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Pluskiewicz W, Adamczyk P, Werner A, Bach M, Drozdzowska B. Height Loss Is an Independent Predictor of Fracture Incidence in Postmenopausal Women: The Results from the Gliwice Osteoporosis Study (GO Study). Biomedicines 2023; 11:2231. [PMID: 37626729 PMCID: PMC10452816 DOI: 10.3390/biomedicines11082231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The aim of a longitudinal, retrospective study was to establish variables predicting fracture incidence over a decade. METHODS The study sample comprises a group of 457 postmenopausal women aged over 55 years, recruited from the database of an outpatient osteoporotic clinic. Several variables with potential influence on bone status, including the measurement of body height and hip bone densitometry, were collected. BMD at the femoral neck (FN BMD) was established using a Prodigy device (Lunar, GE, USA). Current body height was compared with the maximal historical body height in early adulthood, as reported by the patient. RESULTS Three hundred and ninety-four women did not have fractures during the follow up, and 63 subjects presented fractures. Subjects with fracture had lower FN BMD with a T-score of -1.86 ± 1.04 compared to -1.44 ± 0.89 in those without fractures (p < 0.001). Mean height loss (HL) was 3.47 ± 2.11 cm in fractured subjects and 2.50 ± 2.47 cm in unfractured ones, and differed significantly, p < 0.01. Fracture incidence was significantly related to age, rheumatoid arthritis, falls, and previous fractures. In the multivariable analysis using logistic regression, FN BMD, baseline fracture, and HL were identified as the significant predictors of fractures of follow up. CONCLUSIONS Osteoporotic fractures in postmenopausal women were predicted by FN BMD, prior fracture(s), and HL easily established during physical examination.
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Affiliation(s)
- Wojciech Pluskiewicz
- Department and Clinic of Internal Diseases, Diabetology and Nephrology, Metabolic Bone Diseases Unit, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Piotr Adamczyk
- Department of Pediatrics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Aleksandra Werner
- Department of Applied Informatics, Silesian University of Technology, 44-100 Gliwice, Poland; (A.W.); (M.B.)
| | - Małgorzata Bach
- Department of Applied Informatics, Silesian University of Technology, 44-100 Gliwice, Poland; (A.W.); (M.B.)
| | - Bogna Drozdzowska
- Department of Pathomorphology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
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Adachi JD, Berger C, Barron R, Weycker D, Anastassiades TP, Davison KS, Hanley DA, Ioannidis G, Jackson SA, Josse RG, Kaiser SM, Kovacs CS, Leslie WD, Morin SN, Papaioannou A, Prior JC, Shyta E, Silvia A, Towheed T, Goltzman D. Predictors of imminent non-vertebral fracture in elderly women with osteoporosis, low bone mass, or a history of fracture, based on data from the population-based Canadian Multicentre Osteoporosis Study (CaMos). Arch Osteoporos 2019; 14:53. [PMID: 31098708 DOI: 10.1007/s11657-019-0598-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/07/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Using data from the Canadian Multicentre Osteoporosis Study, several risk factors predictive of imminent (2-year) risk of low-trauma non-vertebral fracture among high-risk women were identified, including history of falls, history of low-trauma fracture, poorer physical function, and lower T score. Careful consideration should be given to targeting this population for therapy. PURPOSE Fracture risk assessment has focused on a long-term horizon and populations with a broad risk range. For elderly women with osteoporosis or low bone mass, or a history of fragility fractures ("high-risk women"), risk prediction over a shorter horizon may have greater clinical relevance. METHODS A repeated-observations design and data from the Canadian Multicentre Osteoporosis Study were employed. Study population comprised women aged ≥ 65 years with T score (total hip, femoral neck, spine) ≤ - 1.0 or prior fracture. Hazard ratios (HR) for predictors of low-trauma non-vertebral fracture during 2-year follow-up were estimated using multivariable shared frailty model. RESULTS The study population included 3228 women who contributed 5004 observations; 4.8% experienced low-trauma non-vertebral fracture during the 2-year follow-up. In bivariate analyses, important risk factors included age, back pain, history of falls, history of low-trauma fracture, physical function, health status, and total hip T score. In multivariable analyses, only four independent predictors were identified: falls in past 12 months (≥ 2 falls: HR = 1.9; 1 fall: HR = 1.5), low-trauma fracture in past 12 months (≥ 1 fracture: HR = 1.7), SF-36 physical component summary score (≤ 42.0: HR = 1.6), and total hip T score (≤ - 3.5: HR = 3.7; > - 3.5 to ≤ - 2.5: HR = 2.5; > - 2.5 to ≤ - 1: HR = 1.3). CONCLUSIONS Imminent risk of low-trauma non-vertebral fracture is elevated among high-risk women with a history of falls or low-trauma fracture, poorer physical function, and lower T score. Careful consideration should be given to identifying and targeting this population for therapy.
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Affiliation(s)
| | - Claudie Berger
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Derek Weycker
- Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA.
| | | | | | - David A Hanley
- Cumming School of Medicine, University of Calgary, Calgary, AL, Canada
| | | | | | | | | | | | | | | | | | | | - Erinda Shyta
- Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA
| | - Amanda Silvia
- Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA
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Calcium plus vitamin D supplementation and height loss: findings from the Women's Health Initiative Calcium and Vitamin D clinical trial. Menopause 2018; 23:1277-1286. [PMID: 27483038 DOI: 10.1097/gme.0000000000000704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The aim of this study was to determine the associations between calcium + vitamin D supplementation (vs placebo) and height loss in 36,282 participants of the Women's Health Initiative Calcium and Vitamin D trial. METHODS Post hoc analysis of data from a double-blind randomized controlled trial of 1,000 mg of elemental calcium as calcium carbonate with 400 IU of vitamin D3 daily (CaD) or placebo in postmenopausal women at 40 US clinical centers. Height was measured annually (mean follow-up 5.9 y) with a stadiometer. RESULTS Average height loss was 1.28 mm/y among participants assigned to CaD versus 1.26 mm/y for women assigned to placebo (P = 0.35). Effect modification of the CaD intervention was not observed by age, race/ethnicity, or baseline intake of calcium or vitamin D. Randomization to the CaD group did not reduce the risk of clinical height loss (loss of ≥1.5 inches [3.8 cm]: hazard ratio (95% CI) = 1.00 (0.81, 1.23). A strong association (P < 0.001) was observed between age group and height loss. When we censored follow-up data in participants who became nonadherent to study pills, the results were similar to those of our primary analysis. CONCLUSIONS Compared with placebo, the CaD supplement used in this trial did not prevent height loss in healthy postmenopausal women.
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Crandall CJ. Risk Assessment Tools for Osteoporosis Screening in Postmenopausal Women: A Systematic Review. Curr Osteoporos Rep 2015; 13:287-301. [PMID: 26233285 DOI: 10.1007/s11914-015-0282-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Osteoporotic fractures are common in postmenopausal women. Tools are available to estimate the risk of low bone mineral density (BMD) or fracture. This systematic review retrieved articles that evaluated osteoporosis risk assessment tools among postmenopausal women in North America. For identifying BMD T-score ≤-2.5, most studies of the Simple Calculated Osteoporosis Risk Estimation tool (SCORE) and Osteoporosis Risk Assessment Instrument (ORAI) reported sensitivity ≥90 %. Area under the receiver operating characteristic curve (AUC) was usually <0.75 for SCORE and ≥0.75 for ORAI. Among women 50-64 years old, a Fracture Risk Assessment Tool (FRAX) threshold ≥9.3 % had a sensitivity of 33 % for identifying BMD T-score ≤-2.5 and 26 % for predicting major osteoporotic fracture (MOF). For predicting MOF, sensitivity was higher for SCORE and Osteoporosis Self-assessment Tool equation (OST), and higher in women ≥65 years old. For predicting BMD T-score ≤-2.5 in women ≥65 years old, the sensitivities of SCORE; ORAI; and Age, Body Size, No Estrogen (ABONE) were very high. No optimal osteoporosis risk assessment tool is available for identifying low BMD and MOF risk.
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Affiliation(s)
- Carolyn J Crandall
- David Geffen School of Medicine, University of California, Los Angeles, UCLA Medicine/GIM, 911 Broxton Ave., 1st floor, Los Angeles, CA, 90024, USA,
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Leslie WD, Morin S. Fracture burden in relation to low bone mineral density and FRAX(®) probability. J Clin Densitom 2011; 14:279-85. [PMID: 21723761 DOI: 10.1016/j.jocd.2011.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 04/24/2011] [Accepted: 04/24/2011] [Indexed: 10/18/2022]
Abstract
Although the risk of fracture increases exponentially with declining bone mineral density, most fragility fractures have been shown to occur in individuals who do not meet the conventional densitometric definition for osteoporosis. The World Health Organization fracture risk assessment tool (FRAX(®)) estimates individual 10-yr major osteoporotic and hip fracture probabilities. Intervention criteria based on risk assessment have been proposed by several groups, including the National Osteoporosis Foundation (NOF). We determined the relationship between 10-yr fracture probability and subsequent fracture burden in 36,730 women and 2873 men aged 50yr and older. Using a major fracture probability cutoff of 20%, 29.4% of major osteoporotic fractures were identified in women and 4.9% in men. Based on a hip fracture probability cutoff of 3%, 54.1% of major osteoporotic fractures were detected in women and 53.4% in men. Using all NOF criteria, 65.9% of major osteoporotic fractures were detected in women and 69.3% in men. We conclude that men and women with FRAX probabilities below the high-risk NOF cutoffs have a high burden of major osteoporotic fractures. Strategies to enhance risk stratification in this group should be developed through international collaborations.
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Affiliation(s)
- William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.
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Sausbier U, Dullin C, Missbach-Guentner J, Kabagema C, Flockerzie K, Kuscher GM, Stuehmer W, Neuhuber W, Ruth P, Alves F, Sausbier M. Osteopenia due to enhanced cathepsin K release by BK channel ablation in osteoclasts. PLoS One 2011; 6:e21168. [PMID: 21695131 PMCID: PMC3114853 DOI: 10.1371/journal.pone.0021168] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 05/23/2011] [Indexed: 01/05/2023] Open
Abstract
Background The process of bone resorption by osteoclasts is regulated by Cathepsin K, the lysosomal collagenase responsible for the degradation of the organic bone matrix during bone remodeling. Recently, Cathepsin K was regarded as a potential target for therapeutic intervention of osteoporosis. However, mechanisms leading to osteopenia, which is much more common in young female population and often appears to be the clinical pre-stage of idiopathic osteoporosis, still remain to be elucidated, and molecular targets need to be identified. Methodology/Principal Findings We found, that in juvenile bone the large conductance, voltage and Ca2+-activated (BK) K+ channel, which links membrane depolarization and local increases in cytosolic calcium to hyperpolarizing K+ outward currents, is exclusively expressed in osteoclasts. In juvenile BK-deficient (BK−/−) female mice, plasma Cathepsin K levels were elevated two-fold when compared to wild-type littermates. This increase was linked to an osteopenic phenotype with reduced bone mineral density in long bones and enhanced porosity of trabecular meshwork in BK−/− vertebrae as demonstrated by high-resolution flat-panel volume computed tomography and micro-CT. However, plasma levels of sRANKL, osteoprotegerin, estrogene, Ca2+ and triiodthyronine as well as osteoclastogenesis were not altered in BK−/− females. Conclusion/Significance Our findings suggest that the BK channel controls resorptive osteoclast activity by regulating Cathepsin K release. Targeted deletion of BK channel in mice resulted in an osteoclast-autonomous osteopenia, becoming apparent in juvenile females. Thus, the BK−/− mouse-line represents a new model for juvenile osteopenia, and revealed the BK channel as putative new target for therapeutic controlling of osteoclast activity.
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Affiliation(s)
- Ulrike Sausbier
- Department of Pharmacology and Toxicology, Institute of Pharmacy, University of Tübingen, Tübingen, Germany
| | - Christian Dullin
- Department of Diagnostic Radiology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Clement Kabagema
- Department of Pharmacology and Toxicology, Institute of Pharmacy, University of Tübingen, Tübingen, Germany
| | - Katarina Flockerzie
- Department of Pharmacology and Toxicology, Institute of Pharmacy, University of Tübingen, Tübingen, Germany
| | - Gerd Marten Kuscher
- Max-Planck-Institute for Experimental Medicine, Department of Molecular Biology of Neuronal Signals, Göttingen, Germany
| | - Walter Stuehmer
- Max-Planck-Institute for Experimental Medicine, Department of Molecular Biology of Neuronal Signals, Göttingen, Germany
| | - Winfried Neuhuber
- Institute for Anatomy, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Peter Ruth
- Department of Pharmacology and Toxicology, Institute of Pharmacy, University of Tübingen, Tübingen, Germany
| | - Frauke Alves
- Max-Planck-Institute for Experimental Medicine, Department of Molecular Biology of Neuronal Signals, Göttingen, Germany
- Department of Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Matthias Sausbier
- Department of Pharmacology and Toxicology, Institute of Pharmacy, University of Tübingen, Tübingen, Germany
- * E-mail:
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