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Chattaris T, Yang L, Johansson H, Sahni S, Samelson EJ, Kiel DP, Berry SD. Performance of FRAX in older adults with frailty: the Framingham Heart Study. Osteoporos Int 2024; 35:265-275. [PMID: 37872347 PMCID: PMC10872348 DOI: 10.1007/s00198-023-06950-0] [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: 02/15/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
We compared the performance of FRAX according to frailty status in 3554 individuals from the Framingham Study. During 10-year follow-up, 6.9% and 3.0% of participants with and without frailty experienced MOF. Discrimination profiles were lower in participants with frailty compared to those without, but they improved when FRAX included BMD. INTRODUCTION Frailty increases fracture risk. FRAX was developed to predict fractures but never validated in individuals with frailty. We aimed to compare the predictive performance of FRAX (v4.3) in individuals with and without frailty. METHODS We conducted a cohort study using the Framingham Heart Study. Frailty was defined by the Fried phenotype. Major osteoporotic fractures (MOF) were ascertained from medical records during 10-year follow-up. To evaluate discrimination and calibration of FRAX, we calculated the area-under-the-receiver-operating characteristics curves (AUC) using logistic regression models and observed-to-predicted fracture probabilities. Analyses were stratified by frailty status. RESULTS Frailty was present in 550/3554 (15.5%) of participants. Participants with frailty were older (81.1 vs. 67.6 years), female (68.6% vs. 55.1%), and had greater mean FRAX scores (MOF: 15.9% vs. 10.1%) than participants without frailty. During follow-up, 38 participants with frailty (6.9%) and 91 without (3.0%) had MOFs. The AUC for FRAX (without BMD) was lower in participants with frailty (0.584; 95% CI 0.504-0.663) compared to those without (0.695; 95% CI 0.649-0.741); p value = 0.02. Among participants with frailty, the AUC improved when FRAX included BMD (AUC 0.658, p value < 0.01). FRAX overestimated MOF risk, with larger overestimations in individuals without frailty. Performance of FRAX for hip fracture was similar. CONCLUSION FRAX may have been less able to identify frail individuals at risk for fracture, as compared with individuals without frailty, unless information on BMD is available. This suggests that BMD captures features important for fracture prediction in frail persons. Future fracture prediction models should be developed among persons with frailty.
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Affiliation(s)
- Tanchanok Chattaris
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Nakhon Pathom, Thailand
- Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, 1200 Centre Street, Boston, MA, 02131, USA
| | - Laiji Yang
- Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, 1200 Centre Street, Boston, MA, 02131, USA
| | | | - Shivani Sahni
- Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, 1200 Centre Street, Boston, MA, 02131, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elizabeth J Samelson
- Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, 1200 Centre Street, Boston, MA, 02131, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, 1200 Centre Street, Boston, MA, 02131, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sarah D Berry
- Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, 1200 Centre Street, Boston, MA, 02131, USA.
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Chanidkul P, Sribenjalak D, Charoenngam N, Pongchaiyakul C. The proportion of Thai postmenopausal women who would be eligible for anti-osteoporosis therapy. PLoS One 2023; 18:e0279829. [PMID: 36735672 PMCID: PMC9897565 DOI: 10.1371/journal.pone.0279829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 12/05/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To determine the proportion of postmenopausal Thai women who would be classified as having high risk of fracture and eligible for anti-osteoporosis therapy according to the National Osteoporosis Foundation (NOF) criteria. METHODS Postmenopausal Thai women aged 40-90 years who had been screened for osteoporosis during 2014-2019 were recruited. Demographic data and osteoporosis risk factors were collected based on the Fracture Risk Assessment Tool (FRAX) questionnaire. Bone mineral density (BMD) at the femoral neck and lumbar spine measured using dual energy X-ray absorptiometry. Ten-year probabilities of hip and major osteoporotic fracture (MOF) were calculated based on the Thai FRAX model with BMD. The study's protocol was approved by the Institutional Ethical Committee (HE581241). RESULTS A total of 3,280 postmenopausal women were included. The mean ± SD age was 63.6 ± 10.1 years. A total of 170 (5.2%) participants had a history of hip and/or vertebral fracture. After excluding these participants with fracture history, 699 (21.3%) had osteoporosis, 355 (10.8%) had osteopenia with high risk of fracture (FRAX 10-year probability of hip fracture ≥ 3% and/or MOF ≥ 20%), 1192 (36.3%) had osteopenia with low risk of fracture (FRAX 10-year probability of hip fracture < 3% and MOF < 20%) and 864 (26.3%) had normal BMD. Taken together, a total of 1,224 (37.3%) participants would be eligible for anti-osteoporosis therapy (prior fracture, osteoporosis or osteopenia with high risk of fracture). CONCLUSION The prevalence of Thai postmenopausal women who would be eligible for anti-osteoporosis therapy was 37.3%.
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Affiliation(s)
- Piyachat Chanidkul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Dueanchonnee Sribenjalak
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nipith Charoenngam
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, United States of America
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- * E-mail:
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Battalora L, Armon C, Palella F, Li J, Overton ET, Hammer J, Fuhrer J, Novak RM, Carlson K, Spear JR, Buchacz K. Incident bone fracture and mortality in a large HIV cohort outpatient study, 2000-2017, USA. Arch Osteoporos 2021; 16:117. [PMID: 34337687 DOI: 10.1007/s11657-021-00949-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/03/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We evaluated the association of bone fracture with mortality among persons with HIV, controlling for sociodemographic, behavioral, and clinical factors. Incident fracture was associated with 48% greater risk of all-cause mortality, underscoring the need for bone mineral density screening and fracture prevention. PURPOSE/INTRODUCTION Low bone mineral density (BMD) and fracture are more common among persons with HIV (PWH) than those without HIV infection. We evaluated the association of bone fracture with mortality among PWH, controlling for sociodemographic, behavioral, and clinical factors. METHODS We analyzed data from HIV Outpatient Study (HOPS) participants seen at nine US HIV clinics during January 1, 2000, through September 30, 2017. Incident fracture rates and post-fracture mortality were compared across four calendar periods. Cox proportional hazards analyses determined factors associated with all-cause mortality among all participants and those with incident fracture. RESULTS Among 6763 HOPS participants, 504 (7.5%) had incident fracture (median age = 47 years) and 719 (10.6%) died. Of fractures, 135 (26.8%) were major osteoporotic (hip/pelvis, wrist, spine, arm/shoulder). During observation, 27 participants with major osteoporotic fractures died (crude mortality 2.97/100 person-years [PY]), and 48 with other site fractures died (crude mortality 2.51/100 PY). Post-fracture, age- and sex-adjusted all-cause mortality rates per 100 PY decreased from 8.5 during 2000-2004 to 1.9 during 2013-2017 (P<0.001 for trend). In multivariable analysis, incident fracture was significantly associated with all-cause mortality (Hazard Ratio 1.48, 95% confidence interval 1.15-1.91). Among 504 participants followed post-fracture, pulmonary, kidney, and cardiovascular disease, hepatitis C virus co-infection, and non-AIDS cancer, remained independently associated with all-cause mortality. CONCLUSIONS Incident fracture was associated with 48% greater risk of all-cause mortality among US PWH in care, underscoring the need for BMD screening and fracture prevention. Although fracture rates among PWH increased during follow-up, post-fracture death rates decreased, likely reflecting advances in HIV care.
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Affiliation(s)
- Linda Battalora
- Colorado School of Mines, 1301 19th St., Golden, CO, 80401, USA. .,Cerner Corporation, Kansas City, MO, USA.
| | - Carl Armon
- Cerner Corporation, Kansas City, MO, USA
| | - Frank Palella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Edgar T Overton
- University of Alabama School of Medicine, Birmingham, AL, USA
| | | | - Jack Fuhrer
- Stony Brook School of Medicine, Stony Brook, NY, USA
| | - Richard M Novak
- University of Illinois College of Medicine, Chicago, IL, USA
| | | | - John R Spear
- Colorado School of Mines, 1301 19th St., Golden, CO, 80401, USA
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Zhou S, Huang G, Chen G. Synthesis and biological activities of drugs for the treatment of osteoporosis. Eur J Med Chem 2020; 197:112313. [PMID: 32335412 DOI: 10.1016/j.ejmech.2020.112313] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022]
Abstract
Osteoporosis is an asymptomatic progressive disease. With the improvement of people's living standard and the aging of population, osteoporosis and its fracture have become one of the main diseases threatening the aging society. The serious medical and social burden caused by this has aroused wide public concern. Osteoporosis is listed as one of the three major diseases of the elderly. At present, the drugs for osteoporosis include bone resorption inhibitors and bone formation promoters. The purpose of these anti-osteoporosis drugs is to balance osteoblast bone formation and osteoclast bone resorption. With the development of anti-osteoporosis drugs, new anti osteoporosis drugs have been designed and synthesized. There are many kinds of new compounds with anti osteoporosis activity, but most of them are concentrated on the original drugs with anti osteoporosis activity, or the natural products with anti-osteoporosis activity are extracted from the natural products for structural modification to obtain the corresponding derivatives or analogues. These target compounds showed good ALP activity in vitro and in vivo, promoted osteoblast differentiation and mineralization, or had anti TRAP activity, inhibited osteoclast absorption. This work attempts to systematically review the studies on the synthesis and bioactivity of anti-osteoporosis drugs in the past 10 years. The structure-activity relationship was discussed, which provided a reasonable idea for the design and development of new anti-osteoporosis drugs.
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Affiliation(s)
- Shiyang Zhou
- Key Laboratory of Tropical Medicinal Resource Chemistry of Ministry of Education, College of Chemistry and Chemical Engineering, Hainan Normal University, Haikou, 571158, China
| | - Gangliang Huang
- Active Carbohydrate Research Institute, Chongqing Key Laboratory of Green Synthesis and Application, College of Chemistry, Chongqing Normal University, Chongqing, 401331, China.
| | - Guangying Chen
- Key Laboratory of Tropical Medicinal Resource Chemistry of Ministry of Education, College of Chemistry and Chemical Engineering, Hainan Normal University, Haikou, 571158, China.
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Leslie WD, Morin SN, Lix LM, Binkley N. Comparison of treatment strategies and thresholds for optimizing fracture prevention in Canada: a simulation analysis. Arch Osteoporos 2019; 15:4. [PMID: 31858278 DOI: 10.1007/s11657-019-0660-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/02/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED This comparison of osteoporosis treatment strategies and intervention thresholds highlights tradeoffs in terms of number of individuals qualifying for treatment and estimated fractures prevented. PURPOSE The current analysis was performed to inform the following key question as part of the Osteoporosis Canada's Osteoporosis Guidelines Update: "What is the best strategy to identify those at high fracture risk for pharmacotherapy in order to prevent the most fractures, considering both population and patient perspectives?" METHODS The study population consisted of 66,878 women age 50 years and older (mean age 66.0 ± 9.7 years) with documented fracture probability assessment (FRAX) and fracture outcomes. Fractures over the next 5 years were identified through linked administrative healthcare data. We estimated the fraction of the population that would warrant treatment and the number of fractures avoided per 1000 person-years according to multiple strategies and thresholds. Strategies were then rank ordered using 19 metrics. RESULTS During mean 4.4 years, 863 (3.5%) sustained one or more major osteoporotic fractures (MOF), 212 (0.8%) sustained a hip fracture, and 1210 (4.9%) sustained any incident fracture. For woman age 50-64 years, the highest ranked strategy was treatment based upon total hip T score ≤ -2.5, but several other strategies fell within 0.5 overall ranking. For women age 65 years and older, MOF > 20% was the highest ranked strategy with no closely ranked strategies. Pooling both age subgroups gave MOF > 20% as the highest ranked strategy, with several other strategies within 0.5 overall ranking. CONCLUSIONS Choice of treatment strategy and threshold for osteoporosis management strongly influences the number of individuals for whom pharmacologic treatment would be recommended and on estimated fracture rates in the population. This evidence-based approach to comparing these strategies will help to inform guidelines development in Canada and may be on interest elsewhere.
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Affiliation(s)
- William D Leslie
- Department of Medicine, University of Manitoba, C5121-409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada.
| | | | - Lisa M Lix
- Department of Medicine, University of Manitoba, C5121-409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada
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Lorentzon M, Nilsson AG, Johansson H, Kanis JA, Mellström D, Sundh D. Extensive undertreatment of osteoporosis in older Swedish women. Osteoporos Int 2019; 30:1297-1305. [PMID: 30805678 PMCID: PMC6546648 DOI: 10.1007/s00198-019-04872-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/21/2019] [Indexed: 11/27/2022]
Abstract
In a population-based study of older Swedish women, we investigated the proportion of women treated with osteoporosis medication in relation to the proportion of women eligible for treatment according to national guidelines. We found that only a minority (22%) of those eligible for treatment were prescribed osteoporosis medication. INTRODUCTION Fracture rates increase markedly in old age and the incidence of hip fracture in Swedish women is among the highest in the world. Although effective pharmacological treatment is available, treatment rates remain low. Limited data are available regarding treatment rates in relation to fracture risk in a population-based setting in older women. Therefore, we aimed to investigate the proportion of older women eligible for treatment according to Swedish Osteoporosis Society (SvOS) guidelines. METHODS A population-based study was performed in Gothenburg in 3028 older women (77.8 ± 1.6 years [mean ± SD]). Bone mineral density of the spine and hip was measured with dual-energy X-ray absorptiometry. Clinical risk factors for fracture and data regarding osteoporosis medication was collected with self-administered questionnaires. Logistic regression was used to evaluate whether the 10-year probability of sustaining a major osteoporotic fracture (FRAX-score) or its components predicted treatment with osteoporosis medication. RESULTS For the 2983 women with complete data, 1107 (37%) women were eligible for treatment using SvOS criteria. The proportion of these women receiving treatment was 21.8%. For women eligible for treatment according to SvOS guidelines, strong predictors for receiving osteoporosis medication were glucocorticoid treatment (odds ratio (95% CI) 2.88 (1.80-4.59)) and prior fracture (2.58 (1.84-3.61)). CONCLUSION This study demonstrates that a substantial proportion of older Swedish women should be considered for osteoporosis medication given their high fracture risk, but that only a minority receives treatment.
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Affiliation(s)
- M Lorentzon
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - A G Nilsson
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - H Johansson
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
| | - J A Kanis
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - D Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - D Sundh
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
- Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
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Elde KD, Madsen OR. FRAX 10-yr Fracture Risk in Rheumatoid Arthritis-Assessments With and Without Bone Mineral Density May Lead to Very Different Results in the Individual Patient. J Clin Densitom 2019; 22:31-38. [PMID: 30497868 DOI: 10.1016/j.jocd.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES FRAX is a computer-based algorithm developed by the World Health Organisation for estimation of the 10-yr risk of a hip or major osteoporotic fracture. Inclusion of femoral neck bone mineral density (BMD) in the estimation is optional. The study aimed to investigate the intra-individual agreement between FRAX fracture risk calculated with and without BMD in patients with rheumatoid arthritis (RA). METHODS Clinical data and BMD results from 50 RA patients registered in the Danish rheumatology registry (DANBIO) were used for analysis. Using the Bland-Altman method, lower and upper 95% limits of agreement [LLoA;ULoA] between intraindividual assessments of fracture risk with and without BMD and the bias (mean of individual differences) were calculated. Categorization of patients according to the National Osteoporosis foundation (NOF) treatment thresholds were also assessed with and without BMD. RESULTS Mean age was 63.6 ± 11.7 yr, mean disease activity score (DAS28-CRP) 3.3 ± 3.5 and mean femoral neck T-score -1.43 ± 1.15. The mean 10-yr risk of a major fracture and a hip fracture calculated with BMD was 22.9 ± 15.8% and 8.5 ± 10.8%, respectively. The LLoA and ULoA [bias] calculated without vs with BMD were -14.5 and 20.4 percent point (pp) [2.9 pp] for major fracture risk and -14.0 and 23.2 pp [4.6 pp] for hip fracture. NOF treatment categorization was only dependent on BMD in 4% of the patients. CONCLUSION The FRAX fracture risk estimated with and without BMD may disagree substantially in individual patients with RA but this seems to have only little impact on treatment categorization based on the NOF guidelines.
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Affiliation(s)
- Karen Dombestein Elde
- Osteoporosis Clinic and Center for Rheumatology and Spine Diseases and the DANBIO Registry, Copenhagen University Hospital Gentofte and Rigshospitalet, Denmark.
| | - Ole Rintek Madsen
- Osteoporosis Clinic and Center for Rheumatology and Spine Diseases and the DANBIO Registry, Copenhagen University Hospital Gentofte and Rigshospitalet, Denmark
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Klement MR, Nickel BT, Bala A, Penrose CT, Zura RD, Garrigues GE. Glenohumeral arthritis as a risk factor for proximal humerus nonunion. Injury 2016; 47 Suppl 7:S36-S39. [PMID: 28040076 DOI: 10.1016/s0020-1383(16)30852-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Proximal humerus fractures are common injuries and nonsurgical treatment has proven to yield good to excellent clinical results. A small percentage of these fractures go on to delayed or nonunion and the incidence and risk factors for this complication are poorly understood. We hypothesize that adjacent joint stiffness of the glenohumeral joint might lead to an increased rate of nonunion for proximal humerus fractures. METHODS A search of the entire Medicare database from 2005 to 2011 was performed to identify 38,754 patients who sustained a proximal humerus fracture including 13,802 with co-existing ipsilateral shoulder osteoarthritis (OA) and 24,952 with co-existing diagnosis of rheumatoid arthritis (RA). A cohort of 301,987 patients served as a control. Medical co-morbidities and fracture complications were compared between the cohorts. RESULTS The incidence of delayed union at 3 and 6 months for OA and RA groups were significantly increased compared to control at 0.79% and 1.74%, and 0.67% and 1.86%, respectively (p < 0.001). Nonunion rates were also significantly increased (p < 0.001) in the OA and RA cohorts at 9 months and 1 year with incidences of 2.39%, 2.89% and 2.59% and 3.08%, Respectively. The incidence of nonunion in the control cohort at the same time points was 1.13% and 1.35%. CONCLUSIONS The coexistence of shoulder OA or a diagnosis of RA nearly doubled in the incidence of proximal humerus nonunion. This is the first study investigating this association in the shoulder and should be considered along with traditional nonunion risk factors in the treatment algorithm.
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Affiliation(s)
- Mitchell R Klement
- Department of Orthopedics, Duke University Medical Center, Durham, NC 27710, United States.
| | - Brian T Nickel
- Department of Orthopedics, Duke University Medical Center, Durham, NC 27710, United States
| | - Abiram Bala
- Department of Orthopedics, Duke University Medical Center, Durham, NC 27710, United States
| | - Colin T Penrose
- Department of Orthopedics, Duke University Medical Center, Durham, NC 27710, United States
| | - Robert D Zura
- Department of Orthopedics, Duke University Medical Center, Durham, NC 27710, United States
| | - Grant E Garrigues
- Department of Orthopedics, Duke University Medical Center, Durham, NC 27710, United States
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Kanis JA, Harvey NC, Cooper C, Johansson H, Odén A, McCloskey EV. A systematic review of intervention thresholds based on FRAX : A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. Arch Osteoporos 2016; 11:25. [PMID: 27465509 PMCID: PMC4978487 DOI: 10.1007/s11657-016-0278-z] [Citation(s) in RCA: 269] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/16/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED This systematic review identified assessment guidelines for osteoporosis that incorporate FRAX. The rationale for intervention thresholds is given in a minority of papers. Intervention thresholds (fixed or age-dependent) need to be country-specific. INTRODUCTION In most assessment guidelines, treatment for osteoporosis is recommended in individuals with prior fragility fractures, especially fractures at spine and hip. However, for those without prior fractures, the intervention thresholds can be derived using different methods. The aim of this report was to undertake a systematic review of the available information on the use of FRAX® in assessment guidelines, in particular the setting of thresholds and their validation. METHODS We identified 120 guidelines or academic papers that incorporated FRAX of which 38 provided no clear statement on how the fracture probabilities derived are to be used in decision-making in clinical practice. The remainder recommended a fixed intervention threshold (n = 58), most commonly as a component of more complex guidance (e.g. bone mineral density (BMD) thresholds) or an age-dependent threshold (n = 22). Two guidelines have adopted both age-dependent and fixed thresholds. RESULTS Fixed probability thresholds have ranged from 4 to 20 % for a major fracture and 1.3-5 % for hip fracture. More than one half (39) of the 58 publications identified utilised a threshold probability of 20 % for a major osteoporotic fracture, many of which also mention a hip fracture probability of 3 % as an alternative intervention threshold. In nearly all instances, no rationale is provided other than that this was the threshold used by the National Osteoporosis Foundation of the USA. Where undertaken, fixed probability thresholds have been determined from tests of discrimination (Hong Kong), health economic assessment (USA, Switzerland), to match the prevalence of osteoporosis (China) or to align with pre-existing guidelines or reimbursement criteria (Japan, Poland). Age-dependent intervention thresholds, first developed by the National Osteoporosis Guideline Group (NOGG), are based on the rationale that if a woman with a prior fragility fracture is eligible for treatment, then, at any given age, a man or woman with the same fracture probability but in the absence of a previous fracture (i.e. at the 'fracture threshold') should also be eligible. Under current NOGG guidelines, based on age-dependent probability thresholds, inequalities in access to therapy arise especially at older ages (≥70 years) depending on the presence or absence of a prior fracture. An alternative threshold using a hybrid model reduces this disparity. CONCLUSION The use of FRAX (fixed or age-dependent thresholds) as the gateway to assessment identifies individuals at high risk more effectively than the use of BMD. However, the setting of intervention thresholds needs to be country-specific.
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Affiliation(s)
- John A Kanis
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
- Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia.
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Helena Johansson
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Anders Odén
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Eugene V McCloskey
- Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
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Association between HIV infection and bone mineral density in climacteric women. Arch Osteoporos 2015; 10:33. [PMID: 26420601 DOI: 10.1007/s11657-015-0238-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 09/17/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED A cross-sectional study was conducted with the purpose of evaluating bone mineral density in HIV seropositive and seronegative climacteric women. HIV infection was negatively associated with bone mineral density in the lumbar spine PURPOSE To assess bone mineral density (BMD) and its associated factors in HIV seropositive and seronegative climacteric women METHODS A cross-sectional study with 537 women (273 HIV seropositive and 264 HIV seronegative) aged between 40 and 60 years old receiving follow-up care at two hospitals in Brazil. A questionnaire on clinical and sociodemographic characteristics was completed. Laboratory tests were performed, and BMD was measured at the lumbar spine and hip. Statistical analysis was carried out by Yates and Pearson chi-squared tests, Mann-Whitney test, and multiple linear regression. RESULTS The mean age was 47.7 years in HIV-seropositive women, and 75 % had nadir CD4 above 200, and 77.8 % had viral load below the detection limit. The mean age in the HIV-seronegative women was 49.8 years. The prevalence of low spinal BMD was 14.6 % in the HIV-seropositive and 4.6 % in the HIV-seronegative women (p < 0.01). The prevalence of low BMD at the femoral neck was 5.6 % in HIV-seropositive and 3.3 % in the HIV-seronegative women (p = 0.38). Multiple analyses showed that the factors associated with lower BMD at the spine were being postmenopausal and being HIV-seropositive. Being overweight was associated with a higher BMD. At the femoral neck, factors associated with lower BMD were being postmenopausal and being white. Being overweight and having a greater number of pregnancies were associated with higher BMD CONCLUSIONS: HIV-seropositive women on long-term antiretroviral treatment and in good immunological conditions exhibited low BMD in the spine (L1-L4). However, BMD in the femoral neck was similar to non-infected women.
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Ito K, Leslie WD. Cost-effectiveness of fracture prevention in rural women with limited access to dual-energy X-ray absorptiometry. Osteoporos Int 2015; 26:2111-9. [PMID: 25807913 DOI: 10.1007/s00198-015-3107-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/10/2015] [Indexed: 01/19/2023]
Abstract
UNLABELLED A reduced reimbursement for office-based dual-energy X-ray absorptiometry (DXA) is likely to exacerbate the burden of fractures in rural areas. Our cost-effective analysis suggests that, in areas where access to DXA is limited, treatment for women at high clinical risk for fractures could both improve health and save money. INTRODUCTION To evaluate the cost-effectiveness of various fracture prevention strategies for rural women with limited access to dual-energy X-ray absorptiometry (DXA). METHODS A Markov model was developed using data from the published literature and the Manitoba Bone Density Program. The participants were a simulated cohort of rural women aged 65 years with travel distance between 10 and 24 mi to the nearest DXA site. The evaluated strategies were (1) watchful waiting, (2) bone mineral density (BMD)-based strategy (i.e., DXA screening followed by pharmacotherapy based on BMD), and (3) clinical risk factor (CRF)-based strategy (i.e., pharmacotherapy for women at high risk for fractures by the World Health Organization Fracture Risk Assessment Tool [FRAX]). The outcome was an incremental cost-effectiveness ratio (ICER) measured by cost per quality-adjusted life-year (QALY) gained. The analysis was preformed from a societal perspective over a lifetime horizon. RESULTS In the base-case analysis, the BMD-based strategy had an ICER of $6000 per QALY gained. For those with travel distance between 25 and 39 mi, the BMD-based strategy would have an ICER of $140,800 per QALY gained. For those with travel distance greater than 40 mi, the CRF-based strategy would be more effective and less costly than other strategies. CONCLUSIONS In areas where DXA is readily available, DXA screening followed by pharmacotherapy guided by BMD would be preferred. In areas with more limited access to DXA, pharmacotherapy for women at high clinical risk for fractures based on FRAX could both improve health and save money from the societal perspective.
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Affiliation(s)
- K Ito
- Division of Geriatric Medicine, Department of Primary Care, University of New England College of Osteopathic Medicine, 11 Hills Beach Road, Biddeford, ME, 04005, USA,
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12
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Lin X, Xiong D, Peng YQ, Sheng ZF, Wu XY, Wu XP, Wu F, Yuan LQ, Liao EY. Epidemiology and management of osteoporosis in the People's Republic of China: current perspectives. Clin Interv Aging 2015; 10:1017-33. [PMID: 26150706 PMCID: PMC4485798 DOI: 10.2147/cia.s54613] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
With the progressive aging of the population, osteoporosis has gradually grown into a global health problem for men and women aged 50 years and older because of its consequences in terms of disabilities and fragility fractures. This is especially true in the People's Republic of China, which has the largest population and an increasing proportion of elderly people, as osteoporosis has become a serious challenge to the Chinese government, society, and family. Apart from the fact that all osteoporotic fractures can increase the patient's morbidity, they can also result in fractures of the hip and vertebrae, which are associated with a significantly higher mortality. The cost of osteoporotic fractures, moreover, is a heavy burden on families, society, and even the country, which is likely to increase in the future due, in part, to the improvement in average life expectancy. Therefore, understanding the epidemiology of osteoporosis is essential and is significant for developing strategies to help reduce this problem. In this review, we will summarize the epidemiology of osteoporosis in the People's Republic of China, including the epidemiology of osteoporotic fractures, focusing on preventive methods and the management of osteoporosis, which consist of basic measures and pharmacological treatments.
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Affiliation(s)
- Xiao Lin
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| | - Dan Xiong
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| | - Yi-Qun Peng
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| | - Zhi-Feng Sheng
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| | - Xi-Yu Wu
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| | - Xian-Ping Wu
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| | - Feng Wu
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Ling-Qing Yuan
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
| | - Er-Yuan Liao
- Institute of Metabolism and Endocrinology, Central South University, Changsha, Hunan, People's Republic of China
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Pharmacokinetics and osteogenic potential of PEGylated NELL-1 in vivo after systemic administration. Biomaterials 2015; 57:73-83. [PMID: 25913252 DOI: 10.1016/j.biomaterials.2015.03.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/28/2015] [Accepted: 03/31/2015] [Indexed: 12/11/2022]
Abstract
Osteoporosis is a skeletal disorder attributable to an imbalance in osteoblast and osteoclast activity. NELL-1, a secretory protein that promotes osteogenesis while suppressing osteoclastic activity, holds potential as an osteoporosis therapy. Recently, we demonstrated that PEGylation of NELL-1 significantly improves its thermostability while preserving its bioactivity in vitro. However, the effect of PEGylation on the pharmacokinetics and osteogenic potential of NELL-1 in vivo have yet to be investigated. The present study demonstrated that PEGylation of NELL-1 significantly increases the elimination half-life time of the protein from 5.5 h to 15.5 h while distributing more than 2-3 times the amount of protein to bone tissues (femur, tibia, vertebrae, calvaria) in vivo when compared to naked NELL-1. In addition, microCT and DXA analyses demonstrated that systemic NELL-PEG therapy administered every 4 or 7 days significantly increases not only femoral and lumbar BMD and percent bone volume, but also new bone formation throughout the overall skeleton after four weeks of treatment. Furthermore, immunohistochemistry revealed increased osteocalcin expression, while TRAP staining showed reduced osteoclast numbers in NELL-PEG groups. Our findings suggest that the PEGylation technique presents a viable and promising approach to further develop NELL-1 into an effective systemic therapeutic for the treatment of osteoporosis.
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Low bone mass in human immunodeficiency virus–infected climacteric women receiving antiretroviral therapy. Menopause 2015; 22:224-30. [DOI: 10.1097/gme.0000000000000282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Berry SD, McLean RR, Hannan MT, Cupples LA, Kiel DP. Changes in bone mineral density may predict the risk of fracture differently in older adults according to fall history. J Am Geriatr Soc 2014; 62:2345-9. [PMID: 25438807 DOI: 10.1111/jgs.13127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether the association between change in bone mass density (BMD) over 4 years and risk of hip and nonvertebral fracture differs according to an individual's history of falls. DESIGN Population-based cohort study. SETTING Framingham, Massachusetts. PARTICIPANTS Individuals with two measures of BMD at the femoral neck (mean age 78.8; 310 male, 492 female). MEASUREMENTS Cox proportional hazards models were used to estimate hazard ratios (HRs) for the association between percentage change in BMD (per sex-specific standard deviation) and risk of incident hip and nonvertebral fracture. Models were stratified based on history of falls (≥1 falls in the past year) and recurrent falls (≥2 falls) ascertained at the time of the second BMD test. Interactions were tested by including the term "fall history * change in BMD" in the models. RESULTS Mean change in BMD was -0.6%/year; 27.8% of participants reported falls, and 10.8% reported recurrent falls. Seventy-six incident hip and 175 incident nonvertebral fractures occurred over a median follow-up of 9.0 years. There was no difference in the association between change in BMD and hip fracture according to history of falls (P for interaction = .57). The HR associated with change in BMD and nonvertebral fracture was 1.31 (95% confidence interval (CI) = 1.10-1.56) in participants without a history of falls and 0.95 (95% CI 0.70-1.28) in those with a fall (interaction P = .07). Results for recurrent fallers were similar. CONCLUSION The effect of BMD loss on risk of nonvertebral fracture may be greater in persons without a history of falls. It is possible that change in BMD contributes less to fracture risk when a strong risk factor for fracture, such as falls, is present.
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Affiliation(s)
- Sarah D Berry
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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16
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Ensrud KE, Taylor BC, Peters KW, Gourlay ML, Donaldson MG, Leslie WD, Blackwell TL, Fink HA, Orwoll ES, Schousboe J. Implications of expanding indications for drug treatment to prevent fracture in older men in United States: cross sectional and longitudinal analysis of prospective cohort study. BMJ 2014; 349:g4120. [PMID: 24994809 PMCID: PMC4080830 DOI: 10.1136/bmj.g4120] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To quantify incremental effects of applying different criteria to identify men who are candidates for drug treatment to prevent fracture and to examine the extent to which fracture probabilities vary across distinct categories of men defined by these criteria. DESIGN Cross sectional and longitudinal analysis of a prospective cohort study. SETTING Multicenter Osteoporotic Fractures in Men (MrOS) study in the United States. PARTICIPANTS 5880 untreated community dwelling men aged 65 years or over classified into four distinct groups: osteoporosis by World Health Organization criteria alone; osteoporosis by National Osteoporosis Foundation (NOF) but not WHO criteria; no osteoporosis but at high fracture risk (at or above NOF derived FRAX intervention thresholds recommended for US); and no osteoporosis and at low fracture risk (below NOF derived FRAX intervention thresholds recommended for US). MAIN OUTCOME MEASURES Proportion of men identified for drug treatment; predicted 10 year probabilities of hip and major osteoporotic fracture calculated using FRAX algorithm with femoral neck bone mineral density; observed 10 year probabilities for confirmed incident hip and major osteoporotic (hip, clinical vertebral, wrist, or humerus) fracture events calculated using cumulative incidence estimation, accounting for competing risk of mortality. RESULTS 130 (2.2%) men were identified as having osteoporosis by using the WHO definition, and an additional 422 were identified by applying the NOF definition (total osteoporosis prevalence 9.4%). Application of NOF derived FRAX intervention thresholds led to 936 (15.9%) additional men without osteoporosis being identified as at high fracture risk, raising the total prevalence of men potentially eligible for drug treatment to 25.3%. Observed 10 year hip fracture probabilities were 20.6% for men with osteoporosis by WHO criteria alone, 6.8% for men with osteoporosis by NOF (but not WHO) criteria, 6.4% for men without osteoporosis but classified as at high fracture risk, and 1.5% for men without osteoporosis and classified as at low fracture risk. A similar pattern was noted in observed fracture probabilities for major osteoporotic fracture. Among men with osteoporosis by WHO criteria, observed fracture probabilities were greater than FRAX predicted probabilities (20.6% v 9.5% for hip fracture and 30.0% v 17.4% for major osteoporotic fracture). CONCLUSIONS AND RELEVANCE Choice of definition of osteoporosis and use of NOF derived FRAX intervention thresholds have major effects on the proportion of older men identified as warranting drug treatment to prevent fracture. Among men identified with osteoporosis by WHO criteria, who comprised 2% of the study population, actual observed fracture probabilities during 10 years of follow-up were highest and exceeded FRAX predicted fracture probabilities. On the basis of findings from randomized trials in women, these men are most likely to benefit from treatment. Expanding indications for treatment beyond this small group has uncertain value owing to lower observed fracture probabilities and uncertain benefits of treatment among men not selected on the basis of WHO criteria.
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Affiliation(s)
- Kristine E Ensrud
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA
| | - Brent C Taylor
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA
| | - Katherine W Peters
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Margaret L Gourlay
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Meghan G Donaldson
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Terri L Blackwell
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Howard A Fink
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA
| | - Eric S Orwoll
- Bone and Mineral Unit, Oregon Health and Science University, Portland, OR, USA
| | - John Schousboe
- Park Nicollet Clinic, St Louis Park, MN, USA Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
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Lee SW. Proper time to initiate antiosteoporotic treatment in rheumatoid arthritis with or without glucocorticoid use. Korean J Intern Med 2014; 29:434-6. [PMID: 25045290 PMCID: PMC4101589 DOI: 10.3904/kjim.2014.29.4.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/12/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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18
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Abstract
Whether or not to use pharmacologic agents for primary prevention of fracture among elderly men and women with osteopenia is debated by clinicians. In this review we provide an update to enable better understanding and characterization of this population, including the prevalence of osteopenia, transitioning from osteopenia to osteoporosis, and clinically applicable tools for fracture risk assessment. We also emphasize the very limited evidence of the benefits and risks of anti-osteoporotic agents for this population for primary fracture prevention, and the need for future studies to guide clinical practice.
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Affiliation(s)
- Jie Zhang
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, Ryals 230K, Birmingham, AL, 35294, USA,
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19
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FRAX fracture risk in women with a recent fracture of the distal forearm: agreement between assessments with and without bone mineral density and impact of measurement side in the individual patient. Clin Rheumatol 2014; 34:1265-72. [DOI: 10.1007/s10067-014-2640-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/17/2014] [Indexed: 01/19/2023]
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20
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Kim JH, Kim JS. Effects of Lycii Fructus and Lycii Folium Extracts on Osteoporosis in Ovariectomized Rats. ACTA ACUST UNITED AC 2014. [DOI: 10.3746/jkfn.2014.43.1.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Brandão CMR, Ferré F, Machado GPDM, Guerra AA, Andrade EIG, Cherchiglia ML, Acurcio FDA. [Public spending on drugs for the treatment of osteoporosis in post-menopause]. Rev Saude Publica 2014; 47:390-402. [PMID: 24037367 DOI: 10.1590/s0034-8910.2013047004163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 10/03/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze expenditure on treatment for postmenopausal osteoporosis and associated factors on mean per capita expenditure. METHODS A probabilistic-deterministic linkage between the database of Authorizations for Highly Complex Procedures and the mortality information system was constructed, resulting in a historical cohort of patients using high-cost medications for the treatment of postmenopausal osteoporosis, between 2000-2006. Mean monthly spending on medicines was stratified by age group and described according to demographic and clinical characteristics and the type of drug used. A linear regression model was used to assess the impact of demographic and clinical characteristics on per capita mean monthly expenditure on medicines. RESULTS We identified 72,265 women who received drugs for the treatment of postmenopausal osteoporosis. The average monthly expenditure per capita in the first year of treatment was $ 54.02 (sd $ 86.72). The population was predominantly composed of women aged 60-69 years old, who had started treatment in 2000, resident in the Southeast of Brazil, who had previously suffered osteoporotic fractures, and Alendronate sodium was the drug most commonly used at baseline. For most of the patients, the same active ingredient remained in use throughout the treatment period. During the program, 6,429 deaths were identified among participants. More than a third of women remained in treatment for up to 12 months. Raloxifen and calcitonin were the therapeutic alternatives with the greatest impact on the average monthly expenditure on medicine using alendronate sodium as a reference standard. CONCLUSIONS Due to the high impact of the type of drug used on expenditure on medication, it is recommended that criteria for prescribing and dispensing be established by prioritizing those with lower costs and greater effectiveness in order to optimize the process of pharmaceutical care and provide the population with a greater number of pharmaceutical units.
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Affiliation(s)
- Cristina Mariano Ruas Brandão
- Universidade Federal de Minas Gerais, Faculdade de Farmácia, Departamento de Farmácia Social, Belo HorizonteMG, Brazil
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Sanfélix-Genovés J, Catalá-López F, Sanfélix-Gimeno G, Hurtado I, Baixauli C, Peiró S. Variabilidad en las recomendaciones para el abordaje clínico de la osteoporosis. Med Clin (Barc) 2014; 142:15-22. [DOI: 10.1016/j.medcli.2012.10.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 10/04/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
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Zhang J, Delzell E, Curtis JR, Hooven F, Gehlbach SH, Anderson FA, Saag KG. Use of pharmacologic agents for the primary prevention of osteoporosis among older women with low bone mass. Osteoporos Int 2014; 25:317-24. [PMID: 23982799 DOI: 10.1007/s00198-013-2444-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED We examined the use of pharmacologic agents for the primary prevention of osteoporosis among older women with osteopenia. We found that these individuals were not managed in concordance with the National Osteoporosis Foundation (NOF) guidelines and that self-perceived osteoporosis risk and lower bone density were strongly associated with receipt of treatment. INTRODUCTION Although osteoporosis medications are used for the primary prevention of osteoporosis among persons with low bone mass (osteopenia), their use may be discordant with clinical practice guidelines. METHODS We studied women 55 years and older participating in the Global Longitudinal Study of Osteoporosis in Women (GLOW). Eligible participants had a dual energy x-ray absorptiometry (DXA) test performed at the University of Alabama at Birmingham hospital and had an osteopenia diagnosis based on their DXA test results. Participants' demographics, fracture risk factors, and exposure to osteoporosis medications were determined from the GLOW survey. We examined the proportions of women managed in concordance with the National Osteoporosis Foundation 2008 guidelines, and we assessed factors independently associated with osteoporosis treatment decisions. Women with a prior spine or hip fracture were excluded. RESULTS Among 597 eligible women from GLOW, the mean age ± standard deviation (SD) was 70 ± 7 years. Among all subjects, 309 (52%) were treated in concordance with the NOF 2008 guidelines. Greater self-perceived osteoporosis risk and lower bone mineral density were significantly and consistently associated with receipt of osteoporosis treatment, both for those considered appropriate and for those considered inappropriate for treatment based on the NOF guidelines. CONCLUSIONS We found significant discordance between NOF 2008 guidelines and pharmacologic management of women with osteopenia. A person's self-perceived osteoporosis risk and bone mineral density were most strongly associated with receipt of osteoporosis medication use among women with low bone mass.
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Affiliation(s)
- J Zhang
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Siris ES, Modi A, Tang J, Gandhi S, Sen S. Substantial under-treatment among women diagnosed with osteoporosis in a US managed-care population: a retrospective analysis. Curr Med Res Opin 2014; 30:123-30. [PMID: 24102262 DOI: 10.1185/03007995.2013.851074] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Multiple therapies are approved for the treatment of osteoporosis (OP), but many patients with osteoporosis may not initiate treatment upon osteoporosis diagnosis. OBJECTIVE To characterize initiation of pharmacologic OP treatment among women within 1 year of OP diagnosis in a US managed care population. RESEARCH DESIGN AND METHODS The retrospective cohort study included women aged ≥55 years with a claims-documented diagnosis of OP who were naïve to OP medications prior to OP diagnosis (index date) during 2001-2010. Continuous enrollment for 12 months before (baseline) and after (follow-up) the index date was required. Patients who received OP medications but did not have an OP diagnosis were excluded. Differences in baseline characteristics between the treated and untreated cohorts were compared using Wilcoxon rank-sum (continuous variables) and chi-square tests (categorical variables). MAIN OUTCOMES MEASURES During the follow-up period, the percentages of patients treated with bisphosphonates (alendronate, ibandronate, risedronate, zoledronic acid) and non-bisphosphonates (calcitonin, raloxifene, teriparatide) were determined. RESULTS A total of 65,344 patients, mean age 65.7 years, met study inclusion exclusion criteria. During the follow-up period, 42,033 patients (64.3%) received no OP medication and 23,311 patients (35.7%) received OP treatment. A total of 20,200 patients (30.9% of total study population) received bisphosphonates and 3111 (4.8% of total) patients received non-bisphosphonates as their index medication. At baseline, untreated patients were slightly older and had higher rates of hypertension, chronic inflammatory joint disease, diabetes mellitus, and gastrointestinal events (p ≤ 0.01) compared with treated patients. CONCLUSIONS Among women aged ≥55 years in a US managed-care population, 64.3% received no pharmacologic treatment within 1 year after being diagnosed with OP. The authors were not able to determine if untreated patients did not receive or did not fill a prescription. Further research is needed to understand the barriers to OP treatment and reasons for non-treatment.
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Affiliation(s)
- Ethel S Siris
- Columbia University Medical Center , New York, NY , USA
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Govindarajan P, Schlewitz G, Schliefke N, Weisweiler D, Alt V, Thormann U, Lips KS, Wenisch S, Langheinrich AC, Zahner D, Hemdan NY, Böcker W, Schnettler R, Heiss C. Implications of combined ovariectomy/multi-deficiency diet on rat bone with age-related variation in bone parameters and bone loss at multiple skeletal sites by DEXA. Med Sci Monit Basic Res 2013; 19:76-86. [PMID: 23446183 PMCID: PMC3638667 DOI: 10.12659/msmbr.883815] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 02/07/2013] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Osteoporosis is a multi-factorial, chronic, skeletal disease highly prevalent in post-menopausal women and is influenced by hormonal and dietary factors. Because animal models are imperative for disease diagnostics, the present study establishes and evaluates enhanced osteoporosis obtained through combined ovariectomy and deficient diet by DEXA (dual-energy X-ray absorptiometry) for a prolonged time period. MATERIAL/METHODS Sprague-Dawley rats were randomly divided into sham (laparotomized) and OVX-diet (ovariectomized and fed with deficient diet) groups. Different skeletal sites were scanned by DEXA at the following time points: M0 (baseline), M12 (12 months post-surgery), and M14 (14 months post-surgery). Parameters analyzed included BMD (bone mineral density), BMC (bone mineral content), bone area, and fat (%). Regression analysis was performed to determine the interrelationships between BMC, BMD, and bone area from M0 to M14. RESULTS BMD and BMC were significantly lower in OVX-diet rats at M12 and M14 compared to sham rats. The Z-scores were below -5 in OVX-diet rats at M12, but still decreased at M14 in OVX-diet rats. Bone area and percent fat were significantly lower in OVX-diet rats at M14 compared to sham rats. The regression coefficients for BMD vs. bone area, BMC vs. bone area, and BMC vs. BMD of OVX-diet rats increased with time. This is explained by differential percent change in BMD, BMC, and bone area with respect to time and disease progression. CONCLUSIONS Combined ovariectomy and deficient diet in rats caused significant reduction of BMD, BMC, and bone area, with nearly 40% bone loss after 14 months, indicating the development of severe osteoporosis. An increasing regression coefficient of BMD vs. bone area with disease progression emphasizes bone area as an important parameter, along with BMD and BMC, for prediction of fracture risk.
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Affiliation(s)
| | - Gudrun Schlewitz
- Department of Trauma Surgery, University Hospital of Giessen-Marburg, Giessen, Germany
| | - Nathalie Schliefke
- Department of Trauma Surgery, University Hospital of Giessen-Marburg, Giessen, Germany
| | - David Weisweiler
- Department of Trauma Surgery, University Hospital of Giessen-Marburg, Giessen, Germany
| | - Volker Alt
- Laboratory of Experimental Trauma Surgery, Justus-Liebig University, Giessen, Germany
- Department of Trauma Surgery, University Hospital of Giessen-Marburg, Giessen, Germany
| | - Ulrich Thormann
- Department of Trauma Surgery, University Hospital of Giessen-Marburg, Giessen, Germany
| | - Katrin Susanne Lips
- Laboratory of Experimental Trauma Surgery, Justus-Liebig University, Giessen, Germany
| | - Sabine Wenisch
- Institute of Veterinary Anatomy, Justus-Liebig University, Giessen, Germany
| | | | - Daniel Zahner
- Animal Laboratory, Justus-Liebig University of Giessen, Germany
| | - Nasr Y. Hemdan
- Laboratory of Experimental Trauma Surgery, Justus-Liebig University, Giessen, Germany
- Department of Zoology, Faculty of Science, University of Alexandria, Egypt
| | - Wolfgang Böcker
- Laboratory of Experimental Trauma Surgery, Justus-Liebig University, Giessen, Germany
- Department of Trauma Surgery, University Hospital of Giessen-Marburg, Giessen, Germany
| | - Reinhard Schnettler
- Laboratory of Experimental Trauma Surgery, Justus-Liebig University, Giessen, Germany
- Department of Trauma Surgery, University Hospital of Giessen-Marburg, Giessen, Germany
| | - Christian Heiss
- Laboratory of Experimental Trauma Surgery, Justus-Liebig University, Giessen, Germany
- Department of Trauma Surgery, University Hospital of Giessen-Marburg, Giessen, Germany
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Palacios S, Christiansen C, Sánchez Borrego R, Gambacciani M, Hadji P, Karsdal M, Lambrinoudaki I, Lello S, O'Beirne B, Romao F, Rozenberg S, Stevenson JC, Ben-Rafael Z. Recommendations on the management of fragility fracture risk in women younger than 70 years. Gynecol Endocrinol 2012; 28:770-86. [PMID: 22558997 DOI: 10.3109/09513590.2012.679062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The risk for fragility fracture represents a problem of enormous magnitude. It is estimated that only a small fraction of women with this risk take the benefit of preventive measures. The relationship between estrogen and bone mass is well known as they are the other factors related to the risk for fracture. There are precise diagnostic methods, including a tool to diagnose the risk for fracture. Yet there continues to be an under-diagnosis, with the unrecoverable delay in instituting preventive measures. Women under the age of 70 years, being much more numerous than those older, and having risk factors, are a group in which it is essential to avoid that first fragility fracture. Today it is usual not to differentiate between the treatment and the prevention of osteoporosis since the common aim is to prevent fragility fractures. Included in this are women with osteoporosis or with low bone mass and increased risk for fracture, for whom risk factors play a primary role. There is clearly controversy over the type of treatment and its duration, especially given the possible adverse effects of long-term use. This justifies the concept of sequential treatment, even more so in women under the age of 70, since they presumably will need treatment for many years. Bone metabolism is age-dependent. In postmenopausal women under 70 years of age, the increase in bone resorption is clearly predominant, related to a sharp drop in estrogens. Thus a logical treatment is the prevention of fragility fractures by hormone replacement therapy (HRT) and, in asymptomatic women, selective estradiol receptor modulators (SERMs). Afterwards, there is a period of greater resorption, albeit less intense but continuous, when one could utilise anti-resorptive treatments such as bisphosphonates or denosumab or a dual agent like strontium ranelate. Bone formation treatment, such as parathyroid hormone (PTH), in women under 70 years will be uncommon. That is because it should be used in cases where the formation is greatly diminished and there is a high risk for fracture, something found in much older women.
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Affiliation(s)
- Santiago Palacios
- Instituto Palacios, Salud y Medicina de la Mujer, C/ Antonio Acuña, Madrid, Spain
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Li Vecchi V, Soresi M, Giannitrapani L, Mazzola G, La Sala S, Tramuto F, Caruso G, Colomba C, Mansueto P, Madonia S, Montalto G, Di Carlo P. Dairy calcium intake and lifestyle risk factors for bone loss in hiv-infected and uninfected Mediterranean subjects. BMC Infect Dis 2012; 12:192. [PMID: 22894751 PMCID: PMC3447655 DOI: 10.1186/1471-2334-12-192] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 07/23/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite the reported high prevalence of osteoporosis in the human immunodeficiency virus (HIV)-population, there have been no previous studies examining dairy calcium intake and bone mineral density (BMD) in HIV-subjects. We assessed the prevalence of low BMD in HIV-infected and uninfected subjects and analyzed the effects of calcium intake, lifestyle and HIV-related risk factors on BMD. METHODS One hundred and twelve HIV-infected subjects were consecutively enrolled. Seventy- six HIV-uninfected subjects matched for age and sex were enrolled as the control group. The HIV-subjects were interviewed about lifestyle habits and completed a weekly food-frequency questionnaire to estimate calcium intake. HIV-RNA, CD4+ T-cell count and data on antiretroviral therapy were also recorded. Both biochemical bone turnover markers and BMD, assessed by dual-energy radiographic absorptiometry (DXA) were recorded in the HIV-cases and controls. We also calculated the 10-year fracture risks using the WHO FRAX equation. RESULTS Osteoporosis prevalence was significantly higher in the HIV-cases than controls (p < 0.05). BMI values were positively correlated with BMD (p < 0.05). Vitamin D levels were lower in the HIV-subjects (p < 0.02). No correlation was found with daily calcium intake. BMI values were significantly correlated with dairy intake quartiles (p < 0.003). In HIV-subjects, the mean of FRAX score was 1.2 % for hip and 4.7 % for major osteoporotic fractures. On multivariate analysis of the lumbar spine DXA T-score, age (p < 0.005) and HIV/hepatitis C virus co-infection (p < 0.0001) were negatively correlated with BMD, while yogurt intake was a protective predictor of BMD (p < 0.05). In the femur DXA T-score, age (p < 0.01), nadir CD4 + T-cell count < 200 cells/μL (p < 0.05) and drug addiction ( p < 0.0001) were negatively correlated with BMD. CONCLUSIONS Among the foods rich in calcium, yogurt was a protective predictor of BMD in HIV-subjects. HIV/HCV co-infection, nadir CD4 + T-cell count < 200 cells/μL and drug addiction were independent predictors of severe BMD. Promoting behavioral changes in food intake and lifestyle, aimed at the primary prevention of bone disease in the chronically-infected subjects seems to be essential for implementing medical intervention in these cases.
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Affiliation(s)
- Valentina Li Vecchi
- Dipartimento di Medicina Interna, Università di Palermo, Via del Vespro 141, Palermo I-90127, Italy
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Ettinger B, Liu H, Blackwell T, Hoffman AR, Ensrud KE, Orwoll ES. Validation of FRC, a fracture risk assessment tool, in a cohort of older men: the Osteoporotic Fractures in Men (MrOS) Study. J Clin Densitom 2012; 15:334-42. [PMID: 22445858 PMCID: PMC3387516 DOI: 10.1016/j.jocd.2012.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 01/27/2012] [Accepted: 01/30/2012] [Indexed: 10/28/2022]
Abstract
We evaluated the performance of the Fracture Risk Calculator (FRC) in 5893 men who participated in the baseline visit (March 2000-April 2002) of the Osteoporotic Fractures in Men Study. FRC estimates for 10-yr hip and major osteoporotic (hip, clinical spine, forearm, and shoulder) fractures were calculated and compared with observed 10-yr fracture probabilities. Possible enhancement of the tool's performance when bone mineral density (BMD) was included was evaluated by comparing areas under receiver operating characteristic curves and by Net Reclassification Improvement (NRI). A total of 5893 men were followed-up for an average of 8.4 yr. For most quintiles of predicted fracture risk, the ratios of observed to predicted probabilities were close to unity. Area under the curves improved when BMD was included (p<0.001; 0.79 vs 0.71 for hip fracture and 0.70 vs 0.66 for major osteoporotic fracture, respectively). Using National Osteoporosis Foundation clinical treatment thresholds, BMD inclusion increased NRI significantly, 8.5% (p<0.01) for hip and 4.0% (p=0.01) for major osteoporotic fracture. We conclude that the FRC calibrates well with hip and major osteoporotic fractures observed among older men. Further, addition of BMD to the fracture risk calculation improves the tool's performance.
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Affiliation(s)
- Bruce Ettinger
- Department of Medicine, University of California, San Francisco, CA, USA.
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Gourlay ML, Preisser JS, Lui LY, Cauley JA, Ensrud KE. BMD screening in older women: initial measurement and testing interval. J Bone Miner Res 2012; 27:743-6. [PMID: 22392569 PMCID: PMC3579550 DOI: 10.1002/jbmr.1585] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Margaret L Gourlay
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA.
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Dawson-Hughes B, Looker AC, Tosteson ANA, Johansson H, Kanis JA, Melton LJ. The potential impact of the National Osteoporosis Foundation guidance on treatment eligibility in the USA: an update in NHANES 2005-2008. Osteoporos Int 2012; 23:811-20. [PMID: 21717247 DOI: 10.1007/s00198-011-1694-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 06/01/2011] [Indexed: 11/30/2022]
Abstract
UNLABELLED This analysis of National Health and Nutrition Examination Survey (NHANES) 2005-2008 data describes the prevalence of risk factors for osteoporosis and the proportions of men and postmenopausal women age 50 years and older who are candidates for treatment to lower fracture risk, according to the new Fracture Risk Assessment Tool (FRAX)-based National Osteoporosis Foundation Clinician's Guide. INTRODUCTION It is important to update estimates of the proportions of the older US population considered eligible for pharmacologic treatment for osteoporosis for purposes of understanding the health care burden of this disease. METHODS This is a cross-sectional study of the NHANES 2005-2008 data in 3,608 men and women aged 50 years and older. Variables in the analysis included race/ethnicity, age, lumbar spine and femoral neck bone mineral density, risk factor profiles, and FRAX 10-year fracture probabilities. RESULTS The prevalence of osteoporosis of the femoral neck ranged from 6.0% in non-Hispanic black to 12.6% in Mexican American women. Spinal osteoporosis was more prevalent among Mexican American women (24.4%) than among either non-Hispanic blacks (5.3%) or non-Hispanic whites (10.9%). Treatment eligibility was similar in Mexican American and non-Hispanic white women (32.0% and 32.8%) and higher than it was in non-Hispanic black women (11.0%). Treatment eligibility among men was 21.1% in non-Hispanic whites, 12.6% in Mexican Americans, and 3.0% in non-Hispanic blacks. CONCLUSIONS Nineteen percent of older men and 30% of older women in the USA are at sufficient risk for fracture to warrant consideration for pharmacotherapy.
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Affiliation(s)
- B Dawson-Hughes
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA.
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Leslie WD, Morin S, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA. Fracture risk assessment without bone density measurement in routine clinical practice. Osteoporos Int 2012; 23:75-85. [PMID: 21850546 DOI: 10.1007/s00198-011-1747-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 06/24/2011] [Indexed: 11/30/2022]
Abstract
UNLABELLED Fracture probability assessed without bone mineral density (BMD) could potentially be sufficient for clinical decision making in many individuals categorized as low or high fracture risk. For individuals falling in a moderate risk range, there is incremental value in using BMD in the probability calculation as this appropriately reclassifies risk in over one third of the individuals. INTRODUCTION A new fracture risk assessment tool from the World Health Organization (FRAX) estimates 10-year major osteoporotic and hip fracture probabilities from multiple clinical risk factors with or without hip BMD. The objective of this study is to determine whether fracture probability derived without BMD can be used to identify individuals who would be designated for treatment. METHODS A historical cohort of 36,730 women and 2,873 men aged 50 years and older drawn from the Manitoba Bone Density Program database, which contains clinical BMD results for the Province of Manitoba, Canada, was included in the study. RESULTS When 10-year probability for major osteoporotic fracture estimated without knowledge of BMD was high (≥ 20%), the vast majority (92.8%) qualified for intervention under the National Osteoporosis Foundation (NOF) guidelines, whereas among those at low risk (<10%), the vast majority (80.5%) did not satisfy any NOF intervention criteria. The benefit of including BMD in the risk assessment was greatest among those initially at moderate risk (10-19%) when fracture probability was derived without BMD, but this represented only 29.4% of the cohort (9.3% of those aged < 65 years and 48.7% of those ≥ 65 years). CONCLUSIONS Fracture probability derived without BMD is able to risk stratify women in terms of future fracture risk and could potentially be sufficient for clinical decision making in many of those designated at low or high fracture risk.
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Affiliation(s)
- W D Leslie
- Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, MB, Canada R2H 2A6.
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Pressman AR, Lo JC, Chandra M, Ettinger B. Methods for assessing fracture risk prediction models: experience with FRAX in a large integrated health care delivery system. J Clin Densitom 2011; 14:407-15. [PMID: 21958955 DOI: 10.1016/j.jocd.2011.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 06/23/2011] [Accepted: 06/23/2011] [Indexed: 11/15/2022]
Abstract
Area under the receiver operating characteristics (AUROC) curve is often used to evaluate risk models. However, reclassification tests provide an alternative assessment of model performance. We performed both evaluations on results from FRAX (World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK), a fracture risk tool, using Kaiser Permanente Northern California women older than 50yr with bone mineral density (BMD) measured during 1997-2003. We compared FRAX performance with and without BMD in the model. Among 94,489 women with mean follow-up of 6.6yr, 1579 (1.7%) sustained a hip fracture. Overall, AUROCs were 0.83 and 0.84 for FRAX without and with BMD, suggesting that BMD did not contribute to model performance. AUROC decreased with increasing age, and BMD contributed significantly to higher AUROC among those aged 70yr and older. Using an 81% sensitivity threshold (optimum level from receiver operating characteristic curve, corresponding to 1.2% cutoff), 35% of those categorized above were reassigned below when BMD was added. In contrast, only 10% of those categorized below were reassigned to the higher risk category when BMD was added. The net reclassification improvement was 5.5% (p<0.01). Two versions of this risk tool have similar AUROCs, but alternative assessments indicate that addition of BMD improves performance. Multiple methods should be used to evaluate risk tool performance with less reliance on AUROC alone.
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Affiliation(s)
- Alice R Pressman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
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Calcilytics: antagonists of the calcium-sensing receptor for the treatment of osteoporosis. Future Med Chem 2011; 3:535-47. [PMID: 21526895 DOI: 10.4155/fmc.11.17] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The only bone anabolic agents currently available on the market are based on the parathyroid hormone (PTH). Secretion of endogenous PTH is controlled by a calcium-sensing receptor at the surface of the parathyroid glands. Antagonists of this receptor (calcilytics) induce the release of the hormone. Provided the effect of the calcilytic is of short duration, a bone anabolic effect should also result. Although the first calcilytic series became known approximately 10 years ago, the number of different structural types is still small today. This article outlines the quest from hits to potent development candidates of all relevant calcilytic series currently known. Even after the front-runners unexpectedly failed in the clinic, the approach for an oral alternative to parenteral PTH remains highly attractive.
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Orwig DL, Chiles N, Jones M, Hochberg MC. Osteoporosis in Men: Update 2011. Rheum Dis Clin North Am 2011; 37:401-14, vi. [DOI: 10.1016/j.rdc.2011.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Lu TL, Hu HJ, Zhao W, Chen T. Synthesis andin vivobioactivity of lipophilic alendronate derivatives against osteoporosis. Drug Dev Ind Pharm 2011; 37:656-63. [DOI: 10.3109/03639045.2010.535210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kanis JA, Johansson H, Oden A, McCloskey EV. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int 2011; 22:809-16. [PMID: 21229233 DOI: 10.1007/s00198-010-1524-7] [Citation(s) in RCA: 187] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 11/18/2010] [Indexed: 12/19/2022]
Abstract
UNLABELLED We examined the effect of glucocorticoid dose on FRAX® derived fracture probabilities in a UK setting. A relatively simple adjustment of conventional FRAX estimates of probabilities of hip fracture and a major osteoporotic fracture can be applied to modulate the risk assessment with knowledge of the dose of glucocorticoids. INTRODUCTION The WHO fracture risk assessment (FRAX) tool estimates 10-year probability of fracture based upon multiple clinical risk factors and an optional femoral neck BMD measurement. Ever (past and current) use of systemic glucocorticoids is a dichotomous risk factor (yes/no) and does not therefore take account of the dose of glucocorticoids. The aim of this work was to estimate the adjustment for fracture probability based upon the dose of glucocorticoids. METHODS Dose responses for fracture risk during exposure to glucocorticoids were taken from the General Practice Research Database and used to adjust the relative risks for glucocorticoids in FRAX. In addition to fracture risk, a dose response for the death hazard was estimated and both variables were used to populate the FRAX model for the UK. RESULTS The exposure to glucocorticoids was found to significantly affect fracture probability. The following rule was formulated. For low-dose exposure (< 2.5 mg daily of prednisolone or equivalent), the probability of a major fracture is decreased by about 20% depending on age. For medium doses (2.5-7.5 mg daily), the unadjusted FRAX value can be used. For high doses (> 7.5 mg daily), probabilities can be upward revised by about 15%. Conversion factors were also determined for the adjustment of hip fracture probability. CONCLUSION A relatively simple adjustment of conventional FRAX estimates of probabilities of hip fracture and a major osteoporotic fracture can be applied to modulate the risk assessment with knowledge of the dose of glucocorticoids.
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Affiliation(s)
- J A Kanis
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S102RX, UK.
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Azagra Ledesma R, Prieto-Alhambra D, Encabo Duró G, Casado Burgos E, Aguyé Batista A, Díez-Pérez A. [Usefulness of FRAX tool for the management of osteoporosis in the Spanish female population]. Med Clin (Barc) 2011; 136:613-9. [PMID: 21349558 DOI: 10.1016/j.medcli.2010.09.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 09/06/2010] [Accepted: 09/09/2010] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE Osteoporotic fractures involve a significant consumption of health resources. Bone densitometry has been essential in the management of osteoporosis. However, for fracture absolute risk prediction, other important clinical risk factors are also important. WHO published a risk estimation tool (FRAX), and the National Osteoporosis Guideline Group (NOGG) reported thresholds for densitometry assessment based on cost-effectivity criteria. Our goal is to determine the diagnostic predictive validity of FRAX in our population, and to assess how its use (according to NOGG guidelines) would modify the current number of referrals to DXA scan in our health system. SUBJECTS AND METHODS Diagnostic validation study in a consecutive sample of 1,650 women, 50 to 90 years old, under no treatment with anti-resortives, from the FRIDEX cohort. DXA and a questionnaire regarding risk factors were performed. ROC curve and area under the curve (AUC) were used to assess FRAX's diagnostic validity for femoral neck osteoporosis (FNOP). Risk of fracture was calculated using FRAX pre and postDXA, and women were classified according to their risk, following NOGG recommendations. RESULTS FRAX's ROC AUC for FNOP was 0.812 for major fracture and 0.832 for hip fracture. Using FRAX according to NOGG would result in performing only 25.2% of the current tests. If we added previous fracture antecedent to the algorithm, 49.4% of the tests performed would be advised. CONCLUSIONS The use of NOGG thresholds applied to FRAX would reduce about 50% the current number of referrals to DXA scan in our population. FRAX has a good diagnostic validity for FNOP.
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Affiliation(s)
- Rafael Azagra Ledesma
- EAP Badia del Vallés, Institut Català de la Salut, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
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Vasikaran S, Eastell R, Bruyère O, Foldes AJ, Garnero P, Griesmacher A, McClung M, Morris HA, Silverman S, Trenti T, Wahl DA, Cooper C, Kanis JA. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int 2011; 22:391-420. [PMID: 21184054 DOI: 10.1007/s00198-010-1501-1] [Citation(s) in RCA: 711] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 11/09/2010] [Indexed: 02/06/2023]
Abstract
UNLABELLED The International Osteoporosis Foundation (IOF) and the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) recommend that a marker of bone formation (serum procollagen type I N propeptide, s-PINP) and a marker of bone resorption (serum C-terminal telopeptide of type I collagen, s-CTX) are used as reference analytes for bone turnover markers in clinical studies. INTRODUCTION Bone turnover markers (BTM) predict fracture risk, and treatment-induced changes in specific markers account for a substantial proportion of fracture risk reduction. The aims of this report were to determine their clinical potential in the prediction of fracture risk and for monitoring the treatment of osteoporosis and to set an appropriate research agenda. METHODS Evidence from prospective studies was gathered through literature review of the PUBMED database between the years 2000 and 2010 and the systematic review of the Agency for Healthcare Research and Quality up to 2001. RESULTS High levels of BTMs may predict fracture risk independently from bone mineral density in postmenopausal women. They have been used for this purpose in clinical practice for many years, but there is still a need for stronger evidence on which to base practice. BTMs provide pharmacodynamic information on the response to osteoporosis treatment, and as a result, they are widely used for monitoring treatment in the individual. However, their clinical value for monitoring is limited by inadequate appreciation of the sources of variability, by limited data for comparison of treatments using the same BTM and by inadequate quality control. IOF/IFCC recommend one bone formation marker (s-PINP) and one bone resorption marker (s-CTX) to be used as reference markers and measured by standardised assays in observational and intervention studies in order to compare the performance of alternatives and to enlarge the international experience of the application of markers to clinical medicine. CONCLUSION BTM hold promise in fracture risk prediction and for monitoring treatment. Uncertainties over their clinical use can be in part resolved by adopting international reference standards.
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Affiliation(s)
- S Vasikaran
- Department of Core Clinical Pathology and Biochemistry, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, WA, Australia
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Azagra R, Roca G, Encabo G, Prieto D, Aguyé A, Zwart M, Güell S, Puchol N, Gene E, Casado E, Sancho P, Solà S, Torán P, Iglesias M, Sabaté V, López-Expósito F, Ortiz S, Fernandez Y, Diez-Perez A. Prediction of absolute risk of fragility fracture at 10 years in a Spanish population: validation of the WHO FRAX ™ tool in Spain. BMC Musculoskelet Disord 2011; 12:30. [PMID: 21272372 PMCID: PMC3224379 DOI: 10.1186/1471-2474-12-30] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 01/28/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Age-related bone loss is asymptomatic, and the morbidity of osteoporosis is secondary to the fractures that occur. Common sites of fracture include the spine, hip, forearm and proximal humerus. Fractures at the hip incur the greatest morbidity and mortality and give rise to the highest direct costs for health services. Their incidence increases exponentially with age.Independently changes in population demography, the age - and sex- specific incidence of osteoporotic fractures appears to be increasing in developing and developed countries. This could mean more than double the expected burden of osteoporotic fractures in the next 50 years. METHODS/DESIGN To assess the predictive power of the WHO FRAX™ tool to identify the subjects with the highest absolute risk of fragility fracture at 10 years in a Spanish population, a predictive validation study of the tool will be carried out. For this purpose, the participants recruited by 1999 will be assessed. These were referred to scan-DXA Department from primary healthcare centres, non hospital and hospital consultations. STUDY POPULATION Patients attended in the national health services integrated into a FRIDEX cohort with at least one Dual-energy X-ray absorptiometry (DXA) measurement and one extensive questionnaire related to fracture risk factors. MEASUREMENTS At baseline bone mineral density measurement using DXA, clinical fracture risk factors questionnaire, dietary calcium intake assessment, history of previous fractures, and related drugs. Follow up by telephone interview to know fragility fractures in the 10 years with verification in electronic medical records and also to know the number of falls in the last year. The absolute risk of fracture will be estimated using the FRAX™ tool from the official web site. DISCUSSION Since more than 10 years ago numerous publications have recognised the importance of other risk factors for new osteoporotic fractures in addition to low BMD. The extension of a method for calculating the risk (probability) of fractures using the FRAX™ tool is foreseeable in Spain and this would justify a study such as this to allow the necessary adjustments in calibration of the parameters included in the logarithmic formula constituted by FRAX™.
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Affiliation(s)
- Rafael Azagra
- Department of Medicine, Universitat Autònoma de Barcelona. Psg Vall d'Hebrón 119-129, 08035 Barcelona, Spain
- Primary Healthcare Centre Badia del Vallès, Catalan Health Institute. C/ Bética s/n, 08214 Badia del Vallès (Barcelona), Spain
- Doctorate Program, Department of Medicine, Universitat Autònoma de Barcelona. Psg Vall d'Hebrón 119-129, 08035 Barcelona, Spain
| | - Genís Roca
- Doctorate Program, Department of Medicine, Universitat Autònoma de Barcelona. Psg Vall d'Hebrón 119-129, 08035 Barcelona, Spain
- Primary Healthcare Centre Sant Llàtzer, Sanitary Consortium of Terrassa. C/ de la Riba 62, 08221 Terrassa (Barcelona), Spain
| | - Gloria Encabo
- Nuclear Medicine Service, Vall d'Hebrón University Hospital. Psg Vall d'Hebrón 119-129, 08035 Barcelona, Spain
| | - Daniel Prieto
- Doctorate Program, Department of Medicine, Universitat Autònoma de Barcelona. Psg Vall d'Hebrón 119-129, 08035 Barcelona, Spain
- Primary Healthcare Centre Passeig Sant Joan, Catalan Health Institute. Psg de Sant Joan 267, 08035 Barcelona, Spain
| | - Amada Aguyé
- Primary Healthcare Centre Granollers Centre, Catalan Health Institute. C/ Museu 19, 08400 Granollers (Barcelona), Spain
| | - Marta Zwart
- Doctorate Program, Department of Medicine, Universitat Autònoma de Barcelona. Psg Vall d'Hebrón 119-129, 08035 Barcelona, Spain
- Primary Healthcare Centre Can Gibert del Plà-Girona-2, Catalan Health Institute. C/ Sant Sebastià 50, 17005 Girona, Spain
| | - Sílvia Güell
- Primary Healthcare Centre Montcada i Reixach, Catalan Health Institute. Psg de Jaume I s/n, 08110 Montcada i Reixac (Barcelona), Spain
| | - Núria Puchol
- Primary Healthcare Centre Badia del Vallès, Catalan Health Institute. C/ Bética s/n, 08214 Badia del Vallès (Barcelona), Spain
| | - Emili Gene
- Emergency Department, Hospital de Sabadell, Sanitary Consortium of Parc Taulí, Universitat Autònoma de Barcelona. Parc Tauli s/n, 08208 Sabadell (Barcelona), Spain
| | - Enrique Casado
- Rheumatology Department, Hospital de Sabadell, Sanitary Consortium of Parc Taulí, Universitat Autònoma de Barcelona. Parc Tauli s/n. 08208 Sabadell (Barcelona), Spain
| | - Pilar Sancho
- Primary Healthcare Centre Corbera de Llobregat, Catalan Health Institute. C/ Buenos Aires 9, 08757 Corbera de Llobregat (Barcelona), Spain
| | - Sílvia Solà
- Emergency Department, University Hospital of Bellvitge, Catalan Health Institute. University of Barcelona. C/ de la Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat (Barcelona), Spain
| | - Pere Torán
- Primary Healthcare Research Support Unit Metropolitana Nord, Catalan Health Institute-IDIAP Jordi Gol. Rambla 227, 08223 Sabadell (Barcelona), Spain
| | - Milagros Iglesias
- Primary Healthcare Centre Badia del Vallès, Catalan Health Institute. C/ Bética s/n, 08214 Badia del Vallès (Barcelona), Spain
| | - Victòria Sabaté
- Primary Healthcare Centre Creu Alta, Catalan Health Institute. C/ Castellar del Vallès 222, 08280 Sabadell (Barcelona), Spain
| | | | - Sergio Ortiz
- Primary Healthcare Centre Serraparera, Catalan Health Institute. Avda Diagonal s/n, 08290 Cerdanyola del Vallès (Barcelona), Spain
| | - Yolanda Fernandez
- Doctorate Program, Department of Medicine, Universitat Autònoma de Barcelona. Psg Vall d'Hebrón 119-129, 08035 Barcelona, Spain
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences. University of Oxford. Oxford OX3 7LD. UK
| | - Adolf Diez-Perez
- Doctorate Program, Department of Medicine, Universitat Autònoma de Barcelona. Psg Vall d'Hebrón 119-129, 08035 Barcelona, Spain
- Internal Medicine Service, IMIM-Hospital del Mar. Department of Medicine, Universitat Autònoma de Barcelona. Psg Marítim 25, 08003 Barcelona. Spain
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EMAS position statement: Bone densitometry screening for osteoporosis. Maturitas 2010; 68:98-101. [PMID: 21093180 DOI: 10.1016/j.maturitas.2010.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 09/22/2010] [Accepted: 09/22/2010] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Osteoporosis and its consequent fractures is a major public health problem. AIM To formulate a position statement on the use of bone densitometry in screening postmenopausal women for osteoporosis and in their management. MATERIALS AND METHODS Literature review and consensus of expert opinion. RESULTS AND CONCLUSIONS Bone densitometry has an important role in screening postmenopausal women for osteoporosis. For higher sensitivity and specificity, there may be a stronger case for screening in later life, depending on the extent to which risk factors add to the value of bone mineral density tests.
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An evaluation of the NICE guidance for the prevention of osteoporotic fragility fractures in postmenopausal women. Arch Osteoporos 2010. [DOI: 10.1007/s11657-010-0045-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Southers JA, Bauman JN, Price DA, Humphries PS, Balan G, Sagal JF, Maurer TS, Zhang Y, Oliver R, Herr M, Healy DR, Li M, Kapinos B, Fate GD, Riccardi KA, Paralkar VM, Brown TA, Kalgutkar AS. Metabolism-guided design of short-acting calcium-sensing receptor antagonists. ACS Med Chem Lett 2010; 1:219-23. [PMID: 24900198 DOI: 10.1021/ml100058w] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 05/10/2010] [Indexed: 12/22/2022] Open
Abstract
As part of a strategy to deliver short-acting calcium-sensing receptor (CaSR) antagonists, the metabolically labile thiomethyl functionality was incorporated into the zwitterionic amino alcohol derivative 3 with the hope of increasing human clearance through oxidative metabolism, while delivering a pharmacologically inactive sulfoxide metabolite. The effort led to the identification of thioanisoles 22 and 23 as potent and orally active CaSR antagonists with a rapid onset of action and short pharmacokinetic half-lives, which led to a rapid and transient stimulation of parathyroid hormone in a dose-dependent fashion following oral administration to rats. On the basis of the balance between target pharmacology, safety, and human disposition profiles, 22 and 23 were advanced as clinical candidates for the treatment of osteoporosis.
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Affiliation(s)
| | | | - David A. Price
- Pfizer Global Research and Development, Groton, Connecticut 06340
| | | | - Gayatri Balan
- Pfizer Global Research and Development, Groton, Connecticut 06340
| | - John F. Sagal
- Pfizer Global Research and Development, Groton, Connecticut 06340
| | | | - Yan Zhang
- Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Robert Oliver
- Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Michael Herr
- Pfizer Global Research and Development, Groton, Connecticut 06340
| | - David R. Healy
- Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Mei Li
- Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Brendon Kapinos
- Pfizer Global Research and Development, Groton, Connecticut 06340
| | | | | | | | - Thomas A. Brown
- Pfizer Global Research and Development, Groton, Connecticut 06340
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Morales-Torres J, Clark P, Delezé-Hinojosa M, Cons-Molina F, Messina OD, Hernández J, Jaller-Raad JJ, Quevedo-Solidoro H, Radominski SC. Fracture risk assessment in Latin America: is Frax an adaptable instrument for the region? Clin Rheumatol 2010; 29:1085-91. [PMID: 20632196 DOI: 10.1007/s10067-010-1489-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 05/10/2010] [Indexed: 12/01/2022]
Abstract
Osteoporosis is a generalized disease of bone that increases fracture risk. Multiple factors influence this risk, besides low bone mass. To decrease osteoporotic fractures, those patients who require preventive management should be readily identified. This paper aims to review current information on the use of the fracture risk assessment tool (FRAX) in Latin America. Bone mineral density measurement is currently the method of reference for evaluating the fracture risk and opting for treatment; but, it misses a notable proportion of individuals who have clinical risk factors for osteoporosis and fractures. FRAX was designed to predict the 10-year absolute risk of sustaining a major osteoporotic fracture or a hip fracture. Although data is available for several countries, from Latin America, only Argentina appears in the current version of the tool. Its present use in other Latin American countries is possible with some adaptations based in similarities of epidemiological information of each country with some of the existing databases. The cutoff value beyond which treatment should be initiated needs to be determined, based not only on clinical criteria, but also on economic considerations.
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Affiliation(s)
- Jorge Morales-Torres
- Clínica de Osteoporosis, Hospital Aranda de Parra, Hidalgo 329-704, León, 37000 GTO, México.
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45
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Kalgutkar AS, Griffith DA, Ryder T, Sun H, Miao Z, Bauman JN, Didiuk MT, Frederick KS, Zhao SX, Prakash C, Soglia JR, Bagley SW, Bechle BM, Kelley RM, Dirico K, Zawistoski M, Li J, Oliver R, Guzman-Perez A, Liu KKC, Walker DP, Benbow JW, Morris J. Discovery Tactics To Mitigate Toxicity Risks Due to Reactive Metabolite Formation with 2-(2-Hydroxyaryl)-5-(trifluoromethyl)pyrido[4,3-d]pyrimidin-4(3H)-one Derivatives, Potent Calcium-Sensing Receptor Antagonists and Clinical Candidate(s) for the Treatment of Osteoporosis. Chem Res Toxicol 2010; 23:1115-26. [DOI: 10.1021/tx100137n] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Amit S. Kalgutkar
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - David A. Griffith
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Tim Ryder
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Hao Sun
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Zhuang Miao
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Jonathan N. Bauman
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Mary T. Didiuk
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Kosea S. Frederick
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Sabrina X. Zhao
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Chandra Prakash
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - John R. Soglia
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Scott W. Bagley
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Bruce M. Bechle
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Ryan M. Kelley
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Kenneth Dirico
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Michael Zawistoski
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Jianke Li
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Robert Oliver
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Angel Guzman-Perez
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Kevin K. C. Liu
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Daniel P. Walker
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - John W. Benbow
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
| | - Joel Morris
- Pharmacokinetics, Dynamics and Metabolism Department and Department of Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut 06340
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