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Feng F, Zhou C, Huang P, Zhu Q, Wang G, Zhou B. Value of Biochemical Indexes of Bone Metabolism in Predicting Osteoporotic Lumbar Fractures. Appl Bionics Biomech 2022; 2022:7348884. [PMID: 35782882 PMCID: PMC9246630 DOI: 10.1155/2022/7348884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/29/2022] [Accepted: 06/03/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To investigate the value of bone metabolism indexes such as type I procollagen N-terminal propeptide (P1NP), 25-hydroxyvitamin D (25(OH)D), osteocalcin (OSTEOC), and parathyroid hormone (PTH) in predicting osteoporotic lumbar fractures. Methods 120 female patients with osteoporosis treated in our hospital were selected as research objects. There were 76 cases in the fracture group and 44 cases in the nonfracture group. The relationship between the levels of P1NP, 25(OH)D, OSTEOC, and PTH and the incidence of osteoporotic lumbar fractures were detected and compared between the two groups. The predictive value of biochemical indexes of bone metabolism in patients with osteoporosis was analyzed by ROC curve. Results The levels of P1NP and PTH in the fracture group were significantly higher than those in the nonfracture group, while 25(OH)D and OSTEOC levels were lower than those in the nonfracture group. Moreover, the levels of P1NP, 25(OH)D, OSTEOC, and PTH are important factors affecting the pathogenesis of osteoporosis. The area under the curve (AUC) of fracture in patients with osteoporosis predicted by the combination of P1NP, 25(OH)D, OSTEOC, and PTH levels was 0.886, which was greater than the AUC predicted by each index (0.796, 0.753, 0.670, and 0.824). The best sensitivity and specificity of comprehensive prediction of each index were 78.95% and 79.10%, respectively. Conclusion The abnormal changes of P1NP, 25(OH)D, OSTEOC, and PTH in female patients with osteoporotic lumbar fracture are closely related to the occurrence of the disease. The combination of these indicators has relatively significant application value in predicting the occurrence of fracture, which is helpful to formulate and guide relevant preventive measures for female patients with osteoporotic lumbar fracture and improve the prognosis.
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Affiliation(s)
- Fen Feng
- School of Pharmacy, Shaoyang University, Shaoyang 422000, China
| | - CiLa Zhou
- Department of Endocrinology, The Central Hospital of Shaoyang, Shaoyang 422000, China
| | - Ping Huang
- Department of Endocrinology, The Central Hospital of Shaoyang, Shaoyang 422000, China
| | - QiaoLin Zhu
- Department of Endocrinology, The Central Hospital of Shaoyang, Shaoyang 422000, China
| | - Gang Wang
- Department of Endocrinology, The Central Hospital of Shaoyang, Shaoyang 422000, China
| | - Bin Zhou
- Department of Endocrinology, The Central Hospital of Shaoyang, Shaoyang 422000, China
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Li YF, Wang QY, Xu LL, Yue C, Hu L, Ding N, Yang YY, Qu XL, Sheng ZF. Development of a Nomogram for Predicting Very Low Bone Mineral Density (T-Scores. Int J Gen Med 2022; 15:1121-1130. [PMID: 35153504 PMCID: PMC8824232 DOI: 10.2147/ijgm.s348947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yong-Fang Li
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Qin-Yi Wang
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Lu-Lu Xu
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Chun Yue
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Li Hu
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Na Ding
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Yan-Yi Yang
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Xiao-Li Qu
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Zhi-Feng Sheng
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
- Correspondence: Zhi-Feng Sheng, Tel +86-13574806523, Email
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Prior JC, Oei EHG, Brown JP, Oei L, Koromani F, Lentle BC. Where's the break? Critique of radiographic vertebral fracture diagnostic methods. Osteoporos Int 2021; 32:2391-2395. [PMID: 34674023 PMCID: PMC8608772 DOI: 10.1007/s00198-021-06207-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/08/2021] [Indexed: 11/04/2022]
Affiliation(s)
- J C Prior
- BC Centre of the Canadian Multicentre Osteoporosis Study (CaMos), Vancouver, Canada.
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, Department of Medicine, University of British Columbia, Vancouver, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
- BC Women's Health Research Institute, Vancouver, Canada.
- Endocrinology and Metabolism, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - E H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - J P Brown
- Infectious and Immune Diseases Axis, CHU de Québec Research Centre, Quebec City, Canada
- Department of Medicine, Division of Rheumatology, Laval University, Quebec City, Canada
| | - L Oei
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Van Weel-Bethesda Hospital, Dirksland, The Netherlands
- Department of Internal Medicine, Jan Van Goyen Medical Center, Amsterdam, The Netherlands
| | - F Koromani
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Brian C Lentle
- BC Centre of the Canadian Multicentre Osteoporosis Study (CaMos), Vancouver, Canada.
- Department of Radiology, University of British Columbia, Vancouver, Canada.
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Rinonapoli G, Ruggiero C, Meccariello L, Bisaccia M, Ceccarini P, Caraffa A. Osteoporosis in Men: A Review of an Underestimated Bone Condition. Int J Mol Sci 2021; 22:2105. [PMID: 33672656 PMCID: PMC7924179 DOI: 10.3390/ijms22042105] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis is called the 'silent disease' because, although it does not give significant symptoms when it is not complicated, can cause fragility fractures, with serious consequences and death. Furthermore, the consequences of osteoporosis have been calculated to weigh heavily on the costs of health systems in all the countries. Osteoporosis is considered a female disease. Actually, the hormonal changes that occur after menopause certainly determine a significant increase in osteoporosis and the risk of fractures in women. However, while there is no doubt that women are more exposed to osteoporosis and fragility fractures, the literature clearly indicates that physicians tend to underestimate the osteoporosis in men. The review of the literature done by the authors shows that osteoporosis and fragility fractures have a high incidence also in men; and, furthermore, the risk of fatal complications in hip fractured men is higher than that for women. The authors report the evidence of the literature on male osteoporosis, dwelling on epidemiology, causes of osteoporosis in men, diagnosis, and treatment. The analysis of the literature shows that male osteoporosis is underscreened, underdiagnosed, and undertreated, both in primary and secondary prevention of fragility fractures.
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Affiliation(s)
- Giuseppe Rinonapoli
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Carmelinda Ruggiero
- Orthogeriatric Service, Geriatric Unit, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy;
| | - Luigi Meccariello
- Department of Orthopaedics and Traumatology, AORN San Pio “Gaetano Rummo Hospital”, via R.Delcogliano, 82100 Benevento (BN), Italy;
| | - Michele Bisaccia
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Paolo Ceccarini
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Auro Caraffa
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
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Unknown osteoporosis in older patients admitted to post-acute rehabilitation. Aging Clin Exp Res 2020; 32:1145-1152. [PMID: 31463924 DOI: 10.1007/s40520-019-01302-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Osteoporotic fractures are associated with increased morbidity, mortality, and increased health care use. As the number of older adults increases, identifying those at increased risk for osteoporotic fractures has become of utmost importance to providing them with preventive and therapeutic interventions. AIMS To determine the prevalence of unknown clinical and densitometric osteoporosis and to investigate the performance of different diagnostic strategies for osteoporosis in elderly patients admitted to rehabilitation. METHOD This is an observational study. Eligible participants were older adults admitted to rehabilitation in an academic hospital in Switzerland over an 11-month period. Patients with previously unknown osteoporosis underwent dual-energy X-ray absorptiometry (DXA), vertebral fracture assessment (VFA), and history review for past fractures. RESULTS Complete assessment was available for 252 patients. Previously undiagnosed osteoporosis was identified in 62.3% of these patients, a proportion that was higher among women (71.5%) than men (44.8%). DXA proved most sensitive, followed by VFA and history review. Results differed across gender: DXA remained the most sensitive single test among women, but VFA proved most sensitive in men. The best test to combine with history review was DXA in women (detection increasing from 47.5 to 93.2%) and VFA in men (detection increasing from 35.9 to 84.6%). CONCLUSIONS Prevalence of previously unknown osteoporosis appears very high in elderly patients admitted to post-acute rehabilitation. The combination of history review of previous fractures with DXA in women and with VFA in men appears the best two-step strategy to improving detection of osteoporosis in this population.
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Boyanov MA, Czerwinski E, Shinkov A, Palička V, Lakatos P, Poiana C, Payer J, Killinger Z, Kocjan T, Lesnyak O, Holzer G, Resch H. Patterns in the Diagnosis and Treatment of Osteoporosis in Men: A Questionnaire-based Survey in Central and Eastern European Countries. ACTA MEDICA BULGARICA 2017. [DOI: 10.1515/amb-2017-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
SummaryTo assess the current practice patterns in the diagnosis and treatment of male osteoporosis based on questionnaires. Questionnaires were presented and filled out by osteoporosis experts from Austria, Bulgaria, the Czech Republic, Hungary, Poland, Romania, Slovakia, Slovenia and Russia. The questions included focused on the proportion of male referrals to DXA, the main reasons for referral, the preferred measurement sites and reference database, the definition of male osteoporosis, needed laboratory investigations, data on calcium and vitamin D supplementation as well as on treatment modalities and their reimbursement rate. Men comprised 5 to 10% of all DXA referrals. The main reasons for referral were low back pain and fractures. Most of the respondents used the International male reference database. The diagnosis of osteoporosis was based mainly on a T-score below −2.5 after the age of 50, but a few respondents added fractures as a necessary condition. Only 1/3 of men visiting DXA sites are expected to have normal BMD. A consensus for the use of laboratory investigations in male osteoporosis is practically lacking. Treatment modalities include alendronate, risedronate, zoledronate, denosumab, rhPTH and strontium (with some restrictions for the latter three). Data on treatment adherence and persistence are generally lacking except for Austria, Romania and Slovakia. The levels of reimbursement vary a lot across countries. Osteoporosis in men is an under-recognized problem in CEE countries, leading to a tremendous gap in the diagnosis and treatment.
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Affiliation(s)
- M. A. Boyanov
- Department of Internal Medicine, Clinic of Endocrinology and Metabolism , University Hospital “Alexandrovska”, Medical University – Sofia , Bulgaria
| | - E. Czerwinski
- Jagiellonian University Medical College , Faculty of Health Sciences, Department of Bone and Joint Diseases – Cracow , Poland
| | - A. Shinkov
- Clinic of Thyroid and Bone Metabolic Diseases , University Hospital of Endocrinology “Acad. Ivan Penchev”, Medical University – Sofia , Bulgaria
| | - V. Palička
- Osteocentra , University Hospital and Charles University , School of Medicine , Hradec Kralove , Czech Republic
| | - P. Lakatos
- 1st Department of Medicine , Semmelweis University – Budapеst , Hungary
| | - C. Poiana
- Department of Endocrinology, National Institute of Endocrinology , University of Medicine and Pharmacy – Bucharest , Romania
| | - J. Payer
- 5th Department of Internal Medicine , University Hospital, Medical Faculty of Comenius University , Bratislava , Slovakia
| | - Z. Killinger
- 5th Department of Internal Medicine , University Hospital, Medical Faculty of Comenius University , Bratislava , Slovakia
| | - T. Kocjan
- Department of Endocrinology, Diabetes and Metabolic Diseases , University Medical Centre Ljubljana – Ljubljana , Slovenia
| | - O. Lesnyak
- Urals State Medical University , Yekaterinburg – Russian Federation
- North-Western State Medical University , Saint Petersburg – Russian Federation
| | - G. Holzer
- Department of Orthopedic Surgery , Medical University of Vienna – Vienna , Austria
| | - H. Resch
- Metabolic Bone Diseases, Medical Faculty , “Sigmund Freud” University , Department of Internal Medicine II, St. Vincent Hospital Vienna , Academic Teaching Hospital of the Medical University – Vienna , Austria
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Abstract
Bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry (DXA) is the most commonly used method to assess fracture risk. DXA utilizes two different energy X-rays to calculate BMD and, by comparison to a young normative database, the T-score. In 1994, the World Health Organization defined osteoporosis based on T-score, changing the paradigm of the field and forever placing DXA measurements in the center of osteoporosis diagnosis. Since then, many large studies have demonstrated the predictive value of BMD by DXA-for every standard deviation decline in BMD, there is a relative risk of 1.5-2.5 for fracture. This predictive ability is similar to how blood pressure can predict myocardial infarction. Limitations of DXA are also important to consider. While BMD by DXA can identify those at risk, there is a significant overlap in the BMD of patients who will and will not fracture. Special considerations are also needed in men and ethnic minority groups. These groups may have different bone size, thus affecting the normative range of BMD, and/or distinct bone structure that affect the association between BMD and fractures. Finally, BMD can be affected by positioning errors or artifacts, including osteoarthritis, fracture, and jewelry. Of course, DXA has tremendous strengths as well-namely its wide availability, its low radiation exposure, and a large body of evidence that relate DXA measurements to fracture risk. For these reasons, DXA remains the cornerstone of fracture assessment now and for the foreseeable future.
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Affiliation(s)
- Rajesh K Jain
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637; Department of Medicine, Section of Diabetes, Metabolism, and Endocrinology, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140.
| | - Tamara Vokes
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637
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Abstract
Osteoporosis becomes common with aging in both sexes, but is often ignored in men. The 2013 International Society for Clinical Densitometry consensus conference endorsed a Caucasian female referent database for T-score calculation in men. This recommendation has generated controversy and concern. Accumulating data indicate that at the same DXA-measured body mineral density (BMD) (g/cm(2)), men and women are at approximately the same fracture risk. With this point in mind, using the same database to derive the T-score in men and women is reasonable. As a result, a greater proportion of men who sustain a fragility fracture will have T-scores that are higher than they would if a male database were used; in fact, many men will fracture at T-scores that are "normal." This highlights the importance of diagnosing osteoporosis not just by T-score, but also by the presence of fragility fracture and/or by estimations of fracture risk as generated by tools such as the FRAX calculator. The practical consequences of this change in densitometric definition of osteoporosis in men should be monitored, including the proportion of men at risk identified and treated as well as defining the response to treatment in those assessed by this more comprehensive approach.
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Affiliation(s)
- Neil Binkley
- University of Wisconsin Osteoporosis Clinical Research Program, 2870 University Avenue, Suite 100, Madison, WI 53705. Phone: 608.265.6410 Fax: 608.265.6409
| | - Robert Adler
- Endocrinology Section, McGuire Veterans Affairs Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, 23249. Phone 804 675 5424; Fax 804 675 5425
| | - John P. Bilezikian
- College of Physicians and Surgeons, Department of Medicine, Division of Endocrinology, 630 W. 168 Street, New York, NY 10032 Phone: 212.305.6238; Fax: 212.305.6486
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