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Konno S, Uchi T, Kihara H, Sugimoto H. Long-Term Bone Density Changes and Fracture Risk in Myasthenia Gravis: Implications for FRAX ® Tool Application. Healthcare (Basel) 2024; 12:1793. [PMID: 39273817 PMCID: PMC11394809 DOI: 10.3390/healthcare12171793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/27/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
Myasthenia gravis (MG) patients often require long-term glucocorticoid therapy, which may affect bone health. This study aimed to assess long-term changes in bone mineral density (BMD), evaluate osteoporotic fracture incidence, and examine the relationship between MG-specific factors and bone health outcomes over a 10-year period. This single-center, prospective cohort study included 28 MG patients. BMD, T-scores, Z-scores, and bone turnover markers were measured at baseline. FRAX® scores were calculated and adjusted for glucocorticoid dose. Fracture occurrence was monitored for over 10 years. Five (17.9%) patients experienced major osteoporotic fractures during follow-up. The fracture group had significantly lower baseline BMD and T-scores than the no-fracture group. Baseline FRAX® scores for major osteoporotic fracture risk were significantly higher in the fracture group (median 19.0% vs. 5.7%, p = 0.001). The fracture group progressed from osteopenia at baseline to osteoporosis by the end of this study. This study highlights the importance of early and regular bone health assessments in MG patients, particularly those receiving long-term glucocorticoid therapy. The FRAX® tool may be valuable for fracture risk stratification in this population. These findings can inform clinical practice and improve long-term management strategies for MG patients who are at risk of osteoporotic fractures.
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Affiliation(s)
- Shingo Konno
- Department of Neurology, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan
| | - Takafumi Uchi
- Department of Neurology, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan
| | - Hideo Kihara
- Department of Neurology, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan
| | - Hideki Sugimoto
- Department of Neurology, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan
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Gregori G, Johansson L, Axelsson KF, Jaiswal R, Litsne H, Larsson BAM, Lorentzon M. The role of different physical function tests for the prediction of fracture risk in older women. J Cachexia Sarcopenia Muscle 2024; 15:1511-1519. [PMID: 38894558 PMCID: PMC11294044 DOI: 10.1002/jcsm.13508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/14/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Physical function is an important risk factor for fracture. Previous studies found that different physical tests (e.g., one-leg standing [OLS] and timed up and go [TUG]) predict fracture risk. This study aimed to determine which physical function test is the most optimal independent predictor of fracture risk, together with clinical risk factors (CRFs) used in fracture risk assessment (FRAX) and bone mineral density (BMD). METHODS In total, 2321 women out of the included 3028 older women, aged 77.7 ± 1.6 (mean ± SD), in the Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone Fractures study had complete data on all physical function tests and were included in the analysis. At baseline, hand grip strength, OLS, TUG, walking speed and chair stand tests were performed. All incident fractures were confirmed by X-ray or review of medical records and subsequently categorized as major osteoporotic fractures (MOFs), hip fractures and any fracture. Multivariate Cox regression (hazard ratios [HRs] and 95% confidence intervals [CIs]) analyses were performed with adjustments for age, body mass index (BMI), FRAX CRFs, femoral neck BMD and all physical function tests as predictors both individually and simultaneously. Receiver operating characteristic (ROC) analyses and Fine and Gray analyses were also performed to investigate associations between physical function and incident fractures. RESULTS OLS was the only physical function test to be significantly and independently associated with increased risk of any fracture (HR 1.13 [1.04-1.23]), MOF (HR 1.15 [1.04-1.26]) and hip fracture (HR 1.34 [1.11-1.62]). Adjusting for age, BMI, CRFs and femoral neck BMD did not materially alter these associations. ROC analysis for OLS, together with age, BMI, femoral neck BMD and CRFs, yielded area under the curve values of 0.642, 0.647 and 0.732 for any fracture, MOF and hip fracture, respectively. In analyses considering the competing risk of death, OLS was the only physical function test consistently associated with fracture outcomes (subhazard ratio [SHR] 1.10 [1.01-1.19] for any fracture, SHR 1.11 [1.00-1.22] for MOF and SHR 1.25 [1.03-1.50] for hip fracture). Walking speed was only independently associated with the risk of hip fracture in all Cox regression models and in the Fine and Gray analyses. CONCLUSIONS Among the five physical function tests, OLS was independently associated with all fracture outcomes, even after considering the competing risk of death, indicating that OLS is the most reliable physical function test for predicting fracture risk in older women.
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Affiliation(s)
- Giulia Gregori
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of MedicineUniversity of GothenburgGothenburgSweden
| | - Lisa Johansson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of MedicineUniversity of GothenburgGothenburgSweden
- Department of OrthopedicsSahlgrenska University HospitalMölndalSweden
| | - Kristian F. Axelsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of MedicineUniversity of GothenburgGothenburgSweden
- Region Västra GötalandNärhälsan Norrmalm Health CentreSkövdeSweden
| | - Raju Jaiswal
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of MedicineUniversity of GothenburgGothenburgSweden
| | - Henrik Litsne
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of MedicineUniversity of GothenburgGothenburgSweden
| | - Berit A. M. Larsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of MedicineUniversity of GothenburgGothenburgSweden
- Region Västra GötalandNärhälsan Sisjön Health CentreSisjönSweden
| | - Mattias Lorentzon
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of MedicineUniversity of GothenburgGothenburgSweden
- Region Västra Götaland, Sahlgrenska University Hospital MölndalSahlgrenska Academy, Sahlgrenska University HospitalMölndalSweden
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Sagelv EH, Emaus N, Evensen E, Christoffersen T, Dennison E, Furberg AS, Grimnes G, Johansson J, Nielsen CS, Nilsen OA, Winther A. Acquisition of peak bone mass in a Norwegian youth cohort: longitudinal findings from the Fit Futures study 2010-2022. Arch Osteoporos 2024; 19:58. [PMID: 38960953 PMCID: PMC11222189 DOI: 10.1007/s11657-024-01414-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/20/2024] [Indexed: 07/05/2024]
Abstract
In a Norwegian youth cohort followed from adolescence to young adulthood, bone mineral density (BMD) levels declined at the femoral neck and total hip from 16 to 27 years but continued to increase at the total body indicating a site-specific attainment of peak bone mass. PURPOSE To examine longitudinal trends in bone mineral density (BMD) levels in Norwegian adolescents into young adulthood. METHOD In a prospective cohort design, we followed 980 adolescents (473 (48%) females) aged 16-19 years into adulthood (age of 26-29) on three occasions: 2010-2011 (Fit Futures 1 (FF1)), 2012-2013 (FF2), and 2021-2022 (FF3), measuring BMD (g/cm2) at the femoral neck, total hip, and total body with dual x-ray absorptiometry (DXA). We used linear mixed models to examine longitudinal BMD changes from FF1 to FF3. RESULTS From the median age of 16 years (FF1), femoral neck BMD (mean g/cm2 (95% CI)) slightly increased in females from 1.070 (1.059-1.082) to 1.076 (1.065-1.088, p = 0.015) at the median age of 18 years (FF2) but declined to 1.041 (1.029-1.053, p < 0.001) at the median age of 27 years (FF3). Similar patterns were observed in males: 16 years, 1.104 (1.091-1.116); 27 years, 1.063 (1.050-1.077, p < 0.001); and for the total hip in both sexes (both p < 0.001). Total body BMD increased from age 16 to 27 years in both sexes (females: 16 years, 1.141 (1.133-1.148); 27 years, 1.204 (1.196-1.212), p < 0.001; males: 16 years, 1.179 (1.170-1.188); 27 years, 1.310 (1.296-1.315), p < 0.001). CONCLUSION BMD levels increased from 16 to 18 years at the femoral and total hip sites in young Norwegian females and males, and a small decline was observed at the femoral sites when the participants were followed up to 27 years. Total body BMD continued to increase from adolescence to young adulthood.
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Affiliation(s)
- Edvard H Sagelv
- Division of Neurosciences, Orthopedics and Rehabilitation Services, University Hospital of North Norway, Tromsø, Norway.
| | - Nina Emaus
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Elin Evensen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tore Christoffersen
- School of Sports Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Alta, Norway
- Finnmark Hospital Trust, Alta, Norway
| | - Elaine Dennison
- MRC, Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Anne-Sofie Furberg
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Department of Health and Social Sciences, Molde University College, Molde, Norway
| | - Guri Grimnes
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Division of Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Jonas Johansson
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Christopher Sivert Nielsen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Ole Andreas Nilsen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Anne Winther
- Division of Neurosciences, Orthopedics and Rehabilitation Services, University Hospital of North Norway, Tromsø, Norway
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Gregori G, Pivodic A, Magnusson P, Johansson L, Hjertonsson U, Brättemark E, Lorentzon M. Limosilactobacillus reuteri 6475 and Prevention of Early Postmenopausal Bone Loss: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2415455. [PMID: 38865129 PMCID: PMC11170297 DOI: 10.1001/jamanetworkopen.2024.15455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/05/2024] [Indexed: 06/13/2024] Open
Abstract
Importance Daily supplementation with the probiotic Limosilactobacillus reuteri ATCC PTA 6475 (L reuteri) vs placebo has previously been demonstrated to reduce bone loss in an estrogen deficiency mice model and older women, although the magnitude of the effect was small. We hypothesized that long-term treatment with L reuteri could result in clinically relevant skeletal benefits in postmenopausal osteoporosis. Objective To evaluate whether daily supplementation with L reuteri vs placebo could reduce early postmenopausal bone loss and whether the effects remained or increased over time during 2 years of treatment. Design, Setting, and Participants A double-blind, randomized, placebo-controlled clinical trial was conducted between December 4, 2019, and October 6, 2022, at a single center in Gothenburg, southwestern Sweden. Participants were recruited by online advertisements, and letters were sent to 10 062 women aged 50 to 60 years. Responding women (n = 752) underwent telephone screening, resulting in 292 women being invited to a screening visit. Of those who were screened, 239 women met all inclusion criteria and had no exclusion criteria. Interventions Capsules with L reuteri in 2 doses, 5 × 108 (low dose) or 5 × 109 (high dose) colony-forming units, taken twice daily or placebo were administered. All capsules also included cholecalciferol, 200 IU. Main Outcomes and Measures The primary outcome was the relative change in tibia total volumetric bone mineral density (vBMD) over 2 years. Secondary outcomes included relative change in areal BMD of the lumbar spine and total hip, bone turnover markers C-terminal telopeptide cross-links of collagen type I and type I procollagen intact N-terminal propeptide, as well as tibia trabecular bone volume fraction and cortical vBMD. Both intention-to-treat and per-protocol analyses were conducted. Results A total of 239 postmenopausal women (median age, 55 [IQR, 53-56] years) were included. Tibia vBMD (primary outcome), hip and spine vBMD, and tibia cortical area and BMD decreased significantly in all groups, with no group-to-group differences (percent change tibia vBMD high dose vs placebo least-squares means, -0.08 [95 CI, -0.85 to 0.69] and low dose vs placebo least-squares means, -0.22 [95% CI, -0.99 to 0.55]). There were no significant treatment effects on any other predefined outcomes. A prespecified sensitivity analysis found a significant interaction between body mass index (BMI) and treatment effect at 2 years. No significant adverse effects were observed. Conclusions and Relevance In this randomized clinical trial of 239 early postmenopausal women, supplementation with L reuteri had no effect on bone loss or bone turnover over 2 years. The observed interaction between BMI and treatment effect warrants further investigation. Trial Registration ClinicalTrials.gov Identifier: NCT04169789.
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Affiliation(s)
- Giulia Gregori
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Aldina Pivodic
- APNC, Gothenburg, Sweden
- Department of Ophthalmology, Sahlgrenska University Hospital, the Västra Götaland Region, Mölndal, Sweden
| | - Per Magnusson
- Department of Clinical Chemistry, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lisa Johansson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- The Västra Götaland Region, Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Ulrika Hjertonsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Emma Brättemark
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lorentzon
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital, the Västra Götaland Region, Mölndal, Sweden
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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5
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Alboun SM, Khreisat E, Alawneh ZE, Bani Hani KM, Khreisat RF, Al-Mughrabi MA, Alshagoor BE, Alfarajat RI, Doumi MA, Cycline M. Best Bisphosphonate Threshold for 10-Year Vertebral and Non-vertebral Fracture Mitigation. Cureus 2024; 16:e59830. [PMID: 38846189 PMCID: PMC11156443 DOI: 10.7759/cureus.59830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
AIMS This study was aimed to determine the ideal thresholds for bone mineral densities in our tested Jordanian cohort to initiate bisphosphonate pharmacotherapeutics in order to establish a national protocol for prescribing bisphosphonates that is tailored to the local population, rather than relying on global T and Z scores standards. METHODS This retrospective study analyzed the entire population of adult patients at Prince Rashid bin Al-Hussein Hospital Rehabilitation and Rheumatology Center between August and October 2023 for the purpose of screening, monitoring, diagnosing, and treating osteoporosis. The study included 328 clients suspected to have osteoporosis, selected based on criteria such as primary osteoporosis or potential secondary osteoporosis. The study used two fracture risk assessment tools (FRAX) dichotomized states: <3% (negative state) and ≥3% (positive state), as well as <20% (negative state) and ≥20% (positive state). Binary logistic regression analysis, receiver-operating characteristic, and sensitivity analysis tests were performed sequentially to analyze the performance of prognosticators and sensitivity indices to evaluate their sensitivity, specificity, and accuracy indexes. RESULTS The study involved 328 clients at a rehabilitation clinic, with 82.62% (271) females and 17.38% (57) males. The majority were aged between 60 and 69 years, with a slightly higher obesity rate in females. The study found that initiation of bisphosphonates in Jordanian cohorts with optimal bone mineral density thresholds of 0.775 g/cm2 may significantly reduce the risk of hip osteoporosis over 10 years, with sensitivity, specificity, and accuracy indexes of 78.6%, 88.46%, and 50.61%, respectively, with a performance utility of 0.896±0.026 (p-value<0.001), 95% CI (0.846-0.946). CONCLUSION Due to ethnicity differences, exploring regional or national specific bone mineral density thresholds for bisphosphonates initiation may be a better optional choice than adopting global T-score standards.
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Affiliation(s)
- Samer M Alboun
- Rehabilitation and Rheumatology, Jordanian Royal Medical Services, Amman, JOR
| | - Eman Khreisat
- Family Medicine, King Hussein Medical Center, Amman, JOR
| | - Zaid E Alawneh
- Internal Medicine, Jordanian Royal Medical Services, Amman, JOR
| | - Khaled M Bani Hani
- Rehabilitation and Rheumatology, Jordanian Royal Medical Services, Amman, JOR
| | - Rania F Khreisat
- Rehabilitation and Rheumatology, Jordanian Royal Medical Services, Amman, JOR
| | | | - Bara'ah E Alshagoor
- Rehabilitation and Rheumatology, Jordanian Royal Medical Services, Amman, JOR
| | - Rabaa I Alfarajat
- Rehabilitation and Rheumatology, Jordanian Royal Medical Services, Amman, JOR
| | - Madher A Doumi
- Rehabilitation and Rheumatology, Jordanian Royal Medical Services, Amman, JOR
| | - Mino Cycline
- Research and Development, Jordanian Royal Medical Services, Amman, JOR
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Nagai T, Ishikawa K, Tsuchiya K, Tani S, Dodo Y, Oshita Y, Sakamoto K, Kawate N, Kudo Y. Changes in Testing and Treatment Methods in Osteoporosis Care. J Osteoporos 2024; 2024:9629891. [PMID: 38659619 PMCID: PMC11042906 DOI: 10.1155/2024/9629891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024] Open
Abstract
Osteoporosis treatment plays a crucial role in preventing fractures, particularly in bedridden patients. We conducted a questionnaire survey presenting hypothetical clinical cases in 2015 and 2020 to investigate trends over a 5-year period. The target population included physicians working in clinics and hospitals within our neighbourhood. The cases were presented, and the questionnaire was administered in a confidential format. The orthopaedic surgeons were matched for age and practice, resulting in 74 cases being included in the analysis. Comparing the 2015 and 2020 results, we observed a notable increase in physicians who would perform "bone mineral density measurements of the lumbar spine and hip." Furthermore, there was a significant rise in the percentage of respondents willing to test for bone metabolic markers, such as serum type I collagen cross-linked N-telopeptide (NTX), procollagen I N-terminal propeptide (P1NP), and tartrate-resistant acid phosphatase 5b (TRACP-5b). Regarding therapeutic agents, bisphosphonates decreased in usage, whereas parathyroid hormone and romosozumab witnessed an increase. In conclusion, the percentage of physicians requesting bone mineral density measurements of the lumbar spine and hip increased over the five-year period. In addition, more physicians chose to utilise bone metabolic markers due to their ease of measurement through blood tests and reduced diurnal variation. Finally, there was a marked trend towards the administration of drugs capable of rapidly and effectively increasing bone mineral density at an early stage of treatment.
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Affiliation(s)
- Takashi Nagai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Koji Ishikawa
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Koki Tsuchiya
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Soji Tani
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Yusuke Dodo
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Yusuke Oshita
- Department of Orthopaedic, Showa University Northern Yokohama Hospital, Kanagawa, Yokohama, Japan
| | - Keizo Sakamoto
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Nobuyuki Kawate
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoshifumi Kudo
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
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Hou X, Zhang N, Chen S, Guo L, Yu Y, Wei Z, Liu J, Wu S, Tian F. Association of life's essential 8 and risk of fragility fractures: A large cohort study. J Orthop Res 2024; 42:798-805. [PMID: 37804221 DOI: 10.1002/jor.25708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/29/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023]
Abstract
Cardiovascular health (CVH) score is not only associated with cardiovascular diseases, but also some disorders in other systems. This study aims to investigate the association between CVH score and the risk of fragility fractures. The analysis enrolled 89,464 participants at baseline in Kailuan study initiated in 2006-2007. All participants were then followed up every 2 years and the incidence of fragility fractures was recorded annually. A total CVH score was classified as low (0-49 points), moderate (50-79 points), and ideal (80-100 points). The primary outcome was incident fragility fractures before December 31, 2021. Kaplan-Meier was used to estimate cumulative incidence. Multivariable adjusted Cox proportional hazards regression models and time-dependent Cox hazards regression models were used to estimate fragility fracture hazard ratios (aHR) and 95% confidence intervals (95% CI). After 13.98 ± 2.84 years of follow-up, a total of 1534 cases of fragility fractures were identified, with an incidence density of 1.23 per 1000 person-years. Compared with the low CVH group, the risk of fragility fractures was significantly lower in moderate (aHR = 0.78, 95% CI: 0.66-0.92) and ideal CVH groups (aHR = 0.65, 95% CI: 0.51-0.83), particularly in the age <60 group (aHR = 0.72, 95% CI: 0.59-0.88; aHR= 0.55, 95% CI: 0.41-0.73, respectively). Time-dependent Cox hazards regression models, sensitivity analysis, and death competition model confirmed the reliability of these findings. The ideal CVH score is associated with a decreased risk of fragility fractures. With the increase of CVH score, the risk of fragility fracture decreases.
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Affiliation(s)
- Xiaoli Hou
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Nan Zhang
- Department of Orthopedics, Kailuan General Hospital, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Lu Guo
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Yaohui Yu
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Zhihao Wei
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Jiayin Liu
- Second Hospital of Tangshan, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Faming Tian
- School of Public Health, North China University of Science and Technology, Tangshan, China
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8
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Schini M, Johansson H, Harvey NC, Lorentzon M, Kanis JA, McCloskey EV. An overview of the use of the fracture risk assessment tool (FRAX) in osteoporosis. J Endocrinol Invest 2024; 47:501-511. [PMID: 37874461 PMCID: PMC10904566 DOI: 10.1007/s40618-023-02219-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023]
Abstract
FRAX®, a simple-to-use fracture risk calculator, was first released in 2008 and since then has been used increasingly worldwide. By calculating the 10-year probabilities of a major osteoporotic fracture and hip fracture, it assists clinicians when deciding whether further investigation, for example a bone mineral density measurement (BMD), and/or treatment is needed to prevent future fractures. In this review, we explore the literature around osteoporosis and how FRAX has changed its management. We present the characteristics of this tool and describe the use of thresholds (diagnostic and therapeutic). We also present arguments as to why screening with FRAX should be considered. FRAX has several limitations which are described in this review. This review coincides with the release of a version, FRAXplus, which addresses some of these limitations.
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Affiliation(s)
- M Schini
- Department of Oncology & Metabolism, Metabolic Bone Centre, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK.
| | - H Johansson
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - M Lorentzon
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - E V McCloskey
- Department of Oncology & Metabolism, Metabolic Bone Centre, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
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9
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Minisola S, Cipriani C, Colangelo L, Pepe J. At the Intersection Between Skeletal and Hematopoietic Systems: Incorporating Hemoglobin in FRAX®. J Clin Endocrinol Metab 2024; 109:e856-e857. [PMID: 37579211 DOI: 10.1210/clinem/dgad478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Salvatore Minisola
- Institute of 2nd Medical Clinics, Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Cristiana Cipriani
- Institute of 2nd Medical Clinics, Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Luciano Colangelo
- Institute of 2nd Medical Clinics, Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Jessica Pepe
- Institute of 2nd Medical Clinics, Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
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Ebrahimiarjestan M, Yang L, E. E, Wang T, Carey JJ, Whelan B, Silke C, O’Sullivan M, Gsel A, Brennan A, Dempsey M, Yu M. Bone mineral density and fractures in patients with rheumatoid arthritis: the DXA-HIP project. Rheumatol Adv Pract 2023; 7:rkad091. [PMID: 38025094 PMCID: PMC10640397 DOI: 10.1093/rap/rkad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives RA is a chronic disabling disease affecting 0.5-1% of adults worldwide. People with RA have a greater prevalence of multimorbidity, particularly osteoporosis and associated fractures. Recent studies suggest that fracture risk is related to both non-RA and RA factors, whose importance is heterogeneous across studies. This study seeks to compare baseline demographic and DXA data across three cohorts: healthy controls, RA patients and a non-RA cohort with major risk factors and/or prior major osteoporotic fracture (MOF). Methods This is a cross-sectional study using data collected from three DXA centres in the west of Ireland from January 2000 to November 2018. Results Data were available for 30 503 subjects who met our inclusion criteria: 9539 (31.3%) healthy controls, 1797 (5.9%) with RA and 19 167 (62.8%) others. Although age, BMI and BMD were similar between healthy controls, the RA cohort and the other cohort, 289 (16.1%) RA patients and 5419 (28.3%) of the non-RA cohort had prior MOF. In the RA and non-RA cohorts, patients with previous MOF were significantly older and had significantly lower BMD at the femoral neck, total hip and spine. Conclusion Although age, BMI and BMD were similar between a healthy control cohort and RA patients and others with major fracture risk factors, those with a previous MOF were older and had significantly lower BMD at all three measured skeletal sites. Further studies are needed to address the importance of these and other factors for identifying those RA patients most likely to experience fractures.
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Affiliation(s)
| | - Lan Yang
- Insight SFI Research Centre for Data Analytics, Data Science Institute, National University of Ireland, Galway, Ireland
| | - Erjiang E.
- School of Management, Guangxi Minzu University, Nanning, China
| | - Tingyan Wang
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - John J Carey
- School of Medicine, National University of Ireland, Galway, Ireland
- Department of Rheunatology, Galway University Hospitals, Galway, Ireland
| | - Bryan Whelan
- School of Medicine, National University of Ireland, Galway, Ireland
- Department of Rheumatology, Our Lady’s Hospital, Manorhamilton, Ireland
| | - Carmel Silke
- School of Medicine, National University of Ireland, Galway, Ireland
- Department of Rheumatology, Our Lady’s Hospital, Manorhamilton, Ireland
| | - Miriam O’Sullivan
- School of Medicine, National University of Ireland, Galway, Ireland
- Department of Rheumatology, Our Lady’s Hospital, Manorhamilton, Ireland
| | - Amina Gsel
- School of Medicine, National University of Ireland, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, National University of Ireland, Galway, Ireland
| | - Mary Dempsey
- School of Engineering, National University of Ireland, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
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11
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Vigod SN, Urbach N, Calzavara A, Dennis CL, Gruneir A, Thombs BD, Walker M, Brown HK. Clinical index to quantify the 1-year risk for common postpartum mental disorders at the time of delivery (PMH CAREPLAN): development and internal validation. Br J Psychiatry 2023; 223:422-429. [PMID: 37341030 PMCID: PMC10895501 DOI: 10.1192/bjp.2023.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/09/2023] [Accepted: 03/24/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Common postpartum mental health (PMH) disorders such as depression and anxiety are preventable, but determining individual-level risk is difficult. AIMS To create and internally validate a clinical risk index for common PMH disorders. METHOD Using population-based health administrative data in Ontario, Canada, comprising sociodemographic, clinical and health service variables easily collectible from hospital birth records, we developed and internally validated a predictive model for common PMH disorders and converted the final model into a risk index. We developed the model in 75% of the cohort (n = 152 362), validating it in the remaining 25% (n = 75 772). RESULTS The 1-year prevalence of common PMH disorders was 6.0%. Independently associated variables (forming the mnemonic PMH CAREPLAN) that made up the risk index were: (P) prenatal care provider; (M) mental health diagnosis history and medications during pregnancy; (H) psychiatric hospital admissions or emergency department visits; (C) conception type and complications; (A) apprehension of newborn by child services (newborn taken into care); (R) region of maternal origin; (E) extremes of gestational age at birth; (P) primary maternal language; (L) lactation intention; (A) maternal age; (N) number of prenatal visits. In the index (scored 0-39), 1-year common PMH disorder risk ranged from 1.5 to 40.5%. Discrimination (C-statistic) was 0.69 in development and validation samples; the 95% confidence interval of expected risk encompassed observed risk for all scores in development and validation samples, indicating adequate risk index calibration. CONCLUSIONS Individual-level risk of developing a common postpartum mental health disorder can be estimated with data feasibly collectable from birth records. Next steps are external validation and evaluation of various cut-off scores for their utility in guiding postpartum individuals to interventions that reduce their risk of illness.
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Affiliation(s)
- Simone N. Vigod
- Department of Psychiatry, Women's College Hospital and Research Institute, Toronto, Ontario, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; and Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Urbach
- Faculty of Medicine, Queens University, Kingston, ON, Canada
| | | | - Cindy-Lee Dennis
- Department of Psychiatry, Women's College Hospital and Research Institute, Toronto, Ontario, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Gruneir
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; and Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Psychology McGill University, Montreal, Quebec, Canada; and Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
| | - Mark Walker
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hilary K. Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; and ICES, Toronto, Ontario, Canada
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12
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Zwart M, Azagra-Ledesma R, Saez M, Aguyé-Batista A, Díaz-Herrera MA, Tranche-Iparraguirre S. Predictive capacity of FRAX in a spanish region with a hip fracture rate close to the national mean. BMC Musculoskelet Disord 2023; 24:577. [PMID: 37454058 DOI: 10.1186/s12891-023-06670-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND It is known that standardized incidence rates of hip fracture vary among older people in Spain. So far, the results published on the validation of the FRAX® tool in Spain have suggested that the major osteoporotic fractures (MOFs) risk in our country is underestimated. These studies have practically been based on Spanish cohorts evaluated in Catalonia, a higher hip fracture rate area. The purpose of this study is to analyse the ability of the FRAX® in a Spanish mid-fracture rate population. METHODS Study design: Retrospective cohort study. MEASURES MOFs: hip, humerus, wrist, spine fractures. Risk of fracture assessed by calculating odds ratios (ORs). Predictive capacity of FRAX® according to the osteoporotic fractures observed between 2009 and 2018 (ObsFr) to predicted by FRAX® without densitometry in 2009 (PredFr) ratio. RESULTS 285 participants (156 women, 54.7%) with a mean ± SD of 61.5 ± 14 years. Twenty-four people sustained 27 fractures (15 MOFs). Significant ORs were observed for an age ≥ 65 (2.92; 95% CI, 1.07-7.96), female sex (3.18; 95% CI, 1.24-8.16), rheumatoid arthritis (0.62; 95% CI, 2.03-55.55), proton pump (2.71; 95% CI, 1.20-6.09) and serotonin reuptake (2.51; 95% CI, 1.02-6.16) inhibitors. The ObsFr/PredFr ratio in women were 1.12 (95% CI, 0.95-1.29) for MOFs and 0.47 (95% CI, 0-0.94) for hip fractures. Men had a ratio of 0.57 (95% CI, 0.01-1.14) for MOF, no hip fractures were observed. The ratios for the overall group were 1.29 (95% CI, 1.12-1.48) for MOFs and 0.70 (95% CI, 0.22-1.17) for hip fractures. CONCLUSIONS FRAX® accurately predicted MOFs in women population with a hip fracture incidence rate close to the national mean compared to previous studies conducted in higher incidence regions in Spain.
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Affiliation(s)
- Marta Zwart
- Medicina de Familia. Centro de Atención Primaria Can Gibert del Pla, Institut Català de la Salut (ICS), C/ Sant Sebastià 50, Girona, 17006, Spain
- Departamento de Medicina, Universitat de Girona (UdG), C/ Emili Grahit 77, Campus Centro, Girona, 17003, Spain
- GROICAP. Unitat Suport a la Recerca (USR) Girona-IDIAP Jordi Gol, Girona, 17003, Spain
| | - Rafael Azagra-Ledesma
- Medicina de Familia. Centro de Atención Primaria Badía del Vallés, Institut Català de la Salut (ICS). C/ Bètica s/n, Badia del Vallès, Barcelona, 08214, Spain.
- Departamento de Medicina, Universitat Autònoma de Barcelona, Avda Can Domènech, Bellaterra, Barcelona, 08193, Spain.
- Fundación PRECIOSA para la Investigación, 08210 Barberà del Valles, Barcelona, Spain.
| | - Marc Saez
- Bioestadística. Universitat de Girona (UdG), C/de la Universitat de Girona 10, Campus de Montilivi, Girona, 17003, Spain
- Grup de Recerca en Estadística, Econometria i Salut (GRECS), UdG y CIBER de Epidemiologia y Salud Pública (CIBERESP), Girona, 17003, Spain
| | - Amada Aguyé-Batista
- GROICAP. Unitat Suport a la Recerca (USR) Girona-IDIAP Jordi Gol, Girona, 17003, Spain
- Departamento de Medicina, Universitat Autònoma de Barcelona, Avda Can Domènech, Bellaterra, Barcelona, 08193, Spain
- Medicina de Familia. Centro de Atención Primaria Granollers Vallés Oriental, Institut Català de la Salut (ICS). C/ Museu 19, Granollers, Barcelona, 08401, Spain
| | - Miguel Angel Díaz-Herrera
- GROICAP. Unitat Suport a la Recerca (USR) Girona-IDIAP Jordi Gol, Girona, 17003, Spain
- Departamento de Medicina. Universitat Autònoma de Barcelona. Avda de Can Domènech, Bellaterra, Barcelona, 08193, Spain
- Enfermería. Unidad de Heridas Complejas Atención Primaria Metropolitana Sur. Institut Català de la Salut, Av. Mare de Déu de Bellvitge 3., Hospitalet de Llobregat. Barcelona, 08907, Spain
- Medicina de Familia. Centro de Salud El Cristo, Servicio Asturiano de Salud. C/ Álvaro Flórez Estrada 21, Oviedo, Asturias, 33006, Spain
| | - Salvador Tranche-Iparraguirre
- Comisión de Docencia. Hospital Universitario General de Catalunya-Grupo Quironsalud, C/ Pedro Pons 1, Sant Cugat del Vallès-Barcelona, 08195, Spain
- President of Sociedad Española de Medicina Familiar y Comunitaria (SemFYC), Barcelona, Spain
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13
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Yang L, Dempsey M, Brennan A, Whelan B, Erjiang E, Wang T, Egan R, Gorham K, Heaney F, Armstrong C, Ibarrola GM, Gsel A, Yu M, Carey JJ. Ireland DXA-FRAX may differ significantly and substantially to Web-FRAX. Arch Osteoporos 2023; 18:43. [PMID: 36939937 PMCID: PMC10027809 DOI: 10.1007/s11657-023-01232-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/07/2023] [Indexed: 03/21/2023]
Abstract
Appropriate use of FRAX reduces the number of people requiring DXA scans, while contemporaneously determining those most at risk. We compared the results of FRAX with and without inclusion of BMD. It suggests clinicians to carefully consider the importance of BMD inclusion in fracture risk estimation or interpretation in individual patients. PURPOSE FRAX is a widely accepted tool to estimate the 10-year risk of hip and major osteoporotic fracture in adults. Prior calibration studies suggest this works similarly with or without the inclusion of bone mineral density (BMD). The purpose of the study is to compare within-subject differences between FRAX estimations derived using DXA and Web software with and without the inclusion of BMD. METHOD A convenience cohort was used for this cross-sectional study, consisting of 1254 men and women aged between 40 and 90 years who had a DXA scan and complete validated data available for analysis. FRAX 10-year estimations for hip and major osteoporotic fracture were calculated using DXA software (DXA-FRAX) and the Web tool (Web-FRAX), with and without BMD. Agreements between estimates within each individual subject were examined using Bland-Altman plots. We performed exploratory analyses of the characteristics of those with very discordant results. RESULTS Overall median DXA-FRAX and Web-FRAX 10-year hip and major osteoporotic fracture risk estimations which include BMD are very similar: 2.9% vs. 2.8% and 11.0% vs. 11% respectively. However, both are significantly lower than those obtained without BMD: 4.9% and 14% respectively, P < 0.001. Within-subject differences between hip fracture estimates with and without BMD were < 3% in 57% of cases, between 3 and 6% in 19% of cases, and > 6% in 24% of cases, while for major osteoporotic fractures such differences are < 10% in 82% of cases, between 10 and 20% in 15% of cases, and > 20% in 3% of cases. CONCLUSIONS Although there is excellent agreement between the Web-FRAX and DXA-FRAX tools when BMD is incorporated, sometimes there are very large differences for individuals between results obtained with and without BMD. Clinicians should carefully consider the importance of BMD inclusion in FRAX estimations when assessing individual patients.
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Affiliation(s)
- Lan Yang
- Insight SFI Research Centre for Data Analytics, Data Science Institute, University of Galway, IDA Business Park, Lower Dangan, Galway, H91 AEX4, Ireland.
| | - Mary Dempsey
- School of Engineering, College of Science and Engineering, University of Galway, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, College of Science and Engineering, University of Galway, Galway, Ireland
| | - Bryan Whelan
- School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - E Erjiang
- School of Management, Guangxi Minzu University, Nanning, China
| | - Tingyan Wang
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rebecca Egan
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Kelly Gorham
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Fiona Heaney
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | | | | | - Amina Gsel
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - John J Carey
- School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
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14
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Dimai HP. New Horizons: Artificial Intelligence Tools for Managing Osteoporosis. J Clin Endocrinol Metab 2023; 108:775-783. [PMID: 36477337 PMCID: PMC9999362 DOI: 10.1210/clinem/dgac702] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration leading to increased bone fragility and fracture risk. Typically, osteoporotic fractures occur at the spine, hip, distal forearm, and proximal humerus, but other skeletal sites may be affected as well. One of the major challenges in the management of osteoporosis lies in the fact that although the operational diagnosis is based on bone mineral density (BMD) as measured by dual x-ray absorptiometry, the majority of fractures occur at nonosteoporotic BMD values. Furthermore, osteoporosis often remains undiagnosed regardless of the low severity of the underlying trauma. Also, there is only weak consensus among the major guidelines worldwide, when to treat, whom to treat, and which drug to use. Against this background, increasing efforts have been undertaken in the past few years by artificial intelligence (AI) developers to support and improve the management of this disease. The performance of many of these newly developed AI algorithms have been shown to be at least comparable to that of physician experts, or even superior. However, even if study results appear promising at a first glance, they should always be interpreted with caution. Use of inadequate reference standards or selection of variables that are of little or no value in clinical practice are limitations not infrequently found. Consequently, there is a clear need for high-quality clinical research in this field of AI. This could, eg, be achieved by establishing an internationally consented "best practice framework" that considers all relevant stakeholders.
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Affiliation(s)
- Hans Peter Dimai
- Correspondence: Hans Peter Dimai, MD, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria.
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15
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Nelson RA, Blakely AM, Larson JC, Chlebowski RT, Chen YJ, Cauley JA, Shadyab AH, Lai LL. Long-term pelvic fracture and overall mortality risk after pelvic cancer and pelvic radiation. J Natl Cancer Inst 2023; 115:104-111. [PMID: 36305666 PMCID: PMC9830483 DOI: 10.1093/jnci/djac197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/03/2022] [Accepted: 09/29/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The association of pelvic radiation with pelvic fracture risk has not been examined in prospective cohort settings with comprehensive fracture risk assessment, cancer-free comparison populations, and long-term follow-up. Our objective is to better characterize pelvic fracture and overall mortality risks in postmenopausal women participating in the Women's Health Initiative. METHODS A total of 135 743 Women's Health Initiative participants aged 50 to 79 years enrolled from 40 US clinical centers from 1993 to 1998 who had entry Fracture Risk Assessment Tool scores were eligible. Outcomes included pelvic cancer diagnosis, pelvic fracture occurrence, and mortality. Cox proportional hazards regression models were used to examine associations of pelvic cancer and pelvic radiation with pelvic fracture and mortality risk. RESULTS After 17.7 years (median) follow-up, 4451 pelvic cancers, 10 139 pelvic fractures, and 33 040 deaths occurred. In multivariable analyses, women with incident pelvic cancer, compared with women who remained pelvic cancer free, had higher pelvic fracture risk (hazard ratio [HR] = 1.26, 95% confidence interval [CI] = 1.11 to 1.43) and higher overall mortality risk (HR = 2.91, 95% CI = 2.77 to 3.05). Women with pelvic cancer treated with pelvic radiation, compared with women with pelvic cancer not treated with pelvic radiation, had higher pelvic fracture risk (HR = 1.98, 95% CI = 1.41 to 2.78) and higher overall mortality after pelvic cancer (HR = 1.32, 95% CI = 1.15 to 1.52). CONCLUSIONS Postmenopausal women with pelvic cancer, especially those receiving pelvic radiation, are at higher pelvic fracture risk and higher overall mortality risk. As therapeutic advances have reduced cancer mortality, attention to and interventions for pelvic fracture prevention may be important in pelvic cancer survivors.
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Affiliation(s)
- Rebecca A Nelson
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Andrew M Blakely
- Surgical Oncology Program, National Cancer Institute, Bethesda, MD, USA
| | | | - Rowan T Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Yi-Jen Chen
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Lily L Lai
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
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16
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Chin KY, Ng BN, Rostam MKI, Muhammad Fadzil NFD, Raman V, Mohamed Yunus F, Syed Hashim SA, Ekeuku SO. A Mini Review on Osteoporosis: From Biology to Pharmacological Management of Bone Loss. J Clin Med 2022; 11:6434. [PMID: 36362662 PMCID: PMC9657533 DOI: 10.3390/jcm11216434] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 07/25/2023] Open
Abstract
Osteoporosis refers to excessive bone loss as reflected by the deterioration of bone mass and microarchitecture, which compromises bone strength. It is a complex multifactorial endocrine disease. Its pathogenesis relies on the presence of several endogenous and exogenous risk factors, which skew the physiological bone remodelling to a more catabolic process that results in net bone loss. This review aims to provide an overview of osteoporosis from its biology, epidemiology and clinical aspects (detection and pharmacological management). The review will serve as an updated reference for readers to understand the basics of osteoporosis and take action to prevent and manage this disease.
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De Souza MJ, Strock NCA, Williams NI, Lee H, Koltun KJ, Rogers C, Ferruzzi MG, Nakatsu CH, Weaver C. Prunes preserve hip bone mineral density in a 12-month randomized controlled trial in postmenopausal women: the Prune Study. Am J Clin Nutr 2022; 116:897-910. [PMID: 35798020 DOI: 10.1093/ajcn/nqac189] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/04/2022] [Accepted: 07/05/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Dietary consumption of prunes has favorable impacts on bone health, but more research is necessary to improve upon study designs and refine our understandings. OBJECTIVES We evaluated the effects of prunes (50 g or 100 g/d) on bone mineral density (BMD) in postmenopausal women during a 12-mo dietary intervention. Secondary outcomes include effects on bone biomarkers. METHODS The single-center, parallel-arm 12-mo randomized controlled trial tested the effects of 50 g and 100 g prunes compared with a control group on BMD (every 6 mo) and bone biomarkers in postmenopausal women. RESULTS In total, 235 women (age 62.1 ± 5.0 y) were randomly allocated into control (n = 78), 50-g prune (n = 79), or 100-g prune (n = 78) groups. Compliance was 90.2 ± 1.8% and 87.1 ± 2.1% in the 50-g and 100-g prune groups. Dropout was 22%; however, the dropout rate was 41% for the 100-g prune group (compared with other groups: 10%, control; 15%, 50 g prune; P < 0.001). A group × time interaction for total hip BMD was observed in control compared with 50-g prune groups (P < 0.05) but not in control compared with 100-g prune groups (P > 0.05). Total hip BMD decreased -1.1 ± 0.2% in the control group at 12 mo, whereas the 50-g prune group preserved BMD (-0.3 ± 0.2%) at 12 mo (P < 0.05). Although hip fracture risk (FRAX) worsened in the control group at 6 mo compared with baseline (10.3 ± 0.5% compared with 9.8 ± 0.5%, P < 0.05), FRAX score was maintained in the pooled (50 g + 100 g) prune groups. CONCLUSIONS A 50-g daily dose of prunes can prevent loss of total hip BMD in postmenopausal women after 6 mo, which persisted for 12 mo. Given that there was high compliance and retention at the 50-g dosage over 12 mo, we propose that the 50-g dose represents a valuable nonpharmacologic treatment strategy that can be used to preserve hip BMD in postmenopausal women and possibly reduce hip fracture risk. This trial was registered at clinicaltrials.gov as NCT02822378.
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Affiliation(s)
- Mary Jane De Souza
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Nicole C A Strock
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Nancy I Williams
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kristen J Koltun
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA.,School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Connie Rogers
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Mario G Ferruzzi
- Department of Pediatrics, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Cindy H Nakatsu
- Department of Agronomy, Purdue University, West Lafayette, IN, USA
| | - Connie Weaver
- Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
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18
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Osteoporosis and fractures in rheumatoid arthritis - risk factors. Best Pract Res Clin Rheumatol 2022; 36:101757. [PMID: 35739049 DOI: 10.1016/j.berh.2022.101757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In this chapter, we emphasize among rheumatoid arthritis (RA) patients, whom and how to screen for osteoporosis. We highlight certain modalities, advancements in technology, secondary osteoporosis workup, and laboratory testing as well as their caveats. Finally, we discuss current guidance on how to direct the laboratory and radiology testing in the context of the individual patient with RA to guide and select from the osteoporosis treatment options currently available.
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Carey JJ, Chih-Hsing Wu P, Bergin D. Risk assessment tools for osteoporosis and fractures in 2022. Best Pract Res Clin Rheumatol 2022; 36:101775. [PMID: 36050210 DOI: 10.1016/j.berh.2022.101775] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Osteoporosis is one of the frequently encountered non-communicable diseases in the world today. Several hundred million people have osteoporosis, with many more at risk. The clinical feature is a fragility fracture (FF), which results in major reductions in the quality and quantity of life, coupled with a huge financial burden. In recognition of the growing importance, the World Health Organisation established a working group 30 years ago tasked with providing a comprehensive report to understand and assess the risk of osteoporosis in postmenopausal women. Dual-energy X-ray absorptiometry (DXA) is the most widely endorsed technology for assessing the risk of fracture or diagnosing osteoporosis before a fracture occurs, but others are available. In clinical practice, important distinctions are essential to optimise the use of risk assessments. Traditional tools lack specificity and were designed for populations to identify groups at higher risk using a 'one-size-fits-all' approach. Much has changed, though the purpose of risk assessment tools remains the same. In 2022, many tools are available to aid the identification of those most at risk, either likely to have osteoporosis or suffer the clinical consequence. Modern technology, enhanced imaging, proteomics, machine learning, artificial intelligence, and big data science will greatly advance a more personalised risk assessment into the future. Clinicians today need to understand not only which tool is most effective and efficient for use in their practice, but also which tool to use for which patient and for what purpose. A greater understanding of the process of risk assessment, deciding who should be screened, and how to assess fracture risk and prognosis in older men and women more comprehensively will greatly reduce the burden of osteoporosis for patients, society, and healthcare systems worldwide. In this paper, we review the current status of risk assessment, screening and best practice for osteoporosis, summarise areas of uncertainty, and make some suggestions for future developments, including a more personalised approach for individuals.
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Affiliation(s)
- John J Carey
- National University of Ireland Galway, 1007, Clinical Sciences Institute, Galway, H91 V4AY, Ireland.
| | - Paulo Chih-Hsing Wu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Director, Obesity/Osteoporosis Special Clinic, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Diane Bergin
- National University of Ireland Galway, 1007, Clinical Sciences Institute, Galway, H91 V4AY, Ireland; Galway University Hospitals, Ireland
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20
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Osteosarcopenia—The Role of Dual-Energy X-ray Absorptiometry (DXA) in Diagnostics. J Clin Med 2022; 11:jcm11092522. [PMID: 35566648 PMCID: PMC9100050 DOI: 10.3390/jcm11092522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Osteoporosis and sarcopenia lead to increased mortality, but their early diagnosis allows preventive measures and treatment to be implemented. The dual-energy X-ray absorptiometry (DXA) method enables the assessment of both bone mineral density (BMD) and bone quality based on the trabecular bone score (TBS), the Bone Strain Index (BSI), hip structure analysis (HSA), and comprehensive hip axis length (HAL). The main complications of osteoporosis are fractures, and a BMD value or T-score together with TBS can be also applied in fracture risk calculation using the Fracture Risk Assessment Tool (FRAX). In recent years, the interest in sarcopenia has increased. There are many methods for assessing the quality, quantity and function of muscles. Total body DXA provides information not only about the BMD of the whole skeleton or the amount of lean tissue (identified as fat-free mass), but also about the amount and distribution of adipose tissue. Some parameters obtained from DXA measurements related to muscle and/or fat mass are used in the assessment of osteosarcopenia. The following article presents a wide range of possibilities for the use of the DXA method in the diagnosis of osteosarcopenia because DXA is a useful technique for the diagnosis of bone density and body composition together.
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21
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Affiliation(s)
- T J de Villiers
- Department of Gynecology, Stellenbosch University and Mediclinic Panorama, Cape Town, South Africa
| | - S R Goldstein
- Department of Obstetrics and Gynecology, New York University, Grossman School of Medicine, New York, USA
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22
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Chen W, Mao M, Fang J, Xie Y, Rui Y. Fracture risk assessment in diabetes mellitus. Front Endocrinol (Lausanne) 2022; 13:961761. [PMID: 36120431 PMCID: PMC9479173 DOI: 10.3389/fendo.2022.961761] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022] Open
Abstract
Growing evidence suggests that diabetes mellitus is associated with an increased risk of fracture. Bone intrinsic factors (such as accumulation of glycation end products, low bone turnover, and bone microstructural changes) and extrinsic factors (such as hypoglycemia caused by treatment, diabetes peripheral neuropathy, muscle weakness, visual impairment, and some hypoglycemic agents affecting bone metabolism) probably contribute to damage of bone strength and the increased risk of fragility fracture. Traditionally, bone mineral density (BMD) measured by dual x-ray absorptiometry (DXA) is considered to be the gold standard for assessing osteoporosis. However, it cannot fully capture the changes in bone strength and often underestimates the risk of fracture in diabetes. The fracture risk assessment tool is easy to operate, giving it a certain edge in assessing fracture risk in diabetes. However, some parameters need to be regulated or replaced to improve the sensitivity of the tool. Trabecular bone score, a noninvasive tool, indirectly evaluates bone microstructure by analyzing the texture sparsity of trabecular bone, which is based on the pixel gray level of DXA. Trabecular bone score combined with BMD can effectively improve the prediction ability of fracture risk. Quantitative computed tomography is another noninvasive examination of bone microstructure. High-resolution peripheral quantitative computed tomography can measure volume bone mineral density. Quantitative computed tomography combined with microstructure finite element analysis can evaluate the mechanical properties of bones. Considering the invasive nature, the use of microindentation and histomorphometry is limited in clinical settings. Some studies found that the changes in bone turnover markers in diabetes might be associated with fracture risk, but further studies are needed to confirm this. This review focused on summarizing the current development of these assessment tools in diabetes so as to provide references for clinical practice. Moreover, these tools can reduce the occurrence of fragility fractures in diabetes through early detection and intervention.
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Affiliation(s)
- Weiwei Chen
- Department of Endocrinology, Wuxi No.9 People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Min Mao
- Department of Endocrinology, Wuxi No.9 People’s Hospital Affiliated to Soochow University, Wuxi, China
- *Correspondence: Min Mao,
| | - Jin Fang
- Department of Endocrinology, Wuxi No.9 People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Yikai Xie
- Department of Endocrinology, Wuxi No.9 People’s Hospital Affiliated to Soochow University, Wuxi, China
| | - Yongjun Rui
- Department of Orthopeadics Surgery, Wuxi No.9 People’s Hospital Affiliated to Soochow University, Wuxi, China
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