Update on the epidemiology of osteoporosis

Osteoporosis and Celiac Disease: Updates and Hidden Pitfalls

Celiac disease (CD) is an autoimmune disorder caused by gluten ingestion in genetically predisposed individuals. In addition to the typical gastrointestinal symptoms (e.g., diarrhea, bloating, and chronic abdominal pain), CD may also present with a broad spectrum of manifestations, including low bone mineral density (BMD) and osteoporosis. The etiopathology of bone lesions in CD is multifactorial and other conditions, rather than mineral and vitamin D malabsorption, may affect skeletal health, especially those related to the endocrine system. Here, we describe CD-induced osteoporosis in an attempt to enlighten new and less-known aspects, such as the influence of the intestinal microbiome and sex-related differences on bone health. This review describes the role of CD in the development of skeletal alterations to provide physicians with an updated overview on this debated topic and to improve the management of osteoporosis in CD.

Quantitative Ultrasound Examination (QUS) of the Calcaneus in Long-Term Martial Arts Training on the Example of Long-Time Practitioners of Okinawa Kobudo/Karate Shorin-Ryu

Quantitative research of bone tissue related to physical activity (PA) and sport has a preventive dimension. Increasing the parameters of bone tissue strength, especially reaching the maximum value of peak bone strength in childhood, adolescence, and early adulthood due to practicing sports can contribute to maintaining bone health throughout life. Practicing martial arts (tai chi, traditional karate, judo, and boxing) can effectively improve the quality of bone and reduce the risk of falls and fractures. The study aimed to evaluate the calcaneus bones among Okinawa Kobudo/Karate Shorin-Ryu practitioners using the quantitative ultrasound method as an indicator for assessing bone fracture risk. Forty-four adult martial arts practitioners with a mean age of 36.4 participated in this study. Quantitative ultrasound (QUS) with a portable Bone Ultrasonometer was used in this study. Speed of sound (SOS), broadband ultrasound attenuation (BUA), and the stiffness index (SI) were measured. Subjects were assigned to two groups of black and color belts, according to the advancement in Kobudo/karate practice. The measurements of the SI, BUA, SOS, T-score, and Z-score were significantly higher in subjects from the advanced, long-term practice (black belts) (p < 0.05). The long-term martial arts training in traditional karate and Kobudo significantly impacts the parameters of the calcaneus quantitative ultrasound measurements. Significantly higher bone density was observed among the black belt holders. Long-term practice subjects achieved results far beyond the norm for their age groups. Further studies using non-invasive methods of bone quantification are needed to determine the specific conditions for preventing osteoporosis through physical activity, sports, and martial arts, particularly the duration of the activity, the magnitude of loads, and other related factors.

Core level regulatory network of osteoblast as molecular mechanism for osteoporosis and treatment

To develop and evaluate the long-term prophylactic treatment for chronic diseases such as osteoporosis requires a clear view of mechanism at the molecular and systems level. While molecular signaling pathway studies for osteoporosis are extensive, a unifying mechanism is missing. In this work, we provide experimental and systems-biology evidences that a tightly connected top-level regulatory network may exist, which governs the normal and osteoporotic phenotypes of osteoblast. Specifically, we constructed a hub-like interaction network from well-documented cross-talks among estrogens, glucocorticoids, retinoic acids, peroxisome proliferator-activated receptor, vitamin D receptor and calcium-signaling pathways. The network was verified with transmission electron microscopy and gene expression profiling for bone tissues of ovariectomized (OVX) rats before and after strontium gluconate (GluSr) treatment. Based on both the network structure and the experimental data, the dynamical modeling predicts calcium and glucocorticoids signaling pathways as targets for GluSr treatment. Modeling results further reveal that in the context of missing estrogen signaling, the GluSr treated state may be an outcome that is closest to the healthy state.

Osteoporosis Self-Assessment Tool for Asians Can Predict Neurologic Prognosis in Patients with Isolated Moderate Traumatic Brain Injury

Objectives

Osteoporosis Self-Assessment Tool for Asians (OSTA) has been proved to be a simple and effective tool for recognizing osteoporosis risk. Our previous study has demonstrated that the preoperative OSTA index was a good prognostic predictor for stage II and III colon cancer patients after surgery. We aim to evaluate the value of OSTA index in prognostication of isolated traumatic brain injury with moderate severity (GCS 9-13).

Methods

We retrospectively reviewed all patients visiting Kaohsiung Medical University Hospital emergency department due to isolated moderate traumatic brain injury from Jan. 2010 to Dec. 2012. Background data (including the OSTA index), clinical presentations, management and outcomes (ICU admission days, total admission days, complications, Glasgow outcome score (GOS) at discharge, mortality) of the patients were recorded for further analysis. Our major outcome was good neurologic recovery defined as GOS of 5. Pearson chi-square test and the Mann-Whitney U test were used to compare demographic features. Multiple logistic regression was used to identify independent risk factors.

Results

107 isolated moderate TBI patients were studied. 40 patients (37.4%) showed good recovery and 10 (9.3%) died at discharge. The univariate analysis revealed that younger age, higher OSTA index, lower ISS, lower AIS-H, and avoidance to neurosurgery were associated with better neurologic outcome for all moderate TBI patients. Multivariate analysis revealed that lower ISS, higher OSTA, and the avoidance of neurosurgery were independent risk factors predicting good neurologic recovery.

Conclusion

Higher ISS, lower OSTA index and exposure to neurosurgery were the independent risk factors for poorer recovery from isolated moderate TBI. In addition to labeling the cohort harboring osteoporotic risk, OSTA index could predict neurologic prognosis in patients with isolated moderate traumatic brain injury.

Inter-correlation of knowledge, attitude, and osteoporosis preventive behaviors in women around the age of peak bone mass

BACKGROUND

As silent and preventable in nature, postmenopausal osteoporosis awareness should be raised among young women prior to an irreversible period of declining bone mass. We therefore decided to assess the inter-correlation of knowledge, attitude and osteoporosis preventive behaviors in women around the age of peak bone mass.

METHODS

A cross-sectional study was conducted in 430 women aged 20-35 years. The participants' knowledge, attitude and behaviors concerning osteoporosis prevention were assessed along with demographic data using a four-part questionnaire. The items in this questionnaire were established by extensive literature review, including the Guideline for Management of Osteoporosis of the Thai Osteoporosis Foundation (TOPF) 2010. The content was validated by experts in osteoporosis and reliability was obtained with a Cronbach's alpha score of 0.83.

RESULTS

The mean age of women in this study was 29.4 ± 4.6 years. Half of the participants (49.5%) had heard about osteoporosis, mostly from television (95.3%, n = 203/213) and the internet (72.8%, n = 155/213). Most women had certain knowledge (85.2%) and positive attitude towards osteoporosis (53.3%). Nevertheless, 80% of the studied population did not have appropriate osteoporosis behaviors. We found significant correlation between the level of attitudes and osteoporosis behaviors (adjusted odd ratio = 3.3 with 95% confidence interval of 1.9-5.7); attitude and educational level (adjusted odd ratio = 2.2 with 95% confidence interval of 1.4-3.4); and attitude and knowledge (adjusted odd ratio = 3.5 with 95% confidence interval of 1.8-6.8).

CONCLUSION

Despite having certain knowledge about osteoporosis, the young women did not seem to have appropriate osteoporosis preventive behaviors. Developing a right attitude towards osteoporosis may be a key determinant to improving health practices in order to prevent osteoporosis.

Gender differences in osteoporosis health beliefs and knowledge and their relation to vigorous physical activity in university students

OBJECTIVE

The purpose of this cross-sectional investigation was to examine (1) gender differences in osteoporosis-related knowledge and beliefs and (2) if these beliefs could predict vigorous physical activity behavior in university students.

PARTICIPANTS

Male (n = 176) and female (n = 351) university students participated in the study.

METHODS

Participants completed self-report measures of osteoporosis knowledge and health beliefs and vigorous physical activity.

RESULTS

Regardless of gender, osteoporosis knowledge was relatively poor. Women reported higher knowledge, perceived susceptibility, perceived severity, and calcium barriers, and lower exercise self-efficacy than men. Regression analyses showed that for women, perceived susceptibility, health motivation, and exercise self-efficacy predicted vigorous physical activity, whereas for men, exercise barriers was the only predictor.

CONCLUSIONS

Gender differences in osteoporosis health beliefs appear to be greater in older adults than college-aged students. Interventions designed to increase vigorous physical activity may want to target different beliefs for men and women.

Femoral metaphysis bending test of rat: introduction and validation of a novel biomechanical testing protocol for osteoporosis

BACKGROUND

The diaphysis bending test is generally accepted to assess the biomechanical properties of bone in osteoporotic animals. However, bone strength loss was more pronounced at the metaphysis than diaphysis. Therefore, the biomechanical test should be focused on the metaphysis. This study aimed to validate a novel biomechanical test for femoral metaphysis in ovariectomized rats.

METHODS

Twenty 5-month-old female Sprague-Dawley rats were randomly divided into the ovariectomized (OVX) and sham-operated (Sham) groups. Examination of femur bone mineral density (BMD) and histomorphometry of the distal femur were performed. Femur biomechanical parameters (maximal load, yield load, and stiffness) were determined by the diaphysis bending test and a novel designed metaphysis bending test. Pearson's correlations were used to analyze the relationships between the biomechanical parameters and BMD or bone histomorphometry indexes (%Tb.Ar, Tb.N, Tb.Th), respectively.

RESULTS

The femur BMD, bone histomorphometry indexes, and biomechanical parameters of OVX were inferior to those of the Sham group (P < 0.05). In the diaphysis bending test, the mean difference of the maximum load and yield load between the OVX and Sham groups were 13.83 ± 5.27 and 15.69 ± 4.15 N, which were significantly lower than in the metaphysis bending test (43.34 ± 4.27, 48.90 ± 4.35 N; all P < 0.05). Positive correlations between biomechanical parameters and femur BMD or bone histomorphometry indexes were observed in both the diaphysis bending and metaphysis bending test. The biomechanical parameters in the metaphysis bending test showed stronger correlations with BMD and bone histomorphometry indexes.

CONCLUSIONS

The femoral metaphysis bending test was validated to assess osteoporosis in our study, and it was more sensitive than the diaphysis bending test in evaluating the change of biomechanical properties of the femur in osteoporotic rats.

A blinded randomized controlled trial of motivational interviewing to improve adherence with osteoporosis medications: design of the OPTIMA trial

We have designed an innovative randomized controlled trial for improving adherence with osteoporosis medications. Recruitment and randomization have been successful. Also, the counseling intervention has been well accepted by subjects randomized to this treatment arm.

INTRODUCTION

While many effective treatments exist for osteoporosis, most people do not adhere to such treatments long term. No proven interventions exist to improve osteoporosis medication adherence. We report here on the design and initial enrollment in an innovative randomized controlled trial aimed at improving adherence to osteoporosis treatments.

METHODS

The trial represents a collaboration between academic researchers and a state-run pharmacy benefits program for low-income older adults. Beneficiaries beginning treatment with a medication for osteoporosis are targeted for recruitment. We randomize consenting individuals to receive 12 months of mailed education (control arm) or an intervention consisting of one-on-one telephone-based counseling and the mailed education. Motivational interviewing forms the basis for the counseling program which is delivered by seven trained and supervised health counselors over ten telephone calls. The counseling sessions include scripted dialog and open-ended questions about medication adherence and its barriers, as well as structured questions. The primary end point of the trial is medication adherence measured over the 12-month intervention period. Secondary end points include fractures, nursing home admissions, health care resource utilization, and mortality.

RESULTS

During the first 7 months of recruitment, we have screened 3,638 potentially eligible subjects. After an initial mailing, 1,115 (30.6%) opted out of telephone recruitment and 1,019 (28.0%) could not be successfully contacted. Of the remaining, 879 (24.2%) consented to participate and were randomized. Women comprise over 90% of all groups; mean ages range from 77 to 80 years old, and the majority in all groups was white. The distribution of osteoporosis medications was comparable across groups and the median number of different prescription drugs used in the prior year was eight to ten.

CONCLUSIONS

We have developed a novel intervention for improving osteoporosis medication adherence. The intervention is currently being tested in a large-scale randomized controlled trial. If successful, the intervention may represent a useful model for improving adherence to other chronic treatments.

High bone density is associated with prostate cancer in older Afro-Caribbean men: Tobago prostate survey

OBJECTIVE

To test the hypothesis that bone mineral density (BMD), a possible surrogate of lifetime exposure to hormone/growth factor/vitamin D/calcium exposure, is higher in prostate cancer cases than controls.

METHODS

Hip BMD was measured by dual X-ray absorptiometry in 222 Afro-Caribbean screening-detected prostate cancer cases and 1,503 screened non-cases, aged 45-79, in the population-based Tobago Prostate Survey. Because possible skeletal metastases may modulate BMD, men with prostate specific antigen >20 ng/ml or highly undifferentiated tumors (Gleason score > or = 8) were excluded. Mean BMD, adjusted for age and body mass index, was compared in cases and non-cases by analysis of variance. Risk across age group-specific BMD quartiles was compared using logistic regression.

RESULTS

Overall, adjusted mean hip BMD was higher in cases (1.157 g/cm2) than non-cases (1.134 g/cm2) (p = 0.02). In men aged 60-79, prostate cancer risk was two-fold higher (OR, 2.12; 95% CI: 1.21-3.71) in the highest BMD quartile compared to the lowest. There was no association in younger men (interaction, p = 0.055).

CONCLUSIONS

High bone density is associated with prostate cancer among older men, consistent with an etiological role for lifetime exposure to factors which modulate bone density. However, other etiologies may dominate prostate cancer risk among younger men.

Normative data of bone Mineral Density in healthy population of Tehran, Iran: a cross sectional study

Background

Osteoporosis is a major problem and is a hidden epidemic disease in the world. Early diagnosis by measurement of Bone Mineral Density (BMD) and treatment can prevent and reduce disease complications, especially fractures. As there is no comprehensive study in Iran, this study designed to assess BMD discrepancy in 20–69 yr Tehran population as well as prevalence of osteoporosis and osteopenia.

Methods

553 people (34% men, 66%women) from 50 Blocks in Tehran randomly selected. The assessment of BMD in spine and femur region performed through DXA method. All subjects clinically examined and their BMIs determined.

Results

The average spinal BMD score in men were more than in women. The peak bone mass of spine bone both in men and women occurred during 20–29 yr and reduction began from the age of 40. At the age of 60 to 69, loose of bone density was 19.6% in lumbar spine and 18.5% in femur of women and also 7.9% in lumbar spine and 14.6% in femur of men. Prevalence of osteoporosis in this age group in lumbar spine and femur was 32.4% and 5.9% in women and 9.4% and 3.1% in men respectively.

Conclusion

In all age groups, peak bone mass was lower than European or American population, whereas the rate of bone loss was as much as the some population and actually this process justifies the prevalence of osteoporosis and osteopenia in Tehran population.

Impact of a community pharmacist-directed clinic in improving screening and awareness of osteoporosis

RATIONALE, AIMS AND OBJECTIVES

There is a need to increase screening and awareness of osteoporosis risk in order to prevent fractures and related morbidity. Although one in two women are at risk of developing the condition, only one in five receives bone mineral density screening. The purpose of the current study was to investigate the effectiveness of an osteoporosis screening and awareness programme directed by a pharmacist in the community setting.

METHODS

The study design to test for improved awareness was a prospective, pre-post trial with no control group. The level of awareness of risk was assessed both before the screening and following an educational intervention on osteoporosis provided in the pharmacy. Based on assessed risk level, a recommendation was made for follow-up with a doctor for a dual-energy X-ray absorptiometry (DEXA) scan and/or pharmacotherapy. Patients at medium or high risk were also surveyed as to their intention to follow-up with lifestyle modification recommendations.

RESULTS

There was a significant improvement in tested awareness from pre- to post-intervention at 26%; as well in self-rated awareness. There was also a significant correlation between self-rated and tested awareness. Participants indicated satisfaction with the pharmacist interaction and with their role in improving awareness. A large percentage of participants indicated that they intended to follow-up with the pharmacist's recommendation for calcium intake, exercise and/or consulting with their doctor.

CONCLUSION

The results indicate that the community pharmacist can successfully screen individuals for risk of osteoporosis and improve their awareness about steps to prevent or delay fractures.

Knowledge about osteoporosis: assessment, correlates and outcomes

During the last 10 years, we have witnessed an impressive increase in the number of studies examining knowledge about osteoporosis. The aim of the present paper is to examine the status of research on knowledge about osteoporosis by reviewing and analyzing the current literature as it pertains to assessment of knowledge about osteoporosis, factors associated with knowledge, and relationship between knowledge about osteoporosis and participation in health-related behaviors. Finally, future directions in the field are discussed. Many of the studies are still characterized by the lack of a theoretical framework, as well as by various methodological flaws. Serious deficits in knowledge are reported among healthy and diagnosed women and men, as well as among health professionals. Educational interventions are accompanied by an increase in knowledge, but no change in behavior. There is need to expand the research on knowledge about osteoporosis, especially in an effort to increase its impact on the prevention and early diagnosis of the disease. The deficits found in the knowledge of both the general population and among health care professionals, should be addressed by providing updated and reliable information through appropriate health promotion and professional venues.

Recognizing and treating glucocorticoid-induced osteoporosis in patients with pulmonary diseases

Glucocorticoids are frequently used to treat patients with pulmonary diseases, but continuous long-term use of glucocorticoids may lead to significant bone loss and an increased risk of fragility fractures. Patients with certain lung diseases, regardless of pharmacotherapy-particularly COPD and cystic fibrosis-and patients waiting for lung transplantation are also at increased risk of osteoporosis. Fragility fractures, especially of the hip, will have substantial effects on the health and well-being of older patients. Vertebral collapse and kyphosis secondary to glucocorticoid-induced osteoporosis (GIO) may affect lung function. Identification of patients with osteopenia, osteoporosis, or fragility fractures related to osteoporosis is strongly recommended and should lead to appropriate treatment. Prevention of GIO in patients receiving continuous oral glucocorticoids is also recommended. In patients receiving either high-dose inhaled glucocorticoids or low- to medium-dose inhaled glucocorticoids with frequent courses of oral glucocorticoids, bone mineral density measurements should be performed to screen for osteopenia and osteoporosis. A bisphosphonate (risedronate or alendronate), calcium and vitamin D supplementation, and lifestyle modifications are recommended for the prevention and treatment of GIO.

Self-reported prevalence and correlates of osteoporosis: results from a representative study in Israel

The aim of the present study was to determine self-reported prevalence of osteoporosis and its correlates in a representative sample of Jewish elderly persons aged 60 and older in Israel. Participants included 3022 Jewish community-dwelling men and women who provided information about themselves. Information was collected during home interviews regarding self-reported osteoporosis, health-related information, health behaviors and psychological measures. Osteoporosis self-reported prevalence rate was 7% for men and 25% for women. A history of fracture, joint pain and back pain, and psychological distress were the most important independent predictors in both men and women. Findings of the present study showed that also when based on self-reported measures, osteoporosis is a significant public health problem. Special attention should be paid to those who report themselves as suffering from the disease, but are not involved in health-related behaviors.

Knowledge and Correlates of Osteoporosis: A Comparison of Israeli-Jewish and Israeli-Arab Women

The present study examined levels and correlates of knowledge about osteoporosis among 176 Israeli-Jewish (mean age = 55) and 80 Israeli-Arab (mean age = 51) women. Levels of knowledge about the disease were low among all women, especially regarding some of the risk factors. Knowledge and awareness about the disease were especially deficient among Arab women. Younger age and lower education were the main vulnerability factors among Jewish women, and lower desire to seek information from the medical establishment, higher religiosity, and the lack of extended medical insurance among Arab women. Educational programs, geared to the needs and capabilities of the different ethnic populations, should be encouraged.

Osteoporosis health-related behaviors in secular and orthodox Israeli Jewish women

OBJECTIVE

To compare patterns of osteoporosis health-related behaviors in peri and postmenopausal ultra-orthodox and secular Jewish women.

METHODS

Interviews were conducted with 277 Israeli-Jewish women aged 45+. Health behaviors examined included: physical activity, smoking behavior, alcohol consumption, hormone replacement usage, screening behavior, calcium intake, pharmacological prevention, and help-seeking patterns. Correlates included demographic variables, health characteristics, knowledge, susceptibility beliefs, and familiarity with the disease.

RESULTS

Low proportions of women in both groups participated in physical activities, but differed in type. Calcium intake was deficient in both groups. Education was the only correlate of calcium intake among secular women, and previous experience with the disease was the main determinant among orthodox women. Compared with the secular group, a considerably lower proportion of orthodox women reported using HRT or having performed a bone density examination. Orthodox participants' level of knowledge about osteoporosis was significantly lower as well. Education was an important correlate of knowledge in both groups, as was having performed a bone density examination. Higher age and being menopausal were important correlates of knowledge only for secular women. Having a family member suffering from the disease was associated with higher levels of knowledge among orthodox women. Marked differences were found in the participants' sources of information across groups.

CONCLUSIONS

Findings emphasize the need to expand education in all areas of osteoporosis health-related behaviors among ultra-orthodox women, and in calcium intake and exercise for secular women as well. The transmission of the information should be adapted to the practices of each group.