1
|
Hasegawa T, Ueda N, Yamada SI, Kato S, Iwata E, Hayashida S, Kojima Y, Shinohara M, Tojo I, Nakahara H, Yamaguchi T, Kirita T, Kurita H, Shibuya Y, Soutome S, Akashi M. Denosumab-related osteonecrosis of the jaw after tooth extraction and the effects of a short drug holiday in cancer patients: a multicenter retrospective study. Osteoporos Int 2021; 32:2323-2333. [PMID: 33997909 DOI: 10.1007/s00198-021-05995-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/05/2021] [Indexed: 12/15/2022]
Abstract
UNLABELLED Pre-existing inflammation, corticosteroid therapy, periapical periodontitis, longer duration of denosumab therapy, and female sex were significantly associated with an increased risk of denosumab-related osteonecrosis of the jaw after tooth extraction in patients with cancer on oncologic doses of denosumab. A short drug holiday did not protect against this complication. INTRODUCTION This study retrospectively investigated the relationship between various risk factors, including brief discontinuation of denosumab, and development of denosumab-related osteonecrosis of the jaw (DRONJ) after tooth extraction in patients with cancer who were receiving oncologic doses of this agent. METHODS Data were collected on demographic characteristics, duration of denosumab therapy, whether or not denosumab was discontinued before tooth extraction (drug holiday), duration of discontinuation, presence of pre-existing inflammation, and whether or not additional surgical procedures were performed. Risk factors for DRONJ after tooth extraction were evaluated by univariate and multivariate analyses. RESULTS A total of 136 dental extractions were performed in 72 patients (31 men, 41 women) with cancer who were receiving oncologic doses of denosumab. Post-extraction DRONJ was diagnosed in 39 teeth (28.7%) in 25 patients. Tooth extraction was significantly associated with development of DRONJ only in patients with pre-existing inflammation (odds ratio [OR] 243.77), those on corticosteroid therapy (OR 73.50), those with periapical periodontitis (OR 14.13), those who had been taking oncologic doses of denosumab for a longer period (OR 4.69), and in women (OR 1.04). There was no significant difference in the occurrence of DRONJ between patients who had a drug holiday before tooth extraction and those who did not. CONCLUSIONS These findings suggest that inflamed teeth should be extracted immediately in patients with cancer who are receiving oncologic doses of denosumab. Drug holidays have no significant impact on the risk of DRONJ.
Collapse
Affiliation(s)
- T Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - N Ueda
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - S I Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - S Kato
- Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - E Iwata
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - S Hayashida
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Y Kojima
- Department of Dentistry and Oral Surgery, Kansai Medical University, Hirakata, Japan
| | - M Shinohara
- Department of Oral and Maxillofacial Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - I Tojo
- Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Japan
| | - H Nakahara
- Department of Oral and Maxillofacial Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - T Yamaguchi
- Department of Preventive Dentistry, Research Field in Dentistry, Medical and Dental Sciences Area, Kagoshima University, Kagoshima, Japan
| | - T Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - H Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Y Shibuya
- Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - S Soutome
- Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | | |
Collapse
|
2
|
Chen Y, Zhu J, Zhou Y, Peng J, Wang B. Efficacy and Safety of Denosumab in Osteoporosis or Low Bone Mineral Density Postmenopausal Women. Front Pharmacol 2021; 12:588095. [PMID: 33935694 PMCID: PMC8080120 DOI: 10.3389/fphar.2021.588095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/05/2021] [Indexed: 11/13/2022] Open
Abstract
Denosumab, a human monoclonal antibody, acts against the receptor activator of nuclear factor-κB ligand and is a promising antiresorptive agent in patients with osteoporosis. This study aimed to update the efficacy and safety of denosumab vs. placebo in osteoporosis or low bone mineral density (BMD) postmenopausal women. PubMed, Embase, Cochrane library, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) reporting the efficacy and safety data of denosumab vs. placebo in osteoporosis or low BMD postmenopausal women. A random-effects model was used to calculate pooled weight mean differences (WMDs) or relative risks (RRs) with corresponding 95% confidence intervals (CIs) for treatment effectiveness of denosumab vs. placebo. Eleven RCTs including 12,013 postmenopausal women with osteoporosis or low BMD were preferred for the final meta-analysis. The summary results indicated that the percentage change of BMD in the denosumab group was greater than that of BMD in placebo at 1/3 radius (WMD: 3.43; 95%CI: 3.24–3.62; p < 0.001), femoral neck (WMD: 3.05; 95%CI: 1.78–4.33; p < 0.001), lumbar spine (WMD: 6.25; 95%CI: 4.59–7.92; p < 0.001), total hip (WMD: 4.36; 95%CI: 4.07–4.66; p < 0.001), trochanter (WMD: 6.00; 95%CI: 5.95–6.05; p < 0.001), and total body (WMD: 3.20; 95%CI: 2.03–4.38; p < 0.001). Moreover, denosumab therapy significantly reduced the risk of clinical fractures (RR: 0.57; 95%CI: 0.51–0.63; p < 0.001), nonvertebral fracture (RR: 0.83; 95%CI: 0.70–0.97; p = 0.018), vertebral fracture (RR: 0.32; 95%CI: 0.25–0.40; p < 0.001), and hip fracture (RR: 0.61; 95%CI: 0.37–0.98; p = 0.042). Finally, denosumab did not cause excess risks of adverse events. These findings suggested that postmenopausal women receiving denosumab had increased BMDs and reduced fractures at various sites without inducing any adverse events.
Collapse
Affiliation(s)
- Yi Chen
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jun Zhu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yiqin Zhou
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jinhui Peng
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Bo Wang
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
3
|
No Author. Chapitre 1 : Évaluation et gestion des risques chez les femmes ménopausées. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S36-S48. [DOI: 10.1016/j.jogc.2019.02.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
4
|
LOPEZ-GONZALEZ ANGELA, GRASES FELIX, MARÍ BARTOLOME, TOMÁS-SALVÁ MATIAS, RODRIGUEZ ADRIAN. Urinary phytate concentration and risk of fracture determined by the FRAX index
in a group of postmenopausal women. Turk J Med Sci 2019; 49:458-463. [PMID: 30862150 PMCID: PMC7018201 DOI: 10.3906/sag-1806-117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background/aim This study was designed to evaluate the relationship between urinary phytate concentration and risk of fracture at 10 years, determined by using the FRAX model, in women who had undergone menopause within 5 years of the time of enrollment. Materials and methods Of the 212 postmenopausal women evaluated, 69 were excluded because they had urinary phytate concentrations between 0.51 and 0.99 mg/L. Of the remaining 143 women, 91 had low (≤0.50 mg/L) and 52 had high (≥1.0 mg/L) urinary phytate concentrations. The 10-year risk of fracture was calculated by using the FRAX model. Results The risks of major osteoporotic fracture and hip fracture were higher in women with low urinary phytate levels (P < 0.001 in both cases). Evaluation of the risk of hip fracture in women with and without risk factors for osteoporosis (e.g., tobacco, alcohol, and drug consumption) and according to urinary phytate concentrations indicated that, among women with no risk factors, those with low and high urinary phytate levels had a range of risks of 0%–0.6% and 0%–0.3%, respectively (P = 0.098). Moreover, among women with at least one risk factor, those with low and high urinary phytate had a range of risks of 0.1%–0.8% and 0.1%–0.4%, respectively (P = 0.002). Similar results were observed when the risks of major osteoporotic fracture were analyzed. Conclusion These results indicate the relationship of phytate with the risks of major osteoporotic fracture and hip fracture, with these differences being more marked in women with risk factors for osteoporosis. From this study follows the importance of the consumption of phytate-rich products (nuts, legumes, whole cereals) to protect against the risk of fracture in 10 years, mainly in women with risk factors for osteoporosis.
Collapse
Affiliation(s)
- ANGEL A. LOPEZ-GONZALEZ
- Occupational Health Investigation Group, University Institute of Health Sciences Research (IUNICS), University of the Balearic Islands, PalmaSpain
- * To whom correspondence should be addressed. E-mail:
| | - FELIX GRASES
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS), University of the Balearic Islands, PalmaSpain
| | - BARTOLOME MARÍ
- Occupational Health Investigation Group, University Institute of Health Sciences Research (IUNICS), University of the Balearic Islands, PalmaSpain
| | - MATIAS TOMÁS-SALVÁ
- Occupational Health Investigation Group, University Institute of Health Sciences Research (IUNICS), University of the Balearic Islands, PalmaSpain
| | - ADRIAN RODRIGUEZ
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS), University of the Balearic Islands, PalmaSpain
| |
Collapse
|
5
|
Krishnaraj A, Barrett S, Bregman-Amitai O, Cohen-Sfady M, Bar A, Chettrit D, Orlovsky M, Elnekave E. Simulating Dual-Energy X-Ray Absorptiometry in CT Using Deep-Learning Segmentation Cascade. J Am Coll Radiol 2019; 16:1473-1479. [PMID: 30982683 DOI: 10.1016/j.jacr.2019.02.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/28/2019] [Accepted: 02/09/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Osteoporosis is an underdiagnosed condition despite effective screening modalities. Dual-energy x-ray absorptiometry (DEXA) screening, although recommended in clinical guidelines, remains markedly underutilized. In contrast to DEXA, CT utilization is high and presents a valuable data source for opportunistic osteoporosis screening. The purpose of this study was to describe a method to simulate lumbar DEXA scores from routinely acquired CT studies using a machine-learning algorithm. METHODS Between January 2010 and September 2014, 610 CT studies of the abdomen and pelvis were used to develop spinal column and L1 to L4 multiclass segmentation. DEXA simulation training and validation used 1,843 pairs of CT studies accompanied by DEXA results obtained within a 6-month interval from the same individual. Machine learning-based regression was used to determine correlation between calculated grade (on the basis of vertebrae L1-L4) and DEXA t score. RESULTS Analysis of the t score equivalent, generated by the algorithm, revealed true positives in 1,144 patients, false positives in 92 patients, true negatives in 245 patients, and false negatives in 212 patients, resulting in an accuracy of 82%. Sensitivity for the detection of osteoporosis or osteopenia was 84.4% (95% confidence interval, 82.3%-86.2%), and specificity was 72.7% (95% confidence interval, 67.7%-77.2%). CONCLUSIONS The presented algorithm can identify osteoporosis and osteopenia with a high degree of accuracy (82%) and a small proportion of false positives. Efforts to cull greater information using machine-learning algorithms from pre-existing data have the potential to have a marked impact on population health efforts such as bone mineral density screening for osteoporosis, in which gaps in screening currently exist.
Collapse
Affiliation(s)
- Arun Krishnaraj
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia.
| | - Spencer Barrett
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia
| | | | | | - Amir Bar
- Zebra Medical Vision, Shfayim, Israel
| | | | | | | |
Collapse
|
6
|
Al-Daghri NM, Al-Attas OS, Yakout SM, Alnaami AM, Wani K, Alokail MS. The association of serum 25-OH vitamin D with asthma in Saudi adults. Medicine (Baltimore) 2018; 97:e12286. [PMID: 30200174 PMCID: PMC6133535 DOI: 10.1097/md.0000000000012286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The study aimed to assess the differences and associations of serum 25 (OH)D levels in Saudi adults with and without asthma. A total of 1070 Saudi adults aged 22 to 28 years (359 with known asthma and 711 matched nonasthmatic controls) were selected randomly from the Riyadh Cohort, Saudi Arabia. Serum 25(OH)D serum levels were measured. Asthma diagnosis was taken from questionnaires. In all participants, 359 (33.6%) were known asthmatic and 711 (66.5%) were nonasthmatic. The overall incidence of vitamin D deficiency (serum 25(OH)D <25 nmol/L) was 29.6% in controls and 35.6% in asthma group (P = .01). The asthma group have a significantly lower serum 25(OH)D than the control group (P = .01) but lost significance after adjusting for age, body mass index (BMI), and sex. Nonasthmatic and asthmatic females had a higher incidence of vitamin D deficiency (33% and 46%) than nonasthmatic and asthmatic males (17% and 33%). Vitamin D deficiency is significantly high among Saudi adults with asthma, but more so among women. Whether vitamin D deficiency exacerbates asthma attack remains to be proven in this population.
Collapse
Affiliation(s)
- Nasser M. Al-Daghri
- Biomarkers Research Program
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Omar S. Al-Attas
- Biomarkers Research Program
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sobhy M. Yakout
- Biomarkers Research Program
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah M. Alnaami
- Biomarkers Research Program
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Kaiser Wani
- Biomarkers Research Program
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Majed S. Alokail
- Biomarkers Research Program
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
7
|
Shariati-Sarabi Z, Rezaie HE, Milani N, Rezaie FE, Rezaie AE. Evaluation of Bone Mineral Density in Perimenopausal Period. THE ARCHIVES OF BONE AND JOINT SURGERY 2018; 6:57-62. [PMID: 29430497 PMCID: PMC5799602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 08/27/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND The menopausal transition called perimenopause, happens after the reproductive years, and is specified with irregular menstrual cycles, perimenopause symptoms and hormonal changes. Women going through peri menopausal period are vulnerable to bone loss . Osteoporosis is one of the most common debilitating metabolic bone diseases, especially in the women almost around 50 years. This study was intended to evaluate the prevalence of osteopenia/osteoporosis amongst asymptomatic individuals during the menopause transition period. METHODS A total of 714 asymptomatic peri-menopausal female volunteers were recruited through a billboard invitation for participation in the study. The subjects were selected based on already defined inclusion and exclusion criteria. The project, which was conducted between 2010 and 2014 was affiliated to the Educational and Therapeutic Center, Imam Reza Hospital, Mashhad, Iran. Bone Mineral Densitometry (BMD) measured by DEXA (dual-energy X-ray absorptiometry) was carried out on two distinct sites, the proximal femur and the lumbar vertebrae from L1 to L4. Pertained data were analyzed. RESULTS The mean age of the subjects was 49.7±2.years. The overall prevalence of osteopenia and osteoporosis in these peri-menopausal individuals were 37.6 % and 10% respectively. Thirty five point two percent of 714 women presented with osteopenia and eight percent of them have osteoporosis in the femoral neck, respectively. Nonetheless, BMD values at the lumbar spine indicated 41.6% and 12% of individual participants being affected by osteopenia and osteoporosis. CONCLUSION In general osteopenia or osteoporosis, occurred in 48% of this study population, implying that special attention is required for the bone health status of Iranian women who undergo menopause.Level of evidence: II.
Collapse
Affiliation(s)
- Zhaleh Shariati-Sarabi
- Internal Medicine Department, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Neurosurgery Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Internal Medicine Department, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran Rosalind Franklin University of Medicine and Science 3333 Green Bay Road, North Chicago, USA
| | - Hamid Etemad Rezaie
- Internal Medicine Department, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Neurosurgery Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Internal Medicine Department, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran Rosalind Franklin University of Medicine and Science 3333 Green Bay Road, North Chicago, USA
| | - Nasrin Milani
- Internal Medicine Department, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Neurosurgery Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Internal Medicine Department, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran Rosalind Franklin University of Medicine and Science 3333 Green Bay Road, North Chicago, USA
| | - Farnaz Etemad Rezaie
- Internal Medicine Department, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Neurosurgery Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Internal Medicine Department, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran Rosalind Franklin University of Medicine and Science 3333 Green Bay Road, North Chicago, USA
| | - Ali Etemad Rezaie
- Internal Medicine Department, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Neurosurgery Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Internal Medicine Department, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran Rosalind Franklin University of Medicine and Science 3333 Green Bay Road, North Chicago, USA
| |
Collapse
|
8
|
Leitner-Ferenc V, Atamaniuk J, Jansen-Skoupy S, Stöckelmeier B, Grohs K, Födinger M. CLSI-Based Validation of Manufacturer-Derived Reference Intervals on the Cobas 8000 Platform. Lab Med 2017; 48:e30-e35. [DOI: 10.1093/labmed/lmx020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
9
|
Normal range of BMD in proximal tibia as a different skeletal site at women. North Clin Istanb 2017; 3:201-208. [PMID: 28275752 PMCID: PMC5336625 DOI: 10.14744/nci.2016.95866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/20/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE: Osteoporosis is progressive metabolic bone disease that decreases bone density and features deterioration of bone structure. Dual-energy X-ray absorptiometry (DXA) is commonly used and reliable method to measure bone mineral density (BMD). Aim of this study was to determine normal ranges of BMD in left proximal tibia. METHODS: Fifty-five females were included in this study. BMD was measured at the lumbar spine and the left proximal tibia using DXA. BMD value of subregions in the left proximal tibia was significantly correlated with BMD value of the total lumbar spine (r=0.111–0.766). New average BMD values of the left proximal tibia were calculated according to age using linear regression formula, leading to average BMD value for the total lumbar spine (L1-L4) in normal population. New simulated T-scores for proximal subregions of the tibia were then calculated. RESULTS: T-scores for proximal subregions were not different from T-scores of total lumbar spine (p>0.05). CONCLUSION: It was concluded that proximal tibia is an ideal region for measurement of BMD in osteoporosis.
Collapse
|
10
|
Khan A, Fortier M. Ostéoporose pendant la ménopause. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:S465-S483. [DOI: 10.1016/j.jogc.2016.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Matsumoto A, Sasaki M, Schmelzeisen R, Oyama Y, Mori Y, Voss PJ. Primary wound closure after tooth extraction for prevention of medication-related osteonecrosis of the jaw in patients under denosumab. Clin Oral Investig 2016; 21:127-134. [PMID: 26924135 DOI: 10.1007/s00784-016-1762-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/19/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Some recent reports have indicated that local infection causes osteonecrosis of the jaw and described that tooth extraction may not be a direct cause of developing medication-related osteonecrosis of the jaw (MRONJ) in patients receiving antiresorptive medications. Tooth extraction and elimination of the source of infection are expected to reduce the risk of developing MRONJ. However, there is no data regarding prevention for developing osteonecrosis of the jaw in patients receiving denosumab. Therefore, the aim of this study was to investigate the outcome of tooth extractions with proper wound closure in patients receiving denosumab. PATIENTS AND METHODS Forty teeth in 19 patients treated with denosumab therapy were extracted under preoperative intravenous antibiotics. Patients who had already developed MRONJ in the extraction sites or who had a history of radiation therapy were excluded. During surgery, bone edges were smoothed and all wounds were closed using the double-layered technique. RESULTS Thirty-seven extraction sites (92.5 %) in 17 out of 19 patients (89.5 %) were healed. However, three extraction sites in two patients had complications; one patient had exposed bone and developed MRONJ (stage 1) and the other developed a mucosa fistula. Additional surgical procedures were performed and all wounds were completely healed. CONCLUSIONS Tooth extractions in patients receiving denosumab can be performed in an appropriate manner and result in good outcomes. CLINICAL RELEVANCE This study indicated that tooth extraction with proper wound closure to avoid secondary infection may be effective for the prevention of MRONJ even in high-risk patients.
Collapse
Affiliation(s)
- Akihiko Matsumoto
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Masanori Sasaki
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, University Hospital Freiburg, Hugstetter St. 55, 79106, Freiburg im Breisgau, Germany
| | - Yukiko Oyama
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihide Mori
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Pit Jacob Voss
- Department of Oral and Maxillofacial Surgery, University Hospital Freiburg, Hugstetter St. 55, 79106, Freiburg im Breisgau, Germany
| |
Collapse
|
12
|
McLeod KM, Johnson S, Charturvedi R, St Onge J, Lionel A, Verma A. Bone mineral density screening and its accordance with Canadian clinical practice guidelines from 2000-2013: an unchanging landscape in Saskatchewan, Canada. Arch Osteoporos 2015; 10:227. [PMID: 26173601 DOI: 10.1007/s11657-015-0227-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 07/01/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED We examined the clinical characteristics of patients who underwent initial dual energy X-ray absorptiometry (DXA) testing at a primary care facility from 2000 to 2013, and whether these factors changed over time in accordance with Canadian clinical practice guidelines. The burden of osteoporosis remains high and largely unchanged and clinical practice guidelines are not being followed, overall. PURPOSE This study examined the clinical risk factors, therapeutic health behaviors, and bone mineral density (BMD) status of patients who underwent initial DXA testing at a primary care facility in Saskatchewan, Canada, and whether these factors changed over time from 2000 to 2013 in accordance with Canadian clinical practice guidelines. METHODS We conducted a retrospective cross-sectional medical chart audit of 800 patients 50 years of age and older who underwent their first DXA test to assess BMD status. Data was extracted from 2000 to 2013 and further stratified into four periods (2000-2001, 2002-2006, 2007-2009, and 2010-2013; n = 200 each period) based on the years when practice guidelines were implemented. Extracted data included BMD outcomes, clinical risk factor indicators for DXA testing, and recommendations for therapeutic health behaviors outlined in the clinical practice guidelines. RESULTS There were no differences in BMD status across the four time stratas (p = 0.430). Overall, most clinical risk factors had little change over time. The number of males screened significantly increased over time (p < 0.05), and osteoporosis drug therapy use decreased from 2000-2001 to 2010-2013 (p < 0.001). Increasing age, body mass <60 kg, and history of adult fracture were significant independent predictors of osteoporosis diagnosis. CONCLUSIONS The burden of osteoporosis remains high and largely unchanged in Saskatchewan, Canada. These results serve to inform strategies to enhance health-care provider awareness and compliance with practice guidelines, as well as improve screening rates and patient health behaviors.
Collapse
Affiliation(s)
- Katherine M McLeod
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Pkwy, Regina, SK, S4S 0A2, Canada,
| | | | | | | | | | | |
Collapse
|
13
|
Papaioannou A, Khan A, Belanger A, Bensen W, Kendler D, Theoret F, Amin M, Brekke L, Erdmann M, Walker V, Adachi JD. Persistence with denosumab therapy among osteoporotic women in the Canadian patient-support program. Curr Med Res Opin 2015; 31:1391-401. [PMID: 25993017 DOI: 10.1185/03007995.2015.1053049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate persistence with denosumab among postmenopausal women with osteoporosis participating in the Canadian patient-support program (ProVital * ). Denosumab is an injectable therapeutic option for osteoporosis that is administered subcutaneously every 6 months. METHODS ProVital, a support program in which patients voluntarily enroll, provides next injection reminder calls and educational material. A retrospective database analysis of patient self-reported data was conducted among osteoporotic women aged ≥50 who enrolled in the ProVital program and received their first denosumab injection between August 2010 and June 2011. To achieve 12 month persistence patients had to receive at least two denosumab injections, and to achieve 24 month persistence patients had to receive at least four denosumab injections, with consecutive injections no more than 6 months + 8 weeks apart. Logistic regression analysis was used to identify predictors of persistence. RESULTS A total of 1676 patients (mean age 74 years) were included. The 12 month persistence with denosumab was 81.6% (1367/1676 patients), and the 24 month persistence was 59.1% (991/1676 patients). Characteristics associated with both 12 and 24 month persistence were possession of private medication insurance and residence in Quebec. Additionally, age greater than 75, previous postmenopausal osteoporosis medication use, and fracture were associated with 24 month persistence. LIMITATIONS Patient enrollment in the program was voluntary, so there may be selection bias for the patient population included in this study. Also, this study did not have a control group of patients who were not enrolled in a patient support program. CONCLUSIONS The persistence with denosumab among patients enrolled in the program was higher than historical persistence with oral bisphosphonates, and similar to persistence of patients in an education program taking teriparatide, patients taking bisphosphonates in a pharmaceutical care program, and two observational studies of denosumab.
Collapse
|
14
|
Managing Menopause Chapter 1 Assessment and Risk Management of Menopausal Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014. [DOI: 10.1016/s1701-2163(15)30457-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
15
|
Aker MB, Taha ASA, Zyoud SH, Sawalha AF, Al-Jabi SW, Sweileh WM. Estimation of 10-year probability bone fracture in a selected sample of Palestinian people using fracture risk assessment tool. BMC Musculoskelet Disord 2013; 14:284. [PMID: 24093559 PMCID: PMC3853474 DOI: 10.1186/1471-2474-14-284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 10/02/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Fracture Risk Assessment (FRAX) tool has been developed by the World Health Organization (WHO) to calculate 10-year probability hip fracture (HP) or major osteoporotic fracture (MOF). The objective of this study was to assess the 10-year probability of MOF and HF among a selected sample of Palestinian people. METHODS A sample of 100 subjects was studied. Dual energy X-ray absorpitometry was performed to measure bone mineral density (BMD) which was then inserted into FRAX Palestine online WHO tool to calculate the 10-year probability of MOF and HF. RESULTS The median age of participants was 61.5 years and the majority (79%) were females. The median (interquartile range) of femoral hip BMD was 0.82 (0.76-0.92) g/cm². The mean vertebral and hip T scores were -1.41 ± 0.13 SDs and -0.91 ± 0.10 SDs respectively. About one fifth of the sample (21%) had vertebral osteoporosis and 5% had hip osteoporosis. The median (interquartile range) 10-year probability of MOF and HF based on BMD were 3.7 (2.43-6.18)%, and 0.30 (0.10-0.68)% respectively. CONCLUSION Osteoporosis is common among Palestinian people above 50 years old. Bone fracture prevention strategies and research should be a priority in Palestine. Using FRAX might be a helpful screening tool in primary healthcare centres in Palestine.
Collapse
Affiliation(s)
- Mai B Aker
- College of Graduate Studies, Public Health Program, An-Najah National University, Nablus, Palestine
| | - Adham S Abu Taha
- Division of Pharmacology/ Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Sa’ed H Zyoud
- Division of Pharmacology/ Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Ansam F Sawalha
- Division of Pharmacology/ Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Samah W Al-Jabi
- Division of Clinical Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Waleed M Sweileh
- Division of Pharmacology/ Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| |
Collapse
|
16
|
Hudson M, Avina-Zubieta A, Lacaille D, Bernatsky S, Lix L, Jean S. The validity of administrative data to identify hip fractures is high--a systematic review. J Clin Epidemiol 2013; 66:278-85. [PMID: 23347851 DOI: 10.1016/j.jclinepi.2012.10.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 09/08/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the validity of the diagnostic algorithms for osteoporosis and fractures in administrative data. STUDY DESIGN AND SETTING A systematic search was conducted to identify studies that reported the validity of a diagnostic algorithm for osteoporosis and/or fractures using administrative data. RESULTS Twelve studies were reviewed. The validity of the diagnosis of osteoporosis in administrative data was fair when at least 3 years of data from hospital and physician visit claims were used (area under the receiver operating characteristic [ROC] curve [AUC]=0.70) or when pharmacy data were used (with or without the use of hospital and physician visit claims data, AUC>0.70). Nonetheless, the positive predictive values (PPVs) were low (<0.60). There was good evidence to support the use of hospital data to identify hip fractures (sensitivity: 69-97%; PPV: 63-96%) and the addition of physician claims diagnostic and procedural codes to hospitalization diagnostic codes improved these characteristics (sensitivity: 83-97%; PPV: 86-98%). Vertebral fractures were difficult to identify using administrative data. There was some evidence to support the use of administrative data to define other fractures that do not require hospitalization. CONCLUSIONS Administrative data can be used to identify hip fractures. Existing diagnostic algorithms to identify osteoporosis and vertebral fractures in administrative data are suboptimal.
Collapse
Affiliation(s)
- Marie Hudson
- Lady Davis Institute for Medical Research, Jewish General Hospital, Room A-725, 3755 Cote Ste Catherine Road, Montreal, Quebec H3T 1E2, Canada.
| | | | | | | | | | | |
Collapse
|
17
|
Total vitamin D assay comparison of the Roche Diagnostics "Vitamin D total" electrochemiluminescence protein binding assay with the Chromsystems HPLC method in a population with both D2 and D3 forms of vitamin D. Nutrients 2013; 5:971-80. [PMID: 23525081 PMCID: PMC3705330 DOI: 10.3390/nu5030971] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/11/2013] [Accepted: 03/07/2013] [Indexed: 01/21/2023] Open
Abstract
This study compared two methods of assaying the 25-hydroxylated metabolites of cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2). A fully automated electrochemiluminescence assay from Roche Diagnostics and an HPLC based method from Chromsystems were used to measure vitamin D levels in surplus sera from 96 individuals, where the majority has the D2 form of the vitamin. Deming regression, concordance rate, correlation and Altman Bland agreement were performed. Seventy two subjects (75%) had a D2 concentration >10 nmol/L while the remaining twenty four subjects had vitamin D2 concentration of less than 10 nmol/L by HPLC. Overall, the Roche Diagnostics method showed a negative bias of -2.59 ± 4.11 nmol/L on the e602 as compared to the HPLC with a concordance rate of 84%. The concordance rate was 91% in samples with D2 of less than 10 nmol/L and 82% in those with D2 concentration >10 nmol/L. The overall correlation had an r value of 0.77. The r value was higher in samples with D2 levels of less than 10 nmol/L, r = 0.96, as compared to those with D2 values of greater than 10 nmol/L, r = 0.74. The observed bias had little impact on clinical decision and therefore is clinically acceptable.
Collapse
|
18
|
Nshimyumukiza L, Durand A, Gagnon M, Douville X, Morin S, Lindsay C, Duplantie J, Gagné C, Jean S, Giguère Y, Dodin S, Rousseau F, Reinharz D. An economic evaluation: Simulation of the cost-effectiveness and cost-utility of universal prevention strategies against osteoporosis-related fractures. J Bone Miner Res 2013; 28:383-94. [PMID: 22991210 PMCID: PMC3580046 DOI: 10.1002/jbmr.1758] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 08/30/2012] [Accepted: 09/04/2012] [Indexed: 12/30/2022]
Abstract
A patient-level Markov decision model was used to simulate a virtual cohort of 500,000 women 40 years old and over, in relation to osteoporosis-related hip, clinical vertebral, and wrist bone fractures events. Sixteen different screening options of three main scenario groups were compared: (1) the status quo (no specific national prevention program); (2) a universal primary prevention program; and (3) a universal screening and treatment program based on the 10-year absolute risk of fracture. The outcomes measured were total directs costs from the perspective of the public health care system, number of fractures, and quality-adjusted life-years (QALYs). Results show that an option consisting of a program promoting physical activity and treatment if a fracture occurs is the most cost-effective (CE) (cost/fracture averted) alternative and also the only cost saving one, especially for women 40 to 64 years old. In women who are 65 years and over, bone mineral density (BMD)-based screening and treatment based on the 10-year absolute fracture risk calculated using a Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool is the best next alternative. In terms of cost-utility (CU), results were similar. For women less than 65 years old, a program promoting physical activity emerged as cost-saving but BMD-based screening with pharmacological treatment also emerged as an interesting alternative. In conclusion, a program promoting physical activity is the most CE and CU option for women 40 to 64 years old. BMD screening and pharmacological treatment might be considered a reasonable alternative for women 65 years old and over because at a healthcare capacity of $50,000 Canadian dollars ($CAD) for each additional fracture averted or for one QALY gained its probabilities of cost-effectiveness compared to the program promoting physical activity are 63% and 75%, respectively, which could be considered socially acceptable. Consideration of the indirect costs could change these findings.
Collapse
Affiliation(s)
- Léon Nshimyumukiza
- Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Cerdà D, Peris P, Monegal A, Albaladejo C, Surís X, Guañabens N. [Identification of clinical features and laboratory abnormalities associated with the development of vertebral fractures in women with postmenopausal osteoporosis]. Med Clin (Barc) 2012; 139:626-30. [PMID: 22459575 DOI: 10.1016/j.medcli.2011.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 11/01/2011] [Accepted: 11/03/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Vertebral fractures (VF) are a major risk factor for the development of further fractures. Therefore, it is important to identify clinical risk factors and laboratory abnormalities related to VF. We aimed to analyse clinical and biochemical alterations related to the presence of radiological VF in postmenopausal women with osteoporosis. PATIENTS AND METHODS Two-hundred and four postmenopausal women with osteoporosis (aged 64,9 [10] years) who were referred to an outpatient Rheumatology Unit were prospectively included. Bone mineral density (BMD), spine X-ray, and laboratory tests were performed in all participants before treatment. RESULTS Twenty-eight per cent of patients had VF. Comparing women with and without VF, those with fractures were older (71.9 [10] vs 61.8 [8,6], P<.001), had lower stature (152 [7.2] vs 155 [6.2], P=.01), lower total hip T-score values (-2.2 [0,9] vs -1.9 [0.8], P=.041), higher prevalence of non-VF (38 vs 30%, P=.04) and a higher prevalence of low serum 25(OH)D levels (69 vs 53%, P<.05). In logistic regression analysis, age and BMD at the total hip were independent predictors of VF. Patients over 65 presented a higher frequency of VF (47 vs 12%, P<.0001). In addition, a T-score lower than -2,5 at the total hip was associated with an increased risk of VF (OR 2.5; 95% CI 1.2-4.9). CONCLUSIONS Over the age of 65 nearly half of the postmenopausal women with osteoporosis have VF and a higher prevalence of low 25(OH)D serum measurements. Spinal X-ray and 25(OH)D serum measurements are especially indicated in this group of women since it influences the therapeutic approach.
Collapse
Affiliation(s)
- Dacia Cerdà
- Unidad de Reumatología, Servicio de Medicina Interna, Hospital General de Granollers, Barcelona, España.
| | | | | | | | | | | |
Collapse
|
20
|
Abstract
AIMS To describe the mechanisms of action of denosumab, a novel antiresorptive agent, contrasting it with other antiresorptive and anabolic osteoporosis treatments. METHODS Published papers related to the mechanism of action of approved osteoporosis treatments were sought through MEDLINE searches. FINDINGS Osteoporotic fractures carry a substantial burden of morbidity and mortality, but pharmacotherapy can prevent such fractures in high-risk individuals. Antiresorptive drugs (e.g. bisphosphonates, oestrogen, denosumab) reduce bone turnover by distinct mechanisms. Denosumab, a recently approved therapy, is a fully human monoclonal antibody that binds the cytokine RANKL (receptor activator of NFκB ligand), an essential factor initiating bone turnover. RANKL inhibition blocks osteoclast maturation, function and survival, thus reducing bone resorption. In contrast, bisphosphonates bind bone mineral, where they are absorbed by mature osteoclasts, inducing osteoclast apoptosis and suppressing resorption. These differences in mechanism influence both the onset and reversibility of treatment. DISCUSSION Effective pharmacotherapy is necessary for patients at high risk of fracture. Among the treatment options for postmenopausal osteoporosis, there are significant differences in mechanism and dosing. Denosumab acts by a novel mechanism and is administered twice yearly by subcutaneous injection. Identified by Osteoporosis Canada Clinical Practice Guidelines as a first-line agent for treatment of postmenopausal osteoporosis, denosumab represents an important addition to our treatment options.
Collapse
Affiliation(s)
- D A Hanley
- Departments of Medicine, Community Health Sciences and Oncology, University of Calgary, Calgary, AL, Canada.
| | | | | | | |
Collapse
|
21
|
Kennedy CC, Ioannidis G, Giangregorio LM, Adachi JD, Thabane L, Morin SN, Crilly RG, Marr S, Josse RG, Lohfeld L, Pickard LE, King S, van der Horst ML, Campbell G, Stroud J, Dolovich L, Sawka AM, Jain R, Nash L, Papaioannou A. An interdisciplinary knowledge translation intervention in long-term care: study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial. Implement Sci 2012; 7:48. [PMID: 22624776 PMCID: PMC3533817 DOI: 10.1186/1748-5908-7-48] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/24/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) research in long-term care (LTC) is still in its early stages. This protocol describes the evaluation of a multifaceted, interdisciplinary KT intervention aimed at integrating evidence-based osteoporosis and fracture prevention strategies into LTC care processes. METHODS AND DESIGN The Vitamin D and Osteoporosis Study (ViDOS) is underway in 40 LTC homes (n = 19 intervention, n = 21 control) across Ontario, Canada. The primary objectives of this study are to assess the feasibility of delivering the KT intervention, and clinically, to increase the percent of LTC residents prescribed ≥800 IU of vitamin D daily. Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician. The target audience within each LTC home is the Professional Advisory Committee (PAC), an interdisciplinary team who meets quarterly. The key elements of the intervention are three interactive educational sessions led by an expert opinion leader, action planning using a quality improvement cycle, audit and feedback reports, nominated internal champions, and reminders/point-of-care tools. Control homes do not receive any intervention, however both intervention and control homes received educational materials as part of the Ontario Osteoporosis Strategy. Primary outcomes are feasibility measures (recruitment, retention, attendance at educational sessions, action plan items identified and initiated, internal champions identified, performance reports provided and reviewed), and vitamin D (≥800 IU/daily) prescribing at 6 and 12 months. Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications, and falls and fractures. Qualitative methods will examine the experience of the LTC team with the KT intervention. Homes are centrally randomized to intervention and control groups in blocks of variable size using a computer generated allocation sequence. Randomization is stratified by home size and profit/nonprofit status. Prescribing data retrieval and analysis are performed by blinded personnel. DISCUSSION Our study will contribute to an improved understanding of the feasibility and acceptability of a multifaceted intervention aimed at translating knowledge to LTC practitioners. Lessons learned from this study will be valuable in guiding future research and understanding the complexities of translating knowledge in LTC.
Collapse
Affiliation(s)
- Courtney C Kennedy
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - George Ioannidis
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Charlton Medical Centre, 25 Charlton Ave East, Hamilton, Ontario, L8N 1Y2, Canada
| | - Lora M Giangregorio
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada
| | - Jonathan D Adachi
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Charlton Medical Centre, 25 Charlton Ave East, Hamilton, Ontario, L8N 1Y2, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - Suzanne N Morin
- Department of Medicine, Division of General Internal Medicine, MUHC-Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Richard G Crilly
- Schulich School of Medicine & Dentistry, The University of Western Ontario, Parkwood Hospital, 801 Commissioners Rd. East, London, Ontario, N6C 5J1, Canada
| | - Sharon Marr
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Robert G Josse
- Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lynne Lohfeld
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - Laura E Pickard
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Susanne King
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Mary-Lou van der Horst
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Glenda Campbell
- Medical Pharmacies Group Limited, 590 Granite Court, Pickering, Ontario, L1W 3X6, Canada
| | - Jackie Stroud
- Medical Pharmacies Group Limited, 590 Granite Court, Pickering, Ontario, L1W 3X6, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster Innovation Park, 175 Longwood Road South, Hamilton, Ontario, L8P 0A1, Canada
| | - Anna M Sawka
- Department of Medicine, Division of Endocrinology and Metabolism, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 1090 Don Mills Road, Suite 301, Toronto, Ontario, M3C 3R6, Canada
| | - Lynn Nash
- Department of Family Medicine, McMaster Innovation Park, 175 Longwood Road South, Hamilton, Ontario, L8P 0A1, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| |
Collapse
|
22
|
Cadarette SM, Carney G, Baek D, Gunraj N, Paterson JM, Dormuth CR. Osteoporosis medication prescribing in British Columbia and Ontario: impact of public drug coverage. Osteoporos Int 2012; 23:1475-80. [PMID: 21901476 PMCID: PMC3304053 DOI: 10.1007/s00198-011-1771-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 08/11/2011] [Indexed: 11/25/2022]
Abstract
UNLABELLED We compared the patterns of osteoporosis medication prescribing between two provinces in Canada with different public drug coverage policies. Oral bisphosphonates were the primary drugs used, yet access to the second-generation oral bisphosphonates (alendronate, risedronate) was limited in one region. Implications of differential access to oral bisphosphonates warrants further study. INTRODUCTION Approved therapies for treating osteoporosis in Canada include bisphosphonates, calcitonin, denosumab, raloxifene, and teriparatide. However, significant variation in access to these medications through public drug coverage exists across Canada. We sought to compare patterns of osteoporosis medication prescribing between British Columbia (BC) and Ontario. METHODS Using dispensing data from BC (PharmaNet) and Ontario (Ontario Drug Benefits), we identified all new users of osteoporosis medications aged 66 or more years from 1995/1996 to 2008/2009. We summarized the number of new users by fiscal year, sex, and index drug for each province. BC data were also stratified by whether drugs were dispensed within or outside public PharmaCare. RESULTS We identified 578,254 (n = 122,653 BC) eligible new users. Overall patterns were similar between provinces: (1) most patients received an oral bisphosphonate (93% in BC and 99% in Ontario); (2) etidronate prescribing declined after 2001/2002, reaching a low of 41% in BC and 10% in Ontario in 2008/2009; and (3) the proportion of males treated increased over time, from 7% in 1996/1997 to 25% in 2008/2009. However, we note major differences within versus outside the BC PharmaCare system. In particular, <2% of drugs dispensed within PharmaCare compared to 79% of drugs dispensed outside PharmaCare were for a second-generation bisphosphonate (alendronate or risedronate). CONCLUSIONS Oral bisphosphonates are the primary drugs used to treat osteoporosis in Canada. Prescribing practices changed over time as newer medications came to market, yet access to second-generation bisphosphonates through BC PharmaCare was limited. Implications of differential access to oral bisphosphonates warrants further study.
Collapse
Affiliation(s)
- S M Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, M5S 3M2, ON, Canada.
| | | | | | | | | | | |
Collapse
|
23
|
Jaglal SB, Donescu OS, Bansod V, Laprade J, Thorpe K, Hawker G, Majumdar SR, Meadows L, Cadarette SM, Papaioannou A, Kloseck M, Beaton D, Bogoch E, Zwarenstein M. Impact of a centralized osteoporosis coordinator on post-fracture osteoporosis management: a cluster randomized trial. Osteoporos Int 2012; 23:87-95. [PMID: 21779817 PMCID: PMC3249212 DOI: 10.1007/s00198-011-1726-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 06/01/2011] [Indexed: 11/30/2022]
Abstract
UNLABELLED We conducted a cluster randomized trial evaluating the effect of a centralized coordinator who identifies and follows up with fracture patients and their primary care physicians about osteoporosis. Compared with controls, intervention patients were five times more likely to receive BMD testing and two times more likely to receive appropriate management. INTRODUCTION To determine if a centralized coordinator who follows up with fracture patients and their primary care physicians by telephone and mail (intervention) will increase the proportion of patients who receive appropriate post-fracture osteoporosis management, compared to simple fall prevention advice (attention control). METHODS A cluster randomized controlled trial was conducted in small community hospitals in the province of Ontario, Canada. Hospitals that treated between 60 and 340 fracture patients per year were eligible. Patients 40 years and older presenting with a low trauma fracture were identified from Emergency Department records and enrolled in the trial. The primary outcome was 'appropriate' management, defined as a normal bone mineral density (BMD) test or taking osteoporosis medications. RESULTS Thirty-six hospitals were randomized to either intervention or control and 130 intervention and 137 control subjects completed the study. The mean age of participants was 65 ± 12 years and 69% were female. The intervention increased the proportion of patients who received appropriate management within 6 months of fracture; 45% in the intervention group compared with 26% in the control group (absolute difference of 19%; adjusted OR, 2.3; 95% CI, 1.3-4.1). The proportion who had a BMD test scheduled or performed was much higher with 57% of intervention patients compared with 21% of controls (absolute difference of 36%; adjusted OR, 4.8; 95% CI, 3.0-7.0). CONCLUSIONS A centralized osteoporosis coordinator is effective in improving the quality of osteoporosis care in smaller communities that do not have on-site coordinators or direct access to osteoporosis specialists.
Collapse
Affiliation(s)
- S B Jaglal
- Toronto Rehabilitation Institute, Toronto, ON, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Li-Yu J, Perez EC, Cañete A, Bonifacio L, Llamado LQ, Martinez R, Lanzon A, Sison M. Consensus statements on osteoporosis diagnosis, prevention, and management in the Philippines. Int J Rheum Dis 2011; 14:223-38. [PMID: 21816018 DOI: 10.1111/j.1756-185x.2011.01626.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The consensus statements were developed to assist healthcare practitioners in providing optimal care to postmenopausal individuals at risk for osteoporosis and fragility fractures in the local setting. METHODOLOGY The Technical Review Committee formed by the Osteoporosis Society of the Philippines Foundation Inc. in cooperation with the Philippine Orthopedic Association drafted, retrieved available published evidence, and appraised important issues on osteoporosis and fragility fractures. The Appraisal of Guidelines Research and Evaluation instrument was used to appraise published guidelines while a systematic way of validating the quality of evidence and the level of recommendation was done using the GRADE system. A multidisciplinary panel of experts and stakeholders in an en banc meeting conferred and approved the recommendations. RESULTS AND CONCLUSION There were five key issues on preventive, seven on diagnostic, nine on therapeutic aspects of osteoporosis with four other surgical concerns on fragility fractures. All were approved by a panel of stakeholders through a majority vote. These statements will best inform the clinicians and the specialists including orthopedic surgeons and general care practitioners on issues of postmenopausal Filipino women at risk for osteoporosis and fragility fractures.
Collapse
Affiliation(s)
- Julie Li-Yu
- Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Tebé C, del Río LM, Casas L, Estrada MD, Kotzeva A, Di Gregorio S, Espallargues M. [Risk factors for fragility fractures in a cohort of Spanish women]. GACETA SANITARIA 2011; 25:507-12. [PMID: 21955641 DOI: 10.1016/j.gaceta.2011.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 06/28/2011] [Accepted: 06/29/2011] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Fragility fractures are an important public health issue. The aim of this study was to analyze the association of the main osteoporotic risk factors related to fragility fracture in a cohort of women with an indication of bone densitometry (BD). METHODS A retrospective cohort was followed-up until a fragile fracture occurred, in a population of women aged 40 to 90 years with a first visit for BD between January 1992 and February 2008. We calculated the incidence rate of fracture per 1000 women-years of follow-up, and the hazard ratio (HR) of fragile fracture using a Cox regression model. RESULTS A total of 49,735 women were studied. The average age of participants was 57.8 years (SD: 8.5). Of these, 3631 women (7.1%) reported a new fragility fracture in post-baseline visits. Risk factors with higher adjusted HR were age ≥ 75 years compared with age < 55 years (HR: 3.8; 95% CI: 3.3-4.4) and having a BC result evaluated as osteoporosis compared to normal (HR: 2.0; 95% CI: 1.8-2.2). A personal history of humerus, hip or vertebral fractures had an adjusted HR of 1.2 (95% CI: 1.1-1.3). CONCLUSIONS The main risk factors for fragility fracture were advanced age, BD result and a personal history of fracture, although 74% of fractures were detected with a bone mineral density classified as normal or osteopenia. Other relevant factors were rheumatoid arthritis or having received prolonged corticosteroid therapy.
Collapse
Affiliation(s)
- Cristian Tebé
- Agència d'Informació, Avaluació i Qualitat en Salut (AIAQS), Barcelona, España.
| | | | | | | | | | | | | |
Collapse
|
26
|
Fortin M, Contant E, Savard C, Hudon C, Poitras ME, Almirall J. Canadian guidelines for clinical practice: an analysis of their quality and relevance to the care of adults with comorbidity. BMC FAMILY PRACTICE 2011; 12:74. [PMID: 21752267 PMCID: PMC3146414 DOI: 10.1186/1471-2296-12-74] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 07/13/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Clinical guidelines have been the subject of much criticism in primary care literature partly due to potential conflicts in their implementation among patients with multiple chronic conditions. We assessed the relevance of selected Canadian clinical guidelines on chronic diseases for patients with comorbidity and examined their quality. METHODS We selected 16 chronic medical conditions according to their frequency of occurrence, complexity of treatment, and pertinence to primary care. Recent Canadian clinical guidelines (2004 - 2009) on these conditions, published in English or French, were retrieved. We assessed guideline relevance to the care of patients with comorbidity with a tool developed by Boyd and colleagues. Quality was assessed using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. RESULTS Regarding relevance, 56.2% of guidelines addressed treatment for patients with multiple chronic conditions and 18.8% addressed the issue for older patients. Fifteen guidelines (93.8%) included specific recommendations for patients with one concurrent condition; only three guidelines (18.8%) addressed specific recommendations for patients with two comorbid conditions and one for more than two concurrent comorbid conditions. Quality of the evaluated guidelines was good to very good in four out of the six domains measured using the AGREE instrument. The domains with lower mean scores were Stakeholder Involvement and Applicability. CONCLUSIONS The quality of the Canadian guidelines examined is generally good, yet their relevance for patients with two or more chronic conditions is very limited and there is room for improvement in this respect.
Collapse
Affiliation(s)
- Martin Fortin
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Eric Contant
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Catherine Savard
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Catherine Hudon
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - José Almirall
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| |
Collapse
|
27
|
Abstract
Background—
Heart failure (HF) is associated with several factors that contribute to both reduced bone mineral density and increased risk of osteoporosis-related fractures. Our objectives were to describe the prevalence and predictors of the most common osteoporotic fracture, vertebral compression fractures (VCF), in patients with HF.
Methods and Results—
We conducted a cross-sectional study in a random sample of patients attending a tertiary care HF Clinic in Edmonton, Alberta, Canada. We collected sociodemographic, clinical, medication, and chest radiograph information. Primary outcome was board-certified radiologist–documented VCF on chest radiographs. Multivariable logistic regression was used to determine independent correlates of VCF. Overall, 623 patients with HF were included; 32% were over 75 years of age, 31% were women, 65% had ischemic cardiomyopathy, and 38% had atrial fibrillation. Prevalence of VCF was 77 of 623 (12%; 95% confidence interval, 10% to 15%), and 42 of 77 (55%) patients had multiple fractures. Only 15% of those with VCF were treated for osteoporosis. In multivariable analyses adjusted for age, female sex, weight, and medications, the only remaining predictors independently associated with fracture were atrial fibrillation (present in 42 of 77 [55%] of those with VCF versus 197 of 540 [36%] of those without; adjusted odds ratio, 2.1; 95% confidence interval, 1.2 to 3.6;
P
=0.009) and lipid-lowering drugs (used by 36 of 77 [47%] of those with VCF versus 342 of 540 [63%] of those without; adjusted odds ratio, 0.2; 95% confidence interval, 0.1 to 0.9;
P
=0.03).
Conclusions—
About one-tenth of HF patients had a chest radiograph–documented VCF, and half of those with VCF had multiple fractures; most (85%) were not receiving an osteoporosis-specific therapy. A previously unrecognized risk factor—atrial fibrillation—was found to be independently associated with VCF. Chest radiograph reports may represent an important case-finding tool for osteoporosis-specific VCF, particularly in HF patients with atrial fibrillation.
Collapse
|
28
|
Cox L, Kloseck M, Crilly R, McWilliam C, Diachun L. Underrepresentation of individuals 80 years of age and older in chronic disease clinical practice guidelines. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2011; 57:e263-9. [PMID: 21753085 PMCID: PMC3135465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To determine whether Canadian clinical practice guidelines (CPGs), and the evidence used to create CPGs, include individuals 80 years of age and older. DESIGN Descriptive analysis of 14 CPGs for 5 dominant chronic conditions (diabetes, hypertension, heart failure, osteoporosis, stroke) and descriptive analysis of all research-based references with human participants in the 14 guidelines. MAIN OUTCOME MEASURES To identify recommendations for individuals 65 years of age and older or 80 years of age and older and for those with multiple chronic conditions. RESULTS Although 12 of 14 guidelines provided specific recommendations for individuals 65 years of age and older, only 5 provided recommendations for frail older individuals (≥ 80 years). A total of 2559 studies were used as evidence to support the recommendations in the 14 CPGs; 2272 studies provided the mean age of participants, of which only 31 (1.4%) reported a mean age of 80 years of age and older. CONCLUSION There is very low representation of individuals in advanced old age in CPGs and in the studies upon which these guidelines are based, calling into question the applicability of current chronic disease CPGs to older individuals. The variety of medical and functional issues occurring in the elderly raises the concern of whether or not evidence-based disease-specific CPGs are appropriate for such a diverse population.
Collapse
Affiliation(s)
- Lizebeth Cox
- Faculty of Health Sciences, University of Western Ontario, Arthur and Sonia Labatt Health Sciences Bldg, Room 316, London, ON N6A 5B9.
| | | | | | | | | |
Collapse
|
29
|
Mutasingwa DR, Ge H, Upshur REG. How applicable are clinical practice guidelines to elderly patients with comorbidities? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2011; 57:e253-62. [PMID: 21753084 PMCID: PMC3135464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To examine the applicability of 10 common clinical practice guidelines (CPGs) to elderly patients with multiple comorbidities. DESIGN Content analysis of published Canadian CPGs for the following chronic diseases: diabetes, dyslipidemia, dementia, congestive heart failure, depression, osteoporosis, hypertension, gastroesophageal reflux disease, chronic obstructive pulmonary disease, and osteoarthritis. MAIN OUTCOME MEASURES Presence or absence of 4 key indicators of applicability of CPGs to elderly patients with multiple comorbidities. These indicators include any mention of older adults or people with comorbidities, time needed to treat to benefit in the context of life expectancy, and barriers to implementation of the CPG. RESULTS Out of the 10 CPGs reviewed, 7 mentioned treatment of the elderly, 8 mentioned people with comorbidities, 4 indicated the time needed to treat to benefit in the context of life expectancy, 5 discussed barriers to implementation, and 7 discussed the quality of evidence. CONCLUSION This study shows that although most CPGs discuss the elderly population, only a handful of them adequately address issues related to elderly patients with comorbidities. In order to make CPGs more patient centred rather than disease driven, guideline developers should include information on elderly patients with comorbidities.
Collapse
Affiliation(s)
- Donatus R Mutasingwa
- Public Health and Preventive Medicine program, Dalla Lana School of Public Health, University of Toronto, Ontario
| | | | | |
Collapse
|
30
|
Quesada Gómez JM, Blanch Rubió J, Díaz Curiel M, Díez Pérez A. Calcium citrate and vitamin D in the treatment of osteoporosis. Clin Drug Investig 2011; 31:285-98. [PMID: 21405146 DOI: 10.1007/bf03256927] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The combination of calcium with vitamin D (vitamin D(3) [colecalciferol]) forms the basis of preventive and therapeutic regimens for osteoporosis. A number of studies have suggested that the combination of calcium and vitamin D is effective when administered at respective dosages of at least 1200 mg and 800 IU per day, although efficacy is, as expected, affected by patient compliance. Overall, treatment with this combination appears to be effective in reducing the incidence of non-vertebral and hip fractures. Also, in all drug studies (of antiresorptive and anabolic agents and strontium ranelate) that demonstrated a reduction in risk of osteoporotic fractures, patients also took calcium and vitamin D supplements. An important finding in this regard is that vitamin D levels have been demonstrated to be inadequate in more than half of women treated for osteoporosis in the US and Europe. The capacity of the small intestine to absorb calcium salts depends on the solubility and ionization of the salts. These properties vary for different salts, with fasting calcium citrate absorption being greater than that of calcium lactogluconate and calcium carbonate. Calcium citrate formulations taken between meals may help to prevent abdominal distension and flatulence, as well as minimize the risk of renal calculus formation, thus helping to optimize patient compliance. Therefore, calcium citrate combined with vitamin D is the combination of choice for the prevention or treatment of osteoporosis.
Collapse
|
31
|
von Keyserlingk C, Hopkins R, Anastasilakis A, Toulis K, Goeree R, Tarride JE, Xie F. Clinical efficacy and safety of denosumab in postmenopausal women with low bone mineral density and osteoporosis: a meta-analysis. Semin Arthritis Rheum 2011; 41:178-86. [PMID: 21616520 DOI: 10.1016/j.semarthrit.2011.03.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/21/2011] [Accepted: 03/27/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Clinical trials indicate that denosumab could be a potential treatment for postmenopausal osteoporosis. The objective of this meta-analysis was to assess the clinical efficacy and safety of offering denosumab to postmenopausal women with low bone mass. METHODS Data sources included MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to February 3, 2010 and bibliographies of reviews. Randomized controlled trials comparing the efficacy and safety of denosumab to placebo for treatment of low bone mass (low bone mineral density or osteoporosis) in postmenopausal women were selected. Two reviewers independently abstracted data on study general characteristics and outcomes. Review Manager 5.0 software was used for data syntheses and meta-analysis. RESULTS The database search revealed 4 studies (comprising 8864 patients randomized) that met the inclusion criteria and contributed to some or all of the meta-analysis outcomes. Relative risk (95% CI) of fractures for the denosumab compared with placebo group was 0.58 (0.52 to 0.66); relative risk (95% CI) of serious adverse events was 1.33 (0.83 to 2.14); relative risk (95% CI) of serious adverse events related to infection was 2.10 (0.64 to 6.90); relative risk (95% CI) of neoplasm was 1.11 (0.91 to 1.36); relative risk (95% CI) of study discontinuation due to adverse events was 1.10 (0.83 to 1.47); and relative risk (95% CI) of death was 0.78 (0.57 to 1.06). Findings remained robust to sensitivity analyses. CONCLUSION Our analysis found a significant reduction in relative fracture risk in the denosumab compared with the placebo group.
Collapse
Affiliation(s)
- Camilla von Keyserlingk
- Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
32
|
Quesada Gómez JM, Rubió JB, Curiel MD, Pérez AD. Calcium Citrate and Vitamin D in the Treatment of Osteoporosis. Clin Drug Investig 2011. [DOI: 10.2165/11584940-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
33
|
Ko SS, Jordan VC. Treatment of osteoporosis and reduction in risk of invasive breast cancer in postmenopausal women with raloxifene. Expert Opin Pharmacother 2011; 12:657-74. [PMID: 21294695 DOI: 10.1517/14656566.2011.557360] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Raloxifene, a non-steroidal selective estrogen receptor modulator (SERM), offers a new dimension for the treatment and prevention of osteoporosis and risk reduction of invasive breast cancer in postmenopausal populations at high risk. Both osteoporosis and breast cancer are important public health issues for postmenopausal women. It is well known that estrogen and estrogen receptors play an important role in the pathogenesis of both diseases. Initially, hormone replacement therapy (HRT) was used for the purpose of preventing and treating postmenopausal osteoporosis. However, HRT significantly contributed to an increase in breast cancer risk. The SERM, raloxifene, is used for the prevention and for the treatment of postmenopausal osteoporosis and reducing the risk of invasive breast cancer in postmenopausal women. AREAS COVERED This article reviews the emerging evidence of the efficacy of raloxifene in postmenopausal women, summarizes the results and places in perspective their therapeutic uses for women having either a high risk of osteoporosis or breast cancer. Emerging clinical evidence suggests bisphosphonates, currently used as drugs for the treatment of osteoporosis, may also reduce breast cancer risk. The status of other SERMs and bisphosphonates are included for completeness. A Medline search of raloxifene, osteoporosis, breast cancer and SERMs was used to derive a database of 355 references. EXPERT OPINION Readers will understand the value of raloxifene to prevent osteoporosis and breast cancer in postmenopausal women. Although most women do not require pharmacotherapy for menopausal symptoms, many are severely affected by osteoporosis or breast cancer at and beyond menopause and, for such women, pharmacologic intervention is important if they are to retain an acceptable quality of life. It is reasonable to use raloxifene or bisphosphonate as an appropriate drug that targets symptom-free postmenopausal women for treatment and prevention of osteoporosis but raloxifene is proven to reduce the incidence of invasive breast cancer.
Collapse
Affiliation(s)
- Seung Sang Ko
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Department of Oncology, 3970 Reservoir Rd. N.W., Washington, DC 20057, USA
| | | |
Collapse
|
34
|
Byszewski A, Lemay G, Molnar F, Azad N, McMartin SE. Closing the osteoporosis care gap in hip fracture patients: an opportunity to decrease recurrent fractures and hospital admissions. J Osteoporos 2011; 2011:404969. [PMID: 21977330 PMCID: PMC3184412 DOI: 10.4061/2011/404969] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 07/03/2011] [Accepted: 07/04/2011] [Indexed: 11/26/2022] Open
Abstract
Background. Falls and hip fractures are an increasing health threat to older people who often never return to independent living. This study examines the management of bone health in an acute care setting following a hip fracture in patients over age 65. Methods. Retrospective chart review of all patients admitted to a tertiary health facility who suffered a recent hip fracture. Results. 420 charts of patients admitted over the course of a year (May 1, 2007-April 31, 2008) were reviewed. Thirty-seven percent of patients were supplemented with calcium on discharge, and 36% were supplemented with vitamin D on discharge. Thirty-one percent were discharged on a bisphosphonate. Conclusion. A significant care gap still exists in how osteoporosis is addressed despite guidelines on optimal management. A call to action is required by use of multifaceted approaches to bridge the gap, ensuring that fracture risk is minimized for the aging population.
Collapse
Affiliation(s)
- Anna Byszewski
- The Geriatric Assessment Unit, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON, Canada K1Y 4E9,Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5,*Anna Byszewski:
| | - Genevieve Lemay
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
| | - Frank Molnar
- The Geriatric Assessment Unit, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON, Canada K1Y 4E9,Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
| | - Nahid Azad
- The Geriatric Assessment Unit, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON, Canada K1Y 4E9,Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
| | - Seanna E. McMartin
- School of Public Health, University of Alberta, 3-50 University Terrace, 112 Street Edmonton, AB, Canada T6G 2T4
| |
Collapse
|
35
|
Kastner M, Lottridge D, Marquez C, Newton D, Straus SE. Usability evaluation of a clinical decision support tool for osteoporosis disease management. Implement Sci 2010; 5:96. [PMID: 21143978 PMCID: PMC3016442 DOI: 10.1186/1748-5908-5-96] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 12/10/2010] [Indexed: 01/06/2023] Open
Abstract
Background Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines are available, patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions and a series of focus groups were used to develop a functional multifaceted tool that can support clinical decision-making in osteoporosis disease management at the point of care. The objective of our study was to assess how well the prototype met functional goals and usability needs. Methods We conducted a usability study for each component of the tool--the Best Practice Recommendation Prompt (BestPROMPT), the Risk Assessment Questionnaire (RAQ), and the Customised Osteoporosis Education (COPE) sheet--using the framework described by Kushniruk and Patel. All studies consisted of one-on-one sessions with a moderator using a standardised worksheet. Sessions were audio- and video-taped and transcribed verbatim. Data analysis consisted of a combination of qualitative and quantitative analyses. Results In study 1, physicians liked that the BestPROMPT can provide customised recommendations based on risk factors identified from the RAQ. Barriers included lack of time to use the tool, the need to alter clinic workflow to enable point-of-care use, and that the tool may disrupt the real reason for the visit. In study 2, patients completed the RAQ in a mean of 6 minutes, 35 seconds. Of the 42 critical incidents, 60% were navigational and most occurred when the first nine participants were using the stylus pen; no critical incidents were observed with the last six participants that used the touch screen. Patients thought that the RAQ questions were easy to read and understand, but they found it difficult to initiate the questionnaire. Suggestions for improvement included improving aspects of the interface and navigation. The results of study 3 showed that most patients were able to understand and describe sections of the COPE sheet, and all considered discussing the information with their physicians. Suggestions for improvement included simplifying the language and improving the layout. Conclusions Findings from the three studies informed changes to the tool and confirmed the importance of usability testing on all end users to reduce errors, and as an important step in the development process of knowledge translation interventions.
Collapse
Affiliation(s)
- Monika Kastner
- Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | |
Collapse
|
36
|
Yuksel N, Gunther M. Hormonothérapie bio-identique: synthèse pratique à l'intention des pharmaciens. Can Pharm J (Ott) 2010. [DOI: 10.3821/1913-701x-143.sp2.s17a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
37
|
McKague M, Jorgenson D, Buxton KA. Ocular side effects of bisphosphonates: A case report and literature review. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2010; 56:1015-1017. [PMID: 20944044 PMCID: PMC2954081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Meredith McKague
- University of Saskatchewan, Department of Academic Family Medicine, West Winds Primary Health Centre, Saskatoon, SK S7M 3Y5.
| | | | | |
Collapse
|
38
|
Laliberté MC, Perreault S, Dragomir A, Goudreau J, Rodrigues I, Blais L, Damestoy N, Corbeil D, Lalonde L. Impact of a primary care physician workshop on osteoporosis medical practices. Osteoporos Int 2010; 21:1471-85. [PMID: 19937428 DOI: 10.1007/s00198-009-1116-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Accepted: 09/22/2009] [Indexed: 01/06/2023]
Abstract
SUMMARY Attendance at a fragility-fractures-prevention workshop by primary care physicians was associated with higher rates of osteoporosis screening and treatment initiation in elderly female patients and higher rates of treatment initiation in high-risk male and female patients. However, osteoporosis management remained sub-optimal, particularly in men. INTRODUCTION Rates of osteoporosis-related medical practices of primary care physicians exposed to a fragility-fractures-prevention workshop were compared with those of unexposed physicians. METHODS In a cluster cohort study, 26 physicians exposed to a workshop were matched with 260 unexposed physicians by sex and year of graduation. For each physician, rates of bone mineral density (BMD) testing and osteoporosis treatment initiation among his/her elderly patients 1 year following the workshop were computed. Rates were compared using multilevel logistic regression models controlling for potential patient- and physician-level confounders. RESULTS Twenty-five exposed physicians (1,124 patients) and 209 unexposed physicians (9,663 patients) followed at least one eligible patient. In women, followed by exposed physicians, higher rates of BMD testing [8.5% versus 4.2%, adjusted OR (aOR) = 2.81, 95% CI 1.60-4.94] and treatment initiation with bone-specific drugs (BSDs; 4.8% vs. 2.4%, aOR = 1.95, 1.06-3.60) were observed. In men, no differences were detected. In patients on long-term glucocorticoid therapy or with a previous osteoporotic fracture, higher rates of treatment initiation with BSDs were observed in women (12.0% vs. 1.9%, aOR = 7.38, 1.55-35.26), and men were more likely to initiate calcium/vitamin D (5.3% vs. 0.8%, aOR = 7.14, 1.16-44.06). CONCLUSIONS Attendance at a primary care physician workshop was associated with higher rates of osteoporosis medical practices for elderly women and high-risk men and women. However, osteoporosis detection and treatment remained sub-optimal, particularly in men.
Collapse
Affiliation(s)
- M-C Laliberté
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Crilly RG, Hillier LM, Mason M, Gutmanis I, Cox L. Prevention of hip fractures in long-term care: relevance of community-derived data. J Am Geriatr Soc 2010; 58:738-45. [PMID: 20345863 DOI: 10.1111/j.1532-5415.2010.02766.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Osteoporosis and falling are two major contributing factors to fractures in older persons; the relevant contribution of these may vary according to age, setting, and frailty. The purpose of this review was to examine the existing evidence on osteoporosis treatments to determine whether participants in clinical trials include or resemble the older and frailer adult population living in long-term care (LTC). The trials (N=50) used to support major Canadian guidelines for osteoporosis treatment were reviewed because these are used to recommend treatment for all older adults, and several more-recent studies were added. Trials conducted specifically with participants living in LTC were also reviewed (N=6). The majority of studies (96.0%) on osteoporosis treatments were conducted with community-dwelling participants, with many excluding participants resembling the LTC population. Mean ages ranged from 52 to 84, although for the majority of studies, the mean age was younger than 70. Similarly, 80.0% of studies conducted in LTC included only residents who were ambulatory, mobile, able to transfer independently, or not permanently bedridden. Mean ages in these studies ranged from 83 to 85. These findings suggest that frail older adults, particularly the oldest and frailest adults in LTC, are neglected in clinical trials of osteoporosis fracture prevention. There is little evidence to support the application of community-based guidelines to the LTC population, and studies directly involving this population are needed. The role of age, frailty, and the mechanics of falls in hip fracture are discussed.
Collapse
Affiliation(s)
- Richard G Crilly
- Specialized Geriatric Services, St. Joseph's Health Care London, Ontario, Canada.
| | | | | | | | | |
Collapse
|
40
|
Clinical utility of vitamin d testing: an evidence-based analysis. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2010; 10:1-93. [PMID: 23074397 PMCID: PMC3377517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED This report from the Medical Advisory Secretariat (MAS) was intended to evaluate the clinical utility of vitamin D testing in average risk Canadians and in those with kidney disease. As a separate analysis, this report also includes a systematic literature review of the prevalence of vitamin D deficiency in these two subgroups.This evaluation did not set out to determine the serum vitamin D thresholds that might apply to non-bone health outcomes. For bone health outcomes, no high or moderate quality evidence could be found to support a target serum level above 50 nmol/L. Similarly, no high or moderate quality evidence could be found to support vitamin D's effects in non-bone health outcomes, other than falls. VITAMIN D: Vitamin D is a lipid soluble vitamin that acts as a hormone. It stimulates intestinal calcium absorption and is important in maintaining adequate phosphate levels for bone mineralization, bone growth, and remodelling. It's also believed to be involved in the regulation of cell growth proliferation and apoptosis (programmed cell death), as well as modulation of the immune system and other functions. Alone or in combination with calcium, Vitamin D has also been shown to reduce the risk of fractures in elderly men (≥ 65 years), postmenopausal women, and the risk of falls in community-dwelling seniors. However, in a comprehensive systematic review, inconsistent results were found concerning the effects of vitamin D in conditions such as cancer, all-cause mortality, and cardiovascular disease. In fact, no high or moderate quality evidence could be found concerning the effects of vitamin D in such non-bone health outcomes. Given the uncertainties surrounding the effects of vitamin D in non-bone health related outcomes, it was decided that this evaluation should focus on falls and the effects of vitamin D in bone health and exclusively within average-risk individuals and patients with kidney disease. Synthesis of vitamin D occurs naturally in the skin through exposure to ultraviolet B (UVB) radiation from sunlight, but it can also be obtained from dietary sources including fortified foods, and supplements. Foods rich in vitamin D include fatty fish, egg yolks, fish liver oil, and some types of mushrooms. Since it is usually difficult to obtain sufficient vitamin D from non-fortified foods, either due to low content or infrequent use, most vitamin D is obtained from fortified foods, exposure to sunlight, and supplements. CLINICAL NEED CONDITION AND TARGET POPULATION Vitamin D deficiency may lead to rickets in infants and osteomalacia in adults. Factors believed to be associated with vitamin D deficiency include: darker skin pigmentation,winter season,living at higher latitudes,skin coverage,kidney disease,malabsorption syndromes such as Crohn's disease, cystic fibrosis, andgenetic factors.Patients with chronic kidney disease (CKD) are at a higher risk of vitamin D deficiency due to either renal losses or decreased synthesis of 1,25-dihydroxyvitamin D. Health Canada currently recommends that, until the daily recommended intakes (DRI) for vitamin D are updated, Canada's Food Guide (Eating Well with Canada's Food Guide) should be followed with respect to vitamin D intake. Issued in 2007, the Guide recommends that Canadians consume two cups (500 ml) of fortified milk or fortified soy beverages daily in order to obtain a daily intake of 200 IU. In addition, men and women over the age of 50 should take 400 IU of vitamin D supplements daily. Additional recommendations were made for breastfed infants. A Canadian survey evaluated the median vitamin D intake derived from diet alone (excluding supplements) among 35,000 Canadians, 10,900 of which were from Ontario. Among Ontarian males ages 9 and up, the median daily dietary vitamin D intake ranged between 196 IU and 272 IU per day. Among females, it varied from 152 IU to 196 IU per day. In boys and girls ages 1 to 3, the median daily dietary vitamin D intake was 248 IU, while among those 4 to 8 years it was 224 IU. VITAMIN D TESTING: Two laboratory tests for vitamin D are available, 25-hydroxy vitamin D, referred to as 25(OH)D, and 1,25-dihydroxyvitamin D. Vitamin D status is assessed by measuring the serum 25(OH)D levels, which can be assayed using radioimmunoassays, competitive protein-binding assays (CPBA), high pressure liquid chromatography (HPLC), and liquid chromatography-tandem mass spectrometry (LC-MS/MS). These may yield different results with inter-assay variation reaching up to 25% (at lower serum levels) and intra-assay variation reaching 10%. The optimal serum concentration of vitamin D has not been established and it may change across different stages of life. Similarly, there is currently no consensus on target serum vitamin D levels. There does, however, appear to be a consensus on the definition of vitamin D deficiency at 25(OH)D < 25 nmol/l, which is based on the risk of diseases such as rickets and osteomalacia. Higher target serum levels have also been proposed based on subclinical endpoints such as parathyroid hormone (PTH). Therefore, in this report, two conservative target serum levels have been adopted, 25 nmol/L (based on the risk of rickets and osteomalacia), and 40 to 50 nmol/L (based on vitamin D's interaction with PTH). ONTARIO CONTEXT: VOLUME #ENTITYSTARTX00026; COST: The volume of vitamin D tests done in Ontario has been increasing over the past 5 years with a steep increase of 169,000 tests in 2007 to more than 393,400 tests in 2008. The number of tests continues to rise with the projected number of tests for 2009 exceeding 731,000. According to the Ontario Schedule of Benefits, the billing cost of each test is $51.7 for 25(OH)D (L606, 100 LMS units, $0.517/unit) and $77.6 for 1,25-dihydroxyvitamin D (L605, 150 LMS units, $0.517/unit). Province wide, the total annual cost of vitamin D testing has increased from approximately $1.7M in 2004 to over $21.0M in 2008. The projected annual cost for 2009 is approximately $38.8M. EVIDENCE-BASED ANALYSIS: The objective of this report is to evaluate the clinical utility of vitamin D testing in the average risk population and in those with kidney disease. As a separate analysis, the report also sought to evaluate the prevalence of vitamin D deficiency in Canada. The specific research questions addressed were thus: What is the clinical utility of vitamin D testing in the average risk population and in subjects with kidney disease?What is the prevalence of vitamin D deficiency in the average risk population in Canada?What is the prevalence of vitamin D deficiency in patients with kidney disease in Canada?Clinical utility was defined as the ability to improve bone health outcomes with the focus on the average risk population (excluding those with osteoporosis) and patients with kidney disease. LITERATURE SEARCH A literature search was performed on July 17th, 2009 using OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA) for studies published from January 1, 1998 until July 17th, 2009. Abstracts were reviewed by a single reviewer and, for those studies meeting the eligibility criteria, full-text articles were obtained. Reference lists were also examined for any additional relevant studies not identified through the search. Articles with unknown eligibility were reviewed with a second clinical epidemiologist, then a group of epidemiologists until consensus was established. The quality of evidence was assessed as high, moderate, low or very low according to GRADE methodology. Observational studies that evaluated the prevalence of vitamin D deficiency in Canada in the population of interest were included based on the inclusion and exclusion criteria listed below. The baseline values were used in this report in the case of interventional studies that evaluated the effect of vitamin D intake on serum levels. Studies published in grey literature were included if no studies published in the peer-reviewed literature were identified for specific outcomes or subgroups. Considering that vitamin D status may be affected by factors such as latitude, sun exposure, food fortification, among others, the search focused on prevalence studies published in Canada. In cases where no Canadian prevalence studies were identified, the decision was made to include studies from the United States, given the similar policies in vitamin D food fortification and recommended daily intake. INCLUSION CRITERIA Studies published in EnglishPublications that reported the prevalence of vitamin D deficiency in CanadaStudies that included subjects from the general population or with kidney diseaseStudies in children or adultsStudies published between January 1998 and July 17(th) 2009 EXCLUSION CRITERIA: Studies that included subjects defined according to a specific disease other than kidney diseaseLetters, comments, and editorialsStudies that measured the serum vitamin D levels but did not report the percentage of subjects with serum levels below a given threshold OUTCOMES OF INTEREST Prevalence of serum vitamin D less than 25 nmol/LPrevalence of serum vitamin D less than 40 to 50 nmol/LSerum 25-hydroxyvitamin D was the metabolite used to assess vitamin D status. Results from adult and children studies were reported separately. Subgroup analyses according to factors that affect serum vitamin D levels (e.g., seasonal effects, skin pigmentation, and vitamin D intake) were reported if enough information was provided in the studies QUALITY OF EVIDENCE The quality of the prevalence studies was based on the method of subject recruitment and sampling, possibility of selection bias, and generalizability to the source population. The overall quality of the trials was examined according to the GRADE Working Group criteria. (ABSTRACT TRUNCATED)
Collapse
|
41
|
Sheehy O, Kindundu C, Barbeau M, LeLorier J. Adherence to weekly oral bisphosphonate therapy: cost of wasted drugs and fractures. Osteoporos Int 2009; 20:1583-94. [PMID: 19153677 DOI: 10.1007/s00198-008-0829-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 11/17/2008] [Indexed: 10/21/2022]
Abstract
UNLABELLED In an observational cohort of patients treated with biphosphonates (BP), we observed that poor adherence to these drugs causes important expenditures in terms of avoidable fractures. Of particular interest are the amounts of money wasted by patients who did not take their BPs long enough to obtain a clinical benefit. INTRODUCTION A large proportion of patients initiated with oral weekly BP therapy stop their treatment within the first year. The objective of this study was to estimate the impact of the poor adherence to BPs in terms of drug wasted and avoidable fractures. METHODS The study was done on primary and secondary prevention cohorts from the Régie de l'assurance maladie du Québec (Québec). The concept of the "point of visual divergence" was used to determine the amount of wasted drug. The risk of fracture was estimated using Cox regression models. The hazard ratios of compliant patients (+80%) versus non compliant patients were used to estimate the number of fractures saved. RESULTS The cost of wasted drugs was $25.87 per patient initiated in the primary prevention cohort and $30.52 in the secondary prevention cohort. If all patients had been compliant, 110 fractures would have been avoided in the primary prevention cohort and 19 fractures in the secondary prevention cohort. The cost of these avoidable fractures per patient initiated on BP therapy was $62.95 in primary prevention cohort and $330.84 in secondary prevention cohort. CONCLUSIONS This study confirms that poor adherence to oral BPs leads to a significant waste of money and avoidable fractures.
Collapse
Affiliation(s)
- O Sheehy
- Pharmacoeconomics and Pharmacoepidemiology, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
| | | | | | | |
Collapse
|
42
|
Whelan AM, Jurgens TM, Bowles SK, Doyle H. Efficacy of natural health products in treating osteoporosis: what is the quality of internet patient advice? Ann Pharmacother 2009; 43:899-907. [PMID: 19417114 DOI: 10.1345/aph.1l688] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND With Canadians increasing their use of the Internet to find health-related information, especially regarding natural health products (NHPs), there is a need for high-quality, evidence-based information on Web sites to aid consumers in making informed decisions regarding the appropriate and safe use of NHPs. OBJECTIVE To determine the quality of Web sites that target consumers and advocate the use of NHPs in the management of osteoporosis in postmenopausal women. METHODS Web sites were identified via the Google search engine using the key words "natural treatment osteoporosis." The first pages of the first 91 Web sites identified were assessed for relevance based on the following criteria: (1) written in English, (2) contained consumer information, and (3) claimed a benefit of a single NHP in the management of osteoporosis. This task was completed by 2 investigators; differences were resolved by consensus after discussion with the third investigator. Quality of relevant sites was assessed using an expanded DISCERN instrument that also examined the evidence supporting the claim of benefit. Additionally, readability of the sites was assessed. RESULTS Thirty-eight Web sites met the inclusion criteria. Using the DISCERN instrument, we found that many of the sites scored low, suggesting serious or extensive shortcomings. On many Web sites, benefit claims regarding calcium, vitamin D, phytoestrogens, dehydroepiandrosterone and vitamin K were consistent with empirical evidence. However, for other NHPs, many of these same sites made effectiveness claims that were not supported by current evidence from randomized controlled trials. Twenty-five sites did not provide information as to what resources were used to support their claims. The average reading grade score was grade 11.9 (based on US school grades) and the mean Flesch Reading Ease Score was 41.7. (A higher score out of 100 indicates ease of reading.) CONCLUSIONS Due to the poor quality and content from unknown sources found on some Web sites, consumers who access Web sites for information regarding the use of NHPs in osteoporosis should do so cautiously and discuss results with their healthcare providers.
Collapse
Affiliation(s)
- Anne Marie Whelan
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada.
| | | | | | | |
Collapse
|
43
|
Towards a Healthier Lifestyle. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009. [DOI: 10.1016/s1701-2163(16)34070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
44
|
|
45
|
Cheng N, Green ME. Osteoporosis screening for men: are family physicians following the guidelines? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2008; 54:1140-1141, 1141.e1-5. [PMID: 18697977 PMCID: PMC2515229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To determine rates of screening for osteoporosis among men older than 65 years and to find out whether family physicians are following the recommendations of the Osteoporosis Society of Canada's 2002 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada. DESIGN Chart audit. SETTING The Family Medicine Centre at Hotel Dieu Hospital in Kingston, Ont. PARTICIPANTS All male patients at the Family Medicine Centre older than 65 years for a total of 565 patients associated with 20 different physicians' practices. MAIN OUTCOME MEASURES Rates of screening with bone mineral density (BMD) scans for osteoporosis, results of BMD testing, and associations between results of BMD testing and age. RESULTS Of the 565 patients reviewed, 108 (19.1% of the study population) had received BMD testing. Rates of screening ranged from 0% to 38% in the 20 practices. Among 105 patients tested (reports for 3 patients were not retrievable), 15 (14.3%) were found to have osteoporosis, 43 (41.0%) to have osteopenia, and 47 (44.8%) to have normal BMD results. No significant association was found between BMD results and age. Screening rates were higher among men older than 75 years than among men aged 65 to 75 and peaked among those 85 to 89 years old. CONCLUSION On average, only about 20% of male patients older than 65 years had been screened for osteoporosis, so most of these men were not being screened by BMD testing as recommended in the guidelines. Considering the relatively high rates of osteoporosis and osteopenia found in this study and the known morbidity and mortality associated with osteoporotic fractures in this population, higher rates of BMD screening and more widespread treatment of osteoporosis could prevent many fractures among these patients. Family physicians need to become more aware of the risk factors indicating screening, and barriers to screening and treatment of osteoporosis in men need to be identified and addressed.
Collapse
Affiliation(s)
- Natalie Cheng
- Enhanced Rural Skills, Queen's University in Kingston, Ontario, Canada
| | | |
Collapse
|
46
|
Liao X. Application of consensus methods in making clinical practice guidelines of traditional medicine. ACTA ACUST UNITED AC 2008; 6:555-60. [DOI: 10.3736/jcim20080602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
47
|
Lee WL, Chao HT, Cheng MH, Wang PH. Rationale for using raloxifene to prevent both osteoporosis and breast cancer in postmenopausal women. Maturitas 2008; 60:92-107. [PMID: 18534794 DOI: 10.1016/j.maturitas.2008.04.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 04/05/2008] [Accepted: 04/14/2008] [Indexed: 11/27/2022]
Abstract
Both osteoporosis with fracture and breast cancer are important health issues for postmenopausal women. It is well known that estrogen and estrogen receptors (ERs) play an important role in the pathogenesis of both diseases. In past decades, hormone therapy (HT), mainly estrogen plus progestin (EPT), has been frequently used for the purpose of preventing and treating postmenopausal osteoporosis because of its efficacy, but it also contributes to a significant increase in breast cancer. Currently, there is a dilemma regarding the use of estrogen for postmenopausal women. Fortunately, an increasing understanding of the action of estrogen has led ultimately to the design of new drugs that work by virtue of their interaction with the ER; these drugs have come to be known as selective estrogen receptor modulators (SERMs), and are not only effective in preventing osteoporosis and managing those with osteoporosis, but also in decreasing the incidence of breast cancer. Among these SERMs, raloxifene may be the most attractive agent based on the evidence from five recent large trials (Multiple Outcomes of Raloxifene Evaluation [MORE], Continuing Outcomes Relevant to Evista [CORE], Raloxifene Use for the Heart [RUTH], Study of Tamoxifen and Raloxifene [STAR], and Evista Versus Alendronate [EVA]). The former three trials showed that raloxifene not only decreases the incidence of osteoporosis-associated fractures, but also has efficacy in breast cancer prevention. The head-to-head comparison with the anti-fracture agent alendronate (EVA trial) and the chemoprevention agent tamoxifen (STAR trial) further confirmed that raloxifene is a better choice. We concluded that since there is an absence of a therapeutic effect on relieving climacteric symptoms and there is the presence of a potential risk of thromboembolism in the use of raloxifene, this drug can be prescribed for clear indications, such as the management of osteoporosis, the prevention of fracture, and decreasing the incidence of invasive breast cancer, with careful monitoring for thromboembolism. It is reasonable to use raloxifene as an appropriate medicine that targets climacteric symptom-free postmenopausal women because of its overall favorable risk-benefit safety profile using the global index proposed by the Women's Health Initiation (WHI).
Collapse
Affiliation(s)
- Wen-Ling Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Chen Hsin Rehabilitation Center-Taipei, Taiwan
| | | | | | | |
Collapse
|
48
|
The Role of Selective Estrogen Receptor Modulators on Breast Cancer: From Tamoxifen to Raloxifene. Taiwan J Obstet Gynecol 2008; 47:24-31. [DOI: 10.1016/s1028-4559(08)60051-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
49
|
Grenier S. Vitamin D: Two indications for the price of one? Can Pharm J (Ott) 2007. [DOI: 10.3821/1913-701x(2007)140[390:vdtift]2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
50
|
Affiliation(s)
- Helen Roberts
- Department of Obstetrics and Gynaecology, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| |
Collapse
|