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Ruangnopparut R, Charoensri S, Sribenjalak D, Theerakulpisut D, Pongchaiyakul C. Trabecular Bone Score Improves Fracture Risk Discrimination in Postmenopausal Rheumatoid Arthritis Patients Receiving Glucocorticoids. Int J Gen Med 2024; 17:287-295. [PMID: 38292825 PMCID: PMC10826709 DOI: 10.2147/ijgm.s448659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Abstract
Background Bone mineral density (BMD) might not be a sensitive tool for predicting osteoporotic fracture risk among patients with rheumatoid arthritis (RA), especially when receiving glucocorticoids. Trabecular bone score (TBS), which has emerged as a new assessment technique representing bone microarchitecture and strength, may be considered an alternative approach. Materials and Methods In this cross-sectional analytical study, postmenopausal RA patients receiving glucocorticoids were identified from the postmenopause BMD database. The database included clinical data of postmenopausal outpatients who had at least one BMD measurement between January 2014 and December 2017. TBS was calculated from lumbar spine BMD with the microarchitecture assessment software. The presence of osteoporotic fractures, either vertebral or non-vertebral, was identified at the time of BMD measurement. Results A total of 64 postmenopausal RA patients receiving glucocorticoids were included. The TBS values were inversely associated with osteoporotic fractures, with a TBS cut-off of less than 1.24, showing the best accuracy with a sensitivity of 79% and a specificity of 84% in discriminating fractures. This newly proposed TBS threshold combined with a BMD T-score of -2.5 or less demonstrated a greater area under receiver operating characteristic curve in identifying patients with osteoporotic fractures than the BMD threshold alone (p value = 0.003). Conclusion The reduction in TBS was associated with an osteoporotic fracture in postmenopausal RA patients receiving glucocorticoids. Combining TBS and BMD in these patients incrementally improves fracture risk discrimination and may serve as a supplementary tool in identifying patients at greatest risk of osteoporotic fracture.
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Affiliation(s)
| | - Suranut Charoensri
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Dueanchonnee Sribenjalak
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Daris Theerakulpisut
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Thavonlun S, Houngngam N, Kingpetch K, Numkarunarunrote N, Santisitthanon P, Buranasupkajorn P, Pongchaiyakul C, Sutcharitchan P, Wattanachanya L. Association of osteoporosis and sarcopenia with fracture risk in transfusion-dependent thalassemia. Sci Rep 2023; 13:16413. [PMID: 37775530 PMCID: PMC10541420 DOI: 10.1038/s41598-023-43633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/26/2023] [Indexed: 10/01/2023] Open
Abstract
Patients with transfusion-dependent thalassemia (TDT) have an increased risk of osteoporosis and fractures. They also have several potential factors associated with sarcopenia. There has been currently no study on sarcopenia and its association with falls and fractures in TDT. This study aims to determine the prevalence of and factors associated with osteoporosis, fragility fractures, and sarcopenia in adults with TDT. A cross-sectional study was conducted at the hematologic clinic at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Clinical data and laboratory testing were collected. Bone mineral density and morphometric vertebral fracture were assessed. Sarcopenia was defined using the 2014 and 2019 Asian Working Group for Sarcopenia (AWGS) criteria. We included 112 TDT patients aged 35.1 ± 12.5 years. The prevalence of osteoporosis was 38.4%. Fragility fractures were found in 20.5% of patients. Lower BMI (OR 0.29; 95% CI 0.12-0.72, P = 0.007) and hypogonadal state (OR 3.72; 95% CI 1.09-12.74, P = 0.036) were independently associated with osteoporosis. According to the 2014 AWGS criteria, the prevalence of overall sarcopenia and severe sarcopenia was 44.6% and 13.4%, respectively. Severe sarcopenia was strongly associated with fragility fractures (OR 4.59, 95% CI 1.21-17.46, P = 0.025). In conclusion, osteoporosis, fragility fractures, and sarcopenia were prevalent in adults with TDT. Severe sarcopenia was associated with fragility fractures. Early osteoporosis and sarcopenia screening and prevention may reduce fracture risk and its complications in these patients.
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Affiliation(s)
- Suttana Thavonlun
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Excellence Center for Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Natnicha Houngngam
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Excellence Center for Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Kanaungnit Kingpetch
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Numphung Numkarunarunrote
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Prangareeya Santisitthanon
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Excellence Center for Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Patinut Buranasupkajorn
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Excellence Center for Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Pranee Sutcharitchan
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Lalita Wattanachanya
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
- Excellence Center for Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.
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Saisirivechakun P, Mahakkanukrauh A, Pongchaiyakul C, Boonya-Ussadorn T, Narongroeknawin P, Pakchotanon R, Assavatanabodee P, Chaiamnuay S. Prevalence of low trabecular bone score and its association with disease severity and activity in patients with axial spondyloarthritis. Sci Rep 2023; 13:16258. [PMID: 37758825 PMCID: PMC10533482 DOI: 10.1038/s41598-023-43321-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 09/22/2023] [Indexed: 09/29/2023] Open
Abstract
Axial spondyloarthritis (axSpA) increases the risk of osteoporosis and vertebral fractures. Bone mineral density (BMD) measured by dual X-ray absorptiometry (DXA) has limitations in axSpA patients. Trabecular bone score (TBS) indirectly assesses bone microarchitecture and can be used to predict fracture risk. However, few studies have investigated the role of TBS in axSpA patients. The objective of this study were to compare TBS between axSpA patients and 1:1 sex- and age-matched healthy volunteers and determine factors associated with low TBS in axSpA patients. A cross-sectional study was conducted in two tertiary-care hospitals. A total of 137 axSpA patients and healthy volunteers were enrolled. Demographics, disease characteristics, and risk factors for osteoporosis were recorded. TBS, BMD at the lumbar spine, hip, and vertebral fractures were assessed by DXA. Low TBS was defined as a TBS value < 1.230. Factors associated with low TBS were examined by logistic regression. Most patients were male (75.9%) and tested positive for HLA-B27 (88.3%). The mean (SD) age was 42.8 (12.0) years. The mean (SD) of TBS in the axSpA patients was lower than those in the healthy volunteers [1.402 (0.107) vs 1.440 (0.086), respectively; p = 0.002]. The mean (SD) of lumbar BMD in the axSpA patients was higher than in healthy volunteers [1.186 (0.212) vs 1.087 (0.124), p < 0.001], whereas the mean (SD) of femoral neck BMD in the axSpA group was lower than that in the healthy volunteers [0.867 (0.136) vs 0.904 (0.155), p = 0.038]. Disease severity as indicated by sacroiliac joint fusion and a high ASDAS score were associated with low TBS with the odds ratios (95% confidence interval) of 11.8 (1.2-115.4) and 5.2 (1.6-16.9), respectively. In conclusion, axSpA patients had a higher prevalence of low TBS than healthy volunteers. Sacroiliac joint fusion and a high ASDAS score were associated with low TBS.
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Affiliation(s)
- Pannarat Saisirivechakun
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Ajanee Mahakkanukrauh
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Trirat Boonya-Ussadorn
- Division of Nuclear Medicine, Department of Radiology, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Pongthorn Narongroeknawin
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Rattapol Pakchotanon
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Paijit Assavatanabodee
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Sumapa Chaiamnuay
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand.
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Charoenngam N, Pongchaiyakul C. Current issues in evaluation and management of osteoporosis in Thailand. Osteoporos Sarcopenia 2023; 9:53-59. [PMID: 37496986 PMCID: PMC10366423 DOI: 10.1016/j.afos.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/27/2023] [Accepted: 05/19/2023] [Indexed: 07/28/2023] Open
Abstract
Osteoporosis is a major public health issue in Thailand, which increased morbidity, mortality, and health-care utilization. The objective of this review is to provide current perspectives on epidemiology, evaluation and management of osteoporosis in Thailand. According to epidemiologic data, the prevalence of osteoporosis and the incidence of hip fracture were comparable to the rest of the world. However, among Thai postmenopausal women, the prevalence of asymptomatic vertebral fracture was disproportionately high. In addition to established risk factors, conditions that may affect the risk of osteoporosis in the Thai population include certain genetic variants, thalassemia, vitamin D deficiency, and low dietary calcium intake, which requires further investigations to draw conclusions. In 2021, the Thai Osteoporosis Foundation released a new Clinical Practice Guideline that provides up-to-date evidence-based recommendations for evaluation and management of osteoporosis. Nonetheless, more research is required to provide local evidence in a variety of areas to guide management of osteoporosis in Thailand. These include epidemiology of distal radial fracture, the optimal intervention threshold of the Thai-specific Fracture Risk Assessment Tool model, screening for asymptomatic vertebral fracture, and the economic evaluation of osteoporosis management options, including fracture liaison service.
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Affiliation(s)
- Nipith Charoenngam
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand
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Teawtrakul N, Chansai S, Yamsri S, Chansung K, Wanitpongpun C, Lanamtieng T, Phiphitaporn P, Fucharoen S, Pongchaiyakul C. The association of growth differentiation factor-15 levels and osteoporosis in patients with thalassemia. Am J Med Sci 2023:S0002-9629(23)01173-4. [PMID: 37146903 DOI: 10.1016/j.amjms.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 05/01/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Ineffective erythropoiesis (IE) is a significant risk factor for osteoporosis in individuals with thalassemia. Growth differentiation factor-15 (GDF15), a biomarker of IE, was found to be elevated in thalassemia patients. This study aimed to examine the association between GDF15 levels and osteoporosis in patients with thalassemia. METHODS A cross-sectional study was conducted in 130 adult patients with thalassemia in Thailand. Bone mineral density (BMD) at the lumbar spine was evaluated by dual-energy X-ray absorptiometry (DXA), and with a Z-score of less than -2.0 SD was defined as osteoporosis. GDF-15 was measured using the enzyme-linked immunosorbent assay (ELISA). Logistic regression analysis was used to examine the associated factors with the development of osteoporosis. Receiver operator characteristic (ROC) curve analysis was used to estimate the threshold of GDF15 in predicting osteoporosis. RESULTS Osteoporosis was detected in 55.4% (72/130) of the patients. Advanced age and high GDF15 levels were positively associated with osteoporosis, while an increased hemoglobin level was negatively associated with osteoporosis in patients with thalassemia. In this study, the GDF15 level's ROC demonstrated a good performance in predicting osteoporosis (AUC=0.77). CONCLUSIONS The prevalence of osteoporosis is high among adult thalassemia patients. Age and high GDF15 levels were significantly associated with osteoporosis in this study. A higher hemoglobin level is associated with a lower risk of osteoporosis. This study suggest that GDF15 could be used as a predictive biomarker for osteoporosis in patients with thalassemia. Adequate red blood cell transfusions and suppression of GDF15 function may be beneficial in preventing osteoporosis.
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Affiliation(s)
- Nattiya Teawtrakul
- Division of Hematology, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 40002.
| | - Siriyakorn Chansai
- Medical science program, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand 40002; Centre for Research and Development of Medical Diagnostics Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand. 40002
| | - Supawadee Yamsri
- Centre for Research and Development of Medical Diagnostics Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand. 40002
| | - Kanchana Chansung
- Division of Hematology, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 40002
| | - Chinadol Wanitpongpun
- Division of Hematology, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 40002
| | - Theerin Lanamtieng
- Division of Hematology, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 40002
| | - Pisa Phiphitaporn
- Division of Hematology, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 40002
| | - Supan Fucharoen
- Centre for Research and Development of Medical Diagnostics Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand. 40002
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 40002
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Phapun S, Raruenrom Y, Boonrod A, Kongpetch S, Chotmongkol W, Pongchaiyakul C, KRITMETAPAK K. WCN23-0298 TRABECULAR BONE SCORE IN ADULTS WITH KIDNEY FAILURE RECEIVING HEMODIALYSIS. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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Charoenngam N, Rittiphairoj T, Ponvilawan B, Jaroenlapnopparat A, Waitayangkoon P, Suppakitjanusant P, Prasitsumrit V, Pongchaiyakul C, Holick MF. Bone fragility in Hereditary Connective Tissue Disorders: a Systematic Review and Meta-analysis. Endocr Pract 2023:S1530-891X(23)00045-9. [PMID: 36804968 DOI: 10.1016/j.eprac.2023.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To investigate bone fragility in patients with hereditary connective tissue disorders (HCTD), including Ehlers-Danlos syndrome (EDS), Marfan's syndrome (MFS) and Loeys-Dietz syndrome (LDS). METHODS From inception to June 2022, potentially eligible studies were identified in the Medline and EMBASE databases using search strategy that included terms for "HCTD", "Fracture" and "Osteoporosis". Eligible studies must consist of a group of patients with HCTD and report prevalence/incidence of fracture/osteoporosis in their participants, with or without comparison with healthy individuals. Point estimates with standard errors were obtained from each study and combined using the generic inverse variance method. RESULTS Among the 4,206 articles identified, 19 studies were included. The pooled prevalence of fracture in EDS, MFS and LDS were 44% (95%CI, 25 - 65%, I2 88%), 17% (95%CI, 11 - 26%, I2 68%), 69% (95%CI, 47 - 85%, I2 83%), respectively. The pooled prevalence of osteoporosis in EDS was 17% (95%CI, 8 - 34%, I2 96%). EDS was associated with fracture [pooled odds ratio 4.90 (95%CI, 1.49 - 16.08, I2 86%)], but not osteoporosis [pooled odds ratio 1.34 (95%CI, 0.28 - 6.36, I2 87%). One study reported a 5% (95%CI, 3 - 8%) prevalence of osteoporosis in MFS, which was associated with fracture [incidence rate ratio 1.35 (95%CI, 1.18 - 1.55)] and osteoporosis [subhazard ratio 3.97 (95%CI, 2.53 - 6.25)]. CONCLUSION EDS was associated with fracture, which could be independent of osteoporosis status. MFS had a milder degree of increased risk of fracture and osteoporosis. Despite no data from cohort studies, there was a significantly higher rate of fracture in LDS.
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Affiliation(s)
- Nipith Charoenngam
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA; Section Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | | | - Ben Ponvilawan
- Department of Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | | | | | - Vitchapong Prasitsumrit
- Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Michael F Holick
- Section Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Chanidkul P, Sribenjalak D, Charoenngam N, Pongchaiyakul C. The proportion of Thai postmenopausal women who would be eligible for anti-osteoporosis therapy. PLoS One 2023; 18:e0279829. [PMID: 36735672 PMCID: PMC9897565 DOI: 10.1371/journal.pone.0279829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 12/05/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To determine the proportion of postmenopausal Thai women who would be classified as having high risk of fracture and eligible for anti-osteoporosis therapy according to the National Osteoporosis Foundation (NOF) criteria. METHODS Postmenopausal Thai women aged 40-90 years who had been screened for osteoporosis during 2014-2019 were recruited. Demographic data and osteoporosis risk factors were collected based on the Fracture Risk Assessment Tool (FRAX) questionnaire. Bone mineral density (BMD) at the femoral neck and lumbar spine measured using dual energy X-ray absorptiometry. Ten-year probabilities of hip and major osteoporotic fracture (MOF) were calculated based on the Thai FRAX model with BMD. The study's protocol was approved by the Institutional Ethical Committee (HE581241). RESULTS A total of 3,280 postmenopausal women were included. The mean ± SD age was 63.6 ± 10.1 years. A total of 170 (5.2%) participants had a history of hip and/or vertebral fracture. After excluding these participants with fracture history, 699 (21.3%) had osteoporosis, 355 (10.8%) had osteopenia with high risk of fracture (FRAX 10-year probability of hip fracture ≥ 3% and/or MOF ≥ 20%), 1192 (36.3%) had osteopenia with low risk of fracture (FRAX 10-year probability of hip fracture < 3% and MOF < 20%) and 864 (26.3%) had normal BMD. Taken together, a total of 1,224 (37.3%) participants would be eligible for anti-osteoporosis therapy (prior fracture, osteoporosis or osteopenia with high risk of fracture). CONCLUSION The prevalence of Thai postmenopausal women who would be eligible for anti-osteoporosis therapy was 37.3%.
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Affiliation(s)
- Piyachat Chanidkul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Dueanchonnee Sribenjalak
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nipith Charoenngam
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, United States of America
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- * E-mail:
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Pongchaiyakul C, Theerakulpisut D, Charoenngam N, Rittiphairoj T, Sribenjalak D. Reference Value of Dual X-Ray Absorptiometry-Derived Lumbar Spine Trabecular Bone Score in the Thai Population. J Clin Densitom 2023; 26:27-35. [PMID: 36371391 DOI: 10.1016/j.jocd.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Little is known about the normative values of trabecular bone score (TBS) in Thailand. We aimed to provide reference values of dual-energy x-ray absorptiometry (DXA)-derived lumbar spine TBS in Thai community-dwelling adults of varying ages. METHODOLOGY Bone density studies of participants aged 20-90 years who underwent bone mineral density (BMD) testing at Srinagarind Hospital, Kohn Kaen, Thailand were reviewed. DXA studies were performed using a narrow fan-beam bone densitometer. Lumbar spine TBS for each of the L1-L4 vertebra was obtained using the iNsight software. Mean TBS (L1-L4 TBS) was calculated. This study was approved by the institutional research ethics committee (HE581241). RESULTS A total of 1372 participants were included. The mean ± SD age was 57.25 ± 17.35 years and 799 (58.2%) were female. There were 476 (34.7%) and 243 (17.7%) participants with osteopenia (T-score -1.0 to -2.5) and osteoporosis (T-score ≤-2.5) of the lumbar spine. Age and sex stratified analysis of L1-L4 TBS revealed peak TBS among females aged 30-49 years (mean ± SD: 1.42 ± 0.08) and males aged 30-59 years (mean ± SD: 1.42 ± 0.09). The rate of L1-L4 TBS reduction from ages 30 to 90 year is 13.4% (0.27%/year) for females and 5.6% (0.11%/year) for males. CONCLUSION This is the first study reporting a normative database for DXA derived TBS in Thai community-dwelling population. We found that TBS decreased with age at the rate of approximately 0.27%/year for females and 0.11%/year for males.
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Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Daris Theerakulpisut
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nipith Charoenngam
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA; Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Dueanchonnee Sribenjalak
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Charoenngam N, Apovian CM, Pongchaiyakul C. Increased fat mass negatively influences femoral neck bone mineral density in men but not women. Front Endocrinol (Lausanne) 2023; 14:1035588. [PMID: 36926024 PMCID: PMC10011632 DOI: 10.3389/fendo.2023.1035588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Obesity is known to be a protective factor against osteoporosis. However, recent studies have shown that excessive adiposity may be detrimental for bone health. OBJECTIVE To determine the association of lean mass (LM) and fat mass (FM) with bone mineral density (BMD) in Thais. METHODS Bone density studies of consecutive patients of Srinagarind Hospital, Khon Kaen, Thailand between 2010 and 2015 were reviewed. LM, FM, lumbar spine (LS) and femoral neck (FN) BMD were measured. Lean mass index (LMI) and fat mass index (FMI) were calculated [LMI=LM (kg)/height (m)2, FMI=FM (kg)/height (m)2] and analyzed to determine the association with LS and FN BMD using multiple regression analysis. This study was approved by the institutional ethical committee (HE42116). RESULTS A total of 831 participants were included. The mean ± SD age was 50.0 ± 16.3 years. In men, LMI (per 1 kg/m2 increase) was positively correlated with FN BMD (g/cm2, β 0.033) and LS BMD (g/cm2, β 0.031), after adjusting for age, height and FMI. Whereas FMI (per 1 kg/m2 increase) was negatively correlated with FN BMD (g/cm2, β -0.015) but not with LS BMD (g/cm2, β 0.005) after adjusting for age, height and LMI. In women, both LMI and FMI were positively correlated with LS BMD (g/cm2, LMI: β 0.012; FMI: β 0.016) and FN BMD (g/cm2, LMI: β 0.034; FMI: β 0.007) with age, height, LMI and FMI included in the model. CONCLUSION Our findings indicate that FM has a sex-specific influence on BMD in Thais.
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Affiliation(s)
- Nipith Charoenngam
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, United States
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Caroline M. Apovian
- Department of Medicine, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- *Correspondence: Chatlert Pongchaiyakul,
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11
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Phruetthiphat OA, Pinijprapa P, Satravaha Y, Kitcharanant N, Pongchaiyakul C. An innovative scoring system for predicting an excellent Harris hip score after proximal femoral nail anti-rotation in elderly patients with intertrochanteric fracture. Sci Rep 2022; 12:19939. [PMID: 36402794 PMCID: PMC9675850 DOI: 10.1038/s41598-022-24177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022] Open
Abstract
Typically, intramedullary and extramedullary devices are used to treat elderly with intertrochanteric fractures. The majority of previous research has focused on the association between surgical factors and mechanical failure after internal fixation. There is, however, limited evidence to demonstrate the association between functional outcomes after proximal femoral nail anti-rotation (PFNA) fixation and the non-surgical factors such as patient's comorbidities. The aim of this study is to determine the predictive factors associated with excellent outcome, as well as to develop an integrated scoring system to predict the outcome after PFNA fixation in elderly patients with an intertrochanteric fracture. A retrospective study was conducted between January 2012 and December 2018. Elderly patients with low-energy intertrochanteric fractures who underwent PFNA fixation and at least a year of follow-up were recruited. Demographics, comorbidities, cognitive status, time to operation, and surgical parameters of the patients were all identified. Excellent and non-excellent outcomes were assessed by Harris Hip Score (HHS) after a one-year follow up. Regression analysis was used to determine the predictors for an excellent functional outcome. A new integrated scoring system (ISSI; Integrate Scoring System in elderly patients with Intertrochanteric fracture) was developed and validated. 450 elderly patients were randomly divided into two cohorts: a development (N = 225) and validation cohorts (N = 225). In this study, age < 85 years, normal weight/overweight, Charlson comorbidity index (CCI) < 6, no cognitive impairment, a modified AO/OTA 31A1.3, time to operation < 6 days, and Tip Apex Distance between 20 and 30 mm were significantly associated with an excellent outcome after PFNA fixation. The range of ISSI score was between 0 to 16 and the cut-off score of 13 was found to have the highest discriminatory power to determine the excellent functional outcome where the area of ROC was 0.85. In regards to the validation cohort, the sensitivity and specificity of ISSI score was 69% and 87%, respectively, and the AUC was 0.81. The ISSI score is effortless and practical for orthopedic surgeons for predicting an outcome after PFNA fixation in elderly patients with an intertrochanteric fracture.
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Affiliation(s)
- Ong-art Phruetthiphat
- grid.414965.b0000 0004 0576 1212Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchvidhi Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400 Thailand
| | - Panukorn Pinijprapa
- grid.414965.b0000 0004 0576 1212Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchvidhi Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400 Thailand
| | - Yodhathai Satravaha
- grid.10223.320000 0004 1937 0490Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nitchanant Kitcharanant
- grid.7132.70000 0000 9039 7662Department of Orthopaedics, Chiang Mai University, Chiang Mai, Thailand
| | - Chatlert Pongchaiyakul
- grid.9786.00000 0004 0470 0856Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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12
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Sangaroon A, Foocharoen C, Theerakulpisut D, Srichompoo K, Mahakkanukrauh A, Suwannaroj S, Seerasaporn P, Pongchaiyakul C. Prevalence and clinical association of sarcopenia among Thai patients with systemic sclerosis. Sci Rep 2022; 12:18198. [PMID: 36307496 PMCID: PMC9616808 DOI: 10.1038/s41598-022-21914-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/05/2022] [Indexed: 12/31/2022] Open
Abstract
Patients with systemic sclerosis (SSc) have some potential factors associated with an increased risk of sarcopenia. There has been currently no study to examine such associations in SSc patients. We aimed to determine the prevalence of sarcopenia among SSc patients and examine its association with clinical manifestations and laboratory tests. A cross-sectional study was conducted in 180 adult SSc patients at the Scleroderma Clinic, Khon Kaen University, Thailand, between July 2019 and April 2020. Clinical data, laboratory tests for inflammatory markers, serology, hormone, body composition by dual-energy X-ray absorptiometry, handgrip strength, functional lower extremity strength, and usual gait speed were collected and measured. Sarcopenia was defined according to the criteria of the Asian Working Group for Sarcopenia. One hundred and eighty patients were recruited. Ninety-four cases (52.2%) were the diffuse cutaneous SSc subset. The respective mean age and duration of disease was 58.8 ± 9.4 and 6.2 ± 5.3 years. Sarcopenia was revealed in 41 SSc patients for a prevalence of 22.8% (95% CI 12.1-34.8), while the prevalence was higher in patients with the diffuse cutaneous SSc (dcSSc) compared to the limited cutaneous SSc. BMI at the onset of SSc and C-reactive protein > 5 mg/dL were significantly associated with sarcopenia with a respective OR of 0.60 (95% CI 0.48-0.75) and 3.18 (1.06-9.54). Sarcopenia is common in patients with SSc, but the prevalence is more pronounced in the dcSSc. Inflammatory markers, particularly the CRP level, are strongly associated. BMI at the onset had a negative association with sarcopenia among SSc patients.
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Affiliation(s)
- Arthitaya Sangaroon
- grid.9786.00000 0004 0470 0856Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chingching Foocharoen
- grid.9786.00000 0004 0470 0856Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Daris Theerakulpisut
- grid.9786.00000 0004 0470 0856Department of Nuclear Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kannikar Srichompoo
- grid.9786.00000 0004 0470 0856Department of Rehabilitation Medicines, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ajanee Mahakkanukrauh
- grid.9786.00000 0004 0470 0856Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Siraphop Suwannaroj
- grid.9786.00000 0004 0470 0856Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Patpiya Seerasaporn
- grid.9786.00000 0004 0470 0856Department of Rehabilitation Medicines, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chatlert Pongchaiyakul
- grid.9786.00000 0004 0470 0856Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Sribenjalak D, Charoensri S, Pongchaiyakul C. An optimal intervention threshold of FRAX in postmenopausal Thai women. Arch Osteoporos 2022; 17:21. [PMID: 35072805 DOI: 10.1007/s11657-022-01058-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/29/2021] [Indexed: 02/03/2023]
Abstract
This study was designed to determine a FRAX intervention threshold in postmenopausal Thais, based on a history of hip fracture. The optimal FRAX thresholds for hip fracture were 4.9% (without BMD) and 4% (with BMD), while the thresholds for major osteoporotic fracture were 9.8% (without BMD) and 8.9% (with BMD). INTRODUCTION Fracture Risk Assessment Tool (FRAX) has been widely used as an intervention threshold for initiating osteoporosis treatment. However, there is a lack of data to validate the threshold in Thai population. METHODS A cross-sectional study was conducted from January 2014 to February 2019. Postmenopausal women in the Northeast of Thailand whom has bone mineral density (BMD) measured using dual-energy X-ray absorptiometry (DXA) in the study period were recruited. Participants who had previously received anti-osteoporotic treatment were not eligible. FRAX score, both with and without BMD, was calculated using a Thai reference. Prevalent hip fracture was identified by reviewing the ICD-10 diagnosis from the hospital database during the study period. The receiver operating characteristic (ROC) curve and Youden index were used to determine the FRAX threshold in predicting hip fracture, based on the rationale that women with a prevalent hip fracture would be eligible for treatment. RESULTS A total of 2872 postmenopausal Thai women were recruited, with 45 sustained a recent hip fracture. In association with hip fracture, the optimal FRAX thresholds for hip fracture without and with BMD were 4.9% and 4%, respectively, with 71.1% sensitivity and 83.3% specificity, and 82.2% sensitivity and 78.6% specificity, while the optimal FRAX thresholds for major osteoporotic fracture (MOF) without and with BMD were 9.8% and 8.9%, respectively, with 75.6% sensitivity and 77.0% specificity, and 86.7% sensitivity and 70.9% specificity. CONCLUSION An optimal intervention threshold based on FRAX of hip fracture and MOF in postmenopausal Thai women is slightly different from the standard recommendation, which confirmed the marked variations of thresholds across ethnicities. The proposed threshold should be considered as new cutoff for initiating osteoporosis treatment in postmenopausal Thais.
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Affiliation(s)
- Dueanchonnee Sribenjalak
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Suranut Charoensri
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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14
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Charoensri S, Turnsaket S, Pongchaiyakul C. Hypertriglyceridemia as an Independent Predictor for Ten-Year Incidence of Diabetes in Thais. Vasc Health Risk Manag 2021; 17:519-525. [PMID: 34511921 PMCID: PMC8412820 DOI: 10.2147/vhrm.s326500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/05/2021] [Indexed: 12/26/2022] Open
Abstract
Background Fasting hypertriglyceridemia commonly associates with insulin resistance and is frequently prevalent in type 2 diabetes mellitus (DM). However, hypertriglyceridemia has not been investigated as an independent predictor of incidence of DM, especially in Thais. Methods A 10-year hospital-based retrospective cohort study was conducted in a tertiary care setting in Thailand. Health check-up data in 2007 from healthy participants without underlying disease were extracted as baseline data. In 2017, 10 years following an initial examination, the diagnosis of DM and other laboratory data were identified. Hypertriglyceridemia was defined as fasting triglyceride level ≥ 150 mg/dL. A generalized additive model (GAM) was applied to demonstrate a relationship between fasting TG level and probability of incident DM in 10 years. An association between hypertriglyceridemia and 10-year incidence of DM was evaluated using univariable and multivariable logistic regression analysis. Results A total of 1342 non-diabetic adults with complete both baseline and 10-year follow-up data were included in the analysis. The incidence of DM in the study period was 10.3%. Baseline fasting triglyceride level is significantly higher in participants with incidence of DM, with a median difference of 45 mg/dL (P < 0.01). Univariable logistic regression showed that hypertriglyceridemia was associated with 10-year incidence of DM (odds ratio (OR) 3.03, 95% CI 2.12–4.35). After adjusting for potential confounders, hypertriglyceridemia remained significantly associated with incidence of DM (OR 2.33, 95% CI 1.61–3.39). Conclusion Fasting triglyceride level is an independent risk factor for the development of new-onset DM. Testing for hypertriglyceridemia in people without diabetes may be an alternative screening tool to identify populations at risk of developing future DM, as well as providing triglyceride as a new target for DM risk reduction.
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Affiliation(s)
- Suranut Charoensri
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Supatida Turnsaket
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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15
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Kritmetapak K, Kongpetch S, Chotmongkol W, Raruenrom Y, Sangkhamanon S, Pongchaiyakul C. Incidence of and risk factors for post-parathyroidectomy hungry bone syndrome in patients with secondary hyperparathyroidism. Ren Fail 2021; 42:1118-1126. [PMID: 33143476 PMCID: PMC7646547 DOI: 10.1080/0886022x.2020.1841655] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Hungry bone syndrome (HBS) following parathyroidectomy is associated with severe hypocalcemia and increased morbidity. This study aims to determine the incidence and risk factors of post-parathyroidectomy HBS in dialysis patients with secondary hyperparathyroidism (SHPT). Methods A retrospective cohort study was conducted, and medical records of patients with SHPT requiring parathyroidectomy between January 2014 and January 2020 were reviewed. HBS was defined as the requirement of intravenous calcium administration due to hypocalcemia-related symptoms and/or reductions in serum calcium concentration (<8.4 mg/dL) within 72 h after parathyroidectomy. Results A total of 130 dialysis patients were enrolled. The majority of patients (85.4%) received hemodialysis and the remaining patients (14.6%) received peritoneal dialysis. Ectopic parathyroid glands were identified in 6.6% of patients by preoperative parathyroid scintigraphy. Diffuse parathyroid hyperplasia was the most common histopathological characteristic of SHPT (90.8%). HBS occurred in 82.3% of patients following parathyroidectomy. Preoperative serum intact parathyroid hormone (iPTH) concentration was significantly correlated with serum calcium (r = −0.48, p < 0.01) and alkaline phosphatase (ALP) concentration (r = 0.71, p < 0.01). Patients with HBS had significantly longer hospital stays than patients without (8 versus 3 days, p < 0.01). Based on multiple logistic regression analysis, young age (≤45 years), high preoperative serum ALP (>420 IU/L) and iPTH (>1,000 pg/mL), and absence of preoperative hypercalcemia (>10.2 mg/dL) were significantly associated with HBS. Conclusions Post-parathyroidectomy HBS is common in dialysis patients with SHPT. Young age, high preoperative serum ALP and iPTH, and low preoperative serum calcium concentrations were important risk factors for HBS.
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Affiliation(s)
- Kittrawee Kritmetapak
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sawinee Kongpetch
- Kidney Center of Excellence, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Wijittra Chotmongkol
- Kidney Center of Excellence, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Yutapong Raruenrom
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sakkarn Sangkhamanon
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Chuealee W, Foocharoen C, Mahakkanukrauh A, Suwannaroj S, Pongchaiyakul C, Nanagara R. Prevalence and predictive factors of osteoporosis in Thai systemic sclerosis. Sci Rep 2021; 11:9424. [PMID: 33941800 PMCID: PMC8093198 DOI: 10.1038/s41598-021-88792-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/16/2021] [Indexed: 11/09/2022] Open
Abstract
Systemic sclerosis (SSc) is recognized as a chronic inflammatory disease and several SSc-associated factors may increase the risk of osteoporosis and its related fractures. To determine the prevalence and predictive factors of osteoporosis in Thai SSc, a cross-sectional study was designed in adult SSc patients at Scleroderma clinic, Khon Kaen University Hospital. The prevalence of osteoporosis with the 95% confidence interval (CI) were determined and the odds ratio (OR) with 95%CI were assessed the clinical association with osteoporosis. A total of 205 SSc patients were recruited with the female to male ratio of 2.7:1. The majority of cases were diffuse SSc subset (83.4%) with a disease duration < 5 years (62.9%). The overall prevalence of osteoporosis was 29.3% (95%CI 23.1-36.0). After an age adjusted analysis, the respective prevalence of osteoporosis at lumbar spine (LS) in women and men was 26.3% and 10%, while the prevalence of osteoporosis at the femoral neck (FN) in women and men was 11% and 2.1%. Low BMI (≤ 18.5 kg/m2) and menopause were associated with osteoporosis at both the LS and FN. Using multivariate analysis, low BMI and menopause were associated with osteoporosis at LS (OR 7.78 and 5.32, respectively), while low BMI was also associated with osteoporosis at LS in pre-menopausal women. In conclusion, the prevalence of osteoporosis in Thai SSc was 29.3%. Osteoporosis at the LS is more common than FN in both men and women. Low BMI was associated with osteoporosis in overall SSc and pre-menopausal women, while only menopause was associated with osteoporosis at the FN.
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Affiliation(s)
- Wiriya Chuealee
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Chingching Foocharoen
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Ajanee Mahakkanukrauh
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Siraphop Suwannaroj
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Chatlert Pongchaiyakul
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Ratanavadee Nanagara
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
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Teeratakulpisarn N, Charoensri S, Theerakulpisut D, Pongchaiyakul C. FRAX score with and without bone mineral density: a comparison and factors affecting the discordance in osteoporosis treatment in Thais. Arch Osteoporos 2021; 16:44. [PMID: 33635451 DOI: 10.1007/s11657-021-00911-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/12/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We investigate the rate of concordance between treatment recommendations of osteoporosis with 10-year probability of hip fracture calculated using FRAX scores with and without BMD. We found that predictions were concordant in 83.8% of patients. However, older age, lower BMD, and FRAX without BMD around the intervention threshold were associated with discordant results. In the discordant group, FRAX with BMD suggested treatment in more participants with lower age, higher BMI, and lower BMD when compared with FRAX without BMD. INTRODUCTION The Fracture Risk Assessment Tool (FRAX) is used to calculate the 10-year probability of fracture using important clinical factors, with bone mineral density (BMD) as an optional input variable. We aimed to determine the rate of concordance between treatment recommendations of osteoporosis with 10-year probability of hip fracture calculated using FRAX scores with and without BMD and to identify relevant clinical risk factors associated with discordance. METHODS This was a cross-sectional study conducted in patients between 40 and 90 years of age who were screened for osteoporosis by BMD measurement using dual energy X-ray absorptiometry (DXA) from 2010 to 2018 at a university hospital in Thailand. A FRAX questionnaire was administered to determine demographic data and osteoporotic risk factors. FRAX scores with and without BMD were calculated for each participant using the Thai reference, and patients were categorized into either the treatment or non-treatment group based on a cut-off of 3% 10-year probability of hip fracture. When FRAX scores with and without BMD results were consistent, they were considered concordant. Otherwise, they were deemed discordant. Clinical risk factors were compared between the concordant and discordant groups. RESULTS A total of 3545 participants were included in the study. The majority (83.8%) were in the concordant group. However, older age, lower BMD, and FRAX without BMD around the intervention threshold were significantly associated with discordant results. In the discordant group, FRAX with BMD suggested treatment in more participants with lower age, higher BMI, and lower BMD when compared with FRAX without BMD. CONCLUSION FRAX scores with and without BMD yielded concordant predictions regarding the 10-year probability of hip fracture suggesting pharmacological treatment. However, this concordance declined in elderly and osteoporotic participants and in those with FRAX without BMD around intervention threshold. BMD data may be required in these populations in order to facilitate accurate risk assessment.
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Affiliation(s)
| | - Suranut Charoensri
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Daris Theerakulpisut
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
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Charoensri S, Kritmetapak K, Tangpattanasiri T, Pongchaiyakul C. The Impact of New-Onset Diabetes Mellitus and Hypertension on All-Cause Mortality in an Apparently Healthy Population: A Ten-Year Follow-Up Study. J Diabetes Res 2021; 2021:3964013. [PMID: 34778463 PMCID: PMC8589482 DOI: 10.1155/2021/3964013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The comparative effect of new-onset diabetes mellitus (DM) and hypertension (HT) on long-term mortality is a matter of debate. MATERIALS AND METHODS From 2007 to 2017, a 10-year longitudinal retrospective cohort study was conducted in Thailand's tertiary care setting. As baseline data, health check-up data from apparently healthy participants without underlying disease from 2007 were extracted. The vital status of all participants was determined in 2017, ten years after an initial examination. The impact of new-onset DM and HT at baseline on 10-year all-cause mortality was investigated using multivariable logistic regression analysis. RESULTS The prevalence of new-onset DM and HT was 6.4% and 28.8%, respectively, at baseline. Newly diagnosed diabetes increased the risk of all-cause mortality over 10 years (adjusted OR 4.77 and 95% CI 2.23-9.99). HT, on the other hand, did not increase the risk of death (adjusted OR 1.24 and 95% CI 0.65-2.35). Different HT and DM status combinations were compared to a nondiabetic, nonhypertensive reference. Individuals who were diabetic and hypertensive had a greater risk of death (adjusted OR 6.22 and 95% CI 2.22-17.00). Having DM without HT also increased the risk of death (adjusted OR 4.36 and 95% CI 1.35-12.87). However, having HT without DM did not result in a significant increase in 10-year mortality risk (adjusted OR 1.21 and 95% CI 0.57-2.56). CONCLUSION In an apparently healthy population, new-onset DM is more strongly associated with 10-year all-cause mortality than new-onset HT. Having both DM and HT was associated with a greater risk of death when compared to having DM or HT alone.
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Affiliation(s)
- Suranut Charoensri
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kittrawee Kritmetapak
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Kritmetapak K, Charoensri S, Thaopanya R, Pongchaiyakul C. Elevated Serum Uric Acid is Associated with Rapid Decline in Kidney Function: A 10-Year Follow-Up Study. Int J Gen Med 2020; 13:945-953. [PMID: 33122937 PMCID: PMC7591020 DOI: 10.2147/ijgm.s277957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/07/2020] [Indexed: 01/21/2023] Open
Abstract
Purpose The long-term impact of changes in serum uric acid (SUA) concentration on the estimated glomerular filtration rate (eGFR) among the general population remains unclear. We investigated the longitudinal associations between changes in SUA and eGFR over 10 years in 1222 participants with baseline eGFR ≥60 mL/min/1.73 m2. Methods This was a 10-year retrospective cohort study conducted from 2007 to 2017. Rapid eGFR decline (defined as the highest quartile of change in eGFR between 2007 and 2017) and new-onset kidney disease (defined as an eGFR <60 mL/min/1.73 m2 at a 10-year follow-up) were examined using multiple logistic regression analysis, adjusted for sex, age, body mass index, systolic blood pressure, SUA, fasting plasma glucose, serum total cholesterol, and triglyceride at baseline. Results SUA was inversely correlated with eGFR, and the slopes of the SUA-eGFR regression lines were consistently steeper in females than males. A significant inverse correlation was also observed between 10-year changes in SUA and eGFR in both sexes. Multivariate analysis showed that every 1 mg/dL increase in SUA from baseline was associated with higher risk of rapid eGFR decline and new-onset kidney disease (OR 1.25; 95% CI 1.14–1.33 and OR 1.40; 95% CI 1.26–1.49, respectively). Furthermore, the subjects in the highest SUA quartile (>6.0 mg/dL) had a 2.45 times higher risk of rapid eGFR decline (95% CI 1.51–3.42) compared to those in the lowest SUA quartile (<3.9 mg/dL). Conclusion Elevated baseline SUA is an independent risk factor for rapid eGFR decline and new-onset kidney disease in the general population.
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Affiliation(s)
- Kittrawee Kritmetapak
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Suranut Charoensri
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Rattrai Thaopanya
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Abstract
Aims: This study assessed the cost-effectiveness of denosumab for treating postmenopausal women with osteoporosis (PMO) at high risk of fracture in Thailand.Materials and methods: A published Markov cohort cost-effectiveness model was populated with country-specific data as available and other published data as needed. The model used a societal perspective, lifetime horizon, efficacy data from network meta-analysis of trials, and included costs for direct medical and non-medical care, informal care, and osteoporosis treatments to compare denosumab to no pharmacologic treatment (calcium and vitamin D supplements only) and to oral weekly alendronate. The base case (high-risk population) included postmenopausal women with femoral neck T-score ≤-2.5, mean age 65 years at entry, and history of vertebral fracture.Results: High-risk women with osteoporosis using denosumab had the greatest number of life years and quality-adjusted life-years (QALYs) with higher reductions in hip and vertebral fracture incidence compared with patients with no pharmacologic treatment. The incremental cost-effectiveness ratio (ICER) was 119,575 Thai Baht (THB) per QALY for denosumab versus no pharmacologic treatment and 199,186 THB per QALY for denosumab versus alendronate. Among Thai postmenopausal women with high-risk of fractures, denosumab was cost-effective compared with no pharmacologic treatment at a willingness-to-pay threshold of 160,000 THB per QALY. One-way sensitivity analysis showed models were most sensitive to changes in denosumab pricing.Limitations: Data from other countries used when country-specific data were unavailable may not accurately reflect the true experience in Thailand. The model focused explicitly on hip, vertebral, and wrist fractures, and therefore provides a conservative estimate of the overall potential impact of osteoporosis-related fracture. The fracture risk was not adjusted to reflect potential changes in risk after denosumab treatment discontinuation.Conclusions: In Thailand, denosumab offers a cost-effective osteoporosis treatment option versus no pharmacologic treatment in postmenopausal women at high risk of fracture.
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Affiliation(s)
| | | | | | - Aasis Unnanuntana
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
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21
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Pongchaiyakul C, Charoensri S, Leerapun T, Wongsiri S, Songpatanasilp T, Taechakraichana N. Prevalence of asymptomatic radiographic vertebral fracture in postmenopausal Thai women. Arch Osteoporos 2020; 15:78. [PMID: 32447475 DOI: 10.1007/s11657-020-00762-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/18/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED We aim to investigate the nationwide prevalence of asymptomatic radiographic vertebral fracture in Thailand. We found 29% of postmenopausal women had at least one radiographic vertebral fracture. The prevalence was significantly higher among women with osteoporosis at the total hip (TH) region which implies that TH bone mineral density is a determinant of vertebral fracture risk. INTRODUCTION Radiographic vertebral fracture is associated with an increased risk of osteoporotic fracture and mortality in postmenopausal women. We designed a study to determine the prevalence of asymptomatic vertebral fractures in postmenopausal Thai women. METHODS The study was designed as a cross-sectional investigation at five university hospitals so as to achieve representation of the four main regions of Thailand. Radiographs were taken from 1062 postmenopausal women averaging 60 years of age. The presence of vertebral fracture was assessed by the Genant's semiquantitative method with three independent radiologists. Respective bone mineral density was measured by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine (LS), femoral neck (FN), and total hip (TH). RESULTS Among the 1062 women, 311 were found to have at least one radiographic vertebral fracture-yielding a prevalence of 29% (95% CI 23.6-32.0%)-and 90 (8.5%, 95% CI 6.8-10.2%) had at least two fractures. The prevalence of vertebral fracture increased with advancing age. Most fractures occurred at one vertebra (71%) and only 29% at multiple vertebrae. The prevalence of vertebral fracture was significantly higher among women with osteoporosis compared with non-osteoporosis at the TH region. There was no significant difference in the prevalence among women with or without osteoporosis at the LS or FN. CONCLUSIONS Radiographic vertebral fractures were common among Thai postmenopausal women (~ 29%). These findings suggest that approximately one in three postmenopausal women has undiagnosed vertebral fracture. Radiographic diagnosis should therefore be an essential investigation for identifying and confirming the presence of vertebral fractures.
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Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Suranut Charoensri
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Taninnit Leerapun
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sunton Wongsiri
- Department of Orthopaedics and Physical Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Thawee Songpatanasilp
- Department of Orthopaedics, Phramongkutklao College of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Nimit Taechakraichana
- Menopausal Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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22
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Chaidee A, Onsurathum S, Intuyod K, Haonon O, Pannangpetch P, Pongchaiyakul C, Pinlaor P, Pairojkul C, Welbat JU, Ittiprasert W, Cochran CJ, Mann VH, Brindley PJ, Pinlaor S. Opisthorchis viverrini Infection Augments the Severity of Nonalcoholic Fatty Liver Disease in High-Fat/High-Fructose Diet-Fed Hamsters. Am J Trop Med Hyg 2020; 101:1161-1169. [PMID: 31482785 DOI: 10.4269/ajtmh.19-0442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing worldwide, including in regions where helminth infections such as the fish-borne liver fluke Opisthorchis viverrini (Ov) also occur. We investigated the effects of a high-fat and high-fructose (HFF) diet on the development and progression of NAFLD in experimental opisthorchiasis. Two groups of hamsters were infected with Ov for 4 months before the experiment to induce chronic inflammation. One of these groups (OvHFF) was fed with a HFF diet for up to further 4 months. One uninfected group of hamsters served as the normal control group, and another received the HFF diet (HFF group) for up to 4 months. Histopathology, biochemical parameters, and ultrastructural features of liver were investigated. In a short-term treatment, the OvHFF group showed significantly better homeostatic model assessment for insulin resistance level and lower liver lipid than did the HFF group. By contrast, histopathological characteristics of severe NAFLD were prominent in the OvHFF group after 4 months on the HFF diet, findings which were supported by confirmatory ultrastructural changes. In conclusion, opisthorchiasis induced the severe NAFLD in hamsters fed high-fat/high-fructose diets.
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Affiliation(s)
- Apisit Chaidee
- Chronic Kidney Disease Prevention in The Northeast of Thailand (CKDNET) Working Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sudarat Onsurathum
- Chronic Kidney Disease Prevention in The Northeast of Thailand (CKDNET) Working Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kitti Intuyod
- Chronic Kidney Disease Prevention in The Northeast of Thailand (CKDNET) Working Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ornuma Haonon
- Chronic Kidney Disease Prevention in The Northeast of Thailand (CKDNET) Working Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Porntip Pinlaor
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Chronic Kidney Disease Prevention in The Northeast of Thailand (CKDNET) Working Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chawalit Pairojkul
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Jariya Umka Welbat
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wannaporn Ittiprasert
- Department of Microbiology, Immunology and Tropical Medicine, and Research Center for Neglected Diseases of Poverty, School of Medicine & Health Sciences, The George Washington University, Washington, District of Columbia
| | - Christina J Cochran
- Department of Microbiology, Immunology and Tropical Medicine, and Research Center for Neglected Diseases of Poverty, School of Medicine & Health Sciences, The George Washington University, Washington, District of Columbia
| | - Victoria H Mann
- Department of Microbiology, Immunology and Tropical Medicine, and Research Center for Neglected Diseases of Poverty, School of Medicine & Health Sciences, The George Washington University, Washington, District of Columbia
| | - Paul J Brindley
- Department of Microbiology, Immunology and Tropical Medicine, and Research Center for Neglected Diseases of Poverty, School of Medicine & Health Sciences, The George Washington University, Washington, District of Columbia
| | - Somchai Pinlaor
- Chronic Kidney Disease Prevention in The Northeast of Thailand (CKDNET) Working Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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23
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Sothornwit J, Phunmanee A, Pongchaiyakul C. Atezolizumab-Induced Autoimmune Diabetes in a Patient With Metastatic Lung Cancer. Front Endocrinol (Lausanne) 2019; 10:352. [PMID: 31244772 PMCID: PMC6581023 DOI: 10.3389/fendo.2019.00352] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/17/2019] [Indexed: 12/20/2022] Open
Abstract
Context: Immune checkpoint inhibitors (ICIs), now FDA-approved, are increasingly used as an effective treatment of various cancers. Autoimmune diabetes is a rare but life-threatening endocrine adverse event, which has been reported in patients treated with anti-programmed-cell death-1 (anti-PD-1) and anti-programmed-cell death-1 ligand (anti-PD-L1) therapies. Case description: We report a 52-year-old woman with advanced-stage non-small cell lung cancer who presented with diabetic ketoacidosis (DKA) at 24 weeks after atezolizumab initiation. She initially received oral antidiabetic medication from primary care hospital and experienced recurrent DKA 3 days later. Her plasma glucose on the day that she had recurrent DKA was 332 mg/dL (18.4 mmol/L), A1c was 7.9% (63 mmol/mol), fasting C-peptide was <0.03 nmol/L (0.1 ng/ml), fasting insulin level was <1 μIU/ml, anti-glutamic acid decarboxylase 65 (GADA) was 7.2 U/ml (normal, >5 U/ml), and human leukocyte antigen (HLA) class II typing was DR3-DQ2/DR14-DQ5. A diagnosis of autoimmune diabetes was made. After treatment for DKA, she recovered and received basal-bolus insulin treatment. Atezolizumab had been discontinued after the fifth cycle, prior to the development of DKA, due to progression of lung cancer. Conclusion: To date, there has been neither an effective way to detect if a patient is at high risk for autoimmune diabetes nor to prevent the complications associated with it. Regular glucose monitoring is the best method of early diabetes detection. In patients with new onset diabetes following treatment with ICIs, C-peptide levels and GADA should be screened, and insulin therapy should be prescribed to prevent hyperglycemic emergency while waiting for definite diagnosis.
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Affiliation(s)
- Jin Sothornwit
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- *Correspondence: Jin Sothornwit
| | - Anakapong Phunmanee
- Division of Critical Care, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Boonyavarakul A, Leelawattana R, Pongchaiyakul C, Buranapin S, Phanachet P, Pramyothin P. Effects of meal replacement therapy on metabolic outcomes in Thai patients with type 2 diabetes: A randomized controlled trial. Nutr Health 2018; 24:261-268. [PMID: 30270717 PMCID: PMC6340108 DOI: 10.1177/0260106018800074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: A meal replacement (MR) with a low glycemic index (GI) is possibly beneficial for
glycemic control. However, the effects of MR on diabetes mellitus have not been studied
among Thai patients with type 2 diabetes (T2DM). Aim: To compare metabolic outcomes between T2DM patients receiving the new MR formula (ONCE
PRO) and normal controlled diets. Methods: A multicenter, open-labeled, randomized controlled trial was conducted. Eligible
patients received either ONCE PRO for one meal daily with controlled diets or only
controlled diets for 3 months. The differences in metabolic profile between the baseline
and end point of each group and between groups were measured. Results: 110 participants were enrolled; the mean difference and standard deviation in
hemoglobin A1C (HbA1c) (%) from baseline were –0.21 ± 0.78 (p = 0.060)
and –0.27 ± 0.60 (p = 0.001) in the MR and control groups,
respectively; however, there was no significant difference between groups
(p = 0.637). Patients consuming a MR instead of breakfast had a
significant decrease in HbA1c (p = 0.040). Body weight (BW) and body
mass index (BMI) were significantly reduced in both groups. There were no significant
change in waist circumference, fasting plasma glucose, total cholesterol and
triglycerides. Low-density lipoprotein cholesterol (LDL-C) was significantly decreased
in the MR group compared with the control group (p = 0.049). Conclusions: Short-term conventional diet control and the low-GI MR product were associated with a
decreased BW and BMI. Changes in the other metabolic outcomes, HbA1c, total cholesterol
and triglycerides, were comparable despite ONCE PRO as the MR having a better effect on
LDL-C lowering.
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Affiliation(s)
- Apussanee Boonyavarakul
- Division of Endocrinology, Department of Internal Medicine, Phramongkutklao Hospital, Thailand
| | - Rattana Leelawattana
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khonkaen University, Thailand
| | - Supawan Buranapin
- Division of Endocrinology, Department of Internal medicine, Faculty of Medicine, Chiang Mai University, Thailand
| | - Pariya Phanachet
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
| | - Pornpoj Pramyothin
- Division of Nutrition, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand
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25
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Im-oun S, Kotruchin P, Thinsug P, Mitsungnern T, Techa-atik P, Pongchaiyakul C. Effect of Thai instrumental folk music on blood pressure: A randomized controlled trial in stage-2 hypertensive patients. Complement Ther Med 2018; 39:43-48. [DOI: 10.1016/j.ctim.2018.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/02/2018] [Accepted: 05/25/2018] [Indexed: 12/18/2022] Open
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Kotruchin P, Mitsungnern T, Ruangsaisong R, Imoun S, Pongchaiyakul C. Hypertensive Urgency Treatment and Outcomes in a Northeast Thai Population: The Results from the Hypertension Registry Program. High Blood Press Cardiovasc Prev 2018; 25:309-315. [DOI: 10.1007/s40292-018-0272-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022] Open
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27
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Chaidee A, Onsurathum S, Intuyod K, Pannangpetch P, Pongchaiyakul C, Pinlaor P, Pairojkul C, Ittiprasert W, Cochran CJ, Mann VH, Brindley PJ, Pinlaor S. Co-occurrence of opisthorchiasis and diabetes exacerbates morbidity of the hepatobiliary tract disease. PLoS Negl Trop Dis 2018; 12:e0006611. [PMID: 29953446 PMCID: PMC6040770 DOI: 10.1371/journal.pntd.0006611] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/11/2018] [Accepted: 06/13/2018] [Indexed: 12/31/2022] Open
Abstract
Complications arising from infection with the carcinogenic liver fluke Opisthorchis viverrini cause substantial morbidity and mortality in Thailand and adjacent lower Mekong countries. In parallel, the incidence rate of diabetes mellitus (DM) is increasing in this same region, and indeed worldwide. Many residents in opisthorchiasis-endemic regions also exhibit DM, but the hepatobiliary disease arising during the co-occurrence of these two conditions remains to be characterized. Here, the histopathological profile during co-occurrence of opisthorchiasis and DM was investigated in a rodent model of human opisthorchiasis in which diabetes was induced with streptozotocin. The effects of excretory/secretory products from the liver fluke, O. viverrini (OVES) on hepatocyte and cholangiocyte responses during hyperglycemic conditions also were monitored. Both the liver fluke-infected hamsters (OV group) and hamsters with DM lost weight compared to control hamsters. Weight loss was even more marked in the hamsters with both opisthorchiasis and DM (OD group). Hypertrophy of hepatocytes, altered biliary canaliculi, and biliary hyperplasia were more prominent in the OD group, compared with OV and DM groups. Profound oxidative DNA damage, evidenced by 8-oxo-2'-deoxyguanosine, proliferating cell nuclear antigen, and periductal fibrosis characterized the OD compared to OV and DM hamsters. Upregulation of expression of cytokines in response to infection and impairment of the pathway for insulin receptor substrate (IRS)/phosphatidylinositol-3-kinases (PI3K)/protein kinase B (AKT) signaling attended these changes. In vitro, OVES and glucose provoked time- and dose-dependent effects on the proliferation of both hepatocytes and cholangiocytes. In overview, the co-occurrence of opisthorchiasis and diabetes exacerbated pathophysiological damage to the hepatobiliary tract. We speculate that opisthorchiasis and diabetes together aggravate hepatobiliary pathogenesis through an IRS/PI3K/AKT-independent pathway.
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Affiliation(s)
- Apisit Chaidee
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Sudarat Onsurathum
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Kitti Intuyod
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Porntip Pinlaor
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Chawalit Pairojkul
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wannaporn Ittiprasert
- Department of Microbiology, Immunology and Tropical Medicine, and Research Center for Neglected Diseases of Poverty, School of Medicine & Health Sciences, The George Washington University, Washington, D.C., United States of America
| | - Christina J. Cochran
- Department of Microbiology, Immunology and Tropical Medicine, and Research Center for Neglected Diseases of Poverty, School of Medicine & Health Sciences, The George Washington University, Washington, D.C., United States of America
| | - Victoria H. Mann
- Department of Microbiology, Immunology and Tropical Medicine, and Research Center for Neglected Diseases of Poverty, School of Medicine & Health Sciences, The George Washington University, Washington, D.C., United States of America
| | - Paul J. Brindley
- Department of Microbiology, Immunology and Tropical Medicine, and Research Center for Neglected Diseases of Poverty, School of Medicine & Health Sciences, The George Washington University, Washington, D.C., United States of America
| | - Somchai Pinlaor
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
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28
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Kritmetapak K, Anutrakulchai S, Pongchaiyakul C, Puapairoj A. Clinical and pathological characteristics of non-diabetic renal disease in type 2 diabetes patients. Clin Kidney J 2017; 11:342-347. [PMID: 29942497 PMCID: PMC6007236 DOI: 10.1093/ckj/sfx111] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 08/17/2017] [Indexed: 12/19/2022] Open
Abstract
Background Renal involvement in type 2 diabetes is mainly due to diabetic nephropathy (DN). Nevertheless, a sizable proportion of diabetic patients could actually have nondiabetic renal diseases (NDRDs) or DN plus NDRDs. This study aimed to explore the pathological features of NDRD in diabetic patients and to assess the predictability of diagnosing NDRD (±DN) versus isolated DN on the basis of clinical parameters. Methods Medical records of type 2 diabetes patients who underwent renal biopsy under suspicion of NDRD from January 2011 through November 2015 were analyzed retrospectively. Results A total of 101 patients were enrolled in this study. The most frequent indication for renal biopsy was recent onset of nephrotic syndrome (41%), followed by rapidly progressive renal failure (29%) and active urinary sediment (21%). On renal biopsy, 51% of patients had isolated DN, 20% had isolated NDRD and 29% had DN plus NDRD. IgA nephropathy was the most common cause of isolated NDRD, whereas acute tubular necrosis (39%) and acute interstitial nephritis (33%) were the main causes of NDRD superimposed on DN. Male gender, short-duration diabetes (<8 years), lower glycated hemoglobin and active urinary sediment (≥10 red and white blood cells per high-power field) were independent predictors of NDRD according to multiple logistic regression analysis. Conclusions Judicious use of renal biopsy revealed NDRD (±DN) in nearly half of type 2 diabetes patients with atypical renal presentation, especially in male patients with well-controlled diabetes, those who have had diabetes for a short duration and those with active urinary sediment.
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Affiliation(s)
- Kittrawee Kritmetapak
- Division of Nephrology, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sirirat Anutrakulchai
- Division of Nephrology, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anucha Puapairoj
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Songpatanasilp T, Sritara C, Kittisomprayoonkul W, Chaiumnuay S, Nimitphong H, Charatcharoenwitthaya N, Pongchaiyakul C, Namwongphrom S, Kitumnuaypong T, Srikam W, Dajpratham P, Kuptniratsaikul V, Jaisamrarn U, Tachatraisak K, Rojanasthien S, Damrongwanich P, Wajanavisit W, Pongprapai S, Ongphiphadhanakul B, Taechakraichana N. Thai Osteoporosis Foundation (TOPF) position statements on management of osteoporosis. Osteoporos Sarcopenia 2016; 2:191-207. [PMID: 30775487 PMCID: PMC6372784 DOI: 10.1016/j.afos.2016.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 01/07/2023] Open
Abstract
The adjusted incidence rate of hip fracture in Thailand has increased more than 31% from 1997 to 2006. Mortality and morbidity after hip fracture are also high. One year mortality after a hip fracture has increased from 18% in 1999 to 21% in 2007. The Thai Osteoporosis Foundation (TOPF) developed the first Clinical Practice Guideline (CPG) in 2002 and keeps updating the CPG since then. This latest version of the CPG is our attempt to provide comprehensive positional statement on the diagnosis, prevention and treatment of osteoporosis in Thailand. The study group who revised this position statement contains experts from the TOPF, Four Royal Colleges of Thailand, includes the Orthopaedic Surgeons, Gynecologists and Obstetricians, Physiatrists, Radiologists and 2 Associations of Endocrinologists and Rheumatologists which have involved in the management of patients with osteoporosis.
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Affiliation(s)
- T. Songpatanasilp
- Department of Orthopaedics, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - C. Sritara
- Nuclear Medicine Division, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - W. Kittisomprayoonkul
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - S. Chaiumnuay
- Rheumatology Division, Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - H. Nimitphong
- Endocrinology and Metabolism Division, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - N. Charatcharoenwitthaya
- Endocrinology and Metabolism Division, Department of Medicine, Faculty of Medicine, Thammasat University, Bangkok, Thailand
| | - C. Pongchaiyakul
- Endocrinology and Metabolism Division, Department of Medicine, Faculty of Medicine, Khonkean University, Khonkean, Thailand
| | - S. Namwongphrom
- Department of Radiology, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
| | - T. Kitumnuaypong
- Rheumatology Division, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - W. Srikam
- Department of Rehabilitation Medicine, Faculty of Medicine, Thammasat University, Bangkok, Thailand
| | - P. Dajpratham
- Department of Rehabilitation Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - V. Kuptniratsaikul
- Department of Rehabilitation Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - U. Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - K. Tachatraisak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S. Rojanasthien
- Department of Orthopaedics, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
| | - P. Damrongwanich
- Department of Orthopaedics, Police General Hospital, Bangkok, Thailand
| | - W. Wajanavisit
- Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S. Pongprapai
- Department of Rehabilitation Medicine, Vichaiyut Hospital, Bangkok, Thailand
| | - B. Ongphiphadhanakul
- Endocrinology and Metabolism Division, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - N. Taechakraichana
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Boonyavarakul A, Leelawattana R, Pongchaiyakul C, Buranapin S, Phanachet P, Pramyothin P. SUN-P097: Effects of Meal Replacement Therapy on Clinical and Metabolic Outcomes in Thai Type 2 Diabetes Patients: A Randomized Controlled Trial. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kotruchin P, Pachirat O, Pongchaiyakul C. Efficacy and Safety of Amlodipine versus Captopril and their Combination in Hypertensive Urgency: A Randomized Controlled Trial. ACTA ACUST UNITED AC 2016. [DOI: 10.4172/2329-9126.1000274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kitwitee P, Limwattananon S, Limwattananon C, Waleekachonlert O, Ratanachotpanich T, Phimphilai M, Nguyen TV, Pongchaiyakul C. Metformin for the treatment of gestational diabetes: An updated meta-analysis. Diabetes Res Clin Pract 2015; 109:521-32. [PMID: 26117686 DOI: 10.1016/j.diabres.2015.05.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 03/02/2015] [Accepted: 05/03/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To assess the efficacy of metformin and insulin in the treatment of pregnant women with gestational diabetes mellitus (GDM). METHODS A meta-analysis was conducted by including randomized controlled trials comparing metformin and insulin in GDM. An electronic search was conducted to identify relevant studies. Data were synthesized by a random effects meta-analysis model. A Bayesian analysis was also performed to account for uncertainties in the treatment efficacy. RESULTS Eight clinical trials involving 1712 individuals were included in the final analysis. The pooled estimates of metformin-insulin differences were very small and statistically non-significant in fasting plasma glucose, postprandial plasma glucose and HbA1c, measured at 36-37 weeks of gestation. Notably, 14-46% of those receiving metformin required additional insulin. Compared with the insulin group, metformin treatment was associated with a lower incidence of neonatal hypoglycemia (relative risk, RR 0.74; 95% CI 0.58-0.93; P=0.01) and of neonatal intensive care admission (RR 0.76; 95% CI 0.59-0.97; P=0.03). Bayesian analysis revealed that the efficacy of metformin was consistently higher than insulin with a probability of over 98% on these two neonatal complications. Other outcomes were not significantly different between the two treatment groups. CONCLUSION In women with gestational diabetes, metformin use and insulin therapy have comparable glycemic control profile, but metformin use was associated with lower risk of neonatal hypoglycemia.
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Affiliation(s)
- Pimprapa Kitwitee
- Social and Administrative Pharmacy Program, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand
| | - Supon Limwattananon
- Social and Administrative Pharmacy Program, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand
| | - Chulaporn Limwattananon
- Social and Administrative Pharmacy Program, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand
| | | | | | - Mattabhorn Phimphilai
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chiang Mai University, Thailand
| | - Tuan V Nguyen
- Bone and Mineral Research Program, Garvan Institute of Medical Research, Sydney, Australia
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
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Charoensri S, Khahmahpahte S, Thepsuthammarat K, Pongchaiyakul C. An Evaluation of Blood Glucose Measurement Using TRUEresult Blood Glucose Monitoring System. J Med Assoc Thai 2015; 98:839-846. [PMID: 26591392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Point of care testing using glucose meters that measure capillary blood are the most popular and widely used method for the routine monitoring ofblood glucose level. TR UEresult is one ofsuch commonly used blood glucose measuring tools with high accuracy and precision profile according to the manufacturer's data. OBJECTIVE To evaluate the performance of TRUEresult in real life practice by examining the agreement between capillary and venous glucose result using TR UEresult and a laboratory plasma glucose. MATERIAL AND METHOD The present study is a cross sectional analytical study. All the data were collected from the patients whose blood samples were drawn for the measurement of plasma glucose at the outpatient department of Srinagarind Hospital, Khon Kaen University Thailand. TR UEresult blood glucose monitoring system was used to perform blood glucose measurement in whole blood samples from capillary and veins. This was compared with plasma glucose result from the automated analyzer in the central laboratory, which was considered as reference method at Srinagarind Hospital. RESULTS The ISO 15197:2013 criteria was used to determine technical accuracy of the TRUEresult tool. Blood glucose levels in whole blood sample from capillary and veins, as measured using the TRUEresult, were 88.24% and 92.16% of the acceptable bias limits. This is below the minimal acceptable criteria. When Parkes error grid analysis was used to define the significance in clinical decision, all the errors of blood glucose levels measured using the TRUEresult were within zone A and zone B, meaning that the errors have no or little influence on clinical decision. CONCLUSION The blood glucose levels in whole bloodfrom capillary and veins measured using TR UEresult blood glucose monitoring was within acceptable accuracy limit. The observed error had no or little influence on clinical decision.
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Pongchaiyakul C, Kotruchin P. Lumbar spine and hip bone mineral density in Thai women using the Osteosys Dexxum T-bone densitometer. J Med Assoc Thai 2013; 96:898-904. [PMID: 23991594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To measure lumbar spine and hip bone mineral density (BMD) and to define the Thai normal reference for classifying BMD results and diagnosis of osteoporosis in Thai women using a new mobile central dual energy X-ray absorptiometry (DXA). MATERIAL AND METHOD This cross-sectional investigation recruited 779 Thai women between 20 and 85 years. Lumbar spine and hip BMD was measured by DXA (Osteosys Dexxum-T). The BMD results were classified by T-score asper WHO criteria. RESULTS Advancing age was negatively correlated with BMD at both sites, whereas body weight was positively correlated to BMD at both. The correlation between BMDs at the lumbar spine and hip was 0.67 to 0.69. The peak BMD was observed in women between 20 and 24 years at both sites, with a respective mean and standard deviation of 1.082 +/- 0.153, 1.115 +/- 0.161, 0.878 +/- 0.150, and 0.946 +/- 0.125 at L1-4, L2-4, the femoral neck and total hip. Using the Thai references derived from peak BMD, the prevalence of osteoporosis was 5.1 to 5.5 and 3.1 to 6.3% at the lumbar spine and hip, respectively, which was lower than the Asian reference as provided by DXA. CONCLUSION The present study suggested that using the T-score provided by the Osteosys Dexxum-T over-diagnosed osteoporosis in Thai women. The authors recommend using Thai normal reference from the present study to define the BMD result in Thai women.
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Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department ofMedicine, Faculty ofMedicine, Khon Kaen University, Khon Kaen, Thailand.
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Pongchaiyakul C, Limpawattana P, Kotruchin P, Rajatanavin R. Prevalence of sarcopenia and associated factors among Thai population. J Bone Miner Metab 2013; 31:346-50. [PMID: 23377622 DOI: 10.1007/s00774-013-0422-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 12/20/2012] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to determine the prevalence of sarcopenia using the skeletal muscle index (SMI) criteria in the Thai population. The secondary objective was to demonstrate factors influencing low SMI in this population. Femoral neck bone mass density (BMD) was measured by dual-energy X-ray absorptiometry (GE Lunar, Madison, WI, USA) in 435 urban and 397 rural subjects (334 men and 498 women) between 20 and 84 years of age. Body mass index (BMI) was calculated from weight and height. The respective prevalence of sarcopenia among men and women was 35.33 % (95 % CI, 29.91, 40.41) and 34.74 % (95 % CI, 30.56, 39.10). Factors associated with sarcopenia using multiple logistic regression analyses in both sexes were (a) living in the city, (b) higher BMI, and (c) older age. Living in an urban area was the strongest factor, with an odds ratio (OR) of 17.26 ± 7.12 (95 % CI, 7.68, 38.76) in men and 8.62 ± 2.74 (95 % CI, 4.62, 16.05) in women (p < 0.05). The prevalence rate ratio for persons living in urban compared to rural areas was 2.01 (95 % CI, 1.14, 3.53) in men and 1.69 (95 % CI, 1.31, 2.17) in women (p < 0.05). Sarcopenia, as based on SMI, occurs frequently in the Thai population and increases with age. The prevalence of sarcopenia is particularly high among pre-retirement women (50-59 years of age) whereas the number of men with sarcopenia gradually rises with age. An urban environment is the most predictive factor for sarcopenia, followed by high BMI and age. Given the aging population, early recognition of this condition can be beneficial for prevention of an epidemic of sarcopenia-related disability.
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Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Pongchaiyakul C, Leerapun T, Wongsiri S, Songpattanasilp T, Taechakraichana N. Value and validation of RCOST and TOPF clinical practice guideline for osteoporosis treatment. J Med Assoc Thai 2012; 95:1528-1535. [PMID: 23390783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine the percentage of postmenopausal women who need treatment using the various criteria as set out in clinical practice guideline published by the Royal College of Orthopaedic Surgeons of Thailand (RCOST) and the Thai Osteoporosis Foundation (TOPF). MATERIAL AND METHOD A cross-sectional investigation conducted at five university hospitals around Thailand, evaluated three categories of criteria according to the RCOST and the TOPF guideline for treatment in postmenopausal women, (1) bone mineral density (BMID) measured by DXA, (2) combined quantitative ultrasonography (QUS) measurement and clinical risk indices (CRI), and (3) FRAX or CRI plus spine radiography. RESULTS One thousand sixty two woman averaging 60 years of age were recruited for this study. Of those, women with osteoporosis according to DXA, osteopenia plus FRAX, or one major or two minor risk factors comprised between 1 and 22% (category I). Using the QUS T-score in combination with CRI (OSTA or KKOS score < or = -1) or nomogram criteria, between 11 and 14.4% needed treatment (category II). Using the BMI-based FRAX calculation or CRI (OSTA score of < -4 or KKOS probability of > or =80%) plus osteopenia by spine radiograph, between 2.6 and 15.7% needed treatment (category III). CONCLUSION Using the RCOST and TOPF clinical practice guideline, only one-fifth of postmenopausal Thai women would be eligible to receive treatment.
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Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Pongchaiyakul C, Kosulwat V, Rojroongwasinkul N, Charoenkiatkul S, Thepsuthammarat K, Laopaiboon M, Nguyen TV, Rajatanavin R. Prediction of Percentage Body Fat in Rural Thai Population Using Simple Anthropometric Measurements. ACTA ACUST UNITED AC 2012; 13:729-38. [PMID: 15897482 DOI: 10.1038/oby.2005.82] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To develop and validate sex-specific equations for predicting percentage body fat (%BF) in rural Thai population, based on BMI and anthropometric measurements. RESEARCH METHODS AND PROCEDURES %BF (DXA; GE Lunar Corp., Madison, WI) was measured in 181 men and 255 women who were healthy and between 20 and 84 years old. Anthropometric measures such as weight (kilograms), height (centimeters), BMI (kilograms per meter squared), waist circumference (centimeters), hip circumference (centimeters), thickness at triceps skinfold (millimeters), biceps skinfold (millimeters), subscapular skinfold (millimeters), and suprailiac skinfold (millimeters) were also measured. The sample was randomly divided into a development group (98 men and 125 women) and a validation group (83 men and 130 women). Regression equations of %BF derived from the development group were then evaluated for accuracy in the validation group. RESULTS The equation for estimating %BF in men was: %BF(men) = 0.42 x subscapular skinfold + 0.62 x BMI - 0.28 x biceps skinfold + 0.17 x waist circumference - 18.47, and in women: %BF(women) = 0.42 x hip circumference + 0.17 x suprailiac skinfold + 0.46 x BMI - 23.75. The coefficient of determination (R2) for both equations was 0.68. Without anthropometric variables, the predictive equation using BMI, age, and sex was: %BF = 1.65 x BMI + 0.06 x age - 15.3 x sex - 10.67 (where sex = 1 for men and sex = 0 for women), with R2 = 0.83. When these equations were applied to the validation sample, the difference between measured and predicted %BF ranged between +/-9%, and the positive predictive values were above 0.9. DISCUSSION These results suggest that simple, noninvasive, and inexpensive anthropometric variables may provide an accurate estimate of %BF and could potentially aid the diagnosis of obesity in rural Thais.
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Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002 Thailand.
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Intapan PM, Sanpool O, Thanchomnang T, Imtawil K, Pongchaiyakul C, Nawa Y, Maleewong W. Molecular identification of a case of Paragonimus pseudoheterotremus infection in Thailand. Am J Trop Med Hyg 2012; 87:706-9. [PMID: 22826489 DOI: 10.4269/ajtmh.2012.12-0235] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Paragonimiasis is an important food-borne parasitic zoonosis caused by infection with lung flukes of the genus Paragonimus. In Southeast Asia, Paragonimus heterotremus is the only proven causative pathogen. Recently, a new Paragonimus species, P. pseudoheterotremus, was found in Thailand. This species is genetically similar to P. heterotremus and is considered as a sister species. However, infectivity or pathogenicity of P. pseudoheterotremus to humans remains unclear. We report the first confirmed human pulmonary paragonimiasis case caused by P. pseudoheterotremus infection. After polymerase chain reaction/sequencing of the DNA extracted from Paragonimus eggs in the sputum of the patient, partial internal transcribed spacer 2 and cytochrome c oxidase subunit 1 sequences were approximately identical (98-100%) with those of P. pseudoheterotremus. For P. heterotremus, the partial internal transcribed spacer 2 sequence was approximately identical (99-100%), but the partial mitochondrial cytochrome c oxidase subunit 1 sequence showed a similarity of 90-95%.
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Affiliation(s)
- Pewpan M Intapan
- Department of Parasitology, Research and Diagnostic Center for Emerging Infectious Diseases, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Tatsanavivat P, Thavornpitak Y, Pongchaiyakul C. Comparative effectiveness of three national healthcare schemes in Thailand: in-hospital medical expenses for diabetes and hypertension in 2010. J Med Assoc Thai 2012; 95 Suppl 7:S254-S261. [PMID: 23130463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To compare the health insurance schemes regarding treatment of diabetes (DM) and hypertension (HT). MATERIAL AND METHOD In-patient expense data for all ICD-10 DM and HT for 2010 were accessed from the National Health Security Office (UC), the Social Security office (SS) and the Civil Servants Benefit System (CSMBS). Mean hospital stay charges and mortality rates were calculated and compared across schemes and types of hospital. RESULTS Thais > or = 19 years accounted for 4,863,939 admissions (12.6% DM-All; 17.9% HT-All). Average admission per case was higher for DM-All (1.66) than HT-All (1.46). CSMBS patients trended to be older than UC and SS. Most under UC were admitted to primary care (51.9% DM-All; 50.0% HT-All) vs. tertiary under CSMBS (45.5% DM-All; 48.4% HT-All). Median of stay under CSMBS was longer (1.3-2.0x) and charges higher (1.3-1.6x) than UC for all levels for both DM and HT Mortality rate under CSMBS was higher than UC in primary care for both DM and HT while respective rates were higher under UC than CSMBS for secondary (DM-All: 9.9 vs. 8.1; HT-All: 8.2 vs. 6.6) and tertiary care (DM-All:11.7 vs.8.6; HT-All: 9.8 vs. 6.8). CONCLUSION Inequalities among three health insurance schemes for DM and HT including hospital charge, hospital stay and mortality rate according to health care settings for DM and HT were shown, effectiveness improvement is needed.
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Affiliation(s)
- Pyatat Tatsanavivat
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Leeangkoonsathian E, Boonyanuruk P, Pongchaiyakul C, Panichkul S. Validate of clinical risk index for osteoporosis in Thai women at Phramongkutklao Hospital. J Med Assoc Thai 2012; 95:487-492. [PMID: 22612000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Osteoporosis is a common problem found in elderly people and the cost of treatment with its complications is much higher than the cost of diagnosis and prevention. However diagnosis of osteoporosis is hindered by an unavailability of dual energy x-ray absorptiometry (DXA). Many clinical risk index-scoring systems were developed to help prediction of osteoporosis such as Khon Kaen Osteoporosis Study (KKOS). The KKOS is one among those scoring systems based on the Thai population database. The objectives of the present study were to validate KKOS for prediction of osteoporosis in Thai women at Gynecologic Clinic of Phramongkutklao Hospital and to study the prevalence of women with osteoporosis diagnosed with KKOS. MATERIAL AND METHOD Four hundred forty six Thai women, aged 40 years or more attending the Gynecologic Clinic of Phramongkutklao Hospital, and had Bone mineral density (BMD) result were enrolled in the present study. The results of BMD were measured at the lumbar spine and femoral neck by DXA and KKOS. The score was evaluated and compared. RESULTS Sensitivity and specificity of KKOS for prediction of osteoporosis were 48.6% and 68.1%, respectively. Prevalence of osteoporosis using KKOS was 23% while 32% were diagnosed with DXA. CONCLUSION KKOS had low sensitivity and specificity for diagnosed osteoporosis in Thai women at Gynecologic Clinic of Phramongkutklao Hospital.
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Pongchaiyakul C, Kotruchin P, Wanothayaroj E, Nguyen TV. An innovative prognostic model for predicting diabetes risk in the Thai population. Diabetes Res Clin Pract 2011; 94:193-8. [PMID: 21835485 DOI: 10.1016/j.diabres.2011.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 07/08/2011] [Accepted: 07/14/2011] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To estimate the prevalence and type 2 diabetes, and to develop a prognostic model for identifying individuals at high risk of undiagnosed type 2 diabetes. RESEARCH DESIGN AND METHODS The study was designed as a cross-sectional investigation with 4314 participants of Thai background, aged between 15 and 85 years (mean age: 48). Fasting plasma glucose was initially measured, and repeated if the first measurement was more than 126 mg/dl. Type 2 diabetes was diagnosed using the World Health Organization's criteria. Logistic regression model was used to develop prognostic models for men and women separately. The prognostic performance of the model was assessed by the area under the receiver operating characteristic curve (AUC) and a nomogram was constructed from the logistic regression model. RESULTS The overall prevalence of type 2 diabetes was 7.4% (n = 125/1693) in men and 3.4% (n = 98/2621) in women. In either gender, the prevalence increased with age and body mass index (BMI). Gender, age, BMI and systolic blood pressure (SBP) were independently associated with type 2 diabetes risk. Based on the estimated parameters of model, a nomogram was constructed for predicting diabetes separated by gender. The AUC for the model with 3 factors was 0.75. CONCLUSIONS These data suggest that the combination of age, BMI and systolic blood pressure could help identify Thai individuals at high risk of undiagnosed diabetes.
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Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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Bamrungsong T, Pongchaiyakul C. Bilateral atypical femoral fractures after long-term alendronate therapy: a case report. J Med Assoc Thai 2010; 93:620-624. [PMID: 20524451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Bisphosphonates therapy has been shown to decrease the risk of vertebral, non-vertebral, and hip fractures in postmenopausal women. However the long-term safety of bisphosphonates use has been questioned. Recent reports have demonstrated the association between long-term alendronate therapy with low-energy subtrochanteric fracture or diaphyseal femoral fractures in a small number of patients. The author reported the first case of bilateral atypical femoral fractures in postmenopausal women with osteoporosis receiving long-term alendronate therapy.
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Affiliation(s)
- Tachchai Bamrungsong
- Department of Orthopedics, Phranakhon Si Ayutthaya Hospital, Phranakhon Si Ayutthaya, Thailand
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Pongchaiyakul C, Songpattanasilp T, Taechakraichana N. Osteoporosis: overview in disease, epidemiology, treatment and health economy. J Med Assoc Thai 2008; 91:581-594. [PMID: 18556872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Pongchaiyakul C, Kosulwat V, Charoenkiatkul S, Chailurkit LO, Rojroongwasinkul N, Rajatanavin R. The association of dietary calcium, bone mineral density and biochemical bone turnover markers in rural Thai women. J Med Assoc Thai 2008; 91:295-302. [PMID: 18575280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To investigate the relative contribution of dietary calcium intake on bone mineral density (BMD) and biochemical bone turnover markers in rural Thai women. MATERIAL AND METHOD A cross-sectional investigation was designed in 255 rural Thai women. Usual dietary calcium intake was determined by 3-day food records and quantitative food-frequency questionnaire. BMD was measured by DXA. The three markers for bone turnover event: serum total alkaline phosphatase, serum N-mid osteocalcin and type I collagen C-telopeptide, including serum calcium and were determined in 125 women in the present study. RESULTS An average daily calcium intake in the present study was 265 mg/day. Two hundred and thirty three out of 255 women (87%) consumed dietary calcium less than half of the recommended value and only 3% of women (n = 7) had calcium intake > 800 mg/day. After controlling certain parameters: age and body mass index, women who consumed higher amount of dietary calcium had significantly higher BMD at all sites. Moreover highly increased bone turnover markers were observed in those with lowest quartile calcium intake. Women with osteopenia and osteoporosis were older, lower BMI, consumed less calcium and had significantly higher values of all biochemical bone turnover markers than those who had normal BMD. CONCLUSION The present study showed that a habitual diet of the rural Thai population might not provide enough calcium as needed for bone retention and for prevention of bone loss in the following years. Modification of eating pattern by promotion of increased consumption of locally available calcium rich food may be beneficial for prevention of osteoporosis among this population.
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Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
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Pongchaiyakul C, Songpattanasilp T, Taechakraichana N. Burden of osteoporosis in Thailand. J Med Assoc Thai 2008; 91:261-267. [PMID: 18389994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Pongchaiyakul C, Charoenkiatkul S, Kosulwat V, Rojroongwasinkul N, Rajatanavin R. Dietary calcium intake among rural Thais in Northeastern Thailand. J Med Assoc Thai 2008; 91:153-158. [PMID: 18389978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES The present study examined the amount and relative contribution of calcium from the habitual diet among rural Thais. MATERIAL AND METHOD Calcium intake was assessed using 3-day food records and interviewer-administered quantitative food-frequency questionnaire, containing 73 food items. RESULTS The authors recruited 436 healthy participants (181 men and 255 women), between 20 and 85 years of age. Averaged daily calcium intake among men and women were 378.6 and 265.6 mg, respectively. Sixty-seven percent of men and eighty seven percent of women had less dietary calcium intake than half of the recommended level (< 400 mg/day) whereas only 6 and 3% had an intake more than 800 mg/day. The major food sources of dietary calcium was glutinous rice (32 percent) followed by small animals with edible bones (31 percent) and fresh and fermented fish (20 percent). Dairy products and vegetables constituted only 8 and 5% of dietary calcium, respectively. CONCLUSION The habitual diet among rural Northeast Thais does not meet the recommended calcium intake level. To promote more consumption of dairy products and locally-available calcium-rich foods would be beneficial to prevent osteoporosis among this population.
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Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
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Pongchaiyakul C, Auraiwan K, Kotruchin P, Kularbkaew C. Bisphosphonate-related osteonecrosis of the jaws (ONJ): a report of two cases. J Med Assoc Thai 2007; 90:2494-2498. [PMID: 18181340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Osteonecrosis of thejaw (ONJ) is strongly associated with the use of aminobisphosphonates. Herein, the authors report two cases of ONJ after intravenous bisphosphonate therapy including clinical presentations, X-ray, and pathological findings. Since there is no definite treatment for ONJ, the focus should be on prevention with a dental evaluation for all patients before starting bisphosphonates.
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Affiliation(s)
- Chatlert Pongchaiyakul
- Department of Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Pongchaiyakul C, Panichkul S, Songpatanasilp T. Combined clinical risk indices with quantitative ultrasound calcaneus measurement for identifying osteoporosis in Thai postmenopausal women. J Med Assoc Thai 2007; 90:2016-2023. [PMID: 18041418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To examine the diagnostic performance of clinical risk indices combined with quantitative ultrasound calcaneus measurement (QUS) for identifying osteoporosis in Thai postmenopausal women. MATERIAL AND METHOD The present study was designed as a cross-sectional investigation in 300 Thai women, aged between 38 and 85 years (mean age: 58). Femoral neck bone mineral density (BMD) was measured by DXA (Hologic QDR-4500; Hologic, Bedford, MA, USA). A BMD T-scores < or = -2.5 was defined as "osteoporosis"; otherwise, "non-osteoporosis". QUS was measured by Achilles+ (GE Lunar, Madison, WI, USA) and converted to T-score. The OSTA and KKOS score was calculated for each woman using her age and weight Women with OSTA/KKOS scores < or = -1 and > -1 were classified as "high risk" and "low risk", respectively. RESULTS Using DXA as the gold standard, the sensitivity of QUS to identify osteoporosis was lower than the sensitivity of OSTA/KKOS (60 vs. 71/74%) but the specificity and PPV of QUS were higher than OSTA/KKOS. The sensitivity increased when using OSTA/KKOS combined with QUS to identify osteoporosis (approximately 87-89%) while the specificity, PPV and NPV were comparable with using clinical risk indices alone. The risk (odds ratio; OR) of osteoporosis when QUS T-score < or = -2.5 alone was 9.94 (95%CI: 4.74-20.87), which was higher than high risk by OSTA/KKOS alone (OR: 6.35, 95%CI: 2.99-13.47 for OSTA and 8.15, 95%CI: 3.76-17.66 for KKOS). Furthermore, individuals were classified "high risk" from OSTA/KKOS with QUS T-score < or = -2.5SD, the risk of osteoporosis was increased (OR: 43.68, 95%CI: 13.89-137.36 and OR: 60.92, 95%CI: 17.69-209.76 for OSTA and KKOS, respectively). CONCLUSION Using the clinical risk indices combined with QUS could improve the accuracy of osteoporosis identification. This approach could be used in a primary care setting or community-based hospital where a DXA machine is not available.
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Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Pongchaiyakul C, Wanothayaroj E. Performance of the Khon Kaen Osteoporosis Study (KKOS) score for identifying osteoporosis in men. J Med Assoc Thai 2007; 90:1518-1523. [PMID: 17926979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The present study evaluated the diagnostic performance of Khon Kaen Osteoporosis Study (KKOS) score in identifying osteoporosis in men. MATERIAL AND METHOD This was a cross-sectional investigation in 230 men aged > or = 50 years. Bone mineral density (BMD) was measured at the femoral neck and lumbar spine by DXA (DPX-IQ densitometer LUNAR Corporation, Madison, Wisconsin, USA). The KKOS score was calculated for each man using his age and weight. Men with KKOS scores < or = -1 and > -1 were classified as "high risk" and "low risk", respectively. RESULTS The prevalence of osteoporosis in the entire sample was 17% and 7.4% (n = 39, 17) by femoral neck BMD and lumbar spine BMD, respectively. Using the KKOS score, 80 (34.8%) men were classified as "high risk" (KKOS score < or = -1). The proportion of high risk individuals increased with advancing age, ranging from 16.2% in the 50-65 age group to 64.8% in the > 65 age group. Using BMD from DXA as a gold standard, the overall sensitivity and specificity of KKOS in identifying osteoporosis was 72.5% and 73.2%, respectively. However; the sensitivity was higher at the lumbar spine (94.1% vs. 71.8%) than the femoral neck, while the specificity was comparable. The PPV of KKOS was 36%; and was lower at the lumbar spine (20%) compared to the femoral neck (35%). In the present study, men were classified "high risk" from KKOS, the risk (odds ratio; OR) of osteoporosis at the femoral neck and/or lumbar spine was 7.19 (95% CI: 3.34-15.44). However, the risk of osteoporosis was higher in the younger age (50-65 yr) group (OR: 10.29, 95% CI: 3.31-31.94) compared with the older age (> 65 yr) group (OR: 3.65, 95% CI: 1.12-11.91). CONCLUSION KKOS scoring system based on age and body weight, is a simple tool for clinicians to make a decision to further DXA testing for identifying osteoporosis in Thai men. This tool had a high sensitivity and specificity, but modest PPV.
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Affiliation(s)
- Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
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Pongchaiyakul C, Panichkul S, Songpatanasilp T, Nguyen TV. A nomogram for predicting osteoporosis risk based on age, weight and quantitative ultrasound measurement. Osteoporos Int 2007; 18:525-31. [PMID: 17216132 DOI: 10.1007/s00198-006-0279-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 10/23/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Quantitative ultrasound measurement (QUS) or clinical risk index alone are not reliable tools for the identification of women with osteoporosis. This study examined the prognostic value of combined QUS and clinical risk index for predicting osteoporosis risk in Thai women. METHODS The study was designed as a cross-sectional investigation with 300 women of Thai background, aged between 38 and 85 years (mean age: 58). Femoral neck bone mineral density (BMD) was measured by DXA (Hologic QDR-4500; Bedford, MA, USA). A femoral neck BMD T-scores <or= -2.5 was defined as "osteoporosis"; otherwise, "non-osteoporosis". QUS was measured by Achilles+ (GE Lunar, Madison, WI, USA) and converted to T-score. Three models for predicting osteoporosis were considered: model I included age, weight and QUS, model II included age and weight, and model III included only QUS. The prognostic performance among the models was assessed by the area under the receiver operating characteristic curve (AUC). RESULTS The prevalence of osteoporosis was 12.7% (n=38/300) by femoral neck BMD. Age, weight and QUS were each significantly associated with osteoporosis risk. The AUC+/-SE value for model I was 0.86 +/- 0.03, which was significantly higher (p=0.02) than that for model II (AUC = 0.80 +/- 0.04) or model III (AUC = 0.79 +/- 0.04). Based on the estimated parameters of model I, a nomogram was constructed for predicting osteoporosis. CONCLUSION These data suggest that the combination of QUS and age and weight could significantly improve the prognosis of osteoporosis in Asian women, and that the nomogram can assist primary care physicians in the identification of high-risk women.
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Affiliation(s)
- C Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
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