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Siderius M, Wink F, Kieskamp S, Maas F, Bos R, Kroese FGM, Spoorenberg A, Arends S. Improvement of bone mineral density and new vertebral fractures during 8 years of TNF-α inhibition in patients with axial spondyloarthritis. Semin Arthritis Rheum 2024; 68:152523. [PMID: 39018730 DOI: 10.1016/j.semarthrit.2024.152523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/30/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE In our prospective cohort with standardized bi-annual measurements of bone mineral density (BMD) and spinal radiographs, we evaluated the long-term course of BMD and the development of radiographic vertebral fractures (VFs) during 8 years of TNFi treatment in patients with radiographic axial spondyloarthritis (r-axSpA). METHODS Consecutive axSpA patients from the GLAS cohort receiving TNFi for ≥8 years were included. Patients who received anti-osteoporotic treatment were excluded. Lumbar spine (LS) BMD was assessed at baseline, 1 year and bi-annually using DEXA. Radiographic VFs were evaluated using the Genant classification. RESULTS 126 axSpA patients were included; 75 % male, mean age 42 ± 11 years, ASDAS 3.8 ± 0.8, median LS BMD Z-score -0.5 (IQR -1.4-0.7) and 20 % had radiographic VFs at baseline. Disease activity improved rapidly and sustained. LS BMD Z-score improved significantly up to 4 years compared to the previous time point and sustained thereafter. Median percentage of improvement compared to baseline was 8.9 % (2.8-15.8) and 7.2 % (2.2-14.7) after 4 and 8 years, respectively. Of 90 patients with baseline and 8-year radiographs, 14 (16 %) developed new VFs and 5 (6 %) showed an increase in severity of existing VFs. Of all 44 VFs present at 8 years, 30 % were grade 2 (n = 12) or grade 3 (n = 1). CONCLUSION In r-axSpA patients treated with TNFi for 8 years, LS BMD Z-score increased significantly, especially during the first 4 year of treatment. Radiographic VFs continued to develop or progressed, irrespective of improvement in BMD. Therefore, clinical attention for trabecular bone loss is important in daily clinical practice.
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Affiliation(s)
- Mark Siderius
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Freke Wink
- Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Stan Kieskamp
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Fiona Maas
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Reinhard Bos
- Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Frans G M Kroese
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Anneke Spoorenberg
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Suzanne Arends
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands.
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Wanionok NE, Morel GR, Fernández JM. Osteoporosis and Alzheimer´s disease (or Alzheimer´s disease and Osteoporosis). Ageing Res Rev 2024; 99:102408. [PMID: 38969142 DOI: 10.1016/j.arr.2024.102408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 07/07/2024]
Abstract
Alzheimer's disease (AD) and osteoporosis are two diseases that mainly affect elderly people, with increases in the occurrence of cases due to a longer life expectancy. Several epidemiological studies have shown a reciprocal association between both diseases, finding an increase in incidence of osteoporosis in patients with AD, and a higher burden of AD in osteoporotic patients. This epidemiological relationship has motivated the search for molecules, genes, signaling pathways and mechanisms that are related to both pathologies. The mechanisms found in these studies can serve to improve treatments and establish better patient care protocols.
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Affiliation(s)
- Nahuel E Wanionok
- Laboratorio de Osteopatías y Metabolismo Mineral (LIOMM), Facultad de Cs. Exactas. Universidad Nacional de La Plata UNLP-CIC, Argentina
| | - Gustavo R Morel
- Biochemistry Research Institute of La Plata "Professor Doctor Rodolfo R. Brenner" (INIBIOLP), Argentina
| | - Juan M Fernández
- Laboratorio de Osteopatías y Metabolismo Mineral (LIOMM), Facultad de Cs. Exactas. Universidad Nacional de La Plata UNLP-CIC, Argentina.
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Oishi Y, Nakamura E, Muramatsu K, Murase M, Doi K, Takeuchi Y, Hamawaki JI, Sakai A. Prevalent morphometric vertebral fractures as a risk factor for subsequent clinical vertebral fractures after shortfusion surgery in older Japanese women with degenerative spondylolisthesis. Asian Spine J 2024; 18:435-443. [PMID: 38917857 PMCID: PMC11222878 DOI: 10.31616/asj.2023.0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 06/27/2024] Open
Abstract
STUDY DESIGN A retrospective cohort study using the Kaplan-Meier method with propensity-score matching. PURPOSE To evaluate whether the presence of prevalent morphometric vertebral fractures (VFs) poses a risk for subsequent clinical VFs after short-fusion surgery in women aged ≥60 years with degenerative spondylolisthesis. OVERVIEW OF LITERATURE VFs are common osteoporotic fractures and are associated with a low quality of life. Subsequent VFs are a complication of instrumented fusion in patients with degenerative lumbar disorders. Thus, risk factors for subsequent VFs after fusion surgery must be analyzed. Population-based studies have suggested that prevalent morphometric VFs led to a higher incidence of subsequent VFs in postmenopausal women; however, no studies have investigated whether prevalent morphometric VFs are a risk factor for subsequent VFs after fusion surgery in patients with degenerative spondylolisthesis. METHODS The study enrolled a total of 237 older female patients: 50 and 187 patients had prevalent morphometric VFs (VF [+] group) and nonprevalent morphometric VFs (VF [-] group), respectively. The time to subsequent clinical VFs after fusion surgery was compared between the two groups using the Kaplan-Meier method. Moreover, 40 and 80 patients in the VF (+) and VF (-) groups, respectively, were analyzed and matched by propensity scores for age, follow-up duration, surgical procedure, number of fused segments, body mass index, and number of patients treated for osteoporosis. RESULTS Kaplan-Meier analysis indicated that the VF (+) group had a higher incidence of subsequent clinical VFs than the VF (-) group, and Cox regression analysis showed that the presence of prevalent morphometric VFs was an independent risk factor for subsequent clinical VFs before matching. Kaplan-Meier analysis demonstrated comparable results after matching. CONCLUSIONS The presence of prevalent morphometric VFs may be a risk factor for subsequent clinical VFs in older women with degenerative spondylolisthesis who underwent short-fusion surgery.
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Affiliation(s)
- Yosuke Oishi
- Department of Orthopaedic Surgery, Hamawaki Orthopaedic Hospital, Hiroshima,
Japan
| | - Eiichiro Nakamura
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu,
Japan
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu,
Japan
| | - Masaaki Murase
- Department of Orthopaedic Surgery, Hamawaki Orthopaedic Hospital, Hiroshima,
Japan
| | - Katsumi Doi
- Department of Orthopaedic Surgery, Hamawaki Orthopaedic Hospital, Hiroshima,
Japan
| | - Yoshinori Takeuchi
- Department of Orthopaedic Surgery, Hamawaki Orthopaedic Hospital, Hiroshima,
Japan
| | - Jun-ichi Hamawaki
- Department of Orthopaedic Surgery, Hamawaki Orthopaedic Hospital, Hiroshima,
Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu,
Japan
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Li Q, Yang Z, Zhu M, Li J, Lu C, Li Z, Kong C, Li H, Niu M, Kang P. Prevalence and risk factors of osteoporotic fracture among the elderly population in China: a multicenter cross-sectional study. INTERNATIONAL ORTHOPAEDICS 2024; 48:1323-1330. [PMID: 38467869 DOI: 10.1007/s00264-024-06145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Prevalence of osteoporotic fracture (OPF) is increasing with ageing, resulting in a significant financial burden for healthcare. However, research on the nationwide epidemiological data of OPF in Chinese elderly is still scarce. The aim of this study was to investigate the prevalence and risk factors of OPF in Chinese population aged 60 years or order. METHODS A cross-sectional survey was conducted in an elderly Chinese population in five centres. Questionnaire investigation and imaging examination were taken in all participants to identify OPF prevalence and risk factors. Diagnosis of OPF was determined based on imaging of vertebral fractures or history of fall-related fractures. We then used multivariate logistic regression model to analyze the associations between the potential risk factors and OPF. RESULTS The overall prevalence of OPF in population aged 60 years or older was 24.7% (1,071/4,331), showing an increasing trend with age (P < 0.001). The prevalence of OPF was geographically distinct (P < 0.001), but similar between men and women (P > 0.05). Up to 96.8% of OPFs consisted of vertebral fractures, especially involving T11, T12, and L1 segments. Advanced age (≥ 80), vision loss, severe hearing loss, multiple exercise forms, chronic kidney disease, osteoarthritis, and trauma-related vertebral fractures were significantly associated with risk factors, while education level and vitamin D supplementation were associated with protective factors of OPF. CONCLUSION High prevalence of OPF is a serious threat to bone health among elderly people in China. There is an urgent need for effective strategies to diagnose, prevent, and treat OPF in elderly adults.
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Affiliation(s)
- Qianhao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Zhouyuan Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Mengli Zhu
- Research Core Facility, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Li
- Research Center of Clinical Epidemiology and Evidence-Based Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chunyan Lu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Zhirui Li
- Department of Orthopaedics, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Changchun Rd. 45, Xicheng District, 100053, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Changchun Rd. 45, Beijing, 100053, China
| | - Haifeng Li
- Department of Orthopedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Ming Niu
- Department of Orthopedics, Ganzhou District People's Hospital, Zhangye Gansu, 734000, China
| | - Pengde Kang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
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Salimi H, Takahashi S, Hoshino M, Hori Y, Yasuda H, Tsujio T, Ohyama S, Terai H, Toyoda H, Suzuki A, Kono H, Dohzono S, Tamai K, Nakamura H. Risk Factors for Residual Back Pain After Balloon Kyphoplasty for Osteoporotic Vertebral Fracture. Indian J Orthop 2024; 58:567-574. [PMID: 38694699 PMCID: PMC11058734 DOI: 10.1007/s43465-024-01115-5] [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: 04/10/2023] [Accepted: 01/26/2024] [Indexed: 05/04/2024]
Abstract
Background Balloon kyphoplasty (BKP) is a method for the management of osteoporotic vertebral body fracture (OVF). However, improvement in back pain (BP) is poor in some patients, also previous reports have not elucidated the exact incidence and risk factors for residual BP after BKP. We clarified the characteristics of residual BP after BKP in patients with OVF. Hypothesis In this study, we hypothesize that some risk factors may exist for residual BP 2 years after the treatment of OVF with BKP. Patients and Methods A multicenter cohort study was performed where patients who received BKP within 2 months of OVF injury were followed-up for 2 years. BP at 6 months after surgery and final observation was evaluated by Visual Analog Scale (VAS) score. Patients with a score of 40 mm or more were allocated to the residual BP group, and comparisons between the residual back pain group and the improved group were made for bone density, kyphosis, mobility of the fractured vertebral body, total spinal column alignment, and fracture type (fracture of the posterior element, pedicle fracture, presence or absence of posterior wall damage, etc.). Also, Short Form 36 (SF-36) for physical component summary (PCS) and mental component summary (MCS) at the final follow-up was evaluated in each radiological finding. Results Of 116 cases, 79 (68%) were followed-up for 2 years. Two years after the BKP, 26 patients (33%) experienced residual BP. Neither age nor sex differed between the groups. In addition, there was no difference in bone mineral density, BKP intervention period (period from onset to BKP), and osteoporosis drug use. However, the preoperative height ratio of the vertebral body was significantly worse in the residual BP group (39.8% vs. 52.1%; p = 0.007). Two years after the operation, the vertebral body wedge angle was significantly greater in the residual BP group (15.7° vs. 11.9°; p = 0.042). In the multiple logistic regression model with a preoperative vertebral body height ratio of 50% or less [calculated by receiver operating characteristic (ROC) curve], the adjusted odds ratio for residual BP was 6.58 (95% confidence interval 1.64-26.30; p = 0.007); similarly, patients with vertebral body height ratio less than 50% had a lower score of SF-36 PCS 24.6 vs. 32.2 p = 0.08. Conclusion The incidence of residual BP 2 years after BKP was 33% in the current study. The risk factor for residual BP after BKP was a preoperative vertebral body height ratio of 50% or less, which should be attentively assessed for the selection of a proper treatment scheme and to provide adequate stabilization. Level of Evidence III.
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Affiliation(s)
- Hamidullah Salimi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, Japan
| | - Yusuke Hori
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, Japan
| | - Hiroyuki Yasuda
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Tadao Tsujio
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Nara, Japan
| | - Shoichiro Ohyama
- Department of Orthopaedic Surgery, Nishinomiya Watanabe Hospital, Nishinomiya, Hyogo Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, Japan
| | - Hiroshi Kono
- Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, Osaka, Japan
| | - Sho Dohzono
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, Japan
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Wáng YXJ, Diacinti D, Aparisi Gómez MP, Santiago FR, Becce F, Tagliafico AS, Prakash M, Isaac A, Dalili D, Griffith JF, Guglielmi G, Bazzocchi A. Radiological diagnosis of prevalent osteoporotic vertebral fracture on radiographs: an interim consensus from a group of experts of the ESSR osteoporosis and metabolism subcommittee. Skeletal Radiol 2024:10.1007/s00256-024-04678-4. [PMID: 38662094 DOI: 10.1007/s00256-024-04678-4] [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: 01/07/2024] [Revised: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
When a low-energy trauma induces an acute vertebral fracture (VF) with clinical symptoms, a definitive diagnosis of osteoporotic vertebral fracture (OVF) can be made. Beyond that, a "gold" radiographic standard to distinguish osteoporotic from non-osteoporotic VFs does not exist. Fracture-shaped vertebral deformity (FSVD) is defined as a deformity radiographically indistinguishable from vertebral fracture according to the best of the reading radiologist's knowledge. FSVD is not uncommon among young populations with normal bone strength. FSVD among an older population is called osteoporotic-like vertebral fracture (OLVF) when the FSVD is likely to be associated with compromised bone strength. In more severe grade deformities or when a vertebra is collapsed, OVF diagnosis can be made with a relatively high degree of certainty by experienced readers. In "milder" cases, OVF is often diagnosed based on a high probability rather than an absolute diagnosis. After excluding known mimickers, singular vertebral wedging in older women is statistically most likely an OLVF. For older women, three non-adjacent minimal grade OLVF (< 20% height loss), one minimal grade OLVF and one mild OLVF (20-25% height loss), or one OLVF with ≥ 25% height loss, meet the diagnosis of osteoporosis. For older men, a single OLVF with < 40% height loss may be insufficient to suggest the subject is osteoporotic. Common OLVF differential diagnoses include X-ray projection artifacts and scoliosis, acquired and developmental short vertebrae, osteoarthritic wedging, oncological deformities, deformity due to high-energy trauma VF, lateral hyperosteogeny of a vertebral body, Cupid's bow, and expansive endplate, among others.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Radiology, IMSKE, Valencia, Spain
| | - Fernando Ruiz Santiago
- Department of Radiology and Physical Medicine, Faculty of Medicine, University of Granada, Granada, Spain
- Musculoskeletal Radiology Unit, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Alberto Stefano Tagliafico
- Department of Radiology, DISSAL, University of Genova, Genoa, Italy
- Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Mahesh Prakash
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Danoob Dalili
- Academic Surgical Unit, Southwest London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, London, UK
- Department of Radiology, Epsom and St Hellier University Hospitals NHS Trust, Dorking Road, Epsom, London, UK
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
- Radiology Unit, Dimiccoli Teaching Hospital Barletta, Barletta, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Ma D, Wang Y, Zhang X, Su D, Wang C, Liu H, Yang X, Gao J, Wu Y. Differences in Vertebral Morphology and bone Mineral Density between Grade 1 Vertebral Fracture and Non-Fractured Participants in the Chinese Population. Calcif Tissue Int 2024; 114:397-408. [PMID: 38483546 DOI: 10.1007/s00223-024-01185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/12/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To investigate the difference in vertebral morphology and bone mineral density (BMD) between grade 1 VFs and non-fractured participants in the Chinese population to shed light on the clinical significance of grade 1 VFs from various perspectives. METHODS This retrospective cohort study included patients who received a chest low-dose computed tomography (LDCT) scan for health examination and visited the First Affiliated Hospital of Zhengzhou University, Henan, China, from October 2019 to August 2022. Data were analyzed from March 2023 to July 2023. The main outcome of this study was the difference in morphological parameters and BMD between grade 1 VFs and non-fractured participants. The prevalence of grade 1 VFs in China populations was calculated. The difference in BMD of three fracture types in the Grade 1 group was also evaluated. RESULTS A total of 3652 participants (1799 males, 54.85 ± 9.02 years, range, 40-92 years; 1853 females, 56.00 ± 9.08 years, range, 40-93 years) were included. The prevalence of grade 2 and 3 increase with age. The prevalence of grade 1 VFs gradually increases ≤ 50y to 60-69y group, but there is a decrease in the ≥ 70 years male group (6.6%) and a rise in the female group (25.5%). There was no significant statistical difference observed in vertebral shape indices (VSI) and BMD between the Grade 1 group and the no-fractured group aged < 50 years old except the wedge index in male. The biconcavity index did not differ between the non-fractured group and the Grade 1 group in men aged 50-59 years, whereas a significant statistical difference was observed in women. Additionally, the results of BMD were consistent with these findings. For the 40-59 years age group, there were significant differences between the compression deformity group and the other groups. CONCLUSIONS The grade 1 group had higher VSI and lower BMD than the non-fractured group, suggesting an association between the Grade 1 group and osteoporosis in individuals aged over 50 for women and over 60 for men. Different fracture types have significant variations in BMD among middle-aged people. The prevalence of grade 1 VFs exhibits an age-related increase in both genders, with opposite trends observed between older males and females. We suggested VSI can aid physicians in the diagnosis of grade 1 VFs.
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Affiliation(s)
- Duoshan Ma
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yan Wang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xinxin Zhang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Danyang Su
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Chunyu Wang
- Medical 3D Printing Center, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Huilong Liu
- Medical 3D Printing Center, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xiaopeng Yang
- Medical 3D Printing Center, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yan Wu
- Medical 3D Printing Center, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China.
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8
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Stumpf U, Schmidmaier R. [Secondary fracture prevention/Update osteoporosis guidelines 2023 of the Umbrella Organization Osteology]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:283-289. [PMID: 38526813 DOI: 10.1007/s00113-024-01415-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 03/27/2024]
Abstract
The S3 guidelines on the prophylaxis, diagnostics and treatment of osteoporosis 2023 were completely revised and updated between 2021 and 2023 in accordance with the Association of the Scientific Medical Societies of Germany (AWMF) regulations. The guideline committee consisted of delegates from the 20 specialist societies of the Umbrella Organization Osteology (Dachverband Osteologie, DVO) as well as delegates from the German Society of General Medicine and Family Medicine (DEGAM), the German Society for Nephrology (DGfN) and the Federal Self-help Association for Osteoporosis (BfO).The guidelines focus on preventive measures, diagnostic procedures and treatment approaches for osteoporosis in men aged 50 years and over and postmenopausal women. The main aim is the optimization of care processes, reduction of fracture incidences and maintenance or improvement of the quality of life and functional capacity of patients affected by fractures. A major update to the guidelines includes the introduction of a new risk calculator that can take more risk factors (n = 33) into account and that can estimate the risk of vertebral body and proximal femoral fractures for a 3-year period (previously 10 years). This results in new thresholds for diagnostics and treatment. The programmed app is currently not yet certified as a medical product and a paper version is therefore currently available for patient care with the planned integration of a web-based version of the risk calculator. From the perspective of trauma surgery, the recommendations and innovations for manifest osteoporosis are of particular clinical importance. The focus of the DVO guidelines update is therefore on the implementation of secondary fracture prevention in trauma surgery, orthopedic and geriatric traumatology in the clinical and practical daily routine.
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Affiliation(s)
- Ulla Stumpf
- MUM - Muskoloskelettales Universitätszentrum München, Klinik für Orthopädie und Unfallchirurgie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
- Osteologisches Schwertpunktzentrum DVO der LMU, LMU Klinikum, LMU München, München, Deutschland.
| | - Ralf Schmidmaier
- Osteologisches Schwertpunktzentrum DVO der LMU, LMU Klinikum, LMU München, München, Deutschland
- Medizinische Klinik IV, LMU Klinikum, LMU München, München, Deutschland
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9
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Schene MR, Wyers CE, Driessen AMH, Souverein PC, Gemmeke M, van den Bergh JP, Willems HC. Imminent fall risk after fracture. Age Ageing 2023; 52:afad201. [PMID: 37930741 DOI: 10.1093/ageing/afad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 11/07/2023] Open
Abstract
RATIONALE Adults with a recent fracture have a high imminent risk of a subsequent fracture. We hypothesise that, like subsequent fracture risk, fall risk is also highest immediately after a fracture. This study aims to assess if fall risk is time-dependent in subjects with a recent fracture compared to subjects without a fracture. METHODS This retrospective matched cohort study used data from the UK Clinical Practice Research Datalink GOLD. All subjects ≥50 years with a fracture between 1993 and 2015 were identified and matched one-to-one to fracture-free controls based on year of birth, sex and practice. The cumulative incidence and relative risk (RR) of a first fall was calculated at various time intervals, with mortality as competing risk. Subsequently, analyses were stratified according to age, sex and type of index fracture. RESULTS A total of 624,460 subjects were included; 312,230 subjects with an index fracture, matched to 312,230 fracture-free controls (71% females, mean age 70 ± 12, mean follow-up 6.5 ± 5 years). The RR of falls was highest in the first year after fracture compared to fracture-free controls; males had a 3-fold and females a 2-fold higher risk. This imminent fall risk was present in all age and fracture types and declined over time. A concurrent imminent fracture and mortality risk were confirmed. CONCLUSION/DISCUSSION This study demonstrates an imminent fall risk in the first years after a fracture in all age and fracture types. This underlines the need for early fall risk assessment and prevention strategies in 50+ adults with a recent fracture.
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Affiliation(s)
- Merle R Schene
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Internal Medicine and Geriatrics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Annemariek M H Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
- CARIM School of Cardiovascular Disease, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Marle Gemmeke
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Hanna C Willems
- Internal Medicine and Geriatrics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Bone Center, Movement Sciences Amsterdam, Amsterdam, The Netherlands
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10
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Bodden J, Dieckmeyer M, Sollmann N, Burian E, Rühling S, Löffler MT, Sekuboyina A, El Husseini M, Zimmer C, Kirschke JS, Baum T. Incidental vertebral fracture prediction using neuronal network-based automatic spine segmentation and volumetric bone mineral density extraction from routine clinical CT scans. Front Endocrinol (Lausanne) 2023; 14:1207949. [PMID: 37529605 PMCID: PMC10390306 DOI: 10.3389/fendo.2023.1207949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/14/2023] [Indexed: 08/03/2023] Open
Abstract
Objectives To investigate vertebral osteoporotic fracture (VF) prediction by automatically extracted trabecular volumetric bone mineral density (vBMD) from routine CT, and to compare the model with fracture prevalence-based prediction models. Methods This single-center retrospective study included patients who underwent two thoraco-abdominal CT scans during clinical routine with an average inter-scan interval of 21.7 ± 13.1 months (range 5-52 months). Automatic spine segmentation and vBMD extraction was performed by a convolutional neural network framework (anduin.bonescreen.de). Mean vBMD was calculated for levels T5-8, T9-12, and L1-5. VFs were identified by an expert in spine imaging. Odds ratios (ORs) for prevalent and incident VFs were calculated for vBMD (per standard deviation decrease) at each level, for baseline VF prevalence (yes/no), and for baseline VF count (n) using logistic regression models, adjusted for age and sex. Models were compared using Akaike's and Bayesian information criteria (AIC & BIC). Results 420 patients (mean age, 63 years ± 9, 276 males) were included in this study. 40 (25 female) had prevalent and 24 (13 female) had incident VFs. Individuals with lower vBMD at any spine level had higher odds for VFs (L1-5, prevalent VF: OR,95%-CI,p: 2.2, 1.4-3.5,p=0.001; incident VF: 3.5, 1.8-6.9,p<0.001). In contrast, VF status (2.15, 0.72-6.43,p=0.170) and count (1.38, 0.89-2.12,p=0.147) performed worse in incident VF prediction. Information criteria revealed best fit for vBMD-based models (AIC vBMD=165.2; VF status=181.0; count=180.7). Conclusions VF prediction based on automatically extracted vBMD from routine clinical MDCT outperforms prediction models based on VF status and count. These findings underline the importance of opportunistic quantitative osteoporosis screening in clinical routine MDCT data.
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Affiliation(s)
- Jannis Bodden
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
| | - 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
| | - Egon Burian
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Rühling
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 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
| | - Anjany Sekuboyina
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Informatics, Technical University of Munich, Munich, Germany
- Munich School of BioEngineering, Technical University of Munich, Munich, Germany
| | - Malek El Husseini
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- 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
| | - Jan S. Kirschke
- 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
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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11
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Gao W, Chen Y, Wang X, Liu G, Cui K, Guo J, Zheng J, Hao Y. Establishment and Verification of a Predictive Nomogram for New Vertebral Compression Fracture Occurring after Bone Cement Injection in Middle-Aged and Elderly Patients with Vertebral Compression Fracture. Orthop Surg 2023; 15:961-972. [PMID: 36718651 PMCID: PMC10102309 DOI: 10.1111/os.13655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE New vertebral compression fracture (NVCF) occurring after bone cement injection in middle-aged and elderly patients with vertebral compression fracture is very common. Preoperative baseline characteristics and surgical treatment parameters have been widely studied as a risk factor, but the importance of the patients' laboratory indicators has not been thoroughly explored. We aimed to explore the relationship between laboratory indicators and NVCF, and attempt to construct a clinical prediction model of NVCF together with other risk factors. METHODS Retrospective analysis was performed for 200 patients who underwent bone cement injection (percutaneous kyphoplasty or vertebroplasty) for vertebral compression fractures between January 2019 and January 2020. We consulted the relevant literature and collated the factors affecting the occurrence of NVCF. Feature selection of patients with NVCF was optimized using the least absolute shrinkage and selection operator regression model, which was used to conduct multivariable logistic regression analysis, to create a predictive model incorporating the selected features. The discrimination, calibration, and clinical feasibility of the predictive model were assessed using the concordance index (C-index), calibration plots, and decision curve analysis. Internal validation was performed using Bootstrap resampling verification. RESULTS Time from injury to surgery exceeding 7 days, low osteocalcin levels, elevated homocysteine levels, osteoporosis, mode of operation (percutaneous vertebroplasty), lack of postoperative anti-osteoporosis treatment, and poor diffusion of bone cement were independent risk factors for NVCF in middle-aged and elderly patients with vertebral compression fracture after bone cement injection. The C-index of the nomogram constructed using these seven factors was 0.895, indicating good discriminatory ability. The calibration plot showed that the model was well calibrated. Bootstrap resampling verification yielded a significant C-index of 0.866. Decision curve analysis demonstrated that the greatest clinical net benefit for predicting NVCF after bone cement injection could be achieved with a threshold of 1%-91%. CONCLUSION This nomogram can effectively predict NVCF incidence after bone cement injection in middle-aged and elderly patients with vertebral compression fracture, thus aiding clinical decision-making and postoperative management, promoting effective postoperative rehabilitation, and improving the quality of life.
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Affiliation(s)
- Wenxin Gao
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yungang Chen
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | | | - Guoyan Liu
- Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Kaiying Cui
- Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Jinxing Guo
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jianhu Zheng
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yanke Hao
- Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
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12
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Jia D, Qiao X, Wu D, Song Z, Ma J, Yang K, Mo X, Wu Z. Analysis of lumbar vertebrae fractures among inpatients in a primary hospital: A 10-year epidemiological study. Medicine (Baltimore) 2022; 101:e30111. [PMID: 35984135 PMCID: PMC9387980 DOI: 10.1097/md.0000000000030111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To analyze the epidemiological characteristics and changing trends of lumbar fractures in Xingtai Orthopedic Hospital in the past 10 years, and to improve the prevention and treatment of lumbar fractures. METHODS Using the hospital information system, data on patients with lumbar fractures in our hospital from 2009 to 2018 were collected regarding their age, gender, fracture time, injury mechanism, and the type of fracture. The epidemiological characteristics and trends of lumbar fractures for the period were summarized and analyzed. RESULTS The age of male patients with a high incidence of lumbar fractures was 61 to 70 years, followed by 51 to 60 years. The age of female patients with the highest incidence rate was 61 to 70 years, followed by 51 to 60 years (19.22%). Lumbar fractures in group A were predominantly of men. The majority of lumbar fractures in group B were of women. In group A, the incidence rate was higher in young men (21-50 years) than in women and higher in women >51 years. Most of the affected individuals were women. In group B, there were more middle-aged and young men (21-50 years) than women; however, there were more women than men aged ≥51 years. Car accident injury was the main cause of fractures, but in group B women, low-energy injuries were the main cause of fractures. The periods of high incidence in groups A and B were 4 to 6 years and 7 to 9 years, respectively. The number of injuries in group A was the highest and burst fracture was the main fracture type. In group B, the number of fall injuries was the highest, followed by car accident injuries, and compression fracture was the main fracture type. CONCLUSION The number of lumbar fractures in women caused by low-energy injuries showed an increasing trend. The type of compression fracture increased, which might be related to osteoporosis caused by the decrease in the estrogen level after menopause.
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Affiliation(s)
- Dingding Jia
- Orthopedics Department, Xingtai Orthopaedic Hospital, Xingtai City, Hebei Province, China
| | - Xin Qiao
- Orthopedics Department, Xingtai Orthopaedic Hospital, Xingtai City, Hebei Province, China
| | - Dongwei Wu
- Orthopedics Department, Xingtai Orthopaedic Hospital, Xingtai City, Hebei Province, China
| | - Zhanfeng Song
- Orthopedics Department, Xingtai Orthopaedic Hospital, Xingtai City, Hebei Province, China
| | - Jianqing Ma
- Orthopedics Department, Xingtai Orthopaedic Hospital, Xingtai City, Hebei Province, China
| | - Ke Yang
- Orthopedics Department, Xingtai Orthopaedic Hospital, Xingtai City, Hebei Province, China
| | - Xiufang Mo
- Orthopedics Department, Xingtai Orthopaedic Hospital, Xingtai City, Hebei Province, China
| | - Zhanyong Wu
- Orthopedics Department, Xingtai Orthopaedic Hospital, Xingtai City, Hebei Province, China
- *Correspondence: Zhanyong Wu, Orthopedics Department, Xingtai Orthopaedic Hospital, Xingtai City, Hebei Province, China (e-mail: )
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13
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Palmowski Y, Balmer S, Hu Z, Winkler T, Schnake KJ, Kandziora F, Pumberger M. Relationship Between the OF Classification and Radiological Outcome of Osteoporotic Vertebral Fractures After Kyphoplasty. Global Spine J 2022; 12:646-653. [PMID: 33131331 PMCID: PMC9109556 DOI: 10.1177/2192568220964051] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The OF classification is a new classification for osteoporotic vertebral fractures. The aim of this study was to clarify the relationship between preoperative OF subgroups and the postoperative outcome after kyphoplasty in patients with such fractures. METHODS Patients who underwent kyphoplasty of a single osteoporotic vertebral fracture were included and divided into groups according to the OF subgroups. Pre- and postoperative plain radiographs were analyzed in regard to the restoration of vertebral body height and local kyphotic angle (LKA). Additionally, clinical data including pre- and postoperative Visual Analogue Scale pain scores was documented. The clinical and radiological results were compared pre- and postoperatively within groups and between groups. RESULTS A total of 156 patients from OF subgroups 2 to 4 were included (OF 2: n = 58; OF 3: n = 36; OF 4: n = 62). Patients from all groups experienced significant pain relief postoperatively (P < .001). Patients with OF 2 fractures showed a repositioning of the vertebral body height in the anterior and middle portions (both P < .001), but no significant improvement in LKA. For OF 3 and 4 fractures, there was a significant restoration of vertebral body height (P < .001 for both) and a significant improvement of LKA (P < .001 for both). The highest average restoration was noted in the OF 4 group. CONCLUSIONS A higher OF subgroup is related to a higher radiological benefit from kyphoplasty. This confirms that the OF classification is an appropriate tool for the preoperative assessment of osteoporotic fractures.
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Affiliation(s)
| | | | - Zhouyang Hu
- Charité University Medicine
Berlin, Berlin, Germany
| | - Tobias Winkler
- Charité University Medicine
Berlin, Berlin, Germany
- Berlin Institute of Health Center
for Regenerative Therapies, Charité Universitätsmedizin, Berlin, Germany
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14
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Horii C, Iidaka T, Muraki S, Oka H, Asai Y, Tsutsui S, Hashizume H, Yamada H, Yoshida M, Kawaguchi H, Nakamura K, Akune T, Oshima Y, Tanaka S, Yoshimura N. The cumulative incidence of and risk factors for morphometric severe vertebral fractures in Japanese men and women: the ROAD study third and fourth surveys. Osteoporos Int 2022; 33:889-899. [PMID: 34797391 DOI: 10.1007/s00198-021-06143-7] [Citation(s) in RCA: 1] [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: 02/17/2021] [Accepted: 08/30/2021] [Indexed: 10/19/2022]
Abstract
UNLABELLED This population-based cohort study with a 3-year follow-up revealed that the annual incidence rates of vertebral fracture (VF) and severe VF (sVF) were 5.9%/year and 1.7%/year, respectively. The presence of mild VF at the baseline was a significant risk factor for incident sVF in participants without prevalent sVF. INTRODUCTION This study aimed to estimate the incidence of morphometric vertebral fracture (VF) and severe VF (sVF) in men and women and clarify whether the presence of a mild VF (mVF) increases the risk of incident sVF. METHODS Data from the population-based cohort study, entitled the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study, were analyzed. In total, 1190 participants aged ≥ 40 years (mean age, 65.0 ± 11.2) years completed whole-spine lateral radiography both at the third (2012-2013, baseline) and fourth surveys performed 3 years later (2015-2016, follow-up). VF was defined using Genant's semi-quantitative (SQ) method: VF as SQ ≥ 1, mVF as SQ = 1, and sVF as SQ ≥ 2. Cumulative incidence of VF and sVF was estimated. Multivariate logistic regression analyses were performed to evaluate risk factors for incident sVF. RESULTS The baseline prevalence of mVF and sVF were 16.8% and 6.0%, respectively. The annual incidence rates of VF and sVF were 5.9%/year and 1.7%/year, respectively. The annual incidence rates of sVF in participants without prevalent VF, with prevalent mVF, and with prevalent sVF were 0.6%/year, 3.8%/year, and 11.7%/year (p < 0.001), respectively. Multivariate logistic regression analyses in participants without prevalent sVF showed that the adjusted odds ratios for incident sVF were 4.12 [95% confident interval 1.85-9.16] and 4.53 [1.49-13.77] if the number of prevalent mVF at the baseline was 1 and ≥ 2, respectively. CONCLUSIONS The annual incidence rates of VF and sVF were 5.9%/year and 1.7%/year, respectively. The presence of prevalent mVF was an independent risk factor for incident sVF.
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Affiliation(s)
- C Horii
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - T Iidaka
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - S Muraki
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - H Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Y Asai
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - S Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - H Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - H Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - M Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - H Kawaguchi
- Department of Orthopaedic Surgery, Tokyo Neurological Center, 4-1-17, Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - K Nakamura
- Department of Orthopaedics, Towa Hospital, Towa 4-7-10, Adachi-ku, Tokyo, 120-0003, Japan
| | - T Akune
- Department of Orthopaedics, National Rehabilitation Center for Persons With Disabilities, 4-1 Namiki, Tokorozawa City, Saitama, 359-0042, Japan
| | - Y Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - S Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.
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15
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Katayanagi J, Iida T, Hayamizu A, Matsumoto K, Furukawa H, Konuma H, Yanase T, Ozeki S. Pre-existing vertebral fracture is a risk factor for postoperative proximal junctional fracture after adult spinal deformity surgery: A propensity score-matched analysis. J Orthop Sci 2022; 27:308-316. [PMID: 33640224 DOI: 10.1016/j.jos.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/08/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Corrective surgery for adult spinal deformity has recently been increasingly performed because of aging populations and advances in minimally invasive surgery. Low bone mineral density is a major contributor to proximal junctional kyphosis after spinal long fusion. Assessment for low bone mineral density ideally involves both dual energy X-ray absorptiometry and identification of pre-existing vertebral fractures, the latter, requiring only standard equipment, being performed more frequently. We therefore aimed to examine the impact of pre-existing vertebral fractures on the incidence of type 2 proximal junctional kyphosis, including proximal junctional fracture and failure, after corrective surgery for adult spinal deformity. METHODS We performed a retrospective, single institution study of 106 women aged over 50 years who had undergone corrective long spinal fusion for severely symptomatic spinal deformity from 2014 to 2017. We allocated them to three groups (with and without pre-existing vertebral fractures and with severe [Grades 2-3 according to Genant et al.'s classification] preexisting vertebral fractures) and used propensity score matching to minimize bias. The primary outcome was postoperative proximal junctional fracture and the secondary outcome proximal junctional kyphosis/failure. RESULTS The primary and secondary endpoints were achieved significantly more often in the 28 patients with than in the 78 without preexisting vertebral fractures (total 41). The former group was also significantly older and had greater pelvic tilt and fewer fused segments than those without vertebral fractures. After propensity score matching, the incidences of the endpoints did not differ with pre-existing vertebral fracture status; however, patients with severe vertebral fractures more frequently had proximal junctional fractures postoperatively. Postoperative improvements in health-related quality of life scores did not differ with pre-existing vertebral fracture status. CONCLUSIONS Severe pre-existing vertebral fractures are a risk factor for proximal junctional fracture after correction of adult spinal deformity.
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Affiliation(s)
| | - Takahiro Iida
- Dokkyo Medical University Saitama Medical Center, Japan
| | | | | | | | - Hiroki Konuma
- Dokkyo Medical University Saitama Medical Center, Japan
| | | | - Satoru Ozeki
- Dokkyo Medical University Saitama Medical Center, Japan
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16
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Liu Y, Yu A, Li K, Wang L, Huang P, Geng J, Zhang Y, Duanmu YY, Blake GM, Cheng X. Differences in spine volumetric bone mineral density between grade 1 vertebral fracture and non-fractured participants in the China action on spine and hip status study. Front Endocrinol (Lausanne) 2022; 13:1013597. [PMID: 36387886 PMCID: PMC9647629 DOI: 10.3389/fendo.2022.1013597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/14/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE This study evaluated the prevalence of vertebral fractures (VF) in middle-aged and elderly Chinese men and women and explored the differences in lumbar spine volumetric bone mineral density (vBMD) derived from quantitative CT (QCT) between those with a grade 1 vertebral fracture and non-fractured individuals. MATERIALS AND METHODS 3,457 participants were enrolled in the China Action on Spine and Hip Status (CASH) study and had upper abdominal CT examinations. Vertebral fractures were identified by Genant's semi-quantitative method from lateral CT scout views or CT sagittal views. L1-3 vBMD was measured by Mindways QCT Pro v5.0 software. The characteristics of different fracture severity groups were compared using one-way ANOVA, independent-samples t-tests, and Kruskal-Wallis H-tests. RESULTS 1267 males (aged 62.77 ± 9.20 years) and 2170 females (aged 61.41 ± 9.01 years) were included in the analysis. In men, the prevalence of VF increased from 14.7% at age<50 years to 23.2% at age ≥70 years, and in women from 5.1% at age<50 years to 33.0% at age ≥70 years. Differences in mean age and vBMD were found between the different fracture grade groups. After age stratification, vBMD differences in men aged < 50 years old disappeared (p = 0.162) but remained in the older age bands. There was no significant difference in mean vBMD between those with multiple mild fractures and those with a single mild fracture. CONCLUSION In women, the prevalence of VF increased rapidly after age 50, while it grew more slowly in men. In general, with the exception of men <50 years old, participants with a grade 1 VF had lower vBMD than non-fractured individuals. The majority of women younger than 50 with a grade 1 VF had normal bone mass. We recommend that a vertebral height reduction ratio of <25% be diagnosed as a deformity rather than a fracture in people under the age of 50. The presence of multiple mild fractured vertebrae does not imply lower BMD.
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Affiliation(s)
- Yandong Liu
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Aihong Yu
- Radiology Department, Beijing Anding Hospital Capital Medical University, Beijing, China
| | - Kai Li
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Ling Wang
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Pengju Huang
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Jian Geng
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Yong Zhang
- Intervention Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yang-yang Duanmu
- South Medical Image Center, The First Affiliated Hospital of University of Science and Technology of China (USTC), Anhui, China
| | - Glen M. Blake
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Xiaoguang Cheng
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
- *Correspondence: Xiaoguang Cheng,
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Wang X, Jiang J, Guan W, Yu W, Xu T, Li M, Zhang J. The risk factors for developing clustered vertebral compression fractures: a single center study. Endocr Pract 2021; 28:243-249. [PMID: 34952220 DOI: 10.1016/j.eprac.2021.12.011] [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: 07/12/2021] [Revised: 11/14/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Vertebral compression fractures (VCFs) are common among elderly individuals, but clustered VCFs (C-VCFs) are rare and more severe. The risk factors for C-VCFs remain unclear. Thus, we investigated the clinical characteristics of C-VCFs to identify the imminent fracture risk and to improve the treatment for such patients. METHODS We reviewed records of VCF patients at a single medical center between January 2011 and September 2020. Patients who had four or more VCFs within one year were categorized into the C-VCF group, and the remaining patients were paired into the control group at a ratio of 2:1. We collected demographic, clinical, laboratory, and radiological information regarding these patients. Univariate analyses, stratified analyses, and multivariate logistic regression were performed to identify the risk factors for C-VCFs. RESULTS A total of 156 patients were enrolled, of whom 52 were C-VCF patients. C-VCF patients had more severe fractures and pain, with fractures occurring at uncommon sites of the spine. The independent risk factors for C-VCFs included glucocorticoid treatment (P<0.001, HR: 12.7), recent fracture history (P=0.021, HR: 5.5), and lower trabecular bone score (TBS, P=0.044, HR: 1.6). TBS and bone mineral density had greater predictive values in patients without glucocorticoid treatment (P<0.001). Sex, age, and bone turnover biomarkers were not independent risk factors for C-VCFs. CONCLUSION C-VCFs are rare adverse consequences of severe osteoporosis, for which glucocorticoid treatment, recent fracture history, and lower TBS are unique risk factors that are valuable for the early identification and prevention of C-VCFs.
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Affiliation(s)
- Xianze Wang
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jialin Jiang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Wenmin Guan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Mei Li
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Jia Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Lopes GAL, Mystro Neto S, Rosa AF, Lima MC, Pasqualini W, Tebet MA, Risso Neto MÍ. SPINAL DEFORMITY INDEX AND QUALITY OF LIFE OF PATIENTS WITH A DENSITOMETRIC DIAGNOSIS OF OSTEOPOROSIS. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212004256194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To evaluate the existence of a possible significant correlation between the quality of life of outpatients with osteoporosis and the Spinal Deformity Index (SDI), a radiographic method for semiquantitative assessment of the spine that enables the identification of prevalent and incident fractures. Methods: A cross-sectional observational study carried out with female patients, Caucasians, over 50 years of age, with a densitometric diagnosis of osteoporosis and in an outpatient follow-up, who were submitted to the Oswestry Disability Index (ODI) and SF-36 questionnaires to measure the direct and indirect damage of vertebral fragility fractures on quality of life. The scores obtained in these questionnaires were correlated with the SDI scores, calculated from the radiographs of the lumbar and thoracic spine. Results: 48 patients completed the study, with a mean age of 69.6±6.7 years, mean body mass index (BMI) of 25.4±3.4 kg/m2, mean ODI of 25.1±17.9%, mean SF- 36 of 428.7±192.4 and mean SDI of 4.3±3. For the statistical analysis, Spearman's coefficient was used (p ≤ 0.05). Conclusion: There is no statistically significant correlation between the SDI and the scores obtained on the ODI and SF-36 quality of life questionnaires. Level of evidence: III. Study of non-consecutive patients, without gold standard, applied uniformly.
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19
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Roux C, Rozes A, Reizine D, Hajage D, Daniel C, Maire A, Bréant S, Taright N, Gordon R, Fechtenbaum J, Kolta S, Feydy A, Briot K, Tubach F. Fully automated opportunistic screening of vertebral fractures and osteoporosis on more than 150,000 routine computed tomography scans. Rheumatology (Oxford) 2021; 61:3269-3278. [PMID: 34850864 DOI: 10.1093/rheumatology/keab878] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/12/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Osteoporosis is underdiagnosed and undertreated, although severe complications of osteoporotic fractures, including vertebral fractures, are well known. This study sought to assess the feasibility and results of an opportunistic screening of vertebral fractures and osteoporosis in a large database of lumbar or abdominal CT scans. MATERIAL AND METHODS Data were analyzed from CT scans obtained in 35 hospitals from patients aged 60 years and more and stored in a Picture Archiving and Communication System in Assistance-Publique-Hôpitaux de Paris, from 2007 to 2013. Dedicated software analyzed the presence of at least 1 vertebral fracture (VF), and measured Hounsfield Units (HU) in lumbar vertebrae. A simulated T-score was calculated. RESULTS Data were analyzed from 152 268 patients (73.2 ± 9.07 years). Success rates for VF assessment and HU measurements were 82 and 87% respectively. Prevalence of VF was 24.5% and increased with age. Areas under the receiver operating characteristic curves for the detection of VF were 0.61 and 0.62 for mean HU of lumbar vertebrae and L1 HU, respectively. In patients without VF, HU decreased with age, similarly in males and females. The prevalence of osteoporosis (sT-score ≤ - 2.5) was 23.8% and 36.5% in patients without and with VFs respectively. CONCLUSION Opportunistic screening in patients 60 years and older having lumbar or abdominal CT scans is feasible at large scale to screen vertebral fractures and osteoporosis.
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Affiliation(s)
- Christian Roux
- Department of Rheumatology, INSERM UMR 1153, APHP. Centre-Université de Paris, Institut de Recherche des Maladies Ostéo-Articulaires de l'Université de Paris, Hôpital Cochin
| | - Antoine Rozes
- AP-HP, Sorbonne Université, Hôpital Pitié Salpêtrière, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901
| | | | - David Hajage
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901
| | - Christel Daniel
- AP-HP, Direction des Systèmes d'Information, Pôle Innovation et Données
- INSERM UMRS 1142
| | - Aurélien Maire
- AP-HP, Direction des Systèmes d'Information, Pôle Innovation et Données
| | - Stéphane Bréant
- AP-HP, Direction des Systèmes d'Information, Pôle Innovation et Données
| | - Namik Taright
- AP-HP, Direction de la Stratégie et de la Transformation, Pôle Sciences des données et Information médicale, Paris, France
| | | | - Jacques Fechtenbaum
- Department of Rheumatology, APHP, Centre-Université de Paris, Hôpital Cochin
| | - Sami Kolta
- Department of Rheumatology, APHP, Centre-Université de Paris, Hôpital Cochin
| | - Antoine Feydy
- Department of Rheumatology, INSERM UMR 1153, APHP. Centre-Université de Paris, Institut de Recherche des Maladies Ostéo-Articulaires de l'Université de Paris, Hôpital Cochin
- Service de Radiologie Ostéo-Articulaire, Hôpital Cochin, Collégiale de Radiologie, AP-HP, Paris, France
| | - Karine Briot
- Department of Rheumatology, INSERM UMR 1153, APHP. Centre-Université de Paris, Institut de Recherche des Maladies Ostéo-Articulaires de l'Université de Paris, Hôpital Cochin
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901
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20
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Stathopoulos KD, Chronopoulos E, Galanos A, Kaskani E, Drakopoulou T, Ibro E, Tsekoura M, Kosmidis C. Prevalence of morphometric vertebral fractures in osteoporotic patients in Greece: the Vertebral Integrity Assessment (VERTINAS) study. Arch Osteoporos 2021; 16:165. [PMID: 34735660 DOI: 10.1007/s11657-021-01033-1] [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: 05/05/2021] [Accepted: 10/27/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Our purpose was to assess the prevalence of morphometric vertebral fractures (VFs) in osteoporotic patients in our country. We found that 25.4% of patients had sustained a VF, and the majority of them (76.6%) were undiagnosed prior to inclusion in this study. INTRODUCTION We assessed the prevalence of morphometric vertebral fractures (VFs) in osteoporotic patients in our country. METHODS Patients were recruited via announcements by the national media, their attending physicians or the National patients' Society. Inclusion criteria were (1) age > 50 years, (2) postmenopausal status > 2 years (women), (3) > 1-year use of medication for osteoporosis and (4) lack of radiological vertebral assessment for > 1 year. Exclusion criteria were (1) bone metabolic diseases other than osteoporosis, (2) patients with secondary osteoporosis, (3) patients with inability to stand/walk, (4) previous high-energy VFs. All patients performed lateral X-rays of the thoracic and lumbar spine that were evaluated separately both by certified radiologists on site as well as 3 consultant orthopaedic surgeons remotely through a specifically designed web database system. The Genant semi-quantitative method was used for the classification and grading of VFs and statistical analysis of the results was performed. RESULTS One thousand six hundred fifty-two patients (1516 female, 70.02 ± 8.28 years; 136 male, 74.78 ± 8.25 years) were included in the final analysis. The prevalence of VFs was 25.4%, 76.6% of fractured patients were previously undiagnosed, and of these 39.9% had > 1 VFs. The most common fracture was T12, most fractures were found to be mild (grade 1) across all age groups, and patients 70-79 years and > 80 years were found to have a statistically significantly higher number of fractures than younger patients (p < 0.001). CONCLUSIONS Our results of the high prevalence of morphometric VFs emphasise the need for baseline assessment of vertebral fragility in patients receiving treatment for osteoporosis, as well as follow-up radiographs at specified time periods while on therapy.
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Affiliation(s)
- Konstantinos D Stathopoulos
- Hellenic Society for the Study of Bone Metabolism (HSSBM), Thrakis 2, 15124, Athens, Greece. .,School of Medicine, Post Graduate Course on Bone Metabolic Diseases, National and Kapodistrian University of Athens, Mikras Asias 75, 11527, Athens, Greece.
| | - Efstathios Chronopoulos
- Hellenic Society for the Study of Bone Metabolism (HSSBM), Thrakis 2, 15124, Athens, Greece.,School of Medicine, Second Department of Orthopaedics, National and Kapodistrian University of Athens, Agias Olgas 3-5, 14233, Athens, Greece
| | - Andonis Galanos
- Laboratory for Research of the Musculoskeletal System (LRPMS), Nikis 2, 14561, Athens, Greece
| | - Evangelia Kaskani
- Hellenic Society for the Study of Bone Metabolism (HSSBM), Thrakis 2, 15124, Athens, Greece
| | | | - Eriona Ibro
- "Butterfly" Bone Health Society, Athinas 10, 14561, Athens, Greece
| | - Memi Tsekoura
- "Butterfly" Bone Health Society, Athinas 10, 14561, Athens, Greece
| | - Christos Kosmidis
- Hellenic Society for the Study of Bone Metabolism (HSSBM), Thrakis 2, 15124, Athens, Greece
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21
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El Amri N, Daldoul C, Lataoui S, Baccouche K, Belghali S, Zeglaoui H, Bouajina E. Asymptomatic vertebral fracture in Tunisian post-menopausal women at risk: prevalence and risk factors. Arch Osteoporos 2021; 16:139. [PMID: 34537891 DOI: 10.1007/s11657-021-00989-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Data are still scarce regarding the prevalence and the associated factors of vertebral fractures (VF) in the North Africa and the Middle East region. In this study, VF were common in at risk Tunisian women with a prevalence of 26.19%. Lower total hip T-score, having severe back pain, and being physically inactive were independently associated with VF. INTRODUCTION Vertebral fractures are related to a marked increase in morbidity and mortality and they are associated with a definite risk of subsequent fracture. Nevertheless, they remain underdiagnosed and little is known about their epidemiology in the African countries. In this first Tunisian study, we aimed to assess the prevalence and the associated factors of asymptomatic VF among at risk Tunisian post-menopausal women. METHODS In this cross-sectional study, we included post-menopausal women without a previous diagnosis of VF and who were referred for bone mineral density (BMD) measurement. Each participant had had an extensive medical history investigation, a BMD assessment, and a vertebral fracture assessment (VFA) scan using a dual energy X-ray absorptiometry. VF were defined using Genant semi-quantitative method. RESULTS Two hundred and ten post-menopausal women were included. The overall prevalence of VF was 26.19% and 9.52% of our participants had multiple VF. The prevalence of VF was significantly higher in older participants, those having a history of prior severe fragility fracture, or having at least one intrinsic fall. The percentage of low bone mineral density and osteoporosis were significantly higher in women with VF. After binary logistic regression analysis, severe back pain (OR = 3.016; 95% CI 1.304-6.974), regular physical activity (OR = 0.065; 95% CI 0.02-0.213), and total hip T-score (OR = 0.56; 95% CI 0.383-0.820) were independently associated with VF. CONCLUSION VF are very prevalent among at risk Tunisian post-menopausal women and their incorporation in a clinical and densitometric tool might identify more effectively subsequent fracture.
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Affiliation(s)
- Nejla El Amri
- Department of Rheumatology, Farhat Hached University Hospital, Sousse, Tunisia. .,Faculty of Medicine, University of Sousse, Sousse, Tunisia.
| | - Cyrine Daldoul
- Department of Rheumatology, Farhat Hached University Hospital, Sousse, Tunisia. .,Faculty of Medicine, University of Sousse, Sousse, Tunisia.
| | - Sadok Lataoui
- Department of Rheumatology, Farhat Hached University Hospital, Sousse, Tunisia.,Faculty of Medicine, University of Sousse, Sousse, Tunisia
| | - Khadija Baccouche
- Department of Rheumatology, Farhat Hached University Hospital, Sousse, Tunisia.,Faculty of Medicine, University of Sousse, Sousse, Tunisia
| | - Safaa Belghali
- Department of Rheumatology, Farhat Hached University Hospital, Sousse, Tunisia.,Faculty of Medicine, University of Sousse, Sousse, Tunisia
| | - Héla Zeglaoui
- Department of Rheumatology, Farhat Hached University Hospital, Sousse, Tunisia.,Faculty of Medicine, University of Sousse, Sousse, Tunisia
| | - Elyes Bouajina
- Department of Rheumatology, Farhat Hached University Hospital, Sousse, Tunisia.,Faculty of Medicine, University of Sousse, Sousse, Tunisia
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22
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Bhadada SK, Chadha M, Sriram U, Pal R, Paul TV, Khadgawat R, Joshi A, Bansal B, Kapoor N, Aggarwal A, Garg MK, Tandon N, Gupta S, Kotwal N, Mahadevan S, Mukhopadhyay S, Mukherjee S, Kukreja SC, Rao SD, Mithal A. The Indian Society for Bone and Mineral Research (ISBMR) position statement for the diagnosis and treatment of osteoporosis in adults. Arch Osteoporos 2021; 16:102. [PMID: 34176015 DOI: 10.1007/s11657-021-00954-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/26/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED The Indian Society for Bone and Mineral Research (ISBMR) has herein drafted clinical practice guidelines for the diagnosis and management of osteoporosis for the people of India. Implementation of the position statement in clinical practice is expected to improve the overall care of patients with osteoporosis in India. PURPOSE In India, osteoporosis is a major public health problem. However, in the absence of any robust regional guidelines, the screening, treatment, and follow-up of patients with osteoporosis are lagging behind in the country. METHODS The Indian Society for Bone and Mineral Research (ISBMR), which is a multidisciplinary group of physicians, researchers, dietitians, and epidemiologists and who study bone and related tissues, in their annual meeting, drafted the guidelines for the diagnosis and management of osteoporosis that would be appropriate in a resource constraint setting like India. RESULTS Diagnosis of osteoporosis can be made in a patient with minimal trauma fracture without the aid of any other diagnostic tools. In others, bone mineral density measured by dual-energy X-ray absorptiometry remains the modality of choice. Data indicates that osteoporotic fractures occur at an earlier age in Indians than in the West; hence, screening for osteoporosis should begin at an earlier age. FRAX can be used for fracture risk estimation; however, it may underestimate the risk of future fractures in our population and still needs validation. Maintaining optimum serum 25-hydroxyvitamin D levels is essential, which, in most cases, would require regular vitamin D supplementation. Pharmacotherapy should be guided by the presence/absence of vertebral/hip fractures or the severity of risk based on clinical factors, although bisphosphonates remain the first choice in most cases. Regular follow-up is essential to ensure adherence and response to therapy. CONCLUSIONS Implementation of the position statement in clinical practice is expected to improve the overall care of patients with osteoporosis in India.
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Affiliation(s)
- Sanjay K Bhadada
- Department of Endocrinology, Post Graduate Institute Of Medical Education and Research, Chandigarh, 160012, India.
| | - Manoj Chadha
- Department of Endocrinology, Parmanand Deepchand Hinduja Hospital, Mumbai, 400016, India
| | - Usha Sriram
- Endocrinology and Diabetology Division, Voluntary Health Services Hospital, Chennai, 600020, India
| | - Rimesh Pal
- Department of Endocrinology, Post Graduate Institute Of Medical Education and Research, Chandigarh, 160012, India
| | - Thomas V Paul
- Department of Endocrinology, Christian Medical College, Vellore, 632002, India
| | - Rajesh Khadgawat
- Department of Endocrinology, All India Institute Of Medical Sciences, New Delhi, 110023, India
| | - Ameya Joshi
- Endocrinology Division, Bhaktivedanta Hospital, Thane, 401107, India
| | - Beena Bansal
- Endocrinology and Diabetes Division, Door to Care, Gurgaon, 122018, India
| | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College, Vellore, 632002, India
| | - Anshita Aggarwal
- Department of Endocrinology, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Mahendra K Garg
- Department of Endocrinology, All India Institute Of Medical Sciences, Jodhpur, 342001, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute Of Medical Sciences, New Delhi, 110023, India
| | - Sushil Gupta
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Narendra Kotwal
- Department of Endocrinology, Army Hospital Research & Referral, New Delhi, 110010, India
| | - Shriraam Mahadevan
- Endocrinology Division, Sri Ramachandra Medical Center, Chennai, 600116, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Post-Graduate Medical Education and Research, Kolkata, 700020, India
| | - Soham Mukherjee
- Department of Endocrinology, Post Graduate Institute Of Medical Education and Research, Chandigarh, 160012, India
| | - Subhash C Kukreja
- Department of Medicine, University of Illinois, Chicago, IL, 60612, USA
| | - Sudhaker D Rao
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Bone & Mineral Disorders, Henry Ford, Health System, Detroit, MI, 48202, USA
| | - Ambrish Mithal
- Endocrinology and Diabetes Division, Max Healthcare, New Delhi, 110017, India.
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23
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Park SM, Go SJ, Han H, Park JW, Lee YK, Kim HJ, Yeom JS, Koo KH. Risk factors for subsequent vertebral fractures following a previous hip fracture. J Bone Miner Metab 2021; 39:193-200. [PMID: 32683499 DOI: 10.1007/s00774-020-01133-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/12/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The purpose of our study was to evaluate the incidence and to identify risk factors of subsequent vertebral fractures after hip fractures, and to determine whether the subsequent vertebral fracture increases the mortality rate of elderly hip fracture patients. MATERIALS AND METHODS From January 2009 to July 2016, 1,554 patients were diagnosed as having a hip fracture and were treated surgically at our institution. Among them, 1121 patients age > 50 years at the time of injury and were followed up for 1 year or longer after the hip fracture surgery. In these patients, radiographs of the hip and spine were taken at each follow-up. We reviewed medical records and radiographs of these patients. Among the 1121 patients, 107 patients (9.5%) had subsequent vertebral fractures after the hip fracture during entire follow-up periods. RESULTS In multivariable analysis, previous history of vertebral fracture [odds ratio (OR), 2.62; p < 0.001], medication possession rate (MPR) of osteoporosis treatment < 80% (OR, 1.92; p = 0.014), and a lower lumbar bone mineral density (BMD) (OR, 2.58; p = 0.001) appeared as risk factors for subsequent vertebral fractures. CONCLUSION However, the subsequent vertebral fractures did not affect the mortality after the hip fractures. Age ≥ 70 years [hazard ration (HR) 2.70; p = .039], body mass index < 18.5 kg/m2 (HR, 2.57; p =0 .048), and Charlson comorbidity index ≥ 2 (HR, 2.04; p =0.036) were risk factors of the death. Timely management is warranted to prevent subsequent vertebral fractures in hip fracture patients with risk factors.
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Affiliation(s)
- Sang-Min Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Sung Jun Go
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Heesoo Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Jung Wee Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea.
| | - Ho-Joong Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Jin S Yeom
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
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24
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Fiscaletti M, Samoilenko M, Dubois J, Miron MC, Lefebvre G, Krajinovic M, Laverdière C, Sinnett D, Alos N. Predictors of Vertebral Deformity in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia: The PETALE Study. J Clin Endocrinol Metab 2021; 106:512-525. [PMID: 33150433 DOI: 10.1210/clinem/dgaa806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prevalence of vertebral deformities in long-term survivors of childhood acute lymphoblastic leukemia (ALL) is unknown. Our objectives were to identify the prevalence of vertebral deformities and their risk factors among long-term childhood ALL survivors. METHODS/RESULTS We recruited 245 (49% male) long-term childhood ALL survivors from the Preventing Late Adverse Effects of Leukemia Cohort (French-Canadian ALL survivors treated between the years 1987 and 2010 with the Dana Farber Cancer Institute clinical trials protocols, who did not experience disease relapse and/or receive hematopoietic stem cell transplant). Median age at recruitment was 21.7 years (range, 8.5-41) and median time since diagnosis was 15.1 years (range, 5.4-28.2). All participants underwent spine radiograph and dual-energy X-ray absorptiometry scans. The prevalence of vertebral deformity was 23% with 88% classified as grade 1 according to the Genant method. The majority of vertebral deformities were clinically silent. Regression analysis confirmed male sex (risk ratio [RR] = 1.94; 95% confidence interval [CI], 1.16-3.24; P = 0.011), higher glucocorticoid cumulative dose (RR = 1.05; 95% CI, 1.00-1.10; P = 0.032), and back pain (RR = 2.44; 95% CI, 1.56-3.84; P < 0.001) as predictors of prevalent vertebral deformity. Sex differences in vertebral deformity predictors emerged. CONCLUSIONS We report a significant prevalence of vertebral deformities in this young cohort. Male sex, cumulative glucocorticoid dose, and back pain were identified as predictors of prevalent vertebral deformity. Back pain emerging as a strong predictor of vertebral deformity underscores the importance of ongoing bone health surveillance in survivors with persistent vertebral deformities treated with these earlier protocols.
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Affiliation(s)
- Melissa Fiscaletti
- CHU Sainte Justine Mother and Child University Hospital Center (CHUSJ), Montréal, Québec, Canada
| | - Mariia Samoilenko
- CHU Sainte Justine Mother and Child University Hospital Center (CHUSJ), Montréal, Québec, Canada
- Université du Québec à Montréal (UQAM), Montréal, Québec, Canada
| | - Josée Dubois
- CHU Sainte Justine Mother and Child University Hospital Center (CHUSJ), Montréal, Québec, Canada
| | - Marie-Claude Miron
- CHU Sainte Justine Mother and Child University Hospital Center (CHUSJ), Montréal, Québec, Canada
| | | | - Maja Krajinovic
- CHU Sainte Justine Mother and Child University Hospital Center (CHUSJ), Montréal, Québec, Canada
| | - Caroline Laverdière
- CHU Sainte Justine Mother and Child University Hospital Center (CHUSJ), Montréal, Québec, Canada
| | - Daniel Sinnett
- CHU Sainte Justine Mother and Child University Hospital Center (CHUSJ), Montréal, Québec, Canada
| | - Nathalie Alos
- CHU Sainte Justine Mother and Child University Hospital Center (CHUSJ), Montréal, Québec, Canada
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Yang J, Cosman F, Stone PW, Li M, Nieves JW. Vertebral fracture assessment (VFA) for osteoporosis screening in US postmenopausal women: is it cost-effective? Osteoporos Int 2020; 31:2321-2335. [PMID: 32778935 DOI: 10.1007/s00198-020-05588-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/04/2020] [Indexed: 01/03/2023]
Abstract
UNLABELLED Vertebral fracture assessment (VFA) is cost-effective when it was incorporated in the routine screening for osteoporosis in community-dwelling women aged ≥ 65 years, which support guidelines, such as the National Osteoporosis Foundation (NOF) for the diagnostic use of VFA as an important addition to fracture risk assessment. INTRODUCTION To evaluate the cost-effectiveness of VFA as a screening tool to reduce future fracture risk in US community-dwelling women aged ≥ 65 years. METHODS An individual-level state-transition cost-effectiveness model from a healthcare perspective was constructed using derived data from published literature. The time horizon was lifetime. Five screening strategies were compared, including no screening at all, central dual-energy X-ray absorptiometry (DXA) only, VFA only, central DXA followed by VFA if the femoral neck T-score (FN-T) ≤ - 1.5, or if the FN-T ≤ - 1.0. Various initiation ages and rescreening intervals were evaluated. Oral bisphosphonate treatment for 5-year periods was assumed. Incremental cost-effectiveness ratios (2017 US dollars per quality-adjusted life-year (QALY) gained) were used as the outcome measure. RESULTS The incorporation of VFA slightly increased life expectancy by 0.1 years and reduced the number of subsequent osteoporotic fractures by 3.7% and 7.7% compared with using DXA alone and no screening, respectively, leading to approximately 30 billion dollars saved. Regardless of initiation ages and rescreening intervals, central DXA followed by VFA if the FN-T ≤ - 1.0 was most cost-effective ($40,792 per QALY when the screening is initiated at age 65 years and with rescreening every 5 years). Results were robust to change in VF incidence and medication costs. CONCLUSION In women aged ≥ 65 years, VFA is cost-effective when it was incorporated in routine screening for osteoporosis. Our findings support the National Osteoporosis Foundation (NOF) guidelines for the diagnostic use of VFA as an important addition to fracture risk assessment.
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Affiliation(s)
- J Yang
- Institute for Social and Economic Research and Policy (ISERP), Columbia University, New York, NY, 10027, USA
| | - F Cosman
- Department of Medicine, Columbia University, New York, NY, 10032, USA
| | - P W Stone
- School of Nursing, Columbia University, New York, NY, USA
| | - M Li
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - J W Nieves
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.
- Hospital for Special Surgery, New York, NY, 10021, USA.
- Department of Epidemiology and Institute of Human Nutrition, Columbia University, 630 West 168th Street, IHN PH 1512, New York, NY, 10032, USA.
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Johansson L, Sundh D, Magnusson P, Rukmangatharajan K, Mellström D, Nilsson AG, Lorentzon M. Grade 1 Vertebral Fractures Identified by Densitometric Lateral Spine Imaging Predict Incident Major Osteoporotic Fracture Independently of Clinical Risk Factors and Bone Mineral Density in Older Women. J Bone Miner Res 2020; 35:1942-1951. [PMID: 32539162 DOI: 10.1002/jbmr.4108] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/22/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022]
Abstract
Because prevalent vertebral fracture (VF) is a strong predictor of future fractures, they are important to identify in clinical practice as osteoporosis medications are effective and can be used to reduce fracture risk in postmenopausal women with VF. Lateral spine imaging (LSI) with dual-energy X-ray absorptiometry (DXA) can be used to diagnose VFs accurately but is not widespread in clinical practice. The prognostic value of grade 1 (20% to 25% compression) VFs diagnosed by LSI with DXA has been insufficiently studied. The aim of this study was to determine if grade 1 VF is associated with incident fracture in older women. Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone Fractures (SUPERB) is a population-based study of 3028 older women from Gothenburg, Sweden. Included women were 75 to 80 years of age at baseline, answered questionnaires, and were scanned with DXA (Discovery A, Hologic, Waltham, MA, USA). LSI was used to diagnose VFs, which were classified using the Genant semiquantitative method. Cox regression models were used to estimate the association between VFs at baseline and X-ray-verified incident fractures, with adjustment for confounders. Women with a grade 1 VF (n = 264) or a grade 2-3 VF (n = 349) were compared with women without any fracture (n = 1482). During 3.6 years (median, interquartile range [IQR] 1.5 years) of follow-up, 260 women had any incident fracture and 213 a major osteoporotic fracture (MOF). Women with only grade 1 VF had increased risk of any fracture (hazard ratio [HR] = 1.67; 95% confidence interval [CI] 1.18-2.36) and MOF (HR = 1.86; 95% CI 1.28-2.72). For MOF, this association remained after adjustment for clinical risk factors and femoral neck bone mineral density (BMD). In conclusion, grade 1 VFs were associated with incident MOF, also after adjustment for clinical risk factors and BMD, indicating that all VF identified by DXA should be considered in the evaluation of fracture risk in older women. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research..
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Affiliation(s)
- Lisa Johansson
- Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Daniel Sundh
- Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Magnusson
- Department of Clinical Chemistry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Dan Mellström
- Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Geriatric Medicine Clinic, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Anna G Nilsson
- Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Endocrinology, Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mattias Lorentzon
- Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Geriatric Medicine Clinic, Sahlgrenska University Hospital, Mölndal, Sweden.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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Aboudiab M, Grados F, Batteux B, Henry-Desailly I, Fardellone P, Goëb V. Vertebral fracture assessment (VFA) in patients over 50 years of age with a non-severe peripheral fracture. Osteoporos Int 2020; 31:1477-1486. [PMID: 32266434 DOI: 10.1007/s00198-020-05400-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/23/2020] [Indexed: 12/28/2022]
Abstract
UNLABELLED The prevalence of unknown vertebral fractures evaluated by systematic vertebral fracture assessment (VFA) was 21% in patients over 50 years of age who suffered from a recent low-trauma non-severe peripheral fracture. The outcome of VFA resulted in changes in the management of osteoporosis. INTRODUCTION The aim of this study was to evaluate the utility of VFA in detecting vertebral fractures (VFs) in patients over 50 years of age, who suffered from a recent low-trauma non-severe peripheral fracture. METHODS This was an observational, single-center, cross-sectional study conducted in patients over 50 years of age, who presented a recent low-trauma non-severe peripheral fracture and were identified by the Fracture Liaison Service (FLS) of Amiens University Hospital between December 2017 and March 2019. VFA was interpreted by two trained rheumatologists providing a consensual reading using Genant semi-quantitative assessment. RESULTS Of the 359 eligible patients, 114 patients (31.8%) were included (mean age 65.6 ± 8.4 years; 89.5% female). Twenty-four patients (21%) had one or more VF diagnosed by VFA. The total number of VF diagnosed by VFA was 30: 20 VF (66.7%) grade 1, 7 VF (23.3%) grade 2, and 3 VF (10%) grade 3. Among the 24 patients with at least one prevalent VF diagnosed by VFA, 18 patients had an osteoporosis medication adaptation after the VFA results (16 osteoporosis medication initiation and 2 treatment intensification), and 6 patients would have had an osteoporosis medication even without the VFA results (66.7% versus 33.3% respectively, p < 0.001). Of the 51 patients receiving an osteoporosis medication after DXA and VFA, 18 patients (35.3%) had a change in the management of osteoporosis after knowing the outcome of VFA. All the VFs diagnosed by VFA were unknown before. We did not evidence any threshold (age, T-score, height loss) below which no VF was detected. CONCLUSIONS Our study demonstrates the usefulness of systematic VFA to detect prevalent VF in patients over 50 years of age who suffer from a recent non-severe peripheral fracture.
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Affiliation(s)
- M Aboudiab
- Department of Rheumatology, Amiens University Hospital, Amiens, France.
| | - F Grados
- Department of Rheumatology, Amiens University Hospital, Amiens, France
| | - B Batteux
- Department of Pharmacology, Amiens University Hospital, Amiens, France
| | - I Henry-Desailly
- Department of Rheumatology, Amiens University Hospital, Amiens, France
| | - P Fardellone
- Department of Rheumatology, Amiens University Hospital, Amiens, France
| | - V Goëb
- Department of Rheumatology, Amiens University Hospital, Amiens, France
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Horii C, Asai Y, Iidaka T, Muraki S, Oka H, Tsutsui S, Hashizume H, Yamada H, Yoshida M, Kawaguchi H, Nakamura K, Akune T, Oshima Y, Tanaka S, Yoshimura N. The incidence and risk factors for adjacent vertebral fractures in community-dwelling people with prevalent vertebral fracture: the 3rd and 4th survey of the ROAD study. Arch Osteoporos 2020; 15:74. [PMID: 32424619 DOI: 10.1007/s11657-020-00747-y] [Citation(s) in RCA: 2] [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: 10/22/2019] [Accepted: 04/29/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED In this 3-year follow-up study of 66 community-dwelling adults with severely deformed vertebral fractures, the annual incidence of adjacent vertebral fracture (AVF) was 6.1%/year. Lower bone mineral density at the femoral neck and spinopelvic malalignment were risk factors for AVF. PURPOSE This study aimed to clarify the incidence and risk factors of adjacent vertebral fractures (AVFs)-fractures adjacent to a prevalent vertebral fracture (VF)-using an established population-based cohort from the ROAD study. METHODS Among the 1213 participants who underwent whole-spine radiography in ROAD's third (2012-2013, the baseline) and fourth surveys (2015-2016, the follow-up), 66 (12 men, 54 women) had at least one VF at the baseline. VF and AVF were determined radiographically using Genant's semi-quantitative (SQ) method, where VF was SQ ≥ 2 and AVF was a one-level cranial or caudal vertebra with an SQ grade one or more higher at the follow-up. An interviewer-administered questionnaire was applied, and anthropometric measurements and bone mineral density (BMD) measurements at the lumbar spine and femoral neck were performed. Sagittal imbalance of the spine was defined as a mismatch between pelvic incidence and lumbar lordosis (PI-LL) of > 20°. Multivariate logistic regression analyses were performed to identify risk factors for AVF. RESULTS AVF occurred in 12 participants (1 man, 11 women). The annual incidence of AVF was estimated at 6.1%/year. Logistic regression analyses revealed that lower BMD at the femoral neck and PI-LL > 20° were risk factors for AVF. CONCLUSIONS The annual incidence of AVF in a general population with prevalent VF was 6.1%/year. In addition, lower BMD at the femoral neck and PI-LL > 20° were risk factors for AVF.
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Affiliation(s)
- Chiaki Horii
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshiki Asai
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Toshiko Iidaka
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigeyuki Muraki
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroshi Kawaguchi
- JCHO Tokyo Shinjuku Medical Center, 5-1, Tsukudo-cho, Shinjyuku-ku, Tokyo, 162-8543, Japan
| | - Kozo Nakamura
- National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa City, Saitama, 359-0042, Japan
| | - Toru Akune
- National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa City, Saitama, 359-0042, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.
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Roux C, Briot K. The crisis of inadequate treatment in osteoporosis. THE LANCET. RHEUMATOLOGY 2020; 2:e110-e119. [PMID: 38263657 DOI: 10.1016/s2665-9913(19)30136-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 01/25/2024]
Abstract
The number of fractures related to osteoporosis is expected to increase dramatically in the next few decades because of an increase in the number of elderly patients at high risk of falls and fractures. Developments in the diagnosis and treatment of osteoporosis might change our strategies for management of patients with osteoporosis: the imminent risk of fracture concept, the issue of how to correctly sequence treatment, the potential effectiveness of screening, and goal-directed treatment strategies. Despite advances, few patients receive appropriate treatment for osteoporosis, even after a fracture. The crisis in the treatment of osteoporosis is related to several factors, including the fears and beliefs that patients and physicians have about the adverse effects of treatments. Strategies to address this crisis pose a considerable challenge; nonetheless, prevention of fragility fractures is within our reach. To that end, careful selection of patients at high risk of fracture, selection of the best therapeutic strategy, and accurate communication about fracture risk and bone fragility must be improved.
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Affiliation(s)
- Christian Roux
- Université de Paris, Centre de Recherche Epidémiologie et Statistiques, Unité Mixte de Recherche 1153, Institut National de la Santé et de la Recherche Médicale, Paris, France; Service de Rhumatologie, Assistance Publique-Hopitaux de Paris, Hospital Cochin, Paris, France.
| | - Karine Briot
- Université de Paris, Centre de Recherche Epidémiologie et Statistiques, Unité Mixte de Recherche 1153, Institut National de la Santé et de la Recherche Médicale, Paris, France; Service de Rhumatologie, Assistance Publique-Hopitaux de Paris, Hospital Cochin, Paris, France
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Abstract
UNLABELLED Advancing age, female sex, recent prior fracture and falls, and specific comorbidities and medications contribute to imminent (within 1-2 years) risk of fracture in Medicare enrollees. Clinician awareness of these risk factors and their dynamic nature may lead to improved osteoporosis care for elderly patients. PURPOSE The burden of osteoporotic fracture disproportionately affects the elderly. Growing awareness that fracture risk can change substantially over time underscores the need to understand risk factors for imminent (within 1-2 years) fracture. This study assessed predictors of imminent risk of fracture in the US Medicare population. METHODS Administrative claims data from a random sample of Medicare beneficiaries were analyzed for patients aged ≥ 67 years on January 1, 2011 (index date), with continuous coverage between January 1, 2009 and March 31, 2011, excluding patients with non-melanoma cancer or Paget's disease. Incident osteoporotic fractures were identified during 12 and 24 months post-index. Potential predictors were age, sex, race, history of fracture, history of falls, presence of osteoporosis, cardiovascular diseases, chronic obstructive pulmonary disorder (COPD), mood/anxiety disorders, polyinflammatory conditions, difficulty walking, use of durable medical equipment, ambulance/life support, and pre-index use of osteoporosis medications, steroids, or central nervous system medications. Cox proportional hazards models were used to evaluate predictors of fracture risk in the two follow-up intervals. RESULTS Among 1,780,451 individuals included (mean age 77.7 years, 66% female), 8.3% had prior fracture and 6.1% had a history of falls. During the 12- and 24-month follow-up periods, 3.0% and 5.4% of patients had an incident osteoporotic fracture, respectively. Imminent risk of fracture increased with older age (double/triple), female sex (> 80%), recent prior fracture (> double) and falls, and specific comorbidities and medications. CONCLUSIONS Demographics and factors including fall/fracture history, comorbidities, and medications contribute to imminent risk of fracture in elderly patients.
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31
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Corrigendum to how to define an osteoporotic vertebral fracture. Quant Imaging Med Surg 2019; 9:1922-1931. [PMID: 31867245 DOI: 10.21037/qims.2019.11.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
[This corrects the article DOI: 10.21037/qims.2019.09.10.].
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32
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Kanterewicz E, Puigoriol E, Rodríguez Cros JR, Peris P. Prevalent vertebral fractures and minor vertebral deformities analyzed by vertebral fracture assessment (VFA) increases the risk of incident fractures in postmenopausal women: the FRODOS study. Osteoporos Int 2019; 30:2141-2149. [PMID: 31123788 DOI: 10.1007/s00198-019-04962-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/28/2019] [Indexed: 11/28/2022]
Abstract
UNLABELLED The incidence of vertebral fractures (VF) by vertebral fracture assessment (VFA) was 6.6% in postmenopausal women (FRODOS cohort) after 4 years of follow-up, increasing with prevalent VF and minor vertebral deformities, age, lower bone mass, glucocorticoid use, and rheumatoid arthritis. This study supports the usefulness of VFA to identify VF. PURPOSE Vertebral fracture assessment (VFA) is increasingly used to identify spine fractures, but few cohort studies have used this method in prevalence and incidence assessment. We previously reported the prevalence of vertebral fractures (VF) and minor vertebral deformities (MVD) by morphometric VFA in a population-based cohort of postmenopausal women (FRODOS study). Therefore, the aim of this study was to analyze the incidence of VF, the associated risk factors, and particularly the role of MVD in this cohort of subjects. METHODS We performed a longitudinal analysis of 2510 women aged 59-70 years participating in the FRODOS prevalence study (2006-2009) with evaluable VFA 4 years later. VFA at baseline and in the present study was assessed by quantitative vertebral morphometry and by visual semiquantitative measurement. The multivariate Poisson regression model was performed, and relative risks with confidence interval of 95% were calculated for the incidence of VF. Bone mineral density (BMD) and an osteoporosis questionnaire were collected. RESULTS Overall, the incidence of VF was 6.6%, increasing with prevalent VF (24.5%) and in women with prevalent MVD (17.7%). Age and low BMD were also associated risk factors as were the presence of rheumatoid arthritis and exposure to glucocorticoids and bisphosphonates. CONCLUSIONS The presence of prevalent VF assessed by VFA is associated with further incident spinal fractures in postmenopausal women. In addition, having MVD confers an increased risk of new VF.
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Affiliation(s)
- E Kanterewicz
- Department of Rheumatology, Hospital Universitari de Vic. TR2Lab Group, Universitat de Vic-UCC, C/ Francesc Pla el Vigatà, n° 1, 08500, Vic, Spain.
| | - E Puigoriol
- Department of Clinical Epidemiology. Hospital Universitari de Vic. TR2Lab Group, Universitat de Vic-UCC, Barcelona, Spain
| | - J R Rodríguez Cros
- Department of Rheumatology, Hospital Universitari de Vic. TR2Lab Group, Universitat de Vic-UCC, C/ Francesc Pla el Vigatà, n° 1, 08500, Vic, Spain
| | - P Peris
- Department of Rheumatology, Hospital Clinic i Provincial, Barcelona, Spain
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Abstract
A vertebral deformity (VD) is not always a vertebral fracture (VF). Because of lack of a completely satisfactory "gold standard", there is no consensus on the exact definition of a VF. Therefore, it may sometimes be difficult, especially in mild cases, to discriminate the prevalent VF from a non-fracture deformity or short vertebral height (SVH). A combined standardized approach based on qualitative and semiquantitative (SQ) vertebral assessment may be the most option to correctly identify a VD as a VF. However this visual approach for VF identification is subjective, therefore it is mandatory an adequate training and experience of radiologist to reach a good sensitivity and specificity. Vertebral morphometry, objective and reproducible method, could be used only to evaluate the severity of VFs but requires the availability of reference values of vertebral height ratios. There is actually an evidentiary basis for suggesting that a qualitative approach by expert radiologists to morphological vertebral assessment, combined SQ and morphometric methods seem to be the preferred option for the correct diagnosis of VF as endplate or/and cortex fracture (ECF) or severe vertebral height loss.
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Affiliation(s)
- Daniele Diacinti
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, University Sapienza, Rome, Italy
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Horii C, Asai Y, Iidaka T, Muraki S, Oka H, Tsutsui S, Hashizume H, Yamada H, Yoshida M, Kawaguchi H, Nakamura K, Akune T, Tanaka S, Yoshimura N. Differences in prevalence and associated factors between mild and severe vertebral fractures in Japanese men and women: the third survey of the ROAD study. J Bone Miner Metab 2019; 37:844-853. [PMID: 30607619 DOI: 10.1007/s00774-018-0981-5] [Citation(s) in RCA: 20] [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] [Received: 07/09/2018] [Accepted: 11/21/2018] [Indexed: 01/06/2023]
Abstract
Vertebral fracture (VF) is a common osteoporotic fracture, while its epidemiology varies according to regions and ethnicities, little is known about it in Japan. Using whole-spine radiographs from a population-based cohort study, the Research on Osteoarthritis/Osteoporosis Against Disability study 3rd survey performed in 2012-2013, we estimated the sex- and age-specific prevalence of VF in the Japanese. Genant's semiquantitative method (SQ) was used to define VF; SQ ≥ 1 as VF, SQ = 1 as mild VF, SQ≥ 2 as severe VF. We also revealed accurate site-specific prevalence, and associated factors with mild and severe VF. The participants were 506 men [mean age 66.3 years, standard deviation (SD):13.0] and 1038 women (mean age 65.3 years, SD: 12.6). The prevalence of VF in participants aged under 40, in their 40s, 50s, 60s, 70s, and ≥ 80 years was 17.4, 7.9, 18.5, 25.6, 26.3, and 41.5%, respectively, in men, and 2.9%, 2.4%, 7,3, 10.3, 27.1, and 53.0%, respectively, in women. Men had a significantly higher prevalence of mild VF (21.2%) than women (10.0%, p < 0.001); whereas, severe VF was significantly more prevalent in women (9.1%) than in men (4.7%, p = 0.003). VF was distributed with 2 peaks regarding site; one large peak at the thoracolumbar region, and another at the middle thoracic lesion. Low back pain and decreased walking ability were independently associated with severe VF, but not with mild VF, after adjustment for participant characteristics. Decreased walking ability was associated with multiple VFs in women, but not in men.
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Affiliation(s)
- Chiaki Horii
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshiki Asai
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Toshiko Iidaka
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigeyuki Muraki
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Hiroshi Kawaguchi
- JCHO Tokyo Shinjuku Medical Center, 5-1, Tsukudo-cho, Shinjyuku-ku, Tokyo, 162-8543, Japan
| | - Kozo Nakamura
- National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, 359-0042, Japan
| | - Toru Akune
- National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, 359-0042, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.
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Geusens P, Oates M, Miyauchi A, Adachi JD, Lazaretti-Castro M, Ebeling PR, Perez Niño CA, Milmont CE, Grauer A, Libanati C. The Effect of 1 Year of Romosozumab on the Incidence of Clinical Vertebral Fractures in Postmenopausal Women With Osteoporosis: Results From the FRAME Study. JBMR Plus 2019; 3:e10211. [PMID: 31687647 PMCID: PMC6820457 DOI: 10.1002/jbm4.10211] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/19/2019] [Accepted: 04/07/2019] [Indexed: 12/30/2022] Open
Abstract
Radiographic vertebral fractures (VFxs) are the most common fractures in osteoporosis and are associated with increased morbidity, mortality, and costs. A subset of VFxs manifest clinically, usually with a sudden onset of severe back pain. Romosozumab is a monoclonal antibody that binds and inhibits sclerostin, increasing bone formation and decreasing bone resorption, leading to rapid and large increases in bone density and strength and reduction in fracture risk. The FRAME (Fracture Study in Postmenopausal Women with Osteoporosis) study of postmenopausal women with osteoporosis demonstrated a significant reduction in new VFxs with romosozumab versus placebo. Here, we report the effect of romosozumab versus placebo on clinical VFx incidence over 12 months in women reporting back pain suggestive of VFxs. FRAME enrolled 7180 postmenopausal women with osteoporosis, mean age 70.9 years (hip T‐score −2.5 to −3.5). In the first year of the study, women received monthly romosozumab 210 mg (n = 3589) or placebo (n = 3591). At regular monthly visits, women reporting back pain suggestive of a clinical VFx had a confirmatory spine X‐ray. Clinical VFx risk in the romosozumab group versus the placebo group was calculated by Cox‐proportional hazards model. Of 119 women in FRAME with back pain suggestive of a clinical VFx over 12 months, 20 were confirmed to have experienced a new/worsening VFx. Three women receiving romosozumab had a clinical VFx (<0.1% of 3589 women) versus 17 (0.5% of 3591 women) receiving placebo resulting in a reduction in clinical VFx risk of 83% in the romosozumab group versus placebo through 12 months (HR 0.17; 95% CI, 0.05 to 0.58; p = 0.001). In the three romosozumab‐treated women, clinical VFxs occurred within the first 2 months of the study with no further clinical VFxs throughout the year. Romosozumab treatment for 12 months was associated with rapid and large reductions in clinical VFx risk versus placebo. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Piet Geusens
- Department of Internal Medicine, Rheumatology, Maastricht UMC, Maastricht, The Netherlands, and University Hasselt and ReumaClinic Genk Belgium
| | - Mary Oates
- Pacific Central Coast Health Center Santa Maria CA USA
| | | | | | - Marise Lazaretti-Castro
- Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo Brazil
| | - Peter R Ebeling
- Department of Medicine School of Clinical Sciences, Monash University Clayton Australia
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Carlson BC, Robinson WA, Wanderman NR, Sebastian AS, Nassr A, Freedman BA, Anderson PA. A Review and Clinical Perspective of the Impact of Osteoporosis on the Spine. Geriatr Orthop Surg Rehabil 2019; 10:2151459319861591. [PMID: 31360592 PMCID: PMC6637832 DOI: 10.1177/2151459319861591] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction Osteopenia and osteoporosis are common conditions in the United States. The health consequences of low bone density can be dire, from poor surgical outcomes to increased mortality rates following a fracture. Significance This article highlights the impact low bone density has on spine health in terms of vertebral fragility fractures and its adverse effects on elective spine surgery. It also reviews the clinical importance of bone health assessment and optimization. Results Vertebral fractures are the most common fragility fractures with significant consequences related to patient morbidity and mortality. Additionally, a vertebral fracture is the best predictor of a subsequent fracture. These fractures constitute sentinel events in osteoporosis that require further evaluation and treatment of the patient's underlying bone disease. In addition to fractures, osteopenia and osteoporosis have deleterious effects on elective spine surgery from screw pullout to fusion rates. Adequate evaluation and treatment of a patient's underlying bone disease in these situations have been shown to improve patient outcomes. Conclusion With an increased understanding of the prevalence of low bone mass and its consequences as well an understanding of how to identify these patients and appropriately intervene, spine surgeons can effectively decrease the rates of adverse health outcomes related to low bone mass.
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Affiliation(s)
- Bayard C Carlson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Paul A Anderson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab 2019; 104:1595-1622. [PMID: 30907953 DOI: 10.1210/jc.2019-00221] [Citation(s) in RCA: 405] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective is to formulate clinical practice guidelines for the pharmacological management of osteoporosis in postmenopausal women. CONCLUSIONS Evidence from clinical trials and insights from clinical experience with pharmacologic therapies for osteoporosis were critically evaluated in formulating this guideline for the management of postmenopausal osteoporosis. Patient preferences, data on adherence and persistence, and risks and benefits from the patient and provider perspectives were also considered in writing committee deliberations. A consensus by the Writing Committee members was achieved for four management principles: (i) The risk of future fractures in postmenopausal women should be determined using country-specific assessment tools to guide decision-making. (ii) Patient preferences should be incorporated into treatment planning. (iii) Nutritional and lifestyle interventions and fall prevention should accompany all pharmacologic regimens to reduce fracture risk. (iv) Multiple pharmacologic therapies are capable of reducing fracture rates in postmenopausal women at risk with acceptable risk-benefit and safety profiles.
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Affiliation(s)
| | | | - Dennis M Black
- University of California San Francisco, San Francisco, California
| | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
| | - Dolores Shoback
- Endocrine Research Unit, San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Medicine, University of California San Francisco, San Francisco, California
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Wáng YXJ, Che-Nordin N, Deng M, Leung JCS, Kwok AWL, He LC, Griffith JF, Kwok TCY, Leung PC. Osteoporotic vertebral deformity with endplate/cortex fracture is associated with higher further vertebral fracture risk: the Ms. OS (Hong Kong) study results. Osteoporos Int 2019; 30:897-905. [PMID: 30666373 DOI: 10.1007/s00198-019-04856-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/13/2019] [Indexed: 12/12/2022]
Abstract
UNLABELLED Compared with vertebrae without deformity, vertebrae with mild/moderate deformity have a higher risk of endplate or/and cortex fracture (ecf). Compared with subjects without ecf, subjects with ecf are at a higher risk of short-term (4-year period) deformity progression and new incident deformity. INTRODUCTION The progression and incidence of osteoporotic vertebral deformity/fracture (VD/VF) in elderly Chinese females remain not well documented. METHODS Spine radiographs of 1533 Chinese females with baseline and year-4 follow-up (mean age 75.7 years) were evaluated according to Genant's VD criteria and endplate/cortex fracture (non-existent: ecf0 or existent: ecf1). Grade-2 VDs were divided into mild (vd2m, 25-34% height loss) and severe (vd2s, 34-40% height loss) subgroups. According to their VD/VF, subjects were graded into seven categories: vd0/ecf0, vd1/ecf0, vd2m/ecf0, vd1/ecf1, vd2m/ecf1, vd2s/ecf1, and vd3/ecf1. With an existing VD, a further height loss of ≥ 15% was a VD progression. A new incident VD was a change from grade-0 to grade-2/3 or to grade-1 with ≥ 10% height loss. RESULTS Of subjects with Genant's grades 0, - 1, - 2, and - 3 VD, at follow-up, 4.6%, 8%, 10.6%, and 28.9% had at least one VD progression or new incident VD respectively. Among the three ecf0 groups, there was no difference in VD progression or new VD; while there was a significant difference in new ecf incidence, with vd0/ecf0 being lowest and vd2m/ecf0 being highest. Vd1/ecf0 and vd2m/ecf0 vertebrae had a higher risk of turning to ecf1 than vd0/ecf0 vertebrae. If vd1/ecf0 and vd2m/ecf0 subjects were combined together (range 20-34% height loss) to compare with vd1/ecf1 and vd2m/ecf1 subjects, the latter had significantly higher VD progression and new VD rates. CONCLUSION Vertebrae with grade-1/2 VDs had a higher risk of developing ECF. Subjects with pre-existing ECFs had a higher risk of worsening or new vertebral deformities.
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Affiliation(s)
- Y X J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - N Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - M Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - J C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - A W L Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - L C He
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - J F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - T C Y Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - P C Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Rudman HA, Birrell F, Pearce MS, Tuck SP, Francis RM, Treadgold L, Hind K. Obesity, bone density relative to body weight and prevalent vertebral fracture at age 62 years: the Newcastle thousand families study. Osteoporos Int 2019; 30:829-836. [PMID: 30623213 DOI: 10.1007/s00198-018-04817-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/03/2018] [Indexed: 12/21/2022]
Abstract
UNLABELLED Obesity increases the likelihood of prevalent vertebral fracture (VF) in men and women at age 62 years. The higher absolute bone mineral density (BMD) observed in obese individuals is disproportionate to body weight, and this may partly explain the greater prevalence of VF in this group. INTRODUCTION Obesity is a global epidemic, and there remains uncertainty over the effect of obesity on skeletal health, particularly in the context of osteoporosis. The aim of this study was to investigate associations of body mass index (BMI) and obesity with BMD and prevalent VF in men and women aged 62 years. METHODS Three hundred and forty-two men and women aged 62.5 ± 0.5 years from the Newcastle Thousand Families Study birth cohort underwent DXA evaluations of femoral neck and lumbar spine BMD and of the lateral spine for vertebral fracture assessment. RESULTS The likelihood of prevalent VF was significantly increased in men when compared to women (OR = 2.7, p < 0.001, 95% Cl 1.7-4.4). As BMI increased in women, so did the likelihood of prevalent any-grade VF (OR = 1.09, p = 0.006, 95% CI 1.02-1.17). Compared to normal weight women, obese women were more likely to have at least one VF (OR = 2.65, p = 0.025, CI 1.13-6.20) and at least one grade 1 vertebral deformity (OR = 4.39, p = 0.005, CI 1.57-12.28). Obese men were more likely to have a grade 2 and/or grade 3 VF compared to men of normal weight (OR = 3.36, p = 0.032, CI 1.11-10.16). In men and women, BMI was negatively associated with femoral neck BMD/weight (R = - 0.65, R = - 0.66, p < 0.001) and lumbar spine BMD/weight (R = - 0.66, R - 0.60, p < 0.001). CONCLUSIONS Obesity appears to be a risk factor for prevalent VF, and although absolute BMD is higher in obese individuals, this does not appear commensurate to their increased body weight.
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Affiliation(s)
- H A Rudman
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - F Birrell
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - M S Pearce
- Institute of Health and Society, Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, UK
| | - S P Tuck
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - R M Francis
- Institute of Health and Society, Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, UK
| | - L Treadgold
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - K Hind
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.
- Department of Sport and Exercise Sciences, Durham University, 42 Old Elvet, Durham, DH1 3HN, UK.
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Che H, Breuil V, Cortet B, Paccou J, Thomas T, Chapuis L, Debiais F, Mehsen-Cetre N, Javier RM, Loiseau Peres S, Roux C, Briot K. Vertebral fractures cascade: potential causes and risk factors. Osteoporos Int 2019; 30:555-563. [PMID: 30519756 DOI: 10.1007/s00198-018-4793-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/29/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED We performed a study to identify potential causes and risk factors of vertebral fracture cascade. Vertebral fracture cascade is a severe clinical event in patients with bone fragility. Only half of patients have an identified cause of secondary osteoporosis. INTRODUCTION Vertebral fracture (VF) is the most common osteoporotic fracture, and a strong risk factor of subsequent VFs leading to VF cascade (VFC). We prompted a study to identify potential causes and risk factors of VFC. METHODS VFC observations were collected retrospectively between January 2016 and April 2017. VFC was defined as an occurrence of at least three VFs within 1 year. RESULTS We included in 10 centers a total of 113 patients with VFC (79.6% of women, median age 73, median number of VFs in the cascade, 5). We observed 40.5% and 30.9% of patients with previous major fractures and a previous VF, respectively, and 68.6% with densitometric osteoporosis; 18.9% of patients were currently receiving oral glucocorticoids and 37.1% in the past. VFC was attributed by the physician to postmenopausal osteoporosis in 54% of patients. A secondary osteoporosis associated with the VFC was diagnosed in 52 patients: glucocorticoid-induced osteoporosis (25.7%), non-malignant hemopathies (6.2%), alcoholism (4.4%), use of aromatase inhibitors (3.6%), primary hyperparathyroidism (2.7%), hypercorticism (2.7%), anorexia nervosa (2.7%), and pregnancy and lactation-associated osteoporosis (1.8%). A total of 11.8% of cases were reported following a vertebroplasty procedure. A total of 31.5% patients previously received an anti-osteoporotic treatment. In six patients, VFC occurred early after discontinuation of an anti-osteoporotic treatment, in the year after the last dose effect was depleted: five after denosumab and one after odanacatib. CONCLUSION The results of this retrospective study showed that only half of VFC occurred in patients with a secondary cause of osteoporosis. Prospective studies are needed to further explore the determinants of this severe complication of osteoporosis.
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Affiliation(s)
- H Che
- Rheumatology Department, CHU Lapeyronie Montpellier, 371 avenue du Gaston Giraud, 34090, Montpellier, France.
| | - V Breuil
- Department of Rheumatology, BIAM - UMR E 4320 TIRO-MATOs CEA/UNS, Université Côte D'Azur, Centre Hospitalier Universitaire Nice, Nice, France
| | - B Cortet
- Service de rhumatologie, CHRU France et Université de Lille, Université Littoral Côte d'Opale, 59000 Lille, PMOI EA 4490 faculté de chirurgie dentaire, place de Verdun, 59000, Lille, France
| | - J Paccou
- Service de rhumatologie, CHRU France et Université de Lille, Université Littoral Côte d'Opale, 59000 Lille, PMOI EA 4490 faculté de chirurgie dentaire, place de Verdun, 59000, Lille, France
| | - T Thomas
- Rheumatology Department, CHU de Saint Etienne, INSERM U1059, Lab Biologie Intégrée du Tissu Osseux, Université de Lyon, 42055, Saint-Etienne Cedex 2, France
| | - L Chapuis
- Rheumatology Department, CH Simone Veil du Vitre, 30 route de Rennes, 35500, Vitre, France
| | - F Debiais
- Rheumatology Department, CHU La Miletrie Poitiers, 2 rue de la Miletrie, 86021, Poitiers Cedex, France
| | - N Mehsen-Cetre
- Rheumatology Department, CHU Pellegrin Bordeaux, Rue de la pelouse de Douet, 33000, Bordeaux, France
| | - R M Javier
- Rheumatology Department, Hôpitaux Universitaires de Strasbourg, 1 avenue Moliere, 67098, Strasbourg, France
| | - S Loiseau Peres
- Rheumatology Department, CHR Orléans, 14 avenue de l'Hopital, 45000, Orleans, France
| | - C Roux
- Rheumatology Department, INSERM 1153, CHU Paris Cochin, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - K Briot
- Rheumatology Department, INSERM 1153, CHU Paris Cochin, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
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Sahuguet J, Fechtenbaum J, Molto A, Etcheto A, López-Medina C, Richette P, Dougados M, Roux C, Briot K. Low incidence of vertebral fractures in early spondyloarthritis: 5-year prospective data of the DESIR cohort. Ann Rheum Dis 2018; 78:60-65. [PMID: 30389692 DOI: 10.1136/annrheumdis-2018-213922] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/26/2018] [Accepted: 10/16/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES An increased risk of vertebral fractures (VFs) has been reported in spondyloarthritis (SpA). Our hypothesis is that the prevalence of VFs is lower than reported in previous studies, especially in early SpA. This study aimed at assessing the incidence of radiographical VFs over 5 years in early axial SpA. METHODS The DESIR (DEvenir des Spondylarthropathies Indifférenciées Récentes) cohort, which included patients with inflammatory back pain highly suggestive of axial SpA, is the basis of this study. All radiographs of the DESIR cohort had been assessed at a central facility, by one investigator specialised in the field of the diagnosis of VFs according to Genant's method. We assessed the prevalence and incidence of VFs and vertebral deformities at baseline and over 5 years. RESULTS Five-year X-rays were available for 432 patients (mean age 34.3±8.7 years, 53% women). Diagnosis of VF was doubtful and needed adjudication for 19 patients (4.4%). 13 patients had prevalent VFs (3.0%) which were located at the thoracic spine (12 were grade 1). At 5 years, five patients had an incident VF (1.15%); seven vertebrae were fractured, mostly located at the thoracic spine (n=6/7), and of grade 1 (n=6/7). CONCLUSION In the DESIR cohort, a population of early SpA, we found a low prevalence and incidence of VFs (3.0% and 1.15 %), respectively. This confirms our hypothesis that the actual prevalence and incidence of VFvertebral fracture in SpA is lower than that reported in the previous studies.
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Affiliation(s)
- Julie Sahuguet
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Jacques Fechtenbaum
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Anna Molto
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France.,INSERM U1153, Paris, France
| | - Adrien Etcheto
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | | | - Pascal Richette
- Department of Rheumatology, Lariboisière Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Maxime Dougados
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France.,INSERM U1153, Paris, France.,Paris Descartes University, Paris, France
| | - Christian Roux
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France.,INSERM U1153, Paris, France.,Paris Descartes University, Paris, France
| | - Karine Briot
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France .,INSERM U1153, Paris, France
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Carlson BC, Robinson WA, Wanderman NR, Nassr AN, Huddleston PM, Yaszemski MJ, Currier BL, Jeray KJ, Kirk KL, Bunta AD, Murphy S, Patel B, Watkins CM, Sietsema DL, Edwards BJ, Tosi LL, Anderson PA, Freedman BA. The American Orthopaedic Association's Own the Bone® database: a national quality improvement project for the treatment of bone health in fragility fracture patients. Osteoporos Int 2018; 29:2101-2109. [PMID: 29858634 DOI: 10.1007/s00198-018-4585-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/21/2018] [Indexed: 01/22/2023]
Abstract
UNLABELLED The American Orthopaedic Association initiated the Own the Bone (OTB) quality improvement program in 2009. Herein we show that the data collected through this program is similar to that collected in other large studies. Thus, the OTB registry functions as an externally valid cohort for studying fragility fracture patients. INTRODUCTION The American Orthopedic Association initiated the Own the Bone (OTB) quality improvement program in 2009 to improve secondary prevention of fragility fractures. In this study, we present a summary of the data collected by the OTB program and compare it to data from other large fragility fracture registries with an aim to externally validate the OTB registry. METHODS The OTB registry contained 35,038 unique cases of fragility fracture as of September, 2016. We report the demographics, presenting fracture characteristics, past fracture history, and bone mineral density (BMD) data and compare these to data from large fragility fracture studies across the world. RESULTS Seventy-three percent of the patients in the OTB registry were female, Caucasian, and post-menopausal. In 54.4% of cases, patients had a hip fracture; spine fractures were the second most common fracture type occurring in 11.1% of patients. Thirty-four percent of the patients had a past history of fragility fracture, and the most common sites were the spine and hip. The average femoral neck T-score was - 2.06. When compared to other studies, the OTB database showed similar findings with regard to patient age, gender, race, BMI, BMD profile, prior fracture history, and family history of fragility fractures. CONCLUSION OTB is the first and largest multi-center voluntary fragility fracture registry in the USA. The data collected through the OTB program is comparable to that collected in international studies. Thus, the OTB registry functions as an externally valid cohort for further studies assessing the clinical characteristics, interventions, and outcomes achieved in patients who present with a fragility fracture in the USA.
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Affiliation(s)
| | | | | | | | | | | | | | - K J Jeray
- Greenville Health System, Greenville, SC, USA
| | - K L Kirk
- San Antonio Orthopedic Group, San Antonio, TX, USA
| | - A D Bunta
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Murphy
- The American Orthopaedic Association, Rosemont, IL, USA
| | - B Patel
- The American Orthopaedic Association, Rosemont, IL, USA
| | - C M Watkins
- West Virginia University, Morgantown, WV, USA
| | | | - B J Edwards
- Central Texas Veteran Healthcare System, Temple, TX, USA
| | - L L Tosi
- Children's National Health System, Washington, DC, USA
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Wáng YXJ, Che-Nordin N. Informed communication with study subjects of radiographically detected osteoporotic vertebral deformity. Quant Imaging Med Surg 2018; 8:876-880. [PMID: 30306065 PMCID: PMC6177369 DOI: 10.21037/qims.2018.09.06] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/11/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Nazmi Che-Nordin
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
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van Dort MJ, Geusens P, Driessen JH, Romme EA, Smeenk FW, Wouters EF, van den Bergh JP. High Imminent Vertebral Fracture Risk in Subjects With COPD With a Prevalent or Incident Vertebral Fracture. J Bone Miner Res 2018; 33:1233-1241. [PMID: 29572955 DOI: 10.1002/jbmr.3429] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/08/2018] [Accepted: 03/16/2018] [Indexed: 01/08/2023]
Abstract
Subjects with chronic obstructive pulmonary disease (COPD) have an increased risk of vertebral fractures (VFs); however, VF incidence is largely unknown. Therefore, the aim of our study was to determine the incidence of new and/or worsening VF in subjects with COPD. Smokers and subjects with COPD (GOLD II-IV) from the ECLIPSE study with complete set of chest CT scans (baseline and 1- and 3-year follow-up) to evaluate vertebrae T1 down to L1 were included. If a VF was diagnosed on the last scan, detailed VF assessment of the previous scans was performed. VFs were scored according to the method of Genant as mild, moderate, or severe. Main outcome measure was the cumulative incidence of new and/or worsening VF at subject level, within 1 and 3 years. Of 1239 subjects (mean age 61 years, 757 males [61%], 999 subjects with COPD), 253 (20.5%) had ≥1 prevalent VF. The cumulative incidence of VFs was 10.1% within 1 year and 24.0% within 3 years. After adjustment for age, sex, body mass index (BMI), pack-years, and smoking status, prevalence and incidence were similar between smokers and COPD GOLD stages. Within 1 year, 29.2% of the subjects with a prevalent VF had an incident VF, compared with 5.1% in absence of prevalent VF (hazard ratio [HR] = 5.1; 95% confidence interval [CI] 3.6-7.4) and 58.5% versus 15.0% within 3 years (HR = 3.6; 95% CI 2.9-4.6). The incidence of VF was higher with increasing number and severity of prevalent VFs. Among subjects having an incident VF within the first year, 57.3% had a subsequent VF within the next 2 years. In this study, more than half of the smokers and subjects with COPD with a prevalent VF or an incident VF within the first year sustained a subsequent VF within 3 years. The 3-year risk was even higher in the presence of multiple or severe prevalent VFs. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
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Affiliation(s)
- Mayke J van Dort
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Piet Geusens
- Department of Internal Medicine/Rheumatology, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Johanna Hm Driessen
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Elisabeth Apm Romme
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | - Frank Wjm Smeenk
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | - Emiel Fm Wouters
- Department of Respiratory Diseases, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Joop Pw van den Bergh
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.,Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands
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45
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Wu CH, Kao IJ, Hung WC, Lin SC, Liu HC, Hsieh MH, Bagga S, Achra M, Cheng TT, Yang RS. Economic impact and cost-effectiveness of fracture liaison services: a systematic review of the literature. Osteoporos Int 2018; 29:1227-1242. [PMID: 29460102 DOI: 10.1007/s00198-018-4411-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/24/2018] [Indexed: 01/08/2023]
Abstract
Fracture liaison services (FLS), implemented in different ways and countries, are reported to be a cost-effective or even a cost-saving secondary fracture prevention strategy. This presumed favorable cost-benefit relationship is encouraging and lends support to expanded implementation of FLS per International Osteoporosis Foundation Best Practice Standards. This study summarizes the economic impact and cost-effectiveness of FLS implemented to reduce subsequent fractures in individuals with osteoporosis. This systematic review identified studies reporting economic outcomes for FLS in osteoporotic patients aged 50 and older through a comprehensive search of MEDLINE, EMBASE, Cochrane Central, and PubMed of studies published January, 2000 to December, 2016. Grey literature (e.g., Google scholar, conference abstracts/posters) were also hand searched through February 2017. Two independent reviewers screened titles and abstracts and conducted full-text review on qualified articles. All disagreements were resolved by discussion between reviewers to reach consensus or by a third reviewer. In total, 23 qualified studies that evaluated the economic aspects of FLS were included: 16 cost-effectiveness studies, 2 cost-benefit analyses, and 5 studies of cost savings. Patient populations varied (prior fragility fracture, non-vertebral fracture, hip fracture, wrist fracture), and FLS strategies ranged from mail-based interventions to comprehensive nurse/physician-coordinated programs. Cost-effectiveness studies were conducted in Canada, Australia, USA, UK, Japan, Taiwan, and Sweden. FLS was cost-effective in comparisons with usual care or no treatment, regardless of the program intensity or the country in which the FLS was implemented (cost/QALY from $3023-$28,800 US dollars (USD) in Japan to $14,513-$112,877 USD in USA. Several studies documented cost savings. FLS, implemented in different ways and countries, are reported to be cost-effective or even cost-saving. This presumed favorable cost-benefit relationship is encouraging and lends support to expanded implementation of FLS per International Osteoporosis Foundation Best Practice Standards.
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Affiliation(s)
- C-H Wu
- Department of Family Medicine, National Cheng Kung University College of Medicine and Hospital, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - I-J Kao
- Orthopedic Department, Taitung Christian Hospital, No. 350, Kaifeng Street, Taitung City, Taitung County, 950, Taiwan
| | - W-C Hung
- E-Da Hospital/I-Shou University, No.1, Yida Road, Yanchao District, Kaohsiung City, 824, Taiwan
| | - S-C Lin
- Orthopedic Department, Chung Shan Medical University, No.110, Section1, Jianguo North Road, Taichung City, Taiwan
| | - H-C Liu
- Orthopedic Department, Taitung Christian Hospital, No. 350, Kaifeng Street, Taitung City, Taitung County, 950, Taiwan
| | - M-H Hsieh
- Department of Orthopedics, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, No.2, Min-Sheng Road, Dalin Town, Chia-Yi, Taiwan
| | - S Bagga
- Complete HEOR Solutions LLC, 1046 Knapp Road, North Wales, PA, 19454, USA
| | - M Achra
- Complete HEOR Solutions LLC, 1046 Knapp Road, North Wales, PA, 19454, USA
| | - T-T Cheng
- Chang Gung Memorial Hospital, No.123 Tapei Road, Niao-Sung District, Kaohsiung, Taiwan
| | - R-S Yang
- Department of Orthopaedics, National Taiwan University and Hospital, No. 7, Chung-Shan S. Road, Taipei, Taiwan.
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46
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Szulc P. Vertebral Fracture: Diagnostic Difficulties of a Major Medical Problem. J Bone Miner Res 2018; 33:553-559. [PMID: 29419882 DOI: 10.1002/jbmr.3404] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
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47
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Schmidt T, Ebert K, Rolvien T, Oehler N, Lohmann J, Papavero L, Kothe R, Amling M, Barvencik F, Mussawy H. A retrospective analysis of bone mineral status in patients requiring spinal surgery. BMC Musculoskelet Disord 2018; 19:53. [PMID: 29439698 PMCID: PMC5811985 DOI: 10.1186/s12891-018-1970-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/08/2018] [Indexed: 11/30/2022] Open
Abstract
Background Impaired bone quality is associated with poor outcome of spinal surgery. The aim of the study was to assess the bone mineral status of patients scheduled to undergo spinal surgery and to report frequencies of bone mineral disorders. Methods We retrospectively analyzed the bone mineral status of 144 patients requiring spinal surgery including bone mineral density by dual-energy X-ray absorptiometry (DXA) as well as laboratory data with serum levels of 25-hydroxyvitamin D (25-OH-D), parathyroid hormone, calcium, bone specific alkaline phosphate, osteocalcin, and gastrin. High-resolution peripheral quantitative computed tomography (HR-pQCT) was additionally performed in a subgroup of 67 patients with T-Score below − 1.5 or history of vertebral fracture. Results Among 144 patients, 126 patients (87.5%) were older than 60 years. Mean age was 70.1 years. 42 patients (29.1%) had suffered from a vertebral compression fracture. 12 previously undiagnosed vertebral deformities were detected in 12 patients by vertebral fracture assessment (VFA). Osteoporosis was present in 39 patients (27.1%) and osteopenia in 63 patients (43.8%). Only 16 patients (11.1%) had received anti-osteoporotic therapy, while 54 patients (37.5%) had an indication for specific anti-osteoporotic therapy but had not received it yet. The majority of patients had inadequate vitamin D status (73.6%) and 34.7% of patients showed secondary hyperparathyroidism as a sign for a significant disturbed calcium homeostasis. In a subgroup of 67 patients, severe vertebral deformities were associated with stronger deficits in bone microarchitecture at the distal radius compared to the distal tibia. Conclusions This study shows that bone metabolism disorders are highly prevalent in elderly patients scheduled for spinal surgery. Vertebral deformities are associated with a predominant deterioration of bone microstructure at the distal radius. As impaired bone quality can compromise surgical outcome, we strongly recommend an evaluation of bone mineral status prior to operation and anti-osteoporotic therapy if necessary.
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Affiliation(s)
- Tobias Schmidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany. .,Department of Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Katharina Ebert
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany
| | - Tim Rolvien
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany.,Department of Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Nicola Oehler
- Department of Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jens Lohmann
- Clinic for Spinal Surgery, Schoen Klinik Eilbek, Denhaide 120, 22081, Hamburg, Germany
| | - Luca Papavero
- Clinic for Spinal Surgery, Schoen Klinik Eilbek, Denhaide 120, 22081, Hamburg, Germany
| | - Ralph Kothe
- Clinic for Spinal Surgery, Schoen Klinik Eilbek, Denhaide 120, 22081, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany
| | - Florian Barvencik
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany
| | - Haider Mussawy
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany.,Department of Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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48
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Johansson L, Sundh D, Nilsson M, Mellström D, Lorentzon M. Vertebral fractures and their association with health-related quality of life, back pain and physical function in older women. Osteoporos Int 2018; 29:89-99. [PMID: 29143131 PMCID: PMC5758688 DOI: 10.1007/s00198-017-4296-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022]
Abstract
Studies investigating prevalent vertebral fracture (VF) diagnosed using densitometry-based VF assessment (VFA) and associations with physical function, assessed by performance-based measures, are lacking. In this population-based study of 1027 older women, we found that prevalent VF, identified by VFA, was associated with inferior physical health, back pain and inferior physical function. PURPOSE Several studies have investigated the associations between health-related quality of life (HRQL) and back pain with prevalent VF, detected by spine radiographs, but just a few have been population-based and have used vertebral fracture assessment (VFA) for diagnosing VF. The aims of this study were to investigate associations between prevalent VF, detected by VFA, with HRQL, back pain and physical function, and investigate if also mild VFs were associated with these clinical parameters. METHODS One thousand twenty-seven women aged 75-80 years participated in this population-based cross-sectional study. VF was identified by VFA using dual-energy X-ray absorptiometry. HRQL was assessed by SF-12, back pain during the past 12 months using a questionnaire, and physical function was tested with one leg standing (OLS), Timed Up and Go (TUG), walking speed, 30-s chair stand test and maximum grip strength. RESULTS Physical health (Physical Component Summary, PCS), derived from SF-12, was worse (43.5 ± 11.3 vs. 46.2 ± 10.5, p < 0.001) and back pain more frequent in women with any VF than in women without (69.0 vs. 59.9%, p = 0.008). PCS and physical function (OLS, 30-s chair stand test), were significantly worse for mild VF compared to no VF (43.8 ± 10.9 vs. 46.2 ± 10.5, p < 0.001, 12.7 ± 9.9 vs. 15.3 ± 10.4 s, p = 0.038, 10.7 ± 3.2 vs. 11.4 ± 3.4 times, p = 0.021, respectively). In multivariable adjusted linear regression models, VF prevalence was associated with PCS (β = - 0.079, p = 0.007), TUG (β = 0.067, p = 0.021), walking speed (β = - 0.071, p = 0.009) and 30-s chair stand test (β = - 0.075, p = 0.012). CONCLUSIONS In conclusion, prevalent VF, diagnosed by VFA, was associated with inferior physical health, back pain and inferior physical function, indicating VFA is useful for diagnosing clinically relevant vertebral fractures. Also, mild VF was associated with inferior physical health and inferior physical function.
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Affiliation(s)
- Lisa Johansson
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Daniel Sundh
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Martin Nilsson
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Health and Medical Care, City District Administration of Örgryte-Härlanda, City of Gothenburg, Sweden
| | - Dan Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Institute of Medicine, The Sahlgrenska Academy, Building K, 6th Floor, Sahlgrenska University Hospital, Mölndal, 431 80, Mölndal, Sweden
| | - Mattias Lorentzon
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
- Geriatric Medicine, Institute of Medicine, The Sahlgrenska Academy, Building K, 6th Floor, Sahlgrenska University Hospital, Mölndal, 431 80, Mölndal, Sweden.
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49
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Lee JE, Kim KM, Kim LK, Kim KY, Oh TJ, Moon JH, Choi SH, Lim S, Kim SW, Shin CS, Jang HC. Comparisons of TBS and lumbar spine BMD in the associations with vertebral fractures according to the T-scores: A cross-sectional observation. Bone 2017; 105:269-275. [PMID: 28963079 DOI: 10.1016/j.bone.2017.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/29/2017] [Accepted: 09/26/2017] [Indexed: 01/09/2023]
Abstract
Trabecular bone score (TBS) is a parameter of bone quality that has been shown to be related to vertebral fractures. This study aimed to analyze the difference in discriminatory power of TBS for vertebral fractures according to the bone mineral density (BMD) T-score. Areal BMD at the lumbar spine (LS, L1-L4), femur neck (FN) and total hip were assessed using dual x-ray absorptiometry (Discovery W, Hologic, Bedford, MA) in 929 women aged 50years or older. TBS was analyzed using iNsight software (Med-Imaps, Pessac, France). Vertebral fractures were identified on lateral X-ray films of the thoracic and lumbar spine using a semi-quantitative method. The study subjects consisted of 158 subjects (17.0%) with normal BMD, 461 (49.6%) with osteopenia and 310 (33.4%) with osteoporosis. The incident vertebral fractures were observed in 92 (9.9%) subjects, including 59 fractures in osteoporosis, 29 fractures in osteopenia, and only 4 fractures in normal BMD. We stratified study subjects into two groups according to their BMD T-scores, osteoporosis or osteopenia/normal BMD. The logistic regression model showed that LS BMD values per each 1 standard deviation (SD) decrease were significantly associated with increased risk of vertebral fracture in both osteoporosis and osteopenia/normal BMD group with stronger association in osteoporosis group. However, a TBS value that was lower by 1SD was significantly associated with vertebral fracture risk only in the osteopenia/normal BMD group. The TBS use in addition to FN BMD and age also showed significantly better discriminatory power for vertebral fracture only in the osteopenia/normal BMD group, but not osteoporosis group. In conclusion, TBS is significantly associated with vertebral fractures in subjects with osteopenia/normal BMD levels. Additional assessment of bone microarchitecture using TBS is better able to identify women at risk of fracture, in particular, those with relatively higher BMD.
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Affiliation(s)
- Jie-Eun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea.
| | - Lee-Kyung Kim
- Department of Internal Medicine, Halla General Hospital, Jeju, Republic of Korea
| | - Kyong Young Kim
- Department of Internal medicine, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Borame Hospital and Seoul National University College of Medicine, Republic of Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
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50
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Malgo F, Hamdy NAT, Ticheler CHJM, Smit F, Kroon HM, Rabelink TJ, Dekkers OM, Appelman-Dijkstra NM. Value and potential limitations of vertebral fracture assessment (VFA) compared to conventional spine radiography: experience from a fracture liaison service (FLS) and a meta-analysis. Osteoporos Int 2017; 28:2955-2965. [PMID: 28842721 PMCID: PMC5624976 DOI: 10.1007/s00198-017-4137-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 06/21/2017] [Indexed: 01/07/2023]
Abstract
UNLABELLED We evaluated the value of VFA in the identification of vertebral fractures using a retrospective study and a meta-analysis. Performance of VFA was adequate in the meta-analysis although this was not demonstrated in our centre. We recommend checking the performance of VFA tools before exclusively relying on this tool. INTRODUCTION Vertebral fractures are traditionally diagnosed using conventional radiographs of the spine. Vertebral fracture assessment (VFA) has been advocated as an alternative tool in the diagnosis of these fractures. METHODS We conducted a retrospective study as well as a systematic review and a meta-analysis to evaluate the performance of VFA compared to conventional spinal radiography in patients who had sustained a fracture and thus at risk for osteoporosis. A risk of bias analysis was also performed. RESULTS The diagnostic study included 542 patients (25% male) with fractures. The sensitivity of low-radiation VFA to detect a patient with a vertebral fracture ≥ Genant grade 2 was 0.77 and its specificity 0.80. Two hundred ninety-seven (55%) patients had ≥1 and 135(25%) ≥3 unevaluable vertebrae. The systematic review identified 16 studies including a total of 3238 subjects (19% male) with a mean age range of 45 to 74 years. Seven studies had a low risk of bias and 9 had an intermediate risk, mainly due to not consecutively including patients. The pooled sensitivity of VFA to detect a patient with a vertebral fracture ≥Genant grade 2 was 0.84 (95% CI, 0.72-0.92) and specificity 0.90 (95% CI, 0.84-0.94). CONCLUSIONS Our findings from the meta-analysis suggest an adequate performance of VFA for the detection of vertebral fractures. However, we could not demonstrate these findings in our center, especially the specificity. Our data advocate caution with exclusively relying on VFA in the assessment of vertebral fractures without identifying performance and potential limitations of the technique.
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Affiliation(s)
- F Malgo
- Department of Medicine, Division Endocrinology and Center for Bone Quality, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - N A T Hamdy
- Department of Medicine, Division Endocrinology and Center for Bone Quality, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - C H J M Ticheler
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - F Smit
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - H M Kroon
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - T J Rabelink
- Department of Medicine, Division Endocrinology and Center for Bone Quality, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - O M Dekkers
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - N M Appelman-Dijkstra
- Department of Medicine, Division Endocrinology and Center for Bone Quality, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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