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Gumuchdjian DA, Waltenspül M, Dietrich M, Kabelitz M. Hip Axis Length and Femoral Neck-Shaft Angle as Risk Factors for Proximal Femur Fractures in Octogenarians to Centenarians. J Clin Med 2024; 13:4071. [PMID: 39064111 PMCID: PMC11278120 DOI: 10.3390/jcm13144071] [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: 06/05/2024] [Revised: 07/06/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: The prevention of proximal femoral fractures among people of very advanced age is relevant as they are common and increasing in number. The aim of this study was to determine if the hip axis length (HAL) and the neck-shaft angle (caput-collum-diaphyseal CCD) are risk factors for those fractures among people aged 80 years and over. Consequently, it was additionally analysed if these parameters are associated with a certain fracture type. (2) Methods: Anteroposterior radiographs of the pelvis were collected to form three groups (femoral neck fractures (FNFx), trochanteric fractures (TFx) and non-fractured femora (NFx)). Two independent blinded observers separately conducted each measurement of the HAL and CCD. Statistical analysis was performed to determine the association between the measured parameters and type of fracture. (3) Results: One hundred and fifty patients (50 per group) were examined, of which the mean age was 92.7 ± 3.5 (range 81-104) years. Both the HAL and CCD of the FNFx group were significantly larger than in the TFx group (p = 0.013, 0.003). The CCD was higher in the FNFx than that of the NFx group (p = 0.001). No further significant differences of HAL and CCD were observed between the groups. (4) Conclusions: For people aged 80 years and over, an increased HAL represented no risk factor for proximal femur fractures, and a large HAL was associated with an increased occurrence of FNFx instead of TFx. A large CCD was associated with an increased risk of suffering a femoral neck fracture, showing evidence of the CCD being a risk factor for the extremely old population.
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Affiliation(s)
| | | | | | - Method Kabelitz
- Clinic for Orthopaedics, Trauma Surgery and Hand Surgery, Stadtspital Zürich, Tièchestrasse 99, 8037 Zürich, Switzerland; (D.A.G.); (M.W.); (M.D.)
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2
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Li H, Sun T, Han D, Gong W, Mao W, Gan X, Shu D, Zhou Q, Xu L, Hou L, Zhou M, Cai M, Lai X. Risk factors of osteoporosis in elderly inpatients: A cross-sectional single-centre study. FRONTIERS IN AGING 2023; 4:1126172. [PMID: 37229241 PMCID: PMC10204113 DOI: 10.3389/fragi.2023.1126172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/28/2023] [Indexed: 05/27/2023]
Abstract
Objective: This study aimed to identify factors significantly associated with the occurrence of osteoporosis in elderly and very elderly patients. Methods: Elderly hospitalized patients who were older than 60 years old, from the Rehabilitation Hospital from December 2019 to December 2020 were selected. Barthel index (BI), nutritional assessment, the causes of bone mineral density (BMD) reductions in elderly and elderly patients were analysed. Results: A total of 94 patients (83.56 ± 8.37 years old) were enrolled. With increasing age, the BMD of the lumbar spine, femoral neck, and femoral shaft of elderly patients significantly decreased, and the incidence of osteoporosis (OP) significantly increased. The BMD of the lumbar spine was negatively correlated with female and positively correlated with serum 25-hydroxyvitamin D levels, the difference between actual body weight and ideal body weight, and blood uric acid levels; The BMD of the femoral neck was negatively correlated with age and female, and positively correlated with height and geriatric nutrition risk index score. The BMD of the femoral shaft was negatively correlated with female and positively correlated with BI. Conclusion: With increasing age, the BMD of the lumbar spine and the femoral shaft significantly decreased, and the incidence of OP significantly increased in elderly and very elderly patients. Aric acid may protect bone health in elderly patients. Early attention to the nutritional status, exercise capacity, 25-hydroxyvitamin D level, and blood uric acid level in the elderly population can help identify high-risk elderly patients with OP.
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Affiliation(s)
- Han Li
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
| | - Tianbao Sun
- The Rehabilitation Department, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Dongmei Han
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Weiwei Gong
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Weiwei Mao
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Xianze Gan
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Dan Shu
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Qian Zhou
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Lei Xu
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Liufang Hou
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | | | - Mingwei Cai
- The Rehabilitation Department of Orthopedics, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Xueli Lai
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, China
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Wang Z, Zhong Z, Feng H, Mei J, Feng X, Wang B, Sun L. The impact of disease time, cervical alignment and range of motion on cervical vertebral Hounsfield unit value in surgery patients with cervical spondylosis. J Orthop Surg Res 2023; 18:187. [PMID: 36899400 PMCID: PMC9999622 DOI: 10.1186/s13018-023-03675-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023] Open
Abstract
STUDY DESIGN This study was a retrospective review. OBJECTIVE Bone mineral density (BMD) at the surgical site is associated with complications of surgical internal fixation, and it is very important to study the cervical BMD of patients with cervical spondylosis who need surgery and the related factors that affect cervical BMD. It is still unclear about the age-related influence of disease time, cervical alignment and range of motion (ROM) on cervical vertebral Hounsfield unit (HU) value. METHODS This retrospective study was conducted on patients who underwent cervical surgery at one institution between January 2014 and December 2021. Age, sex, body mass index (BMI), disease type, comorbidities, neck pain, disease time, C2-7 Cobb angle (CA), cervical ROM and the C2-C7 vertebral HU value were recorded. The association between cervical HU value and each parameter of interest was assessed using the Pearson correlation coefficient. Multivariable linear regression analysis was performed to examine the relative influence of the multiple factors on cervical vertebral HU value. RESULTS Among patients younger than 50 years old, the HU value of the cervical vertebral in females was higher than that of males, but after the age of 50 years, the value of females was lower than that of males and decreased significantly after 60 years old. In addition, cervical HU value was significantly correlated with the disease time, flexion CA and ROM. Our age-related subgroup of multivariate linear regression analyses shows that disease time and flexion CA negatively affected the C6-7 HU value in more than 60-year-old males and in more than 50-year-old females. CONCLUSIONS Disease time and flexion CA were negatively affecting the C6-7 HU values in more than 60-year-old males and in more than 50-year-old females. More attention should be paid to bone quality in cervical spondylosis patients with longer disease time and larger convex of flexion CA.
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Affiliation(s)
- Zhiqiang Wang
- Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zaowei Zhong
- Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Haoyu Feng
- Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jun Mei
- Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoning Feng
- Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Beiyang Wang
- Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lin Sun
- Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China. .,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Zhu H, Li Z, Zhou Y, Zheng R, Diao C, Li K, Feng Q, Wang D. Neutrophil-lymphocyte ratio as a risk factor for osteoporotic vertebrae fractures and femoral neck fractures. Medicine (Baltimore) 2022; 101:e32125. [PMID: 36482639 PMCID: PMC9726278 DOI: 10.1097/md.0000000000032125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022] Open
Abstract
Fracture is associated with osteopenia after osteoporosis. Neutrophil-lymphocyte ratio (NLR) is common in inflammatory diseases. NLR can be used as an effective clinical tool to assess postmenopausal osteoporosis. The aim of this study is to further explore the relationship between elevated NLR and the severity of osteoporotic vertebrae fractures and femoral neck fracture based on magnetic resonance imaging (MRI). A total of 80 patients with osteoporotic vertebrae fractures, osteoporotic femoral neck fracture in Baoding Second Central Hospital from 2017 to 2020 were selected as the research objects. This study included a series of pretreatment factors, mainly including white blood cell count, red blood cell count, hemoglobin, and the general condition of the patients. Statistical methods included Pearson chi-square test, Spearman correlation test, logistic regression analysis and receiver operator characteristic (ROC) curve. According to Pearson chi-square test, Spearman correlation test, univariate/multivariate logistic regression analysis, the severity of osteoporotic vertebrae fractures, osteoporotic femoral neck fracture was significantly correlated with NLR (P < .001). NLR (odds ratio [OR] = 13.229, 95% CI: 4.167-41.998, P < .001) was a significant independent risk factor for osteoporotic vertebrae fractures, osteoporotic femoral neck fracture. receiver operator characteristic (ROC) curve was used to detect the specificity and sensitivity. The level of NLR has an important influence on the severity of osteoporotic vertebrae fractures and femoral neck fracture. The higher the level of NLR, the more serious the osteoporotic vertebrae fractures and femoral neck fracture.
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Affiliation(s)
- Hao Zhu
- Department of Orthopedics, The Second Central Hospital of Baoding, Zhuozhou City, Hebei Province, PR China
| | - Zheng Li
- Department of Orthopedics, The Second Central Hospital of Baoding, Zhuozhou City, Hebei Province, PR China
| | - Yizhai Zhou
- Department of Orthopedics, The Second Central Hospital of Baoding, Zhuozhou City, Hebei Province, PR China
| | - Rugeng Zheng
- Department of Orthopedics, The Second Central Hospital of Baoding, Zhuozhou City, Hebei Province, PR China
| | - Cong Diao
- Obstetrics Department, The Second Central Hospital of Baoding, Zhuozhou City, Hebei Province, PR China
| | - Kepeng Li
- Department of Orthopedics, The Second Central Hospital of Baoding, Zhuozhou City, Hebei Province, PR China
| | - Qi Feng
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Donglai Wang
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
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Migliorini F, Colarossi G, Eschweiler J, Oliva F, Driessen A, Maffulli N. Antiresorptive treatments for corticosteroid-induced osteoporosis: a Bayesian network meta-analysis. Br Med Bull 2022; 143:46-56. [PMID: 35641234 PMCID: PMC9494254 DOI: 10.1093/bmb/ldac017] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/01/2022] [Accepted: 05/08/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Corticosteroid-induced osteoporosis (CIO) is the most common type of secondary osteoporosis, leading to fractures, and increased morbidity and mortality. SOURCE OF DATA Pubmed, EMBASE, Scopus and Google Scholar databases. AREAS OF AGREEMENT Prolonged glucocorticoids administration leads to secondary osteoporosis. AREAS OF CONTROVERSY The optimal management for CIO is controversial. GROWING POINTS The present study compared bone mineral density, fractures and adverse events in patients undergoing treatment with risedronate, alendronate, zoledronate, denosumab or etidronate for CIO. AREAS TIMELY FOR DEVELOPING RESEARCH For selected patients with CIO, alendronate performed better overall. These results must be interpreted within the limitations of the present study. LEVEL OF EVIDENCE I, Bayesian network meta-analysis of randomized clinical trials.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, Aachen 52074, Germany
| | - Giorgia Colarossi
- Department of Orthopaedic and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, Aachen 52074, Germany
| | - Jörg Eschweiler
- Department of Orthopaedic and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, Aachen 52074, Germany
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy
| | - Arne Driessen
- Department of Orthopaedic and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, Aachen 52074, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London ST4 7JD, UK
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Favarato MHS, Almeida MFD, Lichtenstein A, Martins MDA, Junior MF. Risk of osteoporotic fracture in women using the FRAX tool with and without bone mineral density score in patients followed at a tertiary outpatient clinic ‒ An observational study. Clinics (Sao Paulo) 2022; 77:100015. [PMID: 35290857 PMCID: PMC8918849 DOI: 10.1016/j.clinsp.2022.100015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Fragility fractures increase morbidity and mortality. Adding assessment of clinical risk factors independently or as a previous step to Bone Densitometry (BD) should provide better accuracy in fracture risk prediction. FRAX tool might be used to stratify patients in order to rationalize the need for BD and risk classification. The primary objective of this study is to describe and perform comparisons between the estimated risk of fractures in 10 years using the FRAX calculator based on clinical factors with and without BD results for women aged 40 or more with clinical diseases monitored in tertiary care service in internal medicine. METHODS Cross-sectional. Women over 40 years with BD in the previous year. After medical chart review, identification of risk factors and risk estimations using FRAX-BRAZIL with (FRAX BDI) and without (FRAX BDNI) the inclusion of T-score. RESULTS 239 women. Age 65 ± 10.35 years. BMI 29.68 ± 6.27kg/m2. RISK FACTORS 32(13.4%) previous fractures; 23 (9.6%) current smoking; 78 (32.6%) corticosteroids use; 44 (18.4%) rheumatoid arthritis; 38 (15.9%) secondary causes; FRAX scores were higher when BD was not included. Spearman correlation coefficients between FRAX BDNI and FRAX BDI for major fractures r = 0.793 (95% CI 0.7388‒0.836). For hip fractures r = 0.6922 (95% CI 0.6174‒0.75446) CONCLUSION: Using FRAX to estimate 10-year fracture risk without BD data might be a reliable tool for screening, even for patients with a high prevalence of risk factors, improving accessibility and equity in health systems. The present study's data suggest an overestimation of fracture risk with FRAX BDNI, suggesting that it is safe to be widely used as a screening tool.
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Affiliation(s)
- Maria Helena Sampaio Favarato
- Serviço de Clínica Geral e Propedêutica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - Maria Flora de Almeida
- Serviço de Clínica Geral e Propedêutica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Arnaldo Lichtenstein
- Serviço de Clínica Geral e Propedêutica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Milton de Arruda Martins
- Serviço de Clínica Geral e Propedêutica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Mario Ferreira Junior
- Serviço de Clínica Geral e Propedêutica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Comparison between real-world practice and application of the FRAX algorithm in the treatment of osteoporosis. Aging Clin Exp Res 2022; 34:2807-2814. [PMID: 35972688 PMCID: PMC9675657 DOI: 10.1007/s40520-022-02212-x] [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] [Received: 01/22/2022] [Accepted: 07/26/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS The most recent guidelines suggest treating patients whose FRAX 10-year fracture risk scores are ≥ 20%. However, this method of evaluation does not take into account parameters that are nonetheless relevant to the therapeutic choice. Our aim was to compare the therapeutic choices for treatment based on a wider assessment (real-world practice) with those based on FRAX scores, taking 20% as the cut-off score. METHODS We obtained the medical history, bone mineral density (BMD) values, and the presence of major fragility fractures in a sample of 856 postmenopausal women. The 10-year FRAX risk of major osteoporotic fracture was calculated, and patients were grouped into risk classes ("FRAX < 20%" = low, "FRAX ≥ 20%" = high); we then compared the treated and untreated patients in each class. After an average interval of 2.5 years, changes in lumbar and femoral BMD and appearances of new fragility fractures were recorded. RESULTS 83% of high-risk patients and 57% of low-risk patients were treated. The therapeutic decision was based mainly on densitometric values and the presence of vertebral fractures. At the 2.5 year follow-up, lumbar spine and femur BMD had decreased in the untreated group; 9.9% of the treated patients developed new vertebral fragility fractures, compared with 5.3% of the untreated patients. DISCUSSION AND CONCLUSIONS Our wider assessment designated as at high fracture risk a group of patients who had not been identified by the FRAX assessment. FRAX could underestimate the risk of fracture in older people, for which the therapeutic choice should consider a broader approach, also based on individual patient's needs.
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Clinical guidelines for the application of panoramic radiographs in screening for osteoporosis. Oral Radiol 2021; 37:189-208. [PMID: 33620644 DOI: 10.1007/s11282-021-00518-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/09/2021] [Indexed: 02/07/2023]
Abstract
Osteoporotic fractures are associated with an increased risk of subsequent fractures, a higher rate of mortality, and incremental medical costs. Incidental findings, which include some measurements related to the mandibular inferior cortex and the alveolar trabecular bone pattern of the mandible determined on panoramic radiographs, are considered to be a useful tool for identifying asymptomatic individuals at risk of having osteoporosis and/or fragility fractures. We undertook a worldwide literature survey and present the following clinical recommendations. Postmenopausal female dental patients with a mandibular inferior cortical width of less than 3 mm on panoramic radiographs may be at risk of having low skeletal bone mineral density (BMD) or osteoporosis, but not fragility fractures. In addition, those with a severely eroded mandibular inferior cortex may have an increased risk of having low skeletal BMD, osteoporosis, and fragility fractures. The alveolar trabecular bone pattern of the mandible might be useful for identifying female dental patients at risk of having fragility fractures, although further investigation is necessary to confirm this possibility. These incidental findings on panoramic radiographs, when used for identifying asymptomatic postmenopausal female patients at risk of having osteoporosis in general dental practice, may be helpful in reducing the incidence of first fractures, with a consequent reduction in the secondary fractures, medical costs, and mortality associated with osteoporotic fragility fractures, without incurring any additional cost.
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Lee BJ, Koo HW, Yoon SW, Sohn MJ. Usefulness of Trabecular CT Attenuation Measurement of Lumbar Spine in Predicting Osteoporotic Compression Fracture: Is the L4 Trabecular Region of Interest Most Relevant? Spine (Phila Pa 1976) 2021; 46:175-183. [PMID: 33065695 DOI: 10.1097/brs.0000000000003756] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The aim of this study was to evaluate the usefulness of computed tomography (CT) attenuation in defining trabecular region-of-interest (t-ROI) at lumbar vertebral body in the assessment of osteoporotic compression fracture (OCF) compared to spinal dual x-ray absorptiometry (DXA). SUMMARY OF BACKGROUND DATA Even though osteoporosis was not diagnosed in the bone mineral density measurement using DXA, we often experienced cases where the screw was weakly inserted due to low bone quality during screw insertion. METHODS A total of 188 patients who met the inclusion criteria were enrolled. We determined best cutoff value of the simple t-ROI attenuation at the most relevant level for predicting OCF. We assessed correlations between the simple t-ROI attenuation at the most relevant level and OCF rate, and investigate the association between the number of compression fracture and simple t-ROI attenuation at the most relevant level. RESULTS L4 ROI attenuation is the most accurate measurement for predicting osteoporotic compression fracture with an area under the curve of 0.798. The optimal cutoff point of L4 ROI attenuation was measured at 90.5 HU with 88.8% and 60.6% sensitivity and specificity, respectively. L4 ROI attenuation was significantly correlated with the osteoporotic compression fracture rate (r = -0.545, P < 0.001). The number of compression fracture (coefficient of determination R2 = 0.286; P < 0.001) was independently correlated with L4 ROI attenuation. CONCLUSION Simple t-ROI computed tomography attenuation is an accurate measurement tool in predicting OCF compared to DXA T-score. The value of L4 t-ROI attenuation is the most relevant measurement for predicting osteoporotic compression fracture, is an alternative to DXA, and can predict the number and rate of compression fractures. Spine surgeons should be aware of L4 t-ROI attenuation to make successful fusion in spine surgery for elderly patients group.Level of Evidence: 3.
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Affiliation(s)
- Byung-Jou Lee
- Department of Neurosurgery, Neuroscience & Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, College of Medicine, Goyang, Korea
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10
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Liu S, Chen R, Ding N, Wang Q, Huang M, Liu H, Xie Z, Ou Y, Sheng Z. Setting the new FRAX reference threshold without bone mineral density in Chinese postmenopausal women. J Endocrinol Invest 2021; 44:347-352. [PMID: 32495298 DOI: 10.1007/s40618-020-01315-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Despite the large number of osteoporosis patients in China, the diagnosis and treatment rates remain low. The Fracture Risk Assessment Tool (FRAX) can be used to effectively evaluate fracture risk. In this study, we explored the Chinese-specific thresholds of FRAX without the T-score. METHODS In all, 264 postmenopausal women aged > 50 years were randomly recruited from community-medical centers. All subjects completed self-reported questionnaires, BMD measurements, and spinal radiographs. The 10-year hip and major osteoporotic fracture risks were calculated by FRAX. A new threshold for both 10-year hip and major osteoporotic fracture risk was explored with receiver operating characteristic (ROC) curve analysis. RESULTS Overall, 92 subjects were diagnosed with osteoporosis. Among them, 14 participants with T-score > - 2.5 were diagnosed with osteoporosis based on clinical fractures. ROC analysis showed the cut-off value of the 10-year hip osteoporotic fracture for detecting osteoporosis was 0.95%, while that of 10-year major osteoporotic fracture was 4.95%. The sensitivity and specificity of the 10-year hip osteoporotic fracture probability for detecting osteoporosis were 0.86 and 0.59, respectively, while the guideline-recommended threshold had a sensitivity of 0.49 and specificity of 0.83. The sensitivity and specificity of the 10-year major osteoporotic fractures with the new threshold were 0.76 and 0.69, respectively, while the recommended threshold had a sensitivity of 0 and specificity of 1. CONCLUSION Current guideline-recommended FRAX thresholds without BMD showed low sensitivity. Therefore, 10-year osteoporotic hip fracture probability ≥ 0.95% and 10-year osteoporotic major fracture probability ≥ 4.95% are recommended as the new thresholds.
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Affiliation(s)
- S Liu
- Department of Metabolism and Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - R Chen
- Department of Metabolism and Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Department of Metabolism and Endocrinology, The Affiliated Zhuzhou Hospital Of XiangYa School Of Medicine, Central South University, Changjiang South Road116, Zhuzhou, 412007, Hunan, People's Republic of China
| | - N Ding
- Department of Metabolism and Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Q Wang
- Department of Metabolism and Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - M Huang
- Department of Metabolism and Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - H Liu
- Department of Metabolism and Endocrinology, The Affiliated Zhuzhou Hospital Of XiangYa School Of Medicine, Central South University, Changjiang South Road116, Zhuzhou, 412007, Hunan, People's Republic of China
| | - Z Xie
- Department of Metabolism and Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Y Ou
- Hospital Infection Control Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Z Sheng
- Department of Metabolism and Endocrinology, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
- National Clinical Research Center for Metabolic Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
- Health Management Center, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The 2nd Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
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Ohira M, Suzuki S, Yoshida T, Koide H, Tanaka T, Tatsuno I. Fracture Risk Assessment Tool May Not Indicate Bone Fragility in Women With Type 2 Diabetes. Am J Med Sci 2020; 360:552-559. [PMID: 32376002 DOI: 10.1016/j.amjms.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/17/2020] [Accepted: 04/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diabetes carries a known risk of bone fracture despite high bone mineral density (BMD). The fracture risk assessment tool (FRAX) predicts the 10-year major osteoporotic fracture risk and hip fracture risk. We investigated the effects of clinical parameters on the FRAX score and evaluated the validity of FRAX for evaluating current bone fragility in diabetes subjects. MATERIALS AND METHODS Forty-seven thousand, three hundred eighty-nine Japanese women participated in the Chiba bone survey, a population-based, multicenter, cross-sectional study of postmenopausal osteoporosis; we estimated FRAX scores without BMD and compared scores between subjects with and without type 2 diabetes. RESULTS Mean FRAX major osteoporotic fracture risk was significantly higher in the diabetes group. A multiple regression model demonstrated some clinical parameters that affected the FRAX score and, after adjusting for such parameters, the FRAX score was not significantly different between the diabetes and nondiabetes groups, although the type 2 diabetes rate was significantly higher in subjects with a fracture in the past 5 years, which reflected current bone fragility. After adjusting for clinical parameters, the diabetes rate remained significantly higher in subjects with a fracture in the past 5 years, confirming that type 2 diabetes influences current bone fragility. Our study demonstrated that type 2 diabetes truly carries a risk of bone fracture, but adjusted FRAX major osteoporotic fracture risk is not significantly different between subjects with and without type 2 diabetes. CONCLUSIONS The FRAX major osteoporotic fracture risk without BMD does not correctly indicate current bone fragility in Japanese middle-aged women with type 2 diabetes.
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Affiliation(s)
- Masahiro Ohira
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Sawako Suzuki
- Department of Clinical Cell Biology & Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomohiko Yoshida
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare, Chiba, Japan
| | - Hisashi Koide
- Department of Clinical Cell Biology & Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoaki Tanaka
- Department of Clinical Cell Biology & Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ichiro Tatsuno
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan.
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Diagnostic and Gradation Model of Osteoporosis Based on Improved Deep U-Net Network. J Med Syst 2019; 44:15. [PMID: 31811448 DOI: 10.1007/s10916-019-1502-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/14/2019] [Indexed: 12/28/2022]
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13
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Fang H, Zhang H, Wang Z, Zhou Z, Li Y, Lu L. Systemic immune-inflammation index acts as a novel diagnostic biomarker for postmenopausal osteoporosis and could predict the risk of osteoporotic fracture. J Clin Lab Anal 2019; 34:e23016. [PMID: 31423643 PMCID: PMC6977145 DOI: 10.1002/jcla.23016] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/30/2019] [Accepted: 08/07/2019] [Indexed: 12/29/2022] Open
Abstract
Background Postmenopausal osteoporosis (PMOP) is a bone metabolism disorder involving systematic inflammation activation. Blood routine examination is easily available in clinical practice and contains abundant information reflecting the systematic inflammation level. Thus, it is attractive to achieve early diagnosis of PMOP and predict osteoporotic fracture risk just based on the biomarkers in blood routine examination. Methods A multi‐centric prospective cohort study was designed and enrolled postmenopausal women from two independent institutions. All participants underwent the dual‐energy X‐ray absorptiometry (DEXA) scanning for diagnosing PMOP. Blood routine examination was conducted, and the key inflammatory biomarkers such as neutrophil‐to‐lymphocyte ratio (NLR) and systemic immune‐inflammation index (SII) were calculated. PMOP patients were followed up to observe osteoporotic fracture and identify the related risk predictors. Results A total of 92 participants out of 238 enrolled postmenopausal women were diagnosed with PMOP, with a prevalence of 38.66%. The main risk factors identified for PMOP included older age (OR = 2.06, 95% CI = 1.14‐3.72), longer menopause duration (OR = 3.14, 95% CI = 2.06‐4.79), higher NLR (OR = 2.11, 95% CI = 1.37‐3.25), and higher SII (OR = 3.02, 95% CI = 1.98‐4.61). Besides age and menopause duration, SII ≥834.89 was newly identified as a prominent risk factor for discriminating osteoporotic fracture risk in PMOP patients (HR = 3.66, 95% CI = 1.249‐10.71). Conclusion As an easy and economical biomarker calculated from blood routine examination, SII not only acts as a good risk predictor for PMOP diagnosis but also well discriminates the osteoporotic fracture risk, which deserves further investigation and application in clinical practice.
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Affiliation(s)
- Hong Fang
- Department of Gynecology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Hanqing Zhang
- Department of Osteology, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Zhi Wang
- Department of Osteology, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Zhongming Zhou
- Department of Gynecology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Yunjun Li
- Department of Gynecology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Lin Lu
- Department of Osteology, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China
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14
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Che Y, Sugita N, Yoshihara A, Iwasaki M, Miyazaki H, Nakamura K, Yoshie H. MAEA rs6815464 polymorphism and periodontitis in postmenopausal Japanese females: A cross-sectional study. Arch Oral Biol 2019; 102:128-134. [PMID: 31005685 DOI: 10.1016/j.archoralbio.2019.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Macrophage erythroblast attacher (MAEA) is a membrane protein that regulates the development of mature macrophages by mediating attachment with erythroblasts. A polymorphism rs6815464 (C/G) in MAEA gene was reported to be associated with type II diabetes. Along with diabetes, osteoporosis shows an increased prevalence in postmenopausal females, and both diseases have been reported to be associated with periodontitis. Therefore, we explored the relevance of the MAEA polymorphism to periodontitis, bone mineral density (BMD) and haemoglobin A1c (HbA1c). DESIGN This was a cross-sectional study with the final sample comprised of 344 postmenopausal Japanese females. Probing pocket depth (PPD) and clinical attachment level (CAL) were measured. Genotype was determined by TaqMan assay. Blood biochemical parameters and BMD of the lumbar spine were evaluated. RESULTS No differences were found in age, body mass index, HbA1c, BMD, number of teeth, bone metabolism parameters between the genotypes. Mean CAL and percentage of sites with PPD or CAL ≥ 5 mm were higher in the G-allele carriers than in the non-carriers. Multiple logistic regression analyses revealed that G-allele carriage was associated with severe periodontitis (odds ratio = 3.73, 95% CI = 1.36-10.19). CONCLUSION Our results suggested that the MAEA gene polymorphism was independently associated with severe periodontitis.
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Affiliation(s)
- Yulan Che
- Division of Periodontology, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Niigata 951-8514, Japan; Department of Stomatology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China.
| | - Noriko Sugita
- Division of Periodontology, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Niigata 951-8514, Japan.
| | - Akihiro Yoshihara
- Division of Oral Science for Health Promotion, Department of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Niigata 951-8514, Japan.
| | - Masanori Iwasaki
- Division of Community Oral Health Development, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka 803-8580, Japan.
| | - Hideo Miyazaki
- Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Niigata 951-8514, Japan.
| | - Kazutoshi Nakamura
- Division of Social and Environmental Medicine, Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City 951-8510, Japan.
| | - Hiromasa Yoshie
- Division of Periodontology, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Niigata 951-8514, Japan.
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Aktaş Ö, Kaplan S, Sezer N. An assessment of the relation between bone mineral density and clinic-demographic properties and life quality during postmenopausal period. J Back Musculoskelet Rehabil 2019; 31:803-810. [PMID: 29865030 DOI: 10.3233/bmr-170933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study was conducted to assess the relation between bone mineral density (BMD) and clinic-demographic properties and life quality during postmenopausal period. METHODS The study group consisted of 172 postmenopausal women who applied to the physical therapy and rehabilitation outpatient clinic at a training and research hospital in Ankara, the capital of Turkey. The Survey Form, The 36-item Short Form Health Survey (SF-36) and the FRAX™ were used as data collection tools in this study. RESULTS The osteoporosis and osteopenia frequencies were respectively 28.5% and 42.4% in this study. The 10-year major osteoporotic fracture risk was 5.15% and the femur fracture risk was estimated as 0.9%. In this study, there was a positive and significant relation found between the L1-4 and FN T-score and SF-36 scale score average (p< 0.05). There was a significant relation between the body mass index and SF-36 subscale 'mental health' (p< 0.05). In this study, the most significant determinant of life quality was exhibited as the "L1-4 T-score" (β= 55.509, p= 0.000). CONCLUSIONS We determined that approximately one of every four women had osteoporosis and as the BMD dropped, the life quality of the women declined. Hence, we think that improving the awareness of health professionals working in this field is essential.
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Affiliation(s)
- Ömür Aktaş
- Faculty of Medicine, Department of Internal Diseases, Intensive Care Unit, Gazi University, Ankara, Turkey
| | - Sena Kaplan
- Faculty of Health Sciences, Nursing Department, Yildirim Beyazit University, Ankara, Turkey
| | - Nebahat Sezer
- Faculty of Medicine, Ataturk Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Yildirim Beyazit University, Ankara, Turkey
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