1
|
Lucioni E, Pellegrino F, Remor D, Cossu A, Niero D, Longo F, Zatelli MC, Giganti M, Carnevale A, Ambrosio MR. Bone densitometry in Thalassemia major: a closer look at pitfalls and operator-related errors in a 10-year follow-up population. LA RADIOLOGIA MEDICA 2024; 129:488-496. [PMID: 38353863 DOI: 10.1007/s11547-024-01759-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/03/2024] [Indexed: 03/16/2024]
Abstract
PURPOSE Dual-energy X-ray absorptiometry (DXA) is the gold standard for measuring bone mineral density (BMD) with tolerable error rate, high precision, and excellent consistency. Our objective was to investigate the frequency and distribution of errors in a cohort of patients with Thalassemia major (TM). METHODS We reviewed the DXA examinations of 340 patients with β-TM followed by our institution, acquired in different imaging centers between 2009 and 2019. We collected sex and age at the time of the first examination and at the last visit, as well as BMD, T-score, and Z-score values. Errors were analyzed by anatomical site (lumbar spine, total hip, femoral neck). RESULTS Out of 5099 total DXA scans, 11.85% presented one or more errors. Specifically, the incorrect examinations were 315 out of 1707 (18.45%) at the lumbar spine level, 113 out of 1697 (6.66%) at the total hip, 176 out of 1695 (10.38%) at the femoral neck. Errors in vertebral inclusion were the most frequently registered (45.86%). A significant difference resulted from the comparison of the T-score and Z-score median values of all the lumbar spine DXA examinations and the correct ones (p value 0.037 and 0.0003, respectively). CONCLUSION Although not directly involved in the performance and interpretation of DXA, physicians interested in osteoporosis management should be familiar with the protocols to minimize errors and allow the proper use of bone densitometry. DXA obtained at the spine level is more frequently affected by errors in patients with TM, potentially influencing the diagnostic assessment of bone health status.
Collapse
Affiliation(s)
- Elisa Lucioni
- Department of Translational Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto, 35, 44121, Ferrara, Italy
| | | | - Damiano Remor
- Department of Translational Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto, 35, 44121, Ferrara, Italy.
| | - Alberto Cossu
- Department of Translational Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto, 35, 44121, Ferrara, Italy
| | - Desy Niero
- Department of Radiology, University of Padova, Via VIII Febbraio, 2, 35122, Padua, Italy
| | - Filomena Longo
- Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of Medicine, Sant'Anna University Hospital, 44123, Ferrara, Italy
| | - Maria Chiara Zatelli
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, 44121, Ferrara, Italy
| | - Melchiore Giganti
- Department of Translational Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto, 35, 44121, Ferrara, Italy
| | - Aldo Carnevale
- Department of Translational Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto, 35, 44121, Ferrara, Italy
| | - Maria Rosaria Ambrosio
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, 44121, Ferrara, Italy
| |
Collapse
|
2
|
Krueger D, Tanner SB, Szalat A, Malabanan A, Prout T, Lau A, Rosen HN, Shuhart C. DXA Reporting Updates: 2023 Official Positions of the International Society for Clinical Densitometry. J Clin Densitom 2024; 27:101437. [PMID: 38011777 DOI: 10.1016/j.jocd.2023.101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Professional guidance and standards assist radiologic interpreters in generating high quality reports. Initially DXA reporting Official Positions were provided by the ISCD in 2003; however, as the field has progressed, some of the current recommendations require revision and updating. This manuscript details the research approach and provides updated DXA reporting guidance. METHODS Key Questions were proposed by ISCD established protocols and approved by the Position Development Conference Steering Committee. Literature related to each question was accumulated by searching PubMed, and existing guidelines from other organizations were extracted from websites. Modifications and additions to the ISCD Official Positions were determined by an expert panel after reviewing the Task Force proposals and position papers. RESULTS Since most DXA is now performed in radiology departments, an approach was endorsed that better aligns with standard radiologic reports. To achieve this, reporting elements were divided into required minimum or optional. Collectively, required components comprise a standard diagnostic report and are considered the minimum necessary to generate an acceptable report. Additional elements were retained and categorized as optional. These optional components were considered relevant but tailored to a consultative, clinically oriented report. Although this information is beneficial, not all interpreters have access to sufficient clinical information, or may not have the clinical expertise to expand beyond a diagnostic report. Consequently, these are not required for an acceptable report. CONCLUSION These updated ISCD positions conform with the DXA field's evolution over the past 20 years. Specifically, a basic diagnostic report better aligns with radiology standards, and additional elements (which are valued by treating clinicians) remain acceptable but are optional and not required. Additionally, reporting guidance for newer elements such as fracture risk assessment are incorporated. It is our expectation that these updated Official Positions will improve compliance with required standards and generate high quality DXA reports that are valuable to the recipient clinician and contribute to best patient care.
Collapse
Affiliation(s)
- Diane Krueger
- School of Medicine and Public Health, Osteoporosis Clinical Research Program, University of Wisconsin-Madison, Madison, WI, USA.
| | - S Bobo Tanner
- Department of Medicine, Divisions of Rheumatology, Allergy & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Auryan Szalat
- Osteoporosis Center, Internal Medicine Ward, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alan Malabanan
- Bone Health Clinic, Boston Medical Center, Boston, MA, USA
| | - Tyler Prout
- Radiology Department, University of Wisconsin, Madison, WI, USA
| | - Adrian Lau
- Division of Endocrinology and Metabolism, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Harold N Rosen
- Osteoporosis Prevention and Treatment Center, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christopher Shuhart
- Bone Health and Osteoporosis Center, Swedish Medical Group, Seattle, WA, USA
| |
Collapse
|
3
|
Prout T, Pelzl C, Christensen EW, Binkley N, Schousboe J, Krueger D. Dual-energy X-ray Absorptiometry Trends Among US Medicare Beneficiaries: 2005-2019. J Clin Densitom 2024; 27:101456. [PMID: 38128449 DOI: 10.1016/j.jocd.2023.101456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Bone density measured using dual-energy X-ray absorptiometry (DXA) volume, performance site and interpreters have changed in the US since 2005. The purpose of this report is to provide updated trends in DXA counts, rates, place of service and interpreter specialty for the Medicare fee-for-service population. METHODS The 100 % Medicare Physician/Supplier Procedure Summary Limited Data Set between 2005-2019 was used. DXA counts and annual rates per 10,000 Medicare beneficiaries were calculated. Annual distributions of scan performance location, provider type and interpreter specialty were described. Place of service trends (significance assigned at p < 0.05) of the mean annual share of DXA utilization were identified using linear regression. RESULTS Annual DXA use per 10,000 beneficiaries peaked in 2008 at 832, declined to 656 in 2015 then increased (p < 0.001) by 38 per year to 807 in 2019. From 2005 to 2019 DXA performance in office settings declined from 70.7 % to 47.2 %. Concurrently, outpatient hospital (OH) DXA increased from 28.6 % to 51.7 %. In 2005, 43.5 % of DXAs were interpreted by radiologists. This increased (p < 0.001) in the office and OH, averaging 0.3 and 2.0 percentage points per year respectively, reaching 73.5 % in 2019. Interpretation by most non-radiologist specialties declined (p < 0.001). CONCLUSIONS From 2005-2019, total DXA use among Medicare beneficiaries declined reaching a nadir in 2015 then returned to 2005 levels by 2019. Office DXA declined since 2005 with 51.7 % of all scans now occurring in an OH setting. The proportion of DXAs interpreted by radiologists increased over time, reaching 73.5 % in 2019.
Collapse
Affiliation(s)
- Tyler Prout
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Casey Pelzl
- Harvey L. Neiman Health Policy Institute, Reston, VA, USA
| | - Eric W Christensen
- Harvey L. Neiman Health Policy Institute, Reston, VA, USA; University of Minnesota, Health Services Management, St. Paul, MN, USA
| | - Neil Binkley
- University of Wisconsin, Osteoporosis Clinical Research Program, Madison, WI, USA
| | - John Schousboe
- Park Nicollet Clinic & Health Partners Institute, Minneapolis, MN, USA
| | - Diane Krueger
- University of Wisconsin, Osteoporosis Clinical Research Program, Madison, WI, USA.
| |
Collapse
|
4
|
Qiao Y, Li J, Liu D, Zhang C, Liu Y, Zheng S. Identification and experimental validation of key m6A modification regulators as potential biomarkers of osteoporosis. Front Genet 2023; 13:1072948. [PMID: 36685841 PMCID: PMC9852729 DOI: 10.3389/fgene.2022.1072948] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/29/2022] [Indexed: 01/08/2023] Open
Abstract
Osteoporosis (OP) is a severe systemic bone metabolic disease that occurs worldwide. During the coronavirus pandemic, prioritization of urgent services and delay of elective care attenuated routine screening and monitoring of OP patients. There is an urgent need for novel and effective screening diagnostic biomarkers that require minimal technical and time investments. Several studies have indicated that N6-methyladenosine (m6A) regulators play essential roles in metabolic diseases, including OP. The aim of this study was to identify key m6A regulators as biomarkers of OP through gene expression data analysis and experimental verification. GSE56815 dataset was served as the training dataset for 40 women with high bone mineral density (BMD) and 40 women with low BMD. The expression levels of 14 major m6A regulators were analyzed to screen for differentially expressed m6A regulators in the two groups. The impact of m6A modification on bone metabolism microenvironment characteristics was explored, including osteoblast-related and osteoclast-related gene sets. Most m6A regulators and bone metabolism-related gene sets were dysregulated in the low-BMD samples, and their relationship was also tightly linked. In addition, consensus cluster analysis was performed, and two distinct m6A modification patterns were identified in the low-BMD samples. Subsequently, by univariate and multivariate logistic regression analyses, we identified four key m6A regulators, namely, METTL16, CBLL1, FTO, and YTHDF2. We built a diagnostic model based on the four m6A regulators. CBLL1 and YTHDF2 were protective factors, whereas METTL16 and FTO were risk factors, and the ROC curve and test dataset validated that this model had moderate accuracy in distinguishing high- and low-BMD samples. Furthermore, a regulatory network was constructed of the four hub m6A regulators and 26 m6A target bone metabolism-related genes, which enhanced our understanding of the regulatory mechanisms of m6A modification in OP. Finally, the expression of the four key m6A regulators was validated in vivo and in vitro, which is consistent with the bioinformatic analysis results. Our findings identified four key m6A regulators that are essential for bone metabolism and have specific diagnostic value in OP. These modules could be used as biomarkers of OP in the future.
Collapse
Affiliation(s)
| | | | | | | | - Yang Liu
- *Correspondence: Yang Liu, ; Shuguo Zheng,
| | | |
Collapse
|
5
|
Billington EO, Binkley N, Krueger D, Kline GA, Leslie WD. Automatic Soft Tissue Detection Failure in DXA: The 4% Fat Error. J Clin Densitom 2023; 26:45-50. [PMID: 36400671 DOI: 10.1016/j.jocd.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Emma O Billington
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Neil Binkley
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Diane Krueger
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Gregory A Kline
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
6
|
Circulating platelet concentration is associated with bone mineral density in women. Arch Osteoporos 2022; 17:44. [PMID: 35257290 DOI: 10.1007/s11657-022-01089-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/26/2022] [Indexed: 02/03/2023]
Abstract
In this cross-sectional study, enrollment included 818 female adults undergoing bone mineral density (BMD) assessment during the health examination. Subjects with osteoporosis had the lowest circulating platelet concentrations. The circulating platelet concentration was positively correlated with BMD. A high platelet concentration had independently low odds of osteoporosis. PURPOSE Platelets play an important role in bone metabolism. However, the association between circulating platelet counts and bone mineral density (BMD) has been inconsistently reported. We aimed to investigate the relationship between platelet counts and osteoporosis in Chinese women. METHODS In this cross-sectional study, a total of 818 female adults who underwent BMD assessment during the health examination were enrolled. Blood cell counts and biochemistry data were recorded. RESULTS Subjects with osteoporosis had the lowest platelet counts (238 ± 59 × 109/L) compared with subjects with osteopenia (256 ± 64 × 109/L) and a normal BMD (269 ± 76 × 109/L, P < 0.001). The circulating platelet concentration was positively correlated with the BMD of the lumbar spine (r = 0.195, P < 0.001), left hip (r = 0.145, P < 0.001), and right hip (r = 0.149, P < 0.001). According to the receiver operating characteristic curve, the cutoff platelet concentration for differentiating osteoporosis was 260 × 109/L. A high platelet concentration had significantly low odds of osteoporosis after adjusting for other covariates (odds ratio = 0.574, 95% confidence interval: 0.346‒0.953, P = 0.032). CONCLUSION The circulating platelet concentration was significantly correlated with BMD in Chinese women.
Collapse
|
7
|
Testini V, Paparella MT, Gangai I, Guglielmi G. Postmenopausal osteoporosis: current status of bone densitometry. Minerva Obstet Gynecol 2021; 73:730-743. [PMID: 34905878 DOI: 10.23736/s2724-606x.20.04674-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Osteoporosis is the most common of all metabolic bone disorders characterized by loss of bone strength, due to modifications in bone turnover. It leads to bone fragility and increased fracture risk. Because of the increasing aging of the world population, the number of people affected by osteoporosis is continuously increasing. The WHO operational definition of osteoporosis, based on a measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), identifies patients at greatest risk of fracture. However, in the population overall a greater total number of fractures occurs in individuals with BMD values above threshold for osteoporosis diagnosis; for this reason, algorithms have been developed to improve the identification of individuals at high fracture risk, including clinical risk factors for fracture. The correct diagnosis of osteoporosis with an appropriate and accurate use of diagnostic imaging results in better management in terms of adequate treatment and follow-up. Moreover, screening strategies will improve identification of patients who are most likely to benefit from drug treatment to prevent fracture. All women after the age of 65 years previously untested and women after the age of 50 years with previous low trauma fractures should be screened by DXA. In fact, osteoporosis-related fractures cause a significant increase in morbidity and mortality, decreasing the quality of life, with an increasing social and economic burdens. For this reason, fracture risk assessment should be a high priority amongst health measures.
Collapse
Affiliation(s)
- Valentina Testini
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | - Maria T Paparella
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | - Ilaria Gangai
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy - .,Radiology Unit, Barletta University Campus UNIFG, "Dimiccoli Hospital", Barletta, Barletta-Andria-Trani, Italy
| |
Collapse
|
8
|
Kirazlı Y, Atamaz Çalış F, El Ö, Gökçe Kutsal Y, Peker Ö, Sindel D, Tuzun Ş, Gogas Yavuz D, Durmaz B, Akarirmak Ü, Bodur H, Hamuryudan V, Inceboz U, Öncel S. Updated approach for the management of osteoporosis in Turkey: a consensus report. Arch Osteoporos 2020; 15:137. [PMID: 32860546 PMCID: PMC7456410 DOI: 10.1007/s11657-020-00799-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/27/2020] [Indexed: 02/03/2023]
Abstract
As a result of the current demographics, increased projections of osteoporosis (OP) and prevalence of the disease in Turkey, a panel of multidisciplinary experts developed a thorough review to assist clinicians in identifying OP and associated fracture risk patients, diagnosing the disease with the appropriate available diagnostic methods, classifying the disease, and initiating appropriate treatment. The panel expects to increase the awareness of this prevalent disease, decrease consequences of OP with corresponding cost savings and, ultimately, decrease the overall burden of OP and related fractures in Turkey. BACKGROUND OP is not officially accepted as a chronic disease in Turkey despite the high prevalence and predicted increase in the following years. However, there are areas where the country is performing well, such as having a country-specific fracture risk assessment model, DXA access, and the uptake of FRAX. Additional efforts are required to decrease the existing treatment gap estimating 75-90% of patients do not receive pharmacological intervention for secondary prevention, and the diagnosis rate is around 25%. METHODS A selected panel of Turkish experts in fields related to osteoporosis was provided with a series of relevant questions to address prior to the multi-day conference. Within this conference, each narrative was discussed and edited by the entire group, through numerous drafts and rounds of discussion until a consensus was achieved. Represented in the panel were a number of societies including The Turkish Osteoporosis Society, The Society of Endocrinology and Metabolism of Turkey (SEMT), and The Turkish Society of Physical Medicine and Rehabilitation. RESULTS Standardized general guidelines to identify OP and related fractures and at-risk population in Turkey, which will enable clinicians to accurately and effectively diagnose the disease, treat the appropriate patients with available pharmacological and non-pharmacological treatments and decrease the burden of the disease. CONCLUSIONS This manuscript provides a review of the current state of OP and related fractures in Turkey. Moreover, this manuscript reviews current international guidelines and national studies and proposes a number of helpful country-specific classifications that can be used by healthcare providers caring for the at-risk population. Additionally, the panel proposes practical recommendations that should be implemented nationally in order to decrease the burden of OP and related fractures and effectively preventing the burden in future generations.
Collapse
Affiliation(s)
- Yeşim Kirazlı
- Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, Izmir, Turkey.
| | - Funda Atamaz Çalış
- Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, Izmir, Turkey
| | - Özlem El
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Yeşim Gökçe Kutsal
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Özlen Peker
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Dilsad Sindel
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Şansın Tuzun
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Dilek Gogas Yavuz
- Department of Internal Medicine, Section of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
| | - Berrin Durmaz
- Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, Izmir, Turkey
| | - Ülkü Akarirmak
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Hatice Bodur
- Department of Physical Medicine and Rehabilitation, Medical Faculty of Yıldırım Beyazıt University, Ankara, Turkey
| | - Vedat Hamuryudan
- Department of Internal Medicine, Section of Rheumatology, Cerrahpaşa Medical Faculty, İstanbul University Cerrahpaşa, İstanbul, Turkey
| | - Umit Inceboz
- İrenbe Obstetrics and Gynecology IVF Center, İzmir, Turkey
| | - Sema Öncel
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| |
Collapse
|
9
|
Camacho PM, Petak SM, Binkley N, Diab DL, Eldeiry LS, Farooki A, Harris ST, Hurley DL, Kelly J, Lewiecki EM, Pessah-Pollack R, McClung M, Wimalawansa SJ, Watts NB. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS-2020 UPDATE. Endocr Pract 2020; 26:1-46. [PMID: 32427503 DOI: 10.4158/gl-2020-0524suppl] [Citation(s) in RCA: 456] [Impact Index Per Article: 114.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: The development of these guidelines is sponsored by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). Methods: Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. Results: The Executive Summary of this 2020 updated guideline contains 52 recommendations: 21 Grade A (40%), 24 Grade B (46%), 7 Grade C (14%), and no Grade D (0%). These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world care of patients. The evidence base presented in the subsequent Appendix provides relevant supporting information for the Executive Summary recommendations. This update contains 368 citations: 123 (33.5%) evidence level (EL) 1 (highest), 132 (36%) EL 2 (intermediate), 20 (5.5%) EL 3 (weak), and 93 (25%) EL 4 (lowest). New or updated topics in this CPG include: clarification of the diagnosis of osteoporosis, stratification of the patient according to high-risk and very-high-risk features, a new dual-action therapy option, and transitions from therapeutic options. Conclusion: This guideline is a practical tool for endocrinologists, physicians in general, regulatory bodies, health-related organizations, and interested laypersons regarding the diagnosis, evaluation, and treatment of post-menopausal osteoporosis. Abbreviations: 25(OH)D = 25-hydroxyvitamin D; AACE = American Association of Clinical Endocrinologists; ACE = American College of Endocrinology; AFF = atypical femoral fracture; ASBMR = American Society for Bone and Mineral Research; BEL = best evidence level; BMD = bone mineral density; BTM = bone turnover marker; CI = confidence interval; CPG = clinical practice guideline; CTX = C-terminal telopeptide type-I collagen; DXA = dual-energy X-ray absorptiometry; EL = evidence level; FDA = U.S. Food and Drug Administration; FRAX® = Fracture Risk Assessment Tool; GI = gastrointestinal; HORIZON = Health Outcomes and Reduced Incidence with Zoledronic acid ONce yearly Pivotal Fracture Trial (zoledronic acid and zoledronate are equivalent terms); ISCD = International Society for Clinical Densitometry; IU = international units; IV = intravenous; LSC = least significant change; NOF = National Osteoporosis Foundation; ONJ = osteonecrosis of the jaw; PINP = serum amino-terminal propeptide of type-I collagen; PTH = parathyroid hormone; R = recommendation; ROI = region of interest; RR = relative risk; SD = standard deviation; TBS = trabecular bone score; VFA = vertebral fracture assessment; WHO = World Health Organization.
Collapse
|
10
|
Blank RD. Practical management of fracture risk among peri- and postmenopausal women. Fertil Steril 2020; 112:782-790. [PMID: 31731932 DOI: 10.1016/j.fertnstert.2019.09.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 12/27/2022]
Abstract
Fractures and their consequences are the clinically important manifestation of osteoporosis; preventing fractures is the primary goal of management. Effective management is achievable given present knowledge and tools but is seldom prescribed. This review will cover the individual and social burden of fracture, essential information about fracture risk and its estimation, an approach to patient care emphasizing specific information to elicit and therapeutic strategies to pursue, and existing gaps in knowledge and important questions for future research.
Collapse
Affiliation(s)
- Robert D Blank
- Medical College of Wisconsin, Wauwatosa, Wisconsin; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.
| |
Collapse
|
11
|
Zhu Y, Yang Y, Yang M, Xia W, Zhou H, Zhu XJ, Tang N, Li PQ. Effect of informatization-based blood glucose team management on the control of hyperglycaemia in noncritical care units. PLoS One 2020; 15:e0230115. [PMID: 32160260 PMCID: PMC7065766 DOI: 10.1371/journal.pone.0230115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/23/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To provide a new system of in-hospital blood glucose team management combined with a network blood glucose monitoring system and analyse the effect on hyperglycaemic participants' blood glucose control in noncritical care units. METHODS Hyperglycaemic participants in noncritical care units were divided into two groups. They underwent active intervention by the hospital's blood glucose management team or the routine consultation group. The better method, based on a shorter length of stay (LOS) and lower hospital cost, could be selected by comparing the two blood glucose management strategies. RESULTS Compared with the routine consultation group, the team management group had a higher detection rate of hyperglycaemia (18.49% vs 16.17%, P<0.01) and glycosylated haemoglobin (51.53% vs 30.97%, P<0.01) and a lower incidence rate of hyperglycaemia (59.24% vs 61.59%, P<0.01), severe hyperglycaemia (3.56% vs 5.19%, P<0.01) and clinically significant hypoglycaemia (0.26% vs 0.35%, P<0.05). Simultaneously, blood glucose drift (mmol/L) (2.50 (1.83, 3.25) vs 2.76 (2.01, 3.57), P<0.01), blood glucose coefficient of variation (%) (28.86 (22.70, 34.83) vs 29.80 (23.47, 36.13), P<0.01), maximum blood glucose fluctuation (mmol/L) (9.30 (6.20, 13.10) vs 10.10 (7.00, 14.40), P<0.01) and nosocomial infection (5.42% vs 8.05%, P<0.05) were all lower among participants in the team management group. In addition, the LOS (P<0.001) and hospital costs (P<0.001) of participants were lower in the team management group. CONCLUSION In-hospital blood glucose team management combined with a network blood glucose monitoring system effectively improved the blood glucose control and fluctuation levels of participants who were admitted to noncritical care units, thereby reducing LOS and hospital cost.
Collapse
Affiliation(s)
- Ying Zhu
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Yan Yang
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Miao Yang
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Wei Xia
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Hui Zhou
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Xian-Jun Zhu
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Nie Tang
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Peng-Qiu Li
- Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| |
Collapse
|