Osteoporosis guidelines from a rehabilitation perspective: systematic analysis and quality appraisal using AGREE II

Disulfidptosis-related Protein RPN1 may be a Novel Anti-osteoporosis Target of Kaempferol

BACKGROUND

Osteoporosis (OP) is an age-related skeletal disease. Kaempferol can regulate bone mesenchymal stem cells (BMSCs) osteogenesis to improve OP, but its mechanism related to disulfidptosis, a newly discovered cell death mechanism, remains unclear.

OBJECTIVE

The study aimed to investigate the biological function and immune mechanism of disulfidptosis- related ribophorin I (RPN1) in OP and to experimentally confirm that RPN1 is the target for the treatment of OP with kaempferol.

METHODS

Differential expression analysis was conducted on disulfide-related genes extracted from the GSE56815 and GSE7158 datasets. Four machine learning algorithms identified disease signature genes, with RPN1 identified as a significant risk factor for OP through the nomogram. Validation of RPN1 differential expression in OP patients was performed using the GSE56116 dataset. The impact of RPN1 on immune alterations and biological processes was explored. Predictive ceRNA regulatory networks associated with RPN1 were generated via miRanda, miRDB, and TargetScan databases. Molecular docking estimated the binding model between kaempferol and RPN1. The targeting mechanism of kaempferol on RPN1 was confirmed through pathological HE staining and immunohistochemistry in ovariectomized (OVX) rats.

RESULTS

RPN1 was abnormally overexpressed in the OP cohort, associated with TNF signaling, hematopoietic cell lineage, and NF-kappa B pathway. Immune infiltration analysis showed a positive correlation between RPN1 expression and CD8+ T cells and resting NK cells, while a negative correlation with CD4+ naive T cells, macrophage M1, T cell gamma delta, T cell follicular helper cells, activated mast cells, NK cells, and dendritic cells, was found. Four miRNAs and 17 lncRNAs associated with RPN1 were identified. Kaempferol exhibited high binding affinity (-7.2 kcal/mol) and good stability towards the RPN1. The experimental results verified that kaempferol could improve bone microstructure destruction and reverse the abnormally high expression of RPN1 in the femur of ovariectomized rats.

CONCLUSION

RPN1 may be a new diagnostic biomarker in patients with OP, and may serve as a new target for kaempferol to improve OP.

Effects of exercise on bone mineral density in middle-aged and older men: A comprehensive meta-analysis

This meta-analysis including 10 randomised controlled trials suggests that exercise is associated with a statistically significant, but relatively mild, improvement effect on bone mineral density in middle-aged and older men, indicating that exercise has the potential to be a safe and effective way toavert bone loss in men.

PURPOSE

To determine the effect of exercise on bone mineral density (BMD) in middle-aged and older men.

METHODS

We searched three electronic databases up to March 21, 2022. A systematic review of the literature according to the PRISMA statement included (1) randomised controlled trials (RCTs), with (2) at least one exercise group as an intervention versus a control group, (3) men aged ≥ 45 years old, and (4) areal BMD of the lumbar spine (LS) and/or femoral neck (FN) and/or total hip (TH) and/or trochanter region. Mean differences (MD) for BMD changes at the LS, FN, TH, and trochanter were defined as outcome measures.

RESULTS

A total of 10 eligible RCTs were included (N = 555 participants). Exercise significantly improved BMD, and the summarised MD was 0.02 (95% CI: 0.00 to 0.05) for LS BMD, 0.01 (95% CI: 0.00 to 0.02) for FN BMD, 0.01 (95% CI: 0.00 to 0.01) for TH BMD, and 0.03 (95% CI: 0.00 to 0.05) for trochanter BMD. Subgoup analyses showed the improvement effect was statistically significant in trials with longer duration and higher intensity in LS (≥ 12 months: MD, 0.01, 95% CI:0.00 to 0.03; higher intensity: MD, 0.01, 95% CI:0.00 to 0.03) and FN (≥ 12 months: MD, 0.02, 95% CI:0.01 to 0.02; higher intensity: MD, 0.01, 95% CI:0.01 to 0.02).

CONCLUSION

Our results suggested a relatively mild, improvement effect of exercise on LS and proximal femur BMD. Exercise has the potential to be an effective way to avert bone loss in middle-aged and older men.

Sequential treatment of teriparatide and alendronate versus alendronate alone for elevation of bone mineral density and prevention of refracture after percutaneous vertebroplasty in osteoporosis: a prospective study

BACKGROUND

Percutaneous vertebroplasty was the most common strategy for osteoporotic vertebral compression fracture. However, refracture after vertebroplasty also occurred and bone mineral density (BMD) was one of the main factors associated with refracture after percutaneous vertebroplasty.

AIMS

To investigate the efficacy of a short-sequential treatment of teriparatide followed by alendronate on prevention of refracture after percutaneous vertebroplasty in osteoporotic patients, and compare it with the therapy of alendronate alone.

METHODS

From January 2018 to January 2020, we recruited 165 female osteoporosis patients after percutaneous vertebroplasty who were assigned into sequential treatment of teriparatide followed by alendronate group (TPTD + ALN group) and alendronate alone group (ALN group). The vertebral fracture occurred during this process was also recorded in both the groups. A total of 105 participants completed the 1-year follow-up. Furthermore, BMD and serum procollagen type I N-terminal propeptide (PINP) and C-terminal cross-linking telopeptide of type I collagen (CTX) were compared between the two groups during 1-year follow-up.

RESULTS

The 105 patients were finally included, with 59 in ALN group and 46 in TPTD + ALN group. During 1-year follow-up, the vertebral refracture rate in TPTD + ALN group was much lower than that in ALN group (2.2% vs. 13.6%, p < 0.05). At 12 months, the BMDs at lumbar in TPTD + ALN group were significantly elevated when compared to the ALN group (0.65 ± 0.10 vs. 0.57 ± 0.07, p < 0.001).

DISCUSSION AND CONCLUSION

A short-sequential administration of teriparatide followed by alendronate was more effective in elevating the BMD and decreasing the refracture rate at 12-month follow-up, compared to the counterpart with alendronate alone.

Risk of primary osteoporosis score (RPOPs): an algorithm model for primary osteoporosis risk assessment in grass-roots hospital

BACKGROUND

This study aimed to develop and validate a lasso regression algorithm model which was established by correlation factors of bone mineral density (BMD) and could be accurately predicted a high-risk population of primary osteoporosis (POP). It provides a rapid, economical and acceptable early screening method for osteoporosis in grass-roots hospitals.

METHODS

We collected 120 subjects from primary osteoporosis screening population in Zhejiang Quhua Hospital between May 2021 and November 2021 who were divided into three groups (normal, osteopenia and osteoporosis) according to the BMD T-score. The levels of three micro-RNAs in the plasma of these people were detected and assessed by qRT-PCR. At the same time, the levels of β-CTX and t-P1NP in serum of the three groups were determined. Based on the cluster random sampling method, 84 subjects (84/120, 70%) were selected as the training set and the rest were the test set. Lasso regression was used to screen characteristic variables and establish an algorithm model to evaluate the population at high risk of POP which was evaluated and tested in an independent test cohort. The feature variable screening process was used 10-fold cross validation to find the optimal lambda.

RESULTS

The osteoporosis risk score was established in the training set: Risk of primary osteoporosis score (RPOPs) = -0.1497785 + 2.52Age - 0.19miR21 + 0.35miR182 + 0.17β-CTx. The sensitivity, precision and accuracy of RPOPs in an independent test cohort were 79.17%, 82.61% and 75%, respectively. The AUC in the test set was 0.80. Some risk factors have a significant impact on the abnormal bone mass of the subjects. These risk factors were female (p = 0.00013), older than 55 (p < 2.2e-16) and BMI < 24 (p = 0.0091) who should pay more attention to their bone health.

CONCLUSION

In this study, we successfully constructed and validated an early screening model of osteoporosis that is able to recognize people at high risk for developing osteoporosis and remind them to take preventive measures. But it is necessary to conduct further external and prospective validation research in large sample size for RPOPs prediction models.

Global trends and hotspots in research on osteoporosis rehabilitation: A bibliometric study and visualization analysis

Background

The field of rehabilitation medicine plays an essential role in the comprehensive management of osteoporosis and its consequences. The benefits of therapeutic exercise are increasingly being recognized in this area, which receives an increasing number of publications. this study was designed to comprehensively identify collaborative networks, parse and track research trends, spotlight present hotspots, and accurately predict frontiers and focus on the health topics related to osteoporosis rehabilitation.

Methods

This research adopted computer retrieval of osteoporosis rehabilitation-related research published in the Web of Science Core Collection (WoSCC) from inception to June 14, 2022. The bibliometric visualization and comparative analysis involving countries, institutions, journals, authors, references, and keywords were performed using the CiteSpace and VOSviewer software.

Results

A total of 3,268 articles were included, and the number of articles published each year has demonstrated a steady increase. The United States and the University of Melbourne were the highest productive country and institution, with 1,325 and 87 articles, respectively. The journal of osteoporosis international has published the greatest number of articles, with 221 publications, and the journal of bone and mineral research ranked first in the co-citation counts (cited by 11,792 times). The most productive and highly-cited authors were Heinonen A and Cummings S, with 35 publications and 680 citations.

Conclusions

At present, "physical activity," "weight bearing exercise," "muscle strength," "whole body vibration," "postmenopausal women," "older women," children, men are the noteworthy research hot topics. Future research that focus on the major modes and parameters of physical activity/exercise for osteoporosis (including whole body vibration, weight bearing exercises, resistance training), targeted multicomponent training regimens, rehabilitation therapy for postmenopausal women, older women, children and men, osteoporosis related-sarcopenia and fractures, and mesenchymal stem cells are becoming frontiers and focus on the health topics related to osteoporosis rehabilitation in the upcoming years, which are worthy of further exploration.

Urinary and Daily Assumption of Polyphenols and Hip-Fracture Risk: Results from the InCHIANTI Study

A high polyphenol intake has been associated with higher bone-mineral density. In contrast, we recently demonstrated that the urinary levels of these micronutrients were associated with the long-term accelerated deterioration of the bone. To expand on the health consequences of these findings, we assessed the association between urinary level and dietary intake of polyphenols and the 9-year risk of hip fractures in the InCHIANTI study cohort. The InCHIANTI study enrolled representative samples from two towns in Tuscany, Italy. Baseline data were collected in 1998 and at follow-up visits in 2001, 2004, and 2007. Of the 1453 participants enrolled at baseline, we included 817 participants in this study who were 65 years or older at baseline, donated a 24 hour urine sample, and underwent a quantitative computerized tomography (pQCT) of the tibia. Fracture events were ascertained by self-report over 9 years of follow-up. Thirty-six hip fractures were reported over the 9-year follow-up. The participants who developed a hip fracture were slightly older, more frequently women, had a higher dietary intake of polyphenols, had higher 24-hour urinary polyphenols excretion, and had a lower fat area, muscle density, and cortical volumetric Bone Mineral Density (vBMD) in the pQCT of the tibia. In logistic regression analyses, the baseline urinary excretion of total polyphenols, expressed in mg as a gallic acid equivalent, was associated with a higher risk of developing a hip fracture. Dietary intake of polyphenols was not associated with a differential risk of fracture. In light of our findings, the recommendation of an increase in dietary polyphenols for osteoporosis prevention should be considered with caution.

Exercise and Exercise Mimetics for the Treatment of Musculoskeletal Disorders

PURPOSE OF REVIEW

The incidence of musculoskeletal disorders affecting bones, joints, and muscles is dramatically increasing in parallel with the increased longevity of the worldwide population, severely impacting on the individual's quality of life and on the healthcare costs. Inactivity and sedentary lifestyle are nowadays considered the main drivers of age-associated musculoskeletal disorders and exercise may counteract such alterations also in other bone- and muscle-centered disorders. This review aims at clarifying the potential use of exercise training to improve musculoskeletal health.

RECENT FINDINGS

Both the skeletal muscle and the bone are involved in a complex crosstalk determining, in part through tissue-specific and inflammatory/immune released factors, the occurrence of musculoskeletal disorders. Exercise is able to modulate the levels of those molecules and several associated molecular pathways. Evidence from preclinical and clinical trials supports the adoption of exercise and the future use of exercise mimicking drugs will optimize the care of individuals with musculoskeletal disorders.

Impact of nutraceuticals and dietary supplements on mitochondria modifications in healthy aging: a systematic review of randomized controlled trials

BACKGROUND

To date, the mitochondrial function has been related to several pathways involved in the cellular aging process. Dietary supplements might have reciprocal and multilevel interactions with mitochondria network; however, no systematic review assessed the role of different nutraceuticals in mitochondria modification of healthy older adults.

AIM

To assess the effects of different dietary supplements on mitochondria modifications in older adults.

METHODS

On February 22, 2022, PubMed, Scopus, Web of Science, and Cochrane were systematically searched from inception for randomized controlled trials (RCTs). According to PICO model, we considered healthy older adults as participants, nutraceutical treatment as intervention, any treatment as comparator, mitochondrial modifications as outcome. Jadad scale was used for the quality assessment.

RESULTS

Altogether, 8489 records were identified and screened until 6 studies were included. A total of 201 healthy older adults were included in the systematic review (mean age ranged from 67.0 ± 1.0 years to 76.0 ± 5.6 years). The dietary supplements assessed were sodium nitrite, N-3 polyunsaturated fatty acids, hydrogen-rich water, nicotinamide riboside, urolithin A, and whey protein powder. Positive effects were reported in terms of mitochondrial oxidative and antioxidant capacity, volume, bioenergetic capacity, and mitochondrial transcriptome based on the nutritional supplements. The quality assessment underlined that all the studies included were of good quality.

DISCUSSION

Although dietary supplements might provide positive effects on mitochondria modifications, few studies are currently available in this field.

CONCLUSION

Further studies are needed to better elucidate the reciprocal and multilevel interactions between nutraceuticals, mitochondria, and environmental stressors in healthy older adults.

Is sarcopenia associated with osteoporosis? A cross-sectional study of 262 women with hip fracture

BACKGROUND

Several lines of evidence support the view that sarcopenia and osteoporosis are strictly connected. However, the capability of the updated sarcopenia definition to capture the concomitant presence of osteoporosis has been scarcely investigated.

AIM

The main aim was to assess the association between sarcopenia defined according to the revised criteria from the European Working Group on Sarcopenia in Older People (EWGSOP2) and osteoporosis in women with a hip fracture. A second aim was to investigate the thresholds for low appendicular lean mass (aLM) and handgrip strength to optimize osteoporosis detection.

DESIGN

Cross-sectional study.

SETTING

Rehabilitation hospital.

POPULATION

Women with subacute hip fracture.

METHODS

A scan by dual-energy X-ray absorptiometry (DXA) was performed to assess body composition. A Jamar dynamometer was used to measure handgrip strength. Sarcopenia was diagnosed with both handgrip strength <16 kg and aLM <15 kg. Osteoporosis was identified with femoral bone mineral density lower than 2.5 standard deviations below the mean of the young reference population.

RESULTS

We studied 262 of 290 women. Osteoporosis was found in 189 of the 262 women (72%; 95% CI: 67-78%) whereas sarcopenia in 147 (56%; 95% CI: 50-62%). After adjustment for age, time interval between fracture and DXA scan and body fat percentage the odds ratio to have osteoporosis for a sarcopenic woman was 2.30 (95% CI: 1.27-4.14; P=0.006). Receiver operating characteristic curve analyses showed that the best cut-off points to discriminate osteoporosis were 20 kg for handgrip strength and 12.5 kg for aLM. Adopting the optimized thresholds to define sarcopenia, the adjusted odds ratio to have osteoporosis for a sarcopenic woman was 3.68 (95% CI: 1.93-7.03; P<0.001).

CONCLUSIONS

This preliminary study shows a positive association between sarcopenia defined according to the EWGSOP2 criteria and osteoporosis in 262 women with hip fracture. The association may be bettered by refining the cut-off points for low aLM and handgrip strength.

CLINICAL REHABILITATION IMPACT

Sarcopenia seems to be a risk factor for osteoporosis in hip-fracture women. The issue, and the potential role of optimized thresholds should be addressed by robust longitudinal studies.

Effects of physical exercise on bone mineral density in older postmenopausal women: a systematic review and meta-analysis of randomized controlled trials

Osteoporosis or decreased bone mineral density (BMD) is the most important risk factor for fractures, especially in older postmenopausal women (PMW). However, the interactions between exercise training and bone mineral density are not completely understood. We evaluated the effects of physical exercise on BMD in women aged ≥ 60 years postmenopausal.

PURPOSE

This systematic review and meta-analysis sets out to determine the effects of physical exercise on BMD in older postmenopausal women.

METHODS

A systematic search was conducted in Medline, Science Direct, Cochrane, PubMed, CINAHL, Google Scholar, Scopus, and ProQuest up to December 25, 2021. Fifty-three studies, which assessed a total of 2896 participants (mean age: between 60 and 82 years), were included and analyzed using a random-effects model to estimate weighted mean differences (WMD) with 95% confidence intervals (CI).

RESULTS

The meta-analysis found that exercise training significantly (p < 0.05) increased femoral neck (WMD: 0.01 g/cm²; 95% CI, 0.00 to 0.01], p = 0.0005; I² = 57%; p < 0.0001), lumbar spine (WMD: 0.01 g/cm², 95% CI, 0.01 to 0.02], I² = 81%; p = 0.0001), and trochanter (WMD: 0.01 g/cm², 95% CI 0.00, 0.02]; p = 0.009; I² = 17%; p = 0.23). There were no significant differences between the intervention and control groups for total body and total hip BMD.

CONCLUSION

Our findings suggest that exercise training may improve bone mineral density in older PMW. This improvement is mediated by increases in the femoral neck, lumbar spine, and trochanter BMD. Further long-term studies are required to confirm these findings.

Role of Dietary Supplements and Probiotics in Modulating Microbiota and Bone Health: The Gut-Bone Axis

Osteoporosis is characterized by an alteration of bone microstructure with a decreased bone mineral density, leading to the incidence of fragility fractures. Around 200 million people are affected by osteoporosis, representing a major health burden worldwide. Several factors are involved in the pathogenesis of osteoporosis. Today, altered intestinal homeostasis is being investigated as a potential additional risk factor for reduced bone health and, therefore, as a novel potential therapeutic target. The intestinal microflora influences osteoclasts’ activity by regulating the serum levels of IGF-1, while also acting on the intestinal absorption of calcium. It is therefore not surprising that gut dysbiosis impacts bone health. Microbiota alterations affect the OPG/RANKL pathway in osteoclasts, and are correlated with reduced bone strength and quality. In this context, it has been hypothesized that dietary supplements, prebiotics, and probiotics contribute to the intestinal microecological balance that is important for bone health. The aim of the present comprehensive review is to describe the state of the art on the role of dietary supplements and probiotics as therapeutic agents for bone health regulation and osteoporosis, through gut microbiota modulation.

Early Denosumab for the prevention of osteoporotic fractures in breast cancer women undergoing aromatase inhibitors: A case-control retrospective study

BACKGROUND

Aromatase inhibitors (AIs) might have a detrimental impact on bone health in breast cancer (BC) women. Denosumab has been shown to reduce the risk of fractures, but the appropriate time for starting is yet to be clearly defined.

OBJECTIVE

To evaluate the effects of early treatment with Denosumab (⩽ 12 months after starting AIs) compared to a delayed treatment in BC women.

METHODS

In this retrospective case-control study, we included medical records of BC post-menopausal women, treated with AIs therapy; they were divided as: study group (starting Denosumab ⩽ 12 months after AIs) and control group (> 12 months). At the baseline (T0) and at 18 months (T1), we evaluated the lumbar spine (LS) Tscore and femoral neck (FN) Tscore. Furthermore, at T1 we assessed the incident fragility fractures.

RESULTS

Fifty-nine BC survivors (mean age: 61.5 ± 11.5 years) were included: 28 with Early Denosumab and 31 with Late Denosumab. At T1, the study group did not show any incident hip or vertebral fragility fracture, whereas the Late Denosumab group showed 2 incident hip fractures (6.5%) and 4 (12.9%) vertebral fragility fractures. Early Denosumab showed a significant positive effect on both LS (p= 0.044) and FN (p= 0.024) Tscore variations.

CONCLUSION

Taken together, our findings suggest that an early start of Denosumab might be considered for the osteoporosis management in BC women undergoing AIs.

Identification of a Potential MiRNA-mRNA Regulatory Network for Osteoporosis by Using Bioinformatics Methods: A Retrospective Study Based on the Gene Expression Omnibus Database

INTRODUCTION

As a systemic skeletal dysfunction, osteoporosis (OP) is characterized by low bone mass, impairment of bone microstructure, and a high global morbidity rate. There is increasing evidence that microRNAs (miRNAs) are associated with the pathogenesis of OP. Weighted gene co-expression network analysis (WGCNA) is a systematic method for identifying clinically relevant genes involved in disease pathogenesis. However, the study of the miRNA-messenger RNA (mRNA) regulatory network in combination with WGCNA in OP is still lacking.

METHODS

The GSE93883 and GSE7158 microarray datasets were downloaded from the Gene Expression Omnibus (GEO) database. Differentially expressed miRNAs (DE-miRNAs) and differentially expressed genes (DEGs) were analyzed with the limma package. OP-related miRNAs from the most clinically relevant module were identified by the WGCNA method. The overlap of DE-miRNAs and OP-related miRNAs was identified as OP-related DE-miRNAs. Both upstream transcription factors and downstream targets of OP-related DE-miRNAs were predicted by FunRich. An intersection of predicted target genes and DEGs was confirmed as downstream target genes of OP-related DE-miRNAs. With the use of clusterProfiler in R, Gene Ontology (GO) annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment were performed on target genes. Finally, both the protein-protein interaction (PPI) network and miRNA-mRNA network were constructed and analyzed.

RESULTS

A total of 79 OP-related DE-miRNAs were obtained, most of which were predicted to be regulated by specificity protein 1 (SP1). Subsequently, 197 downstream target genes were screened out. The target genes were enriched in multiple pathways, including signaling pathways closely related to the onset of OP, such as Ras, PI3K-Akt, and ErbB signaling pathways. Through the construction of the OP-related miRNA-mRNA regulatory network, a hub network that may play a prominent role in the formation of OP was documented.

CONCLUSION

By using WGCNA, we constructed a potential OP-related miRNA-mRNA regulatory network, offering a novel perspective on miRNA regulatory mechanisms in OP.

[Topical issues of rehabilitation of patients with osteoporotic vertebral fractures]

The literature review analyzed 20 Russian and 69 foreign publications on the rehabilitation of elderly patients with osteoporotic vertebral fractures. The article deals in detail with the prevalence, medical and social significance of pathological osteoporotic fractures, including vertebral deformities. The data confirming the importance of osteoporosis for physical and rehabilitation medicine specialists are presented. Changes in the quality of life, functional and gate disorders associated with osteoporotic vertebral fractures are described. Based on the available literature data, the principles of rehabilitation of patients with osteoporotic vertebral compression fractures are formulated, including the effectiveness of various methods of physical therapy, mechanotherapy and apparatus physiotherapy. From the standpoint of evidence-based medicine, the role of orthotics in the complex rehabilitation of such patients is described. Based on the analysis of literature data, it was concluded that the problem of osteoporosis is relevant for physicians working in the field of rehabilitation medicine; osteoporotic vertebral fractures are characterized by a high prevalence over the age of 50 years and are associated with a decrease in the quality of life, motor and functional limitations, and an increased risk of death, and well-planned medical rehabilitation programs including physical exercises, physiotherapy and orthotics can significantly improve patient functionality.

Anthropometric, biochemical, and nutritional risk factors for osteoporosis in Korean adults based on a large cross-sectional study

Background

Osteoporosis a common bone disorder characterized by decreases in bone mass, tension, and strength. Although many previous studies worldwide have sought to identify the risk factors for osteoporosis, studies that simultaneously examine a variety of factors, such as biochemical, anthropometric and nutritional components, are very rare. Therefore, the objective of this study was to simultaneously examine the association of osteoporosis with biochemical profiles, anthropometric factors, and nutritional components in a large-scale cross-sectional study.

Method

This cross-sectional study was based on data from the Korea National Health and Nutrition Examination Survey (KNHANES VI-VII) from 2015 to 2018. Based on data from 16,454 participants, logistic regression was used to examine the association between various parameters in a crude analysis and in models adjusted for confounders.

Results

In men, osteoporosis was significantly associated with the anthropometric variables height and weight; the biochemical components hemoglobin, hematocrit, urea nitrogen and urine pH and creatinine; and the nutritional components total food intake, energy, water, protein, phosphorus, and kalium. However, these associations disappeared in adjusted model 2. In women, osteoporosis was significantly related to the anthropometric measures height, weight, and systolic blood pressure; the biochemical components hemoglobin, hematocrit and urine pH; and the nutritional components total food intake, water, calcium, phosphorus, and kalium. Most of these associations were maintained in the adjusted models.

Conclusion

Osteoporosis was linked to various anthropometric, biochemical and urine and nutritional components in Korean women, but the association between osteoporosis and risk factors differed according to sex.

Assessment of Quality of Life and Pain Severity in Older Men with Osteoporosis: Cross-Sectional Study

BACKGROUND

The quality of life in osteoporosis is studied for men rather than for women. Aim of the study was to determine how bone mass density (BMD) relates to life quality components and the severity of pain felt by men affected by osteoporosis.

METHODS

Presented research is a cross-sectional study. The cohort of 62 men aged 65 to 85 years was divided into a group with osteoporosis (N = 27) and a group without osteoporosis (N = 35). The participants' quality of life was measured with the Qualeffo41 Questionnaire, BMD was quantified by densitometry, and pain intensity was assessed on the Visual Analogue Scale.

RESULTS

We found that lower BMD was strongly correlated to participants' quality of life (r = -0.72), especially the quality of leisure and social activities (r = -0.66), general health perception (r = -0.59), and mobility (r = -0.57). Pain significantly affected general health perception in older men with osteoporosis. General health assessment and pain were highly correlated with each other (r = 0.888).

CONCLUSION

BMD and the overall quality of life of the study participants were related to each other. The strongest relationship occurred between reduced BMD and leisure and social activities component. The pain significantly affected participants' general health perception. The results may be employed to create new prophylactic strategies to improve life quality in men with osteoporosis.

Optimization of transdisciplinary management of elderly with femur proximal extremity fracture: A patient-tailored plan from orthopaedics to rehabilitation

Fractures of femur proximal extremity (FFPE) are the most common fragility fractures requiring hospitalization, with a high risk of mortality, low independence in the activities of daily living and severe consequences on health-related quality of life. Timing for surgery has a key role in the management of elderly patients with FFPE as recommended by the Australian and New Zealand guidelines and the National Institute for Health and Care Excellence guidelines. Early surgery (within 48 h from hospital admission) allows significant benefits in terms of lower rates of postoperative complications and risk of death and can provide better functional outcomes. Therefore, time for surgery could be considered as a comorbidity marker. The choice between conservative or surgical approach surprisingly seems to be still not strongly supported by available literature, but it seems that both 30 d and 1 year risk of mortality is higher with the conservative treatment rather than with surgery. In light of these considerations, the optimization of FFPE management care is mandatory to improve functional outcomes and to reduce sanitary costs. Albeit it is widely accepted that transdisciplinary approach to patients suffering from FFPE is mandatory to optimize both short-term and long-term outcomes, the feasibility of a comprehensive approach in clinical practice is still a challenge. In particular, the large variability of figures involved could be considered both a resource and an additional disadvantage taking into account the difficulty to coordinate multidisciplinary approach covering care in all settings. Therefore, the aim of the present article was to summarize current evidence supporting transdisciplinary management of patients with FFPE, highlighting the benefits, feasibility and limitations of this approach.

[COVID-19 in old age-The geriatric perspective]

Predominantly the older population is affected by a severe course of COVID-19. The mortality of hospitalized patients with COVID-19 above the age of 80 years is up to 54% in international studies. These observations indicate the necessity to highlight the geriatric perspective on this disease. The diagnostics and treatment of COVID-19 do not differ between younger and older patients but atypical symptoms should be expected more frequently in old age. Older subjects show an increased need for rehabilitation after COVID-19. Paradoxically, increasing rehabilitation demands go along with a reduced availability of geriatric rehabilitation options, the latter being a consequence of closure or downsizing of rehabilitation departments during the pandemic. In general, measures of isolation and quarantine should be diligently balanced as the health and emotional consequences of such measures may be severe in older persons. In light of the poor prognosis of older COVID-19 patients, advanced care planning becomes even more relevant. Caregivers and physicians should be encouraged to compose advanced care directives that also reflect the specific circumstances of COVID-19. Fortunately, current data suggest that the effectiveness of the vaccination with the mRNA-vaccines approved in Germany may be equally high in older compared to younger persons.