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Lau H, Janitz TM, Sikarin A, Kasozi RN, Pujalte GGA. Sports Endocrinology. Prim Care 2024; 51:523-533. [PMID: 39067976 DOI: 10.1016/j.pop.2024.04.008] [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: 07/30/2024]
Abstract
Sports endocrinology holds a unique importance in understanding and optimizing an active and healthy lifestyle. Active patients with diabetes will need to consider modifying medications, especially insulin. The use of the dual energy x-ray absorptiometry and Fracture Risk Assessment Tool scores is important as both initiate and monitor bone health treatment. Menstrual disorders and energy imbalances are some special concerns when treating female athletes, calling for a multidisciplinary treatment team. Performance agents are popular and have made their way into recreational sports.
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Affiliation(s)
- Henry Lau
- Department of Family Medicine, Tidelands Health, 4320 Holmestown Road, Myrtle Beach, SC 29588, USA
| | - Tyler M Janitz
- Department of Family Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Alec Sikarin
- Department of Family Medicine, Tidelands Health, 4320 Holmestown Road, Myrtle Beach, SC 29588, USA
| | - Ramla N Kasozi
- Department of Family Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - George G A Pujalte
- Department of Family Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Cai J, Han W, Yang T, Ye H, Jiang Y, Liu Z, Liu Q. MRI-Based Vertebral Bone Quality Score Can Predict the Imminent New Vertebral Fracture After Vertebral Augmentation. Neurosurgery 2024; 95:566-575. [PMID: 38483168 PMCID: PMC11302943 DOI: 10.1227/neu.0000000000002901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/09/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The incidence of imminent new vertebral fracture (NVF) is notably high after vertebral augmentation (VA), but accurately assessing the imminent risk of NVF remains a great challenge. The aim of this study was to investigate whether the MRI-based vertebral bone quality (VBQ) score can predict the risk of imminent NVF after VA within a 2-year period. METHODS A total of 135 patients age 50 years and older who suffered from painful osteoporotic vertebral compression fracture and treated with VA were enrolled in this retrospective study. Each patient's VBQ scores were calculated from T1-weighted, T2-weighted, and short tau inversion recovery sequences of preoperative lumbar MRI. The clinical factors and VBQ score were integrated to create a predictive model by using the logistic regression algorithm and visualize by nomogram. Receiver operating characteristic curve, calibration curve, and decision curve analyses were used to evaluate the predictive performance of the nomogram. RESULTS The mean VBQ-T1WI and VBQ-T2WI scores of the NVF group were 4.61 ± 0.55 and 0.89 ± 0.14, respectively, which were significantly higher than those of the without NVF group (3.99 ± 0.54 and 0.79 ± 0.12, respectively, P < .001), as well as the VBQ-combined score (0.75 ± 1.30 vs -0.80 ± 1.26, P < .001), which is the combination of VBQ-T1WI and VBQ-T2WI scores. On multivariate analysis, the predictors of imminent NVF included age (odds ratio [OR] = 1.064, 95% CI = 1.009-1.122, P = .022), previous vertebral fracture (OR = 2.089, 95% CI = 0.888-4.915, P = .091), and VBQ-combined score (OR = 2.239, 95% CI = 1.529-3.279, P < .001). The nomogram achieved superior performance with an area under the receiver operating characteristic curve of 0.838 (95% CI: 0.773-0.904) in predicting the imminent NVF compared to the clinical factors or VBQ-combined score alone. CONCLUSION The VBQ score obtained from lumbar MRI can be used to assess the VBQ and predict the imminent NVF after VA in patients with osteoporotic vertebral compression fracture.
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Affiliation(s)
- Jinhui Cai
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- Department of Radiology, The Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen Han
- Department of Radiology, The Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tingqian Yang
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Haoyi Ye
- Department of Radiology, The Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yang Jiang
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zhifeng Liu
- Department of Radiology, The Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qingyu Liu
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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Veronese N, Briot K, Guañabens N, Albergaria BH, Alokail M, Al-Daghri N, Bemden ABV, Bruyère O, Burlet N, Cooper C, Curtis EM, Ebeling PR, Halbout P, Hesse E, Hiligsmann M, Camargos BM, Harvey NC, Perez AD, Radermecker RP, Reginster JY, Rizzoli R, Siggelkow H, Cortet B, Brandi ML. Recommendations for the optimal use of bone forming agents in osteoporosis. Aging Clin Exp Res 2024; 36:167. [PMID: 39120740 PMCID: PMC11315730 DOI: 10.1007/s40520-024-02826-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024]
Abstract
Bone forming agents, also known as anabolic therapies, are essential in managing osteoporosis, particularly for patients at very high-risk of fractures. Identifying candidates who will benefit the most from these treatments is crucial. For example, this group might include individuals with severe osteoporosis, multiple vertebral fractures, a recent fragility fracture or those unresponsive to antiresorptive treatments. Definitions of patients with a very high fracture risk vary across nations, are often based on fracture history, bone mineral density (BMD), and/or fracture risk calculated by FRAX® or other algorithms. However, for very high-risk patients, anabolic agents such as teriparatide, abaloparatide, or romosozumab are commonly recommended as first-line therapies due to their ability to stimulate new bone formation and improve bone microarchitecture, offering significant benefits in rapid fracture reduction over antiresorptive therapies. The cost-effectiveness of these agents is a critical consideration for decision-makers. Despite their higher costs, their effectiveness in significantly reducing fracture risk and improving quality of life can justify the investment, especially when long-term savings from reduced fracture rates and associated healthcare costs are considered. Additionally, after completing a course of anabolic therapy, transitioning to antiresorptive agents like bisphosphonates or denosumab is crucial to maintain the gains in bone density and minimize subsequent fracture risks. This sequential treatment approach ensures sustained protection and optimal resource utilization. In summary, the effective use of bone forming agents in osteoporosis requires a comprehensive strategy that includes accurate patient identification, consideration of cost-effectiveness, and implementation of appropriate sequential treatments, ultimately maximizing patient outcomes and healthcare efficiency.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy.
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia.
| | - Karine Briot
- AP-HP, Department of Rheumatology, Cochin Hospital, Paris, France
| | - Nuria Guañabens
- Rheumatology Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ben Hur Albergaria
- Department of Social Medicine (Clinical Epidemiology), Federal University of Espirito Santo, Vitória, Brazil
| | - Majed Alokail
- Protein Research Chair, Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia
| | - Angie Botto-van Bemden
- Global Patient Ambassador, Musculoskeletal Research International, Inc., Miami, FL, USA
- Patient Partner, Holiday, FL, USA
- EUPATI Fellow, Holiday, FL, USA
- Clinical Research Experts, LLC., Tampa, FL, USA
| | - Olivier Bruyère
- Research Unit in Public Health, Epidemiology and Health Economics, Department Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Nansa Burlet
- Research Unit in Public Health, Epidemiology and Health Economics, Department Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Department of Endocrinology, Monash University, Clayton, VIC, Australia
| | | | - Eric Hesse
- Institute of Musculoskeletal Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Musculoskeletal University Center Munich, LMU University Hospital, LMU Munich, Munich, Germany
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Bruno Muzzi Camargos
- Department of Radiology - Densitometry, Rede Materdei de Saúde, Belo Horizonte, Minas Gerais, Brazil
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Adolfo Diez Perez
- Department of Internal Medicine, Hospital del Mar-IMIM, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Régis Pierre Radermecker
- Department of Diabetes, Nutrition and Metabolic Disorders, Clinical Pharmacology, University of Liege, CHU de Liège, Liège, Belgium
| | - Jean-Yves Reginster
- Protein Research Chair, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Heide Siggelkow
- Department of Trauma, Orthopedics and Reconstructive Surgery, MVZ Endokrinologikum Göttingen, University Medical Center Goettingen, Von-Siebold-Straße 3, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Bernard Cortet
- Department of Rheumatology and ULR 44490, University-Hospital of Lille, 59037, Lille Cedex, France
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Chen H, Weng Z, Kalinowska M, Xiong L, Wang L, Song H, Xiao J, Wang F, Shen X. Anti-osteoporosis effect of bioactives in edible medicinal plants: a comprehensive review. Crit Rev Food Sci Nutr 2024:1-17. [PMID: 39093554 DOI: 10.1080/10408398.2024.2386449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Current treatments for osteoporosis include a calcium-rich diet, adequate exercise, and medication. Many synthetic drugs, although fast-acting, can cause a range of side effects for patients when taken over a long period, such as irritation of the digestive tract and a burden on the kidneys. As the world's population ages, the prevalence of osteoporosis is increasing, and the development of safe and effective treatments is urgently needed. Active compounds in edible and medicinal homologous plants have been used for centuries to improve bone quality. It is possible to employ them as dietary supplements to prevent osteoporosis. In this review, we analyze the influencing factors of osteoporosis and systematically summarize the research progress on the anti-osteoporosis effects of active compounds in edible and medicinal homologous plants. The literature suggests that some naturally occurring active compounds in edible and medicinal homologous plants can inhibit bone loss, prevent the degeneration of bone cell microstructure, and reduce bone fragility through alleviating oxidative stress, regulating autophagy, anti-inflammation, improving gut flora, and regulating estrogen level with little side effects. Our review provides useful guidance for the use of edible and medicinal homologous plants and the development of safer novel anti-osteoporosis dietary supplements.
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Affiliation(s)
- Huiling Chen
- College of Food Science and Engineering, Nanjing University of Finance and Economics/Collaborative Innovation Center for Modern Grain Circulation and Safety, Nanjing, China
| | - Zebin Weng
- School of Chinese Medicine, School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Monika Kalinowska
- Department of Chemistry, Biology and Biotechnology, Bialystok University of Technology, Bialystok, Poland
| | - Ling Xiong
- College of Food Science and Engineering, Nanjing University of Finance and Economics/Collaborative Innovation Center for Modern Grain Circulation and Safety, Nanjing, China
| | - Luanfeng Wang
- College of Food Science and Engineering, Nanjing University of Finance and Economics/Collaborative Innovation Center for Modern Grain Circulation and Safety, Nanjing, China
| | - Haizhao Song
- College of Food Science and Engineering, Nanjing University of Finance and Economics/Collaborative Innovation Center for Modern Grain Circulation and Safety, Nanjing, China
| | - Jianbo Xiao
- College of Food Science and Engineering, Nanjing University of Finance and Economics/Collaborative Innovation Center for Modern Grain Circulation and Safety, Nanjing, China
- Department of Analytical Chemistry and Food Science, Instituto de Agroecoloxía e Alimentación (IAA) - CITEXVI, Universidade de Vigo, Nutrition and Bromatology Group, Vigo, Spain
| | - Fang Wang
- College of Food Science and Engineering, Nanjing University of Finance and Economics/Collaborative Innovation Center for Modern Grain Circulation and Safety, Nanjing, China
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Xinchun Shen
- College of Food Science and Engineering, Nanjing University of Finance and Economics/Collaborative Innovation Center for Modern Grain Circulation and Safety, Nanjing, China
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Inderjeeth CA, Inderjeeth DC. The use of anabolic agents in the treatment of osteoporosis: a clinical update. Curr Opin Endocrinol Diabetes Obes 2024; 31:157-163. [PMID: 38752851 DOI: 10.1097/med.0000000000000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
PURPOSE OF REVIEW Anabolic therapies have revolutionized the management of patients with osteoporosis, especially those at very high fracture risk. The current review offers valuable insights into the latest evidence and guidelines on the use of anabolic agents, focusing on their comparative efficacy, safety profiles, and optimal implementation in clinical practice. RECENT FINDINGS Romosozumab, abaloparatide, and teriparatide have shown superior efficacy when compared to antiresorptive therapies in increasing bone mineral density and reducing fracture risk. Notably, sequential treatment strategies, commencing with an anabolic agent followed by an antiresorptive, has emerged as an effective approach for both rapid and sustained reduction of fracture risk in patients at high risk. Additionally, anabolics have shown potential in improving outcomes for patients who have a suboptimal response to antiresorptives. Careful patient selection and vigilant monitoring are essential to optimize therapeutic benefits while mitigating the potential risks. As we gain more clinical experience with these agents, we will better understand how to use them effectively, as part of long term, sequential treatment strategies. Ongoing research into novel anabolic therapies and innovative treatment sequences holds promise for expanding our toolkit against fragility fractures. SUMMARY Integrating anabolic agents into personalized treatment plans has the potential to significantly improve outcomes and quality of life for patients with severe osteoporosis, highlighting the importance of this therapeutic class in the management of this chronic condition.
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Affiliation(s)
- Charles A Inderjeeth
- Sir Charles Gairdner Osborne Park Hospital Group
- University of Western Australia, Nedlands, Western Australia
- Curtin University, Perth, Australia
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Palacios S, González SP, Sánchez-Prieto M, Fasero M. Clinical challenges and considerations in pharmacotherapy of osteoporosis due to menopause. Expert Opin Pharmacother 2024; 25:1359-1372. [PMID: 39039930 DOI: 10.1080/14656566.2024.2383639] [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] [Received: 05/31/2024] [Accepted: 07/19/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Osteoporosis is a chronic systemic skeletal disorder characterized by compromised bone strength and an increased risk of fracture, with a high prevalence worldwide. It is associated with a negative quality of life and an increased morbidity and mortality. Postmenopausal women are more prone to develop osteoporosis, and many of them will suffer at least one fragility fracture along their lifetime. AREAS COVERED This review starts by summarizing the pathogenesis of postmenopausal osteoporosis (PMO), with focus on the estrogen deficiency-associated bone loss. It continues with the current PMO diagnostic and fracture risk prediction tools, and it finally addresses management of PMO. All the efficacy and safety profiles of the current and future osteoporosis medications are reviewed. Furthermore, strategies to optimize the long-term disease management are discussed. For this review, only publications in English language were selected. References were extracted from PubMed, Embase, and Medline. EXPERT OPINION PMO disease management is far from being ideal. Educational and communication programs with the goal of improving disease knowledge and awareness, as well as reducing the health-care gap, should be implemented. In addition, most effective sequential prevention and treatment strategies should be initiated from the early menopause.
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Affiliation(s)
- Santiago Palacios
- Department of Obstetrics and Gynecology, Institute Palacios of Woman's Health, Madrid, Spain
| | - Silvia P González
- Department of Obstetrics and Gynecology, HM Gabinete Velázquez. Menopause and Osteoporosis Unit, Madrid, Spain
| | | | - María Fasero
- Menopause Unit, Clínica Corofas, Universidad Francisco de Vitoria, Madrid, Spain
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Lim J, Kim YJ, Kim S, Choi J. Increased risk of fragility fractures in patients with primary biliary cholangitis. JBMR Plus 2024; 8:ziae056. [PMID: 38855796 PMCID: PMC11162592 DOI: 10.1093/jbmrpl/ziae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/31/2024] [Accepted: 04/15/2024] [Indexed: 06/11/2024] Open
Abstract
Large-scale studies on the risk of fragility fractures in patients with primary biliary cholangitis (PBC) are limited due to low incidence. We aimed to investigate whether PBC is associated with fragility fractures using real-world nationwide data. The Korean National Health Insurance Service claims data from 2007 to 2020 were analyzed in this population-based cohort study. Patients with PBC (n = 4951) were matched with controls (n = 19 793) using a 1:4 ratio based on age, sex, and follow-up duration. The primary outcome was fragility fracture, which comprised fractures of the vertebra, hip, distal radius, and proximal humerus. The incidence rates (IRs) and hazard ratios (HRs) were determined to assess the impact of PBC on fragility fractures. During the median follow-up period of 5.37 years, 524 patients in the PBC group had fragility fractures (IR, 18.59/1000 person-years [PYs]). After adjusting for covariates, PBC increased the risk of fragility fractures by 1.63-fold (95% confidence interval, 1.20-2.22; P = .002). The vertebra and hip were particularly susceptible to fracture in patients with PBC, with adjusted HRs of 1.77 and 2.23, respectively. In the subgroup analysis, the risk of fragility fracture was 2.53-fold higher in men and 1.59-fold higher in women with PBC than that in the respective matched control groups. Considering the morbidity and mortality related to fragility fractures, increasing awareness of fragility fracture risk and implementing appropriate preventive measures in patients with PBC are imperative.
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Affiliation(s)
- Jihye Lim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 07345, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Sehee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Jonggi Choi
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
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Kim A, Hong JH, Shin W, Yoo H, Jung JG, Reginster JY, Kim S, Bae Y, Suh J, Kim S, Lee E, Silverman S. A randomized, double-blind, single-dose, phase 1 study comparing the pharmacokinetics, pharmacodynamics, safety, and immunogenicity of denosumab biosimilar CT‑P41 and reference denosumab in healthy males. Expert Opin Biol Ther 2024; 24:655-663. [PMID: 38349618 DOI: 10.1080/14712598.2024.2316846] [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] [Received: 12/20/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND This study's objective was to demonstrate pharmacokinetic (PK) similarity and safety of denosumab biosimilar, CT‑P41, and United States-licensed reference denosumab (US-denosumab) in healthy male Asian adults, considering also pharmacodynamic (PD) outcomes. RESEARCH DESIGN AND METHODS This double-blind, two-arm, parallel-group, Phase 1 study randomized (1:1) healthy males to a single (60-mg) subcutaneous dose of CT‑P41 or US-denosumab. Primary endpoints were area under the concentration - time curve (AUC) from time zero to infinity (AUC0-inf), AUC from time zero to the last quantifiable concentration (AUC0-last), and maximum serum concentration (Cmax). PK equivalence was determined if 90% confidence intervals (CIs) for ratios of geometric least-squares means (gLSMs) were within the predefined 80-125% equivalence margin. Secondary PK, PD, safety, and immunogenicity outcomes were also evaluated. RESULTS Of 154 participants randomized (76 CT‑P41; 78 US-denosumab), 151 received study drug (74 CT‑P41; 77 US-denosumab). Primary and secondary PK results, PD results, safety, and immunogenicity were comparable between groups. Ninety percent CIs for ratios of gLSMs were within the predefined equivalence margin for AUC0-inf (100.4-114.7), AUC0-last (99.9-114.3), and Cmax (95.2-107.3). CONCLUSIONS Following a single dose in healthy males, CT‑P41 demonstrated PK equivalence with US-denosumab. TRIAL REGISTRATION ClinicalTrials.gov: NCT06037395.
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Affiliation(s)
- Anhye Kim
- Department of Clinical Pharmacology and Therapeutics, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Jang Hee Hong
- Department of Pharmacology, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Wonsuk Shin
- Department of Clinical Pharmacology and Therapeutics, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Hyounggyoon Yoo
- Department of Clinical Pharmacology and Therapeutics, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Jin-Gyu Jung
- Department of Pharmacology, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jean-Yves Reginster
- WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Liège, Belgium
- College of Science, Kind Saud University, Riyadh, Kingdom of Saudi Arabia
| | | | - YunJu Bae
- Celltrion, Inc., Incheon, Republic of Korea
| | - JeeHye Suh
- Celltrion, Inc., Incheon, Republic of Korea
| | - Sera Kim
- Celltrion, Inc., Incheon, Republic of Korea
| | | | - Stuart Silverman
- Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- OMC Clinical Research Center, Beverly Hills, CA, USA
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Khan AA, Slart RHJA, Ali DS, Bock O, Carey JJ, Camacho P, Engelke K, Erba PA, Harvey NC, Lems WF, Morgan S, Moseley KF, O'Brien C, Probyn L, Punda M, Richmond B, Schousboe JT, Shuhart C, Ward KA, Lewiecki EM. Osteoporotic Fractures: Diagnosis, Evaluation, and Significance From the International Working Group on DXA Best Practices. Mayo Clin Proc 2024; 99:1127-1141. [PMID: 38960497 DOI: 10.1016/j.mayocp.2024.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/17/2024] [Accepted: 01/24/2024] [Indexed: 07/05/2024]
Abstract
Osteoporotic fractures, also known as fragility fractures, are reflective of compromised bone strength and are associated with significant morbidity and mortality. Such fractures may be clinically silent, and others may present clinically with pain and deformity at the time of the injury. Unfortunately, and even at the time of detection, most individuals sustaining fragility fractures are not identified as having underlying metabolic bone disease and are not evaluated or treated to reduce the incidence of future fractures. A multidisciplinary international working group with representation from international societies dedicated to advancing the care of patients with metabolic bone disease has developed best practice recommendations for the diagnosis and evaluation of individuals with fragility fractures. A comprehensive narrative review was conducted to identify key articles on fragility fractures and their impact on the incidence of further fractures, morbidity, and mortality. This document represents consensus among the supporting societies and harmonizes best practice recommendations consistent with advances in research. A fragility fracture in an adult is an important predictor of future fractures and requires further evaluation and treatment of the underlying osteoporosis. It is important to recognize that most fragility fractures occur in patients with bone mineral density T scores higher than -2.5, and these fractures confirm the presence of skeletal fragility even in the presence of a well-maintained bone mineral density. Fragility fractures require further evaluation with exclusion of contributing factors for osteoporosis and assessment of clinical risk factors for fracture followed by appropriate pharmacological intervention designed to reduce the risk of future fracture. Because most low-trauma vertebral fractures do not present with pain, dedicated vertebral imaging and review of past imaging is useful in identifying fractures in patients at high risk for vertebral fractures. Given the importance of fractures in confirming skeletal fragility and predicting future events, it is recommended that an established classification system be used for fracture identification and reporting.
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Affiliation(s)
- Aliya A Khan
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada.
| | - Riemer H J A Slart
- University Medical Center Groningen, Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, Groningen, The Netherlands
| | - Dalal S Ali
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Oliver Bock
- Department of Osteoporosis, Inselspital, Bern University Hospital, Switzerland, IG Osteoporose, Bern, Switzerland
| | - John J Carey
- Department of Rheumatology, University of Galway, Galway, Ireland
| | | | - Klaus Engelke
- Department of Medicine 3 and Institute of Medical Physics, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Germany
| | - Paola A Erba
- Department of Medicine and Surgery, Nuclear Medicine UnitASST, Ospedale Papa Giovanni, University of Milan-Bicocca, Piazza, Bergamo, Italy
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital NHS Foundation Trust, Southampton, UK
| | - Willem F Lems
- Department of Rheumatology, Amsterdam University Medical Center, The Netherlands
| | - Sarah Morgan
- Osteoporosis Prevention and Treatment Center and DXA Facility, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Linda Probyn
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marija Punda
- Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | | | - John T Schousboe
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
| | | | - Kate A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital NHS Foundation Trust, Southampton, UK
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Betancur JF, Pérez LE, Bolaños-López JE, Bernal V. High and very high risk of osteoporotic fracture in Colombia, 2003-2022: identifying diagnostic and treatment gaps. Arch Osteoporos 2024; 19:52. [PMID: 38898155 DOI: 10.1007/s11657-024-01409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
This study examined the clinical characteristics and refracture rates of Colombian patients with high- and very high-risk osteoporosis. This reveals osteoporosis diagnoses and treatment gaps. Only 5.3% of the patients were diagnosed with osteoporosis at discharge and 70.5% had refractures. This finding underscores the need for national policies to enhance osteoporosis prevention and treatment. PURPOSE This study aimed to assess the clinical features and refracture rates among patients with high- and very-high-risk osteoporosis in Colombia, highlighting diagnostic and treatment gaps. METHODS A retrospective observational study was conducted using the medical records of patients aged ≥ 50 years who experienced fragility fractures between 2003 and 2022. Clinical and demographic characteristics at the time of the initial fracture were analyzed, as well as the subsequent imminent risk (refracture rate) and the diagnosis and treatment gap. RESULTS 303.982 fragility fractures occurred, and only 5.3% of patients were diagnosed with osteoporosis upon discharge. The most prevalent index fractures were forearm, vertebral, rib, and hip. Only 17.8% of the cohort had a matched osteoporosis diagnosis, indicating a low healthcare capture. Among the diagnosed patients, 10.08% were classified as high- and very high-risk of fracture, predominantly women with a mean age of 73 years. Comorbidities included diabetes, Sjögren's syndrome, and heart failure. The prevalence of osteoporosis has increased significantly from 2004 to 2022, possibly due to improved detection methods, an aging population, or a combination of both. Despite this increase, treatment delay was evident. Refractures affected 70.5% of the patients, with forearm, hip, humerus, and vertebral fractures being the most common, with a mean time of refracture of 7 months. CONCLUSION Significant delays were observed in the diagnosis and treatment of fragility fractures. Colombia's government and health system must address osteoporosis by implementing national policies that prioritize osteoporosis and fragility fracture prevention and reduce delays in diagnosis and treatment.
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Affiliation(s)
- Juan Felipe Betancur
- Internal Medicine Investigation Unit, Centro de Investigaciones Clínicas SURA, Medellín, Colombia.
| | - Luz Eugenia Pérez
- Gestora Metodológica Grupo de Investigación Clínica y Ensayos Clínicos SURA, Medellín, Colombia
| | | | - Verónica Bernal
- Investigation Unit, Grupo de Investigación Clínica y Ensayos Clínicos SURA, Medellín, Colombia
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Veronese N, Ragusa FS, Sabico S, Dominguez LJ, Barbagallo M, Duque G, Al-Daghri N. Osteosarcopenia increases the risk of mortality: a systematic review and meta-analysis of prospective observational studies. Aging Clin Exp Res 2024; 36:132. [PMID: 38888670 PMCID: PMC11189340 DOI: 10.1007/s40520-024-02785-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND & AIMS Osteosarcopenia is a recently recognized geriatric syndrome. The association between osteosarcopenia and mortality risk is still largely underexplored. In this systematic review with meta-analysis of prospective cohort studies, we aimed to explore whether osteosarcopenia could be associated with a higher mortality risk. METHODS Several databases were searched from the inception to 16th February 2024 for prospective cohort studies dealing with osteosarcopenia and mortality. We calculated the mortality risk in osteosarcopenia vs. controls using the most adjusted estimate available and summarized the data as risk ratios (RRs) with their 95% confidence intervals (CIs). A random-effect model was considered for all analyses. RESULTS Among 231 studies initially considered, nine articles were included after exclusions for a total of 14,429 participants (mean age: 70 years; 64.5% females). The weighted prevalence of osteosarcopenia was 12.72%. Over a mean follow-up of 6.6 years and after adjusting for a mean of four covariates, osteosarcopenia was associated with approximately 53% increased risk of mortality (RR: 1.53; 95% CI: 1.28-1.78). After accounting for publication bias, the re-calculated RR was 1.48 (95%CI: 1.23-1.72). The quality of the studies was generally good, as determined by the Newcastle Ottawa Scale. CONCLUSIONS Osteosarcopenia was significantly linked with an increased risk of mortality in older people, indicating the need to consider the presence of osteoporosis in patients with sarcopenia, and vice versa, since the combination of these two conditions typical of older people may lead to further complications, such as mortality.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, 90127, Italy.
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia.
| | - Francesco Saverio Ragusa
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, 90127, Italy
| | - Shaun Sabico
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Ligia J Dominguez
- Department of Medicine and Surgery, Kore University of Enna, Enna, 94100, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, 90127, Italy
| | - Gustavo Duque
- Bone, Muscle & Geroscience Group, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Dr Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
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Muhamad Jamil NK, Naina Mohamed I, Mokhtar SA, Leong JF, Kamudin NAF, Muhammad N. Barriers to osteoporosis management and adherence to Clinical Practice Guideline: a comparative study between tertiary East Coast hospitals and a Fracture Liaison Services (FLS)-accredited hospital in Malaysia. Arch Osteoporos 2024; 19:49. [PMID: 38864939 DOI: 10.1007/s11657-024-01407-1] [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: 02/29/2024] [Accepted: 05/16/2024] [Indexed: 06/13/2024]
Abstract
This study compares osteoporosis management between tertiary East Coast hospitals and a FLS-accredited hospital in Malaysia. It identifies significant barriers and highlights the superior performance of FLS in areas like timely treatment initiation and treatment monitoring. The insights are crucial for improving osteoporosis management strategies. INTRODUCTION Osteoporosis management poses a substantial healthcare challenge, necessitating effective strategies and Clinical Practice Guidelines (CPG) adherence. METHODS The study employed a self-administered online questionnaire via Google Forms. Orthopedic clinicians from all study sites were invited to participate via messaging platforms. A total of 135 participants completed the questionnaire and the data was proceeded to statistical analyses. RESULTS The study identified significant barriers, including inadequate knowledge of current osteoporosis guidelines and medications (p = 0.014), limited choice of anti-osteoporosis medication (p < 0.001), insufficient post-fracture care staff (p < 0.001), patients' financial constraints due to socioeconomic status (p = 0.027), and lack of doctor-patient time (p = 0.042). FLS demonstrated superior performance in CPG adherence in areas such as clinical diagnosis of osteoporosis without BMD assessment (p = 0.046), timely treatment initiation (p < 0.001), treatment monitoring using BMD (p = 0.004), reassessment treatment after 3-5 years of bisphosphonate therapy (p = 0.034) and considering anabolic agents in very high-risk patients (p = 0.018). CONCLUSION The findings highlight an essential opportunity for improvement and emphasize the necessity for robust strategies and strict adherence to Clinical Practice Guidelines (CPG), especially within tertiary East Coast hospitals. The exemplary efficacy demonstrated by the FLS model strongly advocates for its broader integration across multiple hospitals, promising substantial advancements in osteoporotic patient care outcomes throughout Malaysia.
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Affiliation(s)
- Nur Khadijah Muhamad Jamil
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yacob Latif, Bandar Tun Razak, 56000, Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia
- Pharmacology Department, Faculty of Medicine, Universiti Sultan Zainal Abidin, Jalan Sultan Mahmud, 20400, Kuala Terengganu, Terengganu, Malaysia
| | - Isa Naina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yacob Latif, Bandar Tun Razak, 56000, Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Sabarul Afian Mokhtar
- Department of Trauma and Orthopedics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Juzaily Fekry Leong
- Department of Trauma and Orthopedics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Nur Azree Ferdaus Kamudin
- Department of Orthopedics, Faculty of Medicine, Universiti Sultan Zainal Abidin, Jalan Sultan Mahmud, 20400, Kuala Terengganu, Terengganu, Malaysia
| | - Norliza Muhammad
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yacob Latif, Bandar Tun Razak, 56000, Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia.
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13
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Cianferotti L, Cipriani C, Palermo A, Viapiana O, Zavatta G, Mazziotti G. A practical approach for anabolic treatment of bone fragility with romosozumab. J Endocrinol Invest 2024:10.1007/s40618-024-02395-2. [PMID: 38789679 DOI: 10.1007/s40618-024-02395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Romosozumab, a fully humanized anti-sclerostin-antibody, is a bone-builder stimulating osteoblasts and inhibiting osteoclast by activation of the canonical Wnt-beta catenin signaling. This unique mechanism of action has the potential to address unmet needs in osteoporosis management. METHODS The multifaceted practical clinical issues related to romosozumab are discussed, especially focusing on the rationale of employing a sclerostin inhibitor to target bone fragility as first line or second line treatment in post-menopausal osteoporosis and in males at increased risk of fractures. RESULTS Four randomized clinical trials with several post-hoc analyses and more than ten observational studies have consistently demonstrated that romosozumab is effective in rapidly increasing bone mineral density (BMD) and decreasing risk of vertebral, non-vertebral and hip fractures in post-menopausal women at very-high risk of fractures. In male osteoporosis, only data on BMD are available. Noteworthy, romosozumab was shown to be more effective and rapid than teriparatide in improving BMD, bone structure and strength at the hip, especially in women already treated with anti-resorptive drugs. Interestingly, even if romosozumab displays best results in treatment-naïve patients, its favourable effects on BMD were observed even in women previously treated with teriparatide or denosumab, although to a lesser extent. CONCLUSIONS Based on the available evidence, romosozumab could be proposed as ideal drug in several clinical settings, such as non-fractured post-menopausal women at very-high risk of fractures, patients with recent hip fracture, patients non responder to bisphosphonates and short-term denosumab therapy.
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Affiliation(s)
- L Cianferotti
- Bone Metabolic Diseases Unit, Department of Experimental and Clinical Biomedical Sciences, University Hospital of Florence, University of Florence, Florence, Italy
| | - C Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - A Palermo
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Unit of Metabolic Bone and Thyroid Disorders, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - O Viapiana
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - G Zavatta
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - G Mazziotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 420090, Pieve Emanuele, MI, Italy.
- Endocrinology, Diabetology and Andrology Unit, Osteoporosis and Bone Diseases Section, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
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14
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Fassio A, Gatti D, Biffi A, Ronco R, Porcu G, Adami G, Alvaro R, Bogini R, Caputi AP, Cianferotti L, Frediani B, Gonnelli S, Iolascon G, Lenzi A, Leone S, Michieli R, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Rossini M, Brandi ML, Corrao G, Tarantino U. The sequential antifracturative treatment: a meta-analysis of randomized clinical trials. Ther Adv Musculoskelet Dis 2024; 16:1759720X241234584. [PMID: 38654732 PMCID: PMC11036926 DOI: 10.1177/1759720x241234584] [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: 06/07/2023] [Accepted: 02/02/2024] [Indexed: 04/26/2024] Open
Abstract
Background Subjects with a fragility fracture have an increased risk of a new fracture and should receive effective strategies to prevent new events. The medium-term to long-term strategy should be scheduled by considering the mechanisms of action in therapy and the estimated fracture risk. Objective A systematic review was conducted to evaluate the sequential strategy in patients with or at risk of a fragility fracture in the context of the development of the Italian Guidelines. Design Systematic review and meta-analysis. Data sources and methods PubMed, Embase, and the Cochrane Library were investigated up to February 2021 to update the search of a recent systematic review. Randomized clinical trials (RCTs) that analyzed the sequential therapy of antiresorptive, anabolic treatment, or placebo in patients with or at risk of a fragility fracture were eligible. Three authors independently extracted data and appraised the risk of bias in the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Effect sizes were pooled in a meta-analysis using fixed-effects models. The primary outcome was the risk of refracture, while the secondary outcome was the bone mineral density (BMD) change. Results In all, 17 RCTs, ranging from low to high quality, met our inclusion criteria. A significantly reduced risk of fracture was detected at (i) 12 or 24 months after the switch from romosozumab to denosumab versus placebo to denosumab; (ii) 30 months from teriparatide to bisphosphonates versus placebo to bisphosphonates; and (iii) 12 months from romosozumab to alendronate versus the only alendronate therapy (specifically for vertebral fractures). In general, at 2 years after the switch from anabolic to antiresorptive drugs, a weighted BMD was increased at the lumbar spine, total hip, and femoral neck site. Conclusion The Task Force formulated recommendations on sequential therapy, which is the first treatment with anabolic drugs or 'bone builders' in patients with very high or imminent risk of fracture.
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Affiliation(s)
- Angelo Fassio
- Rheumatology Unit, University of Verona, Piazzale A Scuro, Policlinico GB Rossi, Verona 37134, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Annalisa Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano–Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano–Bicocca, Milan, Italy
| | - Raffaella Ronco
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano–Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano–Bicocca, Milan, Italy
| | - Gloria Porcu
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano–Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano–Bicocca, Milan, Italy
| | | | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome ‘Tor Vergata’, Rome, Italy
| | | | - Achille P. Caputi
- Department of Pharmacology, School of Medicine, University of Messina, Messina, Italy
| | | | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda Ospedaliero-Universitaria Senese, University of Siena, Siena, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Salvatore Leone
- AMICI Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell’Intestino, Milan, Italy
| | | | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - Tiziana Nicoletti
- Coordinamento Nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Annalisa Pennini
- Department of Biomedicine and Prevention, University of Rome ‘Tor Vergata’, Rome, Italy
| | - Eleonora Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome ‘Tor Vergata’, Rome, Italy
- Department of Orthopedics and Traumatology, ‘Policlinico Tor Vergata’ Foundation, Rome, Italy
| | | | | | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano–Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano–Bicocca, Milan, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome ‘Tor Vergata’, Rome, Italy
- Department of Orthopedics and Traumatology, ‘Policlinico Tor Vergata’ Foundation, Rome, Italy
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15
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Tuzun S, Akarirmak U, Kulaksiz B, Keles A, Okutan D, Karsli P, Kurtoglu SS, Aygun E, Palamar D. The association of FRAX with predictors of falls in the assessment of postmenopausal osteoporosis in Turkey: the fracture study of Turkey (FRACT study). Arch Osteoporos 2024; 19:29. [PMID: 38642281 PMCID: PMC11032283 DOI: 10.1007/s11657-024-01387-2] [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: 12/27/2023] [Accepted: 04/09/2024] [Indexed: 04/22/2024]
Abstract
Although FRAX is used for fracture risk evaluation, this tool does not include balance and fall risk. The association between the predictors of falls and high FRAX scores we found in this study suggests that risk indicators for falls may add substantial value to FRAX by improving fracture risk prediction. PURPOSE This observational, descriptive, and cross-sectional study aimed to assess the fall risk predictors and explore their association with FRAX in Turkish patients with postmenopausal osteoporosis. METHODS Two hundred and nine (209) women with postmenopausal osteoporosis referred to the Fracture Liaison Service (FLS) at Istanbul University-Cerrahpaşa were enrolled in the FRACT study (The Fracture Study of Turkey). Clinical risk factors were assessed using the FRAX tool. Tandem stance, Tandem walking, Timed up and go (TUG), and Chair stand tests were performed to assess balance and fall risk. RESULTS Among patients with a mean age of 67.6 (± 9.7) years, 66 patients (31.6%) had osteoporosis without fractures and 143 patients (68.4%) had fragility fractures. The proportion of patients with poor performance of fall prediction tests was significantly higher in patients with a fragility fracture than those with osteoporosis alone. There was an inverse relationship between dynamic balance tests and the reported number of prior falls in the past year. FRAX score was higher in patients with impaired Tandem stance, Tandem walking, and TUG tests (p = 0.008, p = 0.035, p = 0.001, respectively). CONCLUSION Assessment of fall risk predictors should be one of the major pillars in the physical evaluation of osteoporotic patients in the FLS setting. FRAX is a useful tool to determine the fracture risk of patients with both static and dynamic balance impairments. Combining balance assessment with FRAX may be an important step to optimize osteoporosis risk assessment.
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Affiliation(s)
- Sansin Tuzun
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey.
| | - Ulku Akarirmak
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Bilal Kulaksiz
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Aslinur Keles
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Dilara Okutan
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Pinar Karsli
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Sevgi Selin Kurtoglu
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Eren Aygun
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Deniz Palamar
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
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16
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Stumpf U, Schmidmaier R. [Secondary fracture prevention/Update osteoporosis guidelines 2023 of the Umbrella Organization Osteology]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:283-289. [PMID: 38526813 DOI: 10.1007/s00113-024-01415-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 03/27/2024]
Abstract
The S3 guidelines on the prophylaxis, diagnostics and treatment of osteoporosis 2023 were completely revised and updated between 2021 and 2023 in accordance with the Association of the Scientific Medical Societies of Germany (AWMF) regulations. The guideline committee consisted of delegates from the 20 specialist societies of the Umbrella Organization Osteology (Dachverband Osteologie, DVO) as well as delegates from the German Society of General Medicine and Family Medicine (DEGAM), the German Society for Nephrology (DGfN) and the Federal Self-help Association for Osteoporosis (BfO).The guidelines focus on preventive measures, diagnostic procedures and treatment approaches for osteoporosis in men aged 50 years and over and postmenopausal women. The main aim is the optimization of care processes, reduction of fracture incidences and maintenance or improvement of the quality of life and functional capacity of patients affected by fractures. A major update to the guidelines includes the introduction of a new risk calculator that can take more risk factors (n = 33) into account and that can estimate the risk of vertebral body and proximal femoral fractures for a 3-year period (previously 10 years). This results in new thresholds for diagnostics and treatment. The programmed app is currently not yet certified as a medical product and a paper version is therefore currently available for patient care with the planned integration of a web-based version of the risk calculator. From the perspective of trauma surgery, the recommendations and innovations for manifest osteoporosis are of particular clinical importance. The focus of the DVO guidelines update is therefore on the implementation of secondary fracture prevention in trauma surgery, orthopedic and geriatric traumatology in the clinical and practical daily routine.
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Affiliation(s)
- Ulla Stumpf
- MUM - Muskoloskelettales Universitätszentrum München, Klinik für Orthopädie und Unfallchirurgie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
- Osteologisches Schwertpunktzentrum DVO der LMU, LMU Klinikum, LMU München, München, Deutschland.
| | - Ralf Schmidmaier
- Osteologisches Schwertpunktzentrum DVO der LMU, LMU Klinikum, LMU München, München, Deutschland
- Medizinische Klinik IV, LMU Klinikum, LMU München, München, Deutschland
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17
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Ishizu H, Shimizu T, Arita K, Sato K, Takahashi R, Kusunoki K, Shimodan S, Asano T, Iwasaki N. Secondary fracture and mortality risk with very high fracture risk osteoporosis and proximal femoral fracture. J Bone Miner Metab 2024; 42:196-206. [PMID: 38308695 DOI: 10.1007/s00774-023-01492-1] [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: 09/24/2023] [Accepted: 12/06/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION We aimed to investigate secondary fracture and mortality rates, and risk factors in patients with proximal femoral fractures. MATERIALS AND METHODS We conducted a multicenter prospective cohort study on female patients with proximal femoral fractures who underwent surgical treatment between April 2020 and March 2021. Postoperative follow-ups were performed at 6-, 12-, 18-, and 24-month intervals to determine the secondary fracture and mortality rates, and the risk factors and its influence were examined. RESULTS Of the 279 registered patients, 144 patients (51.6%) were diagnosed with very high fracture risk osteoporosis. The postoperative osteoporosis rate exceeded 96%; however, osteoanabolic agents were used sparingly. The risk factor of both secondary fracture and mortality was very high fracture risk osteoporosis, and secondary fractures within 12 months were markedly occurred. Secondary fracture rates increased as the number of matched very high fracture risk osteoporosis criteria increased. Notably, secondary fractures and mortality were recorded in 21.4% and 23.5% of the patients who met all criteria, respectively. CONCLUSION Over half of the female patients with proximal femoral fractures had very high fracture risk osteoporosis. Although, very high fracture risk osteoporosis demonstrated a notably increased risk of secondary fractures, particularly at 12 months post-surgery, the use of osteoanabolic agents was substantially low. Collectively, our findings highlight the need to consider the risk of very high fracture risk osteoporosis, expand the use of medications to include osteoanabolic agents, and reconsider the current healthcare approach for proximal femoral fractures.
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Affiliation(s)
- Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Kosuke Arita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, KKR Sapporo Medical Center, Sapporo, Japan
| | - Komei Sato
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Iwamizawa City Hospital, Iwamizawa, Hokkaido, Japan
| | - Renya Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan
| | - Kenichi Kusunoki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Central Hospital, Hakodate, Hokkaido, Japan
| | - Shun Shimodan
- Department of Orthopaedic Surgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan
| | - Tsuyoshi Asano
- Department of Orthopaedic Surgery, KKR Sapporo Medical Center, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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18
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Zhang YY, Xie N, Sun XD, Nice EC, Liou YC, Huang C, Zhu H, Shen Z. Insights and implications of sexual dimorphism in osteoporosis. Bone Res 2024; 12:8. [PMID: 38368422 PMCID: PMC10874461 DOI: 10.1038/s41413-023-00306-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/04/2023] [Accepted: 11/27/2023] [Indexed: 02/19/2024] Open
Abstract
Osteoporosis, a metabolic bone disease characterized by low bone mineral density and deterioration of bone microarchitecture, has led to a high risk of fatal osteoporotic fractures worldwide. Accumulating evidence has revealed that sexual dimorphism is a notable feature of osteoporosis, with sex-specific differences in epidemiology and pathogenesis. Specifically, females are more susceptible than males to osteoporosis, while males are more prone to disability or death from the disease. To date, sex chromosome abnormalities and steroid hormones have been proven to contribute greatly to sexual dimorphism in osteoporosis by regulating the functions of bone cells. Understanding the sex-specific differences in osteoporosis and its related complications is essential for improving treatment strategies tailored to women and men. This literature review focuses on the mechanisms underlying sexual dimorphism in osteoporosis, mainly in a population of aging patients, chronic glucocorticoid administration, and diabetes. Moreover, we highlight the implications of sexual dimorphism for developing therapeutics and preventive strategies and screening approaches tailored to women and men. Additionally, the challenges in translating bench research to bedside treatments and future directions to overcome these obstacles will be discussed.
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Affiliation(s)
- Yuan-Yuan Zhang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Na Xie
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Xiao-Dong Sun
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Edouard C Nice
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, 3800, Australia
| | - Yih-Cherng Liou
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, 117543, Republic of Singapore
| | - Canhua Huang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Huili Zhu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Department of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.
| | - Zhisen Shen
- Department of Otorhinolaryngology and Head and Neck Surgery, The Affiliated Lihuili Hospital, Ningbo University, 315040, Ningbo, Zhejiang, China.
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Hiligsmann M, Silverman SL, Singer AJ, Pearman L, Wang Y, Caminis J, Reginster JY. Comparison of the cost-effectiveness of sequential treatment with abaloparatide in US men and women at very high risk of fractures. Aging Clin Exp Res 2024; 36:14. [PMID: 38289413 PMCID: PMC10827834 DOI: 10.1007/s40520-023-02682-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/03/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Osteoporotic-related fractures represent an increasing burden to patients, health care systems and society. AIMS This study estimated cost-effectiveness of sequential treatment with abaloparatide (ABL) followed by alendronate (ALN) compared to relevant alternative strategies in US men and women aged 50 to 80 years at very high fracture risk (bone mineral density T-score ≤ - 2.5 and a recent fracture). METHODS A lifetime Markov-based microsimulation model was used to estimate healthcare costs and quality-adjusted life years (QALYs). Comparators were sequential treatment with unbranded teriparatide (TPTD)/ALN, generic ALN monotherapy, and no treatment. Analyses were conducted based on initial fracture site (hip, vertebral, or any fracture) and treatment efficacy data (derived from clinical trials or a recent network meta-analysis). RESULTS From all analyses completed, sequential ABL/ALN demonstrated more QALYs for lower healthcare costs versus unbranded TPTD/ALN. No treatment was dominated (higher costs for less QALYs) versus ALN monotherapy. Sequential ABL/ALN resulted in favorable cost-effectiveness (at US threshold of $150,000/QALY) versus generic ALN monotherapy in men aged ≥ 50 years with any fracture type, women aged ≥ 65 years with any fracture type, and women aged ≥ 55 years having a hip or vertebral fracture. DISCUSSION Similar cost-effectiveness of sequential ABL/ALN versus unbranded TPTD/ALN, ALN monotherapy, and no treatment was observed in both US men and women at very high fracture risk, with a moderate improvement in cost-effectiveness in men versus women and in patients with a hip or vertebral fracture. CONCLUSIONS Sequential therapy with ABL/ALN was cost-effective in US men and women at very high risk of fractures.
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Affiliation(s)
- Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Stuart L Silverman
- Cedars-Sinai Medical Center, Los Angeles and the OMC Clinical Research Center, Beverly Hills, CA, USA
| | - Andrea J Singer
- MedStar Georgetown University Hospital and Georgetown University Medical Center, Washington, DC, USA
| | | | | | | | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- World Health Organization Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Liège, Belgium
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20
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Giveon S, Zacay G, Vered I, Foldes AJ, Tripto-Shkolnik L. Zoledronic acid sequential to teriparatide may promote greater inhibition of bone resorption than zoledronic acid alone. Ther Adv Endocrinol Metab 2023; 14:20420188231213639. [PMID: 38028331 PMCID: PMC10666713 DOI: 10.1177/20420188231213639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Teriparatide (TPTD) should be followed by an antiresorptive to maximize bone mineral density gain and anti-fracture protection. Infrequent zoledronic acid (ZOL) administration has demonstrated effectiveness. The duration of ZOL effect following TPTD is unknown. Objective To evaluate the effect of ZOL on bone resorption marker in a post-TPTD versus ZOL-alone scenario in osteoporotic patients. Design Retrospective cohort study. Methods Patients treated with TPTD followed by ZOL (TPTD-ZOL) or with a single ZOL infusion were identified in the database of a tertiary referral center. Clinical and laboratory data, including C-terminal telopeptide of type I collagen (CTX) following ZOL treatment, were compared. Results Twenty-six patients (93% women) treated with TPTD-ZOL and 41 with ZOL were comparable in age (median 70.1 versus 69.6 years, p = 0.6) and sex. Timing of CTX measurement post-ZOL was the same, median 1.0 year. CTX was lower following TPTD-ZOL (median 142.1 versus 184.2 pg/mL, p = 0.005). In a multivariable regression model (controlled for baseline characteristics), pretreatment with TPTD strongly predicted CTX <150 pg/mL, 1 year following ZOL (odds ratio = 7.5, 95% CI 1.3-58.1, p = 0.03). In a subgroup with sequential CTX measurements following one ZOL, significantly lower levels persisted in the TPTD-ZOL group for a median of 4.4 years follow-up. Conclusion ZOL-administered sequential to TPTD yielded deeper and more prolonged bone resorption suppression than ZOL alone. Prospective data are needed to confirm whether in a sequential treatment scenario, subsequent ZOL dosing interval should be less frequent.
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Affiliation(s)
- Sharon Giveon
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Sheba Road 2, Ramat Gan, Tel Hashomer 5262100, Israel
| | - Galia Zacay
- School of Medicine, Tel Aviv University, Israel
- Meuhedet Health Services, Tel Aviv, Israel
| | - Iris Vered
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
- School of Medicine, Tel Aviv University, Israel
| | - A. Joseph Foldes
- Osteoporosis Center, Hadassah Mount-Scopus University Hospital, Jerusalem, Israel
| | - Liana Tripto-Shkolnik
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
- School of Medicine, Tel Aviv University, Israel
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21
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Kristensen SB, Clausen A, Skjødt MK, Søndergaard J, Abrahamsen B, Möller S, Rubin KH. An enhanced version of FREM (Fracture Risk Evaluation Model) using national administrative health data: analysis protocol for development and validation of a multivariable prediction model. Diagn Progn Res 2023; 7:19. [PMID: 37784165 PMCID: PMC10546772 DOI: 10.1186/s41512-023-00158-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Osteoporosis poses a growing healthcare challenge owing to its rising prevalence and a significant treatment gap, as patients are widely underdiagnosed and consequently undertreated, leaving them at high risk of osteoporotic fracture. Several tools aim to improve case-finding in osteoporosis. One such tool is the Fracture Risk Evaluation Model (FREM), which in contrast to other tools focuses on imminent fracture risk and holds potential for automation as it relies solely on data that is routinely collected via the Danish healthcare registers. The present article is an analysis protocol for a prediction model that is to be used as a modified version of FREM, with the intention of improving the identification of subjects at high imminent risk of fracture by including pharmacological exposures and using more advanced statistical methods compared to the original FREM. Its main purposes are to document and motivate various aspects and choices of data management and statistical analyses. METHODS The model will be developed by employing logistic regression with grouped LASSO regularization as the primary statistical approach and gradient-boosted classification trees as a secondary statistical modality. Hyperparameter choices as well as computational considerations on these two approaches are investigated by an unsupervised data review (i.e., blinded to the outcome), which also investigates and handles multicollinarity among the included exposures. Further, we present an unsupervised review of the data and testing of analysis code with respect to speed and robustness on a remote analysis environment. The data review and code tests are used to adjust the analysis plans in a blinded manner, so as not to increase the risk of overfitting in the proposed methods. DISCUSSION This protocol specifies the planned tool development to ensure transparency in the modeling approach, hence improving the validity of the enhanced tool to be developed. Through an unsupervised data review, it is further documented that the planned statistical approaches are feasible and compatible with the data employed.
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Affiliation(s)
- Simon Bang Kristensen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Heden 16, Odense C, 5000, Denmark
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anne Clausen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Heden 16, Odense C, 5000, Denmark
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Michael Kriegbaum Skjødt
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Heden 16, Odense C, 5000, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Bo Abrahamsen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Heden 16, Odense C, 5000, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Sören Möller
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Heden 16, Odense C, 5000, Denmark
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Katrine Hass Rubin
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Heden 16, Odense C, 5000, Denmark.
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
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Schmidmaier R. [Osteoporosis: treatment of high-risk patients]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:799-807. [PMID: 37656201 DOI: 10.1007/s00132-023-04430-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/02/2023]
Abstract
Nowadays, different drugs are available for specific treatment of osteoporosis. On the one hand, antiresorptives (raloxifene, bisphosphonates, denosumab) and, on the other hand, bone anabolic drugs (teriparatide and romosozumab) can be used. For both bone anabolic agents, superiority over oral bisphosphonates in high-risk patients was shown in randomized comparative studies. High-risk patients represent a subgroup of osteoporosis patients requiring treatment with a particularly high fracture risk. The very high risk can be recognized by the clinical manifestation (hip or vertebral fracture), the very low T‑score and/or the clinical risk factors (exceeding the bone anabolic threshold of the DVO risk calculator). High-risk patients should be treated with bone anabolic drugs in the first line of treatment. Patients treated with antiresorptives, who develop a very high risk in the course of the disease should be escalated to bone anabolic compounds. Every bone anabolic treatment requires an antiresorptive follow-up treatment. Drug holidays are only possible in exceptional cases for high-risk patients.
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Affiliation(s)
- Ralf Schmidmaier
- LMU Klinikum, Osteologisches Schwerpunktzentrum der LMU - Bayerisches Osteoporosezentrum, Medizinische Klinik und Poliklinik IV, Ziemssenstr. 5, 80336, München, Deutschland.
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23
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Shevroja E, Reginster JY, Lamy O, Al-Daghri N, Chandran M, Demoux-Baiada AL, Kohlmeier L, Lecart MP, Messina D, Camargos BM, Payer J, Tuzun S, Veronese N, Cooper C, McCloskey EV, Harvey NC. Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging. Osteoporos Int 2023; 34:1501-1529. [PMID: 37393412 PMCID: PMC10427549 DOI: 10.1007/s00198-023-06817-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/31/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Trabecular bone score (TBS) is a grey-level textural measurement acquired from dual-energy X-ray absorptiometry lumbar spine images and is a validated index of bone microarchitecture. In 2015, a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) published a review of the TBS literature, concluding that TBS predicts hip and major osteoporotic fracture, at least partly independent of bone mineral density (BMD) and clinical risk factors. It was also concluded that TBS is potentially amenable to change as a result of pharmacological therapy. Further evidence on the utility of TBS has since accumulated in both primary and secondary osteoporosis, and the introduction of FRAX and BMD T-score adjustment for TBS has accelerated adoption. This position paper therefore presents a review of the updated scientific literature and provides expert consensus statements and corresponding operational guidelines for the use of TBS. METHODS An Expert Working Group was convened by the ESCEO and a systematic review of the evidence undertaken, with defined search strategies for four key topics with respect to the potential use of TBS: (1) fracture prediction in men and women; (2) initiating and monitoring treatment in postmenopausal osteoporosis; (3) fracture prediction in secondary osteoporosis; and (4) treatment monitoring in secondary osteoporosis. Statements to guide the clinical use of TBS were derived from the review and graded by consensus using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. RESULTS A total of 96 articles were reviewed and included data on the use of TBS for fracture prediction in men and women, from over 20 countries. The updated evidence shows that TBS enhances fracture risk prediction in both primary and secondary osteoporosis, and can, when taken with BMD and clinical risk factors, inform treatment initiation and the choice of antiosteoporosis treatment. Evidence also indicates that TBS provides useful adjunctive information in monitoring treatment with long-term denosumab and anabolic agents. All expert consensus statements were voted as strongly recommended. CONCLUSION The addition of TBS assessment to FRAX and/or BMD enhances fracture risk prediction in primary and secondary osteoporosis, adding useful information for treatment decision-making and monitoring. The expert consensus statements provided in this paper can be used to guide the integration of TBS in clinical practice for the assessment and management of osteoporosis. An example of an operational approach is provided in the appendix. This position paper presents an up-to-date review of the evidence base, synthesised through expert consensus statements, which informs the implementation of Trabecular Bone Score in clinical practice.
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Affiliation(s)
- Enisa Shevroja
- Interdisciplinary Center for Bone Diseases, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Jean-Yves Reginster
- World Health Organization Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Liège, Belgium
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000 Liège, Belgium
| | - Olivier Lamy
- Interdisciplinary Center for Bone Diseases, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Nasser Al-Daghri
- Biochemistry Department, College of Science, King Saud University, 11451 Riyadh, Kingdom of Saudi Arabia
| | - Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, ACADEMIA, 20, College Road, Singapore, 169856 Singapore
| | | | - Lynn Kohlmeier
- Spokane Strides for Strong Bones, Medical Director, West Coast Bone Health CME TeleECHO, Spokane, WA USA
| | | | - Daniel Messina
- IRO Medical Research Center, Buenos Aires and Rheumatology Section, Cosme Argerich, Buenos Aires, Argentina
| | - Bruno Muzzi Camargos
- Rede Materdei de Saúde - Hospital Santo Agostinho - Densitometry Unit Coordinator, Belo Horizonte, Brazil
| | - Juraj Payer
- 5th Department of Internal Medicine, Comenius University Faculty of Medicine, University Hospital, Bratislava, Slovakia
- Ružinovská 6, 82101 Bratislava, Slovakia
| | - Sansin Tuzun
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Nicola Veronese
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Eugene V. McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Arboleya L, Cancio-Trujillo JM, Chaves C, Duaso-Magaña E, Mesa-Ramos M, Olmos JM. A Delphi consensus on the management of Spanish patients with osteoporosis at high risk of fracture: OSARIDELPHI study. Arch Osteoporos 2023; 18:110. [PMID: 37610481 PMCID: PMC10447260 DOI: 10.1007/s11657-023-01318-7] [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: 02/10/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
The OSARIDELPHI study evaluated the level of agreement between specialists in osteoporosis regarding the management of patients with high-risk fractures in Spain. The results provide expert-based recommendations for prevention, diagnosis, and treatment related to fracture risk. Therefore, the study facilitates clinical decision-making for managing this patient's profile. PURPOSE To evaluate the level of agreement between specialists in osteoporosis regarding the management of patients with high-risk fractures in Spain. METHODS A two-round Delphi study was performed using an online survey. In round 1, panel members rated their level of agreement with assessments on a 9-point Likert scale. Item selection was based on acceptance by ≥ 66.6% of panel experts and the agreement of the scientific committee. In round 2, the same panelists evaluated non-consensus items in round 1. RESULTS A total of 80 panelists participated in round 1; of these, 78 completed the round 2 survey. In round 1, 122 items from 4 dimensions (definition of fracture risk: 11 items, prevention and diagnosis: 38 items, choice of treatment: 24 items, and treatment-associated quality of life: 49 items) were evaluated. The consensus was reached for 90 items (73.8%). Panelists agreed that categorizing high risk, very high risk, or imminent risk determines secondary prevention actions (97.5%). Experts agreed that treatment with bone-forming drugs should be considered in case of a very high risk of fracture, and a sequential change to antiresorptive drugs should be made after 1-2 years (97.5%). Panelists also recommended corrective action plans for non-adherent patients to improve adherence (97.5%). A total of 131 items were finally accepted after round 2. CONCLUSION This Delphi study provides expert-based recommendations on clinical decision-making for managing patients with osteoporosis at high risk of fracture.
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Affiliation(s)
- Luis Arboleya
- Rheumatology Service, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | | | - Celia Chaves
- Medical Affairs Department, STADA, Barcelona, Spain
| | - Enric Duaso-Magaña
- Acute Geriatric Unit, Geriatric Service, Hospital de Igualada, Barcelona, Spain
| | - Manuel Mesa-Ramos
- Orthopedic Service. Hospital Valle de los Pedroches, Pozoblanco, Córdoba, Spain
| | - Jose Manuel Olmos
- Internal Medicine Service, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Cantabria, Spain
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de Filette JMK, Charles A, Bellanger A, Iconaru L, Baleanu F, Surquin M, Body JJ, Bergmann P. Risk factors predicting the 'time to first fracture' and its association with imminent fractures: a substudy of the FRISBEE cohort. Arch Osteoporos 2023; 18:88. [PMID: 37369953 DOI: 10.1007/s11657-023-01296-w] [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: 01/25/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
Only previous glucocorticoid use and rheumatoid arthritis were predictors of an early fracture (< 2 years after inclusion). A shorter 'time to first fracture' was not an independent clinical risk factor for imminent fractures. PURPOSE Risk factors for fragility fractures independent of BMD were assessed in several prediction models. However, predictors of a shorter 'time to first fracture' and its impact on imminent fractures are unknown. METHODS We studied the concept of 'time to first fracture' in the FRISBEE ("Fracture RIsk Brussels Epidemiological Enquiry") cohort (3560 postmenopausal women). Validated fractures were divided into 3 groups: first fracture < 2 years, 2-5 years, and > 5 years after inclusion. Factors associated with first fracture risk were evaluated with uni- and multivariate analyses using Cox modeling. We examined 'time to first fracture' as a risk factor for imminent fractures in untreated subjects and in those receiving pharmacological treatment. RESULTS Classical risk factors (age, prior fracture, fall history and low BMD) were associated with first fracture in all groups. Previous glucocorticoids and rheumatoid arthritis (RA) were predictors for fracture < 2 years. Imminent fractures were similar in subjects with or without osteoporosis treatment, despite a higher estimated 10-year risk of fragility fracture in those treated, suggesting that treatment is efficient. 'Time to first fracture' was not an independent risk factor for imminent fractures. CONCLUSION Among the risk factors considered, previous glucocorticoid use and RA were predictors for early fracture, consistent with the concept of very high risk. The 'time to first validated fracture' was not an independent risk factor for imminent fractures. Patients with a first osteoporotic fracture should thus be considered at very high risk for re-fracture, independent of the 'time to first fracture'.
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Affiliation(s)
- Jeroen M K de Filette
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Laken, Brussels, Belgium.
| | - Alexia Charles
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Amélie Bellanger
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Laken, Brussels, Belgium
| | - Felicia Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Laken, Brussels, Belgium
| | - Murielle Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Jacques Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Laken, Brussels, Belgium
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Bergmann
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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26
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Rios C, Maldonado G, Vargas S, González J, Vera C, Zuñiga A, Martínez J, Castillo M, Jervis R, Ventura R, Guevara S, Torres G, Uguña F, Messina OD, Neyro JL, Fernández D, Guerrero R, Moreno M. First Ecuadorian statement consensus for the evaluation and treatment of osteoporosis. Arch Osteoporos 2023; 18:81. [PMID: 37316765 DOI: 10.1007/s11657-023-01263-5] [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: 01/14/2023] [Accepted: 05/09/2023] [Indexed: 06/16/2023]
Abstract
Osteoporosis management has become more relevant as the life expectancy increases. In Ecuador, approximately 19% of adults over 65 years of age have been diagnosed with osteoporosis. There is no national consensus for the management and prevention of the disease being this proposal the first Ecuadorian consensus. INTRODUCTION In Ecuador, it is estimated that around 19% of adults over 65 years of age have osteoporosis. Due to the increase in life expectancy in the world population, the evaluation and management of osteoporosis has become more relevant. Currently, there is no national consensus for the management and prevention of the disease. The Ecuadorian Society of Rheumatology presented the project for the elaboration of the first Ecuadorian consensus for the management and prevention of osteoporosis. METHODS A panel of experts in multiple areas and extensive experience was invited to participate. The consensus was carried out using the Delphi method. Six working dimensions were created: definition and epidemiology of osteoporosis, fracture risk prediction tools, non-pharmacological treatment, pharmacological treatment, calcium and vitamin D, and glucocorticoid-induced osteoporosis. RESULTS The first round was held in December 2021, followed by the second round in February 2022 and the third round in March 2022. The data was shared with the specialists at the end of each round. After three rounds of work, a consensus was reached for the management and prevention of osteoporosis. CONCLUSION This is the first Ecuadorian consensus for the management and treatment of postmenopausal osteoporosis.
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Affiliation(s)
- Carlos Rios
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | | | - Sara Vargas
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | - José González
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | - Claudia Vera
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | - Andrés Zuñiga
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | - José Martínez
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | | | - Raúl Jervis
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | - Rosa Ventura
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | | | | | | | | | - José Luis Neyro
- Obstetrics and Gynecology Department, Cruces University Hospital, Vasco Country University EHU-UPV, Baracaldo Bizkaia, Spain
| | - Daniel Fernández
- Rheumatology Department, San Ignacio University Hospital, Bogota, Colombia
| | | | - Mario Moreno
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
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Jiang Y, Cai J, Zeng Y, Ye H, Yang T, Liu Z, Liu Q. Development and validation of a machine learning model to predict imminent new vertebral fractures after vertebral augmentation. BMC Musculoskelet Disord 2023; 24:472. [PMID: 37296426 PMCID: PMC10251538 DOI: 10.1186/s12891-023-06557-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Accurately predicting the occurrence of imminent new vertebral fractures (NVFs) in patients with osteoporotic vertebral compression fractures (OVCFs) undergoing vertebral augmentation (VA) is challenging with yet no effective approach. This study aim to examine a machine learning model based on radiomics signature and clinical factors in predicting imminent new vertebral fractures after vertebral augmentation. METHODS A total of 235 eligible patients with OVCFs who underwent VA procedures were recruited from two independent institutions and categorized into three groups, including training set (n = 138), internal validation set (n = 59), and external validation set (n = 38). In the training set, radiomics features were computationally retrieved from L1 or adjacent vertebral body (T12 or L2) on T1-w MRI images, and a radiomics signature was constructed using the least absolute shrinkage and selection operator algorithm (LASSO). Predictive radiomics signature and clinical factors were fitted into two final prediction models using the random survival forest (RSF) algorithm or COX proportional hazard (CPH) analysis. Independent internal and external validation sets were used to validate the prediction models. RESULTS The two prediction models were integrated with radiomics signature and intravertebral cleft (IVC). The RSF model with C-indices of 0.763, 0.773, and 0.731 and time-dependent AUC (2 years) of 0.855, 0.907, and 0.839 (p < 0.001 for all) was found to be better predictive than the CPH model in training, internal and external validation sets. The RSF model provided better calibration, larger net benefits (determined by decision curve analysis), and lower prediction error (time-dependent brier score of 0.156, 0.151, and 0.146, respectively) than the CPH model. CONCLUSIONS The integrated RSF model showed the potential to predict imminent NVFs following vertebral augmentation, which will aid in postoperative follow-up and treatment.
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Affiliation(s)
- Yang Jiang
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Jinhui Cai
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Yurong Zeng
- Department of Radiology, Huizhou Central People's Hospital, Huizhou, China
| | - Haoyi Ye
- Department of Radiology, The Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tingqian Yang
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Zhifeng Liu
- Department of Radiology, The Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Qingyu Liu
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.
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Al-Saleh Y, Sulimani R, Sabico S, Alshahrani FM, Fouda MA, Almohaya M, Alaidarous SB, Alkhawashki HM, Alshaker M, Alrayes H, Saleh N, Al-Daghri NM. Diagnosis and management of osteoporosis in Saudi Arabia: 2023 key updates from the Saudi Osteoporosis Society. Arch Osteoporos 2023; 18:75. [PMID: 37213036 PMCID: PMC10202978 DOI: 10.1007/s11657-023-01242-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/04/2023] [Indexed: 05/23/2023]
Abstract
The Saudi Osteoporosis Society (SOS) has updated its guidelines for the diagnosis and management of osteoporosis in Saudi Arabia (SA), with emphasis on postmenopausal women. This document is relevant to all healthcare professionals in SA involved in the care of patients with osteoporosis and osteoporosis-related fractures. INTRODUCTION The SOS launched the first national osteoporosis guidelines in 2015 and spearheaded the Gulf Cooperation Council Countries (GCC) osteoporosis consensus report in 2020 which was under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO). This paper highlights a major update of the guidelines in the SA setting. METHODS This guideline is an adaptation of the current guidelines derived from ESCEO, the American Association of Clinical Endocrinologists (AACE), and the GCC osteoporosis consensus report and studies on osteoporosis done in SA. Where accessible, the timeliest systematic review, meta-analysis, and randomized controlled trials were used as evidence. RESULTS The present update includes new recommendations for the assessment of osteoporosis taking into consideration the Saudi model of FRAX for fracture probabilities, appropriate doses for the maintenance of vitamin D status and calcium, the use of representative blood analytes for therapy monitoring, the use of romosozumab and sequential therapy in the pharmacological management strategies, and the establishment of fracture liaison services to prevent secondary fractures. CONCLUSION This updated guideline is for all healthcare professionals involved in osteoporosis and post-fracture care and management in SA and harmonized the most up-to-date changes in the field based on evidence-based medicine for use in the local setting.
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Affiliation(s)
- Yousef Al-Saleh
- Department of Endocrinology, Dr. Mohammad Alfagih Hospital, Riyadh, Saudi Arabia.
- Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Saudi Arabia.
| | - Riad Sulimani
- Department of Medicine, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Shaun Sabico
- Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Fahad M Alshahrani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mona A Fouda
- Department of Medicine, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammed Almohaya
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Salwa B Alaidarous
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Jeddah, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | | | - Mohammed Alshaker
- Department of Family Medicine and Polyclinic, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hanan Alrayes
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Najla Saleh
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nasser M Al-Daghri
- Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Saudi Arabia
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Hiligsmann M, Silverman SS, Singer AJ, Pearman L, Mathew J, Wang Y, Caminis J, Reginster JY. Cost-Effectiveness of Sequential Abaloparatide/Alendronate in Men at High Risk of Fractures in the United States. PHARMACOECONOMICS 2023; 41:819-830. [PMID: 37086385 DOI: 10.1007/s40273-023-01270-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Abaloparatide (ABL) significantly increases bone mineral density in men with osteoporosis similar to what was reported in postmenopausal women with osteoporosis. The cost effectiveness of sequential treatment with ABL followed by alendronate (ALN) in men at high fracture risk was compared to relevant alternative treatments. METHODS A Markov-based microsimulation model based on a lifetime US healthcare decision maker perspective was developed to evaluate the cost (expressed in US$2021) per quality-adjusted life-years (QALYs) gained of sequential ABL/ALN. Comparators were sequential treatment unbranded teriparatide (TPTD)/ALN, generic ALN monotherapy, and no treatment. Discount rates of 3% were used. Consistent with practice guidelines, patients received 18 months of ABL or TPTD followed by ALN for 5 years, or 5 years of ALN monotherapy. Analyses were conducted in high-risk men aged over 50 years defined as having a bone mineral density T-score ≤-2.5 and a recent fracture. Time-specific risk of subsequent fracture after a recent fracture, incremental costs up to 5 years following fractures, real-world medication adherence, and mostly US men-specific data were included in the model. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of results. RESULTS Over the full age range, sequential ABL/ALN led to more QALYs for lower costs than sequential unbranded TPTD/ALN, while no treatment was dominated (more QALYs, lower costs) by ALN monotherapy. The costs per QALY gained of sequential ABL/ALN were lower than the US threshold of US$150,000 versus generic ALN monotherapy. The probabilities that sequential ABL/ALN was cost effective compared to ALN monotherapy were estimated at 51% in men aged 50 years and between 88 and 90% in those aged ≥ 60 years. CONCLUSIONS Sequential therapy using ABL/ALN may be cost effective compared with generic ALN monotherapy in US men aged ≥ 50 years at high fracture risk, especially in those aged ≥ 60 years. Unbranded TPTD/ALN and no treatment were dominated interventions (less QALY, more costs) compared with ABL/ALN or ALN monotherapy.
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Affiliation(s)
- Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Stuart S Silverman
- Cedars-Sinai Medical Center, Los Angeles and the OMC Clinical Research Center, Beverly Hills, CA, USA
| | - Andrea J Singer
- MedStar Georgetown University Hospital and Georgetown University Medical Center, Washington, DC, USA
| | | | | | | | | | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Singer AJ, Sharma A, Deignan C, Borgermans L. Closing the gap in osteoporosis management: the critical role of primary care in bone health. Curr Med Res Opin 2023; 39:387-398. [PMID: 36597741 DOI: 10.1080/03007995.2022.2141483] [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] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The World Health Organization issued a call to action for primary care to lead efforts in managing noncommunicable diseases, including osteoporosis. Although common, osteoporosis remains underdiagnosed and undertreated. Primary care practitioners (PCPs) are critical in identifying individuals at risk for osteoporosis and osteoporotic fractures; however, recent advances in assessment, diagnosis, and treatment of osteoporosis have not been incorporated into clinical practice in primary care due to numerous reasons including time constraints and insufficient knowledge. To close this gap in clinical practice, we believe PCPs need a practical strategy to facilitate osteoporosis assessment and management that is easy to implement. METHODS In this article, we consolidate information from various global guidelines and highlight areas of agreement to create a streamlined osteoporosis management strategy for a global audience of PCPs. RESULTS We present a systematic approach to facilitate osteoporosis assessment and management that includes four steps: (1) identifying patients at risk through proactive screening strategies, (2) investigating and diagnosing patients, (3) intervening with personalized treatment plans, and (4) implementing patient-centered strategies for long-term management and monitoring of patients. CONCLUSION Primary care has a central role in ensuring the incorporation of key elements of holistic care as outlined by the World Health Organization in managing noncommunicable diseases including osteoporosis; namely, a people-centered approach, incorporation of specialist services, and multidisciplinary care. This approach is designed to strengthen the health system's response to the growing osteoporosis epidemic.
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Affiliation(s)
- Andrea J Singer
- Departments of Obstetrics and Gynecology and Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Cynthia Deignan
- Global Clinical Development, Amgen Inc., Thousand Oaks, CA, USA
| | - Liesbeth Borgermans
- Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
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Khan MI. Management of bone loss due to endocrine therapy during cancer treatment. Osteoporos Int 2023; 34:671-680. [PMID: 36656338 DOI: 10.1007/s00198-023-06672-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
Bone modifying agents BMAs (oral and IV bisphosphonates, denosumab) are used to treat bone loss due to endocrine therapy in patients with hormone receptor positive (HR +) early breast cancer and non-metastatic prostate cancer (NMPC). Timely initiation of appropriate sequential therapy is imperative to reduce cancer treatment-induced bone loss (CTIBL). This narrative review summarizes current literature regarding management of CTIBL in HR + early breast cancer and NMPC patients. Risk factors for fragility fractures, screening strategies, optimal timing for the treatment, dosing/duration of therapy, and post treatment monitoring have not been clearly defined in HR + early breast and NMPC patients receiving endocrine therapy. This review aims to discuss the utility of fracture risk assessment (FRAX) tool for the prevention and management of CTIBL, osteoanabolic therapy for imminent fracture risk reduction, and sequential therapy options. Using predefined terms, PubMed, MEDLINE, and Google Scholar were searched for studies on CTIBL in HR + breast and NMPC patients. We included randomized clinical trials, meta-analysis, evidence-based reviews, observational studies, and clinical practice guidelines. Fracture risk assessment tools (FRAX) guide therapy for osteoporosis in patients with early HR + breast cancer and NMPC. BMAs to prevent bone loss should be initiated at higher T-score than recommended by FRAX in premenopausal HR + breast cancer patients with chemotherapy-induced ovarian failure, oophorectomy and gonadotropin releasing hormone (GnRH) therapy, post-menopausal women with HR + breast cancer receiving aromatase inhibitor therapy, and NMPC patients with androgen deprivation therapy. Sequential therapy with osteoanabolic agents as first line treatment offers a potential therapeutic strategy in patients with high imminent fracture risk. Due to limited data in cancer patients regarding management of osteoporosis, a dosing schedule similar to osteoporosis is considered appropriate. Risk stratification to identify vulnerable patient population, choosing the appropriate sequential therapy, and close monitoring of patients at the risk of bone loss can potentially reduce the mortality, morbidity, and health care cost related to CTIBL.
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Geusens P, Appelman-Dijkstra N, Lems W, van den Bergh J. Romosozumab for the treatment of postmenopausal women at high risk of fracture. Expert Opin Biol Ther 2023; 23:11-19. [PMID: 36440489 DOI: 10.1080/14712598.2022.2152320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Romosozumab is a monoclonal antibody that binds to sclerostin (an inhibitor of the Wingless-related integration site (Wnt) signaling pathway). It is a new osteoanabolic drug that simultaneously increases bone formation and decreases bone resorption. It has recently been approved by the US and EU authorities in postmenopausal women with at high risk of fractures. AREAS COVERED The literature on romosozumab in preclinical and in phase II and III clinical studies has been reviewed about the effect on bone, bone markers, and fracture reduction and its safety. EXPERT OPINION Compared to antiresorptive agents, its unique mechanism of action results in a quicker and greater increase in bone mineral density, it repairs and restores trabecular and cortical bone microarchitecture, and reduces fracture risk more rapidly and more effectively than alendronate, with persisting effects for at least two years after transition to antiresorptive agents. This finding has introduced the concept that, in patients at very high risk of fractures, the optimal sequence of treatment is to start with an osteoanabolic agent, followed by a potent AR drug. Recent national and international guidelines recommend the use of romosozumab as an initial treatment in patients at very high fracture risk without a history of stroke or myocardial infarction.
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Affiliation(s)
- Piet Geusens
- Department of Rheumatology, University Maastricht, Minderbroedersberg 4-6, 6211 LK Maastricht, Netherlands
| | - Natasha Appelman-Dijkstra
- Department of Internal Medicine-Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Willem Lems
- Department of Rheumatology, Amsterdam University Medical Centre, De Boelelaan 1117 1081 HV Amsterdam, Netherlands
| | - Joop van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, Tegelseweg 210, 5912 BL Venlo, Netherlands
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Kanis JA, McCloskey EV, Harvey NC, Cooper C, Rizzoli R, Dawson-Hughes B, Maggi S, Reginster JY. The need to distinguish intervention thresholds and diagnostic thresholds in the management of osteoporosis. Osteoporos Int 2023; 34:1-9. [PMID: 36282342 DOI: 10.1007/s00198-022-06567-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/30/2022] [Indexed: 01/07/2023]
Abstract
This position paper of the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) addresses the rationale for separate diagnostic and intervention thresholds in osteoporosis. We conclude that the current BMD-based diagnostic criteria for osteoporosis be retained whilst clarity is brought to bear on the distinction between diagnostic and intervention thresholds.
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Affiliation(s)
- John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
- Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Rene Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland
| | - Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA
| | - Stefania Maggi
- Institute of Neuroscience, Aging Branch, CNR, Padua, Italy
| | - Jean-Yves Reginster
- WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Liege, Belgium
- Division of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liege, Belgium
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Yu G, Tong S, Liu J, Wan Y, Wan M, Li S, You R. A systematic review of cost‑effectiveness analyses of sequential treatment for osteoporosis. Osteoporos Int 2022; 34:641-658. [PMID: 36527476 DOI: 10.1007/s00198-022-06626-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
Sequential treatment of osteoporosis has been increasingly mentioned in recent years. However, the corresponding systematic review has not been reported. This study aims to systematically review and assess all full-text pharmacoeconomic studies of sequential treatment for osteoporosis. A comprehensive literature search was performed using PubMed, EMBASE (Ovid), CNKI, and Wanfang Database to identify original articles, published before June 17, 2022. The quality of included articles was evaluated by the updated Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases International Osteoporosis Foundation (ESCEO-IOF). In general, ten articles were included in this review. For the comparison between sequential treatment and bisphosphonate monotherapy, more than 75% of studies demonstrated the sequential treatment was cost-effective or dominant, with the exception of sequential treatment involving teriparatide. When the comparisons occurred between the two sequential treatment groups, the sequential treatments associated with either abaloparatide or romosozumab were cost-effective or dominant compared to the sequential treatment involving teriparatide. Several major key drivers of cost-effectiveness included drug cost, medication persistence and adherence, drug effect on fracture risk, offset effect, time horizon, and baseline fracture risk. The most of studies were identified as high quality in CHEERS (2022) and ESCEO-IOF. The cost-effectiveness of sequential treatment for osteoporosis is influenced by multiple factors. Generally, the sequential treatments involving abaloparatide, romosozumab, denosumab, and bisphosphonates may be considered as the preferred option for osteoporosis with high fracture risk, while the sequential treatment with teriparatide was not a cost-effectiveness strategy. The ESCEO-IOF and CHEER (2022) increase the transparency, comparability, extrapolation, and quality of research, engage patients and the general public in research on health services and policies, and help improve the quality of health technology assessment.
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Affiliation(s)
- Guangyi Yu
- Department of Pharmacy, People's Hospital of Dongxihu District, Wuhan, Hubei, China
| | - Suiju Tong
- Department of Pharmacy, People's Hospital of Dongxihu District, Wuhan, Hubei, China
| | - Jinyu Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuansheng Wan
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China
| | - Min Wan
- Department of Pharmacy, People's Hospital of Dongxihu District, Wuhan, Hubei, China
| | - Sujuan Li
- Department of Pharmacy, People's Hospital of Dongxihu District, Wuhan, Hubei, China
| | - Ruxu You
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China.
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Kanis JA, McCloskey EV, Harvey NC, Cooper C, Rizzoli R, Dawson-Hughes B, Maggi S, Reginster JY. Intervention thresholds and diagnostic thresholds in the management of osteoporosis. Aging Clin Exp Res 2022; 34:3155-3157. [PMID: 36344804 PMCID: PMC9719445 DOI: 10.1007/s40520-022-02216-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/29/2022] [Indexed: 11/09/2022]
Affiliation(s)
- John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. .,Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.,Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK.,NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Rene Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland
| | - Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Stefania Maggi
- Institute of Neuroscience, Aging Branch, CNR, Padua, Italy
| | - Jean-Yves Reginster
- WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Liège, Belgium.,Division of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liège, Belgium
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Miedany YE, Gadallah NA, Toth M, Hassan W, Elgaafary M, Hassan M, Eissa M, Saber S, Elwakil W, Mahran S. Osteoporosis clinical practice guideline: romosozumab for treating severe osteoporosis – an update by the Egyptian Academy of Bone Health. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00150-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This is a Clinical Practice Guideline update released by the Egyptian Academy of Bone Health and Metabolic Bone Diseases. It does not replace the clinical practice guidelines published for the treatment of osteoporosis in 2021, but it entails specific recommendations and selective criteria for romosozumab as another pharmacological agent for treatment of postmenopausal osteoporosis. It has been issued, in part, due to the imminent approval of romosozumab in Egypt.
Main text
The guideline recommends the use of romosozumab, for up to 1 year, for the reduction of vertebral, hip, and non-vertebral fractures in postmenopausal women with severe osteoporosis at very high risk of fracture/imminent fracture risk: defined as T-score less than − 2.5 and a prior hip or vertebral fracture in the past 24 months or a very high fracture risk, as identified by FRAX (FRAX major osteoporosis fracture > 30%, FRAX hip fracture > 4.5%). The recommended dosage of romosozumab is 210 mg monthly by subcutaneous injection for 12 months. For osteoporotic postmenopausal women who have completed a 12-month course of romosozumab, treatment with an anti-resorptive osteoporosis therapy is recommended to maintain bone mineral density gains and reduce fracture risk. The treatment is not recommended for women at high risk of cardiovascular disease and stroke, which includes those with prior myocardial infarction or stroke.
In conclusion, strategies to osteoporosis management have been highly diversified, with bone health specialists have become able to set up treatment plan tailored to the individual patient’s requirement. Patients with severe osteoporosis at very high fracture risk need stronger therapeutic regimens to start with. Romosozumab endorses bone formation and suppresses bone resorption, leading to a greater anabolic window and a superior positive impact on bone mineral density.
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El Miedany Y, Gadallah NA, Toth M. Optimizing osteoporosis management: targeting to treat — an initiative by the Egyptian Academy of Bone Health. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00161-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AbstractThe overarching goal of treating osteoporotic patients is to reduce the incidence of fractures, yet interventions that support early detection of osteoporosis and prevention of osteoporotic fractures are underutilized. Osteoporosis and, specifically, the associated burden of fractures call for a screening strategy offering an opportunity to intervene early. Such strategy should be clinically feasible and cost-effective, aiming to identify and treat subjects at high or very high risk of fragility fracture.The low sensitivity of bone mineral density measurements in identifying high-risk patients is evidenced by the high number of osteoporotic fractures occurring in subjects with BMD values above threshold required for a diagnosis of osteoporosis. Consequently, DXA scanning is not considered appropriate as a public screening tool identifying patients at risk of sustaining fragility fractures and current efforts focus on identifying non-BMD-related risk factors.In Egypt, we are fortunate in having all modalities of osteoporosis therapy and assessment tools available, yet there remains a significant treatment gap in osteoporosis management. Furthermore, screening for fracture risk is not currently advocated nationally. This manuscript describes a national initiative for a population screening intervention to identify patients at risk of developing a fragility fracture aiming to reduce fragility fractures especially in older adults.
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Osteoporosis treatment in Austria-assessment of FRAX-based intervention thresholds for high and very high fracture risk. Arch Osteoporos 2022; 17:141. [PMID: 36357621 PMCID: PMC9649455 DOI: 10.1007/s11657-022-01175-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/04/2022] [Indexed: 11/12/2022]
Abstract
The adoption of the management pathway proposed by the National Osteoporosis Guideline Group (NOGG), UK applied using the Austrian FRAX® tool in a referral population of Austrian women categorises 22-29% of women age 40 years or more eligible for treatment of whom 28-34% are classified at very high risk. PURPOSE The aim of this study is to provide a reference document for the further development of existing guidelines for the management of osteoporosis in Austria, considering FRAX-based intervention thresholds for high and very high fracture risk. METHODS The model development was based on two Austrian hospital referral cohorts. Baseline information was collected to compute the 10-year probability (using the Austrian FRAX model) of a major osteoporotic fracture (MOF) and hip fracture both with and without the inclusion of femoral neck bone mineral density (BMD). Assessment thresholds for BMD testing were defined, as well as intervention thresholds. In addition, thresholds that characterise men and women at high and very high fracture risk were established. The management pathway followed that currently recommended by the UK National Osteoporosis Guideline Group (NOGG). RESULTS The two cohorts comprised a total of 1306 women and men with a mean age of 66.7 years. Slightly more than 50% were eligible for treatment by virtue of a prior fragility fracture. In those women without a prior fracture, 22% (n = 120) were eligible for treatment based on MOF probabilities. Of these, 28% (n = 33) were found to be at very high risk. When both MOF and hip fracture probabilities were used to characterise risk, 164 women without a prior fracture were eligible for treatment (29%). Of these, 34% (n = 56) were found to be at very high risk. Fewer men without prior fracture were eligible for treatment compared with women. CONCLUSION The management pathway as currently outlined is expected to reduce inequalities in patient management. The characterisation of very high risk may aid in the identification of patients suitable for treatment with osteoanabolic agents.
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Evidence based Latin American Guidelines of clinical practice on prevention, diagnosis, management and treatment of glucocorticoid induced osteoporosis. A 2022 update : This manuscript has been produced under the auspices of the Committee of National Societies (CNS) and the Committee of Scientific Advisors (CSA) of the International Osteoporosis Foundation (IOF). Aging Clin Exp Res 2022; 34:2591-2602. [PMID: 36348222 DOI: 10.1007/s40520-022-02261-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/16/2022] [Indexed: 11/11/2022]
Abstract
Guidelines and recommendations developed and endorsed by the International Osteoporosis Foundation (IOF) are intended to provide guidance for particular pattern of practice for physicians who usually prescribe glucocorticoid (GC) therapy, and not to dictate the care of a particular patient. Adherence to the recommendations within this guideline is voluntary and the ultimate determination regarding their application should be made by the physician in light of each patient's circumstances. Guidelines and recommendations are intended to promote a desirable outcome but cannot guarantee any specific outcome. This guideline and its recommendations are not intended to dictate payment, reimbursement or insurance decisions. Guidelines and recommendations are subjected to periodic revisions as a consequence of the evolution of medicine, technology and clinical practice. A panel of Latin American (LATAM) experts specialized in osteoporosis with recognized clinical experience in managing patients with glucocorticoid-induced osteoporosis (GIO) met to produce evidence-based LATAM recommendations for the diagnosis and management of GIO. These guidelines are particularly intended to general practitioners and primary care physicians who prescribe GC treatments in LATAM to guide their daily clinical practice in terms of evaluation, prevention and treatment of GIO. These recommendations were based on systematic literature review using MEDLINE, EMBASE, SCOPUS and COCHRANE Library database during the period from 2012 to 2021. Randomized clinical trials (RCT), systematic reviews of RCT, controlled observational studies, guidelines and consensus were considered. Based on the review and expert opinion the panel members voted recommendations during two successive rounds of voting by panel members. Agreements for each statement were considered if a concordance of at least 70% was achieved following Delphi methodology. Grading of recommendations was made according to the Oxford Centre for the Evidence-based Medicine (EBM) criteria. Among five GIO guidelines and consensus initially identified, two of them (American College of Rheumatology 2017 and the Brazilian Guidelines 2021) were selected for comparison considering the latter as the most current guides in the LATAM region. Based on this methodology fifty statements were issued. All of them but four (1.20, 1.21, 1.23 and 4.2) attained agreement.
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Fuggle N, Al-Daghri N, Bock O, Branco J, Bruyère O, Casado E, Cavalier E, Cortet B, de Wit M, Giusti A, Halbout P, Harvey NC, Hiligsmann M, Kaufman JM, Kurth A, Maggi S, Matijevic R, Minisola S, Palacios S, Radermecker RP, Thomasius F, Tuzun S, Veronese N, Kanis JA, Reginster JY, Rizzoli R, Cooper C. Novel formulations of oral bisphosphonates in the treatment of osteoporosis. Aging Clin Exp Res 2022; 34:2625-2634. [PMID: 36331798 PMCID: PMC9675642 DOI: 10.1007/s40520-022-02272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Oral bisphosphonates are a key intervention in the treatment of osteoporosis and in reducing the risk of fragility fractures. Their use is supported by over 3 decades of evidence; however, patient adherence to oral bisphosphonates remains poor in part due to complex dosing instructions and adverse events, including upper gastrointestinal symptoms. This problem has led to the development of novel oral bisphosphonate formulations. Buffered, effervescent alendronate is dissolved in water and so seeks to reduce upper gastro-intestinal adverse events, and gastro-resistant risedronate aims to reduce the complexity of dosing procedure (e.g. fasting prior to consumption) whilst still maintaining the efficacy of fracture risk reduction. Clinical trials and real-world data have been employed to demonstrate some benefits in terms of reduced upper gastro-intestinal adverse events, adherence, persistence and health economic outcomes. This report describes the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores where oral bisphosphonates sit in current clinical practice guidelines, review their risk-benefit profile and the consequences of poor adherence before exploring novel oral bisphosphonate formulations and their potential clinical and health economic impact. Further research is required but there are signs that these novel, oral bisphosphonate formulations may lead to improved tolerance of oral bisphosphonates and thus, improved adherence and fracture outcomes.
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Affiliation(s)
- Nicholas Fuggle
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Olivier Bock
- Department of Osteoporosis, Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
- International Osteoporosis Foundation, Nyon, Switzerland
| | - Jaime Branco
- Centro Hospitalar de Lisboa Ocidental-Hospital Egas Moniz, CEDOC/NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
| | - Enrique Casado
- Department of Rheumatology, University Hospital Parc Taulí, I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CIRM, CHU Sart-Tilman, 4000, Liège, Belgium
| | - Bernard Cortet
- Department of Rheumatology, Univ. Lille, CHU Lille, MABlab ULR 4490, 59000, Lille, France
| | - Maarten de Wit
- Department of Medical Humanities, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Andrea Giusti
- Metabolic Bone Diseases Unit and Fracture Liaison Service, Rheumatology Unit, Department of Medical Specialties, Local Health Trust 3, Via Missolungi 14, 16147, Genoa, Italy
| | | | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Andreas Kurth
- Department of Orthopaedic and Trauma Surgery, Community Clinics Middle Rhine, Campus Kemperhof, Koblenz, Germany
| | - Stefania Maggi
- Institute of Neuroscience, Aging Branch, CNR, Padua, Italy
| | - Radmila Matijevic
- Faculty of Medicine, Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Salvatore Minisola
- Department of Clinical, Internal, Anaesthesiology, and Cardiovascular Sciences, Sapienza University of Rome, 00185, Rome, Italy
| | | | - Régis Pierre Radermecker
- Department of Diabetes, Nutrition and Metabolic Disorders, Clinical Pharmacology, University of Liège, CHU de Liège, Liège, Belgium
| | | | - Sansin Tuzun
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - John A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Jean-Yves Reginster
- Centro Hospitalar de Lisboa Ocidental-Hospital Egas Moniz, CEDOC/NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - René Rizzoli
- Department of Osteoporosis, Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
- Department of Rheumatology, Univ. Lille, CHU Lille, MABlab ULR 4490, 59000, Lille, France.
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
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Geusens P, Appelman-Dijkstra NM, Zillikens MC, Willems H, Lems WF, van den Bergh J. How to implement guidelines and models of care. Best Pract Res Clin Rheumatol 2022; 36:101759. [PMID: 35729036 DOI: 10.1016/j.berh.2022.101759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In subjects older than 50 years, the presence of clinical risk factors (CRFs) for fractures or a recent fracture is the cornerstone for case finding. In patients who are clinically at high short- and long-term risk of fractures (those with a recent clinical fracture or with multiple CRFs), further assessment with bone mineral density (BMD) measurement using dual-energy absorptiometry (DXA), imaging of the spine, fall risk evaluation and laboratory examination contributes to treatment decisions according to the height and modifiability of fracture risk. Treatment is available with anti-resorptive and anabolic drugs, and from the start of treatment a lifelong strategy is needed to decide about continuous, intermittent, and sequential therapy. Implementation of guidelines requires further initiatives for improving case finding, public awareness about osteoporosis and national policies on reimbursement of assessment and therapy.
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Affiliation(s)
- Piet Geusens
- Department of Rheumatology, Maastricht University, Minderbroedersberg 4-6, 6211 LK Maastricht, Netherlands.
| | - Natasha M Appelman-Dijkstra
- Department of Internal Medicine-Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Hanna Willems
- Department of Geriatrics, Amsterdam University Medical Center, De Boelelaan 1117 1081 HV Amsterdam, Netherlands.
| | - Willem F Lems
- Department of Rheumatology, Amsterdam University Medical Center, De Boelelaan 1117 1081 HV Amsterdam, Netherlands.
| | - Joop van den Bergh
- Department of Internal Medicine, VieCuri Medisch Cenrum, Tegelseweg 210, 5912 BL Venlo, Netherlands.
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Curtis EM, Dennison EM, Cooper C, Harvey NC. Osteoporosis in 2022: Care gaps to screening and personalised medicine. Best Pract Res Clin Rheumatol 2022; 36:101754. [PMID: 35691824 PMCID: PMC7614114 DOI: 10.1016/j.berh.2022.101754] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Osteoporosis care has evolved markedly over the last 50 years, such that there are now an established clinical definition, validated methods of fracture risk assessment, and a range of effective pharmacological agents. However, it is apparent that both in the context of primary and secondary fracture prevention, there is a considerable gap between the population at high fracture risk and those actually receiving appropriate antiosteoporosis treatment. In this narrative review article, we document recent work describing the burden of disease, approaches to management, and service provision across Europe, emerging data on gaps in care, and existing/new ways in which these gaps may be addressed at the level of healthcare systems and policy. We conclude that although the field has come a long way in recent decades, there is still a long way to go, and a concerted, integrated effort is now required from all of us involved in this field to address these urgent issues to ensure the best possible outcomes for our patients.
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Affiliation(s)
- Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
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Ip TP. Treatment Consideration in Postmenopausal Osteoporosis Patients at Imminent Fracture Risk. JOURNAL OF CLINICAL RHEUMATOLOGY AND IMMUNOLOGY 2022. [DOI: 10.1142/s266134172230004x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Osteoporosis is the most common metabolic bone disease and constitutes a major public health problem all over the world. Most international clinical practice guidelines have conventionally positioned the class of antiresorptive drugs, the bisphosphonates, as the first-line medical therapy for the management of postmenopausal osteoporosis. With the clinical development of more potent antiresorptive drugs as well as bone-forming drugs, more therapeutic options with different mechanisms of action, therapeutic efficacies, and adverse effect profiles are currently available. Bone-forming drugs have demonstrated a faster and better protection to patients with osteoporosis such that clinical management decisions should position their prioritized use in patients with a very high fracture risk. This article provides a review on the preferential selection of bone-forming drugs for management of postmenopausal osteoporosis in patients with imminent fracture risk.
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Affiliation(s)
- Tai Pang Ip
- Department of Medicine, Tung Wah Hospital, Hong Kong, China
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McClung MR, Rothman MS, Lewiecki EM, Hanley DA, Harris ST, Miller PD, Kendler DL. The role of osteoanabolic agents in the management of patients with osteoporosis. Postgrad Med 2022; 134:541-551. [DOI: 10.1080/00325481.2022.2069582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Michael R. McClung
- Oregon Osteoporosis Center, Portland, OR; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Micol S. Rothman
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - David A. Hanley
- Departments of Medicine, Community Health Sciences, and Oncology, Cumming School of Medicine and McCaig Institute for Bone and Joint Health, the University of Calgary, Calgary, Alberta, Canada
| | - Steven T. Harris
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | - David L. Kendler
- Department of Medicine (Endocrinology), University of British Columbia, Vancouver, British Columbia, Canada
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