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Costa R, De Miguel R, García C, de Asúa DR, Castañeda S, Moldenhauer F, Suárez C. Bone Mass Assessment in a Cohort of Adults With Down Syndrome: A Cross-Sectional Study. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 55:315-324. [PMID: 28972872 DOI: 10.1352/1934-9556-55.5.315] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Differences in bone mineral density (BMD) have been observed between adults with Down syndrome (DS) and the general population. The purpose of this article is to describe the prevalence of bone mass disorders in a cohort of adults with DS and their predisposing factors. We performed a cross-sectional study of 104 consecutively recruited adults with DS from an outpatient clinic of a tertiary care hospital in Madrid, Spain. We recorded epidemiological and anthropometric data, nutritional variables, coexisting clinical conditions, and laboratory variables. BMD was measured at the lumbar spine, total hip, and femoral neck using dual-energy X-ray absorptiometry. The prevalence of osteopenia ranged from 48% to 52%, and that of osteoporosis ranged from 19% to 22% depending on the site of measurement (femoral neck or lumbar spine, respectively). Age was the greatest risk factor associated for lower BMD, with similar bone mass accrual curve but with lower peak of BMD than the general population. We conclude that low bone mass is an extremely prevalent condition in adult patients with DS.
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Affiliation(s)
- Ramón Costa
- Ramón Costa, Rosa De Miguel, Clara García, and Diego Real de Asúa, Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Institute for Biomedical Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Rosa De Miguel
- Ramón Costa, Rosa De Miguel, Clara García, and Diego Real de Asúa, Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Institute for Biomedical Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Clara García
- Ramón Costa, Rosa De Miguel, Clara García, and Diego Real de Asúa, Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Institute for Biomedical Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Diego Real de Asúa
- Ramón Costa, Rosa De Miguel, Clara García, and Diego Real de Asúa, Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Institute for Biomedical Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Santos Castañeda
- Santos Castañeda, Department of Rheumatology, Hospital Universitario de La Princesa, Madrid, Spain; and
| | - Fernando Moldenhauer
- Fernando Moldenhauer and Carmen Suárez, Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Institute for Biomedical Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Suárez
- Fernando Moldenhauer and Carmen Suárez, Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Institute for Biomedical Research, Hospital Universitario de La Princesa, Madrid, Spain
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102
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Shen G, Ren H, Qiu T, Zhang Z, Zhao W, Yu X, Huang J, Tang J, Liang D, Yao Z, Yang Z, Jiang X. Mammalian target of rapamycin as a therapeutic target in osteoporosis. J Cell Physiol 2017; 233:3929-3944. [PMID: 28834576 DOI: 10.1002/jcp.26161] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/21/2017] [Indexed: 12/19/2022]
Abstract
The mechanistic target of rapamycin (mTOR) plays a key role in sensing and integrating large amounts of environmental cues to regulate organismal growth, homeostasis, and many major cellular processes. Recently, mounting evidences highlight its roles in regulating bone homeostasis, which sheds light on the pathogenesis of osteoporosis. The activation/inhibition of mTOR signaling is reported to positively/negatively regulate bone marrow mesenchymal stem cells (BMSCs)/osteoblasts-mediated bone formation, adipogenic differentiation, osteocytes homeostasis, and osteoclasts-mediated bone resorption, which result in the changes of bone homeostasis, thereby resulting in or protect against osteoporosis. Given the likely importance of mTOR signaling in the pathogenesis of osteoporosis, here we discuss the detailed mechanisms in mTOR machinery and its association with osteoporosis therapy.
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Affiliation(s)
- Gengyang Shen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hui Ren
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting Qiu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhida Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenhua Zhao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiang Yu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinjing Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingjing Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De Liang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhensong Yao
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhidong Yang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Laboratory Affiliated to National Key Discipline of Orthopaedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
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103
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Fobelo Lozano MJ, Sánchez-Fidalgo S. Adherence and preference of intravenous zoledronic acid for osteoporosis versus other bisphosphonates. Eur J Hosp Pharm 2017; 26:4-9. [PMID: 31157088 DOI: 10.1136/ejhpharm-2017-001258] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/13/2017] [Accepted: 08/01/2017] [Indexed: 01/06/2023] Open
Abstract
Objective To evaluate adherence as well as patient preference and satisfaction of once-yearly intravenous zoledronic acid versus other bisphosphonates treatments. Methods In accordance with the PRISMA guidelines, a systematic literature search was conducted in PubMed, Cochrane Library and EMBASE databases, over the date range of 2000-2016. Following the PICO (Population, Interventions, Comparator, Outcomes) elements, eligibility criteria included: (1) participants: adults over 18 with osteoporosis and adults who were at high risk of developing low bone density as a result of chronic use of glucocorticoids; (2) intervention: adherence or patient preference/satisfaction of once-yearly zoledronic acid treatment; (3) comparator: other bisphosphonates; (4) outcome: data about adherence, persistence, compliance, preference and satisfaction criteria. Specific exclusion criteria were also applied. Results Adherence to zoledronate is only quantified in one study showing that mean proportion of days covered for zoledronic acid was greater than for ibandronate users. Three studies showed 100% of compliance to zoledronate treatment and only one study showed zoledronic acid provided the highest persistence rates. Once-yearly intravenous infusion of zoledronic acid was clearly preferred. Only one article indicated preference for schedules that were once monthly or less frequent and other preference results practically equal between once-yearly intravenous infusion or weekly oral. Although there is little evidence, adherence to osteoporosis treatment is improved with annual intravenous zoledronate regimen. Moreover, patients appear to have preference for less frequent dosing. Switching from oral to intravenous therapy, based on the opportunities offered by an integrated health management area, may allow obtaining better outcomes in adherence to osteoporosis treatment.
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Affiliation(s)
| | - Susana Sánchez-Fidalgo
- Pharmacy Service, University Hospital Valme, Seville, Spain.,Department of Pharmacology, School of Pharmacy, University of Seville, Seville, Spain
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104
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Zhu S, He H, Zhang C, Wang H, Gao C, Yu X, He C. Effects of pulsed electromagnetic fields on postmenopausal osteoporosis. Bioelectromagnetics 2017; 38:406-424. [PMID: 28665487 DOI: 10.1002/bem.22065] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 06/05/2017] [Indexed: 02/05/2023]
Abstract
Postmenopausal osteoporosis (PMOP) is considered to be a well-defined subject that has caused high morbidity and mortality. In elderly women diagnosed with PMOP, low bone mass and fragile bone strength have been proven to significantly increase risk of fragility fractures. Currently, various anabolic and anti-resorptive therapies have been employed in an attempt to retain healthy bone mass and strength. Pulsed electromagnetic fields (PEMFs), first applied in treating patients with delayed fracture healing and nonunions, may turn out to be another potential and effective therapy for PMOP. PEMFs can enhance osteoblastogenesis and inhibit osteoclastogenesis, thus contributing to an increase in bone mass and strength. However, accurate mechanisms of the positive effects of PEMFs on PMOP remain to be further elucidated. This review attempts to summarize recent advances of PEMFs in treating PMOP based on clinical trials, and animal and cellular studies. Possible mechanisms are also introduced, and the future possibility of application of PEMFs on PMOP are further explored and discussed. Bioelectromagnetics. 38:406-424, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Siyi Zhu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
- Laboratory of Endocrinology and Metabolism, Department of Endocrinology, National Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Hongchen He
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Chi Zhang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Haiming Wang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Chengfei Gao
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Xijie Yu
- Laboratory of Endocrinology and Metabolism, Department of Endocrinology, National Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Chengqi He
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, P. R. China
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105
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Abstract
BACKGROUND It is crystal clear how important healthcare providers are well-aware of reasonable knowledge on osteoporosis, because they are at the forefront of such management. However, no study has been yet assessed in the knowledge on osteoporosis among healthcare providers particularly in nurse. Therefore, we evaluated the knowledge on osteoporosis of nurses. METHODS In April 2017, 67 nurses were evaluated using a modified Facts on Osteoporosis Quiz (FOOQ). RESULTS Although nurses grasped some points of osteoporosis, their knowledge was insufficient concerning effects of weight, physical exercise and calcium intake during adolescence. CONCLUSIONS The level of knowledge on osteoporosis was evaluated in nurses, and the effect of weight, physical exercise, and calcium intake during adolescence should be focused in an educational program on osteoporosis for nurses.
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Affiliation(s)
- Chan-Ho Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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106
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Raghuvanshi A, Kumar A, Tyagi AM, Kureel J, Awasthi P, Purohit D, Mansoori MN, Shukla P, Srivastava K, Gautam AK, Saxena R, Dwivedi A, Singh D, Goel A. 3-Piperidylethoxypterocarpan: A potential bone anabolic agent that improves bone quality and restores trabecular micro-architecture in ovariectomized osteopenic rats. Mol Cell Endocrinol 2017; 448:41-54. [PMID: 28288902 DOI: 10.1016/j.mce.2017.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 12/23/2022]
Abstract
A series of new 6H-benzofuro[3, 2-c]chromenes (BFC, pterocarpans) with structure-activity relationships were investigated for their potential use in osteoporosis treatment. One of the BFCs 3-piperidylethoxypterocarpan 20 promotes osteoblast differentiation and mineralization at a dose as low as 1 pM via activation of ER/P38MAPK/BMP-2 pathway. When evaluated for in-vivo osteogenic activity in female Sprague-Dawley rats, BFC 20 increased bone mineral density and new bone formation, compared with control at 1.0 and 10.0 mg/kg/body weight by oral gavage for 30 days. The compound was devoid of any uterotrophic effect and led to the new bone formation in adult ovariectomized osteopenic rats. BFC 20 compound also inhibited bone resorption by reducing Ovx induced increase in urinary CTx, thus exhibiting both bone anabolic and anti-catabolic action. Finally, BFC 20 treatment to Ovx rats led to improved trabecular microarchitectural restoration and exhibited therapeutic potential as a dual acting anti-osteoporotic agent for the management of osteoporosis.
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Affiliation(s)
- Ashutosh Raghuvanshi
- Medicinal and Process Chemistry Division, CSIR-Central Drug Research Institute, Lucknow 226031, India
| | - Amit Kumar
- Medicinal and Process Chemistry Division, CSIR-Central Drug Research Institute, Lucknow 226031, India
| | - Abdul M Tyagi
- Endocrinology Division, CSIR-Central Drug Research Institute, Lucknow 226031, India
| | - Jyoti Kureel
- Endocrinology Division, CSIR-Central Drug Research Institute, Lucknow 226031, India
| | - Pallavi Awasthi
- Medicinal and Process Chemistry Division, CSIR-Central Drug Research Institute, Lucknow 226031, India
| | - Deepak Purohit
- Medicinal and Process Chemistry Division, CSIR-Central Drug Research Institute, Lucknow 226031, India
| | - Mohd Nizam Mansoori
- Endocrinology Division, CSIR-Central Drug Research Institute, Lucknow 226031, India
| | - Priyanka Shukla
- Endocrinology Division, CSIR-Central Drug Research Institute, Lucknow 226031, India
| | - Kamini Srivastava
- Endocrinology Division, CSIR-Central Drug Research Institute, Lucknow 226031, India
| | - Abnish K Gautam
- Endocrinology Division, CSIR-Central Drug Research Institute, Lucknow 226031, India
| | - Ruchi Saxena
- Endocrinology Division, CSIR-Central Drug Research Institute, Lucknow 226031, India
| | - Anila Dwivedi
- Endocrinology Division, CSIR-Central Drug Research Institute, Lucknow 226031, India
| | - Divya Singh
- Endocrinology Division, CSIR-Central Drug Research Institute, Lucknow 226031, India.
| | - Atul Goel
- Medicinal and Process Chemistry Division, CSIR-Central Drug Research Institute, Lucknow 226031, India.
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107
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Cosman F, Krege JH, Looker AC, Schousboe JT, Fan B, Sarafrazi Isfahani N, Shepherd JA, Krohn KD, Steiger P, Wilson KE, Genant HK. Spine fracture prevalence in a nationally representative sample of US women and men aged ≥40 years: results from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. Osteoporos Int 2017; 28:1857-1866. [PMID: 28175980 PMCID: PMC7422504 DOI: 10.1007/s00198-017-3948-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/26/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED Spine fracture prevalence is similar in men and women, increasing from <5 % in those <60 to 11 % in those 70-79 and 18 % in those ≥80 years. Prevalence was higher with age, lower bone mineral density (BMD), and in those meeting criteria for spine imaging. Most subjects with spine fractures were unaware of them. INTRODUCTION Spine fractures have substantial medical significance but are seldom recognized. This study collected contemporary nationally representative spine fracture prevalence data. METHODS Cross-sectional analysis of 3330 US adults aged ≥40 years participating in NHANES 2013-2014 with evaluable Vertebral Fracture Assessment (VFA). VFA was graded by semiquantitative measurement. BMD and an osteoporosis questionnaire were collected. RESULTS Overall spine fracture prevalence was 5.4 % and similar in men and women. Prevalence increased with age from <5 % in those <60 to 11 % in those 70-79 and 18 % in those ≥80 years. Fractures were more common in non-Hispanic whites and in people with lower body mass index and BMD. Among subjects with spine fracture, 26 % met BMD criteria for osteoporosis. Prevalence was higher in subjects who met National Osteoporosis Foundation (NOF) criteria for spine imaging (14 vs 4.7 %, P < 0.001). Only 8 % of people with a spine fracture diagnosed by VFA had a self-reported fracture, and among those who self-reported a spine fracture, only 21 % were diagnosed with fracture by VFA. CONCLUSION Spine fracture prevalence is similar in women and men and increases with age and lower BMD, although most subjects with spine fracture do not meet BMD criteria for osteoporosis. Since most (>90 %) individuals were unaware of their spine fractures, lateral spine imaging is needed to identify these women and men. Spine fracture prevalence was threefold higher in individuals meeting NOF criteria for spine imaging (∼1 in 7 undergoing VFA). Identifying spine fractures as part of comprehensive risk assessment may improve clinical decision making.
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Affiliation(s)
- F Cosman
- Regional Bone Center, Helen Hayes Hospital, Route 9W, West Haverstraw, NY, 10993, USA.
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - J H Krege
- Eli Lilly and Company, Indianapolis, IN, USA
| | - A C Looker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - J T Schousboe
- HealthPartners Institute and Park Nicollet Clinic, HealthPartners, Minneapolis, MN, USA
| | - B Fan
- Department of Radiology, University of California, San Francisco, CA, USA
| | - N Sarafrazi Isfahani
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - J A Shepherd
- Department of Radiology, University of California, San Francisco, CA, USA
| | - K D Krohn
- Eli Lilly and Company, Indianapolis, IN, USA
| | - P Steiger
- Parexel International, Waltham, MA, USA
| | | | - H K Genant
- Department of Radiology, University of California, San Francisco, CA, USA
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108
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Yeap SS, Nur Fazirah M, Nur Aisyah C, Zahari Sham SY, Samsudin IN, C. Thambiah S, Hew FL, Lim BP, Siow YS, Chan SP. Trends in post osteoporotic hip fracture care from 2010 to 2014 in a private hospital in Malaysia. Osteoporos Sarcopenia 2017; 3:112-116. [PMID: 30775514 PMCID: PMC6372761 DOI: 10.1016/j.afos.2017.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 04/28/2017] [Accepted: 05/12/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Following an osteoporotic fracture, pharmacological treatment is recommended to increase bone mineral density and prevent future fractures. However, the rate of starting treatment after an osteoporotic hip fracture remains low. The objective of this study was to survey the treatment rate following a low-trauma hip fracture at a tertiary private hospital in Malaysia over a period of 5 years. METHODS The computerised hospital discharge records were searched using the terms "hip," "femur," "femoral," "trochanteric," "fracture," or "total hip replacement" for all patients over the age of 50, admitted between 2010 and 2014. The medical charts were obtained and manually searched for demographic data and treatment information. Hip operations done for non-low-trauma-related fracture and arthritis were excluded. RESULTS Three hundred seventy patients over the age of 50 years were admitted with a hip fracture, of which 258 (69.7%) were low trauma, presumed osteoporotic, hip fractures. The median age was 79.0 years (interquartile range [IQR], 12.0). Following a hip fracture, 36.8% (95 of 258) of the patients received treatment, but out of these, 24.2% (23 of 95) were on calcium/vitamin D only. The median duration of treatment was 1 month (IQR, 2.5). In 2010, 56.7% of the patients received treatment, significantly more than subsequent years 2011-2014, where approximately only 30% received treatment. CONCLUSIONS Following a low-trauma hip fracture, approximately 72% of patients were not started on active antiosteoporosis therapy. Of those who were, the median duration of treatment was 1 month. This represents a missed opportunity for the prevention of future fractures.
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Affiliation(s)
- Swan Sim Yeap
- Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | - M.F.R. Nur Fazirah
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - C. Nur Aisyah
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Siti Yazmin Zahari Sham
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Intan Nureslyna Samsudin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Subashini C. Thambiah
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Fen Lee Hew
- Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | - Boon Ping Lim
- Department of Orthopaedic Surgery, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | - Yew Siong Siow
- Department of Orthopaedic Surgery, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | - Siew Pheng Chan
- Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
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Masterson J, Woodall T, Wilson CG, Ray L, Scott MA. Interprofessional care for patients with osteoporosis in a continuing care retirement community. J Am Pharm Assoc (2003) 2017; 56:184-8. [PMID: 27000170 DOI: 10.1016/j.japh.2016.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To assess the quality of care provided to patients with osteoporosis in a continuing care retirement community (CCRC) after implementation of an interprofessional osteoporosis clinic (OPC). Specifically, quality measures were evaluated, including dual-emission X-ray absorptiometry (DXA) screening, calcium and vitamin D supplementation, and prescription treatment of osteoporosis and low bone mass in an ambulatory independent living community. SETTING Large family medicine teaching practice that provides primary care for residents in one main practice, 5 rural satellite practices, and 2 CCRCs. An interprofessional OPC was developed at the main practice in 2005. Patients at all of the organization's sites could be referred to the main practice for osteoporosis management. A needs assessment conducted at one of the CCRCs in 2011 revealed that rates of screening and treatment were suboptimal for its residents despite availability of an off-site OPC. PRACTICE INNOVATION In 2012, a new interprofessional OPC including a physician, medical assistant, and pharmacist was replicated on-site at the CCRC so that residents had access to this service within their medical home. EVALUATION Quality measures were evaluated after implementation of the team-based OPC on-site at a CCRC and included: 1) DXA screening; 2) calcium and vitamin D supplementation; and 3) prescription treatment of osteoporosis and low bone mass. RESULTS Twenty-nine patients were seen in the new OPC from January 2012 to August 2013. Ninety-three percent had appropriate DXA testing after OPC implementation. Patients accepted pharmacist recommendations regarding calcium and vitamin D supplementation 90% and 86% of the time, respectively. All but 4 patients received appropriate treatment for osteoporosis or low bone mass. CONCLUSION Providing a team-based OPC on site in a CCRC improved quality measures for screening and treatment of osteoporosis and low bone mass.
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110
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Gillespie CW, Morin PE. Osteoporosis-Related Health Services Utilization Following First Hip Fracture Among a Cohort of Privately-Insured Women in the United States, 2008-2014: An Observational Study. J Bone Miner Res 2017; 32:1052-1061. [PMID: 28229485 DOI: 10.1002/jbmr.3079] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/20/2016] [Accepted: 01/04/2017] [Indexed: 11/09/2022]
Abstract
Timely identification and treatment of osteoporosis following hip fracture is recommended to mitigate future fracture risk, yet prior work has demonstrated a disconnect between evidence-based recommendations and real-world implementation. We sought to describe contemporary patterns of osteoporosis screening and initiation of pharmacotherapy following hip fracture based on medical and pharmacy claims in the OptumLabs™ Data Warehouse. From a national sample, we identified 8349 women aged 50+ years enrolled in private commercial or Medicare Advantage plans with no prior history of osteoporosis diagnosis, osteoporosis pharmacotherapy, or hip fracture who experienced a hip fracture between 2008 and 2013. Just 17.1% and 23.1% of these women had evidence of osteoporosis assessment and/or treatment within 6 or 12 months of their fractures, respectively. Women aged 80+ years were one-third less likely to utilize recommended services within 6 months, compared to those aged 50 to 79 years (13.8% versus 20.8%; p < 0.001). Utilization of bone mass measurement increased significantly among women aged 65+ years over the study period (p < 0.001) while declining among those aged 50 to 64 years (p = 0.2). In contrast, rates of osteoporosis pharmacotherapy remained steady among women aged 50 to 64 years (p = 0.8) yet declined among women aged 65 to 79 years and aged 80+ years (p = 0.07 and p = 0.004, respectively). Accounting for differences in all measured characteristics, receipt of primary care was the strongest and most consistent predictor of osteoporosis assessment or treatment following fracture. © 2017 American Society for Bone and Mineral Research.
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111
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Anagnostis P, Paschou SA, Mintziori G, Ceausu I, Depypere H, Lambrinoudaki I, Mueck A, Pérez-López FR, Rees M, Senturk LM, Simoncini T, Stevenson JC, Stute P, Trémollieres FA, Goulis DG. Drug holidays from bisphosphonates and denosumab in postmenopausal osteoporosis: EMAS position statement. Maturitas 2017; 101:23-30. [PMID: 28539165 DOI: 10.1016/j.maturitas.2017.04.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bisphosphonates and denosumab are used extensively in the treatment of postmenopausal osteoporosis. Despite their proven efficacy in the reduction of vertebral and non-vertebral fractures, their optimal duration of use has not been determined. The occurrence of adverse effects, such as osteonecrosis of the jaw (ONJ) and atypical femoral fractures (AFF), has raised the issue of bisphosphonate or denosumab discontinuation ("drug holiday") after a certain treatment period. AIM To assess the effect of bisphosphonate and denosumab discontinuation on fracture risk, as well as its possible benefits in reducing the risk of adverse effects. METHODS Systematic review and consensus of expert opinion. RESULTS AND CONCLUSIONS Discontinuation of bisphosphonates should be considered in all patients who have beentreated for more than five years with alendronate, risedronate or zoledronic acid. In view of the limited evidence, no robust recommendations can be made for ibandronate and denosumab. If the patient has not experienced fractures before or during therapy and the fracture risk is low, a "drug holiday" canbe recommended. Although there is no solid evidence, 1-2 years for risedronate, 3-5 years for alendronate and 3-6 years for zoledronic acid are suggested. After this time, the patient should be reassessed. If a new fracture is experienced, or fracture risk has increased or BMD remains low (femoral neck T-score ≤-2.5), anti-osteoporotic treatment should be resumed. In the case of denosumab discontinuation, close monitoring is suggested, due to the possibility of rebound fractures.
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Affiliation(s)
- Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece.
| | - Stavroula A Paschou
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Gesthimani Mintziori
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Iuliana Ceausu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, and Department of Obstetrics and Gynecology, 'Dr. I. Cantacuzino' Hospital, Bucharest, Romania
| | - Herman Depypere
- Breast Clinic and Menopause Clinic, University Hospital, De Pintelaan 185, 9000 Gent, Belgium
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, National and Kapodestrian University of Athens, Greece
| | - Alfred Mueck
- University Women's Hospital of Tuebingen,Calwer Street 7, 72076 Tuebingen, Germany
| | - Faustino R Pérez-López
- Department of Obstetrics and Gynecology, Zaragoza University Faculty of Medicine, Lozano-Blesa University Hospital, Zaragoza 50009, Spain
| | - Margaret Rees
- Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Levent M Senturk
- Istanbul University Cerrahpasa School of Medicine, Dept. of Obstetrics and Gynecology, Division of Reproductive Endocrinology, IVF Unit, Istanbul, Turkey
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - John C Stevenson
- National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London SW3 6NP, UK
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Women's Hospital, Bern, Switzerland
| | - Florence A Trémollieres
- Menopause and Metabolic Bone Disease Unit, Hôpital Paule de Viguier, CHU Toulouse, Toulouse, France
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
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Abstract
Osteoporosis is a common but often silent condition among older adults. The characteristic pathological changes associated with osteoporosis may go unnoticed until a fracture occurs or a bone density test is performed. Although osteoporosis occurs in men and among premenopausal women, it is most prevalent among postmenopausal women who are the focus of this article. Within the subpopulation of postmenopausal women, there are major differences in risk status, disease severity, and response to treatment. Two individual examples are presented to highlight these differences and to illustrate appropriate assessment and treatment strategies in each scenario. In addition, general nonpharmacological recommendations for postmenopausal women across risk status and disease severity are presented.
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Mehmet Y, Başbuğ A, Ellibeş Kaya A, Çağlar M, Özkara A, Sungur MA, Ataoğlu S. Osteoporoz Sıklığı ve Tarama Programı Başlangıç Yaşının Belirlenmesi: Düzce Üniversitesi Araştırma ve Uygulama Hastanesi Örneklemi. KONURALP TIP DERGISI 2017. [DOI: 10.18521/ktd.286409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Tabatabaei-Malazy O, Salari P, Khashayar P, Larijani B. New horizons in treatment of osteoporosis. Daru 2017; 25:2. [PMID: 28173850 PMCID: PMC5297185 DOI: 10.1186/s40199-017-0167-z] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/31/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Prevalence of osteoporosis is increasing both in developed and developing countries. Due to rapid growth in the burden and cost of osteoporosis, worldwide, it seems reasonable to focus on the reduction of fractures as the main goal of treatment. Although, efficient pharmacological agents are available for the treatment of osteoporosis, there still remains a need to more specific drugs with less adverse effects. MAIN BODY This review article provides a brief update on the pathogenesis, presenting current pharmacological products approved by the US Food and Drug Administration (FDA) or Europe, and also newer therapeutic agents to treat osteoporosis according to the clinical trial data available at PubMed, UpToDate, International Osteoporosis Foundation (IOF), and clinical practice guidelines. As well, the effect of combination therapy and recommendations for future research will be further discussed. SHORT CONCLUSION The use of current antiresorptive and anabolic agents alone or in combinations for the treatment of osteoporosis entails several limitations. Mainly, their efficacy on non-vertebral fracture reduction is lower than that observed on vertebral fracture. In addition, they have potential adverse events on long time usage. Development of newer agents such as cathepsin k inhibitor and strontium ranelate not only have increased the available options for treating osteoporosis, but also have opened doors of opportunity to improvements in the effective treatment. However, the high cost of new agents have restricted their usage in selective patients who are at high risk of fracture or whom failed response to first line treatment options. Thus, personalized medicine should be considered for future evaluation of genetic risk score and also for environmental exposure assessment. In addition to permanent attention to early diagnosis of osteoporosis and understanding of the pathophysiology of osteoporosis for novel approach in drug discovery, there seems a need to more well-designed clinical trials with larger sample sizes and longer duration on current as well as on newer agents. Also, continuous research on plant-derived components as the source of discovering new agents, and conducting more clinical trials with combination of two or more synthetic drugs, plants, or drug-plant for the treatment of osteoporosis are recommended. Summary of treatment modalities for osteoporosis.
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Affiliation(s)
- Ozra Tabatabaei-Malazy
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Fifth floor, Dr.Shariati Hospital, North Kargar Ave, Tehran, 14114 Iran
| | - Pooneh Salari
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Patricia Khashayar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Center for Microsystems Technology, Imec and Ghent University, Gent-Zwijnaarde, Belgium
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Fifth floor, Dr.Shariati Hospital, North Kargar Ave, Tehran, 14114 Iran
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115
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Smallwood AJ, Schapira MM, Fedders M, Neuner JM. A pilot randomized controlled trial of a decision aid with tailored fracture risk tool delivered via a patient portal. Osteoporos Int 2017; 28:567-576. [PMID: 27647529 DOI: 10.1007/s00198-016-3767-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 09/04/2016] [Indexed: 11/25/2022]
Abstract
UNLABELLED We tested the feasibility of a fracture prevention decision aid in an online patient portal. The decision aid was acceptable for patients and successfully decreased decisional conflict. This study suggests the possible utility of leveraging the patient portal to enhance patient education and decision making in osteoporosis care. INTRODUCTION Although interventions have improved osteoporosis screening and/or treatment for certain populations of high-risk patients, recent national studies suggest that large-scale uptake of these interventions has been limited. We aimed to determine the feasibility and potential efficacy of a patient portal-based osteoporosis decision aid (DA). METHODS We conducted a pilot randomized controlled trial of primary care patients aged ≥55 who were enrolled in a patient portal and had a T-score of <-1. Intervention subjects were provided a link to a patient DA. The DA contained a 10-year fracture risk calculator, summary of medication risks and benefits (prescription and nonprescription), and an elicitation of values. Subjects completed questionnaires assessing the primary outcomes of decisional conflict and preparation for decision making and secondary outcomes related to feasibility and planning for a larger trial. Charts were reviewed for physician-subject interactions and medication uptake. RESULTS The DA was acceptable to subjects, but 17 % of the patients in the decision aid arm incorrectly entered their T-scores into FRAX-based risk calculator. Decisional conflict was lower post-intervention for those who were randomized to the decision aid arm compared to controls (17.8 vs. 47.1, p < .001), and there was a significant difference in the percentage of patients who made a treatment decision at 3 months. No significant differences were observed in medication uptake. CONCLUSIONS A portal-based osteoporosis DA was acceptable and improved several measures of decision quality. Given its effect on improving the quality of patients' decisions, future studies should examine whether it improves physician guideline adherence or medication adherence uptake among treated patients.
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Affiliation(s)
- A J Smallwood
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - M M Schapira
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Ave, Philadelphia, PA, 19104, USA
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, 19104, USA
| | - M Fedders
- Clinical Informatics, Froedtert and the Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI, 53226, USA
| | - J M Neuner
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, CLCC-5th Floor, 9200 W. Wisconsin Ave., Milwaukee, WI, 53226, USA
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Mendonça LT, Pinheiro MM, Szejnfeld VL, Castro CHDM. Bone Mass Outcomes in Patients With Osteoporosis Treated With Risedronate After Alendronate Failure: a 12-Month Follow-Up Study. J Clin Densitom 2017; 20:44-49. [PMID: 27616291 DOI: 10.1016/j.jocd.2016.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/04/2016] [Accepted: 08/11/2016] [Indexed: 11/19/2022]
Abstract
Oral bisphosphonates are the drugs most frequently used for the treatment of osteoporosis. Clinicians usually switch between these drugs in clinical practice based on differences in efficacy. We aim to investigate the reasons associated with switching between oral bisphosphonates and to evaluate bone mass response and the incidence of fractures 12 mo after the exchange in a cohort of patients with osteoporosis seen at a tertiary hospital. Patients with osteoporosis who switched between oral bisphosphonates between January 2007 and December 2014 were included. Bone mass measured by dual-energy X-ray absorptiometry and the incidence of fracture were evaluated. A total of 112 patients (73.1 yr old on average, 95.5% women, 98% postmenopausal) were included. All patients were taking alendronate at the time of the switch to risedronate. In 91 patients (81.3%), the following reasons for the exchange of medication were identified: bone loss (59.8%), adverse events (11.6%), and recent fragility fracture (10.7%). One year after the switch, bone densitometry revealed bone loss in 51 patients (45.5%), bone mass maintenance in 34 (30.4%), and bone mass gain in 27 (24.1%). No new vertebral fracture was detected and no nonvertebral fracture was reported in 12 mo of follow-up. Bone mass outcomes (gain, loss, or maintenance) were not associated with the reason for switching between oral bisphosphonates. Similarly, none of the parameters evaluated could predict good densitometric response (gain or maintenance) in this scenario. Our findings suggest that the use of risedronate should not be recommended in the scenario of treatment failure or adverse events following the use of alendronate.
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Affiliation(s)
- Leonardo Teixeira Mendonça
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Marcelo Medeiros Pinheiro
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Vera Lúcia Szejnfeld
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
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Kim MK, Chon SJ, Noe EB, Roh YH, Yun BH, Cho S, Choi YS, Lee BS, Seo SK. Associations of dietary calcium intake with metabolic syndrome and bone mineral density among the Korean population: KNHANES 2008-2011. Osteoporos Int 2017; 28:299-308. [PMID: 27503170 DOI: 10.1007/s00198-016-3717-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED Excessive amount of calcium intake increased risk for metabolic syndrome in men. However, modest amount decreased the risk of metabolic syndrome and osteoporosis in postmenopausal women. Modest amount of calcium also increased bone mineral density (BMD) in both men and postmenopausal women. INTRODUCTION The present study aimed to evaluate the associations of dietary calcium intake with metabolic syndrome and bone mineral density (BMD) in Korean men and women, especially postmenopausal women. METHODS The study was performed using data from the Korean National Health and Nutrition Examination Survey (2008-2011) and included 14,705 participants (5953 men, 4258 premenopausal women, and 4494 postmenopausal women). Clinical and other objective characteristics, presence of metabolic syndrome, and the BMD of the femur neck and lumbar spine were evaluated according to dietary calcium intake. RESULTS There was a higher tendency for metabolic syndrome in men with a dietary calcium intake of >1200 mg/day than with ≤400 mg of calcium intake; >400 and ≤800 mg of calcium intake was helpful for postmenopausal women to decrease risk for metabolic syndrome. Overall, the group with calcium intake >400 and ≤800 mg daily had significantly increased BMD in both femoral neck and lumbar spine from both men and postmenopausal women. From both femoral neck and lumbar spine, the prevalence of osteoporosis in postmenopausal women significantly decreased in the group whose calcium intake was >400 and ≤800 mg daily. CONCLUSION Excessive dietary calcium may increase the prevalence of metabolic syndrome in men. For postmenopausal women, calcium intake does not increase the risk of metabolic syndrome, but modest amount decreases the risk. It may increase the BMD in men and postmenopausal women, and also reduce the prevalence of both osteoporosis and metabolic syndrome in postmenopausal women.
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Affiliation(s)
- M K Kim
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S J Chon
- Department of Obstetrics and Gynecology, Gil Hospital, Gachon University College of Medicine, Incheon, Republic of Korea
| | - E B Noe
- Seoul Rachel Fertility Center, Seoul, Republic of Korea
| | - Y H Roh
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - B H Yun
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S Cho
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y S Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - B S Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S K Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
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118
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Modi A, Ebeling PR, Lee MS, Min YK, Mithal A, Yang X, Baidya S, Sen S, Sajjan S. Impact of gastrointestinal events on patient-reported outcomes in Asia-Pacific women with osteoporosis: baseline results of the MUSIC OS-AP study. Arch Osteoporos 2017; 12:65. [PMID: 28718004 PMCID: PMC5514202 DOI: 10.1007/s11657-017-0350-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/21/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this study was to describe the impact of gastrointestinal events on patient-reported outcomes and health care resource use among Asia-Pacific women with postmenopausal osteoporosis. The results of this study show that gastrointestinal events decreased adherence, treatment satisfaction, and quality of life in Asia-Pacific women with postmenopausal osteoporosis. PURPOSE This study aimed to describe the impact of gastrointestinal (GI) events on patient-reported outcomes and health care resource use among Asia-Pacific women with postmenopausal osteoporosis. METHODS The MUSIC OS-AP study included an observational cohort study of postmenopausal women with osteoporosis. Women were classified as untreated or treated, with treated patients further classified as new or experienced users. Adherence was measured by the Adherence Evaluation of Osteoporosis treatment (ADEOS) questionnaire, treatment satisfaction by the Osteoporosis Patient Satisfaction Questionnaire (OPSAT) while general health-related and osteoporosis-specific quality of life were measured by the European Quality of Life-5 Dimensions (EQ-5D) questionnaire and the Osteoporosis Assessment Questionnaire (OPAQ), respectively. The association of GI events with these outcomes was determined by covariate-adjusted regression analysis of least squares mean differences in the scores of treated patients with and without GI events. Resource utilization was measured as the number of physician visits over the past 3 months, and multivariate regression analysis was used to assess the association of GI events with the likelihood of a visit. RESULTS The GI event profile, quality of life scores, and resource use were numerically similar in untreated and treated women. The rate of adherence among treated women was higher in experienced than in new users. As indicated by mean scores, experienced users had better quality of life and slightly higher treatment satisfaction and fewer physician visits than new users. Except for adherence in new users, all measures were similarly adversely affected by GI events in both new and experienced users. CONCLUSIONS GI events decreased adherence, treatment satisfaction, and quality of life in Asia-Pacific women with postmenopausal osteoporosis.
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Affiliation(s)
- A. Modi
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc, 600 Corporate Drive, Mailstop: CRB-205, Kenilworth, NJ 08833 USA
| | | | - M. S. Lee
- Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Y. K. Min
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - A. Mithal
- Medanta the Medicity, Gurgaon, Haryana India
| | - X. Yang
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc, 600 Corporate Drive, Mailstop: CRB-205, Kenilworth, NJ 08833 USA
| | | | - S. Sen
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc, 600 Corporate Drive, Mailstop: CRB-205, Kenilworth, NJ 08833 USA
| | - S. Sajjan
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc, 600 Corporate Drive, Mailstop: CRB-205, Kenilworth, NJ 08833 USA
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Kalyanaraman H, Ramdani G, Joshua J, Schall N, Boss GR, Cory E, Sah RL, Casteel DE, Pilz RB. A Novel, Direct NO Donor Regulates Osteoblast and Osteoclast Functions and Increases Bone Mass in Ovariectomized Mice. J Bone Miner Res 2017; 32:46-59. [PMID: 27391172 PMCID: PMC5199609 DOI: 10.1002/jbmr.2909] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 01/06/2023]
Abstract
Most US Food and Drug Administration (FDA)-approved treatments for osteoporosis target osteoclastic bone resorption. Only PTH derivatives improve bone formation, but they have drawbacks, and novel bone-anabolic agents are needed. Nitrates, which generate NO, improved BMD in estrogen-deficient rats and may improve bone formation markers and BMD in postmenopausal women. However, nitrates are limited by induction of oxidative stress and development of tolerance, and may increase cardiovascular mortality after long-term use. Here we studied nitrosyl-cobinamide (NO-Cbi), a novel, direct NO-releasing agent, in a mouse model of estrogen deficiency-induced osteoporosis. In murine primary osteoblasts, NO-Cbi increased intracellular cGMP, Wnt/β-catenin signaling, proliferation, and osteoblastic gene expression, and protected cells from apoptosis. Correspondingly, in intact and ovariectomized (OVX) female C57Bl/6 mice, NO-Cbi increased serum cGMP concentrations, bone formation, and osteoblastic gene expression, and in OVX mice, it prevented osteocyte apoptosis. NO-Cbi reduced osteoclasts in intact mice and prevented the known increase in osteoclasts in OVX mice, partially through a reduction in the RANKL/osteoprotegerin gene expression ratio, which regulates osteoclast differentiation, and partially through direct inhibition of osteoclast differentiation, observed in vitro in the presence of excess RANKL. The positive NO effects in osteoblasts were mediated by cGMP/protein kinase G (PKG), but some of the osteoclast-inhibitory effects appeared to be cGMP-independent. NO-Cbi increased trabecular bone mass in both intact and OVX mice, consistent with its in vitro effects on osteoblasts and osteoclasts. NO-Cbi is a novel direct NO-releasing agent that, in contrast to nitrates, does not generate oxygen radicals, and combines anabolic and antiresorptive effects in bone, making it an excellent candidate for treating osteoporosis. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Hema Kalyanaraman
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652
| | - Ghania Ramdani
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652
| | - Jisha Joshua
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652
| | - Nadine Schall
- Institute of Pharmacology and Toxicology, University of Bonn, 53105 Bonn, Germany
| | - Gerry R. Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652
| | - Esther Cory
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093-0652
| | - Robert L. Sah
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093-0652
| | - Darren E. Casteel
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652
| | - Renate B. Pilz
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0652
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120
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Cummings SR, Cosman F, Lewiecki EM, Schousboe JT, Bauer DC, Black DM, Brown TD, Cheung AM, Cody K, Cooper C, Diez-Perez A, Eastell R, Hadji P, Hosoi T, Jan De Beur S, Kagan R, Kiel DP, Reid IR, Solomon DH, Randall S. Goal-Directed Treatment for Osteoporosis: A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis. J Bone Miner Res 2017; 32:3-10. [PMID: 27864889 DOI: 10.1002/jbmr.3039] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/10/2016] [Accepted: 11/11/2016] [Indexed: 12/13/2022]
Abstract
The American Society for Bone and Mineral Research and the United States National Osteoporosis Foundation (NOF) formed a working group to develop principles of goal-directed treatment and identify gaps that need to be filled to implement this approach. With goal-directed treatment, a treatment goal would first be established and choice of treatment determined by the probability of achieving that goal. Goals of treatment would be freedom from fracture, a T-score > -2.5, which is above the NOF threshold for initiating treatment, or achievement of an estimated risk level below the threshold for initiating treatment. Progress toward reaching the patient's goal would be periodically and systematically assessed by estimating the patient's compliance with treatment, reviewing fracture history, repeating vertebral imaging when indicated, and repeating measurement of bone mineral density (BMD). Using these data, a decision would be made to stop, continue, or change therapy. Some of these approaches can now be applied to clinical practice. However, the application of goal-directed treatment cannot be fully achieved until medications are available that provide greater increases in BMD and greater reduction in fracture risk than those that are currently approved; only then can patients with very high fracture risk and very low BMD achieve such goals. Furthermore, assessing future fracture risk in patients on treatment requires a new assessment tool that accurately captures the change in fracture risk associated with treatment and should also be sensitive to the importance of recent fractures as predictors of imminent fracture risk. Lastly, evidence is needed to confirm that selecting and switching treatments to achieve goals reduces fracture risk more effectively than current standard care. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Steven R Cummings
- California Pacific Medical Center, Research Institute, San Francisco, CA, USA
| | - Felicia Cosman
- Helen Hayes Hospital and Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - John T Schousboe
- Park Nicollet Institute for Research and Education, Division of Rheumatology, Minneapolis, MN, USA
| | - Douglas C Bauer
- Departments of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Dennis M Black
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Thomas D Brown
- University of Iowa, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA
| | | | - Kathleen Cody
- Foundation for Osteoporosis Research and Education, Oakland, CA, USA
| | - Cyrus Cooper
- University of Southampton, MRC Lifecourse Epidemiology Unit, Southhampton, United Kingdom
| | - Adolfo Diez-Perez
- Hospital del Mar-IMIM-Universitat Autònoma de Barcelona and RETICEF, Instituto Carlos III, Spain, Internal Medicine - Infectious Diseases, Barcelona, Spain
| | - Richard Eastell
- University of Sheffield, Human Metabolism, England, United Kingdom
| | - Peyman Hadji
- Philipps-University of Marburg, Department of Endocrinology, Osteoporosis, and Reproductive Medicine, Marburg, Germany
| | - Takayuki Hosoi
- National Center for Geriatrics and Gerontology, Obu City, Aichi Prefecture, Japan
| | | | - Risa Kagan
- University of California, San Francisco, San Francisco, CA, USA
| | - Douglas P Kiel
- Hebrew SeniorLife, Institute for Aging Research, Boston, MA, USA
| | - Ian R Reid
- University of Auckland, Department of Medicine, Auckland, New Zealand
| | - Daniel H Solomon
- Brigham and Women's Hospital, Division of Rheumatology, Boston, MA, USA
| | - Susan Randall
- National Osteoporosis Foundation, Arlington, VA, USA
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121
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Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol 2016; 4:46-56. [PMID: 28293453 DOI: 10.5152/eurjrheum.2016.048] [Citation(s) in RCA: 1063] [Impact Index Per Article: 132.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/08/2016] [Indexed: 01/23/2023] Open
Abstract
Osteoporosis -related to various factors including menopause and aging- is the most common chronic metabolic bone disease, which is characterized by increased bone fragility. Although it is seen in all age groups, gender, and races, it is more common in Caucasians (white race), older people, and women. With an aging population and longer life span, osteoporosis is increasingly becoming a global epidemic. Currently, it has been estimated that more than 200 million people are suffering from osteoporosis. According to recent statistics from the International Osteoporosis Foundation, worldwide, 1 in 3 women over the age of 50 years and 1 in 5 men will experience osteoporotic fractures in their lifetime. Every fracture is a sign of another impending one. Osteoporosis has no clinical manifestations until there is a fracture. Fractures cause important morbidity; in men, in particular, they can cause mortality. Moreover, osteoporosis results in a decreased quality of life, increased disability-adjusted life span, and big financial burden to health insurance systems of countries that are responsible for the care of such patients. With an early diagnosis of this disease before fractures occur and by assessing the bone mineral density and with early treatment, osteoporosis can be prevented. Therefore, increasing awareness among doctors, which, in turn, facilitates increase awareness of the normal populace, will be effective in preventing this epidemic.
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Affiliation(s)
- Tümay Sözen
- Department of Internal Medicine, Near East University School of Medicine, Nicosia, Turkish Republic of Northern Cyprus
| | - Lale Özışık
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Nursel Çalık Başaran
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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Pharmacologic approaches to the prevention and management of low bone mineral density in HIV-infected patients. Curr Opin HIV AIDS 2016; 11:351-7. [PMID: 26890207 DOI: 10.1097/coh.0000000000000271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW Osteoporosis is a growing concern among people living with HIV (PLWH) because of the recognized risk of fractures, which bring with them morbidity and mortality. New evidence is helping clinicians understand how to prevent and manage osteoporosis in this subpopulation. RECENT FINDINGS The benefit of calcium and vitamin D is variable in osteoporosis literature in general, but evidence supports the use of these supplements in PLWH to prevent the loss of bone mineral density when initiating antiretroviral therapy and in enhancing the effectiveness of antiosteoporosis treatments. Of the osteoporosis treatments, alendronate and zoledronate are the only two with substantial evidence of safety and effectiveness in PLWH, but the studies have been small and of limited duration. There are no randomized controlled studies of raloxifene, denosumab or teriparatide in PLWH. Of increasing interest is the possible benefit of statins on bone health through decreased inflammation. SUMMARY Osteoporosis is recognized as an issue for PLWH. Although some of the available osteoporosis treatments have proven safe and effective, future studies of the novel treatments, such as statins, along with well-designed studies of established osteoporosis treatments for use in PLWH are needed to further guide the clinical management of osteoporosis in this population.
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Singh P, Garber JJ. Implementation and adherence to osteoporosis screening guidelines among coeliac disease patients. Dig Liver Dis 2016; 48:1451-1456. [PMID: 27665261 DOI: 10.1016/j.dld.2016.08.121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/27/2016] [Accepted: 08/09/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are no studies evaluating the implementation of American Gastroenterological Association (AGA) guidelines on osteoporosis screening in coeliac disease. AIMS To investigate implementation of osteoporosis screening guidelines in coeliac disease patients and determine how often bone mineral density (BMD) assessment leads to therapeutic intervention. METHODS We screened all patients with biopsy-proven coeliac disease at our center from 2003 to 2013 and collected data on indication and results of dual energy X-ray absorptiometry scanning (DXA) and therapeutic interventions. RESULTS Of 222 adults with coeliac, only 80 (36%) underwent DXA after their diagnosis. Of those, 43 had DXA for osteoporosis screening specifically related to their coeliac diagnosis. Of these 43 patients, 28 (65.1%) had low BMD. A therapeutic intervention was made in the majority of these patients (21/28, 75%). Of 330 pediatric coeliac cases, 52 (15.8%) had DXA specifically in the context of the coeliac disease diagnosis with only 5 being complicated coeliac disease. Of these, 3 (5.8%) had low BMD and only 2 underwent therapeutic intervention. CONCLUSIONS Osteoporosis screening guidelines are not followed in the majority of patients with coeliac disease but, when followed, frequently lead to therapeutic intervention. Osteoporosis screening guidelines in coeliac disease need to be updated, strengthened and publicized.
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Affiliation(s)
- Prashant Singh
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA
| | - John J Garber
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA.
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Kanis JA, Harvey NC, Cooper C, Johansson H, Odén A, McCloskey EV. A systematic review of intervention thresholds based on FRAX : A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. Arch Osteoporos 2016; 11:25. [PMID: 27465509 PMCID: PMC4978487 DOI: 10.1007/s11657-016-0278-z] [Citation(s) in RCA: 254] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/16/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED This systematic review identified assessment guidelines for osteoporosis that incorporate FRAX. The rationale for intervention thresholds is given in a minority of papers. Intervention thresholds (fixed or age-dependent) need to be country-specific. INTRODUCTION In most assessment guidelines, treatment for osteoporosis is recommended in individuals with prior fragility fractures, especially fractures at spine and hip. However, for those without prior fractures, the intervention thresholds can be derived using different methods. The aim of this report was to undertake a systematic review of the available information on the use of FRAX® in assessment guidelines, in particular the setting of thresholds and their validation. METHODS We identified 120 guidelines or academic papers that incorporated FRAX of which 38 provided no clear statement on how the fracture probabilities derived are to be used in decision-making in clinical practice. The remainder recommended a fixed intervention threshold (n = 58), most commonly as a component of more complex guidance (e.g. bone mineral density (BMD) thresholds) or an age-dependent threshold (n = 22). Two guidelines have adopted both age-dependent and fixed thresholds. RESULTS Fixed probability thresholds have ranged from 4 to 20 % for a major fracture and 1.3-5 % for hip fracture. More than one half (39) of the 58 publications identified utilised a threshold probability of 20 % for a major osteoporotic fracture, many of which also mention a hip fracture probability of 3 % as an alternative intervention threshold. In nearly all instances, no rationale is provided other than that this was the threshold used by the National Osteoporosis Foundation of the USA. Where undertaken, fixed probability thresholds have been determined from tests of discrimination (Hong Kong), health economic assessment (USA, Switzerland), to match the prevalence of osteoporosis (China) or to align with pre-existing guidelines or reimbursement criteria (Japan, Poland). Age-dependent intervention thresholds, first developed by the National Osteoporosis Guideline Group (NOGG), are based on the rationale that if a woman with a prior fragility fracture is eligible for treatment, then, at any given age, a man or woman with the same fracture probability but in the absence of a previous fracture (i.e. at the 'fracture threshold') should also be eligible. Under current NOGG guidelines, based on age-dependent probability thresholds, inequalities in access to therapy arise especially at older ages (≥70 years) depending on the presence or absence of a prior fracture. An alternative threshold using a hybrid model reduces this disparity. CONCLUSION The use of FRAX (fixed or age-dependent thresholds) as the gateway to assessment identifies individuals at high risk more effectively than the use of BMD. However, the setting of intervention thresholds needs to be country-specific.
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Affiliation(s)
- John A Kanis
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
- Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia.
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Helena Johansson
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Anders Odén
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Eugene V McCloskey
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
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Osuna PM, Ruppe MD, Tabatabai LS. FRACTURE LIAISON SERVICES: MULTIDISCIPLINARY APPROACHES TO SECONDARY FRACTURE PREVENTION. Endocr Pract 2016; 23:199-206. [PMID: 27849385 DOI: 10.4158/ep161433.ra] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A well-recognized gap exists between evidence-based recommendations for post-fracture care and actual clinical practice, demonstrated by the high percentage of fragility fracture patients who are neither diagnosed nor treated for osteoporosis. Our purpose is to review fracture liaison service (FLS) models and to evaluate national and international experiences in secondary fracture prevention. METHODS We performed a systematic search of publication databases (MEDLINE, SCOPUS) and included randomized controlled trials, meta-analyses, and review articles using the following keywords: Fracture liaison services, Secondary prevention of fracture, Post-fracture healthcare gap, and fragility fractures. References were included from 2001-2015. We subsequently performed reference searches of retrieved articles and available literature was reviewed. RESULTS The efficacy of secondary fracture prevention programs correlates strongly with their intensity. Type A FLS Models are most successful in initiating diagnostic and treatment plans for fragility fracture patients. Adoption of FLS programs improves care by lowering mortality and refracture rates while also lowering healthcare costs. The quality of evidence supporting associations between FLS programs and improved outcomes was moderately strong due to the availability of longitudinal data from nationalized health systems. CONCLUSION As our population ages and challenges to the healthcare system loom ever larger, it is imperative that we fund and champion fracture liaison services. The fracture liaison service has recently emerged as a novel clinical approach that uses coordinated, multidisciplinary care to improve post-fracture outcomes and reduce recurrent fractures. These programs are simple, targeted, high-yield and have the potential to protect our most vulnerable patients. ABBREVIATIONS DXA = dual-energy x-ray absorptiometry FLS = fracture liaison service NCQA = National Committee of Quality Assurance NHS = National Health Service PCP = primary care physician PQRS = Physician Quality Reporting System QCDR = Qualified Clinical Data Registry.
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Man Y, Pan W, Lu J, Li S, Zhang P, Guo J, Yu S, Zhang B, Xiao E, Zhang C, Zuo W, Jin H, Chen Y, Wu B, Shi X, Hong D, Liu X, Gao Y, Li J, Yin L, Xue Q. Treatment and Management of Osteoporotic Fractures: A Nation-wide Survey of 484 Senior Orthopaedists in China. Orthop Surg 2016; 8:432-439. [PMID: 28032704 PMCID: PMC6584207 DOI: 10.1111/os.12296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/23/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the treatment given to osteoporotic fracture patients by orthopaedists at major hospitals in China. METHODS A 25-item quantitative questionnaire survey, categorized into five domains, including primary purpose of osteoporosis treatment, anti-osteoporosis therapy, calcium and vitamin D supplement, monitoring of osteoporosis, and knowledge of osteoporosis treatment, was designed to elicit information on orthopaedists' views on the treatment of osteoporotic fracture. A pre-survey test was conducted with a sample of 40 orthopaedic specialists to confirm the reliability and validity of the questionnaire. Each interview of the survey took approximately 15 min and did not directly involve any patients. The survey was conducted through face-to-face interviews at 119 tier 3 hospitals in 28 cities across Mainland China. RESULTS A total of 484 valid responses were received. Seven in ten respondents have ≥10 years of professional practice. While two-thirds believed that osteoporosis treatment was to prevent fractures or re-fractures, 95.0% agreed that anti-osteoporosis medication should be administered to patients with a history of fragility fractures. Three in four would prescribe anti-osteoporosis medication perioperatively. Of these, 79.0% regarded bisphosphonates as the first-line drug. Approximately 86.0% of the 21-30 years cohort chose bisphosphonates compared to 71.4% for those with ≤10 years. More of the younger (≤10 years) cohort chose calcitonin compared to their older (21-30 years) colleagues (25.7% vs 11.6%). The most commonly prescribed daily dose is 800 IU for vitamin D supplements and 600 mg/day for calcium. CONCLUSIONS Our respondents generally adhered to guidelines for the treatment and management of osteoporosis. A significant number had recommended lower dosages of vitamin D and calcium. Some differences exist between the younger cohort and their older colleagues in the prescription of pharmacological therapies. The criteria for initiating therapy should be more holistic and include other factors besides bone mineral density (BMD). Our results demonstrated that more comprehensive guidelines for osteoporosis management and a greater awareness of these guidelines by orthopaedists are needed to enable them to better manage their patients.
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Affiliation(s)
- Yi Man
- Beijing Novartis PharmaBeijingChina
| | - Wei Pan
- Beijing Novartis PharmaBeijingChina
| | - Jin Lu
- Beijing Novartis PharmaBeijingChina
| | | | | | | | | | | | - En Xiao
- Beijing Novartis PharmaBeijingChina
| | | | - Wei Zuo
- Beijing Novartis PharmaBeijingChina
| | | | - Yi Chen
- Beijing Novartis PharmaBeijingChina
| | - Bin Wu
- Beijing Novartis PharmaBeijingChina
| | | | - Di Hong
- Beijing Novartis PharmaBeijingChina
| | - Xun Liu
- Beijing Novartis PharmaBeijingChina
| | | | - Jing Li
- Beijing Novartis PharmaBeijingChina
| | - Lu Yin
- Beijing Novartis PharmaBeijingChina
| | - Qing‐yun Xue
- Department of OrthopaedicsBeijingChina
- National Center of GerontologyBeijing HospitalBeijingChina
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Abstract
OBJECTIVE To estimate the rate of non-treatment among elderly women with osteoporosis (OP) and to examine the association between patient characteristics and receiving treatment. RESEARCH DESIGN AND METHODS This cross-sectional, retrospective, observational study utilized patient information and claims from the Humana database to identify Medicare covered women aged ≥65 years old and continuously enrolled with evidence of either an OP diagnosis or an OP-related fracture during 2007-2011. The main outcome was receipt of pharmacological treatment of OP during 2012 (follow-up). The percentage of non-treatment was calculated and a stepwise selection logistic regression model was employed to estimate the association between baseline demographic and clinical characteristics and receiving treatment. RESULTS A total of 109,829 patients were included. Mean age was 75.7 years and 79.4% were identified with OP through OP diagnosis codes and did not have evidence of a prior fracture. Approximately one-third (32%) of patients had used OP medications during the baseline period, and 39% had experienced at least one gastro-intestinal event during baseline. Among all patients, 71.4% did not receive OP therapy during follow-up. The strongest factor associated with receiving treatment was prior use of OP therapy (odds ratio [OR] = 31.3; p < .001). Among the subgroup of patients with baseline fractures, 75.9% did not receive OP therapy during follow-up and the strongest factor associated with receiving treatment remained prior use of OP therapy (OR = 20.4; p < .001). Those with high comorbidity burden were less likely to receive treatment in both the overall cohort and within the subgroup with baseline fractures. CONCLUSIONS Among Medicare-eligible women aged ≥65 identified with OP between 2007 and 2011, 71.4% did not receive OP treatment during 2012, including 75.9% of the subgroup of patients with a prior fracture. The use of diagnosis and procedures codes to identify patients with osteoporosis is subject to variation in coding.
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Eliasaf A, Amitai A, Maram Edry M, Yosselson Superstine S, Rotman Pikielny P. Compliance, Persistence, and Preferences Regarding Osteoporosis Treatment During Active Therapy or Drug Holiday. J Clin Pharmacol 2016; 56:1416-1422. [DOI: 10.1002/jcph.738] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/14/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Alona Eliasaf
- Division of Clinical Pharmacy, Pharmacy Services; Meir Medical Center; Kfar Saba Israel
| | - Alina Amitai
- Division of Clinical Pharmacy, Pharmacy Services; Meir Medical Center; Kfar Saba Israel
| | - Mira Maram Edry
- Hospital Administration Department; Meir Medical Center; Kfar Saba Israel
| | | | - Pnina Rotman Pikielny
- Bone Health Service, Endocrine Department, Meir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Schousboe JT. Computed Tomography-Based Bone Density Assessment for Men With Prostate Cancer: Not Ready for Prime Time. J Clin Densitom 2016; 19:407-408. [PMID: 27477627 DOI: 10.1016/j.jocd.2016.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Affiliation(s)
- John T Schousboe
- Park Nicollet Osteoporosis Center and HealthPartners Institute, HealthPartners, Minneapolis, MN.
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130
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Bae SJ, Lee SH, Ahn SH, Kim HM, Kim BJ, Koh JM. The circulating sphingosine-1-phosphate level predicts incident fracture in postmenopausal women: a 3.5-year follow-up observation study. Osteoporos Int 2016; 27:2533-41. [PMID: 26984570 DOI: 10.1007/s00198-016-3565-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/08/2016] [Indexed: 12/31/2022]
Abstract
UNLABELLED A high level of circulating sphingosine-1-phosphate (S1P) is associated with a high incidence of osteoporotic fracture and a high rate of an insufficient response to bisphosphonate therapy. INTRODUCTION Sphingosine-1-phosphate (S1P) is a significant regulator of bone metabolism. Recently, we found that a high plasma S1P level is associated with low bone mineral density (BMD), high levels of bone resorption markers (BRMs), and a high risk of prevalent vertebral fracture in postmenopausal women. We investigated the possibility that S1P is a predictor of incident fracture. METHODS A total of 248 postmenopausal women participated in this longitudinal study and were followed up for a mean duration of 3.5 years (untreated [n = 76] or treated with bisphosphonate or hormone replacement therapy [n = 172]). The baseline plasma S1P level and prevalent and incident fracture occurrence were assessed. RESULTS A high S1P level was significantly associated with a higher rate of prevalent fracture after adjusting for femoral neck (FN) BMD, BRM, and potential confounders (odds ratio = 2.05; 95 % confidence interval [CI] = 1.03-4.00). Incident fractures occurred more frequently in the highest S1P tertile (T3) than in the lower two tertiles (T1-2) after adjusting for confounders, including baseline FN BMD, prevalent fracture, antiosteoporotic medication, annualized changes in FN BMD, BRM, and potential confounders (hazard ratio = 5.52; 95 % CI = 1.04-56.54). Insufficient response to bisphosphonate therapy occurred more frequently in T3 than T1-2 (odds ratio = 4.43; 95 % CI = 1.02-21.25). CONCLUSIONS The plasma S1P level may be a potential predictor of fracture occurrence and an insufficient response to bisphosphonate therapy in postmenopausal women.
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Affiliation(s)
- S J Bae
- Health Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Ulsan, Seoul, 05505, South Korea
| | - S H Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - S H Ahn
- Department of Endocrinology, Inha University School of Medicine, 27 Inhang-ro, Jung-Gu, Songpa-gu, Incheon, 22332, South Korea
| | - H-M Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - B-J Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - J-M Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea.
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North F, Fox S, Chaudhry R. Clinician time used for decision making: a best case workflow study using cardiovascular risk assessments and Ask Mayo Expert algorithmic care process models. BMC Med Inform Decis Mak 2016; 16:96. [PMID: 27439359 PMCID: PMC4955236 DOI: 10.1186/s12911-016-0334-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 07/09/2016] [Indexed: 11/18/2022] Open
Abstract
Background Risk calculation is increasingly used in lipid management, congestive heart failure, and atrial fibrillation. The risk scores are then used for decisions about statin use, anticoagulation, and implantable defibrillator use. Calculating risks for patients and making decisions based on these risks is often done at the point of care and is an additional time burden for clinicians that can be decreased by automating the tasks and using clinical decision-making support. Methods Using Morae Recorder software, we timed 30 healthcare providers tasked with calculating the overall risk of cardiovascular events, sudden death in heart failure, and thrombotic event risk in atrial fibrillation. Risk calculators used were the American College of Cardiology Atherosclerotic Cardiovascular Disease risk calculator (AHA-ASCVD risk), Seattle Heart Failure Model (SHFM risk), and CHA2DS2VASc. We also timed the 30 providers using Ask Mayo Expert care process models for lipid management, heart failure management, and atrial fibrillation management based on the calculated risk scores. We used the Mayo Clinic primary care panel to estimate time for calculating an entire panel risk. Results Mean provider times to complete the CHA2DS2VASc, AHA-ASCVD risk, and SHFM were 36, 45, and 171 s respectively. For decision making about atrial fibrillation, lipids, and heart failure, the mean times (including risk calculations) were 85, 110, and 347 s respectively. Conclusion Even under best case circumstances, providers take a significant amount of time to complete risk assessments. For a complete panel of patients this can lead to hours of time required to make decisions about prescribing statins, use of anticoagulation, and medications for heart failure. Informatics solutions are needed to capture data in the medical record and serve up automatically calculated risk assessments to physicians and other providers at the point of care.
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Affiliation(s)
- Frederick North
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Samuel Fox
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, USA
| | - Rajeev Chaudhry
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, USA
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El-Tawab SS, Saba EKA, Elweshahi HMT, Ashry MH. Knowledge of osteoporosis among women in Alexandria (Egypt): A community based survey. EGYPTIAN RHEUMATOLOGIST 2016. [DOI: 10.1016/j.ejr.2015.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Leder BZ, Tsai JN, Neer RM, Uihlein AV, Wallace PM, Burnett-Bowie SAM. Response to Therapy With Teriparatide, Denosumab, or Both in Postmenopausal Women in the DATA (Denosumab and Teriparatide Administration) Study Randomized Controlled Trial. J Clin Densitom 2016; 19:346-51. [PMID: 26900146 DOI: 10.1016/j.jocd.2016.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/08/2016] [Accepted: 01/12/2016] [Indexed: 01/22/2023]
Abstract
Both antiresorptive and anabolic osteoporosis medications increase bone mineral density (BMD), but no single agent can restore normal bone strength in most osteoporotic patients. Moreover, the magnitude and consistency of the patient response to each individual agent vary depending on the anatomic site. In the DATA study, we reported that in postmenopausal osteoporotic women, 2 years of combined denosumab and teriparatide increase mean BMD at the hip and spine more than either drug alone. In the current analysis, we wished to determine if the individual rates of BMD response were also greater among women treated with both drugs. In DATA, 94 postmenopausal osteoporotic women (ages 51-91) were randomized to receive teriparatide (20 mcg subcutaneously daily), denosumab (60 mg subcutaneously every 6 mo), or both medications for 24 mo. The BMD of the total hip (TH), femoral neck (FN), and lumbar spine (LS) were assessed by dual-energy X-ray absorptiometry. The 82 subjects who completed all 2-yr treatments were analyzed. Responders were defined as experiencing BMD increases of >3%. An "excellent response" was defined as an increase of >6%. Over 24 mo, TH BMD increased by >3% in 36%, 53%, and 92% of women in the teriparatide, denosumab, and combination groups, respectively, and by >6% in 11%, 17%, and 50% in the teriparatide, denosumab, and combination groups, respectively (p < 0.01 for all comparisons vs combination). FN response rates were similar to TH. In the LS, BMD increased by >3% in 85%, 93%, and 100% of women in the teriparatide, denosumab, and combination groups, respectively (p = nonsignificant for all comparisons) and by >6% in 63%, 78%, and 100% of women in the teriparatide, denosumab, and combination groups, respectively (combination vs teriparatide, p = 0.001; combination vs denosumab, p = 0.016). In summary, more women treated with 24 mo of combined denosumab and teriparatide achieved a significant response at the TH and FN than those treated with either drug alone. All women treated with both agents together experienced an excellent response at the LS. These results support the continued investigation of combined denosumab and teriparatide therapy in postmenopausal osteoporotic women utilizing clinical endpoints such as fracture reduction.
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Affiliation(s)
- Benjamin Z Leder
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA.
| | - Joy N Tsai
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Robert M Neer
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Alexander V Uihlein
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Paul M Wallace
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
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Vescini F, Attanasio R, Balestrieri A, Bandeira F, Bonadonna S, Camozzi V, Cassibba S, Cesareo R, Chiodini I, Francucci CM, Gianotti L, Grimaldi F, Guglielmi R, Madeo B, Marcocci C, Palermo A, Scillitani A, Vignali E, Rochira V, Zini M. Italian association of clinical endocrinologists (AME) position statement: drug therapy of osteoporosis. J Endocrinol Invest 2016; 39:807-34. [PMID: 26969462 PMCID: PMC4964748 DOI: 10.1007/s40618-016-0434-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/22/2016] [Indexed: 12/17/2022]
Abstract
Treatment of osteoporosis is aimed to prevent fragility fractures and to stabilize or increase bone mineral density. Several drugs with different efficacy and safety profiles are available. The long-term therapeutic strategy should be planned, and the initial treatment should be selected according to the individual site-specific fracture risk and the need to give the maximal protection when the fracture risk is highest (i.e. in the late life). The present consensus focused on the strategies for the treatment of postmenopausal osteoporosis taking into consideration all the drugs available for this purpose. A short revision of the literature about treatment of secondary osteoporosis due both to androgen deprivation therapy for prostate cancer and to aromatase inhibitors for breast cancer was also performed. Also premenopausal females and males with osteoporosis are frequently seen in endocrine settings. Finally particular attention was paid to the tailoring of treatment as well as to its duration.
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Affiliation(s)
- F. Vescini
- Endocrinology and Metabolic Disease Unit, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, P.le S.M. della Misericordia, 15, 33100 Udine, Italy
| | - R. Attanasio
- Endocrinology Service, Galeazzi Institute IRCCS, Milan, Italy
| | - A. Balestrieri
- Unit of Endocrinology and Diabetology, Department of Internal Medicine, M. Bufalini Hospital, Cesena, Italy
| | - F. Bandeira
- Division of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
| | | | - V. Camozzi
- Unit of Endocrinology, Department of Medicine, University of Padova, Padua, Italy
| | - S. Cassibba
- Endocrinology and Diabetology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - R. Cesareo
- Endocrinology, S. Maria Goretti Hospital, Latina, Italy
| | - I. Chiodini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C. Maria Francucci
- Post Acute and Long Term Care Department, I.N.R.C.A., Ancona, Italy
- San Pier Damiano Hospital, Villa Maria Group Care and Research, Faenza, Ravenna Italy
| | - L. Gianotti
- Endocrinology and Metabolic Diseases, S. Croce e Carle Hospital, Cuneo, Italy
| | - F. Grimaldi
- Endocrinology and Metabolic Disease Unit, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, P.le S.M. della Misericordia, 15, 33100 Udine, Italy
| | - R. Guglielmi
- Endocrinology Unit, Regina Apostolorum Hospital, Albano Laziale, Rome Italy
| | - B. Madeo
- Integrated Department of Medicine, Endocrinology and Metabolism, Geriatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - C. Marcocci
- Endocrine Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - A. Palermo
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - A. Scillitani
- Endocrinology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - E. Vignali
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - V. Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - M. Zini
- Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
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135
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Chung YS, Chung DJ, Kang MI, Kim IJ, Koh JM, Min YK, Oh HJ, Park IH, Lee YS, Kravitz B, Waterhouse B, Fitzpatrick LA, Nino A. Vitamin D Repletion in Korean Postmenopausal Women with Osteoporosis. Yonsei Med J 2016; 57:923-7. [PMID: 27189286 PMCID: PMC4951469 DOI: 10.3349/ymj.2016.57.4.923] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 10/02/2015] [Accepted: 11/13/2015] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Up to 71% of South Korean postmenopausal women have vitamin D deficiency {serum 25-hydroxyvitamin D [25(OH) D] level <50 nmol/L}. Data on vitamin D supplementation was collected during the screening phase of an efficacy/safety study of denosumab in Korean postmenopausal women with osteoporosis. This report describes the effect of vitamin D supplementation on repletion to 25(OH)D levels ≥50 nmol/L in Korean postmenopausal women with osteoporosis. MATERIALS AND METHODS Vitamin D levels of Korean postmenopausal women (60-90 years old) were measured by extracting 25(OH)D₂ and 25(OH)D₃ from serum samples via protein precipitation and using liquid chromatography with tandem mass spectrometry detection. Calibration curves were constructed from the mass chromatograms to obtain total vitamin D levels. Subjects with serum 25(OH)D levels <50 nmol/L were supplemented with 1000 IU of vitamin D tablets during the 2.5-month-long screening period. Dose, frequency, and duration were determined by the investigator. If repletion was achieved (≥50 nmol/L) on retest, subjects were eligible to be rescreened for study entry. RESULTS Of 371 subjects screened, 191 (52%) required vitamin D supplementation, and 88% (168 of 191) were successfully repleted. More than half of the subjects (58%) who were successfully repleted received doses of 2000 IU daily. The mean time to successful repletion was 31 days (standard deviation 8.4 days; range 11-48 days). CONCLUSION Supplementation with daily median doses of 2000 IU vitamin D successfully repleted 88% of Korean postmenopausal women with osteoporosis within 48 days to a serum vitamin D level of 50 nmol/L.
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Affiliation(s)
- Yoon Sok Chung
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Dong Jin Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Moo Il Kang
- Department of Endocrinology and Metabolism, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - In Ju Kim
- Department of Endocrinology and Metabolism, Pusan National University Hospital, Busan, Korea
| | - Jung Min Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Ki Min
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Jin Oh
- Department of Family Medicine, Cheil General Hospital, College of Medicine, Kwandong University, Seoul, Korea
| | - Il Hyung Park
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
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136
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Belaya ZE, Iljin AV, Melnichenko GA, Solodovnikov AG, Rozhinskaya LY, Dzeranova LK, Dedov II. Diagnostic performance of osteocalcin measurements in patients with endogenous Cushing's syndrome. BONEKEY REPORTS 2016; 5:815. [PMID: 27347399 DOI: 10.1038/bonekey.2016.42] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 04/17/2016] [Indexed: 11/09/2022]
Abstract
The aim of this study was to evaluate the diagnostic performance of osteocalcin (OC), as measured by automated electrochemiluminescence immunoassay (ECLIA), in identifying Cushing's syndrome (CS) in two separate populations: among obese and overweight subjects and among women of postmenopausal age with osteoporosis. Among the 106 referral patients with obesity, CS was confirmed in 42 cases. The patients of the referred population provided late-night salivary cortisol (LNSC), underwent low-dose dexamethasone suppression testing (DST) and were further evaluated until CS was pathologically confirmed. A threshold of OC-8.3 ng ml(-1) differentiated CS among obese and overweight subjects with a sensitivity of 73.8% (95% confidence interval (CI) 58.9-84.7) and a specificity of 96.9% (95% CI 89.3-99.1). The total area under the receiver operating characteristic curve (AUC) was 0.859 (95% CI 0.773-0.945), which was lower than LNSC or DST (P=0.01). In the retrospective portion of the study, the OC levels were evaluated in 67 subjects with newly diagnosed postmenopausal osteoporosis and in 23 patients (older than 45) with newly diagnosed CS and osteoporosis (presence of low traumatic fractures or T-score P-2.5). The diagnostic performance of OC for osteoporosis due to CS was within an AUC of 0.959 (95% CI 0.887-1.00). A threshold for OC of 8.3 ng ml-1 yielded a sensitivity of 95.4% (95% CI 78.2-99.2%) and a specificity of 98.5% (95% CI 92.0-99.7%). Thus, osteocalcin could be used in the diagnostic testing for endogenous hypercortisolism in patients referred to exclude CS and to identify CS among patients of postmenopausal age with osteoporosis.
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Affiliation(s)
- Zhanna E Belaya
- Department of Preventative and Family Medicine, Neuroendocrinology and Bone Disease, The National Research Centre for Endocrinology , Moscow, Russia
| | - Alexander V Iljin
- Department of Preventative and Family Medicine, Neuroendocrinology and Bone Disease, The National Research Centre for Endocrinology , Moscow, Russia
| | - Galina A Melnichenko
- Department of Preventative and Family Medicine, Neuroendocrinology and Bone Disease, The National Research Centre for Endocrinology , Moscow, Russia
| | - Alexander G Solodovnikov
- Department of Preventative and Family Medicine, Ural State Medical University , Ekaterinburg, Russia
| | - Liudmila Y Rozhinskaya
- Department of Preventative and Family Medicine, Neuroendocrinology and Bone Disease, The National Research Centre for Endocrinology , Moscow, Russia
| | - Larisa K Dzeranova
- Department of Preventative and Family Medicine, Neuroendocrinology and Bone Disease, The National Research Centre for Endocrinology , Moscow, Russia
| | - Ivan I Dedov
- Department of Preventative and Family Medicine, Neuroendocrinology and Bone Disease, The National Research Centre for Endocrinology , Moscow, Russia
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137
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Nayak S, Greenspan SL. Cost-Effectiveness of Osteoporosis Screening Strategies for Men. J Bone Miner Res 2016; 31:1189-99. [PMID: 26751984 PMCID: PMC4891297 DOI: 10.1002/jbmr.2784] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 02/06/2023]
Abstract
Osteoporosis affects many men, with significant morbidity and mortality. However, the best osteoporosis screening strategies for men are unknown. We developed an individual-level state-transition cost-effectiveness model with a lifetime time horizon to identify the cost-effectiveness of different osteoporosis screening strategies for US men involving various screening tests (dual-energy X-ray absorptiometry [DXA]; the Osteoporosis Self-Assessment Tool [OST]; or a fracture risk assessment strategy using age, femoral neck bone mineral density [BMD], and Vertebral Fracture Assessment [VFA]); screening initiation ages (50, 60, 70, or 80 years); and repeat screening intervals (5 years or 10 years). In base-case analysis, no screening was a less effective option than all other strategies evaluated; furthermore, no screening was more expensive than all strategies that involved screening with DXA or the OST risk assessment instrument, and thus no screening was "dominated" by screening with DXA or OST at all evaluated screening initiation ages and repeat screening intervals. Screening strategies that most frequently appeared as most cost-effective in base-case analyses and one-way sensitivity analyses when assuming willingness-to-pay of $50,000/quality-adjusted life-year (QALY) or $100,000/QALY included screening initiation at age 50 years with the fracture risk assessment strategy and repeat screening every 10 years; screening initiation at age 50 years with fracture risk assessment and repeat screening every 5 years; and screening initiation at age 50 years with DXA and repeat screening every 5 years. In conclusion, expansion of osteoporosis screening for US men to initiate routine screening at age 50 or 60 years would be expected to be effective and of good value for improving health outcomes. A fracture risk assessment strategy using variables of age, femoral neck BMD, and VFA is likely to be the most effective of the evaluated strategies within accepted cost-effectiveness parameters. DXA and OST are also reasonable screening options, albeit likely slightly less effective than the evaluated fracture risk assessment strategy. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Smita Nayak
- Swedish Center for Research and Innovation, Swedish Health Services, Swedish Medical Center, Seattle, WA, USA
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138
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Koh JH, Myong JP, Jung SM, Lee J, Kwok SK, Park SH, Ju JH. Atypical Femoral Fracture in Rheumatoid Arthritis Patients Treated With Bisphosphonates: A Nested Case-Control Study. Arthritis Rheumatol 2016; 68:77-82. [PMID: 26360133 DOI: 10.1002/art.39429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 09/03/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the clinical characteristics of atypical femoral fracture (AFF) and to determine the risk factors for and clinical outcomes of AFFs in rheumatoid arthritis (RA) patients treated with bisphosphonates (BPs). METHODS A nested case-control study was conducted using data derived from the medical records of all RA patients treated with BPs at Seoul St. Mary's Hospital, a tertiary rheumatology center, from January 1, 2008 to December 31, 2014. All of the patients with RA and had been treated with BPs for at least 1 year. Ten RA patients with AFF were identified, and each of these patients (cases) was age- and sex-matched with 4 RA patients without AFF (controls). RESULTS Five hundred fifty-two RA patients had BP exposure. Of the 10 with AFF, all were female (mean ± SD age 66.3 ± 8.7 years), and 90% of cases involved fracture of the proximal femur. The mean ± SD length of BP exposure in patients with AFF was 7.4 ± 3.2 years. Compared with controls, patients with AFF had a longer exposure to BPs and more often had a femorotibial angle of <175 degrees (both P < 0.001). There were no differences in RA duration, medications taken during the previous 6 months, and bone mineral density in the femur and lumbar spine between patients with and those without AFF. Multivariate logistic analyses identified longer BP exposure (odds ratio 2.386 [95% confidence interval 1.066-5.343]) as being associated with an increased risk of AFF. CONCLUSION RA patients who have a valgus deformity and are receiving long-term BP treatment are at higher risk of AFF compared with matched control patients with RA. These patients should be carefully followed up with hip radiography or dual x-ray absorptiometry.
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Affiliation(s)
- Jung Hee Koh
- Seoul St. Mary's Hospital and Catholic University of Korea, Seoul, Republic of Korea
| | - Jun Pyo Myong
- Seoul St. Mary's Hospital and Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Min Jung
- Seoul St. Mary's Hospital and Catholic University of Korea, Seoul, Republic of Korea
| | - Jennifer Lee
- Seoul St. Mary's Hospital and Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Ki Kwok
- Seoul St. Mary's Hospital and Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Hwan Park
- Seoul St. Mary's Hospital and Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hyeon Ju
- Seoul St. Mary's Hospital and Catholic University of Korea, Seoul, Republic of Korea
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139
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Lindsay BR, Olufade T, Bauer J, Babrowicz J, Hahn R. Patient-reported barriers to osteoporosis therapy. Arch Osteoporos 2016; 11:19. [PMID: 27129487 PMCID: PMC4851700 DOI: 10.1007/s11657-016-0272-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/10/2016] [Indexed: 02/03/2023]
Abstract
We investigated reasons for non-treatment of osteoporosis and discontinuation of osteoporosis therapy. Barriers to treatment include patients' preference for alternative treatments and a fear of possible side effects. Side effects are a common reason for treatment discontinuation, and they may be associated with a lack of willingness to restart treatment. PURPOSE/INTRODUCTION Osteoporosis patients commonly cite treatment-related side effects, or the fear thereof, as a reason for discontinuing or not initiating anti-osteoporosis medications. The purpose of this study was to investigate, from the patient's perspective, reasons for (i) non-treatment of osteoporosis and (ii) discontinuation of osteoporosis therapy. METHODS This was an internet-based survey of postmenopausal women in the USA who self-reported having been diagnosed with osteoporosis. Respondents were recruited from consumer research panels and received nominal compensation. RESULTS Within the surveyed population (N = 1407), 581 patients were currently being treated, 503 had never been treated, and 323 had previously been treated. Among patients never treated for osteoporosis, the highest ranking reasons for non-treatment were the use of alternative treatments such as over-the-counter vitamins/supplements (57.5 % of respondents) and fear of side effects (43.9 %). Among previously treated patients, frequent reasons for discontinuation included the direction of the physician (41.2 % of respondents), concerns about long-term safety (30.3 %), and the experience of side effects (29.8 %). When asked about their willingness to restart their osteoporosis medication, previously treated patients who were not willing (N = 104) to restart had a higher frequency of experiencing side effects (44.2 versus 20.5 % of those willing; P < 0.001). CONCLUSIONS From the osteoporosis patient's perspective, barriers to prescription treatment include a preference for alternative, non-prescription treatments and a fear of possible side effects. Side effects are one of the most common reasons for discontinuing osteoporosis medications, and they appear to be associated with a lack of willingness to restart treatment.
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Affiliation(s)
- Brianna R Lindsay
- Center for Observational and Real-World Evidence, Merck & Co. Inc., Kenilworth, NJ, USA.
| | - Temitope Olufade
- Center for Observational and Real-World Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
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140
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Early C, Stuckey L, Tischer S. Osteoporosis in the adult solid organ transplant population: underlying mechanisms and available treatment options. Osteoporos Int 2016; 27:1425-1440. [PMID: 26475288 DOI: 10.1007/s00198-015-3367-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/06/2015] [Indexed: 12/21/2022]
Abstract
The prevention and treatment of osteoporosis is an increasingly important topic in the solid organ transplant (SOT) population. Compared to the general population, these patients are at an elevated risk of developing osteoporosis due to progressive disease, lifelong immunosuppressant therapy, and malnutrition. As patients live longer after transplant, chronic disease management is increasingly more important. Supplementation with calcium and vitamin D is often necessary in the SOT population due to a high incidence of vitamin D deficiency. Bisphosphonate therapy is most commonly used for prevention and treatment of osteoporosis, but therapy can be limited by renal dysfunction which is common in transplant recipients. Alternative agents such as teriparatide and calcitonin have not been shown to provide a significant impact on the rate of fractures in this population. Additionally, denosumab may be a promising treatment option due to its novel mechanism of action, and is currently being studied in renal transplant patients. Timely initiation of supplementation and treatment, and minimizing glucocorticoid exposure prior to and after transplantation will aid in the prevention and proper management of osteoporosis in these patients.
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Affiliation(s)
- C Early
- Department of Pharmacy Services, University of Michigan Hospitals and Health Centers, Victor Vaughan House, 1111 E. Catherine, Ann Arbor, MI, 48109, USA
| | - L Stuckey
- Department of Pharmacy Services, University of Michigan Hospitals and Health Centers, Victor Vaughan House, 1111 E. Catherine, Ann Arbor, MI, 48109, USA
| | - S Tischer
- Department of Pharmacy Services, University of Michigan Hospitals and Health Centers, Victor Vaughan House, 1111 E. Catherine, Ann Arbor, MI, 48109, USA.
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141
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Grgić O, Kovačev-Zavišić B, Veljović T, Novaković-Paro J, Maravić T, Bajkin B. The influence of bone mineral density and bisphosphonate therapy on the determinants of oral health and changes on dental panoramic radiographs in postmenopausal women. Clin Oral Investig 2016; 21:151-157. [PMID: 26941051 DOI: 10.1007/s00784-016-1767-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to assess the determinants of oral health including the number of decayed, missing, and filled teeth (DMFT) and periodontal indices in postmenopausal women with osteoporosis, osteoporosis treated with bisphosphonate therapy, and control group and to examine the correlation between dental panoramic indices (Mental Index-MI, Mandibular Cortical Index-MCI) and bone mineral density in these three groups of patients. MATERIALS AND METHODS The presented non-interventional study involved 120 postmenopausal women: women with osteoporosis (O) (n = 45), women with osteoporosis treated with bisphosphonates (OBP) (n = 45), and control group (C) (n = 30). DMFT, plaque, gingival and papilla bleeding index, pocket depth, clinical attachment loss, and the presence of periodontitis were evaluated for each patient. MI and MCI of all participants were measured on a dental panoramic radiograph. RESULTS Group OBP showed significantly higher gingival, bleeding index and deeper pocket depth than C and/or O group. No significant differences were found in MI (p = .303) or MCI (p = .06) in all the examined groups. Also, there were no significant differences between the three groups in the presence of periodontitis as well as in the DMFT index. CONCLUSION BP therapy could have a negative influence on periodontal health. Further, MI and MCI are not precise diagnostic tools for diagnosing low BMD in postmenopausal women. CLINICAL RELEVANCE BP therapy could have a negative influence on the determinants of oral health in postmenopausal women with osteoporosis.
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Affiliation(s)
- Olja Grgić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Branka Kovačev-Zavišić
- Clinic of Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Vojvodina; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Tanja Veljović
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Jovanka Novaković-Paro
- Clinic of Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Vojvodina; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Tatjana Maravić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Branislav Bajkin
- Department of Oral Surgery, Dental Clinic of Vojvodina, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 12, Novi Sad, 21000, Serbia.
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142
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Lee S, Teschemaker AR, Daniel M, Maneno MK, Johnson AA, Wutoh AK, Lee E. Calcium and Vitamin D Use among Older Adults in U.S.: Results from National Survey. J Nutr Health Aging 2016; 20:300-5. [PMID: 26892579 DOI: 10.1007/s12603-015-0614-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study was conducted to describe a 10-year trend of the supplement from 2000 to 2009 and to evaluate age, gender and racial disparities using a national level health data. DESIGN Cross-sectional observational study. SETTING AND PARTICIPANTS Data collected from patient visit records to stand-alone US ambulatory care clinics. Visits made by men and women who were 40 years of age and older were included (n=175,830). MEASUREMENTS Overall prevalence of recorded calcium and vitamin D use for osteoporosis prevention and treatment, and annual visit rates were estimated by age, gender, race, insurance types, physician specialties, geographical regions, and metropolitan status using chi square test. Multivariate logistic regression was conducted to determine potential predictive factors for calcium and vitamin D supplements. RESULTS An increase in yearly trend of calcium and vitamin D supplements was observed. The increase was proportional to patients' age (p<0.05) and female gender was a strong predictor of calcium and vitamin D supplement (p<0.0001).Visits made by blacks were significantly less likely to be associated with the supplement (<0.05). Visits associated with self-pay and Medicaid was less likely to be recorded with vitamin D (p<0.05) but not calcium supplements. Osteoporosis diagnosis was an independent predictor of calcium and vitamin D records (p<0.0001). CONCLUSIONS In spite of the observed increases in the trend of visits associated with calcium and vitamin D supplements, variability in the access to the medications was observed. More focused strategies targeting elderly, men, or black population are needed to maintain and improve adequate calcium and vitamin D supplements.
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Affiliation(s)
- S Lee
- Euni Lee, Pharm.D., Ph.D. Associate Professor, Seoul National University College of Pharmacy, Gwanak-ro 1, Gwanak-gu, Seoul, 151-742, South Korea, Telephone: +82-2-740-8588, Fax: +82-2-880-9122,
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143
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Schousboe JT, Vo T, Taylor BC, Cawthon PM, Schwartz AV, Bauer DC, Orwoll ES, Lane NE, Barrett-Connor E, Ensrud KE. Prediction of Incident Major Osteoporotic and Hip Fractures by Trabecular Bone Score (TBS) and Prevalent Radiographic Vertebral Fracture in Older Men. J Bone Miner Res 2016; 31:690-7. [PMID: 26378772 PMCID: PMC4795988 DOI: 10.1002/jbmr.2713] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 12/25/2022]
Abstract
Trabecular bone score (TBS) has been shown to predict major osteoporotic (clinical vertebral, hip, humerus, and wrist) and hip fractures in postmenopausal women and older men, but the association of TBS with these incident fractures in men independent of prevalent radiographic vertebral fracture is unknown. TBS was estimated on anteroposterior (AP) spine dual-energy X-ray absorptiometry (DXA) scans obtained at the baseline visit for 5979 men aged ≥65 years enrolled in the Osteoporotic Fractures in Men (MrOS) Study and its association with incident major osteoporotic and hip fractures estimated with proportional hazards models. Model discrimination was tested with Harrell's C-statistic and with a categorical net reclassification improvement index, using 10-year risk cutpoints of 20% for major osteoporotic and 3% for hip fractures. For each standard deviation decrease in TBS, there were hazard ratios of 1.27 (95% confidence interval [CI] 1.17 to 1.39) for major osteoporotic fracture, and 1.20 (95% CI 1.05 to 1.39) for hip fracture, adjusted for FRAX with bone mineral density (BMD) 10-year fracture risks and prevalent radiographic vertebral fracture. In the same model, those with prevalent radiographic vertebral fracture compared with those without prevalent radiographic vertebral fracture had hazard ratios of 1.92 (95% CI 1.49 to 2.48) for major osteoporotic fracture and 1.86 (95% CI 1.26 to 2.74) for hip fracture. There were improvements of 3.3%, 5.2%, and 6.2%, respectively, of classification of major osteoporotic fracture cases when TBS, prevalent radiographic vertebral fracture status, or both were added to FRAX with BMD and age, with minimal loss of correct classification of non-cases. Neither TBS nor prevalent radiographic vertebral fracture improved discrimination of hip fracture cases or non-cases. In conclusion, TBS and prevalent radiographic vertebral fracture are associated with incident major osteoporotic fractures in older men independent of each other and FRAX 10-year fracture risks, and these data support their use in conjunction with FRAX for fracture risk assessment in older men.
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Affiliation(s)
- John T Schousboe
- Park Nicollet Institute, HealthPartners, Minneapolis, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Tien Vo
- Division of Epidemiology, University of Minnesota, Minneapolis, MN, USA
| | - Brent C Taylor
- Division of Epidemiology, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Diseases Outcomes Research, Minneapolis VAMC, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Ann V Schwartz
- Departments of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Douglas C Bauer
- Departments of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Departments of Medicine, University of California, San Francisco, CA, USA
| | - Eric S Orwoll
- Oregon Health Sciences University, Portland, OR, USA
| | | | | | - Kristine E Ensrud
- Division of Epidemiology, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Diseases Outcomes Research, Minneapolis VAMC, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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144
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Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol 2016; 34:611-35. [PMID: 26644543 DOI: 10.1200/jco.2015.64.3809] [Citation(s) in RCA: 542] [Impact Index Per Article: 67.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made. This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for Clinicians and Journal of Clinical Oncology. Copyright © 2015 American Cancer Society and American Society of Clinical Oncology. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Cancer Society or the American Society of Clinical Oncology.
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Affiliation(s)
- Carolyn D. Runowicz
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Corinne R. Leach
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - N. Lynn Henry
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Karen S. Henry
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Heather T. Mackey
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Rebecca L. Cowens-Alvarado
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Rachel S. Cannady
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Mandi L. Pratt-Chapman
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Stephen B. Edge
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Linda A. Jacobs
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Arti Hurria
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Lawrence B. Marks
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Samuel J. LaMonte
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Ellen Warner
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Gary H. Lyman
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Patricia A. Ganz
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
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145
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Gu T, Eisenberg Lawrence DF, Stephenson JJ, Yu J. Physicians' perspectives on the treatment of osteoporosis patients with bisphosphonates. Clin Interv Aging 2016; 11:1-8. [PMID: 26929609 PMCID: PMC4760663 DOI: 10.2147/cia.s97593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Noncompliance with bisphosphonate therapy among osteoporosis patients attenuates the reduction of fracture risk. The objective of this study was to assess physicians' prescribing considerations, preferences for osteoporosis treatments, and perceptions of patients' compliance with oral bisphosphonates. METHODS This was an online survey of US physicians identified in the HealthCore Integrated Research Database (HIRD(SM)) as prescribing oral bisphosphonates to women aged ≥55 years. The survey gauged physicians' prescribing considerations and preferences for various types of osteoporosis medications. The physicians were asked to predict patient persistence and compliance, and rate various reasons for noncompliance. RESULTS Bone mineral density, long-term medication use (eg, corticosteroids), and a history of fracture were ranked as major considerations by 94.9%, 88.6%, and 86.7% of participating physicians (N=158), respectively, when deciding whether to treat an osteoporosis patient. Most physicians expressed a preference for prescribing weekly or monthly oral bisphosphonates, for both newly diagnosed patients (54.4% and 34.2%, respectively) and long-term users of oral bisphosphonates (40.5% and 36.1%, respectively). Most physicians (23.4% always, 58.9% sometimes) incorporated a drug holiday into their prescribing patterns. Although most physicians predicted that more than half of the patients would comply with the prescribed medication for at least a year, 17.7% predicted that less than half of the patients would be compliant in the 1st year, and 29.7% predicted the same result for compliance beyond 1 year. In the opinion of the majority of physicians, the major reasons for noncompliance with oral bisphosphonates were intolerance of a medication due to a gastrointestinal condition (71.5%) and medication side effects (69.6%). CONCLUSION US physicians consider several relevant risk factors when deciding whether to prescribe pharmacotherapy and exhibit a preference for weekly or monthly regimens. The physicians estimated a substantial minority of the patients to be noncompliant with oral bisphosphonates, for reasons including primarily gastrointestinal intolerance and medication-related side effects.
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Affiliation(s)
- Tao Gu
- HealthCore, Wilmington, DE, USA
| | | | | | - Jingbo Yu
- Merck & Co., Inc., Kenilworth, NJ, USA
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146
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Villa P, Lassandro AP, Moruzzi MC, Amar ID, Vacca L, Di Nardo F, De Waure C, Pontecorvi A, Scambia G. A non-invasive prevention program model for the assessment of osteoporosis in the early postmenopausal period: a pilot study on FRAX(®) and QUS tools advantages. J Endocrinol Invest 2016; 39:191-8. [PMID: 26141076 DOI: 10.1007/s40618-015-0341-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The study analyses the performances of FRAX algorithm and quantitative ultrasound (QUS) tool in relationship to the dual-energy X-ray absorptiometry (DXA) categorization to identify patients at risk of osteoporosis during menopause and to reach new thresholds for recommending the first DXA examination. DESIGN Retrospective cohort study. PATIENTS AND MEASUREMENTS Two hundred eighty-two postmenopausal patients filled out a questionnaire which determined their FRAX index and performed a bone evaluation by QUS of the calcaneus to determine their stiffness index (SI). Thereafter, they underwent assessments by the gold-standard DXA bone examination. RESULTS Statistically significant correlations were observed between FRAX (calculated without BMD) and both QUS and DXA diagnosis. FRAX mean indices of risk corresponding to the diagnosis of osteoporosis by QUS and DXA were similar. Receiver operating characteristic (ROC) curve analysis showed that both FRAX and QUS tests were sufficiently accurate in predicting the alteration of bone mineral composition. The ROC curves of QUS allowed us to identify, in our population, SI cutoff for normal patients (SI > 90.5) and for patients having osteoporosis (SI < 78.5). We selected a cutoff screening value from FRAX ROC curve for major clinical fracture (2.94). The following diagnostic algorithm demonstrated that the use of FRAX test alone has a sensitivity of 85.3 % and a specificity of 33.8 % while the use of QUS exam alone showed a sensitivity of 81.3 % and a specificity of 45.1 %. When considering the capacity of QUS exam in combination with FRAX test, the final algorithm showed a sensitivity of 69.4 % and a specificity of 57.7 %. CONCLUSIONS The use of QUS test with adjusted cutoffs offers a similar performance to the FRAX test alone in terms of sensitivity. The combined use of the tests reduces the sensibility but increases the specificity and adds clinical information related to the bone status of the patient.
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Affiliation(s)
- P Villa
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Policlinico 'A. Gemelli', Largo A. Gemelli 8, 00168, Rome, Italy.
| | - A P Lassandro
- Department of Endocrinology, Catholic University of Sacred Heart, Rome, Italy
| | - M C Moruzzi
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Policlinico 'A. Gemelli', Largo A. Gemelli 8, 00168, Rome, Italy
| | - I D Amar
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Policlinico 'A. Gemelli', Largo A. Gemelli 8, 00168, Rome, Italy
| | - L Vacca
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Policlinico 'A. Gemelli', Largo A. Gemelli 8, 00168, Rome, Italy
| | - F Di Nardo
- Institute of Hygiene, Catholic University of Sacred Heart, Rome, Italy
| | - C De Waure
- Institute of Hygiene, Catholic University of Sacred Heart, Rome, Italy
| | - A Pontecorvi
- Department of Endocrinology, Catholic University of Sacred Heart, Rome, Italy
| | - G Scambia
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Policlinico 'A. Gemelli', Largo A. Gemelli 8, 00168, Rome, Italy
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147
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Moriya S, Hayata T, Notomi T, Aryal S, Nakamaoto T, Izu Y, Kawasaki M, Yamada T, Shirakawa J, Kaneko K, Ezura Y, Noda M. PTH regulates β2-adrenergic receptor expression in osteoblast-like MC3T3-E1 cells. J Cell Biochem 2016; 116:142-8. [PMID: 25164990 DOI: 10.1002/jcb.24953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 08/22/2014] [Indexed: 12/30/2022]
Abstract
As the aged population is soaring, prevalence of osteoporosis is increasing. However, the molecular basis underlying the regulation of bone mass is still incompletely understood. Sympathetic tone acts via beta2 adrenergic receptors in bone and regulates the mass of bone which is the target organ of parathyroid hormone (PTH). However, whether beta2 adrenergic receptor is regulated by PTH in bone cells is not known. We therefore investigated the effects of PTH on beta2 adrenergic receptor gene expression in osteoblast-like MC3T3-E1 cells. PTH treatment immediately suppressed the expression levels of beta2 adrenergic receptor mRNA. This PTH effect was dose-dependent starting as low as 1 nM. PTH action on beta2 adrenergic receptor gene expression was inhibited by a transcriptional inhibitor, DRB, but not by a protein synthesis inhibitor, cycloheximide suggesting direct transcription control. Knockdown of beta2 adrenergic receptor promoted PTH-induced expression of c-fos, an immediate early response gene. With respect to molecular basis for this phenomenon, knockdown of beta2 adrenergic receptor enhanced PTH-induced transcriptional activity of cyclic AMP response element-luciferase construct in osteoblasts. Knockdown of beta2 adrenergic receptors also enhanced forskolin-induced luciferase expression, revealing that adenylate cyclase activity is influenced by beta2 adrenergic receptor. As for phosphorylation of transcription factor, knockdown of beta2 adrenergic receptor enhanced PTH-induced phosphorylation of cyclic AMP response element binding protein (CREB). These data reveal that beta2 adrenergic receptor is one of the targets of PTH and acts as a suppressor of PTH action in osteoblasts.
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Affiliation(s)
- Shuichi Moriya
- Department of Molecular Pharmacology, Medical Research Institute, Tokyo Medical & Dental University, Japan; Department of Orthopaedic Surgery, Juntendo University School of Medicine, Japan
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148
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Abstract
Since the implementation of effective combination antiretroviral therapy, HIV infection has been transformed from a life-threatening condition into a chronic disease. As people with HIV are living longer, aging and its associated manifestations have become key priorities as part of HIV care. For women with HIV, menopause is an important part of aging to consider. Women currently represent more than one half of HIV-positive individuals worldwide. Given the vast proportion of women living with HIV who are, and will be, transitioning through age-related life events, the interaction between HIV infection and menopause must be addressed by clinicians and researchers. Menopause is a major clinical event that is universally experienced by women, but affects each individual woman uniquely. This transitional time in women's lives has various clinical implications including physical and psychological symptoms, and accelerated development and progression of other age-related comorbidities, particularly cardiovascular disease, neurocognitive dysfunction, and bone mineral disease; all of which are potentially heightened by HIV or its treatment. Furthermore, within the context of HIV, there are the additional considerations of HIV acquisition and transmission risk, progression of infection, changes in antiretroviral pharmacokinetics, response, and toxicities. These menopausal manifestations and complications must be managed concurrently with HIV, while keeping in mind the potential influence of menopause on the prognosis of HIV infection itself. This results in additional complexity for clinicians caring for women living with HIV, and highlights the shifting paradigm in HIV care that must accompany this aging and evolving population.
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Affiliation(s)
- Nisha Andany
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - V Logan Kennedy
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Muna Aden
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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149
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Abstract
Vertebral compression fractures (VCF's) are the most common form of osteoporotic fractures. Whether symptomatic or asymptomatic, they both represent a high risk for not only vertebral but also nonvertebral fractures in untreated populations. This high risk of future fracture after a VCF is independent of the T-score because bone strength is a combination of bone mineral density and bone quality. VCFs are the single greatest risk for future fractures at all other skeletal sites in untreated populations, including hip fractures. They are often unrecognized despite their exceptionally high prevalence in all genders and most ethnic groups as age increases. This article highlights some of the key messages about VCF's, and how assessment for their presence and then management will reduce the risk of all osteoporotic fractures.
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Affiliation(s)
- Paul D Miller
- Medical Director, Colorado Center for Bone Research, Lakewood, CO, USA.
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150
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Gasser J. Therapy for musculoskeletal disorders. J Orthop Translat 2016; 4:71-74. [PMID: 30035067 PMCID: PMC5987011 DOI: 10.1016/j.jot.2015.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 11/25/2022] Open
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