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Iles B, Ribeiro de Sá Guimarães Nolêto I, Dourado FF, de Oliveira Silva Ribeiro F, de Araújo AR, de Oliveira TM, Souza JMT, Barros AB, Sousa GC, de Jesus Oliveira AC, da Silva Martins C, de Oliveira Viana Veras M, de Carvalho Leitão RF, de Souza de Almeida Leite JR, da Silva DA, Medeiros JVR. Alendronate sodium-polymeric nanoparticles display low toxicity in gastric mucosal of rats and Ofcol II cells. NANOIMPACT 2021; 24:100355. [PMID: 35559814 DOI: 10.1016/j.impact.2021.100355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 06/15/2023]
Abstract
The use of bisphosphonates constitutes the gold-standard therapy for the control and treatment of bone diseases. However, its long-term use may lead to gastric problems, which limits the treatment. Thus, this study aimed to formulate a nanostructured system with biodegradable polymers for the controlled release of alendronate sodium. The nanoparticles were characterized, and its gastric toxicity was investigated in rats. The synthesis process proved to be effective for encapsulating alendronate sodium, exhibiting nanoparticles with an average size of 51.02 nm and 98.5% of alendronate sodium incorporation. The release tests demonstrated a controlled release of the drug in 420 min, while the morphological analyzes showed spherical shapes and no apparent roughness. The biological tests demonstrated that the alendronate sodium nanoformulation reversed the gastric lesions, maintaining the normal levels of malondialdehyde and myeloperoxidase. Also, the encapsulated alendronate sodium showed no toxicity in murine osteoblastic cells, even at high concentrations.
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Affiliation(s)
- Bruno Iles
- Laboratory of Inflammation and Gastrointestinal Disorders (Lafidg), Federal University of the Parnaíba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil; Biotechnology and Biodiversity Research Center (Biotec), Federal University of the Parnaiba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil
| | - Isabela Ribeiro de Sá Guimarães Nolêto
- Laboratory of Inflammation and Gastrointestinal Disorders (Lafidg), Federal University of the Parnaíba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil; Biotechnology and Biodiversity Research Center (Biotec), Federal University of the Parnaiba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil
| | - Flaviane França Dourado
- Biotechnology and Biodiversity Research Center (Biotec), Federal University of the Parnaiba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil
| | - Fábio de Oliveira Silva Ribeiro
- Biotechnology and Biodiversity Research Center (Biotec), Federal University of the Parnaiba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil
| | - Alyne Rodrigues de Araújo
- Biotechnology and Biodiversity Research Center (Biotec), Federal University of the Parnaiba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil
| | - Taiane Maria de Oliveira
- Biotechnology and Biodiversity Research Center (Biotec), Federal University of the Parnaiba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil
| | - Jessica Maria Teles Souza
- Parnaíba Delta Cell Culture Laboratory (LCC-Delta), Federal University of the Parnaíba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil
| | - Ayslan Batista Barros
- Parnaíba Delta Cell Culture Laboratory (LCC-Delta), Federal University of the Parnaíba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil
| | - Gabrielle Costa Sousa
- Laboratory of Inflammation and Gastrointestinal Disorders (Lafidg), Federal University of the Parnaíba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil; Biotechnology and Biodiversity Research Center (Biotec), Federal University of the Parnaiba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil
| | - Antônia Carla de Jesus Oliveira
- Quality Control Center for Medicines and Correlates - NCQMC, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235 - University City, Recife, PE 50670-901, Brazil
| | - Conceição da Silva Martins
- Nucleus of Studies in Microscopy and Image Processing - NEMPI, Federal University of Ceará, Rua Alexandre Baraúna, 994 - Rodolfo Teófilo, Fortaleza, CE 60430-160, Brazil
| | - Mariana de Oliveira Viana Veras
- Nucleus of Studies in Microscopy and Image Processing - NEMPI, Federal University of Ceará, Rua Alexandre Baraúna, 994 - Rodolfo Teófilo, Fortaleza, CE 60430-160, Brazil
| | - Renata Ferreira de Carvalho Leitão
- Nucleus of Studies in Microscopy and Image Processing - NEMPI, Federal University of Ceará, Rua Alexandre Baraúna, 994 - Rodolfo Teófilo, Fortaleza, CE 60430-160, Brazil
| | - José Roberto de Souza de Almeida Leite
- Center for Research in Applied Morphology and Immunology - NuPMIA, University of Brasilia, Campus Darcy Ribeiro - Asa Norte-Brasília-DF, CEP 70.910-900 Brasilia, Brazil
| | - Durcilene Alves da Silva
- Biotechnology and Biodiversity Research Center (Biotec), Federal University of the Parnaiba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil
| | - Jand Venes Rolim Medeiros
- Laboratory of Inflammation and Gastrointestinal Disorders (Lafidg), Federal University of the Parnaíba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil; Biotechnology and Biodiversity Research Center (Biotec), Federal University of the Parnaiba Delta, Av. São Sebastião, 2819, Parnaíba, PI CEP 64202-020, Brazil.
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Takusari E, Sakata K, Hashimoto T, Fukushima Y, Nakamura T, Orimo H. Trends in Hip Fracture Incidence in Japan: Estimates Based on Nationwide Hip Fracture Surveys From 1992 to 2017. JBMR Plus 2020; 5:e10428. [PMID: 33615101 PMCID: PMC7872333 DOI: 10.1002/jbm4.10428] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/28/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022] Open
Abstract
As of 2015, the aging population in Japan was the largest in the world. Although the National Database of Health Insurance Claims (NDB) was developed in 2012, long‐term trends regarding hip fracture incidence in Japan remain unclear. In order to clarify the trend in hip fracture incidence from 1992 to 2017, we estimated the number of new hip fractures in 2017, the seventh in a series of nationwide hip fracture surveys performed every 5 years since 1987. We also investigated regional differences in hip fracture incidence. We collected data through a nationwide mail‐in survey of orthopedic institutions in Japan and calculated hip fracture incidence by sex and age, as well as standardized incidence ratio (SIR) across 12 districts. The total number (95% confidence interval) of hip fractures in 2017 was estimated at 193,400 (187,300–199,500), occurring in 44,100 (42,700–45,500) males and 149,300 (144,500–154,100) females. Of all the hip fracture surveys from 1992 to 2017, the 5‐year hip fracture increase rates from 2012 to 2017 was the lowest among female patients. In males, the 5‐year rates from 2012 to 2017 were lower than those from 2007 to 2012. The age‐adjusted incidence rates for patients in both sexes did not show significant change in the 25‐year period. The estimated incidence rates in 2017 for patients aged 70 to 79 years in both sexes were lowest from 1992 to 2017, and declined significantly over the 25‐year period. SIRs differed between northeast and southwest regions. Our findings were similar to those from a previous study in Japan using the NDB from 2012 to 2015. Progress in the development of osteoporosis medication may contribute to the continuous decline in the 70‐year to 79‐year age group. © 2020 American Society for Bone and Mineral Research © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Eri Takusari
- Department of Hygiene and Preventive Medicine Iwate Medical University School of Medicine Iwate Japan
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine Iwate Medical University School of Medicine Iwate Japan
| | | | | | - Toshitaka Nakamura
- Touto Sangenjaya Rehabilitation Hospital Tokyo Japan.,Japan Osteoporosis Foundation Tokyo Japan
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3
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Salagame U, Kliewer EV, Demers A, Banks E, Velentzis LS, Goldsbury D, Egger S, Leslie WD, Canfell K. Trends in Prescribing Menopausal Hormone Therapy and Bisphosphonates in Australia and Manitoba, Canada and Adherence to Recommendations. J Womens Health (Larchmt) 2020; 29:177-186. [PMID: 31895627 DOI: 10.1089/jwh.2019.7828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Recommendations for using menopausal hormone therapy (MHT) and bisphosphonates for postmenopausal osteoporosis management have changed over time. After the release of the Women's Health Initiative (WHI) trial results in 2002, new evidence on risks and benefits of MHT became available, and newer guidelines generally specify that MHT should not be prescribed for prevention of chronic disease, including osteoporosis. This raises the question of whether bisphosphonate prescribing changed over time to compensate for the decrease in MHT use. Materials and Methods: We examined trends in dispensed prescriptions in Australia (national) and Canada (province of Manitoba) in relation to prescribing recommendations. Administrative data were used to describe dispensing patterns and changes for persons of all ages from 1996 to 2008, and for women aged 50 to ≥80 years from 2003 to 2008 in Australia and 1996 to 2008 in Canada. Results: In both geographic settings, MHT dispensing increased 1996-2001, peaked in 2001, and declined substantially thereafter (67% reduction in MHT prescriptions for Australia; 64% reduction for Manitoba, Canada to 2008). From 2003 to 2008, the number of MHT prescriptions declined among all age groups in both settings, with the highest declines among women in their 50s. Concurrently, bisphosphonate dispensing increased until 2005 (2001-2005: 260% increase in the number of prescriptions in Australia; 125% increase in Manitoba) and stabilized thereafter, in both settings. Annual bisphosphonate dispensing rates increased 4.1-10.9% for women in their 70s and 80s in Australia and Manitoba during the period studied. Conclusions: Based on dispensed prescriptions data, more recent guidelines for MHT and bisphosphonates use for postmenopausal osteoporosis, which were updated during the study period (and are still consistent with the current guidelines), appear to have been broadly adhered to in both settings.
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Affiliation(s)
- Usha Salagame
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Australia.,Centre of Epidemiology and Evidence, NSW Health, Sydney, Australia
| | - Erich V Kliewer
- CancerCare Manitoba, Winnipeg, Canada.,Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Cancer Control Research, British Columbia Cancer Agency, Vancouver, Canada
| | - Alain Demers
- Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.,Sax Institute, Sydney, Australia
| | - Louiza S Velentzis
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Australia.,Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - David Goldsbury
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Australia
| | - Sam Egger
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Australia
| | - William D Leslie
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Lind KE, Jorgensen ML, Gray LC, Georgiou A, Westbrook JI. Anti-osteoporosis Medication Use in a High Fracture-Risk Population: Contemporary Trends in Australian Residential Aged Care Facilities. Health Serv Insights 2019; 12:1178632919852111. [PMID: 31210731 PMCID: PMC6547170 DOI: 10.1177/1178632919852111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/25/2019] [Indexed: 12/15/2022] Open
Abstract
Osteoporotic fractures impose substantial morbidity and mortality among older adults. Undertreatment is an ongoing concern; treatment rates declined following reports of adverse effects of guideline-recommended bisphosphonates, but new antiresorptives have since become available. Our goal was to identify contemporary trends in osteoporosis treatment guideline adherence in a high fracture-risk population. We conducted a secondary data analysis using electronic health record data of adults aged ⩾65 years from 68 residential aged care facilities in Australia during 2014-2017 (n = 9094). Using medication administration data, we identified antiresorptive (bisphosphonates and denosumab) and vitamin D supplement use among residents with osteoporosis. Regression was used to evaluate temporal trends, and resident and facility characteristics associated with antiresorptive use and vitamin D use. In 2014, 34% of women and 42% of men with osteoporosis used antiresorptives; this decreased 8 percentage points by 2017. Antiresorptive use was higher among those with a history of fracture and lower in the last year of life. Denosumab use increased but did not substitute for the continued decline in bisphosphonate use. Vitamin D was consistently used by more than 60% of residents and was higher among those with fracture history. Greater attention to the treatment of osteoporosis treatment rates among this high fracture-risk population is warranted.
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Affiliation(s)
- Kimberly E Lind
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Mikaela L Jorgensen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Leonard C Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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5
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Tamaki J, Fujimori K, Ikehara S, Kamiya K, Nakatoh S, Okimoto N, Ogawa S, Ishii S, Iki M. Estimates of hip fracture incidence in Japan using the National Health Insurance Claim Database in 2012-2015. Osteoporos Int 2019; 30:975-983. [PMID: 30648192 DOI: 10.1007/s00198-019-04844-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
UNLABELLED Using the nationwide health insurance claims database, we found that the age-standardized hip fracture incidence rates in Japan indicated significant increase in males but no significant change in females during 2012-2015. The fracture risk in subjects aged 75-84 years indicated decrease in females but no change in males. INTRODUCTION Nationwide registry data on hip fractures have not yet been established in Japan. Using the newly developed National Database of Health Insurance Claims (NDB), which covers the entire Japanese population, we investigated the incidence rates of hip fractures and the associated regional differences. We also assessed the frequency of osteoporosis prescriptions, bone turnover marker (BTM) level, and bone mineral density (BMD) measurements. METHODS The annual numbers of hip fractures, osteoporosis prescriptions, and BTM level and BMD measurements by prefecture from 2012 to 2015 were obtained from NDB data. We calculated the standardized claims-data ratio (SCR) in each prefecture. RESULTS The age-standardized incidence rates from 2012 to 2015 indicated no significant change in females and significant increase in males (p value for trend; 0.920, 0.002, respectively). The fracture risk decreased in females aged 75-84 years and indicated no increase in females aged 85-89 years during 2012-2015, while the fracture risk indicated no change in males aged 75-84 years and increased in males aged 85-89 years. The frequency of osteoporosis prescriptions, BTM level measurements, and BMD measurements in the general population in the corresponding period increased with statistical or marginal significance in females and males. West-east regional differences were observed in the incidence rates; the highest SCR values in the western prefectures were approximately double the lowest values in the eastern prefectures. CONCLUSIONS The age-standardized hip fracture incidence rates indicated no significant change in females and significant increase in males in Japan from 2012 to 2015.
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Affiliation(s)
- J Tamaki
- Department of Hygiene and Public Health, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan.
| | - K Fujimori
- Department of Health Administration and Policy, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - S Ikehara
- Department of Hygiene and Public Health, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - K Kamiya
- Department of Hygiene and Public Health, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - S Nakatoh
- Asahi General Hospital, 477, Tomari, Asahi-machi, Shimo-Shinkawa-gun, Toyama, 939-0798, Japan
| | - N Okimoto
- Okimoto Clinic, 185-4, Kubi, Yutaka-machi, Kure-city, Hiroshima, 734-0304, Japan
| | - S Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, the University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - S Ishii
- Japan Osteoporosis Foundation, 2-14, Oodemma-cho, Nihombashi, Chuo-ku, Tokyo, 103-0011, Japan
| | - M Iki
- Department of Public Health, Kindai University Faculty of Medicine, 377-2, Oono-Higashi, Osaka Sayama city, Osaka, 589-8511, Japan
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Changing rates in fracture trends are temporally associated with declining testing and treatment: reality or ecologic fallacy? Curr Opin Rheumatol 2019; 31:316-320. [PMID: 30920974 DOI: 10.1097/bor.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The changing patterns of osteoporosis treatment and fragility fractures have led to what leaders are calling a 'crisis in the osteoporosis.' We address data on changing patterns in fractures, and highlight strengths and limitations of recently published data. RECENT FINDINGS Declines in hip fracture rates have been shown in studies from around the world. However, recently, using national Medicare data, Michael Lewiecki and colleagues show a plateau in the decline of hip fracture incidence in the United States from 2012 to 2015. Population-based data is integral for evaluating temporal trends; however, researchers must consider the biases associated with them including: age effects, period effects, and cohort effects. Rosengren and colleagues conducted the most comprehensive evaluation of age, period, and birth cohort effects in their study of hip fracture trends from 1987 to 2010 in Denmark and Sweden, in which they identified changes in hip fracture rates based on age, period, and cohort effects. SUMMARY Recent findings show clear temporal trends in changing fracture rates. Studies, which evaluated these biases largely attribute increased hip fracture rates to various age, period, and cohort effects, highlighting the importance of appropriate screening and treatment.
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Yoo J, Lee JS, Kim S, Kim BS, Choi H, Song DY, Kim WB, Won CW. Length of hospital stay after hip fracture surgery and 1-year mortality. Osteoporos Int 2019; 30:145-153. [PMID: 30361752 DOI: 10.1007/s00198-018-4747-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/18/2018] [Indexed: 11/30/2022]
Abstract
UNLABELLED There is ongoing effort to discharge patients early after hip fracture surgery to reduce the medical and economic burden. We tried to find whether there is any related side effect, and discovered that early discharge, especially before 10 days after surgery, is associated with higher mortality. INTRODUCTION The aim of this study was to analyze the association between the length of hospital stay after hip fracture and 1-year mortality in older adults aged ≥ 65 years old. METHODS We conducted a retrospective cohort study using the Korean National Health Insurance Service data to identify patients who were discharged after hip fracture surgery from 2007 to 2009 among 487,460 older adults of age ≥ 65 years. The lengths of stay involving hip fracture surgery were categorized at 10-day interval, and analyzed in relation to 1-year mortality from the date of hospital discharge. RESULTS A total of 4213 patients were discharged after hip fracture surgery, of whom 604 (14.3%) died within 1 year of discharge. The average length of stay was 30.7 days (standard deviation 24.5 days). The 1-year mortality was the highest for the length of stay ≤ 10 days group at 21.7%, followed by 15.2%, 14.3%, 13.3%, and 12.4% for > 40, 21-30, 31-40, and 11-20 days groups, respectively (p value 0.05). On Cox proportional hazard regression, the adjusted hazard ratio for length of stay ≤ 10 days group was 1.56 (95% confidence interval 1.14-2.12) against the reference group (11-20 days), while other groups did not show statistical significance. Higher risk of death was associated with increasing age, male gender, Charlson comorbidity index ≥3, subtrochanteric fracture, and discharge to tertiary care hospitals and long-term care hospitals. CONCLUSION Older adults discharged within 10 days of hospital admission for hip fracture surgery have higher 1-year mortality after discharge.
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Affiliation(s)
- J Yoo
- Department of Family Medicine, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea
| | - J S Lee
- Clinical Research Center, Asan Medical Center, 88, 43-gil Olympic-ro, Songpa-gu, Seoul, South Korea
| | - S Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea
| | - B S Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea
| | - H Choi
- Department of Family Medicine, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea
| | - D Y Song
- Elderly Frailty Research Center, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea
| | - W B Kim
- Department of Medicine, Graduate School, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea
| | - C W Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea.
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Cipriani C, Pepe J, Minisola S, Lewiecki EM. Adverse effects of media reports on the treatment of osteoporosis. J Endocrinol Invest 2018; 41:1359-1364. [PMID: 29761280 DOI: 10.1007/s40618-018-0898-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/05/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE The review focused on the role that media reporting plays in the level of public awareness about osteoporosis and its influence on osteoporosis treatment decisions. METHODS We reviewed the literature on the role of media on three main aspects influencing patient adherence to osteoporosis treatment: the awareness of osteoporosis as a major health problem, the perception of the effectiveness of osteoporosis medications, and the fear of adverse effects with osteoporosis medications. RESULTS A review of the literature confirmed what is routinely observed in clinical practice-that media report can strongly influence the level of awareness of osteoporosis and fracture risk. Inadequate and/or incorrect information on osteoporosis in the media are associated with a low level of awareness of the disease. High-risk patients may have a poor understanding of the need for treatment. Alarming information in the media over the last 2 decades regarding effectiveness and safety of long-term osteoporosis treatment is associated with reduction in the use of osteoporosis medications. CONCLUSIONS There is a gap between the application of clinical recommendations and patient perceptions of osteoporosis and its treatment. There is a need for better education of patients and practitioners aimed at recognizing the serious consequences of fractures and understanding the expected benefits and potential risks of treatment. Media reports that disseminate evidence-based information on the balance of benefits and risks could help to reduce the osteoporosis treatment gap and mitigate the crisis in osteoporosis care.
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Affiliation(s)
- Cristiana Cipriani
- Department of Internal Medicine and Medical Disciplines, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Jessica Pepe
- Department of Internal Medicine and Medical Disciplines, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - E Michael Lewiecki
- New Mexico Clinical Research and Osteoporosis Center, 300 Oak St. NE, Albuquerque, NM, 87106, USA
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Aguilar Del Rey FJ, Pérez González O. Epidemiology of osteoporotic fractures in Andalusia, Spain, from 2000-2010. Med Clin (Barc) 2018; 150:297-302. [PMID: 28923669 DOI: 10.1016/j.medcli.2017.06.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to examine the epidemiological data on osteoporotic fractures in Andalusia in the period 2000-2010. In view of the lack of epidemiological studies of fractures in Andalusia, we set out to ascertain the number and incidence rates of osteoporotic fractures and their distribution by gender and age, location, comorbidity, seasonality and secular trend. METHODS Cohort study observed over a period of 11 years analysing the data provided by the Minimum Basic Data Set register for the period 2000-2010. RESULTS There were a total of 96,458 osteoporotic fractures, with a crude incidence rate of 374.18 fractures per 100,000 population. Fractures increased in this period by 27% (p<.01, IC 95%, 0.71; 0.73). We found a trend change in female/male ratio, from 3.4 to 3.2, and in the reduction in fractures in the last two years, especially in the past year, with a decrease of 11.2% in hip fractures (p<.001, IC 95%, 0.88; 0.895). CONCLUSIONS In this period, there has been an increase in fractures as a consequence of the ageing of the population, but also a change in trend, with fractures decreasing in some age groups. The incidence rate of fractures varies between different countries and regions of Spain, and between different provinces of Andalusia.
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Affiliation(s)
| | - Olga Pérez González
- Fundación Pública Andaluza para la Investigación de Málaga en Medicina y Salud (FIMABIS), Málaga, España
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Holliday LS. Vacuolar H +-ATPases (V-ATPases) as therapeutic targets: a brief review and recent developments. ACTA ACUST UNITED AC 2017; 1. [PMID: 30957075 DOI: 10.21037/biotarget.2017.12.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Vacuolar H+-ATPases (V-ATPases) are multi-subunit enzymes that play housekeeping roles in eukaryotic cells by acidifying lysosomes, late endosomes, Golgi, and other membrane-bounded compartments. Beyond that, V-ATPases have specialized functions in certain cell types linked to diseases including osteoporosis and cancer. Efforts to identify strategies to develop inhibitors selective for V-ATPases that are involved in disease progression have been ongoing for more than two decades, but so far have not yielded a therapeutic agent that has been translated to the clinic. Recent basic science studies have identified unexpected roles for V-ATPases in nutrient and energy sensing, and renin/angiotensin signaling, which offer additional incentives for considering V-ATPases as therapeutic targets. This article briefly reviews efforts to utilize inhibitors of V-ATPases as drugs. Primary focus is on recent "rational" efforts to identify small molecule inhibitors of the V-ATPases that are selectively expressed in osteoclasts and cancer cells. Enoxacin and bis-enoxacin are two molecules that emerged from these efforts. These molecules block a binding interaction between V-ATPases and microfilaments that occurs in osteoclasts, but not most other cell types, which relates to the specialized function of V-ATPases in bone resorption. Enoxacin and bis-enoxacin have proven useful in the treatment of bone diseases and cancer in animal models and display therapeutic effects that are different, and perhaps better, than current drugs. These results provide evidence that agents targeting subsets of V-ATPases may prove useful in the clinic.
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Affiliation(s)
- L Shannon Holliday
- Departments of Orthodontics and Anatomy & Cell Biology, University of Florida College of Dentistry, Gainesville, Florida, USA
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11
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Laius O, Pisarev H, Maasalu K, Kõks S, Märtson A. Trends in and relation between hip fracture incidence and osteoporosis medication utilization and prices in Estonia in 2004-2015. Arch Osteoporos 2017; 12:48. [PMID: 28497319 DOI: 10.1007/s11657-017-0341-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/26/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Osteoporosis medicines reduce osteoporotic fractures. There is a very strong negative correlation between the consumption of medicines and the price of an average daily dose indicating that affordability is a key factor that could increase consumption of antiosteoporotic medicines and, through that, reduce fractures. PURPOSE Osteoporosis is a major cause of morbidity and mortality in the modern world. Our study aims to describe the trends in incidence of hip fractures in relation to drug utilization patterns and the average price of antiosteoporotic medicines in Estonia. METHODS Data on hip fractures was obtained from the medical claims database of Estonian Health Insurance Fund (EHIF). Consumption and price data was obtained from the Estonian State Agency of Medicines (SAM).Consumption is presented using WHO defined daily doses methodology, and the prices reflect the average wholesale price of medicines. RESULTS From 2004 to 2010 there was a non-significant increasing trend in standardized hip fracture incidence in Estonia, but from 2010 to 2015, the trend turned to a significant decrease of 4.5% per year. The consumption of osteoporosis medication increased significantly from 2004 to 2009 by yearly average of 41.2%. After 2009, the consumption levelled. On contrast, the average price of one daily dose of osteoporosis medication decreased significantly from 2004 to 2009 by 16.9% per year and the decrease also levelled after 2009. This gives a very strong negative correlation of -0.93 (p < 0.001) between the consumption of antiosteoporotic medication and the average price of a daily dose of medication during the study period. CONCLUSIONS The statistically significant decline of standardized incidence of hip fractures from 2010 onward could at least in part be the result of the high increase in consumption of antiosteoporotic medicines which in turn is strongly negatively correlated with the average price of osteoporosis medicines.
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Affiliation(s)
- Ott Laius
- Department of Traumatology and Orthopedics, University of Tartu, L. Puusepa 8, Tartu, Estonia. .,Estonian State Agency of Medicines, Nooruse 1, 50411, Tartu, Estonia.
| | - Heti Pisarev
- Institute of Family Medicine and Public Health, Department of Epidemiology and Biostatistics, University of Tartu, Ravila, 19, Tartu, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, University of Tartu, L. Puusepa 8, Tartu, Estonia.,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, L. Puusepa 8, Tartu, Estonia
| | - Sulev Kõks
- Institute of Biomedicine and Translational Medicine, Department of Pathophysiology, University of Tartu, Ravila, 19, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopedics, University of Tartu, L. Puusepa 8, Tartu, Estonia.,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, L. Puusepa 8, Tartu, Estonia
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12
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Tanaka S, Yoshida A, Kono S, Oguma T, Hasegawa K, Ito M. Effectiveness of elcatonin for alleviating pain and inhibiting bone resorption in patients with osteoporotic vertebral fractures. J Bone Miner Metab 2017; 35:544-553. [PMID: 27830386 DOI: 10.1007/s00774-016-0791-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
Elderly patients with osteoporotic vertebral fractures often experience severe pain that reduces their quality of life (QOL). Calcitonin, a bone resorption inhibitor, has been reported to alleviate pain in such patients; however, few clinical studies have demonstrated this effect. The objective of this study was to compare changes in pain scores, activities of daily living (ADL), QOL, bone resorption, bone mineral density (BMD), and fracture healing among patients with new vertebral fractures who received different treatment modalities. We conducted an open-label, multicenter, randomized, parallel control group study comprising 107 female patients ≥55 years old with acute back pain from vertebral fracture. All subjects received either intramuscular injections of elcatonin, a derivative of calcitonin, or an oral nonsteroidal antiinflammatory drug (NSAID) combined with an active vitamin D3 (VD3) analogue for 6 months. The pain was assessed using a visual analogue scale, and ADL and QOL were assessed using questionnaires. BMD was measured using dual-energy X-ray absorptiometry. A two-tailed significance level of 5% was used. The elcatonin IM group had significantly higher QOL score at 2 weeks and later, and significantly lower VAS and ADL scores than those in the NSAID + VD3 group at 1 month and later. The elcatonin IM group had significantly reduced TRACP-5b levels compared with those in the NSAID + VD3 group at 3 months and later and significantly higher percent changes in BMD than the NSAID + VD3 group. These results suggest that elcatonin significantly alleviated pain, inhibited bone resorption, and improved ADL, QOL, and BMD compared with NSAID + VD3.
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Affiliation(s)
- Shinya Tanaka
- Department of Orthopaedic Surgery, Saitama Medical University, 38 Morohongo Moroyama-cho, Iruma-gun, Saitama, 350-0495, Japan.
| | | | - Shinjiro Kono
- Department of Orthopaedic Surgery, Saitama Medical University, 38 Morohongo Moroyama-cho, Iruma-gun, Saitama, 350-0495, Japan
| | | | - Kyoichi Hasegawa
- Sapporo Orthopaedic and Cardiovascular Hospital, Hokkaido, Japan
| | - Manabu Ito
- National Hospital Organization Hokkaido Medical Center, Hokkaido, Japan
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13
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Khosla S, Cauley JA, Compston J, Kiel DP, Rosen C, Saag KG, Shane E. Addressing the Crisis in the Treatment of Osteoporosis: A Path Forward. J Bone Miner Res 2017; 32:424-430. [PMID: 28099754 DOI: 10.1002/jbmr.3074] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/13/2016] [Accepted: 12/24/2016] [Indexed: 01/11/2023]
Abstract
Considerable data and media attention have highlighted a potential "crisis" in the treatment of osteoporosis. Specifically, despite the availability of several effective drugs to prevent fractures, many patients who need pharmacological therapy are either not being prescribed these medications or if prescribed a medication, are simply not taking it. Although there are many reasons for this "gap" in the treatment of osteoporosis, a major factor is physician and patient concerns over the risk of side effects, especially atypical femur fractures (AFFs) related to bisphosphonate (and perhaps other antiresorptive) drug therapy. In this perspective, we review the current state of undertreatment of patients at increased fracture risk and suggest possible short-, intermediate-, and long-term approaches to address patient concerns, specifically those related to AFF risk. We suggest improved patient and physician education on prodromal symptoms, extended femur scans using dual-energy X-ray absorptiometry (DXA) to monitor patients on antiresorptive treatment, better identification of high-risk patients perhaps using geometrical parameters from DXA and other risk factors, and more research on pharmacogenomics to identify risk markers. Although not the only impediment to appropriate treatment of osteoporosis, concern over AFFs remains a major issue and one that needs to be resolved for effective dissemination of existing treatments to reduce fracture risk. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Sundeep Khosla
- Robert and Arlene Kogod Center on Aging and Endocrine Research Unit, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Juliet Compston
- Department of Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Douglas P Kiel
- Institute for Aging Research, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | | | - Kenneth G Saag
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, USA
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14
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Hawley S, Leal J, Delmestri A, Prieto-Alhambra D, Arden NK, Cooper C, Javaid MK, Judge A. Anti-Osteoporosis Medication Prescriptions and Incidence of Subsequent Fracture Among Primary Hip Fracture Patients in England and Wales: An Interrupted Time-Series Analysis. J Bone Miner Res 2016; 31:2008-2015. [PMID: 27377877 PMCID: PMC5122450 DOI: 10.1002/jbmr.2882] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/26/2016] [Accepted: 05/29/2016] [Indexed: 11/10/2022]
Abstract
In January 2005, the National Institute for Health and Care Excellence (NICE) in England and Wales provided new guidance on the use of antiosteoporosis therapies for the secondary prevention of osteoporotic fractures. This was shortly followed in the same year by market authorization of a generic form of alendronic acid within the UK. We here set out to estimate the actual practice impact of these events among hip fracture patients in terms of antiosteoporosis medication prescribing and subsequent fracture incidence using primary care data (Clinical Practice Research Datalink) from 1999 to 2013. Changes in level and trend of prescribing and subsequent fracture following publication of NICE guidance and availability of generic alendronic acid were estimated using an interrupted time series analysis. Both events were considered in combination within a 1-year "intervention period." We identified 10,873 primary hip fracture patients between April 1999 and Sept 2012. Taking into account prior trend, the intervention period was associated with an immediate absolute increase of 14.9% (95% CI, 10.9 to 18.9) for incident antiosteoporosis prescriptions and a significant and clinically important reduction in subsequent major and subsequent hip fracture: -0.19% (95% CI, -0.28 to -0.09) and -0.17% (95% CI, -0.26 to -0.09) per 6 months, respectively. This equated to an approximate 14% (major) and 22% (hip) reduction at 3 years postintervention relative to expected values based solely on preintervention level and trend. We conclude that among hip fracture patients, publication of NICE guidance and availability of generic alendronic acid was temporally associated with increased prescribing and a significant decline in subsequent fractures. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Samuel Hawley
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Antonella Delmestri
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Daniel Prieto-Alhambra
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona and Red Tematica de Investigacion Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III, Barcelona, Spain
- Grup de Recerca en Malalties Prevalents de I'Aparell Locomotor (GREMPAL) Research Group, Institut d'Investigacio en Atencio Primaria (IDIAP) Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nigel K Arden
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Cyrus Cooper
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - M Kassim Javaid
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Andrew Judge
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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15
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Orimo H, Yaegashi Y, Hosoi T, Fukushima Y, Onoda T, Hashimoto T, Sakata K. Hip fracture incidence in Japan: Estimates of new patients in 2012 and 25-year trends. Osteoporos Int 2016; 27:1777-84. [PMID: 26733376 PMCID: PMC4873530 DOI: 10.1007/s00198-015-3464-8] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 12/15/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED We estimated the number of hip fracture patients in 2012 in Japan and investigated the trends in incidence during a 25-year period from 1987 to 2012. Despite the increasing number of patients, the incidence of hip fracture in both men and women aged 70-79 years showed the possibility of decline. INTRODUCTION The objectives of this study were to estimate the number of hip fracture patients in 2012, to investigate the trends in incidence during a 25-year period from 1987 to 2012, and to determine the regional differences in Japan. METHODS Data were collected through a nationwide survey based on hospitals by a mail-in survey. Hip fracture incidences by sex and age and standardized incidence ratios by region were calculated. RESULTS The estimated numbers of new hip fracture patients in 2012 were 175,700 in total (95 % CI 170,300-181,100), 37,600 (36,600-38,600) for men and 138,100 (134,300-141,900) for women. The incidence rates in both men and women aged 70-79 years were the lowest in the 20-year period from 1992 to 2012. The incidence was higher in western areas of Japan than that in eastern areas in both men and women; however, the difference in the incidence of hip fracture between western and eastern areas is becoming smaller. CONCLUSIONS Despite the increasing number of new patients, the incidence of hip fracture in both men and women aged 70-79 years showed the possibility of decline. The exact reasons for this are unknown, but various drugs for improving bone mineral density or preventing hip fracture might have influenced the results. A decrease in the differences in nutrient intake levels might explain some of the change in regional differences in Japan.
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Affiliation(s)
- H Orimo
- Kenkoin Clinic, Chuo-ku, Tokyo, Japan
| | - Y Yaegashi
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, 2-1-1 Nishitokuta, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan.
| | - T Hosoi
- Kenkoin Clinic, Chuo-ku, Tokyo, Japan
| | - Y Fukushima
- Ministry of Health, Labour and Welfare, Chiyoda-ku, Tokyo, Japan
| | - T Onoda
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, 2-1-1 Nishitokuta, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - T Hashimoto
- Department of Public Health, Wakayama Medical University, Wakayama, Japan
| | - K Sakata
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, 2-1-1 Nishitokuta, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
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16
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Sullivan KJ, Husak LE, Altebarmakian M, Brox WT. Demographic factors in hip fracture incidence and mortality rates in California, 2000-2011. J Orthop Surg Res 2016; 11:4. [PMID: 26746904 PMCID: PMC4705624 DOI: 10.1186/s13018-015-0332-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/04/2015] [Indexed: 02/02/2023] Open
Abstract
Background Hip fractures result in both health and cost burdens from a public health perspective and have a major impact on the health care system in the USA. The purpose was to examine whether there were systematic differences in hip fracture incidence and 30-, 90-, and 365-day mortality after hip fracture in the California population as a function of age, gender, and race/ethnicity from 2000–2011. Methods This was a population-based study from 2000 to 2011 using data from the California Office of Statewide Health and Planning and Development (OSHPD, N = 317,677), California State Death Statistical Master File records (N = 224,899), and the US Census 2000 and 2010. There were a total of 317,677 hospital admissions for hip fractures over the 12-year span and 24,899 deaths following hip fractures. All participants without linkage (substituted for social security) numbers were excluded from mortality rate calculations. Variation in incidence and mortality rates across time, gender, race/ethnicity, and age were assessed using Poisson regression models. Odds ratio and 95 % confidence intervals are provided. Results The incidence rate of hip fractures decreased between 2000 and 2011 (odds ratio (OR) = 0.98, 95 % confidence interval (CI) 0.98, 0.98). Mortality rates also decreased over time. There were gender, race/ethnicity, and age group differences in both incidence and mortality rates. Conclusions Males were half as likely to sustain a hip fracture, but their mortality within a year of the procedure is almost twice the rate than women. As age increased, the prevalence of hip fracture increased dramatically, but mortality did not increase as steeply. Caucasians were more likely to sustain a hip fracture and to die within 1 year after a hip fracture. The disparities in subpopulations will allow for targeted population interventions and opportunities for further research.
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Affiliation(s)
| | - Lisa E Husak
- Orthopaedic Surgery, UCSF-Fresno, 155 N Fresno Street, Fresno, CA, 93701, USA.
| | - Maria Altebarmakian
- Orthopaedic Surgery, UCSF-Fresno, 155 N Fresno Street, Fresno, CA, 93701, USA.
| | - W Timothy Brox
- Orthopaedic Surgery, Kaiser Permanente Medical Center, 7300 N Fresno Street, Fresno, CA, 93720, USA.
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17
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Jha S, Wang Z, Laucis N, Bhattacharyya T. Trends in Media Reports, Oral Bisphosphonate Prescriptions, and Hip Fractures 1996-2012: An Ecological Analysis. J Bone Miner Res 2015; 30:2179-87. [PMID: 26018247 PMCID: PMC11131130 DOI: 10.1002/jbmr.2565] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/18/2015] [Accepted: 05/24/2015] [Indexed: 11/07/2022]
Abstract
Bisphosphonates are effective for the treatment of osteoporosis despite recent reports of safety concerns such as atypical femur fracture. We conducted an ecological analysis of relevant media reports, oral bisphosphonate use, and fracture outcomes in the United States. Trends in media reports and public interest of bisphosphonates were quantified using data from Google Trends. Data from the Medical Expenditure Panel Survey (MEPS) and the National Inpatient Sample (NIS) were used to estimate the trends in oral bisphosphonate use among patients aged 55 years and older and hospitalizations for intertrochanteric and subtrochanteric fractures, respectively. These trends in the prevalence of oral bisphosphonate use and the age-adjusted incidence rate of intertrochanteric and subtrochanteric fractures were examined from 1996 to 2012. A series of spikes in Internet search activity for alendronate (Fosamax) occurred between 2006 and 2010 immediately following media reports of safety concerns. Oral bisphosphonate use declined by greater than 50% between 2008 and 2012 (p < 0.001) after increasing use for more than a decade. The decline was more common in patients with lower education levels. Intertrochanteric hip fractures declined from 1996 through 2006 (p < 0.001) and continued to decline from 2008 to 2012 (p < 0.05). Subtrochanteric and diaphyseal fractures showed a steady and significant increase from 2002 to 2011 (p < 0.05). However, the incidence decreased from a peak of 30.5 per 100,000 in 2011 to 26.7 per 100,000 in 2012. The plateauing and subsequent decline in oral bisphosphonate use since 2006 coincided with reports of safety concerns of bisphosphonates, despite the fact that U.S. Food and Drug Administration (FDA) and American Society of Bone and Mineral Research (ASBMR) reports did not recommend any safety restrictions on their use. This decline in oral bisphosphonate use was followed by the decline in the incidence of subtrochanteric and diaphyseal fractures.
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Affiliation(s)
- Smita Jha
- National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Zhong Wang
- Clinical and Investigative Orthopedics Surgery (CIOS)/Intramural Research Program (IRP), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Nicholas Laucis
- Clinical and Investigative Orthopedics Surgery (CIOS)/Intramural Research Program (IRP), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Timothy Bhattacharyya
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Bethesda, MD, USA
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18
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Haddad PT, Salazar M, Hernandes L. Histomorphometry of the organic matrix of the femur in ovariectomized rats treated with sodium alendronate. Rev Bras Ortop 2015; 50:100-4. [PMID: 26229885 PMCID: PMC4519618 DOI: 10.1016/j.rboe.2014.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/05/2014] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the effect of two different concentrations of sodium alendronate on the quantity of organic matrix in the femur of rats with estrogen suppression caused by ovariectomy. Methods Sixty-days-old Wistar rats (Rattus norvegicus) were subjected to bilateral laparotomy to remove the ovaries. The animals were divided into a control group, in which they only underwent laparotomy; an ovariectomized group (OVX); an ovariectomized group treated with 1 mg/kg of alendronate (OVX 1 mg); and an ovariectomized group treated with 2 mg/kg of alendronate (OVX 2 mg). The rats received alendronate twice a week for 90 days. The left femur was then removed, fixed and processed for embedding in paraffin. Semi-serial sections stained with hematoxylin and eosin were used to determine the area occupied by organic bone matrix, by means of image analysis software. The animals’ weights were obtained at the beginning and end of the experiment. Results The ovariectomized animals and those treated with 1 mg/kg of alendronate presented significant increases in body weight (p < 0.05), in comparison with the control group. Histomorphometric analysis revealed that in the animals treated with 2 mg/kg of alendronate, the area (μm2) occupied by organic matrix (1,81,900 ± 18,130) was similar (p > 0.05) to that of the non-ovariectomized control animals (2,04,800 ± 9590), which indicates that this medication had a preventive effect with regard to bone mass loss. Conclusion The higher concentration of the medication, administered twice a week for 90 days, was more effective than the dose of 1 mg/kg over the same period.
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Affiliation(s)
| | - Márcio Salazar
- State University of Maringá (UEM), Maringá, Paraná, Brazil
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19
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Klop C, Gibson-Smith D, Elders PJM, Welsing PMJ, Leufkens HGM, Harvey NC, Bijlsma JWJ, van Staa TP, de Vries F. Anti-osteoporosis drug prescribing after hip fracture in the UK: 2000-2010. Osteoporos Int 2015; 26:1919-28. [PMID: 25963232 PMCID: PMC4483189 DOI: 10.1007/s00198-015-3098-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/03/2015] [Indexed: 12/16/2022]
Abstract
UNLABELLED The probability of initiating with anti-osteoporosis therapy increased from 7 % in 2000 to 46 % in 2010. This improvement was greater for patients over the age of 75 years. Men, those overweight, having dementia or exposed to antipsychotics, sedatives/hypnotics or opioid analgesics were significantly less likely to receive anti-osteoporosis drugs. INTRODUCTION The objective of this study was to examine trends and determinants of anti-osteoporosis drug prescribing after hip fracture in the UK between 2000 and 2010. METHODS Data were extracted from the UK Clinical Practice Research Datalink for patients ≥50 years who had a first hip fracture between 2000 and 2010 and who did not currently (≤6 months prior) receive anti-osteoporosis drugs (bisphosphonates, strontium ranelate, parathyroid hormone, calcitonin and raloxifene) (n = 27,542). The cumulative incidence probability of being prescribed anti-osteoporosis drugs within 1 year after hip fracture was estimated by Kaplan-Meier life-table analyses. Determinants for treatment initiation were estimated by Cox proportional hazards models. RESULTS The probability of being prescribed any anti-osteoporosis drug after hip fracture increased from 7 % in 2000 to 46 % in 2010. This trend was more marked in patients ≥75 years. The increase in prescribing of anti-osteoporosis drugs was complemented by a similar increase in vitamin D/calcium provision. Cumulative incidence of receiving anti-osteoporosis therapy was greater at any given point in time in women (8 % in 2000, 51 % in 2010) compared to men (4 % in 2000, 34 % in 2010). In addition to male gender, multivariable Cox regression identified reduced likelihood of receiving anti-osteoporosis drugs for those being overweight, having dementia and exposed to psychotropic drugs (antipsychotics, sedatives/hypnotics) or opioid analgesics. CONCLUSION Although the prescribing of anti-osteoporosis drugs after hip fracture has increased substantially since 2000, the overall rate remained inadequate, particularly in men. With the continuing increase in the absolute number of hip fractures, further research should be made into the barriers to optimise osteoporosis management.
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Affiliation(s)
- C. Klop
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - D. Gibson-Smith
- Department of Psychiatry/EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - P. J. M. Elders
- Department of General Practice and Elderly Care, VU University Medical Centre, Amsterdam, The Netherlands
| | - P. M. J. Welsing
- Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H. G. M. Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - N. C. Harvey
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - J. W. J. Bijlsma
- Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - T.-P. van Staa
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
- Health eResearch Centre, University of Manchester, Manchester, UK
| | - F. de Vries
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- Maastricht University/CAPHRI, Maastricht, The Netherlands
- Department of Clinical Pharmacology and Toxicology, University Medical Centre Maastricht, Maastricht, The Netherlands
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20
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Haddad PT, Salazar M, Hernandes L. Histomorfometria da matriz orgânica do fêmur de ratas ovariectomizadas tratadas com alendronato de sódio. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Alves SM, Castiglione D, Oliveira CM, de Sousa B, Pina MF. Age-period-cohort effects in the incidence of hip fractures: political and economic events are coincident with changes in risk. Osteoporos Int 2014; 25:711-20. [PMID: 23982801 DOI: 10.1007/s00198-013-2483-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED An age-period cohort model was fitted to analyse time effects on hip fracture incidence rates by sex (Portugal, 2000-2008). Rates increased exponentially with age (age effect). Incidence rates decreased after 2004 for women and were random for men (period effect). New but comprehensive fluctuations in risk were coincident with major political/economic changes (cohort effect). INTRODUCTION Healthcare improvements have allowed prevention but have also increased life expectancy, resulting in more people being at risk. Our aim was to analyse the separate effects of age, period and cohort on incidence rates by sex in Portugal, 2000-2008. METHODS From the National Hospital Discharge Register, we selected admissions (aged ≥ 49 years) with hip fractures (ICD9-CM, codes 820.x) caused by low/moderate trauma (falls from standing height or less), readmissions and bone cancer cases. We calculated person-years at risk using population data from Statistics Portugal. To identify period and cohort effects for all ages, we used an age-period-cohort model (1-year intervals) followed by generalised additive models with a negative binomial distribution of the observed incidence rates of hip fractures. RESULTS There were 77,083 hospital admissions (77.4 % women). Incidence rates increased exponentially with age for both sexes (age effect). Incidence rates fell after 2004 for women and were random for men (period effect). There was a general cohort effect similar in both sexes; risk of hip fracture altered from an increasing trend for those born before 1930 to a decreasing trend following that year. Risk alterations (not statistically significant) coincident with major political and economic change in the history of Portugal were observed around birth cohorts 1920 (stable-increasing), 1940 (decreasing-increasing) and 1950 (increasing-decreasing only among women). CONCLUSIONS Hip fracture risk was higher for those born during major economically/politically unstable periods. Although bone quality reflects lifetime exposure, conditions at birth may determine future risk for hip fractures.
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Affiliation(s)
- S Maria Alves
- Instituto de Engenharia Biomédica (INEB), Rua do Campo Alegre, 823, 4150-180, Porto, Portugal,
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Polesie S, Sigurdsen U, Bjørgul K. Unchanging incidence of hip fracture in southeastern norway. Geriatr Orthop Surg Rehabil 2013; 4:58-63. [PMID: 24093078 DOI: 10.1177/2151458513501321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study was to ascertain trends in the incidence of hip fracture in southeastern Norway by comparing the hip fracture incidence for the years 2008 to 2010 to that of a study from 1998 to 2003 in the same area. METHODS We determined the number of hip fractures for the geographical area of Ostfold county, and the age- and gender-specific incidence per 100 000, with 95% confidence intervals, was calculated. Use of bisphosphonates was determined by extracting data from public databases. RESULTS The hip fracture incidence for men aged 50 to 74 and older than 75 years was 120 (100-141) and 1305 (1237-1372) in the latest time period, 1998-2003, whereas the incidence for the previous period, 2008-2010, was 124 (103-146) for men aged 50 to 75 and 1333 (1189-1476) for men older than 75 years. For women of 50 to 74 years, the incidence was 184 (158-209), and for women older than 75 years, it was 2523 (2428-2618). In the first time period, the corresponding incidence was 228 (200-257) for women aged 50 to 74 and 2330 (2189-2471) for women older than 75 years. As the 95% confidence intervals overlap in all the comparisons, it indicates the the incidence did not significantly differ between the time periods. Bisphosphonate use did not exceed 2% in any age group for men. For women, the highest rate of bisphosphonate use was 12.6% in the 85- to 89-year groups. CONCLUSION We cannot confirm reports of decreasing incidence of hip fracture.
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Affiliation(s)
- Sam Polesie
- Department of Orthopedic Surgery, Ostfold Hospital Trust, Fredrikstad, Norway
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Alves SM, Economou T, Oliveira C, Ribeiro AI, Neves N, Goméz-Barrena E, Pina MF. Osteoporotic hip fractures: bisphosphonates sales and observed turning point in trend. A population-based retrospective study. Bone 2013; 53:430-6. [PMID: 23274347 DOI: 10.1016/j.bone.2012.12.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 12/03/2012] [Accepted: 12/17/2012] [Indexed: 11/21/2022]
Abstract
The aim is to examine the temporal trends of hip fracture incidence in Portugal by sex and age groups, and explore the relation with anti-osteoporotic medication. From the National Hospital Discharge Database, we selected from 1st January 2000 to 31st December 2008, 77,083 hospital admissions (77.4% women) caused by osteoporotic hip fractures (low energy, patients over 49years-age), with diagnosis codes 820.x of ICD 9-CM. The 2001 Portuguese population was used as standard to calculate direct age-standardized incidence rates (ASIR) (100,000 inhabitants). Generalized additive and linear models were used to evaluate and quantify temporal trends of age specific rates (AR), by sex. We identified 2003 as a turning point in the trend of ASIR of hip fractures in women. After 2003, the ASIR in women decreased on average by 10.3 cases/100,000 inhabitants, 95% CI (-15.7 to -4.8), per 100,000 anti-osteoporotic medication packages sold. For women aged 65-69 and 75-79 we identified the same turning point. However, for women aged over 80, the year 2004 marked a change in the trend, from an increase to a decrease. Among the population aged 70-74 a linear decrease of incidence rate (95% CI) was observed in both sexes, higher for women: -28.0% (-36.2 to -19.5) change vs -18.8%, (-32.6 to -2.3). The abrupt turning point in the trend of ASIR of hip fractures in women is compatible with an intervention, such as a medication. The trends were different according to gender and age group, but compatible with the pattern of bisphosphonates sales.
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Affiliation(s)
- Sandra Maria Alves
- Rua do Campo Alegre, 823, 4150-180 Porto, INEB, Instituto de Engenharia Biomédica, Portugal.
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Hip fracture rates and bisphosphonate consumption in Spain. An ecologic study. Eur J Clin Pharmacol 2012; 69:559-64. [DOI: 10.1007/s00228-012-1337-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 06/12/2012] [Indexed: 10/28/2022]
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Hiligsmann M, Bruyère O, Roberfroid D, Dubois C, Parmentier Y, Carton J, Detilleux J, Gillet P, Reginster JY. Trends in hip fracture incidence and in the prescription of antiosteoporosis medications during the same time period in Belgium (2000-2007). Arthritis Care Res (Hoboken) 2012; 64:744-50. [PMID: 22238220 DOI: 10.1002/acr.21607] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To examine the secular trend of hip fracture incidence in Belgium between 2000 and 2007 and the concomitant change in the prescriptions of antiosteoporosis medications. METHODS The incidence of hip fractures and the number of prescriptions were determined using national databases. A logistic regression including years and 5-year age range was performed to assess the secular trend of hip fracture incidence, and Pearson's correlation coefficient was calculated to examine the relationship between hip fracture incidence and the prescriptions of antiosteoporosis medications. RESULTS The annual number of hip fractures increased in Belgium from 13,512 in 2000 to 14,744 in 2007, with a more marked increased in men (20.4%) than in women (5.7%). The age-adjusted incidence of hip fractures was significantly decreased by 1.12% per year in women, but declined nonsignificantly by 0.34% per year in men. An increase in the prescriptions of antiosteoporosis medications in women was observed during the same time period. CONCLUSION Despite an increase in the number of hip fractures in Belgium between 2000 and 2007, there was a significant decrease in age-adjusted incidence in women but not in men. Although our results suggest that the decrease may be related to the extent of antiosteoporosis medications, a causal relationship cannot be ascertained and many other factors may have contributed to the decrease in age-adjusted incidence.
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Affiliation(s)
- Mickaël Hiligsmann
- Department of Public Health Sciences, University of Liège, Avenue de l'Hôpital 3, Liège, Belgium.
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Leslie WD, Giangregorio LM, Yogendran M, Azimaee M, Morin S, Metge C, Caetano P, Lix LM. A population-based analysis of the post-fracture care gap 1996-2008: the situation is not improving. Osteoporos Int 2012; 23:1623-9. [PMID: 21476038 DOI: 10.1007/s00198-011-1630-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 03/09/2011] [Indexed: 01/06/2023]
Abstract
UNLABELLED The post-fracture care gap has not narrowed in recent years. Following an initial improvement, rates of medication initiation have actually declined. INTRODUCTION The current study characterizes temporal changes in post-fracture bone mineral density (BMD) testing or osteoporosis treatment initiation from 1996/1997 to 2007/2008. METHODS A population-based administrative data repository for Manitoba, Canada was accessed to identify non-traumatic fractures in individuals aged 50 years and older. Outcomes included BMD testing or dispensation of an osteoporosis medication in the 12 months following the fracture. RESULTS Thirty thousand nine hundred and twenty (30,920) fracture events met the inclusion criteria; 15,670 affected major osteoporotic fracture sites. Based on either BMD testing or treatment initiation, intervention rates reached a maximum of only 15.5% in 2003/2004, compared with 6.3% in 1996/1997, and 13.2% in 2007/2008 (p-for-trend < 0.001). Post-fracture BMD testing increased from 0.7% in 1996/1997 to 8.9% 2007/2008 (p-for-trend < 0.001). Osteoporosis medication use increased from 6.1% in 1996/1997 to 12.3% in 2001/2002 and then progressively declined to 5.9% by 2007/2008 (p-for-trend = 0.025). Similar trends were observed when only major osteoporotic fractures were included. The initiation of BMD testing or medication varied according to age, gender, geographic region, and income. CONCLUSION Despite increased attention to gaps in osteoporosis management post-fracture in the last 10 years, the situation has not improved: in 2007/20008, fewer than 20% of untreated individuals with a low-trauma fracture received intervention. Novel strategies are required to disseminate and implement best practices at the point of care to reduce the risk of recurrent fractures.
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Affiliation(s)
- W D Leslie
- Department of Medicine, University of Manitoba, C5121 409 Tache Avenue, Winnipeg, MB R2H 2A6, Canada.
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