Prevalence of postmenopausal osteoporosis in Italy and validation of decision rules for referring women for bone densitometry

Quality of life of postmenopausal women with teriparatide, denosumab and alendronate: One-year prospective study with a propensity score-matched comparison

Background/purpose: To evaluate and compare the effects of parathyroid hormone analogues, receptor activators of nuclear factor kappa-B ligand inhibitors and bisphosphonates on the quality of life of postmenopausal women. Methods: A prospective observational study of 23 matched postmenopausal women was conducted with propensity score analysis on quality of life at one-year follow-up. Visual analogue scale for back pain and outcome scores were carried out as the quality of life or treatment adherence measurements. Results: Teriparatide use was associated with significant improvements in visual analogue scale, EuroQol 5-level 5-dimension general health status and Osteoporosis Assessment Questionnaire physical function, whereas denosumab and alendronate groups only demonstrated improved Osteoporosis Assessment Questionnaire scores but worsened back pain. Baseline average visual analogue scale back pain predicted one-year average back pain progression (partial eta squared = 0.617, p = 0.001). Conclusions: One-year continuous teriparatide treatment is most effective in improving quality of life outcomes in postmenopausal osteoporotic women. Baseline average visual analogue scale back pain remained the only predictive factor for one-year back pain progression.

Bone Mineral Density Reference Values in 18- to 95-Year-Old Population in Lombardy Region, Italy

The aim of this study is to assess the bone mineral density (BMD) and T-score reference values in a population from 18 to 95 years old in Lombardy region, Italy. This study also investigates the association between BMD values and body mass index (BMI) divided by gender and age. The evaluation of BMD was analyzed by T-score and BMD in each site, femur, and column. A total of 10,503 patients (9,627 females and 876 males, 65.04±12.18 years) have been enrolled in this study. The women hip femur reference values associated with a situation of osteopenia highlighted in-line with the class of age of 45 to 55 years were: mean values: -1.3132 T-score; 95% confidence interval (CI): -1.3600 to -1.2664 and of osteoporosis from the class of age 85 to 95 years, mean values: -2.6591 T-score, 95% CI: -2.7703 to -2.5479. The men hip femur reference values associated with a situation of osteopenia highlighted in-line with the class of age of 45 to 55 years were: mean values: 1.2986 T-score; 95% CI: -1.5454 to -1.0518. A positive association between BMI and the two sites of BMD was recorded (p > .05). This study provides an Italian overview of national and regional reference values about the BMD and T-score values divided by age and gender as reference values for clinicians for a correct assessment and monitoring.

Prevalence of osteopenic syndrome and osteoporosis among residents of the older age group of Kyrgyzstan

Osteoporosis is the most common metabolic bone disease. However, because it is asymptomatic, it cannot be diagnosed until a clinical event such as a fracture occurs. It is osteoporotic fractures, not osteoporosis itself, that lead to noticeable clinical and economic consequences.

The aim. To study the frequency of osteopenia and osteoporosis in the older age group of the population of Kyrgyzstan using ultrasound bone densitometry.

Materials and methods. A total of 1988 people were examined – 1105 women, 883 men. By age, the patients were divided into three age groups: 40–59, 60–74 and 75–90 years old. A portable ultrasonic bone densitometer SONOST-3000 (South Korea) was used to measure bone mineral density.

Results. The prevalence of osteoporosis, osteopenia, and normal bone mineral density in the first age group was 20.9 %, 40.0 % and 39.1 %; in the second group – 30.2 %, 38.9 % and 30.9 %, and in the third group – 39.9 %, 34.9 % and 25.2 %, respectively. The incidence of osteoporosis increased with age and was gender-dependent – more common in women (p < 0.05 and p < 0.041, respectively). The probability of developing osteoporosis was lower in patients with a higher body weight (p < 0.002). Smoking had a bad effect on bone density (p < 0.001), physical exercise, on the contrary, inhibited the development of osteoporosis (p < 0.001). The use of alcohol and tea had no effect on the development of osteoporosis in our study (p = 0.421, p = 0.387, respectively).

Conclusions. The study of osteoporosis from an epidemiological point of view in Kyrgyz residents revealed a higher-than-expected incidence of osteoporosis according to densitometry. Further large-scale studies are needed throughout the country, which will help to understand the outcome of low bone mineral density in the population of Kyrgyz residents.

Postmenopausal osteoporosis: current status of bone densitometry

Osteoporosis is the most common of all metabolic bone disorders characterized by loss of bone strength, due to modifications in bone turnover. It leads to bone fragility and increased fracture risk. Because of the increasing aging of the world population, the number of people affected by osteoporosis is continuously increasing. The WHO operational definition of osteoporosis, based on a measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), identifies patients at greatest risk of fracture. However, in the population overall a greater total number of fractures occurs in individuals with BMD values above threshold for osteoporosis diagnosis; for this reason, algorithms have been developed to improve the identification of individuals at high fracture risk, including clinical risk factors for fracture. The correct diagnosis of osteoporosis with an appropriate and accurate use of diagnostic imaging results in better management in terms of adequate treatment and follow-up. Moreover, screening strategies will improve identification of patients who are most likely to benefit from drug treatment to prevent fracture. All women after the age of 65 years previously untested and women after the age of 50 years with previous low trauma fractures should be screened by DXA. In fact, osteoporosis-related fractures cause a significant increase in morbidity and mortality, decreasing the quality of life, with an increasing social and economic burdens. For this reason, fracture risk assessment should be a high priority amongst health measures.

The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis

BACKGROUND

Osteoporosis affects all sections of society, including families with people affected by osteoporosis, government agencies and medical institutes in various fields. For example, it involves the patient and his/her family members, and government agencies in terms of the cost of treatment and medical care. Providing a comprehensive picture of the prevalence of osteoporosis globally is important for health policymakers to make appropriate decisions. Therefore, this study was conducted to investigate the prevalence of osteoporosis worldwide.

METHODS

A systematic review and meta-analysis were conducted in accordance with the PRISMA criteria. The PubMed, Science Direct, Web of Science, Scopus, Magiran, and Google Scholar databases were searched with no lower time limit up till 26 August 2020. The heterogeneity of the studies was measured using the I2 test, and the publication bias was assessed by the Begg and Mazumdar's test at the significance level of 0.1.

RESULTS

After following the systematic review processes, 86 studies were selected for meta-analysis. The sample size of the study was 103,334,579 people in the age range of 15-105 years. Using meta-analysis, the prevalence of osteoporosis in the world was reported to be 18.3 (95% CI 16.2-20.7). Based on 70 studies and sample size of 800,457 women, and heterogenicity I2: 99.8, the prevalence of osteoporosis in women of the world was reported to be 23.1 (95% CI 19.8-26.9), while the prevalence of osteoporosis among men of the world was found to be 11.7 (95% CI 9.6-14.1 which was based on 40 studies and sample size of 453,964 men.). The highest prevalence of osteoporosis was reported in Africa with 39.5% (95% CI 22.3-59.7) and a sample size of 2989 people with the age range 18-95 years.

CONCLUSION

According to the medical, economic, and social burden of osteoporosis, providing a robust and comprehensive estimate of the prevalence of osteoporosis in the world can facilitate decisions in health system planning and policymaking, including an overview of the current and outlook for the future; provide the necessary facilities for the treatment of people with osteoporosis; reduce the severe risks that lead to death by preventing fractures; and, finally, monitor the overall state of osteoporosis in the world. This study is the first to report a structured review and meta-analysis of the prevalence of osteoporosis worldwide.

Type 2 diabetes affects bone cells precursors and bone turnover

BACKGROUND

Here we study the effect of type 2 diabetes (T2DM) on bone cell precursors, turnover and cytokines involved in the control of bone cell formation and activity.

METHODS

We enrolled in the study 21 T2DM women and 21 non diabetic controls matched for age and body mass index (BMI). In each subject we measured bone cell precursors, Receptor Activator of Nuclear Factor κB (RANKL), Osteoprotegerin (OPG), Sclerostin (SCL) and Dickoppf-1 (DKK-1) as cytokines involved in the control of osteoblast and osteoclast formation and activity, bone density (BMD) and quality trough trabecular bone score (TBS) and bone turnover. T2DM patients and controls were compared for the analyzed variables by one way ANOVA for Gaussian ones and by Mann-Whitney or Kruskal-Wallis test for non-Gaussian variables.

RESULTS

RANKL was decreased and DKK-1 increased in T2DM. Accordingly, patients with T2DM have lower bone turnover compared to controls. BMD and TBS were not significantly different from healthy controls. Bone precursor cells were more immature in T2DM. However the number of osteoclast precursors was increased and that of osteoblasts decreased.

CONCLUSIONS

Patients with T2DM have more immature bone cells precursors, with increased number of osteoclasts and decreased osteoblasts, confirming low bone turnover and reduced cytokines such as RANKL and DKK-1. BMD and TBS are not significantly altered in T2DM although, in contrast with other studies, this may be due to the match of patients and controls for BMI rather than age.

The epidemiology of osteoporosis in Italian postmenopausal women according to the National Bone Health Alliance (NBHA) diagnostic criteria: a multicenter cohort study

PURPOSE

The study was aimed at evaluating the prevalence of osteoporosis, defined by BMD and the National Bone Health Alliance (NBHA) criteria, and the prevalence of clinical risk factors for fractures in Italian postmenopausal women.

METHODS

This is a cross-sectional, multicenter, cohort study evaluating 3247 postmenopausal women aged ≥ 50 and older in different areas of Italy in the period 2012-2014. All the participants were evaluated as far as anthropometrics; questionnaires for FRAX^® and DeFRA calculation were administered and bone mineral density was measured at lumbar spine, femoral neck and total hip by DXA.

RESULTS

The prevalence of osteoporosis, as assessed by BMD and NBHA criteria was 36.6 and 57%, respectively. Mean ± SD values of FRAX^® and DeFRA were: 10.2 ± 7.3 and 11 ± 9.4 for major fractures, and 3.3 ± 4.9 and 3.9 ± 5.9 for hip fractures, respectively. Among clinical risk factors for fracture, the presence of previous fracture, particularly non-spine/non-hip fracture, parental history of hip fracture and current smoking were the most commonly observed.

CONCLUSIONS

Our study showed that more that the half of postmenopausal women aged 50 and older in Italy has osteoporosis on the basis of the NBHA criteria. There is a relevant high risk of femur fracture, as assessed by the FRAX^® and DeFRA and previous fracture, parental history of hip fracture and current smoking are the most common risk factors. The data should be considered particularly in relation to the need to increase prevention strategies on modifiable risk factors and therapeutic intervention.

Prevalence of osteoporosis and related lifestyle and metabolic factors of postmenopausal women and elderly men: A cross-sectional study in Gansu province, Northwestern of China

The aim of this study was to investigate the osteoporosis prevalence and the risks of postmenopausal women and elderly men in Gansu province.This cross-sectional study involved 3359 postmenopausal women and 3205 elderly males who were randomly selected from 7 areas in Gansu province. Areal bone mineral density (BMD) (g/cm) was measured at the distal one-third radius of the nonstressed forearm using dual-energy X-ray absorptiometry (DXA: Osteometer MediTech). Factors related to osteoporosis were analyzed.The prevalence of osteoporosis in the entire study population was 9.65% for postmenopausal women and 8.08% for elderly males by WHO criteria, while the rate of osteopenia were 27.09% for postmenopausal women and 26.68% for elderly males. Risk of osteoporosis was significantly associated with age, menopause age, duration of menopause, body mass index (BMI), educational level, and alcohol consumption in postmenopausal women. In elderly men, age, BMI, current smoking, alcohol consumption, physical activity, and sun exposure were associated with osteoporosis. The bone turnover markers osteocalcin (OC) and C-terminal cross-linked telopeptides of type I collagen (β-CTX) were inversely correlated with BMD in both genders; serum P and 25(OH)D found no significant correlation with BMD. Serum Ca showed a positive effect on BMD in elderly men only.The osteoporosis prevalence of postmenopausal women and the men aged over 60 years in Gansu province is presented. Risk of osteoporosis was significantly associated with age, menopause age, year since menopause, BMI, and educational level in postmenopausal women. In elderly men, age, BMI, and current smoking were associated with osteoporosis. This study also found that higher OC and β-CTX level were associated with lower BMD. Poor 25(OH)D, Ca, P status were not associated with an increased risk of low BMD.

Prevalence and Risk Factors of Osteoporosis Among Jordanian Postmenopausal Women Attending the National Center for Diabetes, Endocrinology and Genetics in Jordan

To assess the prevalence of osteoporosis and osteopenia among Jordanian postmenopausal women attending the National Center for Diabetes, Endocrinology, and Genetics (NCDEG), and to determine the potential associated risk factors. A cross-sectional study was conducted at (NCDEG) in Amman, Jordan. A total of 1079 Jordanian postmenopausal women aged between 45 and 84 years were included in this study that was conducted during the period between April 2013 and December 2014. All patients underwent bone mineral density measurement through dual-energy X-ray absorptiometry (DEXA) scan. DEXA scan was interpreted in terms of T score as per World Health Organization guidelines. The overall prevalence of osteoporosis and osteopenia was 37.5% and 44.6%, respectively. The maximum prevalence of osteoporosis was observed at the lumbar spine (32.4%) followed by the left femoral neck (14.4%), while the maximum prevalence of osteopenia was observed at the left femoral neck (56.1%) followed by the lumbar spine (41.3%). Patients with longer menopausal duration, normal or overweight body mass index, high parity, physical inactivity, positive family history of osteoporosis, inadequate sun exposure, high daily caffeine intake, low daily calcium intake, and delay in the age of menarche were all positively associated with osteoporosis. On the other hand, women with type 2 diabetes mellitus had lower risk of osteoporosis. There is a high prevalence of osteoporosis and osteopenia among Jordanian postmenopausal women. Necessary steps are needed for more public education and a wider dissemination of information about osteoporosis and its prevention.

Association of haematological parameters with bone mineral density in elderly diabetic women

OBJECTIVES

In this study, we aimed to evaluate whether an association exists between complete blood count (CBC) parameters and bone mineral density (BMD) in elderly females with type 2 diabetes mellitus (T2DM) and to estimate the differences in BMD in T2DM.

METHODS

The medical records of female patients who had been referred for BMD analysis to a tertiary hospital in Ankara, Turkey were reviewed.

RESULTS

A total of 275 women (66 with T2DM, 209 without T2DM; mean age 72.1 ± 5.4 years) were included in study. White blood cell (WBC) counts, lumbar spine BMD (LSBMD) and femoral neck BMD (FNBMD) were found to be significantly higher in T2DM. There was an inverse association between haematocrit (Hct) and LSBMD in diabetic group (r =  - 0.330; P = 0.008).

CONCLUSION

Diabetic patients had higher BMD levels. Regardless of the mechanisms, Hct could be a readily available potential candidate to identify diabetic patients with osteoporosis.