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de Filette JMK, Charles A, Bellanger A, Iconaru L, Baleanu F, Surquin M, Body JJ, Bergmann P. Risk factors predicting the 'time to first fracture' and its association with imminent fractures: a substudy of the FRISBEE cohort. Arch Osteoporos 2023; 18:88. [PMID: 37369953 DOI: 10.1007/s11657-023-01296-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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
Only previous glucocorticoid use and rheumatoid arthritis were predictors of an early fracture (< 2 years after inclusion). A shorter 'time to first fracture' was not an independent clinical risk factor for imminent fractures. PURPOSE Risk factors for fragility fractures independent of BMD were assessed in several prediction models. However, predictors of a shorter 'time to first fracture' and its impact on imminent fractures are unknown. METHODS We studied the concept of 'time to first fracture' in the FRISBEE ("Fracture RIsk Brussels Epidemiological Enquiry") cohort (3560 postmenopausal women). Validated fractures were divided into 3 groups: first fracture < 2 years, 2-5 years, and > 5 years after inclusion. Factors associated with first fracture risk were evaluated with uni- and multivariate analyses using Cox modeling. We examined 'time to first fracture' as a risk factor for imminent fractures in untreated subjects and in those receiving pharmacological treatment. RESULTS Classical risk factors (age, prior fracture, fall history and low BMD) were associated with first fracture in all groups. Previous glucocorticoids and rheumatoid arthritis (RA) were predictors for fracture < 2 years. Imminent fractures were similar in subjects with or without osteoporosis treatment, despite a higher estimated 10-year risk of fragility fracture in those treated, suggesting that treatment is efficient. 'Time to first fracture' was not an independent risk factor for imminent fractures. CONCLUSION Among the risk factors considered, previous glucocorticoid use and RA were predictors for early fracture, consistent with the concept of very high risk. The 'time to first validated fracture' was not an independent risk factor for imminent fractures. Patients with a first osteoporotic fracture should thus be considered at very high risk for re-fracture, independent of the 'time to first fracture'.
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Affiliation(s)
- Jeroen M K de Filette
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Laken, Brussels, Belgium.
| | - Alexia Charles
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Amélie Bellanger
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Laken, Brussels, Belgium
| | - Felicia Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Laken, Brussels, Belgium
| | - Murielle Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Jacques Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Laken, Brussels, Belgium
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Bergmann
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Iconaru L, Charles A, Baleanu F, Moreau M, Surquin M, Benoit F, de Filette J, Karmali R, Body JJ, Bergmann P. Selection for treatment of patients at high risk of fracture by the short versus long term prediction models - data from the Belgian FRISBEE cohort. Osteoporos Int 2023; 34:1119-1125. [PMID: 37022466 DOI: 10.1007/s00198-023-06737-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/27/2023] [Indexed: 04/07/2023]
Abstract
Our imminent model was less sensitive but more selective than FRAX® in the choice of treatment to prevent imminent fractures. This new model decreased NNT by 30%, which could reduce the treatment costs. In the Belgian FRISBEE cohort, the effect of recency further decreased the selectivity of FRAX®. PURPOSE We analyzed the selection for treatment of patients at high risk of fracture by the Belgian FRISBEE imminent model and the FRAX® tool. METHODS We identified in the FRISBEE cohort subjects who sustained an incident MOF (mean age 76.5 ± 6.8 years). We calculated their estimated 10-year risk of fracture using FRAX® before and after adjustment for recency and the 2-year probability of fracture using the FRISBEE model. RESULTS After 6.8 years of follow-up, we validated 480 incident and 54 imminent MOFs. Of the subjects who had an imminent fracture, 94.0% had a fracture risk estimated above 20% by the FRAX® before correction for recency and 98.1% after adjustment, with a specificity of 20.2% and 5.9%, respectively. The sensitivity and specificity of the FRISBEE model at 2 years were 72.2% and 55.4%, respectively, for a threshold of 10%. For these thresholds, 47.3% of the patients were identified at high risk in both models before the correction, and 17.2% of them had an imminent MOF. The adjustment for recency did not change this selection. Before the correction, 34.2% of patients were selected for treatment by FRAX® only, and 18.8% would have had an imminent MOF. This percentage increased to 47% after the adjustment for recency, but only 6% of those would suffer a MOF within 2 years. CONCLUSION In our Belgian FRISBEE cohort, the imminent model was less sensitive but more selective in the selection of subjects in whom an imminent fracture should be prevented, resulting in a lower NNT. The correction for recency in this elderly population further decreased the selectivity of FRAX®. These data should be validated in additional cohorts before using them in everyday practice.
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Affiliation(s)
- L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, 1020 Laeken, Brussels, Belgium.
| | - A Charles
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, 1020 Laeken, Brussels, Belgium
| | - M Moreau
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Benoit
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J de Filette
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, 1020 Laeken, Brussels, Belgium
| | - R Karmali
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, 1020 Laeken, Brussels, Belgium
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, 1020 Laeken, Brussels, Belgium
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Charles A, Iconaru L, Baleanu F, Benoit F, Surquin M, Mugisha A, Bergmann P, Body JJ. Are there specific clinical risk factors for the occurrence of multiple fractures? The FRISBEE study. Osteoporos Int 2023; 34:501-506. [PMID: 36598524 DOI: 10.1007/s00198-022-06663-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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023]
Abstract
UNLABELLED This study showed additional clinical risk factors for the occurrence of multiple fractures with regards to a single fracture, with often higher hazard ratios. It would be important to include the risk of the occurrence of multiple fractures in future prediction models. PURPOSE To identify clinical risk factors (CRFs) which would specifically increase the risk of multiple fractures. METHODS Data of the 3560 postmenopausal women of the FRISBEE study were analysed. The CRFs and the fractures are collected annually. The cohort was divided into three groups: those who had no incident fracture, those who had a single incident fracture and those who had 2 two or more incident fractures (i.e. multiple fractures). Statistical analyses were performed using Cox proportional hazards models. RESULTS Among the 3560 subjects (followed for 9.1 (7.2-10.6) years), 261 subjects had two or more validated fractures during follow-up (146 were major osteoporotic fractures (MOFs)), 628 had one fracture (435 MOFs), 2671 had no fracture (2979 had no MOF); 157 subjects had two or more central fractures, 389 had only one and 3014 had none. The risk factors for those with multiple fractures at any site were age, history of fracture, history of fall, total hip bone mineral density (BMD), spine BMD and rheumatoid arthritis. For those with multiple MOFs, significant CRFs were age, history of fracture, parental hip fracture, total hip BMD and rheumatoid arthritis. CONCLUSION We found in a prospective cohort study that there were more CRFs and higher hazard ratios for the occurrence of multiple fractures than for a single fracture.
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Affiliation(s)
- A Charles
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
| | - L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Benoit
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - A Mugisha
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Iconaru L, Charles A, Baleanu F, Moreau M, Surquin M, Benoit F, Body J, Bergmann P. The effect of fracture recency on observed 5-year fracture probability: A study based on the FRISBEE cohort. Bone Rep 2023; 18:101660. [PMID: 36824480 PMCID: PMC9941353 DOI: 10.1016/j.bonr.2023.101660] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/18/2023] [Accepted: 02/04/2023] [Indexed: 02/09/2023] Open
Abstract
Introduction Prediction models, especially the FRAX®, are largely used to estimate the fracture risk at ten years, but the current algorithm does not take into account the time elapsed after a fracture. Kanis et al. recently proposed correction factors allowing to adjust the FRAX® score for fracture recency. The objective of this work was to analyze the effect of fracture recency in the FRISBEE cohort. Methods We identified in the FRISBEE cohort subjects who sustained a validated fracture during the first 5 years following an incident MOF. We calculated their estimated 5-year risk of fracture using FRAX® uncorrected, adjusted for recency and further adjusted for the MOF/hip ratios calibration factors previously derived for the Belgian FRAX®. We compared the fracture risk estimated by FRAX® before and after these corrections to the observed incidence of validated fractures in our cohort. Results In our ongoing cohort, 376 subjects had a first non-traumatic incident validated MOF after inclusion; 81 had a secondary fracture during the 5 years follow-up period after this index fracture. The FRAX® score significantly under-evaluated the observed incidence of fractures in our cohort by 54.7 % (fracture rate of 9.7 %; 95 % CI, 6.8-12.9 %) if uncorrected (p < 0.001) and by 32.6 % after correction for recency (14.5 %; 95 % CI, 11.1-18.2 %) (p = 0.01). The calibration for MOF/hip ratios improved the prediction (17.5 %; 95 % CI: 13.7-21.4 %) (p = 0.2). After correcting for recency and for calibration, the predicted value was over-evaluated by 22 % (fracture rate of 26.1 %; 95 % CI, 21.6-30.5 %) but this over-evaluation was not significant (p = 0.1). Conclusion Our data indicate that the correction of the FRAX® score for fracture recency improves fracture prediction. However, correction for calibration and recency tends to overestimate fracture risk in this population of elderly women.
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Affiliation(s)
- L. Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium,Corresponding author at: Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, 1020 Laeken, Brussels, Belgium.
| | - A. Charles
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F. Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M. Moreau
- Data Centre, Institut J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - M. Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F. Benoit
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J.J. Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium,Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium,Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P. Bergmann
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium,Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Agarwal A, Baleanu F, Moreau M, Charles A, Iconaru L, Surquin M, Benoit F, Paesmans M, Karmali R, Bergmann P, Body JJ, Leslie WD. External validation of FRISBEE 5-year fracture prediction models: a registry-based cohort study. Arch Osteoporos 2022; 18:13. [PMID: 36564674 DOI: 10.1007/s11657-022-01205-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/29/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
Five-year fracture risk prediction from the Fracture Risk Brussels Epidemiological Enquiry (FRISBEE) models was externally tested in 9716 Canadian women and demonstrated good discrimination but consistently overestimated risk. INTRODUCTION Five-year risk prediction models for all fractures, major osteoporotic fractures (MOFs) and central fractures (proximal to forearm and ankle) from the FRISBEE cohort demonstrated good performance in the original derivation cohort. Our aim was to externally validate the FRISBEE-based 5-year prediction models in routine practice. METHODS Using the population-based Manitoba Bone Mineral Density (BMD) registry, we identified women aged 60-85 years undergoing baseline BMD assessment from September 1, 2012 to March 31, 2018. Five-year probabilities of all fractures, MOFs and central fractures were calculated using the FRISBEE prediction models. We identified incident non-traumatic fractures up to 5 years from population-based healthcare data sources. Performance characteristics included area under the receiver operating characteristic curve (AUROC), gradient of risk (hazard ratio [HR] per SD increase and across risk tertiles) from Cox regression analysis, and calibration (ratio 5-year observed cumulative incidence to predicted fracture probability). RESULTS We included 9716 women (mean age 70.7 + / - SD 5.3 years). During a mean observation time of 2.5 years, all fractures, MOFs and central fractures were identified in 377 (3.9%), 264 (2.7%) and 259 (2.7%) of the women. AUROC showed significant fracture risk stratification with the FRISBEE models (all fractures 0.69 [95%CI 0.67-0.72], MOFs 0.71 [95%CI 0.68-0.74], central fractures 0.72 [95%CI 0.69-0.75]). There was a strong gradient of risk for predicting fracture outcomes per SD increase (HRs from 1.98 to 2.26) and across risk tertiles (HRs for middle vs lowest from 2.25 to 2.41, HRs for highest vs lowest from 4.70 to 6.50). However, risk was overestimated for all fractures (calibration-in-the-large 0.63, calibration slope 0.63), MOF (calibration-in-the-large 0.51, calibration slope 0.57) and central fractures (calibration-in-the-large 0.55, calibration slope 0.60). CONCLUSIONS FRISBEE 5-year prediction models were externally validated to stratify fracture risk similar to the derivation cohort, but would need recalibration for Canada as risk was overestimated.
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Affiliation(s)
- Arnav Agarwal
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Felicia Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Michel Moreau
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexia Charles
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Murielle Surquin
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Florence Benoit
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Marianne Paesmans
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Rafik Karmali
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Bergmann
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Jacques Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - William D Leslie
- Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada.
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Marecek R, De Keyzer E, Taujan G, Baleanu F, Rosu M, Papadopoulou I, Kosmopoulou O, Laura I. Rare cause of a resistant hypertension in a middle-aged man: A case report. Clin Case Rep 2022; 10:e6606. [PMID: 36514461 PMCID: PMC9731286 DOI: 10.1002/ccr3.6606] [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: 09/24/2022] [Accepted: 10/30/2022] [Indexed: 12/13/2022] Open
Abstract
Congenital adrenal hyperplasia associated to 11-beta-hydroxylase deficiency is a rare cause of secondary hypertension, usually discovered during childhood; however, a late diagnosis in adults has also been reported. Despite low cortisol levels, accumulated adrenal steroid precursors can activate the glucocorticoid receptor and thus protect the patient against adrenal crisis.
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Affiliation(s)
- Renata Marecek
- Department of Internal Medicine, Centre Hospitalier Universitaire BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Eva De Keyzer
- Department of Cardiology, Centre Hospitalier Universitaire BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Georgiana Taujan
- Department of Endocrinology, Centre Hospitalier Universitaire BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Felicia Baleanu
- Department of Endocrinology, Centre Hospitalier Universitaire BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Mihaela Rosu
- Department of Endocrinology, Centre Hospitalier Universitaire BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Ioanna Papadopoulou
- Department of Endocrinology, Centre Hospitalier Universitaire BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Olga Kosmopoulou
- Department of Endocrinology, Centre Hospitalier Universitaire BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Iconaru Laura
- Department of Endocrinology, Centre Hospitalier Universitaire BrugmannUniversité Libre de BruxellesBrusselsBelgium
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Baleanu F, Taujan G, Rosu M, Kosmopoulou O, Papadopoulou BI, Boros E, Iconaru L. Congenital hyperinsulinism-A case of mild hypoglycemia in an adult, detected by family testing. Clin Case Rep 2022; 10:e6636. [PMID: 36514475 PMCID: PMC9731303 DOI: 10.1002/ccr3.6636] [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: 03/12/2022] [Revised: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 12/13/2022] Open
Abstract
Symptoms of mild hypoglycemia are easily overlooked especially when there are no complaints from the patients, but it could be a warning sign of an underlying genetic disease. Genetic testing for the entire family is a key step in neonatal hypoglycemia workup.
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Affiliation(s)
- Felicia Baleanu
- Department of Endocrinology, CHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Georgiana Taujan
- Department of Endocrinology, CHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Mihaela Rosu
- Department of Endocrinology, CHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Olga Kosmopoulou
- Department of Endocrinology, CHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | | | - Emese Boros
- Paediatric Endocrinology UnitHôpital Universitaire des Enfants Reine Fabiola, Université Libre de BruxellesBrusselsBelgium
| | - Laura Iconaru
- Department of Endocrinology, CHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
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Taujan GC, Iconaru L, Rosu M, Kosmopoulou O, Papadopoulou IB, Baleanu F. Severe osteoporosis as atypical presentation of hereditary hemochromatosis. Clin Case Rep 2022; 10:e6396. [PMID: 36245464 PMCID: PMC9547343 DOI: 10.1002/ccr3.6396] [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: 08/01/2021] [Revised: 06/02/2022] [Accepted: 09/20/2022] [Indexed: 11/11/2022] Open
Abstract
Besides important metabolic repercussions, iron overload is reported to be associated with deleterious effects on articulations and bones. We present the case of a male patient diagnosed with severe osteoporosis and vertebral fracture, in whom the evaluation for secondary osteoporosis revealed hereditary hemochromatosis.
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Affiliation(s)
| | - Laura Iconaru
- Department of EndocrinologyCentre Hospitalier Universitaire BrugmannBrusselsBelgium
| | - Mihaela Rosu
- Department of EndocrinologyCentre Hospitalier Universitaire BrugmannBrusselsBelgium
| | - Olga Ana Kosmopoulou
- Department of EndocrinologyCentre Hospitalier Universitaire BrugmannBrusselsBelgium
| | | | - Felicia Baleanu
- Department of EndocrinologyCentre Hospitalier Universitaire BrugmannBrusselsBelgium
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Charles A, Mugisha A, Iconaru L, Baleanu F, Benoit F, Surquin M, Bergmann P, Body JJ. Distribution of Fracture Sites in Postmenopausal Overweight and Obese Women: The FRISBEE Study. Calcif Tissue Int 2022; 111:29-34. [PMID: 35316360 DOI: 10.1007/s00223-022-00968-y] [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: 01/03/2022] [Accepted: 03/05/2022] [Indexed: 12/01/2022]
Abstract
The association between obesity and fracture sites in postmenopausal women has been little studied. We examined the most common types of fractures in obese and overweight postmenopausal women compared to subjects with a normal BMI in the FRISBEE study, a cohort of postmenopausal women followed since 9.1 (7.2-10.6) years. Chi-squared tests and logistic regressions were used to compare the percentages of fracture sites in overweight/obese subjects to subjects with a normal BMI. Their mean (± SD) age was 76.7 ± 6.9 years and their mean BMI was 26.4 ± 4.4. Seven hundred seventy-seven subjects suffered at least one validated fragility fracture with a total of 964 fractures in the whole cohort. Subjects with a BMI higher than 25 had significantly more ankle fractures and less pelvic fractures than subjects with a normal BMI (OR 1.63, 95% CI 1.02-2.56, P = 0.04 and OR 0.55, 95% CI 0.34-0.89, P = 0.01, respectively). There were no significant differences between overweight and obese subjects. Among those older than 75, there were significantly fewer pelvic fractures in overweight/obese subjects (OR 0.49, 95% CI 0.27-0.87, P = 0.01), but before 75, ankle fractures were significantly more frequent in overweight/obese subjects than in subjects with a normal BMI (OR 1.89, 95% CI 1.01-3.57, P = 0.04). In conclusion, the proportion of ankle and pelvic fractures in obese and overweight subjects differs from that in subjects with a normal BMI, but these differences are age dependent. Fracture prevention strategies should take into account the differential effects of excess weight according to age and the site of fracture.
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Affiliation(s)
- A Charles
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
| | - A Mugisha
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Benoit
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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10
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Baleanu F, Moreau M, Charles A, Iconaru L, Karmali R, Surquin M, Benoit F, Mugisha A, Paesmans M, Rubinstein M, Rozenberg S, Bergmann P, Body JJ. Fragility Fractures in Postmenopausal Women: Development of 5-Year Prediction Models Using the FRISBEE Study. J Clin Endocrinol Metab 2022; 107:e2438-e2448. [PMID: 35176768 PMCID: PMC9113827 DOI: 10.1210/clinem/dgac092] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Individualized fracture risk may help to select patients requiring a pharmacological treatment for osteoporosis. FRAX and the Garvan fracture risk calculators are the most used tools, although their external validation has shown significant differences in their risk prediction ability. OBJECTIVE AND METHODS Using data from the Fracture Risk Brussels Epidemiological Enquiry study, a cohort of 3560 postmenopausal women aged 60 to 85 years, we aimed to construct original 5-year fracture risk prediction models using validated clinical risk factors (CRFs). Three models of competing risk analysis were developed to predict major osteoporotic fractures (MOFs), all fractures, and central fractures (femoral neck, shoulder, clinical spine, pelvis, ribs, scapula, clavicle, sternum). RESULTS Age, a history of fracture, and hip or spine BMD were predictors common to the 3 models. Excessive alcohol intake and the presence of comorbidities were specific additional CRFs for MOFs, a history of fall for all fractures, and rheumatoid arthritis for central fractures. Our models predicted the fracture probability at 5 years with an acceptable accuracy (Brier scores ≤ 0.1) and had a good discrimination power (area under the receiver operating curve of 0.73 for MOFs and 0.72 for central fractures) when internally validated by bootstrap. Three simple nomograms, integrating significant CRFs and the mortality risk, were constructed for different fracture sites. In conclusion, we derived 3 models predicting fractures with an acceptable accuracy, particularly for MOFs and central fractures. The models are based on a limited number of CRFs, and we constructed nomograms for use in clinical practice.
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Affiliation(s)
- Felicia Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Correspondence: Felicia Baleanu, MD, CHU Brugmann, Place A. Van Gehuchten 4, 1020 Brussels, Belgium.
| | - Michel Moreau
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexia Charles
- Translational Research Unit, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Rafik Karmali
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Murielle Surquin
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Florence Benoit
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Aude Mugisha
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Marianne Paesmans
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Michel Rubinstein
- Department of Nuclear Medicine, Ixelles Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge Rozenberg
- Department of Gynecology, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Bergmann
- Translational Research Unit, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Jacques Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Translational Research Unit, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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11
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Iconaru L, Charles A, Baleanu F, Surquin M, Benoit F, Mugisha A, Moreau M, Paesmans M, Karmali R, Rubinstein M, Rozenberg S, Body JJ, Bergmann P. Prediction of an imminent fracture after an index fracture – models derived from the Frisbee cohort. Bone Rep 2022. [DOI: 10.1016/j.bonr.2022.101344] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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12
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Badr DA, Kassem C, Carlin A, Dobrescu O, Iconaru L, Baleanu F, Taujan GC, Jani JC. Antenatal insulin therapy in gestational diabetes mellitus: validation of the new Brugmann scores. Gynecol Endocrinol 2022; 38:411-415. [PMID: 35277105 DOI: 10.1080/09513590.2022.2048296] [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] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Following the adoption of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for gestational diabetes mellitus (GDM) diagnosis by the World Health Organization (WHO) in 2014, many investigators have tried to identify independent risk factors for antenatal insulin therapy (AIT). The purpose of the current study is to build and validate a score that stratifies patients according to their need for AIT. METHODS All pregnant women diagnosed with GDM according to the IADPSG definition were included. Group 1 comprised patients of 2018, and group 2 comprised patients of 2019. Each group was divided into two subgroups: subgroup A comprised patients diagnosed according to the 75-g oral glucose tolerance test (OGTT), and subgroup B comprised patients diagnosed according to fasting plasma glucose (FPG). RESULTS A total of 1298 patients were included; 19.3% of those diagnosed by OGTT and 40.9% by FPG required AIT. The risk for AIT was stratified as low, moderate, and high. Brugmann FPG score comprised six risk factors and Brugmann OGTT score 12. Higher scores were associated with higher risk for AIT. The use of these scores in the two subgroups of group 2 showed no statistical differences compared to group 1. CONCLUSIONS Both Brugmann FPG and OGTT scores may be useful to stratify patients with GDM according to their need for AIT. Future studies should be conducted to prospectively validate these scores, and to examine whether or not using oral anti-hyperglycemic agents in a high-risk group may decrease the need for AIT.
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Affiliation(s)
- Dominque A Badr
- Department of Obstetrics and Gynaecology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Chirine Kassem
- Department of Obstetrics and Gynaecology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew Carlin
- Department of Obstetrics and Gynaecology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Oana Dobrescu
- Department of Obstetrics and Gynaecology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Iconaru
- Department of Endocrinology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Felicia Baleanu
- Department of Endocrinology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Georgiana Cristina Taujan
- Department of Endocrinology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynaecology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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13
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Iconaru L, Charles A, Baleanu F, Surquin M, Benoit F, Mugisha A, Moreau M, Paesmans M, Karmali R, Rubinstein M, Rozenberg S, Body JJ, Bergmann P. Prediction of an Imminent Fracture After an Index Fracture - Models Derived From the Frisbee Cohort. J Bone Miner Res 2022; 37:59-67. [PMID: 34490908 DOI: 10.1002/jbmr.4432] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 03/29/2021] [Revised: 08/12/2021] [Accepted: 08/29/2021] [Indexed: 11/06/2022]
Abstract
Patients who sustain a fracture are at greatest risk of recurrent fracture during the next 2 years. We propose three models to identify subjects most at risk of an imminent fracture, according to fracture site (any fracture, major osteoporotic fracture [MOF] or central). They were constructed using data of the prospective Frisbee cohort, which includes 3560 postmenopausal women aged 60 to 85 years who were followed for at least 5 years. A total of 881 subjects had a first incident validated fragility fracture before December 2018. Among these, we validated 130 imminent fractures occurring within the next 2 years; 79 were MOFs, and 88 were central fractures. Clinical risk factors were re-evaluated at the time of the index fracture. Fine and Gray proportional hazard models were derived separately for each group of fractures. The following risk factors were significantly associated with the risk of any imminent fracture: total hip bone mineral density (BMD) (p < 0.001), a fall history (p < 0.001), and comorbidities (p = 0.03). Age (p = 0.05 and p = 0.03, respectively) and a central fracture as the index fracture (p = 0.04 and p = 0.005, respectively) were additional predictors of MOFs and central fractures. The three prediction models are presented as nomograms. The calibration curves and the Brier scores based on bootstrap resampling showed calibration scores of 0.089 for MOF, 0.094 for central fractures, and 0.132 for any fractures. The predictive accuracy of the models expressed as area under the receiver operating characteristic (AUROC) curve (AUC) were 0.74 for central fractures, 0.72 for MOFs, and 0.66 for all fractures, respectively. These AUCs compare well with those of FRAX and Garvan to predict the 5- or 10-year fracture probability. In summary, five predictors (BMD, age, comorbidities, falls, and central fracture as the incident fracture) allow the calculation with a reasonable accuracy of the imminent risk of fracture at different sites (MOF, central fracture, and any fracture) after a recent sentinel fracture. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Laura Iconaru
- Department of Endocrinology, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexia Charles
- Laboratoire de Recherche Translationnelle, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Felicia Baleanu
- Department of Endocrinology, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Murielle Surquin
- Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Florence Benoit
- Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Aude Mugisha
- Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Michel Moreau
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Mairanne Paesmans
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Rafix Karmali
- Department of Endocrinology, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Michel Rubinstein
- Department of Nuclear Medicine, Ixelles Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Serge Rozenberg
- Department of Gynecology, Centre Hospitalier Universitaire (CHU) St Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jean-Jacques Body
- Department of Endocrinology, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,Laboratoire de Recherche Translationnelle, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Bergmann
- Laboratoire de Recherche Translationnelle, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,Department of Nuclear Medicine, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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14
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Mugisha A, Bergmann P, Kinnard V, Iconaru L, Baleanu F, Charles A, Surquin M, Rozenberg S, Benoit F, Body JJ. MOF/Hip Fracture Ratio in a Belgian Cohort of Post-menopausal Women (FRISBEE): Potential Impact on the FRAX® Score. Calcif Tissue Int 2021; 109:600-604. [PMID: 34159447 DOI: 10.1007/s00223-021-00875-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/29/2021] [Accepted: 06/08/2021] [Indexed: 02/06/2023]
Abstract
The ratio between major osteoporotic fractures (MOFs) and hip fractures in the Belgian FRAX® tool to predict fractures is currently based on Swedish data. We determined these ratios in a prospective cohort of Belgian postmenopausal women. 3560 women, aged 60-85 years (70.1 ± 6.4 years), were included in a prospective study from 2007 to 2013 and surveyed yearly (FRISBEE). We analyzed the number of validated incident fractures until October 2020 by age and sites and compared the MOFs/hip ratios in this cohort with those from the Swedish databases. We registered 1336 fractures (mean follow-up of 9.1 years). The MOFs/hip ratios extracted from the FRISBEE cohort were 10.7 [95% CI: (5.6-20.5)], 6.4 [4.7-8.7], and 5.0 [3.9-6.5] for women of 60-69, 70-79, and 80-89 years old, respectively. These ratios were 1.7-1.8 times higher for all age groups than those from the Swedish data, which decreased from 6.5 (60-64 years group) down to 1.8 (85-89 age group). The overall MOFs/hip ratio in Frisbee was 6.0 [5.9-6.1], which was higher than any Swedish ratio between 65 and 85 years. Nevertheless, the decrease of the ratios with age paralleled that observed in Sweden. In this Brussels prospective cohort, MOFs/hip ratios were 1.7-1.8 times those observed in Sweden currently used for MOFs prediction in the Belgian FRAX® version. This discrepancy can greatly modify the estimation of the risk of MOFs, which is among the main criteria used to recommend a pharmacological treatment for osteoporosis in several countries.
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Affiliation(s)
- A Mugisha
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4 Laeken, 1020, Brussels, Belgium.
| | - P Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - V Kinnard
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - A Charles
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4 Laeken, 1020, Brussels, Belgium
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - S Rozenberg
- Department of Gynaecology-Obstetrics, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - F Benoit
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4 Laeken, 1020, Brussels, Belgium
| | - J J Body
- Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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15
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Charles A, Mugisha A, Iconaru L, Baleanu F, Benoit F, Surquin M, Bergmann P, Body JJ. Impact of non-hip fractures in elderly women: a narrative review. Climacteric 2021; 25:240-245. [PMID: 34806931 DOI: 10.1080/13697137.2021.1998433] [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] [Indexed: 10/19/2022]
Abstract
The association of hip fractures with adverse outcomes is well established, but for non-hip fractures this association still needs to be further investigated. The objective of this narrative review is to describe the state of the art with regards to the health impact of clinically relevant non-hip fracture locations in postmenopausal women. PubMed and Scopus databases were searched from January 2010 until December 2020. Studies were included when the crude rates and/or relative risk of 1-year subsequent fractures and/or mortality were reported as well as the precise fracture site. Twenty-three studies met the inclusion criteria. Regarding mortality rates, there was a high variability between studies, with higher rates for vertebral, proximal humerus and pelvic fractures. There was a small or no impact of wrist, ankle or tibia fractures. The mortality rate increased with age after vertebral, proximal humerus and wrist fractures. Moreover, proximal humerus and vertebral fractures were associated with a higher mortality risk. This narrative review indicates that, besides fractures of the hip, fractures of the vertebrae, proximal humerus or pelvis deserve more attention when trying to prevent adverse outcomes of osteoporosis. More studies on the topic of non-hip fractures are urgently needed.
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Affiliation(s)
- A Charles
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - A Mugisha
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Benoit
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Baleanu F, Iconaru L, Charles A, Kinnard V, Fils JF, Moreau M, Karmali R, Surquin M, Benoit F, Mugisha A, Paesmans M, Laurent MR, Bergmann P, Body JJ. Independent External Validation of FRAX and Garvan Fracture Risk Calculators: A Sub-Study of the FRISBEE Cohort. JBMR Plus 2021; 5:e10532. [PMID: 34532617 PMCID: PMC8441269 DOI: 10.1002/jbm4.10532] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 04/27/2021] [Revised: 06/04/2021] [Accepted: 06/30/2021] [Indexed: 01/24/2023] Open
Abstract
Probabilistic models including clinical risk factors with or without bone mineral density (BMD) have been developed to estimate the 5‐ or 10‐year absolute fracture risk. We investigated the performance of the FRAX and Garvan tools in a well‐characterized population‐based cohort of 3560 postmenopausal, volunteer women, aged 60 to 85 years at baseline, included in the Fracture Risk Brussels Epidemiological Enquiry (FRISBEE) cohort, during 5 years of follow‐up. Baseline data were used to calculate the estimated 10‐year risk of hip and major osteoporotic fractures (MOFs) for each participant using FRAX (Belgium). We computed the 5‐year risk according to the Garvan model with BMD. For calibration, the predicted risk of fracture was compared with fracture incidence across a large range of estimated fracture risks. The accuracy of the calculators to predict fractures was assessed using the area under the receiver operating characteristic curves (AUC). The FRAX tool was well calibrated for hip fractures (slope 1.09, p < 0.001; intercept −0.001, p = 0.46), but it consistently underestimated the incidence of major osteoporotic fractures (MOFs) (slope 2.12, p < 0.001; intercept −0.02, p = 0.06). The Garvan tool was well calibrated for “any Garvan” fractures (slope 1.05, p < 0.001; intercept 0.01, p = 0.37) but largely overestimated the observed hip fracture rate (slope 0.32, p < 0.001; intercept 0.006, p = 0.05). The predictive value for hip fractures was better for FRAX (AUC: 0.841, 95% confidence interval [CI] 0.795–0.887) than for Garvan (AUC: 0.769, 95% CI 0.702–0.836, p = 0.01). The Garvan AUC for “any Garvan” fractures was 0.721 (95% CI 0.693–0.749) and FRAX AUC for MOFs was 0.708 (95% CI 0.675–0.741). In conclusion, in our Belgian cohort, FRAX estimated quite well hip fractures but underestimated MOFs, while Garvan overestimated hip fracture risk but showed a good estimation of “any Garvan” fractures. Both models had a good discriminatory value for hip fractures but only a moderate discriminatory ability for MOFs or “any Garvan” fractures. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Felicia Baleanu
- Department of Endocrinology, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Laura Iconaru
- Department of Endocrinology, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Alexia Charles
- Department of Clinical Research, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Virginie Kinnard
- Department of Geriatrics, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | | | - Michel Moreau
- Data Centre, Institute Jules Bordet Université Libre de Bruxelles Brussels Belgium
| | - Rafik Karmali
- Department of Endocrinology, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Murielle Surquin
- Department of Geriatrics, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Florence Benoit
- Department of Geriatrics, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Aude Mugisha
- Department of Geriatrics, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Marianne Paesmans
- Data Centre, Institute Jules Bordet Université Libre de Bruxelles Brussels Belgium
| | - Michaël R Laurent
- Centre for Metabolic Bone Diseases University Hospitals Leuven Leuven Belgium.,Imelda Hospital Bonheiden Belgium
| | - Pierre Bergmann
- Department of Nuclear Medicine, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Jean-Jacques Body
- Department of Endocrinology, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
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Iconaru L, Moreau M, Baleanu F, Kinnard V, Charles A, Mugisha A, Surquin M, Benoit F, Karmali R, Paesmans M, Body JJ, Bergmann P. Risk factors for imminent fractures: a substudy of the FRISBEE cohort. Osteoporos Int 2021; 32:1093-1101. [PMID: 33411010 DOI: 10.1007/s00198-020-05772-8] [Citation(s) in RCA: 6] [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: 10/13/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
UNLABELLED Multiple factors increase the risk of an imminent fracture, including a recent fracture, older age, osteoporosis, comorbidities, and the fracture site. These findings could be a first step in the development of a model to predict an imminent fracture and select patients most at need of immediate treatment. INTRODUCTION The risk of a recurrent fragility fracture is maximal during the first 2 years following an incident fracture. In this prospective cohort study, we looked at the incidence of recurrent fractures within 2 years after a first incident fracture and we assessed independent clinical risk factors (CRFs) increasing this imminent fracture risk. METHODS A total of 3560 postmenopausal women recruited from 2007 to 2013 were surveyed yearly for the occurrence of fragility fractures. We identified patients who sustained a fracture during the first 2 years following a first incident fragility fracture. We quantified the risk of a new fracture and assessed independent CRFs, associated with an imminent fracture at various sites. RESULTS A recent fracture was a significant CRF for an imminent fracture (OR (95% CI): 3.7 (2.4-5.7) [p < 0.0001]). The incidence of an imminent fracture was higher in subjects above 80 years (p < 0.001). Other CRFs highly predictive in a multivariate analysis were osteoporosis diagnosis (p < 0.01), a central fracture as the index fracture (p < 0.01), and the presence of comorbidities (p < 0.05), with likelihood ratios of 1.9, 1.9, and 2.2, respectively. An imminent fracture was better predicted by a central fracture (p < 0.01) than by a major osteoporotic fracture. The hazard ratio was the highest for a central fracture. CONCLUSION In patients with a recent fracture, older age, osteoporosis, comorbidities, and fracture site were associated with an imminent fracture risk. These findings could be a first step in the development of a model to predict an imminent fracture and select patients most at need of immediate and most appropriate treatment.
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Affiliation(s)
- L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, Laeken, 1020, Brussels, Belgium.
| | - M Moreau
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, Laeken, 1020, Brussels, Belgium
| | - V Kinnard
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - A Charles
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - A Mugisha
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Benoit
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - R Karmali
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, Laeken, 1020, Brussels, Belgium
| | - M Paesmans
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, Laeken, 1020, Brussels, Belgium
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Mugisha A, Bergmann P, Kinnard V, Iconaru L, Baleanu F, Charles A, Surquin M, Karmali R, Benoit F, Body JJ. MOF/Hip fracture ratio in a Belgian cohort of post-menopausal women (FRISBEE): Potential impact on the FRAX® score. Bone Rep 2021. [DOI: 10.1016/j.bonr.2021.100809] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Iconaru L, Moreau M, Baleanu F, Kinnard V, Charles A, Mugisha A, Surquin M, Benoit F, Karmali R, Paesmans M, Body JJ, Bergmann P. Risk factors for imminent fractures: A substudy of the Frisbee cohort. Bone Rep 2021. [DOI: 10.1016/j.bonr.2021.100970] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mugisha A, Body JJ, Kinnard V, Iconaru L, Baleanu F, Charles A, Surquin M, Karmali R, Bergmann P, Benoit F. Fracture distribution in elderly women: A FRISBEE sub-study. Bone Rep 2021. [DOI: 10.1016/j.bonr.2021.100821] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Cappelle SI, Moreau M, Karmali R, Iconaru L, Baleanu F, Kinnard V, Paesmans M, Rozenberg S, Rubinstein M, Surquin M, Blard PH, Chapurlat R, Body JJ, Bergmann P. Discriminating value of HR-pQCT for fractures in women with similar FRAX scores: A substudy of the FRISBEE cohort. Bone 2021; 143:115613. [PMID: 32871273 DOI: 10.1016/j.bone.2020.115613] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/29/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Abstract
Areal bone mineral density (aBMD) has a low sensitivity to identify women at high fracture risk. The FRAX algorithm, by combining several clinical risk factors, might improve fracture prediction compared to aBMD alone. Several micro-architectural and biomechanical parameters which can be measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) are associated with fracture risk. HR-pQCT in combination or not with finite element analysis (FEA) may be used to improve bone strength prediction. Our aim was to assess whether HR-pQCT measurements (densities, cortical and trabecular microarchitecture, biomechanical proprieties assessed by FEA) had an added value in predicting fractures in a subgroup of women belonging to the Belgian FRISBEE cohort. One hundred nineteen women who sustained a fracture (aged 60 to 85 years) during the initial follow-up of our cohort had a radius and tibia examination by HR-pQCT and were compared with controls matched for their FRAX score at baseline. We found that low distal radius total (OR = 1.41 [1.07-1.86] per SD, p < 0.05) and trabecular densities (OR = 1.45 [1.10-1.90], p < 0.01), trabecular number (OR = 1.32 [1.01-1.72], p < 0.05), intra individual distribution of separation (OR = 0.73 [0.54-0.99], p < 0.05) as several FEA parameters were significantly associated with fractures. At the distal tibia, impaired cortical density (OR = 1.32 [1.03-1.70] per SD, p < 0.05) and thickness (OR = 1.29 [1.01-1.63], p < 0.05) and apparent modulus (OR = 1.30 [1.01-1.66], p < 0.05) were significantly correlated with fractures. A low ultra distal radial aBMD (UDR) measured at the time of HR-pQCT was significantly associated with fractures (OR = 1.67 [1.22-2.28], p < 0.01). Women from both groups were followed further after the realization of the HR-pQCT and 46 new fractures were registered. In this second part of the study, low UDR aBMD (OR = 1.66 [1.18-2.35], p < 0.01), total (OR = 1.48 [1.08-2.03], p < 0.05), cortical (OR = 1.40 [1.04-1.87], p < 0.05) and trabecular (OR = 1.37 [1.01-1.85], p < 0.05) densities or apparent modulus (OR = 1.49 [1.07-2.05], p < 0.05) at the radius were associated with a significant increase of fracture risk. At the tibia, only the cortical density was significantly associated with the fracture risk (OR = 1.34 [1.02-2.76], p < 0.05). These results confirm the interest of HR-pQCT measurements for the evaluation of fracture risk, also in women matched for their baseline FRAX score. They also highlight that UDR aBMD contains pertinent information.
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Affiliation(s)
- S I Cappelle
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - M Moreau
- Data Centre, Bordet Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - R Karmali
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - L Iconaru
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - F Baleanu
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - V Kinnard
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - M Paesmans
- Data Centre, Bordet Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - S Rozenberg
- Department of Obstetrics and gynaecology, Université Libre de Bruxelles (ULB) and Vrije Universiteit (VUB), Brussels, Belgium
| | - M Rubinstein
- Department of Nuclear Medicine, Ixelles Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - M Surquin
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - P-H Blard
- CNRS, Université de Lorraine, CRPG, F-54000 Nancy, France
| | - R Chapurlat
- INSERM Research Unit 1033-Lyos, Hôpital E. Herriot, Lyon, France
| | - J J Body
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU-Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Baleanu F, Moreau M, Kinnard V, Iconaru L, Karmali R, Rozenberg S, Rubinstein M, Paesmans M, Bergmann P, Body JJ. Assessment of self-reported fractures: data from the FRISBEE cohort. Bone Rep 2020. [DOI: 10.1016/j.bonr.2020.100550] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Iconaru L, Smeys C, Baleanu F, Kinnard V, Moreau M, Cappelle S, Surquin M, Rubinstein M, Rozemberg S, Paesmans M, Karmali R, Bergmann P, Body JJ. Osteoporosis treatment gap in the FRISBEE cohort. Bone Rep 2020. [DOI: 10.1016/j.bonr.2020.100561] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Iconaru L, Baleanu F, Taujan G, Duttmann R, Spinato L, Karmali R, Bergmann P, Hambye AS. Can we safely reduce the administration of 131-iodine in patients with differentiated thyroid cancer? - experience of the Brugmann hospital in Brussels. Thyroid Res 2020; 13:15. [PMID: 32944083 PMCID: PMC7488699 DOI: 10.1186/s13044-020-00089-4] [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: 07/01/2020] [Accepted: 08/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background 131-iodine (131I) administration after surgery remains a standard practice in differentiated thyroid cancer (DTC). In 2014, the American Thyroid Association presented new guidelines for the staging and management of DTC, including no systematic 131I in patients at low-risk of recurrence and a reduced 131I activity in intermediate risk.The present study aims at evaluating the rate of response to treatment following this new therapeutic management compared to our previous treatment strategy in patients with DTC of different risks of recurrence. Methods Patients treated and followed up for DTC according to the 2014-ATA guidelines (Group 2) were compared to those treated between 2007 and 2014 (Group 1) in terms of general characteristics, risk of recurrence (based on the 2015-ATA recommendations), preparation to 131I administration, cumulative administered 131I activity and response to treatment. Results In total, 136 patients were included: 78 in Group 1 and 58 in Group 2. The two groups were not statistically different in terms of clinical characteristics nor risk stratification: 42.3% in Group 1 and 31% in Group 2 were classified as low risk, 38.5 and 48.3% as intermediate risk and 19.2 and 20.7% as high risk (P = 0.38). Two patients (one in each group) with distant metastases were excluded from the analysis.Preparation to 131I administration consisted in rhTSH stimulation in 23.4% of the patients in Group 1 and 100% in Group 2 (p < 0.001).131I was administered to 46/77 patients (59.7%) in Group 1 (5 at low risk of recurrence) and 38/57 patients (66.7%) in Group 2 (0 with a low risk). Among the patients treated by 131I, median cumulative activity was significantly higher in Group 1 (3.70GBq [100 mCi] range 1.11-11.1 GBq [30-300 mCi]) than in Group 2 (1.11 GBq [30 mCi], range 1.11-7.4 GBq [30-200 mCi], P < 0.001). Complete response was found in 90.9% in Group 1 vs. 96.5% in Group 2 (P = 0.20). Conclusions Using the 2015-ATA evidence-based guidelines for the management of DTC, meaning no 131I administration in low-risk patients, a low activity in intermediate and even high risk patients, and a systematic use of rhTSH stimulation before 131I therapy allowed us to reduce significantly the median administered 131I activity, with a similar rate of complete therapeutic response.
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Affiliation(s)
- Laura Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten4, 1020 Laeken, Brussels, Belgium
| | - Felicia Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten4, 1020 Laeken, Brussels, Belgium
| | - Georgiana Taujan
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten4, 1020 Laeken, Brussels, Belgium
| | - Ruth Duttmann
- Department of Anatomopathology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Linda Spinato
- Department of Otorhinolaryngology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Rafik Karmali
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten4, 1020 Laeken, Brussels, Belgium
| | - Pierre Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne-Sophie Hambye
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Taujan GC, Baleanu F, Spinato L, Duttmann R, Karmali R, Iconaru L. Multiple Endocrine Neoplasia or Accidental Association? Eur J Case Rep Intern Med 2020; 7:001818. [PMID: 33194854 DOI: 10.12890/2020_001818] [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: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 11/05/2022] Open
Abstract
Pheochromocytoma, papillary thyroid carcinoma and hyperparathyroidism have rarely been reported together. Whether this association is coincidental or results from an unknown genetic predisposition is difficult to ascertain. We present the case of a patient who was diagnosed with pheochromocytoma, bilateral papillary thyroid carcinoma and parathyroid hyperplasia with primary hyperparathyroidism. A genetic mutation was hypothesized as the connection between these lesions. Previously described mutations were explored. LEARNING POINTS Parathyroid hyperplasia, primary hyperparathyroidism and papillary thyroid carcinoma individually are common conditions, but association with each other, although possibly incidental, should trigger genetic testing.Further research is needed to reliably explain the relationship between primary hyperparathyroidism and non-medullary thyroid cancer.
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Affiliation(s)
| | - Felicia Baleanu
- Endocrinology Department, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
| | - Linda Spinato
- Oto-Rhino-Laryngology Department, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
| | - Ruth Duttmann
- Anatomic Pathology Department, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
| | - Rafik Karmali
- Endocrinology Department, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
| | - Laura Iconaru
- Endocrinology Department, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
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Iconaru L, Smeys C, Baleanu F, Kinnard V, Moreau M, Cappelle S, Surquin M, Rubinstein M, Rozenberg S, Paesmans M, Karmali R, Bergmann P, Body JJ. Osteoporosis treatment gap in a prospective cohort of volunteer women. Osteoporos Int 2020; 31:1377-1382. [PMID: 32128600 DOI: 10.1007/s00198-020-05339-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/20/2019] [Accepted: 02/06/2020] [Indexed: 12/11/2022]
Abstract
UNLABELLED Despite the availability of efficient drugs to prevent osteoporotic fractures, only a minority of women receives osteoporosis therapy after a fracture. The high treatment gap in our cohort consisted of unselected volunteer patients highlights the urgent need of additional education, especially for the medical profession, regarding the risk-benefit balance of treatment. INTRODUCTION Despite the availability of efficient drugs to prevent osteoporotic fractures, only a minority of women receives osteoporosis therapy after a fracture, with a treatment gap around 80%. This can have dramatic consequences for patients and the healthcare systems. METHODS In this study based on longitudinal data from the FRISBEE (Fracture RIsk Brussels Epidemiological Enquiry) cohort of 3560 volunteer women aged 60 to 85 years, we evaluated the 1-year treatment gap after a first major incident fragility fracture. RESULTS There were 386 first validated fragility fractures, 285 major osteoporotic fractures (MOF) and 101 "other major" fractures. The rate of untreated patients was 85.0% (82.8% for MOF versus 91.0 % for "other major" fracture sites) (p = 0.04), with a lower rate for spine (70.5%) and hip (72.5%) versus shoulder (91.6%) and wrist (94.1%) (p < 0.0001). More specifically, the treatment gap for patients with osteoporosis, defined by a T-score < - 2.5 SD was 74.6% versus 76.5% for patients with osteoporosis defined by the presence of hip, shoulder, or spine fractures, independently of DXA results. When considering age groups, the rate of untreated women was 87.9% for women 60-70 years old, 88.2% between 70 and 80 years and 77.8% above 80 years (p = 0.03), with a greater difference between women who were younger or older than 80 years at inclusion: 88.1% versus 77.8% (p = 0.009). A diagnosis of osteoporosis (p = 0.01) and age (p = 0.03) were the only clinical risk factors (CRFs) significantly associated with treatment initiation. CONCLUSIONS This study highlights the urgent need of additional education, especially for the medical profession, regarding the risk-benefit balance of treatment.
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Affiliation(s)
- L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
| | - C Smeys
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - V Kinnard
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Moreau
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S Cappelle
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Rubinstein
- Department of Nuclear Medicine, Ixelles Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - S Rozenberg
- Department of Gynecology, CHU St Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - M Paesmans
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - R Karmali
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Baleanu F, Moreau M, Kinnard V, Iconaru L, Karmali R, Paesmans M, Bergmann P, Body JJ. What is the validity of self-reported fractures? Bone Rep 2020; 12:100256. [PMID: 32382588 PMCID: PMC7200867 DOI: 10.1016/j.bonr.2020.100256] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 08/14/2019] [Revised: 02/13/2020] [Accepted: 03/06/2020] [Indexed: 11/25/2022] Open
Abstract
We assessed the validity of self-reported fractures, over a median follow-up period of 6.2 years, in a well characterized population-based cohort of 3560 postmenopausal women, aged 60-85 years, from the Fracture Risk Brussels Epidemiological Enquiry (FRISBEE) study. Incident low-traumatic (falls from a standing height or less) or non-traumatic fractures, including peripheral fractures, were registered during each annual follow-up telephone interview. A self-reported fracture was considered as a true positive if it was validated by written reliable medical reports (radiographs, CT scans or surgical report). False positives fractures were considered to be those for which the radiology report indicated that there was no fracture at the reported site. Among self-reported fractures, false positive rates were 14.4% for all fractures. The rate of false positives of 11.2% (n = 48/429) was not negligible for the four classical major osteoporotic fractures (MOFs: hip, clinical spine, forearm or shoulder fractures). In terms of fracture site, we found the lowest false positive rate (4.4%) at the hip, and the highest (16.8%) at the spine, with the proximal humerus and the wrist in between, at about 10% each. The global rates of false positives were 12.5% (n = 22/176) for other major fractures and 22.3% (n = 49/220) for minor fractures. Younger subjects, individuals with fractures at sites other than the hip, with a lower education level, or with a higher BMI were more likely to report false positive fractures. Our data indicate that the inaccuracy of self-reported fractures is clinically relevant for several major fractures, which could influence any fracture risk prediction model.
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Affiliation(s)
- F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Moreau
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - V Kinnard
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - R Karmali
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Paesmans
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Kinnard V, Baleanu F, Iconaru L, Moreau M, Paesmans M, Body JJ, Bergmann P. Postfracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT. J Bone Miner Res 2020; 35:827-828. [PMID: 32027756 DOI: 10.1002/jbmr.3960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/07/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Virginie Kinnard
- Department of Endocrinology and Nuclear Medicine, and Laboratoire de Médecine Translationnelle, Centre Hospitalier Universitaire Brugmann (CHUB), Université Libre de Bruxelles, Brussels, Belgium
| | - Felicia Baleanu
- Department of Endocrinology and Nuclear Medicine, and Laboratoire de Médecine Translationnelle, Centre Hospitalier Universitaire Brugmann (CHUB), Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Iconaru
- Department of Endocrinology and Nuclear Medicine, and Laboratoire de Médecine Translationnelle, Centre Hospitalier Universitaire Brugmann (CHUB), Université Libre de Bruxelles, Brussels, Belgium
| | - Michel Moreau
- Department of Endocrinology and Nuclear Medicine, and Laboratoire de Médecine Translationnelle, Centre Hospitalier Universitaire Brugmann (CHUB), Université Libre de Bruxelles, Brussels, Belgium
| | - Marianne Paesmans
- Department of Endocrinology and Nuclear Medicine, and Laboratoire de Médecine Translationnelle, Centre Hospitalier Universitaire Brugmann (CHUB), Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Jacques Body
- Department of Endocrinology and Nuclear Medicine, and Laboratoire de Médecine Translationnelle, Centre Hospitalier Universitaire Brugmann (CHUB), Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Bergmann
- Department of Endocrinology and Nuclear Medicine, and Laboratoire de Médecine Translationnelle, Centre Hospitalier Universitaire Brugmann (CHUB), Université Libre de Bruxelles, Brussels, Belgium
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Iconaru L, Moreau M, Kinnard V, Baleanu F, Paesmans M, Karmali R, Body JJ, Bergmann P. Does the Prediction Accuracy of Osteoporotic Fractures by BMD and Clinical Risk Factors Vary With Fracture Site? JBMR Plus 2019; 3:e10238. [PMID: 31844826 PMCID: PMC6894722 DOI: 10.1002/jbm4.10238] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 07/03/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 01/08/2023] Open
Abstract
Several clinical risk factors (CRFs) have been shown to predict the risk of fragility fractures independently of BMD, but their accuracy in the prediction of a particular fracture site has not been extensively studied. In this study based on longitudinal data from the FRISBEE cohort (Fracture Risk Brussels Epidemiological Enquiry), we evaluated if CRFs are specific for sites of incident osteoporotic fractures during follow‐up. We recruited 3560 postmenopausal women, aged 60 to 85 years, from 2007 to 2013, and surveyed yearly for the occurrence of fragility fractures during 6.2 years (median). We analyzed the association between CRFs included in the FRAX (fracture risk assessment tool) model or additional CRFs (falls, sedentary lifestyle, early untreated menopause, diabetes, use of selective serotonin reuptake inhibitors or proton pump inhibitors) and the first incident validated major osteoporotic fracture (MOF; n = 362; vertebra, hip, shoulder, and wrist) or other major fractures (n = 74; ankle, pelvis/sacrum, elbow, knee, long bones). Uni‐ and multivariate analyses using the Cox proportional hazards model were used. For MOFs considered together, the risk of fracture was highly associated in uni‐ and multivariate analyses (p<0.01) with osteoporosis (T‐score < −2.5), prior fracture, age, BMD (assessed by DXA), and fall history (HR 2.34, 1.82,1.71, 1.38, and 1.32, respectively). For each site analyzed separately, prior OF, age, smoking, and total hip BMD remained independent predictors for hip fractures (HR 5.72, 3.98, 3.10, 2.32, and 1.92, respectively); osteoporosis, age, prior OF, glucocorticoids, and spine BMD for vertebral fracture (HR 2.08, 1.87, 1.78, 1.76, and 1.45, respectively); osteoporosis, prior OF, and femoral neck BMD (HR 1.83, 1.60, and 1.56, respectively) for wrist fracture; osteoporosis, prior OF, and spine BMD (HR 2.48, 1.78, and 1.31, respectively) for shoulder fracture; prior OF and diabetes (HR 2.62 and 2.03) for other major fractures. Thus, a prior fracture and BMD were the best predictors of fracture risk at any site. Other CRFs have a weaker predictive value, which is a function of the site of a future fracture. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- L Iconaru
- Department of Endocrinology CHU Brugmann, Université Libre de Bruxelles Brussels Belgium
| | - M Moreau
- Data Centre Institut Jules Bordet, Université Libre de Bruxelles Brussels Belgium
| | - V Kinnard
- Department of Internal Medicine, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - F Baleanu
- Department of Endocrinology CHU Brugmann, Université Libre de Bruxelles Brussels Belgium
| | - M Paesmans
- Data Centre Institut Jules Bordet, Université Libre de Bruxelles Brussels Belgium
| | - R Karmali
- Department of Endocrinology CHU Brugmann, Université Libre de Bruxelles Brussels Belgium
| | - J J Body
- Department of Endocrinology CHU Brugmann, Université Libre de Bruxelles Brussels Belgium
| | - P Bergmann
- Department of Nuclear Medicine CHU Brugmann, Université Libre de Bruxelles Brussels Belgium
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Baleanu F, Bergmann P, Hambye AS, Dekelver C, Iconaru L, Cappelle SI, Moreau M, Paesmans M, Karmali R, Body JJ. Assessment of bone quality with trabecular bone score in type 2 diabetes mellitus: A study from the FRISBEE cohort. Int J Clin Pract 2019; 73:e13347. [PMID: 30912212 DOI: 10.1111/ijcp.13347] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 08/24/2018] [Revised: 03/08/2019] [Accepted: 03/21/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The purpose of our study was to compare bone mineral density (BMD) and trabecular bone score (TBS) values between patients with type 2 diabetes (T2D) and control subjects with similar FRAX scores in order to evaluate TBS as an additional tool for assessing fracture risk in diabetic subjects. METHODS A cross-sectional analysis was performed using BMD results from 260 subjects participating in the FRISBEE study (Fracture RISk Brussels Epidemiological Enquiry), an ongoing prospective epidemiological study in a population-based cohort (Brussels, Belgium) of 3560 postmenopausal women aged 60-85 years. TBS measurement was possible in 1108 subjects from the FRISBEE cohort. Among these 1108 subjects, 65 had known T2D at inclusion. For each diabetic case we selected 3 controls from our database. (n = 195). Diabetic subjects and controls were matched for age and baseline FRAX score for major osteoporotic fractures. RESULTS BMD (g/cm2 ) tended to be higher in T2D than in control subjects, significantly so at the total hip 0.90 ± 0.13 versus 0.87 ± 0.12 (P = 0.015). On the contrary, TBS was significantly lower in the T2D group (mean = 1.19 ± 0.17) compared with the control group (mean = 1.27 ± 0.13) (P = 0.005). Mean TBS remained significantly lower in T2D (1.22 ± 0.17) compared with the control group (1.27 ± 0.13) (P = 0.02) after adjustment for body mass index. CONCLUSION Our data suggest that TBS complements BMD at the total hip, in demonstrating the "diabetes-associated bone disease".
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Affiliation(s)
- Felicia Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Sophie Hambye
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Carole Dekelver
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Sylvie I Cappelle
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Michel Moreau
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Marianne Paesmans
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Rafik Karmali
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Jacques Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Cappelle S, Ramon I, Dekelver C, Rozenberg S, Baleanu F, Karmali R, Rubinstein M, Tondeur M, Moreau M, Paesmans M, Bergmann P, Body JJ. Distribution of clinical risk factors for fracture in a Brussels cohort of postmenopausal women: The FRISBEE study and comparison with other major cohort studies. Maturitas 2017; 106:1-7. [DOI: 10.1016/j.maturitas.2017.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/08/2017] [Accepted: 08/11/2017] [Indexed: 11/15/2022]
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Baleanu F, Kong MF, Iconaru L, Karmali R. Swinging Thyroid Function Test Results in a Young Woman. Am J Med 2016; 129:e13-4. [PMID: 26772650 DOI: 10.1016/j.amjmed.2015.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 12/07/2015] [Accepted: 12/07/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Felicia Baleanu
- Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium.
| | - Marie-France Kong
- Department of Diabetes & Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Laura Iconaru
- Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Rafik Karmali
- Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium
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Affiliation(s)
- Marie-France Kong
- Centre Hospitalier Universitaire Brugmann, Bruxelles, Belgium; University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Gérald Glibert
- Centre Hospitalier Universitaire Brugmann, Bruxelles, Belgium
| | - Felicia Baleanu
- Centre Hospitalier Universitaire Brugmann, Bruxelles, Belgium
| | - Rafik Karmali
- Centre Hospitalier Universitaire Brugmann, Bruxelles, Belgium
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