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Elamin Ahmed H, Al-Dadah O. Bone mineral density in fracture neck of femur patients: What's the significance? World J Orthop 2022; 13:160-170. [PMID: 35317402 PMCID: PMC8891661 DOI: 10.5312/wjo.v13.i2.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/01/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The National Institute for Health and Care Excellence (NICE) guidelines have advised further research is required into investigating the added prognostic value of bone mineral density (BMD) in the assessment of fracture risk with the Fracture Risk Assessment Tool (FRAX) score.
AIM To investigate the significance of BMD in fracture neck of femur patients and compare it to the outcome of the FRAX score.
METHODS Inclusion criteria for this study were all patients who underwent dual-energy X-ray absorptiometry (DXA) scan following fracture neck of femur between 2015 and 2017. Analysis of BMD, FRAX scores and patient demographic data was undertaken.
RESULTS A total of 69 patients were included in the study, mean age 74.1 years. There was no significant difference between mean BMD of the femoral neck in males (0.65) as compared to females (0.61) (P = 0.364). Analyses showed no significant correlation between BMD and menopause age (rs = -0.28, P = 0.090). A significant difference was seen of the femoral neck BMD between the different fracture pattern types (P = 0.026). A stronger correlation was observed between BMD of femoral neck and FRAX major score (rs = -0.64, P < 0.001) than with BMD of lumbar spine and FRAX major score (rs = -0.37, P = 0.003).
CONCLUSION This study demonstrated that BMD of the femoral neck measured by DXA scan is of added prognostic value when assessing patients for risk of fracture neck of femur in combination with the FRAX predictive scoring system.
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Affiliation(s)
- Hussam Elamin Ahmed
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Tyneside NE34 0PL, United Kingdom
| | - Oday Al-Dadah
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Tyneside NE34 0PL, United Kingdom
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne NE2 4HH, United Kingdom
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Feehan J, Tripodi N, Fleischmann M, Zanker J, Duque G. A clinician's guide to the management of geriatric musculoskeletal disease: Part 1 - Osteoporosis. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Teeratakulpisarn N, Charoensri S, Theerakulpisut D, Pongchaiyakul C. FRAX score with and without bone mineral density: a comparison and factors affecting the discordance in osteoporosis treatment in Thais. Arch Osteoporos 2021; 16:44. [PMID: 33635451 DOI: 10.1007/s11657-021-00911-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/12/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We investigate the rate of concordance between treatment recommendations of osteoporosis with 10-year probability of hip fracture calculated using FRAX scores with and without BMD. We found that predictions were concordant in 83.8% of patients. However, older age, lower BMD, and FRAX without BMD around the intervention threshold were associated with discordant results. In the discordant group, FRAX with BMD suggested treatment in more participants with lower age, higher BMI, and lower BMD when compared with FRAX without BMD. INTRODUCTION The Fracture Risk Assessment Tool (FRAX) is used to calculate the 10-year probability of fracture using important clinical factors, with bone mineral density (BMD) as an optional input variable. We aimed to determine the rate of concordance between treatment recommendations of osteoporosis with 10-year probability of hip fracture calculated using FRAX scores with and without BMD and to identify relevant clinical risk factors associated with discordance. METHODS This was a cross-sectional study conducted in patients between 40 and 90 years of age who were screened for osteoporosis by BMD measurement using dual energy X-ray absorptiometry (DXA) from 2010 to 2018 at a university hospital in Thailand. A FRAX questionnaire was administered to determine demographic data and osteoporotic risk factors. FRAX scores with and without BMD were calculated for each participant using the Thai reference, and patients were categorized into either the treatment or non-treatment group based on a cut-off of 3% 10-year probability of hip fracture. When FRAX scores with and without BMD results were consistent, they were considered concordant. Otherwise, they were deemed discordant. Clinical risk factors were compared between the concordant and discordant groups. RESULTS A total of 3545 participants were included in the study. The majority (83.8%) were in the concordant group. However, older age, lower BMD, and FRAX without BMD around the intervention threshold were significantly associated with discordant results. In the discordant group, FRAX with BMD suggested treatment in more participants with lower age, higher BMI, and lower BMD when compared with FRAX without BMD. CONCLUSION FRAX scores with and without BMD yielded concordant predictions regarding the 10-year probability of hip fracture suggesting pharmacological treatment. However, this concordance declined in elderly and osteoporotic participants and in those with FRAX without BMD around intervention threshold. BMD data may be required in these populations in order to facilitate accurate risk assessment.
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Affiliation(s)
| | - Suranut Charoensri
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Daris Theerakulpisut
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
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Aziziyeh R, Garcia Perlaza J, Saleem N, Kirazlı Y, Akalın E, McTavish RK, Duperrouzel C, Cameron C. The burden of osteoporosis in Turkey: a scorecard and economic model. Arch Osteoporos 2020; 15:128. [PMID: 32794017 DOI: 10.1007/s11657-020-00801-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/29/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED The burden of osteoporosis in Turkey is not well characterized. Our results indicate that osteoporosis is undertreated in Turkey with 1.35 million fractures predicted to occur from 2019 to 2023 at an associated cost of 2.42 billion USD. Interventions are needed to close the treatment gap and minimize the economic burden. PURPOSE The number of osteoporotic fractures is expected to increase as populations age, posing a major risk to health systems and patients. We created a scorecard summarizing the burden of disease, policy framework, service provision, and service uptake for osteoporosis in Turkey and estimated the economic burden of osteoporotic fractures in Turkey. METHODS A systematic review of osteoporosis in Turkey was performed. Gaps in the literature were supplemented by surveys with osteoporosis experts. The findings were used to populate a scorecard and burden of illness model focused on adults aged 50 to 89 years in Turkey. The scorecard provided a visual representation of osteoporosis burden and management using a traffic light color coding system. The model quantified osteoporosis-related fracture costs (2019 USD) including hospitalizations, dual-energy x-ray absorptiometry testing, hip fracture surgery, prescription drugs, and patient productivity losses. RESULTS The scorecard showed that osteoporosis is undertreated in Turkey. Despite timely access to diagnosis, > 75% of high-risk patients fail to initiate on appropriate therapies. In 2019, the economic model predicted that 255,183 osteoporosis-related fractures would occur in Turkey with an associated annual cost of approximately 455 million USD and an average burden per 1000 at risk of 23,987 USD. The cumulative 5-year cost of 1,354,817 fractures was 2.42 billion USD. CONCLUSIONS Approximately 1.35 million fragility fractures are predicted to occur in Turkey during the next 5 years with costs of 2.42 billion USD. Closing the treatment gap will be imperative for preventing these fractures and minimizing the burden of osteoporosis in Turkey.
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Affiliation(s)
- Rima Aziziyeh
- Amgen Inc., 6775 Financial Dr #100, Mississauga, ON, L5N 0A4, Canada.
| | | | | | - Yeşim Kirazlı
- Medical Faculty, Ege University, Bornova, İzmir, Turkey
| | - Elif Akalın
- Medical Faculty, Dokuz Eylül University, Balçova, İzmir, Turkey
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Wang QF, Bi HS, Qin ZL, Wang P, Nie FF, Zhang GW. Associations of LRP5 Gene With Bone Mineral Density, Bone Turnover Markers, and Fractures in the Elderly With Osteoporosis. Front Endocrinol (Lausanne) 2020; 11:571549. [PMID: 33101205 PMCID: PMC7545741 DOI: 10.3389/fendo.2020.571549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/20/2020] [Indexed: 12/06/2022] Open
Abstract
Objective: The study aimed to explore the associations of rs4988300 and rs634008 in the low-density lipoprotein receptor-related protein 5 (LRP5) gene with bone mineral density (BMD), bone turnover markers (BTM), and fractures in elderly patients with osteoporosis (OP). Methods: Our study included 328 unrelated OP patients with or without fractures. Genomic DNA was extracted for genotyping. BTM levels were assessed by electrochemiluminescence (ECL). Dual-energy X-ray absorptiometry (DXA) was employed to measure BMD in the lumbar spine (LS) and proximal femur. Basic features between the OP and fracture groups were analyzed using the t-test. The Chi-square test was performed to analyze the differences in allele and genotype frequencies. The associations of single-nucleotide polymorphisms (SNPs) with BMD and BTM in the subgroups were investigated by the analysis of covariance (ANCOVA) adjusted for confounding factors. Results: In both females and males, individuals with fractures exhibited higher BTM levels and lower BMD values than those with OP (P < 0.05). The allele and genotype frequencies of rs4988300 in the subgroups were significantly different (P < 0.05). In both females and males suffering from OP, participants with rs4988300 GG or rs634008 TT presented lower procollagen I N-terminal propeptide (PINP) levels (P < 0.05). Women with OP carrying rs4988300 GG exhibited lower BMD values at FN and TH (P < 0.05). In both females and males with fractures, individuals carrying rs4988300 GG genotype or rs634008 TT genotype exhibited lower PINP levels and BMD values at FN and TH than those with other genotypes (P < 0.05). Conclusions: Rs4988300 and rs634008 polymorphisms in the LRP5 gene are associated with bone phenotypes in the elderly with OP or fractures.
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Affiliation(s)
- Qi-Fei Wang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Hong-Sen Bi
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Ze-Lian Qin
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
- *Correspondence: Ze-Lian Qin
| | - Pu Wang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Fang-Fei Nie
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Guang-Wu Zhang
- Department of Orthopedics, Peking University Shougang Hospital, Beijing, China
- Guang-Wu Zhang
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Associations of IDUA and PTCH1 with Bone Mineral Density, Bone Turnover Markers, and Fractures in Chinese Elderly Patients with Osteoporosis. DISEASE MARKERS 2019; 2019:9503762. [PMID: 31275456 PMCID: PMC6589188 DOI: 10.1155/2019/9503762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 12/22/2022]
Abstract
Introduction Osteoporosis (OP) is a common polygenic disorder in the aging population, and several single nucleotide polymorphisms (SNPs) in the alpha-L-iduronidase (IDUA) gene and patched homolog 1 (PTCH1) gene regulate bone metabolism and affect bone mass. The study aimed at investigating the relationships of rs3755955 and rs6831280 in the IDUA gene and rs28377268 in the PTCH1 gene with bone mineral density (BMD), bone turnover markers (BTMs), and fractures in the elderly Chinese subjects with OP. Materials and Methods A cohort of 328 unrelated senile osteoporosis (SOP) patients with or without osteoporotic fractures was recruited. rs3755955, rs6831280, and rs28377268 polymorphisms were identified using SNaPshot technology. BTM levels were determined by electrochemiluminescence (ECL). Bone mineral densities (BMDs) at the lumbar spine (LS) and proximal femur sites were measured by dual-energy X-ray absorptiometry (DEXA) in all subjects. The Hardy-Weinberg equilibrium (HWE) test was performed. HWE P values and comparisons of genotype frequencies were estimated using the chi-square test. Analysis of covariance (ANCOVA) adjusted for confounding factors was performed to investigate associations of SNPs with BMDs and BTMs in subgroups. Results The chi-square test indicated that genotype distributions in the control group conformed to HWE (P > 0.05). The distributions of allele and genotype frequencies of rs6831280 between fracture and osteoporotic participants were significantly different (P-allele = 0.002 and P-genotype = 0.012, respectively). Concerning rs6831280, ANCOVA found BMDs at LS 2-4 (L2-4) and total hip (TH) among the study subjects suffering from SOP with GA genotype were lower than in those carrying GG or AA (P-L2-4 = 0.004 and P-TH = 0.027, respectively). Conclusions IDUA rs6831280 is associated with BMDs at L2-4 and TH in the elderly Chinese population with SOP and may serve as a marker for the genetic susceptibility to osteoporotic fractures.
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Locquet M, Beaudart C, Reginster JY, Bruyère O. Association Between the Decline in Muscle Health and the Decline in Bone Health in Older Individuals from the SarcoPhAge Cohort. Calcif Tissue Int 2019; 104:273-284. [PMID: 30511152 DOI: 10.1007/s00223-018-0503-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/27/2018] [Indexed: 01/29/2023]
Abstract
The longitudinal relationship between bone health and muscle health is scarcely explored. We aimed to explore the relationship between bone decline and muscle decline over 1 year in older individuals. We used data from the SarcoPhAge cohort, which aims to identify the consequences of sarcopenia. In this way, this study also highlights the yearly changes in muscle mass (by dual-energy absorptiometry), muscle weakness (by grip strength), and/or physical performance (by the short physical performance battery test). Measurements of areal bone mineral density (aBMD), enabling the diagnosis of osteoporosis, and bone microarchitecture (by means of the trabecular bone score) were also performed each year. A 1-year clinically relevant decline in bone and muscle health components was evidenced using the Edwards-Nunnally index. Among the 232 participants with complete data (75.5 ± 5.4 years, 57.8% women), we observed an association between a clinically relevant decline in the skeletal muscle mass index (SMI) and a decrease in aBMD (adjusted OR = 2.12 [1.14-2.51] for the spine, 2.42 [1.10-5.34] for the hip and 2.12 [1.04-5.81] for the neck), as well as a significant association between SMI and deterioration of the skeletal microarchitecture (aOR = 3.99 [2.07-7.70]). A clinically relevant decline in muscle strength was associated with a decrease in spine aBMD (aOR = 2.93 [1.21-7.12]) and hip aBMD (aOR = 3.42 [1.37-7.64]) only. The decline in muscle performance was related to the decline in bone microarchitecture only (aOR = 2.52 [1.23-5.17]). Individuals with incident sarcopenia had an approximately fivefold higher risk of concomitantly developing osteoporosis. A dynamic relationship between impaired muscle and bone health was observed, with an obvious association between the concomitant incidences of osteoporosis and sarcopenia.
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Affiliation(s)
- Médéa Locquet
- World Health Organization Collaborating Center for the Public Health Aspects of Musculoskeletal Health and Aging, Department of Public Health Sciences, Epidemiology and Health Economics, University of Liège, CHU of Liège, B.23, Avenue Hippocrate, 13, 4000, Liège, Belgium.
| | - Charlotte Beaudart
- World Health Organization Collaborating Center for the Public Health Aspects of Musculoskeletal Health and Aging, Department of Public Health Sciences, Epidemiology and Health Economics, University of Liège, CHU of Liège, B.23, Avenue Hippocrate, 13, 4000, Liège, Belgium
| | - Jean-Yves Reginster
- World Health Organization Collaborating Center for the Public Health Aspects of Musculoskeletal Health and Aging, Department of Public Health Sciences, Epidemiology and Health Economics, University of Liège, CHU of Liège, B.23, Avenue Hippocrate, 13, 4000, Liège, Belgium
- Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Olivier Bruyère
- World Health Organization Collaborating Center for the Public Health Aspects of Musculoskeletal Health and Aging, Department of Public Health Sciences, Epidemiology and Health Economics, University of Liège, CHU of Liège, B.23, Avenue Hippocrate, 13, 4000, Liège, Belgium
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Nakada T, Teranishi M, Ueda Y, Sone M. Fracture probability assessed using FRAX® in elderly women with benign paroxysmal positional vertigo. Auris Nasus Larynx 2018; 45:1173-1177. [DOI: 10.1016/j.anl.2018.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 01/01/2023]
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