vertebral fractures. These findings should be confirmed in larger prospective studies with a suitable control group.
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Affiliation(s)
- Arthur N Lau
- Division of Rheumatology and Department of Medicine, St, Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada.
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Vondracek SF, Minne P, McDermott MT. Clinical challenges in the management of osteoporosis. Clin Interv Aging 2008; 3:315-29. [PMID: 18686753 PMCID: PMC2546475 DOI: 10.2147/cia.s2539] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
While knowledge regarding the diagnosis and treatment of osteoporosis has expanded dramatically over the last few years, gaps in knowledge still exist with guidance lacking on the appropriate management of several common clinical scenarios. This article uses fictional clinical scenarios to help answer three challenging questions commonly encountered in clinical practice. The first clinical challenge is when to initiate drug therapy in a patient with low bone density. It is estimated that 34 million America have low bone density and are at a higher risk for low trauma fractures. Limitations of using bone mineral density alone for drug therapy decisions, absolute risk assessment and evidence for the cost-effectiveness of therapy in this population are presented. The second clinical challenge is the prevention and treatment of vitamin D deficiency. Appropriate definitions for vitamin D insufficiency and deficiency, the populations at risk for low vitamin, potential consequences of low vitamin D, and how to manage a patient with low vitamin D are reviewed. The third clinical challenge is how to manage a patient receiving drug therapy for osteoporosis who has been deemed a potential treatment failure. How to define treatment failure, common causes of treatment failure, and the approach to the management of a patient who is not responding to appropriate osteoporosis therapy are discussed.
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Affiliation(s)
- Sheryl F Vondracek
- Department of Clinical Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, CO 80045, USA.
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Vertebral fracture assessment using standard bone densitometry equipment predicts incident fractures in women. ACTA ACUST UNITED AC 2008; 4:652-3. [PMID: 18838969 DOI: 10.1038/ncpendmet0984] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 09/03/2008] [Indexed: 01/07/2023]
Abstract
Vertebral fractures are the most common fracture among the elderly, have a detrimental effect on patients' quality of life, and increase the risk of future fractures. Yet, two-thirds of vertebral fractures remain undiagnosed; therefore, improved detection methods are needed. In this Practice Point commentary, we discuss the study by McCloskey et al., in which low radiation dose imaging with a bone densitometer was used for vertebral fracture assessment (VFA) in a prospective cohort of elderly women. Participants were enrolled in a randomized, double-blind, placebo-controlled trial of the oral bisphosphonate clodronate. Prevalent vertebral fractures detected by VFA were associated with an elevated risk of subsequent osteoporotic fractures, including hip fractures. This finding remained significant after adjustment for age, weight and treatment effect, and in a few instances even after adjustment for femoral BMD. Here, we highlight the importance of identifying vertebral fractures, and the potentially substantial role of VFA in the clinical evaluation and management of patients suspected to have osteoporosis.
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Vertebral fracture assessment (VFA) with a densitometer predicts future fractures in elderly women unselected for osteoporosis. J Bone Miner Res 2008; 23:1561-8. [PMID: 18505372 DOI: 10.1359/jbmr.080515] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Low radiation dose imaging of the lateral spine acquired with a bone densitometer for vertebral fracture assessment (VFA) has great potential for clinical use. We have undertaken an evaluation of VFA in a prospective population cohort of elderly women to examine the prevalence of vertebral fractures, their ability to predict incident fractures, and their use in targeting therapy. Women (n = 5157) >or=75 yr of age living in the general community in the United Kingdom underwent posteroanterior and lateral imaging of the spine (T(4)-L(4)) with a densitometer (Hologic QDR4500A) at entry to a randomized, double-blind, controlled trial of 800 mg oral clodronate (Bonefos) or matching placebo daily over 3 yr. The women were identified from general practice registers and recruited by letter of invitation regardless of skeletal status. The proportion of vertebrae interpretable varied from 98.2% at T(12) to 57.1% at T(4), with >92% interpretable at levels between T(8) and L(3). As judged by BMD at the total hip, 19.6% of the women had osteoporosis, and the prevalence of vertebral fracture was 14.5%. Women with one or more vertebral fractures had a relative risk (RR) for incident osteoporotic fractures of 2.01 (95% CI, 1.64-2.47). The RR for hip fractures was 2.29 (95% CI, 1.63-3.21). After adjustment for age, femoral neck BMD, weight, and treatment, the RR was 1.50 (95% CI, 1.21-1.86) for osteoporotic fractures, with similar results for hip fractures (RR, 1.41; 95% CI, 0.99-2.02). For women with two or more vertebral fractures, the adjusted RRs were 1.97 (95% CI, 1.24-2.72) and 1.86 (95% CI, 1.14-3.03) for osteoporotic and hip fractures, respectively. We conclude that VFA can frequently detect vertebral fractures in a population cohort of elderly women. These fractures, like radiographic fractures, predict future clinical fractures independent of age, weight, and BMD. Having multiple vertebral fractures was associated with greater risk of incident osteoporotic fractures and hip fractures.
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Abstract
Osteoporosis represents a major public health problem through its association with fragility fractures. All osteoporotic fractures increase patient morbidity; however, fractures of the hip and vertebrae are also linked with significant mortality. The public health burden of osteoporotic fracture is likely to rise in future generations, due in part to an increase in life expectancy. Understanding the epidemiology of this disease is therefore essential in trying to develop strategies to help reduce this load. This chapter will review the epidemiology of osteoporosis, including the relationship between low bone mass and fracture. It will review the epidemiology of fractures, concentrating on the sites where the majority of age-related fractures occur. Finally it will discuss new developments in the assessment of fracture risk.
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Affiliation(s)
- Christopher Holroyd
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK
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Karlsson MK, Nordqvist A, Karlsson C. Physical activity increases bone mass during growth. Food Nutr Res 2008; 52:1871. [PMID: 19109652 PMCID: PMC2596740 DOI: 10.3402/fnr.v52i0.1871] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 07/22/2008] [Accepted: 08/10/2008] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The incidence of fragility fractures has increased during the last half of the 1990's. One important determinant of fractures is the bone mineral content (BMC) or bone mineral density (BMD), the amount of mineralised bone. If we could increase peak bone mass (the highest value of BMC reached during life) and/or decrease the age-related bone loss, we could possibly improve the skeletal resistance to fracture. OBJECTIVE This review evaluates the importance of exercise as a strategy to improve peak bone mass, including some aspects of nutrition. DESIGN PUBLICATIONS WITHIN THE FIELD WERE SEARCHED THROUGH MEDLINE (PUBMED) USING THE SEARCH WORDS: exercise, physical activity, bone mass, bone mineral content, bone mineral density, BMC, BMD, skeletal structure and nutrition. We included studies dealing with exercise during growth and young adolescence. We preferably based our inferences on randomised controlled trials (RCT), which provide the highest level of evidence. RESULTS Exercise during growth increases peak bone mass. Moderate intensity exercise intervention programs are beneficial for the skeletal development during growth. Adequate nutrition must accompany the exercise to achieve the most beneficial skeletal effects by exercise. CONCLUSION Exercise during growth seems to enhance the building of a stronger skeleton through a higher peak bone mass and a larger bone size.
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Affiliation(s)
- Magnus K. Karlsson
- Clinical and Osteoporosis Research Unit, Department of Clinical Sciences and Department of Orthopaedics, Malmö University Hospital, Lund University, Malmö, Sweden
| | - Anders Nordqvist
- Clinical and Osteoporosis Research Unit, Department of Clinical Sciences and Department of Orthopaedics, Malmö University Hospital, Lund University, Malmö, Sweden
| | - Caroline Karlsson
- Clinical and Osteoporosis Research Unit, Department of Clinical Sciences and Department of Orthopaedics, Malmö University Hospital, Lund University, Malmö, Sweden
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Vertebral Fracture Assessment: the 2007 ISCD Official Positions. J Clin Densitom 2008; 11:92-108. [PMID: 18442755 DOI: 10.1016/j.jocd.2007.12.008] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 12/05/2007] [Indexed: 12/15/2022]
Abstract
Vertebral fracture assessment (VFA) is an established, low radiation method for detection of prevalent vertebral fractures. Vertebral fractures are usually not recognized clinically at the time of their occurrence, but their presence indicates a substantial risk for subsequent fractures independent of bone mineral density. Significant evidence supporting VFA use for many post-menopausal women and older men has accumulated since the last ISCD Official Position Statement on VFA was published. The International Society for Clinical Densitometry considered the following issues at the 2007 Position Development Conference: (1) What are appropriate indications for Vertebral Fracture Assessment; (2) What is the most appropriate method of vertebral fracture detection with VFA; (3) What is the sensitivity and specificity for detection of vertebral fractures with this method; (4) When should additional spine imaging be performed following a VFA; and (5) What are the reporting obligations for those interpreting VFA images?
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