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Maas L, Boonen A, Li N, Wyers CE, Van den Bergh JP, Hiligsmann M. Cost-effectiveness of a multicomponent-adherence intervention in fracture liaison services. Expert Rev Pharmacoecon Outcomes Res 2024:1-10. [PMID: 38860294 DOI: 10.1080/14737167.2024.2366439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/28/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND This study aims to assess the lifetime cost-effectiveness of a multi-component adherence intervention (MCAI), including a patient decision aid and motivational interviewing, compared to usual care in patients with a recent fracture attending fracture liaison services (FLS) and eligible for anti-osteoporosis medication (AOM). RESEARCH DESIGN AND METHODS Data on AOM initiation and one-year persistence were collected from a quasi-experimental study conducted between 2019 and 2023 in two Dutch FLS centers. An individual level, state-transition Markov model was used to simulate lifetime costs and quality-adjusted life years (QALYs) with a societal perspective of MCAI vs usual care. One-way and probabilistic sensitivity analyses were conducted including variation in additional FLS and MCAI costs (no MCAI cost in baseline). RESULTS MCAI was associated with gain in QALYs (0.0012) and reduction in costs (-€16) and is therefore dominant. At the Dutch willingness-to-pay threshold of €50,000/QALY, MCAI remained cost-effective when increasing costs of the FLS visit or the yearly maintenance cost for MCAI up to +€60. Probabilistic sensitivity analysis demonstrated MCAI to be dominant in 54% of the simulations and cost-effective in 87% with a threshold of €50,000/QALY. CONCLUSIONS A MCAI implemented in FLS centers may lead to cost-effective allocation of resources in FLS care, depending on extra costs.
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Affiliation(s)
- Lieke Maas
- Department of Health Services research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Annelies Boonen
- Department of Health Services research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nannan Li
- Department of Health Services research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joop P Van den Bergh
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Chauhan D, Dadge S, Yadav PK, Sultana N, Agarwal A, Vishwakarma S, Rathaur S, Yadav S, K Chourasia M, Gayen JR. LC-MS/MS method for simultaneous estimation of raloxifene, cladrin in rat plasma: application in pharmacokinetic studies. Bioanalysis 2024; 16:141-153. [PMID: 38197392 DOI: 10.4155/bio-2023-0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Aim: A newer LC-MS/MS method was developed and validated for the simultaneous quantification of raloxifene (RL) and cladrin (CL). Methodology: Both drugs were resolved in RP-18 (4.6 × 50 mm, 5 μ) Xbridge Shield column using acetonitrile and 0.1% aqueous solution of formic acid (FA) (70:30% v/v) as mobile phase by using biological matrices in female Sprague-Dawley rats using-MS/MS. Results: The developed method was found to be linear over the concentration ranges of 1-600 ng/ml, and lower limit of quantification was 1 ng/ml for RL and CL, respectively. Pharmacokinetic results of RL+CL showed Cmax = 4.23 ± 0.61, 26.97 ± 1.14 ng/ml, at Tmax(h) 5.5 ± 1.00 and 3.5 ± 1.00, respectively. Conclusion: Pharmacokinetic study results will be useful in the future for the combined delivery of RL and CL for osteoporosis treatment.
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Affiliation(s)
- Divya Chauhan
- Division of Pharmaceutics & Pharmacokinetics, Central Drug Research Institute, Lucknow, Uttar Pradesh, 226031, India
- Academy of Scientific & Innovative Research, Ghaziabad, 201002, India
| | - Shailesh Dadge
- Division of Pharmaceutics & Pharmacokinetics, Central Drug Research Institute, Lucknow, Uttar Pradesh, 226031, India
- Academy of Scientific & Innovative Research, Ghaziabad, 201002, India
| | - Pavan K Yadav
- Division of Pharmaceutics & Pharmacokinetics, Central Drug Research Institute, Lucknow, Uttar Pradesh, 226031, India
- Academy of Scientific & Innovative Research, Ghaziabad, 201002, India
| | - Nazneen Sultana
- Division of Pharmaceutics & Pharmacokinetics, Central Drug Research Institute, Lucknow, Uttar Pradesh, 226031, India
| | - Arun Agarwal
- Division of Pharmaceutics & Pharmacokinetics, Central Drug Research Institute, Lucknow, Uttar Pradesh, 226031, India
- Academy of Scientific & Innovative Research, Ghaziabad, 201002, India
| | - Sachin Vishwakarma
- Division of Pharmaceutics & Pharmacokinetics, Central Drug Research Institute, Lucknow, Uttar Pradesh, 226031, India
| | - Shivam Rathaur
- Division of Pharmaceutics & Pharmacokinetics, Central Drug Research Institute, Lucknow, Uttar Pradesh, 226031, India
| | - Shubhi Yadav
- Division of Pharmaceutics & Pharmacokinetics, Central Drug Research Institute, Lucknow, Uttar Pradesh, 226031, India
| | - Manish K Chourasia
- Division of Pharmaceutics & Pharmacokinetics, Central Drug Research Institute, Lucknow, Uttar Pradesh, 226031, India
- Academy of Scientific & Innovative Research, Ghaziabad, 201002, India
| | - Jiaur R Gayen
- Division of Pharmaceutics & Pharmacokinetics, Central Drug Research Institute, Lucknow, Uttar Pradesh, 226031, India
- Academy of Scientific & Innovative Research, Ghaziabad, 201002, India
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Plais N, Bustos JG, Mahillo-Fernández I, Tomé-Bermejo F, Mengis C, Alvarez-Galovich L. Osteoporotic vertebral fractures localized in the lumbar area significantly impact sagittal alignment. Osteoporos Int 2024; 35:277-284. [PMID: 37833542 DOI: 10.1007/s00198-023-06936-y] [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: 04/13/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
Lumbar fractures and/or multiple fractures at the lumbar or thoracolumbar regions are risk factors for sagittal malalignment in patients older than 70 years old. Although patients with OVF show a huge capacity to compensate after the fractures, lumbar and TL lumbar fractures require closer monitoring. PURPOSE To assess the impact of osteoporotic vertebral fractures on the sagittal alignment of the elderly and identify risk factors for sagittal malalignment. METHODS We performed a retrospective study on a cohort of 249 patients older than 70 years old and diagnosed with osteoporosis who suffered chronic vertebral fractures. Demographic and radiological data were collected. Full-spine lateral X-rays were obtained to analyze the sagittal plane. Patients were classified according to the number and location of the fractures. Pearson's correlation coefficient was used to assess the relationships between the type of fractures and sagittal alignment. RESULTS A total of 673 chronic fractures were detected in 249 patients with a mean number of vertebral fractures per patient of 2.7 ± 1.9. Patients were divided into 9 subgroups according to the location and the number of fractures. Surprisingly, any of the aggregated parameters used to assess sagittal alignment exceeded the threshold defined for malalignment. In the second part of the analysis, 41 patients with sagittal malalignment were identified. In this subpopulation, an overrepresentation of patients with lumbar fractures (34% vs. 11%) and an under-representation of thoracic fractures (9% vs. 34%) were reported. We also observed that patients with 3 or more lumbar or thoracolumbar fractures had an increased risk of sagittal malalignment. CONCLUSIONS Lumbar fractures and/or multiple fractures at the lumbar or thoracolumbar regions are risk factors for sagittal malalignment in patients older than 70 years old. Although patients show a remarkable capacity to compensate, fractures at the lumbar and thoracolumbar regions need closer monitoring.
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Li N, van den Bergh JP, Boonen A, Wyers CE, Bours SPG, Hiligsmann M. Cost-effectiveness analysis of fracture liaison services: a Markov model using Dutch real-world data. Osteoporos Int 2024; 35:293-307. [PMID: 37783759 PMCID: PMC10837229 DOI: 10.1007/s00198-023-06924-2] [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: 04/19/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023]
Abstract
This study assessed the lifetime cost-effectiveness of a fracture liaison service (FLS) compared to no-FLS in the Netherlands from a societal perspective and suggested that FLS was cost-effective in patients with a recent fracture aged 50 years and older. The implementation of FLS could lead to lifetime health-economic benefits. INTRODUCTION The objective of this study was to investigate the lifetime cost-effectiveness of a fracture liaison service (FLS) compared to no-FLS in the Netherlands from a societal perspective and using real-world data. METHODS Annual fracture incidence, treatment scenarios as well as treatment initiation in the years 2017-2019 were collected from a large secondary care hospital in the Netherlands. An individual-level, state transition model was designed to simulate lifetime costs and quality-adjusted life years (QALYs). Treatment pathways were differentiated by gender, presence of osteoporosis and/or prevalent vertebral fracture, and treatment status. Results were presented as incremental cost-effectiveness ratios (ICER). Both one-way and probabilistic sensitivity analyses were conducted. RESULTS For patients with a recent fracture aged 50 years and older, the presence of an FLS was associated with a lifetime €45 higher cost and 0.11 additional QALY gained leading to an ICER of €409 per QALY gained, indicating FLS was cost-effective compared to no-FLS at the Dutch threshold of €20,000/QALY. The FLS remained cost-effectiveness across different age categories. Our findings were robust in all one-way sensitivity analyses, the higher the treatment initiation rate in FLS, the greater the cost-effective of FLS. Probabilistic sensitivity analyses revealed that FLS was cost-effective in 90% of the simulations at the threshold of €20,000/QALY, with women 92% versus men 84% by gender. CONCLUSION This study provides the first health-economic analysis of FLS in the Netherlands, suggesting the implementation of FLS could lead to lifetime health-economic benefits.
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Affiliation(s)
- N Li
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - J P van den Bergh
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- School of Nutrition and Translational Research and Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A Boonen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- School of Nutrition and Translational Research and Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S P G Bours
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Hiligsmann
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Skjødt MK, Nicolaes J, Smith CD, Libanati C, Cooper C, Olsen KR, Abrahamsen B. Healthcare costs associated with opportunistically identifiable vertebral fractures. Bone 2023; 175:116831. [PMID: 37354964 DOI: 10.1016/j.bone.2023.116831] [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: 02/23/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Vertebral fractures (VFs) are often available on radiological imaging undertaken during daily clinical work, yet the healthcare cost burden of these opportunistically identifiable fractures has not previously been reported. In this study, we examine the direct healthcare costs of subjects with vertebral fractures available for identification on routine CT scans. METHODS Thoracolumbar vertebral fractures were identified from 2000 routine CT scans. Subjects with VF on the scan were matched 1:2 against subjects with no VF on the scan, and similarly in a 1:3-ratio against a general population cohort. We excluded those subjects who received treatment with osteoporosis medication(s) in the year prior to baseline. Direct healthcare costs, identified from the national Danish registers, were accrued over up to 6 years of follow-up, and reported per day at risk and per year. RESULTS In subjects undergoing a CT scan, costs were initially high, yet declined over time. Comparing subjects with prevalent vertebral fracture (n = 321) against those subjects with no vertebral fracture (n = 606), mean total healthcare costs per day at risk was numerically higher in the first three years after baseline, while healthcare costs per year were similar between the cohorts. No differences reached statistical significance. When compared to the general population cohort, costs were significantly higher in the vertebral fracture cohort. CONCLUSION Subjects with vertebral fractures available for identification on routine CT scans incur substantially higher healthcare costs than matched subjects representing the general population, and numerically, albeit non-significantly, higher healthcare costs per day at risk in the short term, as compared to subjects with no visible VF on the CT scan.
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Affiliation(s)
- Michael Kriegbaum Skjødt
- Department of Medicine, Holbæk Hospital, Smedelundsgade 60, DK-4300 Holbæk, Denmark; OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, J. B. Winsløws Vej 9A, 3rd floor, DK-5000 Odense C, Denmark.
| | - Joeri Nicolaes
- UCB Pharma, Allée de la Recherche 60, 1070 Brussels, Belgium; Medical Image Computing, ESAT-PSI, Department of Electrical Engineering, KU Leuven, Kasteelpark Arenberg 10, Box 2441, 3001 Leuven, Belgium
| | - Christopher Dyer Smith
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, J. B. Winsløws Vej 9A, 3rd floor, DK-5000 Odense C, Denmark
| | - Cesar Libanati
- UCB Pharma, Allée de la Recherche 60, 1070 Brussels, Belgium
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Center, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Windmill Road, Headington, Oxford OX3 7HE, UK
| | - Kim Rose Olsen
- DaCHE, Institute of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9, 1st floor, DK-5000 Odense C, Denmark
| | - Bo Abrahamsen
- Department of Medicine, Holbæk Hospital, Smedelundsgade 60, DK-4300 Holbæk, Denmark; OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, J. B. Winsløws Vej 9A, 3rd floor, DK-5000 Odense C, Denmark; NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Windmill Road, Headington, Oxford OX3 7HE, UK
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Böker KO, Komrakova M, Fahrendorff L, Spelsberg BR, Hoffmann DB, Schilling AF, Lehmann W, Taudien S, Sehmisch S. Treatment of osteoporosis using a selective androgen receptor modulator ostarine in an orchiectomized rat model. Endocrine 2023; 81:579-591. [PMID: 37378829 PMCID: PMC10403398 DOI: 10.1007/s12020-023-03422-7] [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: 12/12/2022] [Accepted: 06/10/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE The selective androgen receptor modulator ostarine has been shown to have advantageous effects on skeletal tissue properties, reducing muscle wasting and improving physical function in males. However, data on effects in male osteoporosis remain limited. In this study, the effects of ostarine on osteoporotic bone were evaluated in a rat model of male osteoporosis and compared with those of testosterone treatments. METHODS Eight-month-old male Sprague-Dawley rats were either non-orchiectomized to serve as a healthy control (Non-Orx, Group 1) or orchiectomized (Orx, Groups 2-6) and then grouped (n = 15/group): (1) Non-Orx, (2) Orx, (3) Ostarine Therapy, (4) Testosterone Therapy, (5) Ostarine Prophylaxis and (6) Testosterone Prophylaxis. Prophylaxis treatments started directly after orchiectomy and continued for 18 weeks, whereas Therapy treatments were initiated 12 weeks after Orx. Ostarine and Testosterone were applied orally at daily doses of 0.4 and 50 mg/kg body weight, respectively. The lumbar vertebral bodies and femora were analyzed using biomechanical, micro-CT, ashing, and gene expression analyses. RESULTS Ostarine Prophylaxis showed positive effects in preventing osteoporotic changes in cortical and trabecular bone (femoral trabecular density: 26.01 ± 9.1% vs. 20.75 ± 1.2% in Orx and in L4: 16.3 ± 7.3% vs 11.8 ± 2.9% in Orx); biomechanical parameters were not affected; prostate weight was increased (0.62 ± 0.13 g vs 0.18 ± 0.07 g in Orx). Ostarine Therapy increased solely the cortical density of the femur (1.25 ± 0.03 g/cm3 vs. 1.18 ± 0.04 g/cm3 in Orx); other bone parameters remained unaffected. Testosteron Prophylaxis positively influenced cortical density in femur (1.24 ± 0.05 g/cm3 vs. 1.18 ± 0.04 g/cm3 in Orx); Test. Therapy did not change any bony parameters. CONCLUSION Ostarine Prophylaxis could be further investigated as a preventative treatment for male osteoporosis, but an androgenic effect on the prostate should be taken into consideration, and combination therapies with other anti-osteoporosis agents could be considered.
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Affiliation(s)
- K O Böker
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany.
| | - M Komrakova
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - L Fahrendorff
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - B R Spelsberg
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - D B Hoffmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - A F Schilling
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - W Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - S Taudien
- Division of Infection Control and Infectious Diseases, University Medical Center Goettingen, 37075, Goettingen, Germany
| | - S Sehmisch
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany
- Department of Trauma Surgery, Hannover Medical School, University of Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Lu X, Wei J, Liu Y, Lu Y. Effects of exercise on bone mineral density in middle-aged and older men: A comprehensive meta-analysis. Arch Osteoporos 2023; 18:108. [PMID: 37548809 DOI: 10.1007/s11657-023-01317-8] [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: 05/23/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023]
Abstract
This meta-analysis including 10 randomised controlled trials suggests that exercise is associated with a statistically significant, but relatively mild, improvement effect on bone mineral density in middle-aged and older men, indicating that exercise has the potential to be a safe and effective way toavert bone loss in men. PURPOSE To determine the effect of exercise on bone mineral density (BMD) in middle-aged and older men. METHODS We searched three electronic databases up to March 21, 2022. A systematic review of the literature according to the PRISMA statement included (1) randomised controlled trials (RCTs), with (2) at least one exercise group as an intervention versus a control group, (3) men aged ≥ 45 years old, and (4) areal BMD of the lumbar spine (LS) and/or femoral neck (FN) and/or total hip (TH) and/or trochanter region. Mean differences (MD) for BMD changes at the LS, FN, TH, and trochanter were defined as outcome measures. RESULTS A total of 10 eligible RCTs were included (N = 555 participants). Exercise significantly improved BMD, and the summarised MD was 0.02 (95% CI: 0.00 to 0.05) for LS BMD, 0.01 (95% CI: 0.00 to 0.02) for FN BMD, 0.01 (95% CI: 0.00 to 0.01) for TH BMD, and 0.03 (95% CI: 0.00 to 0.05) for trochanter BMD. Subgoup analyses showed the improvement effect was statistically significant in trials with longer duration and higher intensity in LS (≥ 12 months: MD, 0.01, 95% CI:0.00 to 0.03; higher intensity: MD, 0.01, 95% CI:0.00 to 0.03) and FN (≥ 12 months: MD, 0.02, 95% CI:0.01 to 0.02; higher intensity: MD, 0.01, 95% CI:0.01 to 0.02). CONCLUSION Our results suggested a relatively mild, improvement effect of exercise on LS and proximal femur BMD. Exercise has the potential to be an effective way to avert bone loss in middle-aged and older men.
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Affiliation(s)
- Xiaoqin Lu
- Department of General Practice, Dongyang People's Hospital, Dongyang, 322100, China
| | - Jiapei Wei
- Department of General Practice, Dongyang People's Hospital, Dongyang, 322100, China
| | - Yupeng Liu
- Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Yangzhen Lu
- Department of General Practice, Dongyang People's Hospital, Dongyang, 322100, China.
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Li J, Viceconti M, Li X, Bhattacharya P, Naimark DMJ, Osseyran A. Cost-Effectiveness Analysis of CT-Based Finite Element Modeling for Osteoporosis Screening in Secondary Fracture Prevention: An Early Health Technology Assessment in the Netherlands. MDM Policy Pract 2023; 8:23814683231202993. [PMID: 37900721 PMCID: PMC10605708 DOI: 10.1177/23814683231202993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 08/20/2023] [Indexed: 10/31/2023] Open
Abstract
Objective. To conduct cost-utility analyses for Computed Tomography To Strength (CT2S), a novel osteoporosis screening service, compared with dual-energy X-ray absorptiometry (DXA), treat all without screening, and no screening methods for Dutch postmenopausal women referred to fracture liaison service (FLS). CT2S uses CT scans to generate femur models and simulate sideways fall scenarios for bone strength assessment. Methods. Early health technology assessment (HTA) was adopted to evaluate CT2S as a novel osteoporosis screening tool for secondary fracture prevention. We constructed a 2-dimensional simulation model considering 4 strategies (no screening, treat all without screening, DXA, CT2S) together with screening intervals (5 y, 2 y), treatments (oral alendronate, zoledronic acid), and discount rate scenarios among Dutch women in 3 age groups (60s, 70s, and 80s). Strategy comparisons were based on incremental cost-effectiveness ratios (ICERs), considering an ICER below €20,000 per QALY gained as cost-effective in the Netherlands. Results. Under the base-case scenario, CT2S versus DXA had estimated ICERs of €41,200 and €14,083 per QALY gained for the 60s and 70s age groups, respectively. For the 80s age group, CT2S was more effective and less costly than DXA. Changing treatment from weekly oral alendronate to annual zoledronic acid substantially decreased CT2S versus DXA ICERs across all age groups. Setting the screening interval to 2 y increased CT2S versus DXA ICERs to €100,333, €55,571, and €15,750 per QALY gained for the 60s, 70s, and 80s age groups, respectively. In all simulated populations and scenarios, CT2S was cost-effective (in some cases dominant) compared with the treat all strategy and cost-saving (more effective and less costly) compared with no screening. Conclusion. CT2S was estimated to be potentially cost-effective in the 70s and 80s age groups considering the willingness-to-pay threshold of the Netherlands. This early HTA suggests CT2S as a potential novel osteoporosis screening tool for secondary fracture prevention. Highlights For postmenopausal Dutch women who have been referred to the FLS, direct access to CT2S may be cost-effective compared with DXA for age groups 70s and 80s, when considering the ICER threshold of the Netherlands. This study positions CT2S as a potential novel osteoporosis-screening tool for secondary fracture prevention in the clinical setting.A shorter screening interval of 2 y increases the effectiveness of both screening strategies, but the ICER of CT2S compared with DXA also increased substantially, which made CT2S no longer cost-effective for the 70s age group; however, it remains cost-effective for individuals in their 80s.Annual zoledronic acid treatment with better adherence may contribute to a lower cost-effectiveness ratio when comparing CT2S to DXA screening and the treat all strategies for all age groups.
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Affiliation(s)
- Jieyi Li
- Amsterdam Business School, University of Amsterdam, Amsterdam, Netherland
| | - Marco Viceconti
- Department of Industrial Engineering, University of Bologna, Bologna, Italy
| | - Xinshan Li
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Pinaki Bhattacharya
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - David M. J. Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Anwar Osseyran
- Amsterdam Business School, University of Amsterdam, Amsterdam, Netherland
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Luyendijk M, Jager A, Buijs SM, Siesling S, Groot CAUD, Blommestein HM. Cost-Effectiveness Analysis of MammaPrint ® to Guide the Use of Endocrine Therapy in Patients with Early-Stage Breast Cancer. PHARMACOECONOMICS 2023:10.1007/s40273-023-01277-4. [PMID: 37245167 DOI: 10.1007/s40273-023-01277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Gene expression profiling tests can predict the risk of disease recurrence and select patients who are expected to benefit from therapy, while allowing other patients to forgo therapy. For breast cancers, these tests were initially designed to tailor chemotherapy decisions, but recent evidence suggests that they may also guide the use of endocrine therapy. This study evaluated the cost effectiveness of a prognostic test, MammaPrint®, to guide the use of adjuvant endocrine therapy in patients eligible according to Dutch treatment guidelines. METHODS We constructed a Markov decision model to calculate the lifetime costs (in 2020 Euros) and effects (survival and quality-adjusted life-years) of MammaPrint® testing versus usual care (endocrine therapy for all patients) in a simulated cohort of patients. The population of interest includes patients for whom MammaPrint® testing is currently not indicated, but for whom it may be possible to safely omit endocrine therapy. We applied both a health care perspective and a societal perspective and discounted costs (4%) and effects (1.5%). Model inputs were obtained from published research (including randomized controlled trials), nationwide cancer registry data, cohort data and publicly available data sources. Scenario and sensitivity analyses were conducted to explore the impact of uncertainty around input parameters. Additionally, threshold analyses were performed to identify under which circumstances MammaPrint® testing would be cost effective. RESULTS Adjuvant endocrine therapy guided by MammaPrint® resulted in fewer side effects, more (quality-adjusted) life-years (0.10 and 0.07 incremental QALYS and LYs, respectively) and higher costs (€18,323 incremental costs) compared with the usual care strategy in which all patients receive endocrine therapy. While costs for hospital visits, medication costs and productivity costs were somewhat higher in the usual care strategy, these did not outweigh costs of testing in the MammaPrint® strategy. The incremental cost-effectiveness ratio was €185,644 per QALY gained from a healthcare perspective and €180,617 from a societal perspective. Sensitivity and scenario analyses showed that the conclusions remained the same under changed input parameters and assumptions. Our results show that MammaPrint® can become a cost-effective strategy when either the price of the test is reduced (> 50%), or the proportion of patients for which treatment is altered (i.e. those with ultra-low risk) increases to > 26%. CONCLUSION Standard MammaPrint® testing to guide the use of endocrine therapy in our simulated patient population appears not to be a cost-effective strategy compared with usual care. The cost effectiveness of the test can be improved by reducing the price or preselecting a population more likely to benefit from the test.
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Affiliation(s)
- Marianne Luyendijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB, Utrecht, The Netherlands.
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Sanne M Buijs
- Department of Medical Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB, Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. BOX 217, 7500 AE, Enschede, the Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR, Rotterdam, The Netherlands
| | - Hedwig M Blommestein
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR, Rotterdam, The Netherlands
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Trends in data quality and quality indicators 5 years after implementation of the Dutch Hip Fracture Audit. Eur J Trauma Emerg Surg 2022; 48:4783-4796. [PMID: 35697872 DOI: 10.1007/s00068-022-02012-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The Dutch Hip Fracture Audit (DHFA), a nationwide hip fracture registry in the Netherlands, registers hip fracture patients and aims to improve quality of care since 2016. This study shows trends in the data quality during the first 5 years of data acquisition within the DHFA, as well as trends over time for designated quality indicators (QI). METHODS All patients registered in the DHFA between 1-1-2016 and 31-12-2020 were included. Data quality-registry case coverage and data completeness-and baseline characteristics are reported. Five QI are analysed: Time to surgery < 48 h, assessment for osteoporosis, orthogeriatric co-management, registration of functional outcomes at three months, 30-day mortality. The independent association between QI results and report year was tested using mixed-effects logistic models and in the case of 30-day mortality adjusted for casemix. RESULTS In 2020, the case capture of the DHFA comprised 85% of the Dutch hip fracture patients, 66/68 hospitals participated. The average of missing clinical values was 7.5% in 2016 and 3.2% in 2020. The 3 months follow-up completeness was 36.2% (2016) and 46.8% (2020). The QI 'time to surgery' was consistently high, assessment for osteoporosis remained low, orthogeriatric co-management scores increased without significance, registration of functional outcomes improved significantly and 30-day mortality rates remained unchanged. CONCLUSION The DHFA has successfully been implemented in the past five years. Trends show improvement on data quality. Analysis of several QI indicate points of attention. Future perspectives include lowering the burden of registration, whilst improving (registration of) hip fracture patients outcomes.
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11
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Li N, van Oostwaard M, van den Bergh JP, Hiligsmann M, Boonen A, van Kuijk SMJ, Vranken L, Bours SPG, Wyers CE. Health-related quality of life of patients with a recent fracture attending a fracture liaison service: a 3-year follow-up study. Osteoporos Int 2022; 33:577-588. [PMID: 34671823 PMCID: PMC8843901 DOI: 10.1007/s00198-021-06204-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED This study explored the course of health state utility value over 3 years in patients with a recent fracture attending a Fracture Liaison Service and suggested that the overall change in health-related quality of life was not significant, although significant improvements were observed at 6 and 12 months compared to baseline. INTRODUCTION To estimate the 3-year health-related quality of life (HRQoL) of patients with a recent fracture presenting at a Fracture Liaison Service (FLS) and to explore factors associated with health state utility value (HSUV). METHODS Patients' HSUVs were derived from the EQ-5D-5L and SF-6D and calculated at six time points. Multiple imputation was applied for missing data. Linear mixed-effects regression analysis with random intercept and slope was applied to explore the course of HSUV over 3 years. The impact of subsequent fracture and the length of time between FLS visit and patients' index fracture on HSUV were also investigated. A backward stepwise elimination was applied to identify factors associated with HSUV. RESULTS A total of 499 patients were included. The change of EQ-5D HSUV was not significant over 3-year follow-up (P = 0.52), although slightly but significantly higher HSUV was captured at 6 months (mean difference (MD): 0.015, P = 0.02) and 12 months (MD: 0.018, P = 0.01). There was no significant difference in the course of EQ-5D HSUV between fracture locations (P = 0.86). A significant increase in HSUV was only captured for patients had shorter time period (< 107 days) between FLS visit and their index fracture. Suffering a subsequent fracture was associated with significant QoL loss (MD: - 0.078, P < 0.001). Subsequent fracture, previous treatment with anti-osteoporosis medication, a prevalent vertebral fracture (grade 2 or 3), use of a walking aid, previous falls, and higher BMI were negatively associated with mean EQ-5D HSUV over 3 years. Comparable results were found using SF-6D HSUV. The lack of HRQoL data immediately after fracture and selection bias were two main limitations. CONCLUSION The 3-year change in HSUV was not statistically significant, although significant improvements were observed at 6 and 12 months in comparison with baseline. Six factors were negatively associated with EQ-5D HSUV.
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Affiliation(s)
- N Li
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - M van Oostwaard
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Medicine, Hasselt University, Hasselt, Belgium
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - A Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L Vranken
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S P G Bours
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
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12
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Wang C, Xie Q, Sun W, Zhou Y, Liu Y. lncRNA WT1-AS is upregulated in osteoporosis and regulates the apoptosis of osteoblasts by interacting with p53. Exp Ther Med 2021; 22:734. [PMID: 34055051 PMCID: PMC8138279 DOI: 10.3892/etm.2021.10166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 01/17/2020] [Indexed: 12/30/2022] Open
Abstract
In cervical cancer, cellular tumor antigen p53 (p53) interacts with long non-coding WT1 antisense RNA (WT1-AS) and this protein serves an important role in osteoporosis. The present study aimed to investigate the role of WT1-AS in osteoporosis. WT1-AS was upregulated in the plasma of patients with osteoporosis and was positively correlated with p53 expression. Altered expression of WT1-AS and p53 separated patients with osteoporosis from healthy controls. Expression levels of WT1-AS and p53 decreased with prolonged treatment. In osteoblasts, WT1-AS overexpression resulted in increased p53 expression, while WT1-AS small interfering RNA (siRNA) silencing resulted in decreased p53 expression. In addition, WT1-AS overexpression resulted in increased apoptosis rate, while WT1-AS siRNA silencing resulted in decreased apoptosis rate in osteoblasts. p53 overexpression attenuated the effects of WT1-AS siRNA silencing on cell apoptosis. Therefore, WT1-AS was upregulated during osteoporosis and regulated the apoptosis of osteoblasts by interacting with p53.
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Affiliation(s)
- Chaoqun Wang
- Department of Nuclear Medicine, Hainan General Hospital, Haikou, Hainan 570311, P.R. China
| | - Quan Xie
- Department of Nuclear Medicine, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570100, P.R. China
| | - Wen Sun
- Department of Nuclear Medicine, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570100, P.R. China
| | - Ying Zhou
- Department of Nuclear Medicine, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570100, P.R. China
| | - Yu Liu
- Cancer Institute Of Hainan Medicail University, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570100, P.R. China
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13
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Makan AM, Hout HV, Onder G, van der Roest H, Finne-Soveri H, Topinková E, Denkinger M, Gindin J, van Marum R. Pharmacological management of osteoporosis in nursing home residents: the Shelter study. Maturitas 2020; 143:184-189. [PMID: 33308627 DOI: 10.1016/j.maturitas.2020.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 08/15/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To prevent osteoporotic fractures in nursing home residents a combination of bisphosphonates, calcium and vitamin D is recommended. This study assessed the prevalence of pharmacological osteoporosis prevention in nursing home residents from eight countries, and assessed its association with patient characteristics. DESIGN Cross-sectional analyses of the SHELTER study data. We assessed the overall prevalence of osteoporosis medication (OM) use (vitamin D, calcium and bisphosphonates) in residents stratified for falls and fractures over last 30 days, health instability with high mortality risk, cognitive impairment, and dependence in walking. SETTING AND PARTICIPANTS Nursing home residents in the Czech Republic, England, Finland, France, Germany, Italy, The Netherlands and Israel. RESULTS Of 3832 eligible residents, vitamin D, calcium and bisphosphonates were used by 16.2%, 10.4%, and 4.5% respectively. All 3 classes of OM together were used by 1.5% of all residents. Of residents with a recent fracture, 9.5% used a bisphosphonate (2.7% all 3 OMs). In patients with recent falls, 20.8% used vitamin D and 15.3% calcium. In residents with severe cognitive impairment, 15.5% used vitamin D and 9.3% used calcium. Of the bisphosphonate users, 33.7% also used both vitamin D and calcium, 25.8% used only calcium in addition and 17.4% only vitamin D in addition. The use of any OM varied widely across countries, from 66.8% in Finland to 3.0% in Israel. CONCLUSIONS AND IMPLICATIONS We found substantial pharmacological under-treatment of prevention of osteoporosis in residents with recent falls, fractures and dependence in walking. Only two-thirds of bisphosphonate users also took a vitamin D-calcium combination, despite guideline recommendations. On the other hand, possible over-treatment was found in residents with high mortality risk in whom preventive pharmacotherapy might not have still been appropriate. The prevalence of pharmacological prevention of osteoporosis differed substantially between countries. Efforts are needed to improve pharmacotherapy in residents.
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Affiliation(s)
- Alireza Malek Makan
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands; Care Group Coloriet, Lelystad, the Netherlands; Care group Almere, Almere, the Netherlands
| | - Hein van Hout
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands.
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Henriëtte van der Roest
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Eva Topinková
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Michael Denkinger
- Agaplesion Bethesda Clinic, Geriatric Centre Ulm/Alb-Donau, Ulm University, Ulm, Germany
| | - Jacob Gindin
- Department of Geriatrics, Assuta Medical Centers, Tel Aviv, Israel
| | - Rob van Marum
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands; Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
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14
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Almog YA, Rai A, Zhang P, Moulaison A, Powell R, Mishra A, Weinberg K, Hamilton C, Oates M, McCloskey E, Cummings SR. Deep Learning With Electronic Health Records for Short-Term Fracture Risk Identification: Crystal Bone Algorithm Development and Validation. J Med Internet Res 2020; 22:e22550. [PMID: 32956069 PMCID: PMC7600029 DOI: 10.2196/22550] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/05/2020] [Accepted: 09/12/2020] [Indexed: 12/18/2022] Open
Abstract
Background Fractures as a result of osteoporosis and low bone mass are common and give rise to significant clinical, personal, and economic burden. Even after a fracture occurs, high fracture risk remains widely underdiagnosed and undertreated. Common fracture risk assessment tools utilize a subset of clinical risk factors for prediction, and often require manual data entry. Furthermore, these tools predict risk over the long term and do not explicitly provide short-term risk estimates necessary to identify patients likely to experience a fracture in the next 1-2 years. Objective The goal of this study was to develop and evaluate an algorithm for the identification of patients at risk of fracture in a subsequent 1- to 2-year period. In order to address the aforementioned limitations of current prediction tools, this approach focused on a short-term timeframe, automated data entry, and the use of longitudinal data to inform the predictions. Methods Using retrospective electronic health record data from over 1,000,000 patients, we developed Crystal Bone, an algorithm that applies machine learning techniques from natural language processing to the temporal nature of patient histories to generate short-term fracture risk predictions. Similar to how language models predict the next word in a given sentence or the topic of a document, Crystal Bone predicts whether a patient’s future trajectory might contain a fracture event, or whether the signature of the patient’s journey is similar to that of a typical future fracture patient. A holdout set with 192,590 patients was used to validate accuracy. Experimental baseline models and human-level performance were used for comparison. Results The model accurately predicted 1- to 2-year fracture risk for patients aged over 50 years (area under the receiver operating characteristics curve [AUROC] 0.81). These algorithms outperformed the experimental baselines (AUROC 0.67) and showed meaningful improvements when compared to retrospective approximation of human-level performance by correctly identifying 9649 of 13,765 (70%) at-risk patients who did not receive any preventative bone-health-related medical interventions from their physicians. Conclusions These findings indicate that it is possible to use a patient’s unique medical history as it changes over time to predict the risk of short-term fracture. Validating and applying such a tool within the health care system could enable automated and widespread prediction of this risk and may help with identification of patients at very high risk of fracture.
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Affiliation(s)
- Yasmeen Adar Almog
- Digital Health & Innovation, Amgen Inc, Thousand Oaks, CA, United States
| | - Angshu Rai
- Digital Health & Innovation, Amgen Inc, Thousand Oaks, CA, United States
| | - Patrick Zhang
- Digital Health & Innovation, Amgen Inc, Thousand Oaks, CA, United States
| | - Amanda Moulaison
- Digital Health & Innovation, Amgen Inc, Thousand Oaks, CA, United States
| | - Ross Powell
- Digital Health & Innovation, Amgen Inc, Thousand Oaks, CA, United States
| | - Anirban Mishra
- Digital Health & Innovation, Amgen Inc, Thousand Oaks, CA, United States
| | - Kerry Weinberg
- Digital Health & Innovation, Amgen Inc, Thousand Oaks, CA, United States
| | - Celeste Hamilton
- Global Medical Operations, Amgen Inc, Thousand Oaks, CA, United States
| | - Mary Oates
- US Medical, Amgen Inc, Thousand Oaks, CA, United States
| | - Eugene McCloskey
- Department of Oncology & Metabolism, The University of Sheffield, Sheffield, United Kingdom
| | - Steven R Cummings
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
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15
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Cornelissen D, de Kunder S, Si L, Reginster JY, Evers S, Boonen A, Hiligsmann M. Interventions to improve adherence to anti-osteoporosis medications: an updated systematic review. Osteoporos Int 2020; 31:1645-1669. [PMID: 32358684 PMCID: PMC7423788 DOI: 10.1007/s00198-020-05378-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/04/2020] [Indexed: 01/25/2023]
Abstract
UNLABELLED An earlier systematic review on interventions to improve adherence and persistence was updated. Fifteen studies investigating the effectiveness of patient education, drug regimen, monitoring and supervision, and interdisciplinary collaboration as a single or multi-component intervention were appraised. Multicomponent interventions with active patient involvement were more effective. INTRODUCTION This study was conducted to update a systematic literature review on interventions to improve adherence to anti-osteoporosis medications. METHODS A systematic literature review was carried out in Medline (using PubMed), Embase (using Ovid), Cochrane Library, Current Controlled Trials, ClinicalTrials.gov , NHS Centre for Review and Dissemination, CINHAL, and PsycINFO to search for original studies that assessed interventions to improve adherence (comprising initiation, implementation, and discontinuation) and persistence to anti-osteoporosis medications among patients with osteoporosis, published between July 2012 and December 2018. Quality of included studies was assessed. RESULTS Of 585 studies initially identified, 15 studies fulfilled the inclusion criteria of which 12 were randomized controlled trials. Interventions were classified as (1) patient education (n = 9), (2) drug regimen (n = 3), (3) monitoring and supervision (n = 2), and (4) interdisciplinary collaboration (n = 1). In most subtypes of interventions, mixed results on adherence (and persistence) were found. Multicomponent interventions based on patient education and counseling were the most effective interventions when aiming to increase adherence and/or persistence to osteoporosis medications. CONCLUSION This updated review suggests that patient education, monitoring and supervision, change in drug regimen, and interdisciplinary collaboration have mixed results on medication adherence and persistence, with more positive effects for multicomponent interventions with active patient involvement. Compared with the previous review, a shift towards more patient involvement, counseling and shared decision-making, was seen, suggesting that individualized solutions, based on collaboration between the patient and the healthcare provider, are needed to improve adherence and persistence to osteoporosis medications.
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Affiliation(s)
- D Cornelissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Room 0.038, 6200, Maastricht, MD, Netherlands.
| | - S de Kunder
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, Netherlands
| | - L Si
- The George Institute for Global Health, UNSW Sydney, Kensington, Australia
| | - J-Y Reginster
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - S Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Room 0.038, 6200, Maastricht, MD, Netherlands
- Centre for economic evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - A Boonen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Room 0.038, 6200, Maastricht, MD, Netherlands
- Department of Internal Medicine, Rheumatology, Maastricht University Medical Centre and CAPHRI, Maastricht University, Maastricht, Netherlands
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Room 0.038, 6200, Maastricht, MD, Netherlands
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16
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Alipour V, Meshkani Z, Rezapour A, Aboutorabi A, Bagherzadeh R, Saber N. Medical costs of osteoporosis in the Iranian elderly patients. Med J Islam Repub Iran 2020; 34:37. [PMID: 32617276 PMCID: PMC7320975 DOI: 10.34171/mjiri.34.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Indexed: 01/21/2023] Open
Abstract
Background: In the coming years and near future, Iran will experience a main demographic transition resulting in an aging phenomenon and increased number of people over 65 years. Aging leads to increased medical expenditures associated with chronic diseases such as osteoporosis. This study aimed to investigate the patient-specific hospitalization costs of osteoporosis treatment in elderly patients. Methods: A retrospective cost analysis of hospitalization arising from osteoporosis conducted on all the elderly patients (adults aged 65 years and above) in a teaching hospital in Tehran through examining hospital admissions during 2017. The elderly patients consisted of 295 with a length of stay ≥ 24 hours. Cost analysis was performed using a bottom-up micro-costing approach and payer perspective (patient and insurer); and the result was statistically significant (p≤0.05). Nonparametric tests, including Mann–Whitney and Kruskal–Wallis tests, were used to investigate the relationship between affecting variables. Hospital training was considered as a control variable. The data were analyzed using SPSS 11 software Results: The mean age of the patients was 71.3 years; of the patients, 79% were female and 21% male. The overall crude prevalence of osteoporosis was 80% among people ≥ 65 years and 85% among patients who experienced relevant surgeries. The average cost of hospitalization was $3794.13. Also, 3 main areas of hospital costs were identified: consumables (57.70%), hoteling (17.24%), and surgical services (15.76%). The prevalence of osteoporosis was 4 times higher in women compared with men. Moreover, there were significant differences between the variables affecting hospital costs, such as gender, length of stay, diagnosis, intensive care unit services, and surgery (p<0.05). Conclusion: Age-associated diseases such as osteoporosis increase the health care costs. The dominant cost drivers in this study were the consumables, hoteling, and surgical services, respectively. Policymakers and health care planners should consider such variables as gender, previous surgeries in the patients’ records, length of stay, and intensive care unit services as driving factors and determinants of hospital costs for older seniors with osteoporosis.
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Affiliation(s)
- Vahid Alipour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Meshkani
- Department of Health Economics, School of Health Management and Information Science, Iran University of medical Science, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Aboutorabi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rafat Bagherzadeh
- English Department, School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Naser Saber
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
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17
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Kim SH, Sobez LM, Spiro JE, Curta A, Ceelen F, Kampmann E, Goepfert M, Bodensohn R, Meinel FG, Sommer WH, Sommer NN, Galiè F. Structured reporting has the potential to reduce reporting times of dual-energy x-ray absorptiometry exams. BMC Musculoskelet Disord 2020; 21:248. [PMID: 32299400 PMCID: PMC7164197 DOI: 10.1186/s12891-020-03200-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/10/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In recent years, structured reporting has been shown to be beneficial with regard to report completeness and clinical decision-making as compared to free-text reports (FTR). However, the impact of structured reporting on reporting efficiency has not been thoroughly evaluted yet. The aim of this study was to compare reporting times and report quality of structured reports (SR) to conventional free-text reports of dual-energy x-ray absorptiometry exams (DXA). METHODS FTRs and SRs of DXA were retrospectively generated by 2 radiology residents and 2 final-year medical students. Time was measured from the first view of the exam until the report was saved. A random sample of DXA reports was selected and sent to 2 referring physicians for further evaluation of report quality. RESULTS A total of 104 DXA reports (both FTRs and SRs) were generated and 48 randomly selected reports were evaluated by referring physicians. Reporting times were shorter for SRs in both radiology residents and medical students with median reporting times of 2.7 min (residents: 2.7, medical students: 2.7) for SRs and 6.1 min (residents: 5.0, medical students: 7.5) for FTRs. Information extraction was perceived to be significantly easier from SRs vs FTRs (P < 0.001). SRs were rated to answer the clinical question significantly better than FTRs (P < 0.007). Overall report quality was rated significantly higher for SRs compared to FTRs (P < 0.001) with 96% of SRs vs 79% of FTRs receiving high or very high-quality ratings. All readers except for one resident preferred structured reporting over free-text reporting and both referring clinicians preferred SRs over FTRs for DXA. CONCLUSIONS Template-based structured reporting of DXA might lead to shorter reporting times and increased report quality.
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Affiliation(s)
- Su Hwan Kim
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Lara M Sobez
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Judith E Spiro
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Adrian Curta
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Felix Ceelen
- Munich Transplant Center, University Hospital, LMU Munich, Munich, Germany
| | - Eric Kampmann
- Department of Internal Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Martin Goepfert
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Raphael Bodensohn
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Felix G Meinel
- Department of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Wieland H Sommer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nora N Sommer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Franziska Galiè
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
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18
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van den Berg P, Schweitzer DH, van Haard PMM, Geusens PP, van den Bergh JP. The use of pulse-echo ultrasound in women with a recent non-vertebral fracture to identify those without osteoporosis and/or a subclinical vertebral fracture: a pilot study. Arch Osteoporos 2020; 15:56. [PMID: 32291527 DOI: 10.1007/s11657-020-00730-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/23/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED A pilot study on the use of P-EU to identify patients without osteoporosis and/or a subclinical vertebral fracture after a recently sustained non-vertebral fracture (NVF). INTRODUCTION Screening with portable devices at emergency departments or plaster rooms could be of interest to limit referrals for dual X-ray absorptiometry (DXA) and vertebral fracture assessment (VFA). We calculated the number of negative tests for osteoporosis and/or subclinical vertebral fractures (VFs) using pulse-echo ultrasonometry (P-UE) at different thresholds. PATIENTS AND METHODS In this cross-sectional study, 209 consecutive women of 50-70 years with a recent non-vertebral fracture (NVF) were studied at the Fracture Liaison Service (FLS) of one hospital. All women received DXA/VFA and P-EU (Bindex®) assessments. Various P-EU thresholds (based on the density index (DI, g/cm2)) were analyzed to calculate the best balance between true negative (indeed no osteoporosis and/or subclinical VF) and false negative tests (osteoporosis and/or subclinical VF according to DXA/VFA). RESULTS Eighty-three women had osteoporosis (40%) and 17 women at least one VF (8%). Applying the manufacturer's recommended P-EU threshold (DI 0.844 g/cm2) being their proposed cut-off for not having hip osteoporosis resulted in 77 negative tests (37%, 31% true negative and 6% false negative tests). A DI of 0.896 g/cm2 resulted in 40 negative tests (19.3%) (38 true negative (18.3%) and 2 false negative tests (1.0%)). CONCLUSION The application of P-EU enables the identification of a substantial proportion of women with recent non-vertebral fractures at the FLS who would not need a DXA/VFA referral because they had no osteoporosis and/or subclinical vertebral fractures. The most conservative P-EU threshold resulted in 18.3% true negative tests verified by DXA/VFA against 1% false negative test results.
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Affiliation(s)
- Peter van den Berg
- Department of Orthopedics and Surgery, Fracture Liaison Service, Reinier de Graaf Gasthuis, Delft, the Netherlands.
| | - Dave H Schweitzer
- Department of Internal Medicine and Endocrinology, Reinier the Graaf Gasthuis, Delft, the Netherlands
| | - Paul M M van Haard
- Department of Medical Laboratories, Association of Clinical Chemistry, Reinier the Graaf Gasthuis, Delft, the Netherlands
| | - Piet P Geusens
- Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands
- Hasselt University, Hasselt, Belgium
| | - Joop P van den Bergh
- Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands
- Hasselt University, Hasselt, Belgium
- Department of Internal Medicine, VieCuri Medical Centre Noord-Limburg and Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands
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19
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de Groot R, Nijmeijer WS, Folbert EC, Vollenbroek-Hutten MMR, Hegeman JH. 'Nonagenarians' with a hip fracture: is a different orthogeriatric treatment strategy necessary? Arch Osteoporos 2020; 15:19. [PMID: 32088776 DOI: 10.1007/s11657-020-0698-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/07/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Nonagenarians differ from patients aged 70-79 and 80-89 years in baseline characteristics, complication and mortality rates. Differences increased gradually with age. The results of this study can be used, in combination with the Almelo Hip Fracture Score, to deliver efficiently targeted orthogeriatric treatment to the right patient group. PURPOSE In previous literature, elderly with a hip fracture are frequently defined as ≥ 70 years. However, given the ageing population and the rapidly increasing number of 'nonagenarians' (aged ≥ 90 years), the question rises whether this definition is still actual. The aim of this study is to determine whether nonagenarians show differences compared to patients aged 70-79 years and patients aged 80-89 years in terms of patient characteristics, complications and mortality rate. METHODS From April 2008 until December 2016, hip fracture patients aged ≥ 70 years treated according to our orthogeriatric treatment model were included. Patients were divided into three different groups based on age at admission: 70-79 years, 80-89 years and ≥ 90 years. Patient characteristics, risk of early mortality, complications and outcomes were analysed. Risk factors for 30-day mortality in nonagenarians were determined. RESULTS A total of 1587 patients were included: 465 patients aged 70-80 years, 867 patients aged 80-90 years and 255 patients aged ≥ 90 years. Nonagenarians were more often female and had a lower haemoglobin level at admission. Prefracture, they were more often living in a nursing home, were more dependent in activities of daily living and mobility and had a higher risk of early mortality calculated with the Almelo Hip Fracture Score (AHFS). Post-operative, nonagenarians suffer significantly more often from delirium and anaemia. The 30-day mortality and 1-year mortality were significantly higher. Differences increased gradually with age. CONCLUSION Nonagenarians differ from patients aged 70-79 and 80-89 years in baseline characteristics, complication and mortality rates. Differences increased gradually with age. The results of this study can be used, in combination with the Almelo Hip Fracture Score, to deliver efficiently targeted orthogeriatric treatment to the right patient group.
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Affiliation(s)
- R de Groot
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands
| | - W S Nijmeijer
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands.
- Telemedicine Group, Biomedical Signals and Systems, Faculty of Electrical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands.
| | - E C Folbert
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands
| | - M M R Vollenbroek-Hutten
- Telemedicine Group, Biomedical Signals and Systems, Faculty of Electrical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
- ZGT Academy, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands
| | - J H Hegeman
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands
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20
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Marycz K, Sobierajska P, Roecken M, Kornicka-Garbowska K, Kępska M, Idczak R, Nedelec JM, Wiglusz RJ. Iron oxides nanoparticles (IOs) exposed to magnetic field promote expression of osteogenic markers in osteoblasts through integrin alpha-3 (INTa-3) activation, inhibits osteoclasts activity and exerts anti-inflammatory action. J Nanobiotechnology 2020; 18:33. [PMID: 32070362 PMCID: PMC7027282 DOI: 10.1186/s12951-020-00590-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background Prevalence of osteoporosis is rapidly growing and so searching for novel therapeutics. Yet, there is no drug on the market available to modulate osteoclasts and osteoblasts activity simultaneously. Thus in presented research we decided to fabricate nanocomposite able to: (i) enhance osteogenic differentiation of osteoblast, (i) reduce osteoclasts activity and (iii) reduce pro-inflammatory microenvironment. As a consequence we expect that fabricated material will be able to inhibit bone loss during osteoporosis. Results The α-Fe2O3/γ-Fe2O3 nanocomposite (IOs) was prepared using the modified sol–gel method. The structural properties, size, morphology and Zeta-potential of the particles were studied by means of XRPD (X-ray powder diffraction), SEM (Scanning Electron Microscopy), PALS and DLS techniques. The identification of both phases was checked by the use of Raman spectroscopy and Mössbauer measurement. Moreover, the magnetic properties of the obtained IOs nanoparticles were determined. Then biological properties of material were investigated with osteoblast (MC3T3), osteoclasts (4B12) and macrophages (RAW 264.7) in the presence or absence of magnetic field, using confocal microscope, RT-qPCR, western blot and cell analyser. Here we have found that fabricated IOs: (i) do not elicit immune response; (ii) reduce inflammation; (iii) enhance osteogenic differentiation of osteoblasts; (iv) modulates integrin expression and (v) triggers apoptosis of osteoclasts. Conclusion Fabricated by our group α-Fe2O3/γ-Fe2O3 nanocomposite may become an justified and effective therapeutic intervention during osteoporosis treatment.
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Affiliation(s)
- K Marycz
- The Department of Experimental Biology, University of Environmental and Life Sciences Wroclaw, Norwida 27B, 50-375, Wrocław, Poland. .,Faculty of Veterinary Medicine, Equine Clinic-Equine Surgery, Justus-Liebig-University, Frankfurter 108, 35392, Giessen, Lahn, Germany. .,International Institute of Translational Medicine, Jesionowa 11, Malin, 55-114, Wisznia Mała, Poland.
| | - P Sobierajska
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, Okolna 2, 50-422, Wrocław, Poland
| | - M Roecken
- Faculty of Veterinary Medicine, Equine Clinic-Equine Surgery, Justus-Liebig-University, Frankfurter 108, 35392, Giessen, Lahn, Germany
| | - K Kornicka-Garbowska
- The Department of Experimental Biology, University of Environmental and Life Sciences Wroclaw, Norwida 27B, 50-375, Wrocław, Poland.,International Institute of Translational Medicine, Jesionowa 11, Malin, 55-114, Wisznia Mała, Poland
| | - M Kępska
- The Department of Experimental Biology, University of Environmental and Life Sciences Wroclaw, Norwida 27B, 50-375, Wrocław, Poland
| | - R Idczak
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, Okolna 2, 50-422, Wrocław, Poland
| | - J-M Nedelec
- Université Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, Clermont-Ferrand, France
| | - R J Wiglusz
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, Okolna 2, 50-422, Wrocław, Poland.,Centre for Advanced Materials and Smart Structures, Polish Academy of Sciences, Okolna 2, 50-950, Wrocław, Poland
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21
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Merlijn T, Swart KM, van Schoor NM, Heymans MW, van der Zwaard BC, van der Heijden AA, Rutters F, Lips P, van der Horst HE, Niemeijer C, Netelenbos JC, Elders PJ. The Effect of a Screening and Treatment Program for the Prevention of Fractures in Older Women: A Randomized Pragmatic Trial. J Bone Miner Res 2019; 34:1993-2000. [PMID: 31220365 PMCID: PMC6900199 DOI: 10.1002/jbmr.3815] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/27/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Abstract
Population screening for fracture risk may reduce the fracture incidence. In this randomized pragmatic trial, the SALT Osteoporosis Study (SOS), we studied whether screening for fracture risk and subsequent treatment in primary care can reduce fractures compared with usual care. A total of 11,032 women aged 65 to 90 years with ≥1 clinical risk factor for fractures were individually randomized to screening (n = 5575) or usual care (n = 5457). Participants in the screening group underwent a screening program, including bone densitometry and vertebral fracture assessment. Participants with a high 10-year fracture probability (FRAX) or a vertebral fracture were offered treatment with anti-osteoporosis medication by their general practitioner. Incident fractures as reported by questionnaires were verified with medical records. Follow-up was completed by 94% of the participants (mean follow-up = 3.7 years). Of the 5575 participants in the screening group, 1417 (25.4%) had an indication for anti-osteoporosis medication. Screening and subsequent treatment had no statistically significant effect on the primary outcome fracture (hazard ratio [HR] = 0.97; 95% confidence interval [CI] 0.87-1.08), nor on the secondary outcomes osteoporotic fractures (HR = 0.91; 95% CI 0.81-1.03), major osteoporotic fractures (HR = 0.91; 95% CI 0.80-1.04), hip fractures (HR = 0.91; 95% CI 0.71-1.15), falls (odds ratio [OR] = 0.91; 95% CI 0.72-1.15), or mortality (HR = 1.03; 95% CI 0.91-1.17). Post hoc explorative finding suggested that screening might be most effective after a recent fracture (HR = 0.65; 95% CI 0.44-0.96 for major osteoporotic fractures and HR = 0.38; 95% CI 0.18-0.79 for hip fractures). The results of this study might have been compromised by nonparticipation and medication nonadherence in the screening group. Overall, this study does not provide sufficient indications to consider screening for fracture prevention. However, we cannot exclude its clinical relevance to reduce (major) osteoporotic fractures and hip fractures because of the relatively small number of women with a treatment indication in the intervention group. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Thomas Merlijn
- Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Karin Ma Swart
- Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Stichting Artsen Laboratorium en Trombosedienst, Koog aan de Zaan, Netherlands
| | - Natasja M van Schoor
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Martijn W Heymans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Babette C van der Zwaard
- Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Jeroen Bosch Ziekenhuis, Department of Orthopaedics, 's-Hertogenbosch, Netherlands
| | - Amber A van der Heijden
- Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Femke Rutters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Paul Lips
- Amsterdam UMC, Vrije Universiteit Amsterdam, Internal Medicine, Endocrine Section, Amsterdam, Netherlands
| | - Henriëtte E van der Horst
- Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Christy Niemeijer
- Stichting Artsen Laboratorium en Trombosedienst, Koog aan de Zaan, Netherlands
| | - J Coen Netelenbos
- Amsterdam UMC, Vrije Universiteit Amsterdam, Internal Medicine, Endocrine Section, Amsterdam, Netherlands
| | - Petra Jm Elders
- Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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22
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Meijer HA, Graafland M, Obdeijn MC, Goslings JC, Schijven MP. Face Validity and Content Validity of a Game for Distal Radius Fracture Rehabilitation. J Wrist Surg 2019; 8:388-394. [PMID: 31579548 PMCID: PMC6773587 DOI: 10.1055/s-0039-1688948] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 04/09/2019] [Indexed: 10/26/2022]
Abstract
Background Patients recovering from a variety of wrist injuries are frequently advised to exercise to regain lost wrist and hand function. Treatment regimens to regain motion in the wrist are highly variable, and adherence to exercise protocols is known to be low. A serious game ReValidate! incorporating standardized exercise regimens was developed to motivate patients. In this study, the game is evaluated regarding its face validity and content validity. Methods In this cross-sectional study, a mixed group of "users" ( n = 53) including patients currently recovering from wrist injury, and a mixed group of "experts" ( n = 46) including professionals advising patients on therapy regimen after wrist injury played at least one complete level of the serious game. Players evaluated the game by means of a structured questionnaire regarding its content, clinical applicability, and user experience. Questions were answered on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Results All groups valued the game as being able to support wrist rehabilitation and being of use to patients recovering from a distal radius fracture (users: median 4, P25-P75 3-4 vs. experts: median 4, P25-P75 3.50-5; p = not significant). The types of exercises performed during the game were considered to be both realistic and complete compared with regular physiotherapy exercises (users: median 4, P25-P75 3-4 vs. experts: median 4, P25-P75 3-5, p = not significant). Conclusions The ReValidate! serious game can be regarded as a valid tool for patients to regain their wrist function after injury. Level of evidence This is a Level II study.
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Affiliation(s)
- Henriëtte A.W. Meijer
- Department of Surgery, Academic Medical Center, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maurits Graafland
- Department of Surgery, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Miryam C. Obdeijn
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J. Carel Goslings
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Marlies P. Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, the Netherlands
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23
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van Maren MA, Wyers CE, Driessen JHM, Visser JV, de Vries F, van de Wijdeven K, Gevers S, Lems WF, Emmelot-Vonk MH, van den Bergh JPW. Two-year persistence with teriparatide improved significantly after introduction of an educational and motivational support program. Osteoporos Int 2019; 30:1837-1844. [PMID: 31321446 PMCID: PMC6717185 DOI: 10.1007/s00198-019-05052-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/06/2019] [Indexed: 11/01/2022]
Abstract
UNLABELLED This study evaluated the 2-year persistence with teriparatide in the Netherlands. Analyses showed that the risk of non-persistence was 28% lower in patients who were followed according to an additional educational and motivational support program. INTRODUCTION Until recently, teriparatide (TPTD) was a third-line treatment option for severe osteoporosis in the Netherlands, which could only be prescribed by medical specialists based on a specific medical statement. We aimed to determine whether an educational and motivational support program (EMSP) increased 2-year treatment persistence with TPTD in patients with severe osteoporosis. METHODS We evaluated persistence in 1573 Dutch patients treated with TPTD from January 2013 until January 2018. From January 2013 onwards, all patients received a basic support program (BSP) consisting of an educational home visit to initiate TPTD treatment and phone calls (at 1, 2.5 and 8 weeks). Since May 2015, all patients received the EMSP consisting of the BSP extended with evaluation of medication adherence during phone calls, an additional phone call (at 12 months), and motivational letters at 9 and 14 months. RESULTS The EMSP showed a statistically significantly higher 2-year persistence (78%) with TPTD as compared with the BSP (72%). Reasons for treatment discontinuation were comparable between groups, except for the proportion of patients who had stopped TPTD administration due to side effects, which was significantly lower in the EMSP group (8% vs. 15% in BSP, p < 0.001). Overall, the risk of non-persistence was 28% lower in the EMSP compared with the BSP group (HR: 0.72; 95% CI: 0.55-0.93). CONCLUSION The introduction of the EMSP has demonstrated to improve the persistence with TPTD, resulting in 78% of the patients being persistent with TPTD during the 2-year treatment period.
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Affiliation(s)
- M A van Maren
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, the Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, the Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - J H M Driessen
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Division of Pharmacoepidemiology and Clinical Epidemiology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center (Maastricht UMC+), Maastricht, the Netherlands
| | | | - F de Vries
- Division of Pharmacoepidemiology and Clinical Epidemiology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center (Maastricht UMC+), Maastricht, the Netherlands
| | | | - S Gevers
- ApotheekZorg, Bladel, the Netherlands
| | - W F Lems
- Location VU Medical Center, Department of Rheumatology and Immunology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - M H Emmelot-Vonk
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, the Netherlands.
- Department of Internal Medicine, Maastricht University, Maastricht, the Netherlands.
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium.
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24
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van den Berg P, van Haard PMM, Geusens PP, van den Bergh JP, Schweitzer DH. Challenges and opportunities to improve fracture liaison service attendance: fracture registration and patient characteristics and motivations. Osteoporos Int 2019; 30:1597-1606. [PMID: 31129686 DOI: 10.1007/s00198-019-05016-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022]
Abstract
UNLABELLED This questionnaire-based study evaluated the reasons for attendance or non-attendance at the fracture liaison service in patients with a recent fracture. Frailty, male sex, living alone, and low education were associated with non-attendance, and the information perceived by the patient was associated with attendance. INTRODUCTION The purpose of this study was to evaluate hospital registration- and patient-related factors associated with attendance or non-attendance to the Fracture Liaison Service (FLS). METHODS Out of 1728 consecutive patients registered with a recent fracture at hospital entry, and after exclusion of 440 patients because of death, residence in a nursing home, already on osteoporosis treatment, or recent DXA, 1288 received an FLS invitation. We evaluated the hospital registration of fractures at entry and exit of the hospital. A questionnaire was sent to all invited patients to evaluate factors related to non-attendance (including age, gender, frailty, living alone, income, education, extrinsic motivations (impact of perceived information) and intrinsic motivations (patient's own perceived views and opinions) and to attendance (personal impact of clinical professionals' advice). RESULTS There were 278 more hospital exit codes than entry codes. Of the 1288 invited patients, 745 returned analyzable questionnaires (537 attenders and 208 non-attenders). Non-attendance was associated with male gender (OR: 2.08, 95% CI: 1.35, 3.21), frailty (OR: 1.62, CI: 1.08, 2.45), living alone (OR:2.05, CI: 1.48, 2.85), low education (OR: 1.82, CI: 1.27, 2.63), not interested in bone strength (OR: 1.85, CI: 1.33, 2.63), and being unaware of increased subsequent fracture risk (OR: 1.75, CI: 1.08, 2.86). Information perceived by the patient was significantly associated with attendance (OR: 3.32, CI: 1.75, 6.27). CONCLUSION Fracture entry registration inaccuracies, male gender, frailty, living alone, having low general education, or low interest in bone health and subsequent fracture risk were independently associated with FLS non-attendance. Adequately perceived advice (to have a bone densitometry and attend the FLS) was strongly associated with FLS attendance.
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Affiliation(s)
- P van den Berg
- Department of Orthopedics and Traumasurgery, Fracture Liaison Service, Reinier de Graaf Hospital, Delft, The Netherlands.
| | - P M M van Haard
- Department of Medical Laboratories, Association of Clinical Chemistry, Reinier the Graaf Hospital, Delft, The Netherlands
| | - P P Geusens
- Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Hasselt University, Hasselt, Belgium
| | - J P van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre Noord-Limburg and Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - D H Schweitzer
- Department of Internal Medicine and Endocrinology, Reinier the Graaf Hospital, Delft, The Netherlands
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25
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Daniels AM, Theelen LMA, Wyers CE, Janzing HMJ, van Rietbergen B, Vranken L, van der Velde RY, Geusens PPMM, Kaarsemaker S, Poeze M, van den Bergh JP. Bone Microarchitecture and Distal Radius Fracture Pattern Complexity. J Orthop Res 2019; 37:1690-1697. [PMID: 30977554 PMCID: PMC6767516 DOI: 10.1002/jor.24306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/02/2019] [Accepted: 03/27/2019] [Indexed: 02/04/2023]
Abstract
Distal radius fractures (DRFs) occur in various complexity patterns among patients differing in age, gender, and bone mineral density (BMD). Our aim was to investigate the association of patient characteristics, BMD, bone microarchitecture, and bone strength with the pattern complexity of DRFs. In this study, 251 patients aged 50-90 years with a radiologically confirmed DRF who attended the Fracture Liaison Service of VieCuri Medical Centre, the Netherlands, between November 2013 and June 2016 were included. In all patients fracture risk factors and underling metabolic disorders were evaluated and BMD measurement with vertebral fractures assessment by dual-energy X-ray absorptiometry was performed. Radiographs of all DRFs were reviewed by two independent investigators to assess fracture pattern complexity according to the AO/OTA classification in extra-articular (A), partially articular (B), and complete articular (C) fractures. For this study, patients with A and C fractures were compared. Seventy-one patients were additionally assessed by high-resolution peripheral quantitative computed tomography. Compared to group A, mean age, the proportion of males, and current smokers were higher in group C, but BMD and prevalent vertebral fractures were not different. In univariate analyses, age, male gender, trabecular area, volumetric BMD (vBMD), and stiffness were associated with type C fractures. In multivariate analyses, only male gender (odds ratio (OR) 8.48 95% confidence interval (CI) 1.75-41.18, p = 0.008]) and age (OR 1.11 [95% CI 1.03-1.19, p = 0.007]) were significantly associated with DRF pattern complexity. In conclusion, our data demonstrate that age and gender, but not body mass index, BMD, bone microarchitecture, or strength were associated with pattern complexity of DRFs.© 2019 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. J Orthop Res 37:1690-1697, 2019.
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Affiliation(s)
- Anne M. Daniels
- Department of SurgeryVieCuri Medical CentreVenloThe Netherlands,NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Luuk M. A. Theelen
- Department of Orthopaedic SurgeryVieCuri Medical CentreVenloThe Netherlands
| | - Caroline E. Wyers
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineVieCuri Medical CentreVenloThe Netherlands,Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
| | | | - Bert van Rietbergen
- Department of Biomedical Engineering, Orthopaedic BiomechanicsEindhoven University of TechnologyEind hovenThe Netherlands,Department of Orthopaedic Surgery, Research School CAPHRIMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Lisanne Vranken
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineVieCuri Medical CentreVenloThe Netherlands
| | - Robert Y. van der Velde
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineVieCuri Medical CentreVenloThe Netherlands
| | - Piet P. M. M. Geusens
- Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands,Faculty of Medicine, Division of Internal MedicineHasselt UniversityHasseltBelgium
| | - Sjoerd Kaarsemaker
- Department of Orthopaedic SurgeryVieCuri Medical CentreVenloThe Netherlands
| | - Martijn Poeze
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Surgery, Division of TraumasurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Joop P. van den Bergh
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineVieCuri Medical CentreVenloThe Netherlands,Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands,Faculty of Medicine, Division of Internal MedicineHasselt UniversityHasseltBelgium
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26
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Beek KJ, Rusman T, van der Weijden MAC, Lems WF, van Denderen JC, Konsta M, Visman I, Nurmohamed MT, van der Horst-Bruinsma IE. Long-Term Treatment With TNF-Alpha Inhibitors Improves Bone Mineral Density But Not Vertebral Fracture Progression in Ankylosing Spondylitis. J Bone Miner Res 2019; 34:1041-1048. [PMID: 30690799 DOI: 10.1002/jbmr.3684] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 01/15/2019] [Accepted: 01/19/2019] [Indexed: 01/14/2023]
Abstract
The aim of this cohort study was to evaluate the long-term effects of TNF inhibitors (TNFis) on BMD and the incidence of vertebral fractures (VFxs) in patients with ankylosing spondylitis (AS). Consecutive patients with active AS with TNFi treatment duration up to 4 years with available DXA scans and spine X-rays were included. BMD (classified according to the WHO criteria for osteoporosis) of the hip and lumbar spine, the VFx (classified as a Genant score >1/>20% height loss), and radiological progression (modified stoke ankylosing spondylitis spinal score [mSASSS]) scores were obtained at baseline and at 4 years of TNFi treatment. Overall, 135 AS patients were included. At baseline, 40.1% of patients had low BMD of the hip and 40.2% of the lumbar spine. This decreased to 38.1% (p = 0.03) with low hip BMD and 25.3% (p < 0.001) of the lumbar spine BMD after 4 years of TNFi treatment. VFxs were present at baseline in 11.1% of the 131 patients, which increased to 19.6% after 4 years of TNFi treatment. A Genant score ≥2, was found at baseline in 3 out of 14 VFx (21.4%) patients, which increased to 7 out of 27 VFx (25.9%) patients after 4 years. All disease activity parameters-the ankylosing spondylitis disease activity scale, the C-reactive protein, the erythrocyte sedimentation rate, and the bath ankylosing spondylitis disease activity index-decreased significantly (p < 0.001). The mean radiological progression (n = 80) increased significantly from a median mSASSS of 4.0 (1.5 to 16.0) at baseline to 6.5 (2.1 to 22.9) after 4 years of TNFi treatment (p < 0.001). Despite the improvement in BMD and the decrease in disease activity, we still found new VFxs, an increase in severity in the number and grade of VFxs, and radiographic progression during 4 years of treatment with TNFis in AS patients with long disease duration. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Kimberley Johanna Beek
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tamara Rusman
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Willem Frederik Lems
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Centre, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and Immunology Centre, Reade, Amsterdam, The Netherlands
| | | | - Maria Konsta
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Centre, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Rheumatology, Veterans Administration Hospital (NIMTS), Athens, Greece
| | - Ingrid Visman
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michael Twahier Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Centre, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and Immunology Centre, Reade, Amsterdam, The Netherlands
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27
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Aso-Escario J, Sebastián C, Aso-Vizán A, Martínez-Quiñones JV, Consolini F, Arregui R. Delay in diagnosis of thoracolumbar fractures. Orthop Rev (Pavia) 2019; 11:7774. [PMID: 31210909 PMCID: PMC6551460 DOI: 10.4081/or.2019.7774] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 01/23/2019] [Indexed: 11/30/2022] Open
Abstract
The time interval between the date of trauma and the diagnosis of vertebral column fractures hinders management and increases liability. We have examined the features and implications of this delay. 585 consecutive thoracolumbar fractures (2005-2016), were considered; 382 (65.30%) were males and 203 (34.70%) females. Mean age was 51 yr. Fall from a height (187; 31.97%), simple fall (147; 25.13%) and road accidents (111; 18.97%) were the most frequent causes of trauma. Physical exertion caused 8.38% (N=49). 142 patients (24.27%) were not diagnosed on the injury day (mean = 3.2 days). Delay was longer in females (mean = 5.5 vs. 2.7 days) and shorter in falls from a height (mean = 2.3) or road accidents (2.8). Mean age of diagnosed on the injury day differed from those diagnosed in the first month (49.2 vs 60.1). Plain X-ray signs were found in 7 misdiagnosed cases (46.6%). Delay was more frequent in low mineralization cases. Diagnostic delay of spine fractures is frequent. Some risk profiles can help to reduce it. Careful emergency X-ray examination is encouraged, as well as early magnetic resonance imaging in risk profiles.
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Affiliation(s)
| | | | - Alberto Aso-Vizán
- Department of Traumatology and Orthopedic Surgery, Hospital General de la Defensa, Zaragoza, Spain
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28
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Watcho P, Guiadem Kamto Kamto B, Defo Deeh PB, Nguelefack TB, Kamanyi A, Kamtchouing P. The aqueous and methanol extracts of Bambusa vulgaris (Poaceae) improve calcium and phosphorus levels, and bone microstructure in ovariectomized model of osteoporosis. J Basic Clin Physiol Pharmacol 2019; 30:jbcpp-2018-0157. [PMID: 30951500 DOI: 10.1515/jbcpp-2018-0157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/23/2019] [Indexed: 06/09/2023]
Abstract
Background Osteoporosis represents the most common metabolic bone disease. Bambusa vulgaris (Poaceae) is a plant with potential antiosteoporotic effects, due to its phytoestrogenic, antioxidative, and anti-inflammatory properties. This study was undertaken to evaluate the effects of aqueous and methanol extracts of B. vulgaris on osteoporosis in rats. Methods Adult female Wistar rats were randomly divided into normal (n = 6) and ovariectomized (n = 42) groups. Twelve weeks after ovariectomy, animals were treated for 4 weeks as follows: distilled water (10 mL/kg, per os (p.o.)), 17β-estradiol (10 μg/kg, intraperitoneal (i.p.)), soya oil (1 mL/kg, i.p.), aqueous or methanol extract of B. vulgaris (55 or 110 mg/kg, p.o.). All rats were weighed daily and sacrificed on day 29. Plasma was collected, and the uterus and femur were dissected out, weighed, and used for biochemical and histological measurements. Results In the untreated ovariectomized females, a non-significant (p > 0.05) increase in body weight and a significant decrease (p < 0.001) in the uterine and bone weights were recorded. Ovariectomy also significantly (p < 0.001) lowered the bone calcium and phosphorus concentrations, and deteriorated the microarchitecture of the femur. Interestingly, B. vulgaris extracts significantly (p < 0.001) improved the bone calcium concentration and femur microarchitecture (increase in trabecular bone density, reorganization of the trabecular network, and increase in bone marrow) with estrogenic-like effects compared to 17β-estradiol. Conclusion These results suggest that B. vulgaris is a potential therapeutic drug for the treatment of osteoporosis. The present findings further justify the ethno-medicinal claims of B. vulgaris.
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Affiliation(s)
- Pierre Watcho
- Department of Animal Biology, Faculty of Science, Animal Physiology and Phytopharmacology Laboratory, University of Dschang, P.O. BOX 67, Dschang, Cameroon
| | - Bernadette Guiadem Kamto Kamto
- Department of Animal Biology, Faculty of Science, Animal Physiology and Phytopharmacology Laboratory, University of Dschang, Dschang, Cameroon
| | - Patrick Brice Defo Deeh
- Department of Animal Biology, Faculty of Science, Animal Physiology and Phytopharmacology Laboratory, University of Dschang, Dschang, Cameroon
| | - Telesphore Benoit Nguelefack
- Department of Animal Biology, Faculty of Science, Animal Physiology and Phytopharmacology Laboratory, University of Dschang, Dschang, Cameroon
| | - Albert Kamanyi
- Department of Animal Biology, Faculty of Science, Animal Physiology and Phytopharmacology Laboratory, University of Dschang, Dschang, Cameroon
| | - Pierre Kamtchouing
- Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
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29
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de Bruin IJA, Klop C, Wyers CE, Overbeek JA, Geusens PPMM, van den Bergh JPW, Driessen JHM, de Vries F. All-cause mortality with current and past use of antidepressants or benzodiazepines after major osteoporotic and hip fracture. Osteoporos Int 2019; 30:573-581. [PMID: 30737577 PMCID: PMC6422967 DOI: 10.1007/s00198-019-04851-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/10/2019] [Indexed: 01/22/2023]
Abstract
UNLABELLED In the first year, after an osteoporotic fracture of a hip, forearm, upper arm, or spine, the dispensing rates of antidepressants and benzodiazepines increased significantly. After those fractures, recent and past use of antidepressants and benzodiazepines was associated with increased all-cause mortality; current use was not associated with mortality risk. INTRODUCTION It remains unclear to what extent use of antidepressants and benzodiazepines is associated with mortality risk after a major osteoporotic fracture (MOF). We aimed to study the cumulative use of antidepressants and benzodiazepines during the year after MOF or hip fracture (HF) and whether the use was associated with mortality. METHODS A cohort study was performed within the Dutch PHARMO Database Network including all patients aged 65+ with a first record of MOF (hip, humerus, forearm, and clinical vertebral fracture) between 2002 and 2011. Data were analyzed using Cox regression models, adjusted for comorbidities, and concomitant medication use and broken down to index fracture type. RESULTS A total of 4854 patients sustained a first MOF, of whom 1766 patients sustained a HF. Mean follow-up was 4.6 years, divided in 30-day periods. The cumulative antidepressant and benzodiazepine use during the first year after MOF increased from 10.6 to 14.7% and from 24.0 to 31.4%, respectively. Recent (31-92 days before each follow-up period) and past use (> 92 days before) of antidepressants and benzodiazepines after MOF or HF was associated with an increased all-cause mortality risk but current use (< 30 days before) was not. CONCLUSION There is a considerable increase in dispensing rate of antidepressants and benzodiazepines in the first year after a MOF. Recent and past use of these medications was associated with all-cause mortality. The finding that current use was not associated with mortality should be further explored and may probably be explained by the healthy survivor's bias.
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Affiliation(s)
- I J A de Bruin
- Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands
- NUTRIM, Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, Netherlands
| | - C Klop
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands
- NUTRIM, Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, Netherlands
| | - J A Overbeek
- PHARMO Institute for Drug Outcome Research, Utrecht, Netherlands
| | - P P M M Geusens
- Biomedical Research Center, Hasselt University, Diepenbeek, Belgium
- CAPHRI, Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center +, Maastricht, Netherlands
| | - J P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands
- NUTRIM, Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, Netherlands
- Biomedical Research Center, Hasselt University, Diepenbeek, Belgium
| | - J H M Driessen
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- NUTRIM/CAPHRI, Maastricht University Medical Center +, Maastricht, Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, P Debyelaan 25, Maastricht, Netherlands
| | - F de Vries
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, P Debyelaan 25, Maastricht, Netherlands.
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.
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30
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Winters AM, Hartog LC, Roijen H, Brohet RM, Kamper AM. Relationship between clinical outcomes and Dutch frailty score among elderly patients who underwent surgery for hip fracture. Clin Interv Aging 2018; 13:2481-2486. [PMID: 30584288 PMCID: PMC6287424 DOI: 10.2147/cia.s181497] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Frailty is a geriatric condition that is associated with an increased risk of mortality and functional decline. To date, mainly the Groningen Frailty Indicator (GFI) and Hospital Safety Management (VeiligheidsManagementSysteem [VMS]) frailty score are used to determine frailty in several hospitals in the Netherlands. However, it is yet unknown, which method has the best predictive value on clinical outcomes. Objective The aim of this study was to investigate the predictive value of GFI and VMS on clinical outcomes among patients who underwent hip fracture surgery. Design This is a prospective observational cohort study. Methods We selected all patients aged 70 years or higher, who underwent hip fracture surgery in our general hospital, between November 2014 and November 2015. Among all patients, VMS, GFI and Barthel-20 index (BI) were assessed. McNemar’s paired test and Cohen’s κ were used to examine the difference and the level of agreement between the two scoring methods. Kaplan–Meier and multivariable regression analyses were performed to determine overall survival and mortality, respectively, 3 years and 30 days after surgery. Results A total of 280 patients were included in the study. The median follow-up was 25 months. No systematic difference was found between the two methods (P=0.237), while a fair level of agreement could be measured (κ=0.363 [95% CI =0.23–50]). VMS showed a statistically significant difference in overall survival as compared to nonfrail patients (57 vs 80%, respectively [Plogrank <0.001] with an HR of 3.5 [95% CI =2.1–5.7; P<0.001]). Classification according to GFI yielded a lower but still significant HR 2.3 (95% CI =1.2–4.1; P=0.008). Conclusion VMS can be used in classifying frailty, whereby VMS frailty score is associated with clinical outcomes as overall survival mortality in older patients with hip fracture and who underwent surgery.
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Affiliation(s)
- A M Winters
- Department of Geriatrics, Isala, 8025 AB, Zwolle, the Netherlands,
| | - L C Hartog
- Diabetes Centre, Isala, 8025 AB, Zwolle, the Netherlands
| | - Hif Roijen
- Department of Geriatrics, Isala, 8025 AB, Zwolle, the Netherlands,
| | - R M Brohet
- Isala Academy, 8025 BP, Zwolle, the Netherlands
| | - A M Kamper
- Department of Geriatrics, Isala, 8025 AB, Zwolle, the Netherlands,
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31
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van de Ven LI, Klop C, Overbeek JA, de Vries F, Burden AM, Janssen PK. Association between use of antidepressants or benzodiazepines and the risk of subsequent fracture among those aged 65+ in the Netherlands. Osteoporos Int 2018; 29:2477-2485. [PMID: 30112636 PMCID: PMC6208956 DOI: 10.1007/s00198-018-4632-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 07/03/2018] [Indexed: 11/29/2022]
Abstract
UNLABELLED This is the first study to examine the association between antidepressant and benzodiazepine use following a MOF and risk of subsequent fracture in those 65+. Using national data, drug use following MOF showed that the 1-year fully adjusted risk of subsequent MOF in those on antidepressants was more than doubled. INTRODUCTION We evaluated the association between the use of antidepressants or benzodiazepines and the risk of a subsequent major osteoporotic fracture. METHODS A cohort study was performed using the Dutch PHARMO Database Network. Between 2002 and 2011, a total of 4854 patients sustained a first major osteoporotic fracture after the age of 65 years, of which 1766 sustained a hip fracture. Incidence rates and adjusted hazard ratios were calculated using Cox proportional hazards models. RESULTS Within 1 year following a major osteoporotic fracture, 15% (95% CI 13.7-15.7) and 31% (95% CI 30.1-32.8) of patients were dispensed an antidepressant or benzodiazepine, respectively. Current use of antidepressants in the first year following a major osteoporotic fracture was associated with subsequent fracture (adjusted HR 2.17 (95% CI 1.37-3.43)). Recent and past use of antidepressants were also associated with an increased risk of subsequent fracture. When the complete follow-up period was included, only the current use of antidepressants was associated with subsequent fracture following a major osteoporotic fracture (adjusted HR 1.48; 95% CI 1.06-2.06). Current benzodiazepine use was not associated with an increased risk of fracture within 1 year following a major osteoporotic fracture (adjusted HR 1.18; 95% CI 0.76-1.81) or during the complete follow-up period (adjusted HR 1.18; 95% CI 0.90-1.55). CONCLUSION This study provides evidence that antidepressants should be used with caution following a major osteoporotic fracture. It provides needed insights that can be used to inform clinicians when assessing subsequent fracture risk in patients.
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Affiliation(s)
- L I van de Ven
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C Klop
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - J A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - F de Vries
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands.
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - A M Burden
- Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zürich, Zürich, Switzerland
| | - P K Janssen
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Departments of Hospital Pharmacy and Intensive Care, VieCuri Medical Center, Venlo, The Netherlands
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32
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Swart KMA, van Vilsteren M, van Hout W, Draak E, van der Zwaard BC, van der Horst HE, Hugtenburg JG, Elders PJM. Factors related to intentional non-initiation of bisphosphonate treatment in patients with a high fracture risk in primary care: a qualitative study. BMC FAMILY PRACTICE 2018; 19:141. [PMID: 30139341 PMCID: PMC6108118 DOI: 10.1186/s12875-018-0828-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/14/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Adherence to osteoporosis treatment is crucial for good treatment effects. However, adherence has been shown to be poor and a substantial part of the patients don't even initiate treatment. This study aimed to gain insight into the considerations of both osteoporosis patients and general practitioners (GP) concerning intentional non-initiation of bisphosphonate treatment. METHODS Osteoporosis patients and GPs were recruited from the SALT Osteoporosis Study and a transmural fracture liaison service, both carried out in the Netherlands. Using questionnaires, we identified non-starters and starters of bisphosphonate treatment. Semi-structured interviews were conducted to gain a detailed overview of all considerations until saturation of the data was reached. Starters were asked to reflect on the considerations that were brought forward by the non-starters. Interviews were open coded and the codes were classified into main themes and subthemes using an inductive approach. RESULTS 16 non-starters, 10 starters, and 13 GPs were interviewed. We identified three main themes: insufficient medical advice, attitudes towards medication use including concerns about side effects, and disease awareness. From patients' as well as GPs' perspective, insufficient or ambiguous information from the GP influenced the decision of the non-starters to not start bisphosphonates. In contrast, starters were either properly informed, or they collected information themselves. Patients' aversion towards medication, fear of side effects, and a low risk perception also contributed to not starting the medication, whereas starters were aware of their fracture risk and were confident of the outcome of the treatment. Concerns about osteoporosis treatment and its side effects were also expressed by several GPs. Some GPs appeared to have a limited understanding of the current osteoporosis guidelines and the indications for treatment. CONCLUSIONS Many reasons we found for not starting bisphosphonate treatment were related to the patients or the GPs themselves being insufficiently informed. Attitudes of the GPs were shown to play a role in the decision of patients not to start treatment. Interventions need to be developed that are aimed at GPs, and at education of patients.
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Affiliation(s)
- Karin M. A. Swart
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- Stichting Artsen Laboratorium en Trombosedienst, Molenwerf 11, 1541 WR Koog aan de Zaan, Netherlands
| | - Myrthe van Vilsteren
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- Stichting Artsen Laboratorium en Trombosedienst, Molenwerf 11, 1541 WR Koog aan de Zaan, Netherlands
| | - Wesley van Hout
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Esther Draak
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Babette C. van der Zwaard
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Henriette E. van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Jacqueline G. Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Petra J. M. Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
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Cho H, Byun JH, Song I, Kim HY, Ha YC, Kim TY, Lee YK, Jang S. Effect of improved medication adherence on health care costs in osteoporosis patients. Medicine (Baltimore) 2018; 97:e11470. [PMID: 30045269 PMCID: PMC6078738 DOI: 10.1097/md.0000000000011470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Osteoporosis is a chronic disease that requires continuous health care spending for pharmacotherapy and examinations. Osteoporotic fractures are a major economic burden. However, little is known about the economic effects of osteoporosis and osteoporotic fractures in Korea.The purpose of this study was to determine the predictors of osteoporosis-related health care costs and to evaluate the economic effects of fracture prevention through medication adherence among osteoporosis patients.Using the Korea National Health Insurance Claims Database (KNHICD), we identified osteoporosis patients aged 50 years and older from 2011 to 2012. Annual health care costs of osteoporosis were analyzed from the insurer's perspective and compared between patients with fractures and those without fractures. Adherents were defined as patients with a medication possession ratio of ≥80%. A generalized linear model (GLM) was used to estimate the predictors of osteoporosis-related health care costs.The major predictors of osteoporosis-related health care costs were age, medication adherence, and the occurrence of fractures (P < .001). The proportion of fractures among non-adherents was approximately 1.1 times the proportion among adherents. Health care costs per patient with fractures were 3.8 times the costs per patient without fractures. Patients with fractures had higher health care costs due to hospitalization and outpatient costs but lower pharmacy costs than non-adherents. We estimated that about $5 million of health insurance expenses could be saved annually if all non-adherents became adherents.Improved osteoporosis medication adherence can reduce osteoporosis-related health care costs by preventing fractures. Persistent pharmacotherapy for osteoporosis is necessary to prevent osteoporotic fractures and to reduce osteoporosis-related health care costs.
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Affiliation(s)
- Hyemin Cho
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon
| | - Ji-Hye Byun
- Pharmaceutical Policy Research Team, Health Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Inmyung Song
- College of Pharmacy, Sungkyunkwan University, Suwon
| | - Ha Y. Kim
- Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo
| | - Yong-Chan Ha
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine
| | - Tae-Young Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon
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Xu L, Zheng L, Wang Z, Li C, Li S, Xia X, Zhang P, Li L, Zhang L. TNF-α-Induced SOX5 Upregulation Is Involved in the Osteogenic Differentiation of Human Bone Marrow Mesenchymal Stem Cells Through KLF4 Signal Pathway. Mol Cells 2018; 41:575-581. [PMID: 29890823 PMCID: PMC6030245 DOI: 10.14348/molcells.2018.2359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/11/2018] [Accepted: 03/21/2018] [Indexed: 02/07/2023] Open
Abstract
Postmenopausal osteoporosis (PMOP) is a common systemic skeletal disease characterized by reduced bone mass and microarchitecture deterioration. Although differentially expressed SOX5 has been found in bone marrow from ovariectomized mice, its role in osteogenic differentiation in human mesenchymal stem cells (hMSCs) from bone marrow in PMOP remains unknown. In this study, we investigated the biological function of SOX5 and explore its molecular mechanism in hMSCs from patients with PMOP. Our findings showed that the mRNA and protein expression levels of SOX5 were upregulated in hMSCs isolated from bone marrow samples of PMOP patients. We also found that SOX5 overexpression decreased the alkaline phosphatase (ALP) activity and the gene expression of osteoblast markers including Collagen I, Runx2 and Osterix, which were increased by SOX5 knockdown using RNA interference. Furthermore, TNF-α notably upregulated the SOX5 mRNA expression level, and SOX5 knockdown reversed the effect of TNF-α on osteogenic differentiation of hMSCs. In addition, SOX5 overexpression increased Kruppel-like factor 4 (KLF4) gene expression, which was decreased by SOX5 silencing. KLF4 knockdown abrogated the suppressive effect of SOX5 overexpression on osteogenic differentiation of hMSCs. Taken together, our results indicated that TNF-α-induced SOX5 upregulation inhibited osteogenic differentiation of hMSCs through KLF4 signal pathway, suggesting that SOX5 might be a novel therapeutic target for PMOP treatment.
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Affiliation(s)
- Lijun Xu
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,
China
| | - Lili Zheng
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,
China
| | - Zhifang Wang
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,
China
| | - Chong Li
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,
China
| | - Shan Li
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,
China
| | - Xuedi Xia
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,
China
| | - Pengyan Zhang
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,
China
| | - Li Li
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,
China
| | - Lixia Zhang
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,
China
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Correlation between Helicobacter pylori Infection and Metabolic Abnormality in General Population: A Cross-Sectional Study. Gastroenterol Res Pract 2018; 2018:7410801. [PMID: 29743888 PMCID: PMC5883933 DOI: 10.1155/2018/7410801] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 02/01/2018] [Accepted: 02/07/2018] [Indexed: 12/13/2022] Open
Abstract
Background Previous studies have suggested a link between Helicobacter pylori (H. pylori) and metabolic abnormality. This study aimed at investigating the correlation between H. pylori infection and metabolic abnormality in a general population. Methods All enrolled participants underwent a carbon-13 urea breath test (13C-UBT). For each individual, the following data were collected: age, gender, alanine transaminase (ALT), total protein, albumin, cholesterol, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), urea nitrogen, creatinine, uric acid, fasting plasma glucose, postprandial blood sugar, nonalcoholic fatty liver disease (NAFLD), and bone mineral density (BMD). Results The study included 1867 (393 females and 1474 males, aged 54.0 ± 9.6 years) people that took a physical examination. There was no significant difference in gender and age between the study participants with and without H. pylori infection. The statistical data are as follows: albumin: P = 0.045, uric acid: P = 0.025, fasting glucose: P = 0.043, and postprandial blood glucose: P = 0.035. In terms of the patients with NAFLD, there were significant differences in ALT and HDL-C between the study participants with and without H. pylori infection. TG (P = 0.048), HDL-C (P = 0.011), and fasting blood glucose (P = 0.018) were significantly different in both groups among individuals who got osteopenia. Conclusion H. pylori infection may be an important factor affecting metabolic abnormality and osteoporosis.
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Elders PJM, Merlijn T, Swart KMA, van Hout W, van der Zwaard BC, Niemeijer C, Heymans MW, van der Heijden AA, Rutters F, van der Horst HE, Lips P, Netelenbos JC, van Schoor NM. Design of the SALT Osteoporosis Study: a randomised pragmatic trial, to study a primary care screening and treatment program for the prevention of fractures in women aged 65 years or older. BMC Musculoskelet Disord 2017; 18:424. [PMID: 29078762 PMCID: PMC5658954 DOI: 10.1186/s12891-017-1783-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 10/15/2017] [Indexed: 01/07/2023] Open
Abstract
Background Several drugs have become available for the treatment of osteoporosis. However, screening and treatment of patients with a high fracture risk is currently not recommended in the Netherlands, because the effectiveness of bone sparing drugs has not been demonstrated in the general primary care population. Here we describe the design of the SALT Osteoporosis study, which aims to examine whether the screening and treatment of older, female patients in primary care can reduce fractures, in comparison to usual care. Methods A randomised pragmatic trial has been designed using a stepwise approach in general care practices in the Netherlands. Women aged ≥65 years, who are not prescribed bone sparing drugs or corticosteroids are eligible for the study. First, women with at least one clinical risk factor for fractures, as determined by questionnaires, are randomly assigned to the intervention or control group. Second, women in the intervention group having a high fracture risk according to our screening program, including an adapted fracture risk assessment (FRAX) tool, combined with dual-energy x-ray absorptiometry (DXA), and instant vertebral assessment (IVA), are offered a structured treatment program. The women in the control group receive care as usual and will undergo the same screening as the intervention group at the end of the trial. The follow-up duration will be three years and the primary outcome is time to first incident fracture and the total number of fractures. Discussion The results of the current study will be very important for underpinnings of the prevention strategy of the osteoporosis guidelines. Trial registration ID NTR2430. Registered 26 July 2010.
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Affiliation(s)
- P J M Elders
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - T Merlijn
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - K M A Swart
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Stichting ArtsenLaboratorium en Trombosedienst, Koog aan de Zaan, The Netherlands
| | - W van Hout
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - B C van der Zwaard
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - C Niemeijer
- Stichting ArtsenLaboratorium en Trombosedienst, Koog aan de Zaan, The Netherlands
| | - M W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - A A van der Heijden
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - F Rutters
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - H E van der Horst
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - P Lips
- Department of Internal Medicine, Endocrine Section, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - J C Netelenbos
- Department of Internal Medicine, Endocrine Section, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - N M van Schoor
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Dunnewind T, Dvortsin EP, Smeets HM, Konijn RM, Bos JHJ, de Boer PT, van den Bergh JP, Postma MJ. Economic Consequences and Potentially Preventable Costs Related to Osteoporosis in the Netherlands. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:762-768. [PMID: 28577693 DOI: 10.1016/j.jval.2017.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/01/2017] [Accepted: 02/08/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Osteoporosis often does not involve symptoms, and so the actual number of patients with osteoporosis is higher than the number of diagnosed individuals. This underdiagnosis results in a treatment gap. OBJECTIVES To estimate the total health care resource use and costs related to osteoporosis in the Netherlands, explicitly including fractures, and to estimate the proportion of fracture costs that are linked to the treatment gap and might therefore be potentially preventable; to also formulate, on the basis of these findings, strategies to optimize osteoporosis care and treatment and reduce its related costs. METHODS In this retrospective study, data of the Achmea Health Database representing 4.2 million Dutch inhabitants were used to investigate the economic consequence of osteoporosis in the Netherlands in 2010. Specific cohorts were created to identify osteoporosis-related fractures and their costs. Besides, costs of pharmaceutical treatment regarding osteoporosis were included. Using data from the literature, the treatment gap was estimated. Sensitivity analysis was performed on the base-case results. RESULTS A total of 108,013 individuals with a history of fractures were included in this study. In this population, 59,193 patients were using anti-osteoporotic medication and 86,776 patients were using preventive supplements. A total number of 3,039 osteoporosis-related fractures occurred. The estimated total costs were €465 million. On the basis of data presented in the literature, the treatment gap in our study population was estimated to vary from 60% to 72%. CONCLUSIONS The estimated total costs corrected for treatment gap were €1.15 to €1.64 billion. These results indicate room for improvement in the health care policy against osteoporosis.
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Affiliation(s)
- Tom Dunnewind
- Unit of PharmacoTherapy, -Epidemiology and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Evgeni P Dvortsin
- Unit of PharmacoTherapy, -Epidemiology and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Asc Academics B.V., Groningen, The Netherlands
| | - Hugo M Smeets
- Achmea Health Care Insurance N.V., Leusden, The Netherlands
| | - Rob M Konijn
- Achmea Health Care Insurance N.V., Leusden, The Netherlands
| | - Jens H J Bos
- Unit of PharmacoTherapy, -Epidemiology and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Pieter T de Boer
- Unit of PharmacoTherapy, -Epidemiology and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, Viecuri Medical Center, Venlo, The Netherlands; Department of Internal Medicine, University Medical Center Maastricht, Maastricht, The Netherlands; Faculty of Medicine and Life Sciences, University of Hasselt, Diepenbeek, Belgium
| | - Maarten J Postma
- Unit of PharmacoTherapy, -Epidemiology and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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38
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Kamycheva E, Goto T, Camargo CA. Celiac disease is associated with reduced bone mineral density and increased FRAX scores in the US National Health and Nutrition Examination Survey. Osteoporos Int 2017; 28:781-790. [PMID: 27714440 DOI: 10.1007/s00198-016-3791-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 09/25/2016] [Indexed: 12/17/2022]
Abstract
UNLABELLED We investigated the association between celiac disease (CD) and bone mass density (BMD) and risk of osteoporotic fractures in the general US population. In children and men ≥18 years, CD was associated with reduced BMD, and in men ≥40 years, CD was associated with increased risk of osteoporotic fractures. INTRODUCTION Celiac disease (CD) is an autoimmune condition, characterized by inflammation of the small intestine. CD has an increasing prevalence, and if unrecognized or untreated, CD can lead to complications from malabsorption and micronutrient deficiencies. We aimed to study whether CD is an independent predictor of reduced bone mineral density (BMD) and FRAX scores in the general US population. METHODS We used data from the National Health and Nutrition Examination Survey, 2009-2010 and 2013-2014. CD was defined by positive tissue transglutaminase IgA antibody test. Multivariable models of BMD and FRAX scores were adjusted for BMI, serum 25-hydroxyvitamin D, vitamin D and calcium supplements, milk intake, serum calcium, and smoking status, when available. RESULTS In children, aged 8-17 years, CD was associated with decreased Z-scores, by 0.85 for hip and 0.46 for spine (both P < 0.001). In men aged ≥ 18 years, CD was associated with 0.06 g/cm2 decrease in BMD in hip and with 0.11 g/cm2 decrease in BMD in spine (P = 0.08 and P < 0.001, respectively). In women, there were no statistically significant differences in the multiple-adjusted model. In men aged ≥ 40 years, CD predicted FRAX scores, resulting in increased scores by 2.25 % (P = 0.006) for hip fracture and by 2.43 % (P = 0.05) for major osteoporotic fracture. CD did not predict FRAX scores in women aged ≥40 years. CONCLUSION CD is independently associated with reduced BMD in children and adults aged ≥18 years and is an independent risk factor of osteoporotic fractures in men aged ≥40 years.
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Affiliation(s)
- E Kamycheva
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua St, Suite 920, Boston, MA, 02114, USA.
- Medical Clinic, University Hospital of North Norway, Sykehusveien 38, 9038, Tromsoe, Norway.
- Endocrine Research Group, Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Hansine Hansens veg 18, 9017, Tromsoe, Norway.
| | - T Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua St, Suite 920, Boston, MA, 02114, USA
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - C A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua St, Suite 920, Boston, MA, 02114, USA
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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Hong-Jhe C, Chin-Yuan K, Ming-Shium T, Fu-Wei W, Ru-Yih C, Kuang-Chieh H, Hsiang-Ju P, Ming-Yueh C, Pan-Ming C, Chih-Chuan P. The incidence and risk of osteoporosis in patients with anxiety disorder: A Population-based retrospective cohort study. Medicine (Baltimore) 2016; 95:e4912. [PMID: 27661037 PMCID: PMC5044907 DOI: 10.1097/md.0000000000004912] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The purpose of this study was to investigate the relationship between anxiety disorder (AD) and the subsequent development of osteoporosis.We conducted a population-based retrospective cohort analysis according to the data in the Longitudinal Health Insurance Database 2000 of Taiwan. We included 7098 patients in both the AD and no-anxiety cohort who were matched according to age and sex between January 1, 2000, and December 31, 2013. The incidence rate and the risk ratios (RRs) of subsequent new-onset osteoporosis were calculated for both cohorts. We used Cox proportional hazards models to assess the effect of AD. The Kaplan-Meier method was applied to estimate the cumulative osteoporosis incidence curves.The AD cohort consisted of 7098 patients, and the comparison cohort comprised the same matched control patients without anxiety. The risk of osteoporosis was higher in the AD cohort than in the comparison cohort. In addition, the incidence of newly diagnosed osteoporosis remained significantly increased in all of the stratified follow-up durations (0-1, 1-5, 5-10, ≥10years). Patients with AD were 1.79 times more likely to get osteoporosis than those without AD. We also observed a significant increase in osteoporotic risk in AD patients who are comorbid with hypertension, diabetes mellitus, and chronic liver disease.The incidence of osteoporosis in Taiwan is associated with an a priori AD history. The risk ratios are the highest for osteoporosis within 1 year of AD diagnosis, but the risk remains statistically significant for >1 year. Clinicians should pay particular attention to osteoporotic comorbidities in AD patients.
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Affiliation(s)
- Chen Hong-Jhe
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Kuo Chin-Yuan
- Department of Psychiatry, Yuli Branch, Taipei Veterans General Hospital, Yuli
| | - Tu Ming-Shium
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Wang Fu-Wei
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Chen Ru-Yih
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Hsueh Kuang-Chieh
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Pan Hsiang-Ju
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Chou Ming-Yueh
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung
- School of Medicine, National Yang-Ming University
| | - Chen Pan-Ming
- Department of Psychiatry, Yuanshan & Su-Ao Branch, Taipei Veterans General Hospital, Taipei
- Correspondence: Chen Pan-Ming, Department of Psychiatry, Yuanshan & Su-Ao Branch, Taipei Veterans General Hospital, Taiwan, Address: No. 301, Sec. 1, Subin Rd., Suao Township, Yilan County 27047, Taiwan (e-mail: ); Pan Chih-Chuan, Department of Psychiatry. Kaohsiung Veterans General Hospital, Taiwan, Address: No. 386, Ta-Chung 1st Rd., Tzuo-Yin Dist., Kaohsiung City 81362, Taiwan (e-mail: )
| | - Pan Chih-Chuan
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Correspondence: Chen Pan-Ming, Department of Psychiatry, Yuanshan & Su-Ao Branch, Taipei Veterans General Hospital, Taiwan, Address: No. 301, Sec. 1, Subin Rd., Suao Township, Yilan County 27047, Taiwan (e-mail: ); Pan Chih-Chuan, Department of Psychiatry. Kaohsiung Veterans General Hospital, Taiwan, Address: No. 386, Ta-Chung 1st Rd., Tzuo-Yin Dist., Kaohsiung City 81362, Taiwan (e-mail: )
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