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Chakhtoura M, Dagher H, Sharara S, Ajjour S, Chamoun N, Cauley J, Mahfoud Z, Boudreau R, El Hajj Fuleihan G. Systematic review of major osteoporotic fracture to hip fracture incidence rate ratios worldwide: implications for Fracture Risk Assessment Tool (FRAX)-derived estimates. J Bone Miner Res 2021; 36:1942-1956. [PMID: 34152628 PMCID: PMC8531513 DOI: 10.1002/jbmr.4395] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/04/2021] [Accepted: 06/16/2021] [Indexed: 12/21/2022]
Abstract
The Fracture Risk Assessment Tool (FRAX) is the most widely used tool for fracture prediction. It provides 10-year probabilities for hip and major osteoporotic fracture (MOF). It uses country-specific hip fracture incidence and life expectancy data, and for most countries, MOF/hip fracture incidence rate ratios (IRRs) from Malmo Sweden. However, the risk of MOF varies by age, sex, and geography. The objective is to compare the MOF/hip IRRs across countries, by sex and age. This systematic review targeted observational studies of MOF and hip fractures in individuals >50 years (PROSPERO 2019 CRD42019129259). One reviewer screened potential articles. Two reviewers completed duplicate and independent data abstraction, and assessed study quality based on population representativeness, study design and duration, definition of ethnicity, and fracture characteristics. We calculated the MOF/hip IRRs (95% confidence interval) and Z-values to compare IRRs in various countries to those for Sweden. We included 27 studies, of fair to good quality in the majority, from Europe (15), US and Canada (7), Asia (3), and Australia (2). The IRRs were twofold to 10-fold higher in younger compared to older age categories, and in women compared to men, with few exceptions. Within Europe, and using Sweden as a reference, MOF/Hip IRRs in women 50-54 years from Finland, Italy, Netherlands, Denmark, and UK were significantly lower by 38% to 60%. Findings were similar in men. At older ages, MOF/Hip IRRs were consistently lower in women from European countries compared to Sweden, by 10%-40% and 11%-51%, at 75-79 years and 85-89 years, respectively. Findings were heterogenous in men and in non-European countries. In conclusion, the MOF/hip fracture IRR may vary between countries. The variability at older ages may affect FRAX prediction when country-specific fracture IRRs are not used. Further research is needed to elucidate the implication of our findings to FRAX-derived MOF estimates in various countries. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Marlene Chakhtoura
- Calcium Metabolism & Osteoporosis Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hiba Dagher
- Calcium Metabolism & Osteoporosis Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sima Sharara
- Calcium Metabolism & Osteoporosis Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sara Ajjour
- Calcium Metabolism & Osteoporosis Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nariman Chamoun
- Calcium Metabolism & Osteoporosis Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jane Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Robert Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ghada El Hajj Fuleihan
- Calcium Metabolism & Osteoporosis Program, American University of Beirut Medical Center, Beirut, Lebanon
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Copês RM, Comim FV, Barrios NS, Premaor MO. Incidence of fractures in women in the post-menopause: a cohort study in primary care in southern Brazil. Arch Osteoporos 2021; 16:126. [PMID: 34490540 DOI: 10.1007/s11657-021-00972-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/14/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED The incidences of total fracture, major fracture, and hip fractures in primary care in Southern Brazil were 22.3, 15.0, and 3.3 per 1000 person/year. The FRAX algorithm showed an adequate discriminatory capacity for the identification of these fractures. OBEJECTIVE Few studies are evaluating the incidence of fractures in Latin America and Brazil. This study aimed to estimate the incidence of bone fractures in postmenopausal women seen in primary care and evaluate the FRAX algorithm's performance in these women. METHODS A cohort study was carried out in the municipality of Santa Maria, Southern Brazil. Postmenopausal women aged 55 years and over who attended primary health care were included. The recruitment period was from March 1 to August 31, 2013, and the participants were followed for 5 years. The fracture risk was calculated using the FRAX algorithm. The reported incident fractures were confirmed by imaging studies or surgical reports. RESULTS Of the 1057 women recruited for the study, 854 were followed. They contributed to 2732 person/year. The mean follow-up time was 3.2 years (SD 1.05). The incidences of total fractures, major fractures, and hip fractures were 22.3, 15.0, and 3.3 per 1000 person/year. The most frequent fracture sites were the wrist, shoulder, and ribs. The fracture predictors were rheumatoid arthritis, previous fracture, and the use of glucocorticoids. The discriminatory capacity of incident fractures calculated by FRAX without the inclusion of BMD was AUC 0.730 (95% CI 0.570, 0.890) for hip fracture and AUC 0.691 (95% CI 0.598, 0.784) for major fractures. CONCLUSION The FRAX algorithm showed an adequate discriminatory capacity to identify incident fractures in primary care in our study. The incidence of fractures found in our study appears to be lower than that reported in North America and Europe.
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Affiliation(s)
| | - Fabio Vasconcellos Comim
- Department of Clinical Medicine, Medical School, Federal University of Minas Gerais (UFMG), Avenida Professor Alfredo Balena, 190 - sala 246, Belo Horizonte, MG, Brazil
| | | | - Melissa Orlandin Premaor
- Department of Clinical Medicine, Medical School, Federal University of Minas Gerais (UFMG), Avenida Professor Alfredo Balena, 190 - sala 246, Belo Horizonte, MG, Brazil.
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Alpantaki K, Papadaki C, Raptis K, Dretakis K, Samonis G, Koutserimpas C. Gender and Age Differences in Hip Fracture Types among Elderly: a Retrospective Cohort Study. MÆDICA 2020; 15:185-190. [PMID: 32952683 DOI: 10.26574/maedica.2020.15.2.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives: To investigate the differences in distribution of intracapsular and extracapsular hip fractures among genders and age groups treated surgically. Materials and methods: This is a nine-year retrospective cohort study. The type of hip fractures, age, and sex-related as well as overall incidence among 2 430 patients aged over 65, surgically treated at the "Venizeleio" General Hospital of Heraklion, Crete, Greece, were explored and evaluated. Outcomes: Women suffered hip fractures 2.9 times more often than men. The majority of patients hospitalized with hip fracture were above 75 years of age (62.3% in females and 59.3% in males). The proportion of extracapsular and intracapsular fractures were 59.6% and 40.4% in men and 62.7% and 37.2% in women, respectively. Extracapsular-intertrochanteric fractures were found to increase dramatically with age in women (from 52.3% in patients younger than 75 to 58.8% in those older than 75; p-value=0.007), while in men they slightly increased with age (57.7% in patients older than 75, compared to 55.7% in those less than 75; p-value=0.62). Conclusion: The pattern of hip fractures was found to differ between genders and age groups in the present patients' population. Most likely, these findings reflect differences in the nature and rate of bone loss, and frequency of falling events between males and females. It has become evident that the two main hip fracture types (extracapsular and intracapsular) are distinct clinical entities. Hence, they should be addressed independently in terms of underlying causes and prevention strategies.
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Affiliation(s)
- Kalliopi Alpantaki
- Department of Orthopaedics, "Venizeleio" General Hospital of Heraklion, Crete, Greece
| | | | - Konstantinos Raptis
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece
| | | | - George Samonis
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece
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Wang J, Shu B, Li CG, Xie XW, Liang D, Chen BL, Lin XC, Wei X, Wang L, Leng XY, Zhou YJ, Chen PZ, Tao YR, Zhou Y, Zhang Y, Cui XJ, Lu S, Wang H, Shi Q, Wang YJ. Polymorphisms of genes related to vitamin D metabolism and transportation and its relationship with the risk of osteoporosis: protocol for a multicentre prospective cohort study in China. BMJ Open 2019; 9:e028084. [PMID: 31767578 PMCID: PMC6886991 DOI: 10.1136/bmjopen-2018-028084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Osteoporotic fracture is one of the most common causes of disability and a major contributor to medical care costs in many regions of the world. The polymorphisms of genes related to vitamin D metabolism and transportation are associated with variation in bone mineral density and the risk of osteoporosis. METHODS AND ANALYSIS The China Community-based Cohort of Osteoporosis study is an observational, longitudinal, multicentre, prospective cohort study for middle-aged and older permanent residents of China, which has been ongoing in six cities since 2016. Female residents aged 45-80 years old and male residents aged 50-80 years old are identified through permanent resident lists. All the enrolled participants will complete questionnaires on their personal characteristics and histories. The bone mineral density of their lumbar vertebrae and left hip will be measured and serum bone metabolism parameters assessed. Polymorphisms of genes related to vitamin D metabolism and transportation will be detected, and their relationship with the risk of osteoporosis, and osteoporotic fracture, will be analysed. About 18 000 residents will be involved in the study. ETHICS AND DISSEMINATION The study was approved by Institutional Ethics Board of Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine (2016LCSY065). Results will be published in peer-reviewed journals. The results of this study are expected to improve the understanding of the association between polymorphisms of genes related to vitamin D metabolism and transportation and the risk of osteoporosis and osteoporotic fracture among middle-aged and older residents of China. TRIAL REGISTRATION NUMBER NCT02958020.
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Affiliation(s)
- Jing Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai, China
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai, China
| | - Bing Shu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen-Guang Li
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai, China
| | - Xing-Wen Xie
- Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - De Liang
- The First Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Bo-Lai Chen
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Xin-Chao Lin
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xu Wei
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Liang Wang
- The 309th Hospital of Chinese People's Liberation Army, Beijing, China
| | - Xiang-Yang Leng
- Hospital Affiliated to Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Ying-Jie Zhou
- Luoyang Zhenggu Hospital of Henan Province, Luoyang, China
| | - Pei-Zhan Chen
- Clinical Research Center, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Ren Tao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai, China
| | - Yong Zhou
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Zhang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xue-Jun Cui
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai, China
| | - Sheng Lu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Shi
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai, China
| | - Yong-Jun Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- University of Traditional Chinese Medicine, Shanghai, China
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Lang P, Merz C, Hackenbroch C, Friemert B, Stuby F, Palm HG. Magnetic Resonance Imaging in Pelvic Fractures – Part 1: Which Criteria Lead Us to Supplementary MRI Diagnostics? ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 158:351-359. [DOI: 10.1055/a-0965-7589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Introduction Isolated pelvic fractures are relatively rare with an incidence of 3 – 6% of all fractures, but their incidence in polytraumatized individuals increases to 25%. The S3 guideline Polytrauma gives a clear recommendation for diagnostics by means of pelvic radiography (X-ray) and computed tomography (CT). A recommendation for the diagnosis by means of magnetic resonance tomography (MRI) especially in patients with low energetic/missing trauma does not currently exist. It is unclear on the basis of which criteria the MRI can be indicated in pelvic fractures. The aim of our study was therefore to retrospectively record indications for the indication of MRI in pelvic fractures – with adequate as well as inadequate trauma.
Material and Methods In a retrospective clinical study, a total of 140 patients (median 68 years, range 15 – 97, 75 female, and 66 male) with a pelvic fracture were included in the study over a period of three years. Overall, the trauma mechanism revealed 73 adequate and 67 inadequate fractures. 31/140 patients had undergone MRI of the pelvis in addition to a CT/X-ray scan. The two subgroups “with MRI” and “without MRI” were analyzed with regard to the parameters “sex”, “age”, “adequacy of the trauma”, “fracture localization”, “duration of admission to imaging”, “type of therapy” and “duration to surgery” compared.
Results It was shown that the MRI diagnosis was performed especially in female, elderly patients (81 years, range 19 – 94 years). Patients with inappropriate trauma have received MRI more frequently (74%) than patients with adequate trauma (26%). With regard to fracture localization no differences could be shown. The MRI was performed on a median 4 days after the CT examination. Regarding the decision “conservative” vs. “operationally” our two groups without and with MRT tended to differ not. Patients with MRI were operated on median 2 days later than patients who did not receive MRI.
Conclusions Pelvic fracture MRI should be performed primarily in elderly female patients without adequate trauma. In patients with adequate trauma, MRI is of low value, especially as MRI diagnostics are performed with delay, resulting in later surgery.
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Affiliation(s)
- Patricia Lang
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm
| | - Charlotte Merz
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm
| | | | - Benedikt Friemert
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm
| | | | - Hans-Georg Palm
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm
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Ferrari S, Butler PW, Kendler DL, Miller PD, Roux C, Wang AT, Huang S, Wagman RB, Lewiecki EM. Further Nonvertebral Fracture Reduction Beyond 3 Years for Up to 10 Years of Denosumab Treatment. J Clin Endocrinol Metab 2019; 104:3450-3461. [PMID: 31125092 DOI: 10.1210/jc.2019-00271] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/20/2019] [Indexed: 01/22/2023]
Abstract
CONTEXT Evidence for further nonvertebral fracture (NVF) reductions with long-term antiresorptive therapy in osteoporosis is lacking. OBJECTIVE To evaluate NVF risk reduction in subjects receiving ≤10 years of denosumab treatment. DESIGN Phase 3, randomized, placebo-controlled, 3-year Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months (FREEDOM) trial (NCT00089791) and its open-label 7-year extension (NCT00523341). SETTING One hundred seventy-two study centers worldwide. PATIENTS Women 60 to 90 years, lumbar spine or total hip bone mineral density T-scores <-2.5 (≥-4.0 at both). INTERVENTIONS Subjects randomly assigned 1:1 denosumab 60 mg SC Q6M (long-term) or placebo (crossover) in FREEDOM; eligible subjects could enroll in the extension to receive denosumab 60 mg SC Q6M. MAIN OUTCOME MEASURES NVF Exposure-adjusted subject incidence (per 100 subject-years) during denosumab treatment years 1 to 3 and 4 to 7 (all subjects) and years 4 to 10 (long-term only), and rate ratios (RRs) for years 4 to 7 or 4 to 10 vs 1 to 3. RESULTS Among 4074 subjects (2343 long-term, 1731 crossover), NVF rates (95% CI) in all subjects were 2.15 (1.90 to 2.43) during years 1 to 3 and 1.53 (1.34 to 1.75) during years 4 to 7 of denosumab treatment [RR (95% CI) = 0.72 (0.61 to 0.86); P < 0.001]; in long-term only were 1.98 (1.67 to 2.34) during years 1 to 3 and 1.44 (1.24 to 1.66) during years 4 to 10 [RR = 0.74 (0.60 to 0.93); P = 0.008]. combined osteonecrosis of the jaw and atypical femoral fracture rate was 0.06. CONCLUSIONS Long-term denosumab treatment, >3 and ≤10 years, was associated with further reductions in NVF rates compared with the first 3 years.
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Affiliation(s)
| | | | - David L Kendler
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul D Miller
- Colorado Center for Bone Research, Lakewood, Colorado
| | | | | | | | | | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, New Mexico
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A multicenter observational study on the distribution of orthopaedic fracture types across 17 low- and middle-income countries. OTA Int 2019; 2:e026. [PMID: 33937655 PMCID: PMC7997096 DOI: 10.1097/oi9.0000000000000026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Abstract
Objectives: To describe the regional distribution of fractures sustained by women and health care system characteristics across 17 low- and middle-income countries (LMICs). Methods: The INternational ORthopaedic MUlticentre Study in fracture care (INORMUS) is an observational study collecting data on patients in LMICs who sustained a fracture or musculoskeletal injury. As a planned analysis for the INORMUS study, we explored differences in fracture locations and demographics reported among 9878 female patients who sustained a fracture within 17 LMICs in 5 regions (China, Africa, India, Other Asia, and Latin America). Results: Half of our study population (49.6%) was ≥60 years of age. Across all regions, 58.3% of patients possessed health insurance. Latin America possessed the highest proportion (88.8%) of health insurance, while in Africa, patients possessed the lowest (18.0%). Falls from standing were the most prevalent mechanism of injury (51.7%) followed by falls from height (12.8%) and motorcycle-related road traffic injuries (9.7%). The majority of the fractures (65.6%) occurred in patients aged 50 and older. Hip fractures were the most common fracture (26.8%), followed by tibia/fibula (12.6%) and spine fractures (9.7%). Open fractures accounted for 7.6% of fractures and were most commonly tibia/fibula fractures (35.1%). Despite these severe injuries, less than one-third (28.8%) of patients were transported for care after sustaining a fracture by ambulance. Regionally, a majority of female patients in Africa were working age and suffered tibia/fibula (21.6%) and femur fractures (14.0%). Patients in the regional category Other Asia, suffered the highest frequencies of open fractures (9.6% low grade, 7.1% high grade), and disproportionately from motorcycle road traffic injuries (29.9%). Conclusion: Across all regions, the most significant source of fracture burden was in the elderly, and included common fragility fractures, such as hip fractures. Notable regional deviations in fracture distributions were observed within Africa, and Other Asia. Across all studied LMICs, ambulance usage was low, and health insurance coverage was particularly low in Africa and India.
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Mantovani A, Dauriz M, Gatti D, Viapiana O, Zoppini G, Lippi G, Byrne CD, Bonnet F, Bonora E, Targher G. Systematic review with meta-analysis: non-alcoholic fatty liver disease is associated with a history of osteoporotic fractures but not with low bone mineral density. Aliment Pharmacol Ther 2019; 49:375-388. [PMID: 30600540 DOI: 10.1111/apt.15087] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/29/2018] [Accepted: 11/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several studies have explored the effect of non-alcoholic fatty liver disease (NAFLD) on bone mineral density (BMD) and risk of osteoporotic fractures in adults. However, the extent to which NAFLD adversely affects bone health remains uncertain. AIM To provide a quantitative estimation of the magnitude of the association of NAFLD with BMD or history of osteoporotic fractures in adults. METHODS We searched PubMed, Web of Science, and Scopus using predefined keywords to identify all observational studies, published up to 31 August 2018, in which NAFLD was diagnosed by imaging or histology; BMD was measured by dual energy X-ray absorptiometry; and a self-reported history of osteoporotic fractures was collected with interviewer-assisted questionnaires. Data from selected studies were extracted, and meta-analysis was performed using random-effects modelling. RESULTS Twelve cross-sectional or case-control studies with aggregate data on 30 041 adults of predominantly Asian ethnicity (30% with NAFLD) were included in the final analysis. No significant differences in BMD at different skeletal sites (whole body, lumbar spine, or femur) were observed between individuals with and without NAFLD. Conversely, NAFLD was associated with increased odds of osteoporotic fractures, especially in older Chinese men (n = 2 studies; random-effects odds ratio 2.10, 95% CI 1.36-3.25; I2 = 0%). Sensitivity analyses did not alter these findings. The funnel plot and Egger test did not reveal significant publication bias. CONCLUSIONS This meta-analysis suggests that imaging-defined or biopsy-proven NAFLD is associated with a self-reported history of osteoporotic fractures (principally in Chinese men), but not with low BMD, in middle-aged and elderly individuals.
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Affiliation(s)
- Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Marco Dauriz
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Davide Gatti
- Section of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Ombretta Viapiana
- Section of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giacomo Zoppini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona, Italy
| | - Christopher D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK.,Southampton National Institute for Health Research Biomedical Research Centre, Southampton General Hospital, University Hospital Southampton, Southampton, UK
| | - Fabrice Bonnet
- Department of Endocrinology, INSERM UMR 991, University Hospital of Rennes, Rennes Cedex 9, France
| | - Enzo Bonora
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Chen X, Yang L, Ge D, Wang W, Yin Z, Yan J, Cao X, Jiang C, Zheng S, Liang B. Long non-coding RNA XIST promotes osteoporosis through inhibiting bone marrow mesenchymal stem cell differentiation. Exp Ther Med 2018; 17:803-811. [PMID: 30651866 PMCID: PMC6307375 DOI: 10.3892/etm.2018.7033] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/01/2018] [Indexed: 12/31/2022] Open
Abstract
The purpose of the present study was to identify the key long non-coding (lnc)RNAs in the occurrence and development of osteoporosis (OP) and to explore the associated molecular mechanism. First, the Gene Expression Omnibus (GEO) datasets, with key words ‘osteoporosis’ and ‘HG-133A’, were screened. RankProd R package was used to calculate the dysregulated lncRNAs in OP. Following this, bone marrow mesenchymal stem cells (BM-MSCs) harvested from 3-week-old Sprague Dawley rats were employed for detection of osteoblast differentiation. Following overexpression or interference with X-inactive specific transcript (XIST), osteogenesis-associated genes and proteins in BM-MSCs were detected using reverse transcription-quantitative polymerase chain reaction and western blot analysis. Alkaline phosphatase (ALP) and Alizarin Red S staining were also performed to measure the osteogenic ability of BM-MSCs. Results from the two datasets indicated that 6 lncRNAs were dysregulated in OP. Notably, XIST is key lncRNA in diverse diseases, and was subsequently selected for analysis. It was revealed that XIST was significantly upregulated in plasma and monocytes from patients with OP compared with the normal controls. Furthermore, results indicated that overexpression of XIST significantly inhibited osteoblast differentiation in BM-MSCs, as evidenced by the decreased expression of ALP, bone γ-carboxyglutamic acid-containing protein and runt related transcription factor 2, reduced ALP activity and a decreased number of calcium deposits. However, interference of XIST exhibited the opposite biological effects in BM-MSCs. Taken together, XIST was highly expressed in the serum and monocytes of patients with OP. In addition, the findings suggested that XIST could inhibit osteogenic differentiation of BM-MSCs.
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Affiliation(s)
- Xi Chen
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Lei Yang
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Dawei Ge
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Weiwei Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Zhaowei Yin
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Junwei Yan
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Xiaojian Cao
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Chunzhi Jiang
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Shengnai Zheng
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Bin Liang
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
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Litwic AE, Westbury LD, Robinson DE, Ward KA, Cooper C, Dennison EM. Bone Phenotype Assessed by HRpQCT and Associations with Fracture Risk in the GLOW Study. Calcif Tissue Int 2018; 102:14-22. [PMID: 28913616 PMCID: PMC5760585 DOI: 10.1007/s00223-017-0325-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/05/2017] [Indexed: 11/06/2022]
Abstract
The epidemiology and pathogenesis of fractures in postmenopausal women has previously been investigated in the Global Longitudinal study of Osteoporosis in Women (GLOW). To date, however, relationships between bone imaging outcomes and fracture have not been studied in this cohort. We examined relationships between high-resolution peripheral quantitative computed tomography (HRpQCT) parameters and fracture in the UK arm of GLOW, performing a cluster analysis to assess if our findings were similar to observations reported from older participants of the Hertfordshire Cohort Study (HCS), and extended the analysis to include tibial measurements. We recorded fracture events and performed HRpQCT of the distal radius and tibia and dual-energy X-ray absorptiometry (DXA) of the hip in 321 women, mean age 70.6 (SD 5.4) years, identifying four clusters at each site. We saw differing relationships at the radius and tibia. Two radial clusters (3 and 4) had a significantly lower hip areal bone mineral density (p < 0.001) compared to Cluster 1; only individuals in Cluster 4 had a significantly higher risk of fracture (p = 0.005). At the tibia, clusters 1, 3 and 4 had lower hip areal bone mineral density (p < 0.001) compared to Cluster 2; individuals in Cluster 3 had a significantly higher risk of fracture (p = 0.009). In GLOW our findings at the radius were very similar to those previously reported in the HCS, suggesting that combining variables derived from HRpQCT may give useful information regarding fracture risk in populations where this modality is available. Further data relating to tibial HRpQCT-phenotype and fractures are provided in this paper, and would benefit from validation in other studies. Differences observed may reflect age differences in the two cohorts.
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Affiliation(s)
- A E Litwic
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - L D Westbury
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - D E Robinson
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - K A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
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11
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Rasmussen JV, Brorson S, Hallan G, Dale H, Äärimaa V, Mokka J, Jensen SL, Fenstad AM, Salomonsson B. Is it feasible to merge data from national shoulder registries? A new collaboration within the Nordic Arthroplasty Register Association. J Shoulder Elbow Surg 2016; 25:e369-e377. [PMID: 27107732 DOI: 10.1016/j.jse.2016.02.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 02/19/2016] [Accepted: 02/24/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Nordic Arthroplasty Register Association was initiated in 2007, and several papers about hip and knee arthroplasty have been published. Inspired by this, we aimed to examine the feasibility of merging data from the Nordic national shoulder arthroplasty registries by defining a common minimal data set. METHODS A group of surgeons met in 2014 to discuss the feasibility of merging data from the national shoulder registries in Denmark, Norway, and Sweden. Differences in organization, definitions, variables, and outcome measures were discussed. A common minimal data set was defined as a set of variables containing only data that all registries could deliver and where consensus according to definition of the variables could be made. RESULTS We agreed on a data set containing patient-related data (age, gender, and diagnosis), operative data (date, arthroplasty type and brand), and data in case of revision (date, reason for revision, and new arthroplasty brand). From 2004 to 2013, there were 19,857 primary arthroplasties reported. The most common indications were osteoarthritis (35%) and acute fracture (34%). The number of arthroplasties and especially the number of arthroplasties for osteoarthritis have increased in the study period. The most common arthroplasty type was total shoulder arthroplasty (34%) for osteoarthritis and stemmed hemiarthroplasty (90%) for acute fractures. CONCLUSION We were able to merge data from the Nordic national registries into 1 common data set; however, the set of details was reduced. We found considerable differences between the 3 countries regarding incidence of shoulder arthroplasty, age, diagnoses, and choice of arthroplasty type and brand.
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Affiliation(s)
- Jeppe V Rasmussen
- Department of Orthopaedic Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
| | - Stig Brorson
- Department of Orthopaedic Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Geir Hallan
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Håvard Dale
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ville Äärimaa
- Departments of Orthopaedics and Traumatology, Turku University Hospital, Åbo, Finland
| | - Jari Mokka
- Departments of Orthopaedics and Traumatology, Turku University Hospital, Åbo, Finland
| | - Steen L Jensen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Anne M Fenstad
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Björn Salomonsson
- Department of Orthopedics, Karolinska Institutet, Danderyds Sjukhus AB, Danderyd, Stockholm, Sweden
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Çankaya D, Yoldaş B, Çankaya E, Çakir Y, Aydin C, Tabak AY. Analysis of the hip fracture records of a central training and research hospital by selected characteristics. Turk J Med Sci 2016; 46:35-41. [PMID: 27511330 DOI: 10.3906/sag-1406-150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 02/11/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Despite the importance of hip fractures, very few studies have assessed their epidemiological characteristics in Turkey. The aim of this study was to evaluate the frequency and demography of hip fractures from the recent data of a central training and research hospital. MATERIALS AND METHODS In this descriptive study, we identified hip fracture cases between 2009 and 2013. The age, sex, region, injury pattern, and calendar year for all patients were evaluated. RESULTS Among the 687 patients (488 women, 199 men) described in our clinic's records, 122, 131, 144, 138, and 154 patients applied with hip fractures from the years 2009 to 2013, respectively. The mean ages of the women and men were 74.8 and 68.5 years, respectively. There were 220 patients who had femoral neck fracture (32%), 419 who had intertrochanteric fracture (61%), and 48 who had subtrochanteric fracture (7%). CONCLUSION The female geriatric population may have an increasing and distinct hip fracture risk, mainly in the trochanteric region. Furthermore, recent studies that show variations in the frequency and demography of hip fractures highlight the importance of meticulous recording of patients' information. A nationwide survey of different categories of hospitals and various geographic regions of Turkey is also needed to inform effective prevention strategies.
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Affiliation(s)
- Deniz Çankaya
- Department of Orthopedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Burak Yoldaş
- Department of Orthopedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Elif Çankaya
- Department of Internal Audit, Ministry of Health, Ankara, Turkey
| | - Yalçın Çakir
- Department of Orthopedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Cemal Aydin
- Department of Orthopedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Abdullah Yalçın Tabak
- Department of Orthopedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Klop C, Welsing PMJ, Leufkens HGM, Elders PJM, Overbeek JA, van den Bergh JP, Bijlsma JWJ, de Vries F. The Epidemiology of Hip and Major Osteoporotic Fractures in a Dutch Population of Community-Dwelling Elderly: Implications for the Dutch FRAX® Algorithm. PLoS One 2015; 10:e0143800. [PMID: 26633011 PMCID: PMC4669166 DOI: 10.1371/journal.pone.0143800] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/10/2015] [Indexed: 11/18/2022] Open
Abstract
Background Incidence rates of non-hip major osteoporotic fractures (MOF) remain poorly characterized in the Netherlands. The Dutch FRAX® algorithm, which predicts 10-year probabilities of hip fracture and MOF (first of hip, humerus, forearm, clinical vertebral), therefore incorporates imputed MOF rates. Swedish incidence rate ratios for hip fracture to MOF (Malmo 1987–1996) were used to perform this imputation. However, equality of these ratios between countries is uncertain and recent evidence is scarce. Aims were to estimate incidence rates of hip fracture and MOF and to compare observed MOF rates to those predicted by the imputation method for the Netherlands. Methods Using hospitalisation and general practitioner records from the Dutch PHARMO Database Network (2002–2011) we calculated age-and-sex-specific and age-standardized incidence rates (IRs) of hip and other MOFs (humerus, forearm, clinical vertebral) and as used in FRAX®. Observed MOF rates were compared to those predicted among community-dwelling individuals ≥50 years by the standardized incidence ratio (SIR; 95% CI). Results Age-standardized IRs (per 10,000 person-years) of MOF among men and women ≥50 years were 25.9 and 77.0, respectively. These numbers were 9.3 and 24.0 for hip fracture. Among women 55–84 years, observed MOF rates were significantly higher than predicted (SIR ranged between 1.12–1.50, depending on age). In men, the imputation method performed reasonable. Conclusion Observed MOF incidence was higher than predicted for community-dwelling women over a wide age-range, while it agreed reasonable for men. As miscalibration may influence treatment decisions, there is a need for confirmation of results in another data source. Until then, the Dutch FRAX® output should be interpreted with caution.
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Affiliation(s)
- Corinne Klop
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
| | - Paco M. J. Welsing
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands
| | - Hubert G. M. Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
| | - Petra J. M. Elders
- Department of General Practice and Elderly Care, VU University Medical Centre, Amsterdam, Netherlands
| | | | - Joop P. van den Bergh
- Department of Internal Medicine, Viecuri Medical Centre, Venlo, Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
- Biomedical Research Institute, University Hasselt, Hasselt, Belgium
| | - Johannes W. J. Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, Netherlands
| | - Frank de Vries
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Netherlands
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, United Kingdom
- * E-mail:
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Siris ES, Yu J, Bognar K, DeKoven M, Shrestha A, Romley JA, Modi A. Undertreatment of osteoporosis and the role of gastrointestinal events among elderly osteoporotic women with Medicare Part D drug coverage. Clin Interv Aging 2015; 10:1813-24. [PMID: 26604724 PMCID: PMC4639522 DOI: 10.2147/cia.s83488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives To examine the rate of osteoporosis (OP) undertreatment and the association between gastrointestinal (GI) events and OP treatment initiation among elderly osteoporotic women with Medicare Part D drug coverage. Methods This retrospective cohort study utilized a 20% random sample of Medicare beneficiaries. Included were women ≥66 years old with Medicare Part D drug coverage, newly diagnosed with OP in 2007–2008 (first diagnosis date as the index date), and with no prior OP treatment. GI event was defined as a diagnosis or procedure for a GI condition between OP diagnosis and treatment initiation or at the end of a 12-month follow-up, whichever occurred first. OP treatment initiation was defined as the use of any bisphosphonate (BIS) or non-BIS within 1 year postindex. Logistic regression, adjusted for patient characteristics, was used to model the association between 1) GI events and OP treatment initiation (treated versus nontreated); and 2) GI events and type of initial therapy (BIS versus non-BIS) among treated patients only. Results A total of 126,188 women met the inclusion criteria: 72.1% did not receive OP medication within 1 year of diagnosis and 27.9% had GI events. Patients with a GI event were 75.7% less likely to start OP treatment (odds ratio [OR]=0.243; P<0.001); among treated patients, patients with a GI event had 11.3% lower odds of starting with BIS versus non-BIS (OR=0.887; P<0.001). Conclusion Among elderly women newly diagnosed with OP, only 28% initiated OP treatment. GI events were associated with a higher likelihood of not being treated and, among treated patients, a lower likelihood of being treated with BIS versus non-BIS.
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Affiliation(s)
- Ethel S Siris
- Toni Stabile Osteoporosis Center, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, USA
| | - Jingbo Yu
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - Mitch DeKoven
- Real-World Evidence Solutions, IMS Health, Fairfax, VA, USA
| | | | - John A Romley
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
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Copês RM, Comim FV, Langer FW, Codevilla AADS, Sartori GR, de Oliveira C, Cocco AR, de Almeida AM, de Almeida LL, Dal Osto LC, Compston JE, Premaor MO. Obesity and Fractures in Postmenopausal Women: A Primary-care Cross-Sectional Study at Santa Maria, Brazil. J Clin Densitom 2015; 18:165-71. [PMID: 25534276 DOI: 10.1016/j.jocd.2014.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 09/26/2014] [Indexed: 01/14/2023]
Abstract
Obesity and osteoporosis are chronic disorders with increasing prevalence worldwide. The aim of this study was to investigate the association between obesity and fracture in postmenopausal women from Santa Maria, Brazil. A cross-sectional study was carried out at Santa Maria (parallel 29° south), Brazil. Postmenopausal women aged ≥55 yr who had at least 1 appointment at the primary care in the 2 years before the study were recruited from March 1, 2013 to August 31, 2013. The Global Longitudinal Study of Osteoporosis in Women study questionnaire was applied with permission of The Center for Outcomes Research, University of Massachusetts Medical School. Height and weight were measured according to the World Health Organization protocol. Bone fractures (excluding hand, feet, and head) that occurred after the age of 45 yr were considered as the outcome. Overall, 1057 women completed the study, of whom 984 had body mass index measured. The mean (standard deviation) age and body mass index of the women included in the study were 67.1 (7.6) yr and 29.2 (5.5) kg/m(2), respectively. The prevalence of fractures in obese and nonobese women was similar (17.3% vs 16.0%); 41.4% of all fractures occurred in obese women. Obese postmenopausal women make a substantial contribution to the overall burden of prevalent fractures in this population. Our results provide further evidence in support of the concept that obesity is not protective against fracture.
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Affiliation(s)
- Rafaela Martinez Copês
- Pós-graduação em Ciências da Saúde, Federal University of Santa Maria, Santa Maria, Brazil; Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | - Fabio Vasconcellos Comim
- Pós-graduação em Ciências da Saúde, Federal University of Santa Maria, Santa Maria, Brazil; Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | - Felipe Welter Langer
- Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Giovani Ruviaro Sartori
- Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | - Cristina de Oliveira
- Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | - Aline Rubin Cocco
- Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | - Adriana Maria de Almeida
- Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | - Luciana Leiria de Almeida
- Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | - Léo Canterle Dal Osto
- Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Melissa Orlandin Premaor
- Pós-graduação em Ciências da Saúde, Federal University of Santa Maria, Santa Maria, Brazil; Grupo de Pesquisas em Doenças Osteometabólicas Crônicas, Departamento de Clínica Médica, Federal University of Santa Maria, Santa Maria, Brazil.
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16
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Lambrinoudaki I, Flokatoula M, Armeni E, Pliatsika P, Augoulea A, Antoniou A, Alexandrou A, Creatsa M, Panoulis C, Dendrinos S, Papacharalambous X. Vertebral fracture prevalence among Greek healthy middle-aged postmenopausal women: association with demographics, anthropometric parameters, and bone mineral density. Spine J 2015; 15:86-94. [PMID: 25106754 DOI: 10.1016/j.spinee.2014.07.021] [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: 02/11/2014] [Accepted: 07/29/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The prevalence of skeletal fractures shows a marked geographic variability; however, data regarding the Greek population remain limited. PURPOSE To evaluate the frequency of asymptomatic vertebral fractures (VFs), and potential risk factors, in a large sample of Greek postmenopausal women. STUDY DESIGN A cross-sectional study at the University Menopause Clinic. PATIENT SAMPLE Four hundred fifty-four postmenopausal women aged 35 to 80 years, with an average menopausal age of 9.2±7.1 years. OUTCOME MEASURES They included medical history, anthropometric and biochemical parameters, bone mineral density (BMD) at lumbar spine (LS) and femoral neck (FN), and LS lateral radiographs. METHODS Lumbar spine lateral radiographs were evaluated according to quantitative procedures, aiming to identify VFs. Anthropometric and biochemical parameters and values of BMD were compared according to the presence of VFs. RESULTS A total of 37 (8.15%) women had at least one VF. Lumbar spine and FN-osteoporosis was identified in up to 23.1% and 40.9% subjects with prevalent VFs, respectively. The prevalence of VFs was largely associated with age, with women aged 60 years or more presenting an up to fourfold risk compared with younger women. Moreover, the presence of VFs was associated with higher menopausal age, advanced age at menarche, a history of early menopause, and prolonged lactation. Lower LS-BMD and, especially, FN-BMD were negatively associated with VF prevalence (prevalent VF vs. no VF: LS-BMD, 0.89±0.16 g/cm(2) vs. 0.98±0.16 g/cm(2), p=.010; FN-BMD, 0.72±0.10 g/cm(2) vs. 0.81±0.12 g/cm(2), p=.008). CONCLUSIONS Asymptomatic VFs are common among Greek healthy middle-aged postmenopausal women. More than 50% subjects with prevalent VFs present with normal BMD or osteopenia. Age and bone density classification at the FN presented the strongest association with the prevalence of VFs.
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Affiliation(s)
- Irene Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece.
| | - Maria Flokatoula
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Eleni Armeni
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Paraskevi Pliatsika
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Areti Augoulea
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Aris Antoniou
- 1st Department of Radiology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Andreas Alexandrou
- 1st Department of Surgery, University of Athens, Laiko Athens General Hospital, 17 Agiou Thoma St, GR-11527 Athens, Greece
| | - Maria Creatsa
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Constantinos Panoulis
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Spyridon Dendrinos
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Xenofon Papacharalambous
- 1st Department of Radiology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
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Abstract
GLOW is an observational, longitudinal, practice-based cohort study of osteoporosis in 60,393 women aged ≥55 years in 10 countries on three continents. In this Review, we present insights from the first 3 years of the study. Despite cost analyses being frequently based on spine and hip fractures, we found that nonvertebral, nonhip fractures were around five times more common and doubled the use of health-care resources compared with hip and spine fractures combined. Fractures not at the four so-called major sites in FRAX(®) (upper arm, forearm, hip and clinical vertebral fractures) account for >40% of all fractures. The risk of fracture is increased by various comorbidities, such as Parkinson disease, multiple sclerosis and lung and heart disease. Obesity, although thought to be protective against all fractures, substantially increased the risk of fractures in the ankle or lower leg. Simple assessment by age plus fracture history has good predictive value for all fractures, but risk profiles differ for first and subsequent fractures. Fractures diminish quality of life as much or more than diabetes mellitus, arthritis and lung disease, yet women substantially underestimate their own fracture risk. Treatment rates in patients at high risk of fracture are below those recommended but might be too frequent in women at low risk. Comorbidities and the limits of current therapeutic regimens jeopardize the efficacy of drugs; new regimens should be explored for severe cases.
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Affiliation(s)
- Nelson B Watts
- Mercy Health Osteoporosis and Bone Health Services, 4760 E. Galbraith Road, Suite 212, Cincinnati, OH 45236, USA
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18
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Azagra R, López-Expósito F, Martin-Sánchez JC, Aguyé A, Moreno N, Cooper C, Díez-Pérez A, Dennison EM. Changing trends in the epidemiology of hip fracture in Spain. Osteoporos Int 2014; 25:1267-74. [PMID: 24322478 PMCID: PMC4890654 DOI: 10.1007/s00198-013-2586-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/18/2013] [Indexed: 01/08/2023]
Abstract
UNLABELLED Temporal trends in hip fracture incidence have recently been reported in some developed countries. Such data in Spain has previously been incomplete; this study reports the stratified incidence of hip fractures in people over 65 in Spain during the last 14 years. INTRODUCTION The main objective is to establish whether temporal trends in hip fracture incidence in Spain exist. METHODS Ecological study with data from hospital discharges nationwide. The study includes patients aged ≥ 65 years during a 14-year period (1997-2010). The analysis compares two periods of four years: 1997-2000 (P1) and 2007-2010 (P2). RESULTS There were 119,857 fractures in men and 415,421 in women. Comparing periods (P1 vs P2) over 10 years, the crude incidence rate/100,000 inhabitant/year increased an average of 2.3%/year in men and 1.4% in women. After adjustment, the rate increased an average of 0.4%/year in men (p < 0.0001), but decreased 0.2%/year in women (p < 0.0001). In men, younger than 85, the decrease was not significant except in 70-74 years, and from 80 years, the adjusted rate increases significantly (p < 0.0001). In women under 80 years of age, the decrease in adjusted rate was significant; there was no change in 80-84 years, and the adjusted rate increased significantly in individuals 85 years and older (p < 0.0001). Mortality rates declined by 22% in both sexes, and the index of overaging population rises 30.1 % in men and 25.2% in women. CONCLUSIONS This study supports other international studies by showing changes in the incidence of hip fractures after age-population adjustment, which denotes a decrease in the younger age groups and among women and shows an increase in both groups over 85 years. The increase in the crude incidence rate of hip fracture in Spain reflects changes in population structure.
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Affiliation(s)
- R Azagra
- Department of Medicine, Universitat Autònoma de Barcelona, ps/ Vall d' Hebron 119, 08135, Barcelona, Spain,
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Ma YL, Zeng QQ, Chiang AY, Burr D, Li J, Dobnig H, Fahrleitner-Pammer A, Michalská D, Marin F, Pavo I, Stepan JJ. Effects of teriparatide on cortical histomorphometric variables in postmenopausal women with or without prior alendronate treatment. Bone 2014; 59:139-47. [PMID: 24269280 DOI: 10.1016/j.bone.2013.11.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 11/05/2013] [Accepted: 11/12/2013] [Indexed: 11/25/2022]
Abstract
Cortical bone, the dominant component of the human skeleton by volume, plays a key role in protecting bones from fracture. We analyzed the cortical bone effects of teriparatide treatment in postmenopausal women with osteoporosis who had previously received long-term alendronate (ALN) therapy or were treatment naïve (TN). Tetracycline-labeled paired iliac crest biopsies obtained from 29 ALN-pretreated and 16 TN women were evaluated for dynamic histomorphometric parameters of bone formation at the periosteal, endocortical and intracortical bone compartments, before and after 24months of teriparatide treatment. At baseline, the frequency of specimens without any endocortical and periosteal tetracycline labeling, and the percentage of quiescent osteons, was higher in the ALN than the TN group. Endocortical and periosteal mineralizing surface (MS/BS%), periosteal bone formation rate (BFR/BS), mineral apposition rate (MAR) and the number of intracortical forming osteons were significantly lower in the ALN-pretreated patients than in the TN group. Following teriparatide treatment, the frequency of endocortical and periosteal unlabeled biopsies decreased; in the ALN-pretreated group the percentage of quiescent osteons decreased and, in contrast, forming and resorbing osteons were increased. Teriparatide treatment resulted in significant increases of MAR in the endocortical, and MS/BS% in the periosteal compartment in the ALN-pretreated group. Most indices of bone formation remained lower in the ALN-pretreated group compared with the TN group at study end. Endocortical wall width was increased in both ALN-pretreated and TN groups. Cortical porosity and cortical thickness were significantly increased in the ALN-pretreated group after teriparatide treatment. Our results suggest that 24months of teriparatide treatment increases cortical bone formation and cortical turnover in patients who were either TN or had previous ALN therapy.
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Affiliation(s)
- Yanfei L Ma
- Lilly Research Laboratories, Indianapolis, IN, USA.
| | - Qing Q Zeng
- Lilly Research Laboratories, Indianapolis, IN, USA.
| | | | - David Burr
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Jiliang Li
- Department of Biology, Indiana University Purdue University, Indianapolis, IN, USA.
| | - Harald Dobnig
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria.
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria.
| | - Dana Michalská
- 3rd Dept. of Internal Medicine, Charles University Faculty of Medicine 1, Prague, Czech Republic.
| | | | - Imre Pavo
- Lilly Research Centre, Windlesham, United Kingdom.
| | - Jan J Stepan
- Institute of Rheumatology, and Charles University Faculty of Medicine 1, Prague, Czech Republic.
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Lam A, Leslie WD, Lix LM, Yogendran M, Morin SN, Majumdar SR. Major osteoporotic to hip fracture ratios in canadian men and women with Swedish comparisons: a population-based analysis. J Bone Miner Res 2014; 29:1067-73. [PMID: 24243719 DOI: 10.1002/jbmr.2146] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/21/2013] [Accepted: 11/12/2013] [Indexed: 12/17/2022]
Abstract
Fracture Risk Assessment (FRAX) tools are calibrated from country-specific fracture epidemiology. Although hip fracture data are usually available, data on non-hip fractures for most countries are often lacking. In such cases, rates are often estimated by assuming similar non-hip to hip fracture ratios from historical (1987 to 1996) Swedish data. Evidence that countries share similar fracture ratios is limited. Using data from Manitoba, Canada (2000 to 2007, population 1.2 million), we identified 21,850 incident major osteoporotic fractures (MOF) in men and women aged >50 years. Population-based age- and sex-specific ratios of clinical vertebral, forearm, and humerus fractures to hip fractures were calculated, along with odds ratios (ORs) and 95% confidence intervals (CIs). All ratios showed decreasing trends with increasing age for both men and women. Men and women showed similar vertebral/hip fracture ratios (all p > 0.1, with ORs 0.86 to 1.25). Forearm/hip and humerus/hip fracture ratios were significantly lower among men than women (forearm/hip ratio: p < 0.01 for all age groups, with ORs 0.29 to 0.53; humerus/hip ratio: p < 0.05 for all age groups [except 80 to 84 years] with ORs 0.46 to 0.86). Ratios for any MOF/hip fracture were also significantly lower among men than women in all but two subgroups (p < 0.05 for all age groups [except 80 to 84 and 90+ years] with ORs 0.48 to 0.87). Swedish vertebral/hip fracture ratios were similar to the Canadian fracture ratios (within 7%) but significantly lower for other sites (men and women: 46% and 35% lower for forearm/hip ratios, 19% and 15% lower for humerus/hip ratios, and 19% and 23% lower for any MOF/hip ratios). These differences have implications for updating and calibrating FRAX tools, fracture risk estimation, and intervention rates. Moreover, wherever possible, it is important that countries try to collect accurate non-hip fracture data.
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Affiliation(s)
- Anna Lam
- University of Manitoba, Winnipeg, Canada
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Eriksen EF, Díez-Pérez A, Boonen S. Update on long-term treatment with bisphosphonates for postmenopausal osteoporosis: a systematic review. Bone 2014; 58:126-35. [PMID: 24120384 DOI: 10.1016/j.bone.2013.09.023] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 09/26/2013] [Accepted: 09/30/2013] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Osteoporosis is a progressive skeletal disorder that requires long-term treatment. However, there is little guidance regarding optimal treatment duration and what the treatment discontinuation and retreatment criteria should be. Given that bisphosphonates are the most commonly prescribed class of agent for the treatment of osteoporosis, we reviewed the long-term data relating to these therapies and discussed the considerations for using bisphosphonates in postmenopausal women with osteoporosis. METHODS A PubMed search, using the search terms 'bisphosphonate', 'postmenopausal osteoporosis' and 'long term' and/or 'extension' was conducted in January 2013. Results from nine controlled studies that prospectively assessed alendronate, risedronate, ibandronate or zoledronic acid in women with postmenopausal osteoporosis were reviewed. FINDINGS Clinical studies in postmenopausal women with osteoporosis showed that long-term use of bisphosphonates resulted in persistent antifracture and bone mineral density (BMD) increasing effects beyond 3 years of treatment. No unexpected adverse events were identified in these studies and the long-term tolerability profiles of bisphosphonates remain favorable. Data from the withdrawal extension studies of alendronate and zoledronic acid also showed that residual fracture benefits were seen in patients who discontinued treatment for 3 to 5 years after an initial 3- to 5-year treatment period. BMD monitoring and fracture risk assessments should be conducted regularly to determine whether treatment could be stopped or should be reinitiated. Patients exhibiting T-scores<-2.5 or who have suffered a new fracture while on treatment should continue treatment, while patients with T-scores>-2.5 could be considered for discontinuation of active treatment while undergoing continued monitoring of their bone health. The duration and potential discontinuation of treatment should be personalized for individual patients based on their response to treatment, fracture risk and comorbidities.
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Affiliation(s)
- Erik F Eriksen
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway.
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Abstract
Osteoporosis and related fractures disproportionately impact patients with advanced age, those with the frailty phenotype, and those with multiple comorbidities. Recent studies report a changing incidence in fracture type among the oldest old throughout the world, a finding not satisfactorily explained by advances in treatment of lifestyle factors. A growing recognition of the importance of muscle and bone interaction is leading to improved understanding of the underlying biochemical pathways linking them and new therapeutic targets. New models of care for frail older populations, particularly after hip fracture, are being developed but have been challenged to identify appropriate outcomes to target. An appreciation for the relationship between age-related comorbidities, fracture risk, and competing mortality risk is essential for practitioners caring for the oldest-old population.
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Affiliation(s)
- Cathleen S Colón-Emeric
- Duke University Medical Center and the Durham VA Geriatrics Research Education and Clinical Center, 508 Fulton St. GRECC 182, Durham, NC, 27705, USA,
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