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Meertens R, Lopez B, Crone B, Gundry M, Metcalfe-Smith E, Gibbard W, Jubb T, Manning F, Scott P, McWilliam R. Development of an opportunistic diagnostic prediction algorithm for osteoporosis and fragility fracture risk estimates from forearm radiographs (The OFFER1 Study). JBMR Plus 2024; 8:ziae020. [PMID: 38505820 PMCID: PMC10945724 DOI: 10.1093/jbmrpl/ziae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/22/2023] [Accepted: 01/19/2024] [Indexed: 03/21/2024] Open
Abstract
Osteoporosis and associated fractures are an increasingly prevalent concern with an ageing population. This study reports testing of IBEX Bone Health (IBEX BH) software, applied following acquisition of forearm radiographs. IBEX Bone Health analyses the radiograph to measure areal bone mineral density (aBMD) at the examination site. A non-randomized cross-sectional study design was performed involving 261 (254 after exclusions) participants (112/142 m/f; mean age 70.8 years (SD+/-9.0); 53 with osteoporosis). They underwent posterior-anterior distal forearm radiographs; dual X-ray absorptiometry (DXA) of the wrists, hips, and lumbar spine; and questionnaires exploring clinical risk factors. IBEX Bone Health automatically identifies regions of interest (ROI) at the ultra-distal (UD) and distal third (TD) regions of the radius. Analysis investigated area under the receiver operating characteristics curve performance of IBEX BH for prediction of (i) osteoporosis (based on clinical reporting of the hip and spine DXA) and (ii) treatment recommendations by Fracture Risk Assessment Tool (FRAX) inclusive of neck of femur (NoF) areal bone mineral density (aBMD) results following National Osteoporosis Guideline Group (NOGG) guidelines. Area under the receiver operating characteristics curve for osteoporosis prediction at the UD and TD ROIs were 0.86 (99% confidence interval (CI) [0.80, 0.91]) and 0.81 (99% CI [0.75, 0.88]), respectively. Area under the receiver operating characteristics curve for treatment recommendation using FRAX inclusive of NoF aBMD at the UD and TD ROIs were 0.95 (99% CI [0.91, 1.00]) and 0.97 (99% CI [0.93,1.00]), respectively. With a matched sensitivity to FRAX (without NoF aBMD) 0.93 (99% CI [0.78, 0.99]), IBEX BH predicted at the UD and TD ROIs recommended treatment outcomes by NOGG guidelines using FRAX (with NoF aBMD) with specificity 0.89 (99% CI 0.83, 0.94]) and 0.93 (99% CI [0.87, 0.97]), respectively. This is compared with 0.60 (99% CI [0.51, 0.69]) for FRAX (without NoF aBMD). Results demonstrate the potential clinical utility of IBEX BH as an opportunistic screening tool.
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Affiliation(s)
- Robert Meertens
- University of Exeter, Medical Imaging Exeter, EX1 2LU, United Kingdom
| | - Ben Lopez
- Ibex Innovations Ltd., Sedgefield, TS21 3FD, United Kingdom
| | - Ben Crone
- Ibex Innovations Ltd., Sedgefield, TS21 3FD, United Kingdom
| | - Mike Gundry
- University of Exeter, Medical Imaging Exeter, EX1 2LU, United Kingdom
| | | | - Warren Gibbard
- Ibex Innovations Ltd., Sedgefield, TS21 3FD, United Kingdom
| | - Thomas Jubb
- Ibex Innovations Ltd., Sedgefield, TS21 3FD, United Kingdom
| | - Fay Manning
- University of Exeter, Medical Imaging Exeter, EX1 2LU, United Kingdom
| | - Paul Scott
- Ibex Innovations Ltd., Sedgefield, TS21 3FD, United Kingdom
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Agarwal AR, Tarawneh O, Cohen JS, Gu A, Moseley KF, DeBritz JN, Golladay GJ, Thakkar SC. The incremental risk of fragility fractures in aging men. Osteoporos Int 2024; 35:495-503. [PMID: 37938405 DOI: 10.1007/s00198-023-06956-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION While the United States Preventative Services Task Force recommends osteoporosis screening for women 65 years and older, there is no definitive recommendation for routine osteoporosis screening in men. The purpose of this study was to determine the age at which the odds of fragility fractures (FFx) increase in men to help guide future policy discussions evaluating an optimal screening strategy in this population. METHODS Men older than 49 years were identified in the PearlDiver Patient Records Database. Patients were excluded if they had a prior fragility fracture, if they were at high risk for osteoporosis due to comorbidities, or if they carried a diagnosis of and/or were on treatment for osteoporosis. The prevalence of FFx was trended for each age group. A stratum-specific likelihood ratio (SSLR) analysis was conducted to identify data-driven strata that maximize the incremental FFx risk by age for men. Logistic regression analyses controlling for potential confounders were conducted to test these identified strata. RESULTS The incidence of FFx started to increase after the age of 64 years for men. Further, the identified data-driven age strata associated with a significant and incremental difference in fragility fractures were the following: 50-64, 65-69, 70-72, 73-75, 76-78, 79-80, and 81+. When compared to the youngest age stratum (50-64 years), multivariable regression showed the risk of fragility fracture incrementally increased starting in those aged 70-72 (RR, 1.31; 95% CI. 1.21-1.46; p < 0.001) with the highest risk in those aged 81+ (RR, 5.35; 95% CI, 5.10-5.62; p < 0.001). CONCLUSION In men without a pre-existing history of osteoporosis, the risk of fragility fractures starts to increase after the age of 70. Further work building upon these data may help to identify a specific age at which routine bone health screening in males can help to minimize fractures and their associated morbidity and mortality.
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Affiliation(s)
- A R Agarwal
- Department of Orthopaedic Surgery, George Washington University School of Medicine and, Health Sciences, Washington, DC, USA.
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA.
| | - O Tarawneh
- Department of Orthopaedic Surgery, New York Medical College, Valhalla, NY, USA
| | - J S Cohen
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelpha, PA, USA
| | - A Gu
- Department of Orthopaedic Surgery, George Washington University School of Medicine and, Health Sciences, Washington, DC, USA
| | - K F Moseley
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - J N DeBritz
- Department of Orthopaedic Surgery, George Washington University School of Medicine and, Health Sciences, Washington, DC, USA
| | - G J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health Center, Richmond, VA, USA
| | - S C Thakkar
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
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Yadav RN, Oravec DJ, Morrison CK, Bevins NB, Rao SD, Yeni YN. Digital wrist tomosynthesis (DWT)-based finite element analysis of ultra-distal radius differentiates patients with and without a history of osteoporotic fracture. Bone 2023; 177:116901. [PMID: 37714502 DOI: 10.1016/j.bone.2023.116901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023]
Abstract
Despite effective therapies for those at risk of osteoporotic fracture, low adherence to screening guidelines and limited accuracy of bone mineral density (BMD) in predicting fracture risk preclude identification of those at risk. Because of high adherence to routine mammography, bone health screening at the time of mammography using a digital breast tomosynthesis (DBT) scanner has been suggested as a potential solution. BMD and bone microstructure can be measured from the wrist using a DBT scanner. However, the extent to which biomechanical variables can be derived from digital wrist tomosynthesis (DWT) has not been explored. Accordingly, we measured stiffness from a DWT based finite element (DWT-FE) model of the ultra-distal (UD) radius and ulna, and correlate these to reference microcomputed tomography image based FE (μCT-FE) from five cadaveric forearms. Further, this method is implemented to determine in vivo reproducibility of FE derived stiffness of UD radius and demonstrate the in vivo utility of DWT-FE in bone quality assessment by comparing two groups of postmenopausal women with and without a history of an osteoporotic fracture (Fx; n = 15, NFx; n = 51). Stiffness obtained from DWT and μCT had a strong correlation (R2 = 0.87, p < 0.001). In vivo repeatability error was <5 %. The NFx and Fx groups were not significantly different in DXA derived minimum T-scores (p > 0.3), but stiffness of the UD radius was lower for the Fx group (p < 0.007). Logistic regression models of fracture status with stiffness of the nondominant arm as the predictor were significant (p < 0.01). In conclusion this study demonstrates the feasibility of fracture risk assessment in mammography settings using DWT imaging and FE modeling in vivo. Using this approach, bone and breast screening can be performed in a single visit, with the potential to improve both the prevalence of bone health screening and the accuracy of fracture risk assessment.
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Affiliation(s)
- Ram N Yadav
- Bone and Joint Center, Henry Ford Health, Detroit, MI, USA
| | | | | | | | - Sudhaker D Rao
- Division of Endocrinology, Diabetes and Bone, Mineral Disorders, and Bone, Mineral Research Laboratory, Henry Ford Health, Detroit, MI, USA
| | - Yener N Yeni
- Bone and Joint Center, Henry Ford Health, Detroit, MI, USA; Henry Ford Health + Michigan State University Health Sciences, Detroit, MI, USA.
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Rühling S, Schwarting J, Froelich MF, Löffler MT, Bodden J, Hernandez Petzsche MR, Baum T, Wostrack M, Aftahy AK, Seifert-Klauss V, Sollmann N, Zimmer C, Kirschke JS, Tollens F. Cost-effectiveness of opportunistic QCT-based osteoporosis screening for the prediction of incident vertebral fractures. Front Endocrinol (Lausanne) 2023; 14:1222041. [PMID: 37576975 PMCID: PMC10422975 DOI: 10.3389/fendo.2023.1222041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Objectives Opportunistic quantitative computed tomography (oQCT) derived from non-dedicated routine CT has demonstrated high accuracy in diagnosing osteoporosis and predicting incident vertebral fractures (VFs). We aimed to investigate the cost-effectiveness of oQCT screening compared to dual-energy X-ray absorptiometry (DXA) as the standard of care for osteoporosis screening. Methods Three screening strategies ("no osteoporosis screening", "oQCT screening", and "DXA screening") after routine CT were simulated in a state-transition model for hypothetical cohorts of 1,000 patients (women and men aged 65 years) over a follow-up period of 5 years (base case). The primary outcomes were the cumulative costs and the quality-adjusted life years (QALYs) estimated from a U.S. health care perspective for the year 2022. Cost-effectiveness was assessed based on a willingness-to-pay (WTP) threshold of $70,249 per QALY. The secondary outcome was the number of prevented VFs. Deterministic and probabilistic sensitivity analyses were conducted to test the models' robustness. Results Compared to DXA screening, oQCT screening increased QALYs in both sexes (additional 2.40 per 1,000 women and 1.44 per 1,000 men) and resulted in total costs of $3,199,016 and $950,359 vs. $3,262,934 and $933,077 for women and men, respectively. As a secondary outcome, oQCT screening prevented 2.6 and 2.0 additional VFs per 1,000 women and men, respectively. In the probabilistic sensitivity analysis, oQCT screening remained cost-effective in 88.3% (women) and 90.0% (men) of iterations. Conclusion oQCT screening is a cost-effective ancillary approach for osteoporosis screening and has the potential to prevent a substantial number of VFs if considered in daily clinical practice.
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Affiliation(s)
- Sebastian Rühling
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julian Schwarting
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias F. Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Mannheim, Germany
| | - Maximilian T. Löffler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Jannis Bodden
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Moritz R. Hernandez Petzsche
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A. Kaywan Aftahy
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Vanadin Seifert-Klauss
- Department of Gynecology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Fabian Tollens
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Mannheim, Germany
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Li N, Beaudart C, Cauley JA, Ing SW, Lane NE, Reginster JY, Silverman S, Singer AJ, Hiligsmann M. Cost Effectiveness Analyses of Interventions for Osteoporosis in Men: A Systematic Literature Review. PHARMACOECONOMICS 2023; 41:363-391. [PMID: 36738425 PMCID: PMC10020287 DOI: 10.1007/s40273-022-01239-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 05/06/2023]
Abstract
BACKGROUND Osteoporosis is often considered to be a disease of women. Over the last few years, owing to the increasing clinical and economic burden, the awareness and imperative for identifying and managing osteoporosis in men have increased substantially. With the approval of agents to treat men with osteoporosis, more economic evaluations have been conducted to assess the potential economic benefits of these interventions. Despite this concern, there is no specific overview of cost-effectiveness analyses for the treatment of osteoporosis in men. OBJECTIVES This study aims (1) to systematically review economic evaluations of interventions for osteoporosis in men; (2) to critically appraise the quality of included studies and the source of model input data; and (3) to investigate the comparability of results for studies including both men and women. METHODS A literature search mainly using MEDLINE (via Ovid) and Embase databases was undertaken to identify original articles published between 1 January, 2000 and 30 June, 2022. Studies that assessed the cost effectiveness of interventions for osteoporosis in men were included. The Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases and the International Osteoporosis Foundation osteoporosis-specific guideline was used to assess the quality of design, conduct, and reporting of included studies. RESULTS Of 2973 articles identified, 25 studies fulfilled the inclusion criteria, classified into economic evaluations of active drugs (n = 8) or nutritional supplements (n = 4), intervention thresholds (n = 5), screening strategies (n = 6), and post-fracture care programs (n = 2). Most studies were conducted in European countries (n = 15), followed by North America (n = 9). Bisphosphonates (namely alendronate) and nutritional supplements were shown to be generally cost effective compared with no treatment in men over 60 years of age with osteoporosis or prior fractures. Two other studies suggested that denosumab was cost effective in men aged 75 years and older with osteoporosis compared with bisphosphates and teriparatide. Intervention thresholds at which bisphosphonates were found to be cost effective varied among studies with a 10-year probability of a major osteoporotic fracture that ranged from 8.9 to 34.2% for different age categories. A few studies suggested cost effectiveness of screening strategies and post-fracture care programs in men. Similar findings regarding the cost effectiveness of drugs and intervention thresholds in women and men were captured, with slightly greater incremental cost-effectiveness ratios in men. The quality of the studies included had an average score of 18.8 out of 25 (range 13-23.5). Hip fracture incidence and mortality risk were mainly derived from studies in men, while fracture cost, treatment efficacy, and disutility were commonly derived from studies in women or studies combining both sexes. CONCLUSIONS Anti-osteoporosis drugs and nutritional supplements are generally cost effective in men with osteoporosis. Screening strategies and post-fracture care programs also showed economic benefits for men. Cost-effectiveness and intervention thresholds were generally similar in studies conducted in both men and women, with slightly greater incremental cost-effectiveness ratios in men.
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Affiliation(s)
- Nannan Li
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Charlotte Beaudart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven W Ing
- Division of Endocrinology, Diabetes and Metabolism, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nancy E Lane
- Department of Medicine, University of California at Davis, School of Medicine, Sacramento, CA, USA
| | - Jean-Yves Reginster
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
- Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Stuart Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrea J Singer
- Departments of Obstetrics and Gynecology and Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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David K, Narinx N, Antonio L, Evenepoel P, Claessens F, Decallonne B, Vanderschueren D. Bone health in ageing men. Rev Endocr Metab Disord 2022; 23:1173-1208. [PMID: 35841491 DOI: 10.1007/s11154-022-09738-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 01/11/2023]
Abstract
Osteoporosis does not only affect postmenopausal women, but also ageing men. The burden of disease is projected to increase with higher life expectancy both in females and males. Importantly, osteoporotic men remain more often undiagnosed and untreated compared to women. Sex steroid deficiency is associated with bone loss and increased fracture risk, and circulating sex steroid levels have been shown to be associated both with bone mineral density and fracture risk in elderly men. However, in contrast to postmenopausal osteoporosis, the contribution of relatively small decrease of circulating sex steroid concentrations in the ageing male to the development of osteoporosis and related fractures, is probably only minor. In this review we provide several clinical and preclinical arguments in favor of a 'bone threshold' for occurrence of hypogonadal osteoporosis, corresponding to a grade of sex steroid deficiency that in general will not occur in many elderly men. Testosterone replacement therapy has been shown to increase bone mineral density in men, however data in osteoporotic ageing males are scarce, and evidence on fracture risk reduction is lacking. We conclude that testosterone replacement therapy should not be used as a sole bone-specific treatment in osteoporotic elderly men.
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Affiliation(s)
- Karel David
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000 , Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Nick Narinx
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000 , Leuven, Belgium
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Leen Antonio
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000 , Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Evenepoel
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Frank Claessens
- Laboratory of Molecular Endocrinology, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Brigitte Decallonne
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000 , Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000 , Leuven, Belgium.
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
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Miller KL, Mccoy K, Richards C, Seaman A, Solimeo SL. Engagement in Primary Prevention Program among Rural Veterans With Osteoporosis Risk. JBMR Plus 2022; 6:e10682. [PMID: 36248271 PMCID: PMC9549732 DOI: 10.1002/jbm4.10682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 02/05/2023] Open
Abstract
A primary osteoporosis prevention program using a virtual bone health team (BHT) was implemented to comanage the care of rural veterans in the Mountain West region of the United States. The BHT identified, screened, and treated rural veterans at risk for osteoporosis using telephone and United States Postal Service communications. Eligibility was determined by regular use of Veterans Health Administration primary care, age 50 or older, and evidence of fracture risk. This study was conducted to identify demographic and clinical factors associated with the acceptance of osteoporosis screening and the initiation of medication where indicated. A cross-sectional cohort design (N = 6985) was utilized with a generalized estimating equation and logit link function to account for facility-level clustering. Fully saturated and reduced models were fitted using backward selection. Less than a quarter of eligible veterans enrolled in BHT's program and completed screening. Factors associated with a lower likelihood of clinic enrollment included being of older age, unmarried, greater distance from VHA services, having a copayment, prior fracture, or history of rheumatoid arthritis. A majority of veterans with treatment indication started medication therapy (N = 453). In this subpopulation, Fisher's exact test showed a significant association between osteoporosis treatment uptake and a history of two or more falls in the prior year, self-reported parental history of fracture, current smoking, and weight-bearing exercise. The BHT was designed to reduce barriers to screening; however, for this population cost and travel continue to limit engagement. The remarkable rate of medication initiation notwithstanding, low enrollment reduces the impact of this primary prevention program, and findings pertaining to fracture, smoking, and exercise imply that health beliefs are an important contributing factor. Efforts to identify and address barriers to osteoporosis screening and treatment, such as clinical factors, social determinants of health, and health beliefs, may pave the way for effective implementation of population bone health care delivery systems. Published 2022. This article is a U.S. Government work and is in the public domain in the USA. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Karla L. Miller
- VHA Office of Rural Health, Veterans Rural Health Resource Center‐Salt Lake City, Department of Internal Medicine, Rheumatology SectionVeterans Affairs Salt Lake City Health Care SystemSalt Lake CityUtahUSA,Associate Professor (Clinical) of Medicine, Division of RheumatologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Kimberly Mccoy
- VHA Office of Rural Health, Veterans Rural Health Resource Center‐Iowa City (VRHRC‐IC), Center for Access & Delivery Research and Evaluation (CADRE)Veterans Affairs Iowa City VHA Health Care SystemIowa CityIowaUSA
| | - Chris Richards
- VHA Office of Rural Health, Veterans Rural Health Resource Center‐Iowa City (VRHRC‐IC), Center for Access & Delivery Research and Evaluation (CADRE)Department of Veterans Affairs Iowa City VHA Health Care SystemIowa CityIowaUSA
| | - Aaron Seaman
- VHA Office of Rural Health, Veterans Rural Health Resource Center‐Iowa City (VRHRC‐IC)Veterans Affairs Iowa City VHA Health Care SystemIowa CityIowaUSA,Division of General Internal Medicine, Department of Internal Medicine, Carver College of MedicineUniversity of IowaIowa CityIowaUSA
| | - Samantha L. Solimeo
- VHA Office of Rural Health, Veterans Rural Health Resource Center‐Iowa City (VRHRC‐IC), Center for Access & Delivery Research and Evaluation (CADRE), Primary Care Analytics Team Iowa City (PCAT‐IC)Veterans Affairs Iowa City VHA Health Care SystemIowa CityIowaUSA,Division of General Internal Medicine, Department of Internal Medicine, Carver College of MedicineUniversity of IowaIowa CityIowaUSA
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Daggett SM, Cantarelli T, Gyftopoulos S, Krueger P, Ross AB. Cost-effectiveness Analysis in Diagnostic Musculoskeletal Radiology: A Systematic Review. Curr Probl Diagn Radiol 2022; 52:20-24. [DOI: 10.1067/j.cpradiol.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/27/2022] [Indexed: 11/22/2022]
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9
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Letters To The Editor. Menopause 2022; 29:496-497. [PMID: 35324539 DOI: 10.1097/gme.0000000000001968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Nayak S, Singer A, Greenspan SL. Cost-effectiveness of secondary fracture prevention intervention for Medicare beneficiaries. J Am Geriatr Soc 2021; 69:3435-3444. [PMID: 34343339 PMCID: PMC9291535 DOI: 10.1111/jgs.17381] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/23/2021] [Accepted: 07/03/2021] [Indexed: 01/04/2023]
Abstract
Background Secondary fracture prevention intervention such as fracture liaison services are effective for increasing osteoporosis treatment rates, but are not currently widely used in the United States. We evaluated the cost‐effectiveness of secondary fracture prevention intervention after osteoporotic fracture for Medicare beneficiaries. Methods An individual‐level state‐transition microsimulation model was developed to evaluate the cost‐effectiveness of secondary fracture prevention intervention compared with usual care for U.S. Medicare patients aged 65 and older who experience a new osteoporotic fracture. Patients who initiated pharmacotherapy and remained adherent were assumed to be treated for 5 years. Outcome measures included subsequent fractures, average lifetime costs, quality‐adjusted life‐years (QALYs), and incremental cost‐effectiveness ratios in 2020 U.S. dollars per QALY gained. The model time horizon was lifetime, and analysis perspective was payer. Results Base‐case analysis results showed that the secondary fracture prevention intervention strategy was both more effective and less expensive than usual care—thus, it was cost‐saving. Model findings indicated that the intervention would reduce the number of expected fractures by approximately 5% over a 5‐year period, preventing approximately 30,000 fractures for 1 million patients. Secondary fracture prevention intervention resulted in an average cost savings of $418 and an increase in QALYs of 0.0299 per patient over the lifetime; for 1 million patients who receive the intervention instead of usual care, expected cost savings for Medicare would be $418 million dollars. One‐way and probabilistic sensitivity analyses supported base‐case findings of cost savings. Conclusion Secondary fracture prevention intervention for Medicare beneficiaries after a new osteoporotic fracture is very likely to both improve health outcomes and reduce healthcare costs compared with usual care. Expansion of its use for this population is strongly recommended.
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Affiliation(s)
- Smita Nayak
- Berkeley Madonna, Inc., Albany, California, USA
| | - Andrea Singer
- MedStar Georgetown University Hospital, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Susan L Greenspan
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Ramachandran S, Williams SA, Weiss RJ, Wang Y, Zhang Y, Nsiah I, Bhattacharya K. Gender Disparities in Osteoporosis Screening and Management Among Older Adults. Adv Ther 2021; 38:3872-3887. [PMID: 34053012 DOI: 10.1007/s12325-021-01792-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/15/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION One in two women and one in four men experience an osteoporosis-related fracture in their lifetime. Related morbidity and mortality rates are higher in men versus women. Current guidelines are inconsistent in the screening recommendations for osteoporosis in men. Examination of gender disparities in the management of osteoporosis-related fractures among Medicare enrollees is currently lacking. METHODS In this retrospective cohort study using 5% National Medicare claims data from January 1, 2012 through December 31, 2016, eligible patients who were at least 65 years of age on the date of a new fracture episode were classified into two mutually exclusive cohorts on the basis of whether they received testing and/or treatment for osteoporosis in the 6-month period after the new fracture episode. The cohorts were defined on the basis of the National Committee for Quality Assurance (NCQA) quality measure "osteoporosis management in women who had a fracture." Patients were followed to identify the occurrence of subsequent fracture, all-cause mortality, and a composite outcome-defined as the first occurrence of either subsequent fracture or mortality. Logistic regression models were carried out to identify predictors of testing and/or treatment and time-varying survival analysis to identify the relationship between the presence of testing and/or treatment and patient outcomes. RESULTS Of the 35,774 eligible patients, only 10.2% (12.1% women and 5.7% men) received osteoporosis testing and/or treatment within 6 months after a fracture. The interaction between gender and fragility fracture was significant (P < 0.0001). Fragility fracture had greater adjusted odds of testing and/or treatment among men (adjusted odds ratio [AOR] 3.47; 95% CI 2.94-4.10) than women (AOR 1.65; 95% CI 1.53-1.79). Of patients who were eligible for the outcome assessment, 27.5% experienced a subsequent fracture, 23.2% died, and 44.3% experienced a composite outcome during follow-up. Patients who received testing and/or treatment had a significantly lower hazard of all-cause mortality (hazard ratio [HR] 0.57; 95% CI 0.50-0.65; P < 0.0001) and the composite outcome (HR 0.42; 95% CI 0.39-0.45; P < 0.0001), but no difference in the risk of subsequent fracture (HR 1.02; 95% CI 0.94-1.11; P = 0.6083). Men were found to have a significantly lower hazard of subsequent fracture (HR 0.69; 95% CI 0.64-0.73; P < 0.0001), all-cause mortality (HR 0.67; 95% CI 0.61-0.72; P < 0.0001), and the composite outcome (HR 0.69; 95% CI 0.65-0.73; P < 0.0001). CONCLUSION Testing and/or treatment for osteoporosis among older adults with a fracture is poor in the Medicare fee-for-service population overall and worse for men compared to women. Receiving appropriate testing and/or treatment was associated with reduced mortality and the risk of composite outcome. Improving osteoporosis testing and/or treatment and reducing health disparities are essential for managing the clinical and economic burden of osteoporosis in the USA.
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Affiliation(s)
- Sujith Ramachandran
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA.
| | - Setareh A Williams
- Health Economics and Outcomes Research, Radius Health, Inc., Boston, MA, USA
| | - Richard J Weiss
- Global Medical Affairs, Radius Health, Inc., Boston, MA, USA
| | | | - Yiqiao Zhang
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA
| | - Irene Nsiah
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA
| | - Kaustuv Bhattacharya
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA
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Ito K. Cost-effectiveness of Screening for Osteoporosis in Older Men With a History of Falls. JAMA Netw Open 2020; 3:e2027584. [PMID: 33258906 PMCID: PMC7708999 DOI: 10.1001/jamanetworkopen.2020.27584] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/06/2020] [Indexed: 12/01/2022] Open
Abstract
Importance Falls and osteoporosis share the potential clinical end point of fractures among older patients. To date, few fall prevention guidelines incorporate screening for osteoporosis to reduce fall-related fractures. Objective To assess the cost-effectiveness of screening for osteoporosis using dual-energy x-ray absorptiometry (DXA) followed by osteoporosis treatment in older men with a history of falls. Design, Setting, and Participants In this economic evaluation, a Markov model was developed to simulate the incidence of major osteoporotic fractures in a hypothetical cohort of community-dwelling men aged 65 years who had fallen at least once in the past year. Data sources included literature published from January 1, 1946, to July 31, 2020. The model adopted a societal perspective, a lifetime horizon, a 1-year cycle length, and a discount rate of 3% per year for both health benefits and costs. The analysis was designed and conducted from October 1, 2019, to September 30, 2020. Interventions Screening with DXA followed by treatment for men diagnosed with osteoporosis compared with usual care. Main Outcomes and Measures Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained. Results Among the hypothetical cohort of men aged 65 years, the screening strategy had an ICER of $33 169/QALY gained and was preferred over usual care at the willingness-to-pay threshold of $100 000/QALY gained. The number needed to screen to prevent 1 hip fracture was 1876; to prevent 1 major osteoporotic fracture, 746. The screening strategy would become more effective and less costly than usual care for men 77 years and older. The ICER for the screening strategy did not substantially change across a wide range of assumptions tested in all other deterministic sensitivity analyses. At a willingness-to-pay threshold of $50 000/QALY gained, screening was cost-effective in 56.0% of simulations; at $100 000/QALY gained, 90.8% of simulations; and at $200 000/QALY gained, 99.6% of simulations. Conclusions and Relevance These findings suggest that for older men who have fallen at least once in the past year, screening with DXA followed by treatment for those diagnosed with osteoporosis is a cost-effective use of resources. Fall history could be a useful cue to trigger assessment for osteoporosis in men.
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Affiliation(s)
- Kouta Ito
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
- Meyers Primary Care Institute, Worcester, Massachusetts
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13
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Keaveny TM, Clarke BL, Cosman F, Orwoll ES, Siris ES, Khosla S, Bouxsein ML. Biomechanical Computed Tomography analysis (BCT) for clinical assessment of osteoporosis. Osteoporos Int 2020; 31:1025-1048. [PMID: 32335687 PMCID: PMC7237403 DOI: 10.1007/s00198-020-05384-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/09/2020] [Indexed: 12/12/2022]
Abstract
The surgeon general of the USA defines osteoporosis as "a skeletal disorder characterized by compromised bone strength, predisposing to an increased risk of fracture." Measuring bone strength, Biomechanical Computed Tomography analysis (BCT), namely, finite element analysis of a patient's clinical-resolution computed tomography (CT) scan, is now available in the USA as a Medicare screening benefit for osteoporosis diagnostic testing. Helping to address under-diagnosis of osteoporosis, BCT can be applied "opportunistically" to most existing CT scans that include the spine or hip regions and were previously obtained for an unrelated medical indication. For the BCT test, no modifications are required to standard clinical CT imaging protocols. The analysis provides measurements of bone strength as well as a dual-energy X-ray absorptiometry (DXA)-equivalent bone mineral density (BMD) T-score at the hip and a volumetric BMD of trabecular bone at the spine. Based on both the bone strength and BMD measurements, a physician can identify osteoporosis and assess fracture risk (high, increased, not increased), without needing confirmation by DXA. To help introduce BCT to clinicians and health care professionals, we describe in this review the currently available clinical implementation of the test (VirtuOst), its application for managing patients, and the underlying supporting evidence; we also discuss its main limitations and how its results can be interpreted clinically. Together, this body of evidence supports BCT as an accurate and convenient diagnostic test for osteoporosis in both sexes, particularly when used opportunistically for patients already with CT. Biomechanical Computed Tomography analysis (BCT) uses a patient's CT scan to measure both bone strength and bone mineral density at the hip or spine. Performing at least as well as DXA for both diagnosing osteoporosis and assessing fracture risk, BCT is particularly well-suited to "opportunistic" use for the patient without a recent DXA who is undergoing or has previously undergone CT testing (including hip or spine regions) for an unrelated medical condition.
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Affiliation(s)
- T M Keaveny
- Departments of Mechanical Engineering and Bioengineering, University of California, Berkeley, CA, USA.
| | - B L Clarke
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - F Cosman
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - E S Orwoll
- Bone and Mineral Unit, Oregon Health and Science University, Portland, OR, USA
| | - E S Siris
- Toni Stabile Osteoporosis Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - S Khosla
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - M L Bouxsein
- Orthopedic Biomechanics Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Association Between Muscular Strength and Bone Health from Children to Young Adults: A Systematic Review and Meta-analysis. Sports Med 2020; 50:1163-1190. [DOI: 10.1007/s40279-020-01267-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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15
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Pisu M, Kopperdahl DL, Lewis CE, Saag KG, Keaveny TM. Cost-Effectiveness of Osteoporosis Screening Using Biomechanical Computed Tomography for Patients With a Previous Abdominal CT. J Bone Miner Res 2019; 34:1229-1239. [PMID: 30779860 PMCID: PMC6687393 DOI: 10.1002/jbmr.3700] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/22/2019] [Accepted: 02/10/2019] [Indexed: 12/11/2022]
Abstract
Osteoporosis screening rates by DXA are low (9.5% women, 1.7% men) in the US Medicare population aged 65 years and older. Addressing this care gap, we estimated the benefits of a validated osteoporosis diagnostic test suitable for patients age 65 years and older with an abdominal computed tomography (CT) scan taken for any indication but without a recent DXA. Our analysis assessed a hypothetical cohort of 1000 such patients in a given year, and followed them for 5 years. Separately for each sex, we used Markov modeling to compare two mutually exclusive scenarios: (i) utilizing the CT scans, perform one-time "biomechanical computed tomography" (BCT) analysis to identify high-risk patients on the basis of both femoral strength and hip BMD T-scores; (ii) ignore the CT scan, and rely instead on usual care, consisting of future annual DXA screening at typical Medicare rates. For patients with findings indicative of osteoporosis, 50% underwent 2 years of treatment with alendronate. We found that BCT provided greater clinical benefit at lower cost for both sexes than usual care. In our base case, compared to usual care, BCT prevented hip fractures over a 5-year window (3.1 per 1000 women; 1.9 per 1000 men) and increased quality-adjusted life years (2.95 per 1000 women; 1.48 per 1000 men). Efficacy and savings increased further for higher-risk patient pools, greater treatment adherence, and longer treatment duration. When the sensitivity and specificity of BCT were set to those for DXA, the prevented hip fractures versus usual care remained high (2.7 per 1000 women; 1.5 per 1000 men), indicating the importance of high screening rates on clinical efficacy. Therefore, for patients with a previously taken abdominal CT and without a recent DXA, osteoporosis screening using biomechanical computed tomography may be a cost-effective alternative to current usual care. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, University of Alabama Birmingham, Birmingham, AL, USA
| | | | - Cora E Lewis
- Department of Epidemiology, University of Alabama Birmingham, Birmingham, AL, USA
| | - Kenneth G Saag
- Division of Clinical Immunology and Rheumatolog, University of Alabama Birmingham, Birmingham, AL, USA
| | - Tony M Keaveny
- Departments of Mechanical Engineering and Bioengineering, University of California Berkeley, Berkeley, CA, USA
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Colón-Emeric CS, Pieper CF, Van Houtven CH, Grubber JM, Lyles KW, Lafleur J, Adler RA. Limited Osteoporosis Screening Effectiveness Due to Low Treatment Rates in a National Sample of Older Men. Mayo Clin Proc 2018; 93:1749-1759. [PMID: 30497697 PMCID: PMC6338211 DOI: 10.1016/j.mayocp.2018.06.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/25/2018] [Accepted: 06/04/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the association between dual-energy x-ray absorptiometry (DXA) testing for osteoporosis and subsequent fractures in US male veterans without a previous fracture. PATIENTS AND METHODS This is a propensity score-matched observational study using Centers for Medicare and Medicaid Services and Veterans Affairs (VA) data from January 1, 2000, through December 31, 2010, with a mean follow-up time of 4.7 years (range, 0-10 years). Men receiving VA primary care aged 65 to 99 years without a previous fracture (N=2,539,812) were included. Men undergoing DXA testing were propensity score matched with untested controls in a 1:3 ratio, indicating the probability of DXA testing within the next year. Time to first clinical fracture was the primary outcome. Comorbidities, demographic characteristics, medications, DXA results, and osteoporosis treatment were defined using administrative data and natural language processing. A landmark analysis contingent on surviving to 12 months after screening was completed, accounting for competing risk of mortality. RESULTS During follow-up of 153,311 men tested by DXA and 390,158 controls, 56,083 (10.3%) had sustained a fracture and 111,774 (20.6%) died. Overall, DXA testing was not associated with a decrease in fractures; conclusions are limited by unmeasured confounders and low medication initiation and adherence in those meeting treatment thresholds (12% of follow-up time). In contrast, DXA testing in prespecified subgroups was associated with a lower risk of fracture in comparison to the overall population who underwent DXA testing: androgen deprivation therapy (hazard ratio [HR], 0.77; 95% CI, 0.66-0.89), glucocorticoids (HR, 0.77; 95% CI, 0.72-0.84), age 80 years and older (HR, 0.85; 0.81-0.90), 1 or more VA guideline risk factors (HR, 0.91; 95% CI, 0.87-0.95), and high Fracture Risk Assessment Tool using body mass index score (HR, 0.90; 95% CI, 0.86-0.95). CONCLUSION Current VA DXA testing practices are ineffective overall; interventions to improve treatment adherence are needed. Targeted DXA testing in higher-risk men was associated with a lower fracture risk.
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Affiliation(s)
- Cathleen S Colón-Emeric
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC; Durham VA Geriatric Research, Education and Clinical Center, Durham, NC.
| | - Carl F Pieper
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
| | - Courtney H Van Houtven
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC; Durham VA Health Services Research and Development Center of Innovation, Durham, NC
| | - Janet M Grubber
- Durham VA Health Services Research and Development Center of Innovation, Durham, NC
| | - Kenneth W Lyles
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC; Durham VA Geriatric Research, Education and Clinical Center, Durham, NC
| | | | - Robert A Adler
- Hunter Holmes McGuire VA Medical Center, Richmond, VA; Department of Medicine, Virginia Commonwealth University, Richmond, VA
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17
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Song LJ, Wang LL, Ning L, Fan SW, Zhao X, Chen YL, Li ZZ, Hu ZA. A modification and validation of quantitative morphometry classification system for osteoporotic vertebral compressive fractures in mainland Chinese. Osteoporos Int 2018; 29:2495-2504. [PMID: 30030586 DOI: 10.1007/s00198-018-4641-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/11/2018] [Indexed: 02/07/2023]
Abstract
UNLABELLED This study described a modified quantitative morphometry (mQM) system adapted to specific reference values for Mainland Chinese population. The mQM system is validated using the Genant Semiquantative system and is sensitive for detecting vertebral height changes and predicting cement leakage after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compressive fracture (OVCF). INTRODUCTION OVCF is a manifestation of osteoporosis. To improve clinical management of osteoporosis, the quantitative morphometry (QM) system has been widely used for the early diagnosis and precise classification of OVCF in developed countries. Here, we present an mQM system and validated its use in detecting OVCF in Mainland Chinese. METHODS Using our mQM system, the pre- and post-operative values of vertebral heights were measured and evaluated in 309 Mainland Chinese who received percutaneous kyphoplasty (PKP) as OVCF treatment. Measurements and classification of fractures from the mQM system were validated by comparing to values obtained by the Genant semiquantative (SQ) method. Moreover, we evaluated the sensitivity of the mQM system by its ability to detect restoration of vertebral heights and predict cement leakage after PKP. RESULTS The five classification of fractures, No deformity (ND), anterior wedge (AW), posterior wedge (PW), biconcavity (BC), and compression (CP), evaluated by the mQM method shared similar distribution characteristics compared to those obtained by the SQ method. In addition, mQM evaluation showed that the vertebra height of all fracture types showed significant restoration after PKP. The incidence of cement leakage was most common in CP (37.5%), followed by AW (31.6%), BC (26.5%), ND (23.7%), and PW (0.0%). CONCLUSIONS Our mQM system is suitable for classification of fractures, detection of vertebral height restoration, and correlation of cement leakage after PKP in Mainland Chinese population.
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Affiliation(s)
- L-J Song
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
- Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - L-L Wang
- School of Statistics and Mathematics, Zhejiang Gongshang University, Hangzhou, China
| | - L Ning
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
- Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - S-W Fan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
- Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - X Zhao
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
- Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Y-L Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
- Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Z-Z Li
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
- Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Z-A Hu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.
- Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.
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Su Y, Lai FTT, Yip BHK, Leung JCS, Kwok TCY. Cost-effectiveness of osteoporosis screening strategies for hip fracture prevention in older Chinese people: a decision tree modeling study in the Mr. OS and Ms. OS cohort in Hong Kong. Osteoporos Int 2018; 29:1793-1805. [PMID: 29774400 DOI: 10.1007/s00198-018-4543-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 04/20/2018] [Indexed: 01/08/2023]
Abstract
UNLABELLED Despite the high costs of hip fracture, many governments provide limited support for osteoporosis screening. We demonstrated that osteoporosis screening by dual-energy X-ray absorptiometry (DXA) with or without pre-screening by Fracture Risk Assessment Tool (FRAX) or calcaneal ultrasound are more cost-effective than no screening in Chinese people aged 65 or over in Hong Kong. INTRODUCTION To examine the cost-effective potential osteoporosis screening strategies for hip fracture prevention in Hong Kong. METHODS Decision tree models were constructed to evaluate the cost per quality-adjusted life years (QALYs) of the different osteoporosis screening strategies followed by subsequent 5-year treatment with alendronate compared to no screening (but treat if a hip fracture occurs). The multiple osteoporosis screening strategies were composed of alternative tests and initiation age groups were evaluated with a 10-year horizon, and treatment were assigned if central dual-energy X-ray absorptiometry (DXA) T-score (at either the hip or spine) is - 2.5 or less. Strategies included DXA for all people and pre-screening with the Fracture Risk Assessment Tool (FRAX) at specific thresholds or by calcaneal quantitative ultrasonography (QUS) before taking DXA examination. All the model inputs were based on the Mr. OS and Ms. OS Hong Kong cohort; data are obtained from the Social Welfare Department or the published literature. RESULTS All of the screening strategies, including the universal screening with DXA and the pre-screening with FRAX or QUS before DXA, were consistently more cost-effective than no screening for people aged 65 years old or over. One-way sensitivity analysis with a more optimistic assumption on treatment adherence or inclusion of other major osteoporotic fractures did not change the results materially. Probabilistic sensitivity analyses showed a dominant role of pre-screening with FRAX followed by subsequent osteoporosis drug treatment in people aged 70 years old or over in Hong Kong. CONCLUSIONS Osteoporosis screening strategies based on DXA with or without pre-screening are more cost-effective compared to no screening for Chinese people aged 65 or over in Hong Kong.
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Affiliation(s)
- Y Su
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - F T T Lai
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - B H K Yip
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - J C S Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - T C Y Kwok
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Pavone V, Testa G, Giardina SMC, Vescio A, Restivo DA, Sessa G. Pharmacological Therapy of Osteoporosis: A Systematic Current Review of Literature. Front Pharmacol 2017; 8:803. [PMID: 29163183 PMCID: PMC5682013 DOI: 10.3389/fphar.2017.00803] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/24/2017] [Indexed: 01/22/2023] Open
Abstract
Osteoporosis is the most common bone disease affecting millions of people worldwide, particularly in elderly or in post-menopausal women. The pathogenesis is useful to understand the possible mechanism of action of anti-osteoporotic drugs. Early diagnosis, possible with several laboratory and instrumental tests, allows a major accuracy in the choice of anti-osteoporosis drugs. Treatment of osteoporosis is strictly related to severity of pathology and consists on prevention of fragility fractures with a correct lifestyle and adequate nutritional supplements, and use of pharmacological therapy, started in patients with osteopenia and history of fragility fracture of the hip or spine. The purpose of this review is to focus on main current pharmacological products to treat osteoporotic patients.
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Affiliation(s)
- Vito Pavone
- Dipartimento di Chirurgia Generale e Specialità Medico-Chirurgiche, Sezione di Ortopedia, A.O.U.P. Vittorio Emanuele, Università di Catania, Catania, Italy
| | - Gianluca Testa
- Dipartimento di Chirurgia Generale e Specialità Medico-Chirurgiche, Sezione di Ortopedia, A.O.U.P. Vittorio Emanuele, Università di Catania, Catania, Italy
| | - Serena M. C. Giardina
- Dipartimento di Chirurgia Generale e Specialità Medico-Chirurgiche, Sezione di Ortopedia, A.O.U.P. Vittorio Emanuele, Università di Catania, Catania, Italy
| | - Andrea Vescio
- Dipartimento di Chirurgia Generale e Specialità Medico-Chirurgiche, Sezione di Ortopedia, A.O.U.P. Vittorio Emanuele, Università di Catania, Catania, Italy
| | - Domenico A. Restivo
- Neurologic Unit, Department of Internal Medicine, Nuovo “Garibaldi” Hospital, Catania, Italy
| | - Giuseppe Sessa
- Dipartimento di Chirurgia Generale e Specialità Medico-Chirurgiche, Sezione di Ortopedia, A.O.U.P. Vittorio Emanuele, Università di Catania, Catania, Italy
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Williams ST, Lawrence PT, Miller KL, Crook JL, LaFleur J, Cannon GW, Nelson RE. A comparison of electronic and manual fracture risk assessment tools in screening elderly male US veterans at risk for osteoporosis. Osteoporos Int 2017; 28:3107-3111. [PMID: 28756457 DOI: 10.1007/s00198-017-4172-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/20/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED This study compares four screening tools in their ability to predict osteoporosis. We found that there was no significant difference between the tools. These results provide support for the use of automated screening tools which work in conjunction with the electronic medical record and help improve screening rates for osteoporosis. INTRODUCTION The purpose of this study is to compare the performance of four fracture risk assessment tools (FRATs) in identifying osteoporosis by bone mineral density (BMD) T-score: Veterans Affairs Fracture Absolute Risk Assessment Tool (VA-FARA), World Health Organization's Fracture Risk Assessment Tool (FRAX), electronic FRAX (e-FRAX), and Osteoporosis Self-Assessment Screening Tool (OST). METHODS We performed a cross-sectional analysis of all patients enrolled in the VA Salt Lake City bone health team (BHT) who had completed a DXA scan between February 1, 2012, and February 1, 2013. DXA scan results were obtained by chart abstraction. For calculation of FRAX, osteoporosis risk factors were obtained from a screening questionnaire completed prior to DXA. For VA-FARA and e-FRAX, risk factors were derived from the electronic medical record (EMR). Clinical risk scores were calculated and compared against the gold standard of DXA-based osteoporosis. Sensitivity, specificity, and predictive values were calculated. Receiver operator characteristic (ROC) curves were plotted, and areas under the curve (AUC) were compared. RESULTS A cohort of 463 patients met eligibility criteria (mean age 80.4 years). One hundred twelve patients (24%) had osteoporosis as defined by DXA T-score ≤-2.5. Sensitivity, specificity, and predictive values were calculated. ROC statistics were compared and did not reach statistical significance difference between FRATs in identifying DXA-based osteoporosis. CONCLUSIONS Our study suggests that all FRATs tested perform similarly in identifying osteoporosis among elderly, primarily Caucasian, male veterans. If these electronic screening methods perform similarly for fracture outcomes, they could replace manual FRAX and thus improve efficiency in identifying individuals who should be sent for DXA scan.
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Affiliation(s)
- S T Williams
- Salt Lake City VA Medical Center and University of Utah Department of Internal Medicine, Salt Lake City, UT, USA.
- George E. Wahlen VA Medical Center, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.
| | - P T Lawrence
- Salt Lake City VA Medical Center and Roseman University of Health Sciences, Salt Lake City, UT, USA
| | - K L Miller
- Salt Lake City VA Medical Center and University of Utah Division of Rheumatology, Salt Lake City, UT, USA
| | - J L Crook
- University of Utah Division of Epidemiology and Salt Lake City VA Medical Center, Salt Lake City, UT, USA
| | - J LaFleur
- University of Utah Department of Pharmacotherapy and Salt Lake City VA Medical Center, Salt Lake City, UT, USA
| | - G W Cannon
- Salt Lake City VA Medical Center and University of Utah Division of Rheumatology, Salt Lake City, UT, USA
| | - R E Nelson
- University of Utah Division of Epidemiology and Salt Lake City VA Medical Center, Salt Lake City, UT, USA
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Ning L, Song LJ, Fan SW, Zhao X, Chen YL, Li ZZ, Hu ZA. Vertebral heights and ratios are not only race-specific, but also gender- and region-specific: establishment of reference values for mainland Chinese. Arch Osteoporos 2017; 12:88. [PMID: 29022168 DOI: 10.1007/s11657-017-0383-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 09/29/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study established gender-specific reference values in mainland Chinese (MC) and is important for quantitative morphometry for diagnosis and epidemiological study of osteoporotic vertebral compressive fracture. Comparisons of reference values among different racial populations are then performed to demonstrate the MC-specific characteristic. PURPOSE Osteoporotic vertebral compressive fracture (OVCF) is a common complication of osteoporosis in the elder population. Clinical diagnosis and epidemiological study of OVCF often employ quantitative morphometry, which relies heavily on the comparison of patients' vertebral parameters to existing reference values derived from the normal population. Thus, reference values are crucial in clinical diagnosis. To our knowledge, this is the first study to establish reference values of the mainland Chinese (MC) for quantitative morphometry. METHODS Vertebral heights including anterior (Ha), middle (Hm), posterior (Hp) heights, and predicted posterior height (pp) from T4 to L5 were obtained; and ratios of Ha/Hp, Hm/Hp and Hp/pp. were calculated from 585 MC (both female and male) for establishing reference values and subsequent comparisons with other studies. RESULTS Vertebral heights increased progressively from T4 to L3 but then decreased in L4 and L5. Both genders showed similar ratios of vertebral dimensions, but male vertebrae were statistically larger than those of female (P < 0.01). Vertebral size of MC population was smaller than that of US and UK population, but was surprisingly larger than that of Hong Kong Chinese, although these two are commonly considered as one race. Data from different racial populations showed similar dimensional ratios in all vertebrae. CONCLUSIONS We established gender-specific reference values for MC. Our results also indicated the necessity of establishing reference values that are not only race- and gender-specific, but also population- or region-specific for accurate quantitative morphometric assessment of OVCF.
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Affiliation(s)
- Lei Ning
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.,Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Li-Jiang Song
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.,Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Shun-Wu Fan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.,Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Xing Zhao
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.,Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Yi-Lei Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.,Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Zhao-Zhi Li
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.,Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Zi-Ang Hu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China. .,Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.
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22
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Abstract
PURPOSE OF THE REVIEW The purposes of this study are to examine the literature within the past 5 years regarding osteoporosis and offer a discussion on new topics and controversies. RECENT FINDINGS Patient compliance with therapy remains an issue. The effectiveness of Vitamin D and calcium are being called into question Atypical femur fractures have been associated with bisphosphonate and denosumab use. Treatment is both surgical and pharmaceutical. A multidisciplinary approach to osteoporotic fractures is important and having some form of fracture liaison service (FLS) improves the efficacy of osteoporotic care and decreases secondary fractures. Screening for osteoporosis remains low. Ultrasound may be cost-effective for diagnosis. Understanding of osteoporosis has come a long way in the medical community, but the translation to the lay community has lagged behind. Patients often take a laissez-faire attitude toward osteoporosis that can affect compliance. Information read by patients often focuses on complications, such as atypical femur fractures and myocardial infarctions. It is essential for providers to be able to discuss these issues with patients. Newer medications and more cost-effective diagnostic tests exist, but availability may be limited. FLS are effective, but the most cost-effective model for therapy still eludes us. Areas for further investigation include FLS models, the effectiveness of vitamin supplementation, and more ubiquitous and cost-effective diagnostic tools.
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Affiliation(s)
- Kyle M Schweser
- Department of Orthopaedic Surgery, University of Missouri, N116, One Hospital Dr, Columbia, MO, 65212, USA
| | - Brett D Crist
- Department of Orthopaedic Surgery, University of Missouri, N116, One Hospital Dr, Columbia, MO, 65212, USA.
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