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MRI-based vertebral bone quality score effectively reflects bone quality in patients with osteoporotic vertebral compressive fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1131-1137. [PMID: 35316408 DOI: 10.1007/s00586-022-07177-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 01/23/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The present study is aimed to validate the ability of the vertebral bone quality (VBQ) score to evaluate bone quality in patients with osteoporotic vertebral compression fractures (OVCF) and to compare it with the ability of T-score by DXA. In addition, the sensitivity of VBQ score with cerebrospinal fluid (CSF) of L2 and L3 segments as baseline is evaluated. METHODS 196 inpatients were collected and assigned into OVCF and Non-OVCF groups, respectively. For each patient, the VBQ score was calculated by the signal intensity of the L1-L4 vertebral bodies and CSF at L3 or L2 level from T1-weighted MRIs, while T-score from DXA was also obtained. The VBQ and T-score was compared between OVCF and non-OVCF groups, and among age groups. The OVCF ORs by VBQ score and T-score were calculated using logistic regression. RESULTS OVCF group was significantly different to the non-OVCF group in the T-score (- 2.9 vs. - 0.7) and VBQ score (4.0 vs. 3.5). VBQ score and T-score in patient aged 60-79 years old could indicate the bone quality, but only T-score in patients aged 50-59 years old. OVCF are associated with both higher VBQ score and lower T-score. The VBQ scores calculated by L2 CSF and L3 CSF were similar. CONCLUSIONS The VBQ score is an effective indicator of bone quality in OVCF patients and comparable to T-score, particularly in people over 60 years old. The VBQ score is not sensitive to CSF of different segments as a baseline.
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Scott D, Seibel MJ, Cumming R, Naganathan V, Blyth F, Le Couteur DG, Handelsman DJ, Hsu B, Waite LM, Hirani V. Comparison of clinical risk factors for incident fracture in obese and non-obese community-dwelling older men. Bone 2020; 137:115433. [PMID: 32422298 DOI: 10.1016/j.bone.2020.115433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/30/2020] [Accepted: 05/13/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Obese older adults have higher bone mineral density (BMD), but other characteristics of obesity may predispose these individuals to fracture. We aimed to compare clinical risk factors for incident fracture in obese and non-obese older men. METHODS Body mass index (BMI) and body fat percentage were assessed at baseline by anthropometry and dual-energy X-ray absorptiometry, respectively, in 1625 community-dwelling men aged ≥70 years. Categories for non-obese and obese were <30 kg/m2and ≥30 kg/m2 for BMI, and <30% and ≥30% for body fat percentage. Sociodemographic, medical, physical function and blood biochemistry parameters were collected at baseline. Self-reported incident fractures of any type and cause (excluding pathological fractures and fractures of hands, fingers, feet, toes and the skull) were confirmed by radiographic reports and recorded up to 9 years. Hip fractures were followed for 14 years using data linkage. RESULTS Prevalence of obesity was 27% according to BMI and 44% according to body fat percentage. There were no differences in incidence of any fracture between non-obese and obese men by BMI (10.7 vs 9.3%, respectively; P > 0.05) or body fat percentage (10.2 vs 10.6%, respectively; P > 0.05). Significant interactions were observed demonstrating that dementia increased hazard for incident any and hip fracture in non-obese men (adjusted hazard ratio 7.08; 95% CI 3.27-15.36 and 8.36; 3.13-22.31, respectively) but not obese men. Past-year falls increased hazard for any fracture in obese men (2.86; 95% CI 1.60-5.10) but not non-obese men while higher luteinizing hormone concentrations reduced hazard for hip fracture in obese men (0.91; 0.85-0.97 per IU/L) but not non-obese men. CONCLUSIONS In community-dwelling older men, obesity does not protect against incident fracture. Assessments of falls history and gonadotrophin levels, in addition to established clinical risk factors for fracture, may contribute to improvements in fracture prediction in obese older men.
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Affiliation(s)
- David Scott
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Medicine and Australian Institute of Musculoskeletal Science, Melbourne Medical School - Western Campus, The University of Melbourne, St Albans, Victoria, Australia; School of Exercise and Nutrition Sciences and Institute for Physical Activity and Nutrition (IPAN), Faculty of Health, Deakin University, Burwood, Victoria, Australia.
| | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, and Dept of Endocrinology & Metabolism, Concord Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Robert Cumming
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Centre for Education and Research on Ageing and Alzheimer's Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia; The ARC Centre of Excellence in Population Ageing Research, University of Sydney, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing and Alzheimer's Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Fiona Blyth
- Centre for Education and Research on Ageing and Alzheimer's Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing and Alzheimer's Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia; ANZAC Research Institute & Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - David J Handelsman
- Department of Andrology, Concord Hospital & ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Benjumin Hsu
- Department of Andrology, Concord Hospital & ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing and Alzheimer's Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Vasant Hirani
- Centre for Education and Research on Ageing and Alzheimer's Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia; School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
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MacIntyre J, Drake P, Garland-Baird L, Loo J, Nisbet M, McClure C. Optimizing osteoporosis care in a rural primary health care center: Findings of a research study aimed to support seniors. Nurs Forum 2019; 54:611-618. [PMID: 31506955 DOI: 10.1111/nuf.12385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Osteoporosis is one of the most under-diagnosed and under-treated health conditions in Canada. This study questioned whether an invitation to self-refer for osteoporosis risk evaluation would improve the number of patients who were tested for bone mineral density (BMD) at a rural Primary Health Care Center (PHCC). PURPOSE The purpose of this study is to improve osteoporosis care and decrease bone fracture risk in a population of patients 65 years of age and older. METHODOLOGY A quasi-experimental research design was used to review screening rates of BMD testing and identified patients in this population who were at low, moderate, and high risk for developing osteoporosis. Screening rates at the PHCC were compared to screening rates at another rural PHCC in the province. CONCLUSION The self-referral program for BMD testing and a nurse-led intervention resulted in an increased number of people who were BMD tested at the study PHCC compared with the control PHCC, and identified more male patients 65 years of age and older who were at risk for osteoporosis and bone fractures. Recommendations suggest future research in other provincial PHCCs that may encourage self-referral programs for BMD testing and improved osteoporosis care for patients 65 years of age and older.
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Affiliation(s)
- Janet MacIntyre
- Department of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Patrice Drake
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | | | | | - Mary Nisbet
- Health PEI, Charlottetown, Prince Edward Island, Canada
| | - Carol McClure
- Health PEI, Charlottetown, Prince Edward Island, Canada
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Rothmann MJ, Möller S, Holmberg T, Højberg M, Gram J, Bech M, Brixen K, Hermann AP, Glüer CC, Barkmann R, Rubin KH. Non-participation in systematic screening for osteoporosis-the ROSE trial. Osteoporos Int 2017; 28:3389-3399. [PMID: 28875257 DOI: 10.1007/s00198-017-4205-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Population-based screening for osteoporosis is still controversial and has not been implemented. Non-participation in systematic screening was evaluated in 34,229 women age 65-81 years. Although participation rate was high, non-participation was associated with comorbidity, aging other risk factors for fractures, and markers of low social status, e.g., low income, pension, and living alone. A range of strategies is needed to increase participation, including development of targeted information and further research to better understand the barriers and enablers in screening for osteoporosis. INTRODUCTION Participation is crucial to the success of a screening program. The objective of this study was to analyze non-participation in Risk-stratified Osteoporosis Strategy Evaluation, a two-step population-based screening program for osteoporosis. METHODS Thirty-four thousand two hundred twenty-nine women aged 65 to 81 years were randomly selected from the background population and randomized to either a screening group (intervention) or a control group. All women received a self-administered questionnaire designed to allow calculation of future risk of fracture based on FRAX. In the intervention group, women with an estimated high risk of future fracture were invited to DXA scanning. Information on individual socioeconomic status and comorbidity was obtained from national registers. RESULTS A completed questionnaire was returned by 20,905 (61%) women. Non-completion was associated with older age, living alone, lower education, lower income, and higher comorbidity. In the intervention group, ticking "not interested in DXA" in the questionnaire was associated with older age, living alone, and low self-perceived fracture risk. Women with previous fracture or history of parental hip fracture were more likely to accept screening by DXA. Dropping out when offered DXA, was associated with older age, current smoking, higher alcohol consumption, and physical impairment. CONCLUSIONS Barriers to population-based screening for osteoporosis appear to be both psychosocial and physical in nature. Women who decline are older, have lower self-perceived fracture risk, and more often live alone compared to women who accept the program. Dropping out after primary acceptance is associated not only with aging and physical impairment but also with current smoking and alcohol consumption. Measures to increase program participation could include targeted information and reducing physical barriers for attending screening procedures.
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Affiliation(s)
- M J Rothmann
- Department of Endocrinology, Odense University Hospital, Kloevervaenget 10, 6.sal, 5000, Odense C, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - S Möller
- Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - T Holmberg
- Department of Health Promotion and Prevention, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - M Højberg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Research, Hospital of Southern Norway, Kristiansand, Norway
| | - J Gram
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - M Bech
- KORA, the Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
| | - K Brixen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Odense University Hospital, Odense, Denmark
| | - A P Hermann
- Department of Endocrinology, Odense University Hospital, Kloevervaenget 10, 6.sal, 5000, Odense C, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - C-C Glüer
- Section Biomedical Imaging, Department of Radiology and Neuroradiology, Christian-Albrechts-Universitäts zu Kiel, Kiel, Germany
| | - R Barkmann
- Section Biomedical Imaging, Department of Radiology and Neuroradiology, Christian-Albrechts-Universitäts zu Kiel, Kiel, Germany
| | - K H Rubin
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
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Danan ER, Krebs EE, Ensrud K, Koeller E, MacDonald R, Velasquez T, Greer N, Wilt TJ. An Evidence Map of the Women Veterans' Health Research Literature (2008-2015). J Gen Intern Med 2017; 32:1359-1376. [PMID: 28913683 PMCID: PMC5698220 DOI: 10.1007/s11606-017-4152-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/08/2017] [Accepted: 07/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Women comprise a growing proportion of Veterans seeking care at Veterans Affairs (VA) healthcare facilities. VA initiatives have accelerated changes in services for female Veterans, yet the corresponding literature has not been systematically reviewed since 2008. In 2015, VA Women's Health Services and the VA Women's Health Research Network requested an updated literature review to facilitate policy and research planning. METHODS The Minneapolis VA Evidence-based Synthesis Program performed a systematic search of research related to female Veterans' health published from 2008 through 2015. We extracted study characteristics including healthcare topic, design, sample size and proportion female, research setting, and funding source. We created an evidence map by organizing and presenting results within and across healthcare topics, and describing patterns, strengths, and gaps. RESULTS We identified 2276 abstracts and assessed each for relevance. We excluded 1092 abstracts and reviewed 1184 full-text articles; 750 were excluded. Of 440 included articles, 208 (47%) were related to mental health, particularly post-traumatic stress disorder (71 articles), military sexual trauma (37 articles), and substance abuse (20 articles). The number of articles addressing VA priority topic areas increased over time, including reproductive health, healthcare organization and delivery, access and utilization, and post-deployment health. Three or fewer articles addressed each of the common chronic diseases: diabetes, hypertension, depression, or anxiety. Nearly 400 articles (90%) used an observational design. Eight articles (2%) described randomized trials. CONCLUSIONS Our evidence map summarizes patterns, progress, and growth in the female Veterans' health and healthcare literature. Observational studies in mental health make up the majority of research. A focus on primary care delivery over clinical topics in primary care and a lack of sex-specific results for studies that include men and women have contributed to research gaps in addressing common chronic diseases. Interventional research using randomized trials is needed.
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Affiliation(s)
- Elisheva R Danan
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA. .,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Erin E Krebs
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kristine Ensrud
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eva Koeller
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Roderick MacDonald
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Tina Velasquez
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Nancy Greer
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Timothy J Wilt
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Cunningham TD, Di Pace BS, Ullal J. Osteoporosis treatment disparities: a 6-year aggregate analysis from national survey data. Osteoporos Int 2014; 25:2199-208. [PMID: 24899101 DOI: 10.1007/s00198-014-2747-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 05/11/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED We studied factors to determine the receipt of osteoporosis treatment in individuals with osteoporosis. Treatment was associated with age, gender, race, body mass index (BMI), family history, arthritis and thyroid problems, daily glucocorticoid use, number of prescriptions and healthcare visits, and insurance type. INTRODUCTION Osteoporosis is underrecognized and undertreated. Few studies have examined factors associated with osteoporosis treatment in a large, national sample of men and women. METHODS We aggregated National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2010 and created a subsample which included individuals 50 years or older who were identified to have osteoporosis either by self-report data or by bone density measurements. The primary outcome was the receipt of osteoporosis treatment either from self-report or from prescription records. Covariates included sociodemographics, clinical characteristics, and access to healthcare variables. Logistic regression analyses were performed to determine factors that associate with osteoporosis treatment. RESULTS From a sample of 31,0134 participants, 1,133 subjects (3.65 %) met the study criteria. Treatment was associated with age (odds ratio (OR) = 1.14), gender (OR = 13.25), race (OR = 2.23, White vs. Black; OR = 1.76, other vs. Black), BMI (OR = 1.67, normal vs. obese; OR = 2.68, overweight vs. obese), family history of osteoporosis (OR = 1.94), arthritis (OR = 1.43), daily glucocorticoid use (OR = 1.43), number of prescriptions (OR = 1.01), and number of healthcare visits in the past year (OR = 1.44, 4-9 vs. 0-3 visits). All odds ratios were statistically significant. CONCLUSION A large number of individuals diagnosed with osteoporosis above the age of 50 remain untreated. It is important for healthcare providers to better assess older adults with osteoporosis, including individuals who frequently receive medical care.
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Affiliation(s)
- T D Cunningham
- Graduate Program in Public Health, Eastern Virginia Medical School, Harry Lester Building, 651 Colley Avenue, Norfolk, VA, 23507, USA,
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Yoo JW, Kim S, Kim SJ, Ryu WS, Min TJ, Shin HP, Kim K, Choi JB, Nakagawa S. Effects of health insurance on racial disparity in osteoporosis medication adherence. J Am Pharm Assoc (2003) 2014; 53:626-31. [PMID: 24141382 DOI: 10.1331/japha.2013.13061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore whether racial disparity in osteoporosis drug therapy maintenance varies by health insurance coverage status. DESIGN Longitudinal observation study. SETTING Cleveland Clinic Health System (Cleveland, OH) from January 2006 to December 2009. PATIENTS 3,901 black and white female Medicare beneficiaries starting osteoporosis drug therapy. INTERVENTION Analysis of the health system's integrated electronic medical records. MAIN OUTCOME MEASURES Drug therapy adherence (medication possession ratio ≥80%) for more than 12 of 15 surveillance units and occurrence of extended nonadherence gaps for at least two surveillance units in a row. RESULTS Among patients with supplementary health insurance (n = 2,278), no difference was observed for drug therapy adherence ( P = 0.17) and extended nonadherence gaps ( P = 0.53) between black and white participants. When patients did not have supplementary health insurance (n = 1,623), blacks (36% [95% CI 28-47]) were less likely to adhere to drug therapy than whites (47% [38-57]; odds ratio [OR] 0.34 [95% CI 0.09-0.92], P = 0.004). Blacks (25% [19-32]) also were more likely to have an extended nonadherence gap episode than whites (18% [11-26]; OR 2.42 [1.13-3.50], P = 0.03). CONCLUSION Similar to previous research on racial disparity in health services, racial disparity in osteoporosis drug therapy maintenance between black and white female older patients existed when supplementary health insurance was not affordable.
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Sato M, Vietri J, Flynn JA, Fujiwara S. Bone fractures and feeling at risk for osteoporosis among women in Japan: patient characteristics and outcomes in the National Health and Wellness Survey. Arch Osteoporos 2014; 9:199. [PMID: 25391755 PMCID: PMC4229644 DOI: 10.1007/s11657-014-0199-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 10/24/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED Women aged 50 and older in Japan were compared according to perceived risk for osteoporosis and fracture history. Perceived risk was associated with family history of osteoporosis but few other risk factors. Few felt at risk, and perception was only loosely related to epidemiological risks, indicating a need for patient education. PURPOSE Osteoporosis is prevalent but underdiagnosed and undertreated. This study was conducted to explore characteristics associated with history of fractures and feeling at risk for osteoporosis in women aged 50 and older in Japan. METHODS Data were provided by a large annual survey representative of Japanese aged 18 and older. Women 50 and older without diagnosed osteoporosis were categorized into four mutually exclusive groups based on fracture history since age 50 and feeling at risk for developing osteoporosis. Sociodemographic and health characteristics were compared across groups using bivariate statistics, and health outcomes were compared using generalized linear models. RESULTS A total of 16,801 women aged 50 and older were included in the analyses. Most (n = 12,798; 76.2 %) had no fracture since age 50 and did not feel at risk for osteoporosis, 12.9 % (n = 2170) felt at risk but had no fracture, 8.7 % (n = 1455) did not feel at risk despite having a fracture, and 2.2 % (n = 378) had a fracture and felt at risk for osteoporosis. Feeling at risk was slightly more common among those with than without a fracture since age 50 (20.6 vs. 14.5 %, p < 0.001). Feeling at risk was most associated with family history of osteoporosis, though known risk factors for fracture did not significantly differ across the fracture/perceived-risk group. CONCLUSIONS Approximately 15 % of women in Japan aged 50 and older felt at risk for developing osteoporosis in the future, far fewer than expected by epidemiologists. Risk perception was only loosely related to epidemiological risks for fracture, indicating a need for patient education.
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Affiliation(s)
- Masayo Sato
- Eli Lilly K.K., Lilly Research Laboratories, Kobe, Japan
| | - Jeffrey Vietri
- Kantar Health, Health Outcomes Practice, Via Paleocapa 7, 20121 Milan (MI), Italy
| | | | - Saeko Fujiwara
- Hiroshima Atomic Bomb Casualty Council, Hiroshima, Japan
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Nielson CM, Srikanth P, Orwoll ES. Obesity and fracture in men and women: an epidemiologic perspective. J Bone Miner Res 2012; 27:1-10. [PMID: 23348758 DOI: 10.1002/jbmr.1486] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 11/24/2011] [Accepted: 11/29/2011] [Indexed: 11/11/2022]
Abstract
In Western societies, mean body weight has increased dramatically in older people, and a similar trend exists in Asia. Yet insufficient attention has been directed to the problem of osteoporotic fractures in the overweight and obese. Many, if not most, osteoporotic fractures occur in overweight or obese people, and obese men may be particularly susceptible. We discuss the potential implications of these findings, including the challenge of identifying individuals at highest risk, screening and treatment strategies, and future research directions.
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Affiliation(s)
- Carrie M Nielson
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR 97201, USA
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Powell H, O'Connor K, Greenberg D. Adherence to the U.S. Preventive Services Task Force 2002 osteoporosis screening guidelines in academic primary care settings. J Womens Health (Larchmt) 2011; 21:50-3. [PMID: 22150154 DOI: 10.1089/jwh.2010.2560] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Osteoporosis is very common in older women in the United States. Osteoporotic fractures cause significant morbidity and mortality, as well as high healthcare costs. Since 2002, the United States Preventive Services Task Force (USPSTF) has recommended screening for osteoporosis of all women aged ≥65. Our objective was to determine adherence to osteoporosis screening guidelines by primary care internists in a large academic medical center and to assess if adherence varies based on provider gender or practice location. METHODS This was a retrospective electronic medical record (EMR) review. All women aged ≥65 who were seen in the General Internal Medicine Center (GIMC) or the Women's Health Care Center (WHCC) at the University of Washington Medical Center by internal medicine attending physicians between January 1, 2006, and February 2, 2008, were included in the study. We determined if the patient had a dual energy x-ray absorptiometry (DEXA) study in the EMR database. We calculated the percentage of patients screened per provider and also compared the rate of screening for male vs. female providers and for GIMC vs. WHCC providers. RESULTS Of the 1363 women included in the study, 70% had documentation of a DEXA study. Adherence to screening recommendations for individual providers varied from 33% to 100%. Screening was more likely to occur in the WHCC than in the GIMC (79.2% vs. 66.7%, p<0.001). Although women providers were more likely to screen than their male counterparts (72.2% vs. 66.1%, p=0.023), this relationship did not hold true after excluding women providers from the WHCC. CONCLUSIONS We found good adherence to the USPSTF 2002 guidelines for osteoporosis screening in women aged ≥65 years by primary care physicians in a large urban academic medical center. The practice site and not gender of the provider resulted in significantly different screening rates.
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Affiliation(s)
- Heidi Powell
- Department of Medicine, University of Washington, Seattle, WA 98105, USA.
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Compliance with mammography and bone mineral density screening in women at least 50 years old. Menopause 2011; 18:794-801. [DOI: 10.1097/gme.0b013e3182083f28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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