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Pflug EM, Lott A, Konda SR, Leucht P, Tejwani N, Egol KA. Bone Health Evaluations and Secondary Fragility Fractures in Hip Fracture Patients. Hip Pelvis 2024; 36:55-61. [PMID: 38420738 DOI: 10.5371/hp.2024.36.1.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 03/02/2024] Open
Abstract
Purpose This study sought to examine the utilization of bone health evaluations in geriatric hip fracture patients and identify risk factors for the development of future fragility fractures. Materials and Methods A consecutive series of patients ≥55 years who underwent surgical management of a hip fracture between September 2015 and July 2019 were identified. Chart review was performed to evaluate post-injury follow-up, performance of a bone health evaluation, and use of osteoporosis-related diagnostic and pharmacologic treatment. Results A total of 832 patients were included. The mean age of the patients was 81.2±9.9 years. Approximately 21% of patients underwent a comprehensive bone health evaluation. Of this cohort, 64.7% were started on pharmacologic therapy, and 73 patients underwent bone mineral density testing. Following discharge from the hospital, 70.3% of the patients followed-up on an outpatient basis with 95.7% seeing orthopedic surgery for post-fracture care. Overall, 102 patients (12.3%) sustained additional fragility fractures within two years, and 31 of these patients (3.7%) sustained a second hip fracture. There was no difference in the rate of second hip fractures or other additional fragility fractures based on the use of osteoporosis medications. Conclusion Management of osteoporosis in geriatric hip fracture patients could be improved. Outpatient follow-up post-hip fracture is almost 70%, yet a minority of patients were started on osteoporosis medications and many sustained additional fragility fractures. The findings of this study indicate that orthopedic surgeons have an opportunity to lead the charge in treatment of osteoporosis in the post-fracture setting.
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Affiliation(s)
- Emily M Pflug
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Ariana Lott
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Sanjit R Konda
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Philipp Leucht
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Nirmal Tejwani
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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2
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Triantafyllopoulos G, Mitsea A, Rontogianni A, Korres D. Osteoporosis Screening Using Dental Panoramic Radiographs and Age at Menarche. Diagnostics (Basel) 2023; 13:diagnostics13050881. [PMID: 36900024 PMCID: PMC10000716 DOI: 10.3390/diagnostics13050881] [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: 02/08/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
Since early detection of osteoporosis is essential, the development of an efficient and cost-effective screening model would be incredibly beneficial. The aim of this study was to evaluate the diagnostic accuracy of MCW and MCI indices from dental panoramic radiographs in combination with a new variable, age at menarche, for the detection of osteoporosis. The study enrolled 150 Caucasian women (aged 45 to 86) who met the eligibility criteria, had DXA scans of the left hip and lumbar spine (L2 to L4), and were classified as osteoporotic, osteopenic, or normal based on T-score. Two observers evaluated MCW and MCI indexes on panoramic radiographs. There was a statistically significant correlation between the T-score and MCI and MCW. In addition, age at menarche had a statistically significant correlation with T-score (p = 0.006). In conclusion, in the current study, MCW proved to be more effective in detecting osteoporosis when combined with age at menarche. Individuals with MCW less than 3.0 mm and age at menarche later than 14 years old should be referred for DXA since they present high risk of osteoporosis.
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Affiliation(s)
| | - Anastasia Mitsea
- Dental School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-6937025812
| | - Aliki Rontogianni
- Dental School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Demitrios Korres
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Shim YB, Park JA, Nam JH, Hong SH, Kim JW, Jeong J, Shin JY. Incidence and risk factors of subsequent osteoporotic fracture: a nationwide cohort study in South Korea. Arch Osteoporos 2020; 15:180. [PMID: 33188505 DOI: 10.1007/s11657-020-00852-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/05/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study analyzed the incidence and risk factors of subsequent osteoporotic fractures in South Korea. The results showed that the incidence rate of subsequent fractures within 24 months was 10.23 per 100 person-years. Additionally, the index hip fracture site was a significant risk factor for a subsequent fracture. PURPOSE To identify and analyze the incidence and risk factors of subsequent osteoporotic fractures in South Korea. METHODS This retrospective cohort study analyzed data from the National Health Insurance Review and Assessment claims database from 2012 to 2017. Men and women with osteoporosis, aged ≥50 years, with index fractures between July 1, 2014, and July 1, 2015, were included. The incidence rate of subsequent fractures was calculated by determining the number of second event within 2 years from the index fracture. To identify the risk factors for subsequent fractures, we applied the Cox proportional hazard model to estimate the hazard ratios (HRs). RESULTS Of the 73,717 patients with osteoporotic fractures, 13,203 (17.91%) had a subsequent fracture. The incidence rate of subsequent fractures within 24 months was 10.23/100 person-years. The index fracture site was a significant risk factor for a subsequent fracture, with the hip showing the highest risk (HR, 7.51; 95% confidence interval [CI], 6.77-8.34), followed by the vertebra (HR, 1.99; 95% CI, 1.91-2.06). The risk of subsequent fractures increased with a higher Charlson Comorbidity Index (CCI) score (CCI score ≥ 5: HR, 1.79; 95% CI, 1.67-1.92). CONCLUSION The incidence rate of subsequent osteoporotic fractures in South Korea is similar or higher than that reported in the USA and Europe. A hip fracture within the prior 2 years, relative to other fracture sites, significantly increased the risk of subsequent fractures in osteoporosis patients. Patients who have these risk factors need closer disease management to prevent subsequent fractures.
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Affiliation(s)
- Yoon-Bo Shim
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, Republic of Korea
| | - Jae-A Park
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, Republic of Korea
| | - Jin Hyun Nam
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, Republic of Korea
| | - Sung-Hyun Hong
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, Republic of Korea. .,Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea.
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Lee I, Kim J, Kang H. Cardiorespiratory Fitness is Inversely Associated with Risk of Low Bone Mineral Density in Older Korean Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217907. [PMID: 33126597 PMCID: PMC7663600 DOI: 10.3390/ijerph17217907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022]
Abstract
Little is known regarding the association between physical fitness and bone health in older Korean men. This study investigated the relationship between estimated cardiorespiratory fitness (eCRF) and bone mineral density (BMD). This cross-sectional study included 2715 Korean men aged 50 years and older selected from those who participated in the 2008–2011 Korea National Health and Nutritional Examination and Survey. eCRF was obtained using a sex-specific algorithm developed on the basis of age, body mass index, resting heart rate, and physical activity and classified into low, middle, and high categories. Femoral neck BMD was assessed by dual X-ray absorptiometry. Odds ratios (OR) and 95% confidence intervals (CI) for osteopenia, osteoporosis, and low BMD were calculated for eCRF categories in models fully adjusted for age, waist circumference, education, income, smoking, heavy alcohol intake, serum vitamin D, serum parathyroid hormone, and dietary intake of energy, protein, calcium, and vitamins A and C. Overall, eCRF levels were positively associated with BMD and negatively with prevalence of osteopenia, osteoporosis, and low BMD. Logistic regression showed inverse trends in the risks of osteopenia (high vs. low: OR = 0.692; 95% CI, 0.328–0.517; p = 0.049) and low BMD (high vs. low: OR = 0.669; 95% CI, 0.497–0.966; p = 0.029) by eCRF category in models fully adjusted for all the measured covariates. The current findings suggest that maintaining high eCRF via regular physical activity may contribute to attenuation of age-related loss of BMD and decreased risk for low BMD in older Korean men.
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Llorente I, Merino L, Escolano E, Quintanilla DM, García-Vadillo JA, González-Álvaro I, Castañeda S. Reproducibility of Metacarpal Bone Mineral Density Measurements Obtained by Dual-Energy X-Ray Absorptiometry in Healthy Volunteers and Patients With Early Arthritis. J Clin Densitom 2020; 23:678-684. [PMID: 30910402 DOI: 10.1016/j.jocd.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 01/01/2023]
Abstract
Reduction in cortical bone mineral density at diaphysis of metacarpal bones of the hand, evaluated by dual X-ray radiogrammetry, has a bad prognostic value in patients with early arthritis. Nevertheless, this technique is hardly accessible in clinical practice. By contrast, evaluation of cortical bone mineral density at that location has not been previously assessed by conventional dual X-ray absorptiometry. The aim of this study is to evaluate the reproducibility of bone mineral density measurements at diaphysis of metacarpal bones using conventional dual X-ray densitometry in a population of healthy volunteers and patients with early arthritis. Nondominant hand dual X-ray densitometry was performed at three consecutive times with complete hand replacement in 27 subjects: 10 early arthritis and 17 healthy volunteers. Three different evaluators analyzed the 3 measurements of second to fourth metacarpal bones. To assess the reproducibility and accuracy of the measurements, intra- and interobserver agreement degrees, intra- and interclass correlation coefficients, smallest difference detectable assessment, and Bland Altman graphs were calculated. The coefficients of variation obtained for the different metacarpal evaluations were 2.25%, 2.91%, 2.85%, and 2.07% for metacarpal-2, metacarpal-3, metacarpal-4, and mean metacarpal-second to fourth, respectively, with a smallest difference detectable of 0.028, 0.034, 0.028, and 0.03 g/cm2, respectively. The mean intra- and interobserver correlation coefficients between of metacarpal second to fourth were 0.990 (95% confidence interval [CI]: 0.982-0.995) and 0.995 (95% CI: 0.991-0.997), respectively. As expected, women had lower bone mineral density at metacarpal bones, especially after menopause. The results obtained in this study show an excellent reproducibility of bone mineral density measurements at diaphysis of metacarpal bones of the hand, measured by conventional dual X-ray densitometry, in a mixed population of healthy subjects and patients with early arthritis. This is of great interest for longitudinal studies in patients with early arthritis.
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Affiliation(s)
- Irene Llorente
- Rheumatology Department, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
| | - Leticia Merino
- Rheumatology Department, Hospital Universitario de San Pedro, Logroño, Rioja, Spain
| | - Eugenio Escolano
- Radiology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | | | - Santos Castañeda
- Rheumatology Department, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain.
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Kim DG, Seo GW, Nam HW. Trends in the Diagnosis of Osteoporosis in Patients with Distal Radius Fractures Based on a National Claims Database. J Bone Metab 2019; 26:247-252. [PMID: 31832390 PMCID: PMC6901691 DOI: 10.11005/jbm.2019.26.4.247] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/21/2019] [Accepted: 10/31/2019] [Indexed: 11/11/2022] Open
Abstract
Background A history of osteoporotic fractures is strongly associated with the subsequent osteoporotic fractures. To prevent subsequent fractures, the diagnosis and treatment of osteoporosis following osteoporotic fractures are very important. A distal radius fracture (DRF) is the second most common type of osteoporotic fracture in South Korea. We analyzed the rate of osteoporosis diagnosis within 6 months post-DRF. Methods We used data from the Korean Health Insurance Review and Assessment Service nationwide claims database from 2010 to 2016. International Classification of Diseases, 10th revision codes and procedures codes were used to identify patients aged over 50 years with newly diagnosed DRFs; the osteoporosis assessments of these patients were then analyzed. We used Cochran-Armitage trend test to examine trends in osteoporosis diagnosis. Results A search of database identified 77,209 DRFs in patient aged above 50 years of age from 2011 to 2016. Among these patients, only 19,305 (25.0%) underwent diagnostic examination for osteoporosis. The number of osteoporosis examinations increased slightly, but not significantly, every year (P=0.061). Conclusions Clinicians who treat DRFs shoulder also evaluated patients for osteoporosis after DRFs.
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Affiliation(s)
- Dae Geun Kim
- Department of Orthopedic Surgery, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Gi-Won Seo
- Department of Orthopedic Surgery, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Hye-Won Nam
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Korea
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Balto KA, Gomaa MM, Feteih RM, AlAmoudi NM, Elsamanoudy AZ, Hassanien MA, Ardawi MSM. Dental Panoramic Radiographic Indices as a Predictor of Osteoporosis in Postmenopausal Saudi Women. J Bone Metab 2018; 25:165-173. [PMID: 30237996 PMCID: PMC6135653 DOI: 10.11005/jbm.2018.25.3.165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 01/27/2023] Open
Abstract
Background Many oral presentations of osteoporosis-a bone metabolic disease-were recorded. Thus, we aimed to assess panoramic radiomorphometric indices with bone mineral density (BMD) values among Saudi postmenopausal women and its importance in the prediction of osteoporosis. Methods A total of 431 Saudi women were enrolled in this study. Panoramic radiographs were obtained at the time of BMD measurement. Subjects were fatherly classified into; normal BMD, osteopenia, and osteoporosis groups. Serum follicle-stimulating hormone, luteinizing hormone (LH), estradiol (E2), 25-hydroxy-vitamin D (25[OH]D) and intact-parathyroid hormone were measured. Moreover, serum creatinine, calcium, and phosphate, together with serum osteocalcin (s-OC), procollagen type I N-terminal propeptide (s-PINP) and cross-linked C-terminal telopeptide of type 1 collagen (s-CTX) were measured. Receiver-operator curve (ROC) curve analysis for use of mandibular cortical width (MCW), panoramic mandibular index (PMI), and maxillary-mandibular ratio (M/M ratio) to differentiate women with osteoporosis or osteopenia from normal subjects was calculated. Cut off values of 4.6 at T score <−1 and 4.1 at T score ≤−2.5 were used. Results Body mass index is significantly low in the osteoporotic group. There is no significant difference in serum levels of LH, E2, calcium, phosphate, and 25(OH)D between the studied groups. Moreover, s-OC, C-terminal propeptide of procollagen type I, s-PINP, s-CTX, and urinary-CTX are significantly higher in osteoporosis than normal and osteopenia groups. ROC curve analysis revealed that MCW and PMI showed significant data while M/M ratio is non-significant. Conclusions It could be concluded that MCW as an important panoramic radiographic parameter can be used for prediction and diagnosis of osteoporosis in postmenopausal Saudi women with low BMD.
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Affiliation(s)
- Khaled Abdullah Balto
- Center of Excellence for Osteoporosis Research, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Endodontics, Faculty of Dentistry, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Madiha Mahmoud Gomaa
- Center of Excellence for Osteoporosis Research, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Endodontics, Faculty of Dentistry, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rabab Mohammed Feteih
- Center of Excellence for Osteoporosis Research, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Orthodontics and Maxillofacial Orthopedics, Faculty of Dentistry, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Najlaa Mohammed AlAmoudi
- Center of Excellence for Osteoporosis Research, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ayman Zaky Elsamanoudy
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Ahmed Hassanien
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed-Salleh M Ardawi
- Center of Excellence for Osteoporosis Research, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
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Yoon BH, Yu W. Clinical Utility of Biochemical Marker of Bone Turnover: Fracture Risk Prediction and Bone Healing. J Bone Metab 2018; 25:73-78. [PMID: 29900156 PMCID: PMC5995756 DOI: 10.11005/jbm.2018.25.2.73] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 05/31/2018] [Accepted: 05/31/2018] [Indexed: 12/29/2022] Open
Abstract
Bone turnover markers (BTMs) are released during bone remodeling and are thought to reflect the metabolic activity of bone at the cellular level. This review examines BTM as a biological response marker for monitoring future fracture prediction and fracture healing processes. Substantial evidence has been of high value to investigate the use of BTM in fracture risk prediction; nevertheless, the conclusions of some studies are inconsistent due to their large variability. BTM is promising for fracture risk prediction for adopting international reference standards or providing absolute risks, such as 10-year fracture probabilities. There are uncertainties over their clinical use for monitoring osteoporotic fracture healing. More rigorous evidence is needed that can provide more detailed insights for fracture healing and for ascertaining the progression of fracture healing.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Woojin Yu
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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