Impact of a community-based osteoporosis and fall prevention program on fracture incidence

[Effects of physical activity and decreased sedentary behaviours in menopausal women. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines]

The purpose of this chapter is to examine, in postmenopausal women, the effect of physical activity (PA) on overall mortality, cardiovascular mortality and prevention of cardiovascular disease, bone health and body composition. An analysis of the scientific literature was carried out and more than 100 studies were selected. In postmenopausal women, regular endurance PA significantly reduced overall and cardiovascular mortality. It is effective in primary and tertiary prevention. Regarding bone health, combined exercises combining weight-bearing exercises with impacts associated with muscle strengthening are the most effective to maintain or improve bone mineral density and prevent fractures. In terms of body composition, regular endurance or combined PA (endurance+muscle strengthening) decreases visceral fat regardless of BMI, and this in the absence of caloric restriction. For muscle mass, only muscle strengthening or combined training (endurance+muscle strengthening) have shown their effectiveness in slowing down the loss of muscle mass or even in increasing it. In all cases, the minimum duration of PA is 12 weeks and above all, it must be continued so that the effects are maintained over the long term. All these parameters will also be improved with a reduction in time spent sitting, regardless of the level of PA. No study has reported a major incident related to the practice of moderate to high intensity levels of PA, provided that certain precautions are observed, the main one being with regard to cardiovascular risk. The recommendations for postmenopausal women are a reduction in sedentary behaviour associated with specific recommendations for regular physical activity.

What factors affect the methodological and reporting quality of clinical practice guidelines for osteoporosis? Protocol for a systematic review

BACKGROUND

Osteoporosis is a disease with a high prevalence and low treatment rate, which poses a serious threat to the lives of patients and brings a heavy economic burden. Clinical practice guidelines (CPGs) provide vital guidance for disease management. Up to now, different countries, regions, and organizations have issued a certain number of CPGs for osteoporosis, but the recommendations in different guidelines are inconsistent. This protocol plans to evaluate the quality of the CPGs for osteoporosis and then make a comparative analysis of the recommendations in the CPGs.

METHODS

Several databases including PubMed, Web of Science, Embase, and Cochrane Library, as well as the official website of relevant organizations will be searched. Screen and data extraction will be performed by two reviewers independently, and the third reviewer help to resolve the divergence between them. Using the AGREE II instrument and RIGHT checklist to assess the methodological and reporting quality of the CPGs. The extracted recommendations, including but not limited to screening, diagnosis, evaluation and treatment, will be summarized and analyzed, and the results will be presented in tabular form. Bubble charts will be used to show quality differences between CPGs and to describe the correlation between methodological and reporting quality through regression analysis. Excel, EndnoteX9 and SPSS 25.0 will be used.

RESULT

To evaluate the advantages and disadvantages of the existing CPGs of osteoporosis and analyze the similarities and differences between the recommendations, the results will be published in a peer-reviewed journal.

CONCLUSION

This study will provide systematic evidence for existing CPGs of osteoporosis and to provide a reference for CPGs users.

PROTOCOL REGISTRATION

INPLASY 202070031.

Long-term effects of a ten-year osteoporosis intervention program in a Swedish population—A cross-sectional study

The aim of the study was to explore long-term effects seven years after the completion of a ten-year community-based osteoporosis intervention program in Vadstena, Sweden. The association between calcaneal bone mineral density and several life style factors, and the impact of risk factors for sustaining a fracture after the age of 50 were also studied. Previous participants in the intervention group, and matched subjects were invited to calcaneal bone mass measurement by a portable device including the dual X-ray and laser (DXL) technology by Calscan, and to complete a questionnaire in 2006. A total of 417 persons (63% of those invited) in the intervention (I) group, and 120 persons (47% of those invited) in the control (C) group participated. Mean age was 63 years (37–94 years). There was somewhat more knowledge of osteoporosis in the I-group (M = 18) than in the C-group (M = 17) (p < 0.05), and more use of shoe/cane spikes in elderly women in the I-group (67%) than in the C-group (40.5%). The fully adjusted model of logistic regression showed that participants with an osteoporotic DXL T-score (≤− 2.5) had a 3-fold increased risk (95%CI 1.48–6.89) of having a history of a self-reported fracture after the age of fifty compared to women with a calcaneal T-score >− 2.5. The long-term effects of a ten-year, community-based, osteoporosis intervention program on knowledge and behavior were modest seven years after its completion.

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The effect of community-based osteoporosis intervention seems modest in the long run.

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Elderly women were compliant with fall prevention advice using spikes in winter.

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An osteoporotic calcaneal T-score may imply increased risk for fracture.

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Moderate/high physical activity was positively associated with calcaneal BMD in men.

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Brisk walks in the summer were positively associated with calcaneal BMD in women.

[Compliance of osteoporosis patients with additional specific osteoporosis-training course]

BACKGROUND

In the present study patients with an osteoporotic fracture were examined in order to determine how many patients decided to continue their therapy as outpatients having taken part in osteoporosis training at the Dr. Becker Rhein-Sieg Clinic.

PATIENTS AND METHODS

Patients who had previously suffered an osteoporotic fracture and thereafter received inpatient rehabilitation were selected for the study. Patients (n = 95) who had taken part in inpatient rehabilitation after an osteoporotic fracture were approached either via telephone or mail and were then followed up after 6 and 12 months with regard to their adherence to the treatment.

RESULTS

From a total of 95 patients, after 6 months 82 % (n = 78) were contacted successfully and included in the study. 68 out of 78 patients (72 %) had continued their medication. After 1 year 76 % of patients (n = 72) were successfully contacted once. Here, 62 % of patients (n = 59) had continued their medication under medical supervision. In the 1‑year follow-up period there were eight cases of falls, and one of these resulted in a peripheral fracture, which was treated conservatively.

CONCLUSION

Osteoporosis-specific information and osteoporosis training of patients after osteoporotic fracture are important tools to improve the motivation and compliance of patients. One possibility to realize this is osteoporosis-specific training with video presentations and individual care and education of the patients within outpatient or inpatient rehabilitation.

A systematic review of healthcare professional-led education for patients with osteoporosis or those at high risk for the disease

BACKGROUND

The effect of healthcare professional-led education for patients with osteoporosis or those at high risk for the disease on adherence with treatment recommendations was investigated.

METHODS

Eight databases were searched using multiple key words, and combinations of key words, to find the highest level of evidence available. Four randomized controlled trials, 2 quasi-experimental trials, and 3 descriptive longitudinal comparative studies were identified and assessed.

FINDINGS

Eight of the 9 studies showed improved adherence with treatment recommendations for patients with osteoporosis or those at high risk for the disease after the healthcare professional-led educational intervention. A professional nurse may be in the best position to lead this type of education, with 6 of the 9 studies using nurses as educators.

Shorter unipedal standing time and lower bone mineral density in women with distal radius fractures

Unipedal standing time was shorter and bone mineral density was lower in Japanese women aged 50 years and over with low-energy distal radius fractures resulting from falls than those in age-matched community-dwelling Japanese women without distal radius fractures.

INTRODUCTION

The aim of this study was to compare unipedal standing time and bone mineral density (BMD) of women >or=50 years of age with distal radius fractures with those of age-matched women without fractures.

METHODS

Fracture group was 54 Japanese women with low-energy distal radius fractures resulting from fall. Non-fracture group was 52 community-dwelling Japanese women without fractures. Unipedal standing time and BMD were measured.

RESULTS

There were no significant differences in age and body mass index between the two groups. The percentage of women with unipedal standing time <15 s was 44.4% in the fracture group and 13.5% in the non-fracture group, while the respective frequencies for >120 s were 20.4% and 50.0%. The T-score of BMD was significantly lower in the fracture than non-fracture group. Logistic regression analysis identified unipedal standing time <15 s and T-score <70% as significant factors associated with distal radius fractures. Notably, T-score <70% was significant in subjects <65 years, and unipedal standing time <15 s was significant in those >or=65 years.

CONCLUSION

Unipedal standing time was shorter and BMD was lower in women >or=50 years of age with distal radius fractures than those in age-matched women without fractures.

Austrian Osteoporosis Report: epidemiology, lifestyle factors, public health strategies

The first Austrian Osteoporosis Report was initiated to create a comprehensive reference document for the pathogenesis, diagnostics, therapy, and rehabilitation of osteoporosis. Furthermore, the aim was to present the extent and severity of osteoporosis and the associated complications in Austria. On the basis of current international prevalence, it can be estimated that approximately 740,000 of people in Austria over 50 years are affected by osteoporosis, of whom around 617,000 are women. A special analysis of the hospital discharge statistics showed that, in the year 2005, 1382 men and 8080 women were discharged from Austrian hospitals with the main diagnosis, osteoporosis. Added to these 9711 male cases and 54,840 females cases were documented with osteoporosis as a secondary diagnosis. In Austria around 16,500 people suffer a hip fracture each year. Thus, with a fracture rate of 19.7 fractures per year per 10,000 inhabitants over the age of 65 years, Austria lies within the peak for Europe. The hospital mortality rate amongst patients with fracture of the femur is 3.8% in men and 3.2% in women in Austria. Everybody's bone health can be positively influenced by a healthy lifestyle; however, the Osteoporoses Report revealed insufficiencies regarding lifestyle risk factors in the Austrian population. Average calcium intake amongst Austrian adult women and amongst male and female seniors is lower than recommended and only adult men achieve around the recommended amount. The mean vitamin D intake in Austria is very poor, especially amongst pre-schoolers and seniors. The rate of Austrians reporting regular physical exercise is in need of improvement, especially amongst elderly people. The data presented in the Austrian Osteoporosis Report are useful to enable the development of public health strategies and methods to help resolve some of these problems, and ultimately contribute to improved bone health in the nation.

A demonstration project of a multi-component educational intervention to improve integrated post-fracture osteoporosis care in five rural communities in Ontario, Canada

This study evaluated a multi-component intervention (educational materials and outreach visits) to increase knowledge and improve post-fracture care management in five rural communities in Canada. One hundred and twenty-five patients pre- intervention and 149 post-intervention were compared. No significant improvement in post-fracture care was documented suggesting that a more targeted intervention is needed.

INTRODUCTION

Currently, the majority of patients with a low trauma fracture are under-investigated and under-treated for osteoporosis. We set out to evaluate an educational intervention on increasing knowledge of post-fracture care among health care professionals (HCPs) and fracture patients and on improving post-fracture management.

METHODS

We studied five rural communities in Ontario, Canada, using a multi-component intervention ("Behind the Break"), including educational material for HCPs and patients and educational outreach visits to physicians. The study had a historical control, non-equivalent pre/post design. Telephone surveys were carried out with individuals > or =40 years of age who had a low trauma fracture in 2003 (n = 125) or in 2005 (n = 149). Family physicians and emergency department staff were also surveyed.

RESULTS

A total of 4,207 educational packages were distributed. Seventy-three percent of family physicians had an outreach visit. Two-thirds indicated that they received enough information about post-fracture follow-up to incorporate it into their practice. Despite this, no significant improvement in post-fracture care was documented (32% in the "pre" group had a bone mineral density test and 25% in the "post" group). Of those diagnosed with osteoporosis, the majority were prescribed a bone-sparing medication (63% "pre" and 80% "post").

CONCLUSION

A more targeted intervention linking fracture patients to their physician needs to be evaluated in rural communities.

[Metabolic bone diseases]

Osteomalacia is caused by impaired vitamin D receptor (VDR) signaling, calcium deficiency, and altered bone mineralization. This can be due to insufficient sunlight exposure, malabsorption, reduced D hormone activation in chronic kidney disease, and rare alterations of VDR signaling and phosphate metabolism. Leading symptoms are bone pain, muscular cramps, and increased incidence of falls in the elderly. The adequate respective countermeasures are to optimize the daily intake of calcium and vitamin D3 and to replace active D hormone and phosphate if deficient. Osteoporosis is characterized by bone fragility fractures upon minor physical impact. Indications for diagnosis and treatment can be established by estimating the absolute fracture risk, taking into account bone mineral density, age, gender, and individual risk factors. Exercise, intervention programs to avoid falls, and specific drugs are capable of substantially reducing fracture risk even in the elderly. Secondary osteoporosis primarily requires both bone-altering medications and effective treatment of underlying diseases.

Health-protective behaviours and risk of fall-related hip fractures: a population-based case-control study

BACKGROUND

Fall-related hip fractures are one of the most common causes of disability and mortality in older age. The study aimed to quantify the relationship between lifestyle behaviours and the risk of fall-related hip fracture in community-dwelling older people. The purpose was to contribute evidence for the promotion of healthy ageing as a population-based intervention for falls injury prevention.

METHODS

A case-control study was conducted with 387 participants, with a case-control ratio of 1:2. Incident cases of fall-related hip fracture in people aged 65 and over were recruited from six hospital sites in Brisbane, Australia, in 2003-04. Community-based controls, matched by age, sex and postcode, were recruited via electoral roll sampling. A questionnaire designed to assess lifestyle risk factors, identified as determinants of healthy ageing, was administered at face-to-face interviews.

RESULTS

Behavioural factors which had a significant independent protective effect on the risk of hip fracture included never smoking [adjusted odds ratio (AOR): 0.33 (0.12-0.88)], moderate alcohol consumption in mid- and older age [AOR: 0.49 (0.25-0.95)], not losing weight between mid- and older age [AOR: 0.36 (0.20-0.65)], playing sport in older age [AOR: 0.49 (0.29-0.83)] and practising a greater number of preventive medical care [AOR: 0.54 (0.32-0.94)] and self-health behaviours [AOR: 0.56 (0.33-0.94)].

CONCLUSION

With universal exposures, clear associations and modifiable behavioural factors, this study has contributed evidence to reduce the major public health burden of fall-related hip fractures using readily implemented population-based healthy ageing strategies.

Risk factors for fractures in older men and women: The Leisure World Cohort Study

BACKGROUND

Osteoporosis results in >1.5 million fractures in the United States each year, leading to substantial health care costs and loss of quality of life. One major gap in our knowledge is how to effectively identify individuals at risk of developing a fracture.

OBJECTIVE

We examined a population-based cohort for risk factors for fractures of the hip, wrist, and spine in men and women.

METHODS

The Leisure World Cohort Study was established between 1981 and 1985 when residents of a southern California retirement community completed a postal health survey. Multiple lifestyle, medical, attitudinal, and anthropomorphic factors were self-reported. Fractures were identified from 4 follow-up surveys, hospital discharge records, and death certificates. Fracture rates were determined separately for men and women. Cox proportional hazards regression was used to identify predictors of fracture.

RESULTS

Incident fractures of the hip (n = 1,227), wrist (n = 445), and spine (n = 729) incurred over the course of 2 decades were identified in the 13,978 residents surveyed. Mean (SD) age at entry was 74.9 (7.2) years for men and 73.7 (7.4) years for women. The most important risk factors for fracture were the same in men and women: age increased risk of hip and spine fractures (hazard ratio [HR] = 2.3-3.2 per 10 years) and history of fracture increased fracture risk at all 3 sites (HR = 1.4-3.2). In both men and women, glaucoma was a significant risk factor for hip fracture (HR = 1.9 and 1.3, respectively), and smoking was a risk factor for hip and spine fractures. Men and women with a positive mental attitude had fewer hip and spine fractures (HR = 0.7-0.9). High body mass index was protective at all 3 fracture sites in women (HR = 0.7-0.8), but those who used vitamin A supplements had increased rates of hip and wrist fracture (HR = 1.1 per 10,000 IU per day).

CONCLUSIONS

Attitude, lifestyle choices, and the presence of medical conditions may influence the rate of osteoporotic fracture in older women and men and may help identify individuals at high risk.

Evaluation of an osteoporosis and fall risk intervention program for community-dwelling elderly. A quasi-experimental study of behavioral modifications

BACKGROUND AND AIMS

Osteoporosis and fall fractures are increasing problems amongst the elderly. The aim of this study was to explore whether combined population-based and individual interventions directed at risk factors for osteoporosis and falls result in behavioral changes in an elderly population.

METHODS

A quasi-experimental design was used for the study. Persons aged >or=65 years were randomly selected in the intervention and control community. An intervention program was managed from the primary health care center and delivered to the community. Health education was designed to increase awareness of risk factors for the development of osteoporosis and falling. Questionnaires about lifestyle, health, previous fractures, safety behavior and physical activity level were distributed at baseline in 1989 and at the follow-ups in 1992 and 1994 in both communities.

RESULTS

There was a difference of 17.7% between the dual intervention (receiving both population-based and individual interventions) and the control samples regarding the self-reported use of shoe/cane spikes, and a difference of 20.5% regarding the reported "moderate level" of physical activity in 1994. There was an increase in the number of participants in the dual intervention sample who, at baseline, had not reported equipping their homes with non-slip mats and removing loose rugs but who did report these changes in 1994. The increase in the reported use of shoe/cane spikes in the dual intervention sample was observed mainly for the period 1992-1994.

CONCLUSIONS

A public health intervention model, including both population-based and individual interventions, can contribute to behavioral changes in the prevention of falls and changed physical activity patterns amongst elderly people.