Underdiagnosis and undertreatment of osteoporotic patients admitted in internal medicine wards in Italy between 2010 and 2016 (the REPOSI Register)

Drug prescription appropriateness in hospitalized older patients: 15-year results and lessons from a countrywide register

The global increase of aging with the related increase of multiple noncommunicable diseases is inevitably accompanied by the associated issue of multimorbidity and polypharmacy. The latter is not without peculiar consequences on health, because it has been shown to be associated with drug-related adverse events, mainly due to poor prescription appropriateness and drug-drug interactions. To contribute to tackle this gigantic problem, a registry of drug dispensation in hospitalized older patient has been initiated in Italy in 2008. Through the last 15 years, data on nearly 11,000 older people have been accrued during their hospital stay in internal medicine and geriatric wards. This review article summarizes the main findings obtained, and how these data contribute to tackle the issue of appropriateness of drug prescription and the need of deprescribing in hospitalized older people affected by the most common noncommunicable diseases.

Deep Radiomics-based Approach to the Diagnosis of Osteoporosis Using Hip Radiographs

PURPOSE

To develop and validate deep radiomics models for the diagnosis of osteoporosis using hip radiographs.

MATERIALS AND METHODS

A deep radiomics model was developed using 4924 hip radiographs from 4308 patients (3632 women; mean age, 62 years ± 13 [SD]) obtained between September 2009 and April 2020. Ten deep features, 16 texture features, and three clinical features were used to train the model. T score measured with dual-energy x-ray absorptiometry was used as a reference standard for osteoporosis. Seven deep radiomics models that combined different types of features were developed: clinical (model C); texture (model T); deep (model D); texture and clinical (model TC); deep and clinical (model DC); deep and texture (model DT); and deep, texture, and clinical features (model DTC). A total of 444 hip radiographs obtained between January 2019 and April 2020 from another institution were used for the external test. Six radiologists performed an observer performance test. The area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic performance.

RESULTS

For the external test set, model D (AUC, 0.92; 95% CI: 0.89, 0.95) demonstrated higher diagnostic performance than model T (AUC, 0.77; 95% CI: 0.70, 0.83; adjusted P < .001). Model DC (AUC, 0.95; 95% CI: 0.92, 0.97; adjusted P = .03) and model DTC (AUC, 0.95; 95% CI: 0.92, 0.97; adjusted P = .048) showed improved diagnostic performance compared with model D. When observer performance without and with the assistance of the model DTC prediction was compared, performance improved from a mean AUC of 0.77 to 0.87 (P = .002).

CONCLUSION

Deep radiomics models using hip radiographs could be used to diagnose osteoporosis with high performance.Keywords: Skeletal-Appendicular, Hip, Absorptiometry/Bone Densitometry© RSNA, 2022.

Direct costs of common osteoporotic fractures (Hip, Vertebral and Forearm) in Iran

BACKGROUND

Osteoporotic fractures impose significant costs on society. The objective of this study was to estimate the direct costs of the hip, vertebral, and forearm fractures in the first year after fracture incidence in Iran.

METHODS

We surveyed a sample of 300 patients aged over 50 years with osteoporotic fractures (hip, vertebral, and forearm) admitted to four hospitals affiliated to Tehran University of Medical Sciences, Iran, during 2017 and were alive six months after the fracture. Inpatient cost data were obtained from the hospital patient records. Using a questionnaire, the data regarding outpatient costs were collected through a phone interview with patients at least six months after the fracture incidence. Direct medical and non-medical costs were estimated from a societal perspective. All costs were converted to the US dollar using the average exchange rate in 2017 (1USD = IRR 34,214) RESULTS: The mean ± standard deviation (SD) age of the patient was 69.83 ± 11.25 years, and 68% were female. One hundred and seventeen (39%) patients had hip fractures, 56 (18.67%) patients had vertebral fractures, and 127 (42.33%) ones had forearm fractures. The mean direct cost (medical and non-medical) during the year after hip, vertebral and forearm fractures were estimated at USD5,381, USD2,981, and USD1,209, respectively.

CONCLUSION

The direct cost of osteoporotic fracture in Iran is high. Our findings might be useful for the economic evaluation of preventive and treatment interventions for osteoporotic fractures as well as estimating the economic burden of osteoporotic fractures in Iran.