1
|
Bendtsen MG, Hitz MF. Opportunistic Identification of Vertebral Compression Fractures on CT Scans of the Chest and Abdomen, Using an AI Algorithm, in a Real-Life Setting. Calcif Tissue Int 2024; 114:468-479. [PMID: 38530406 PMCID: PMC11061033 DOI: 10.1007/s00223-024-01196-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/13/2024] [Indexed: 03/28/2024]
Abstract
This study evaluated the performance of a vertebral fracture detection algorithm (HealthVCF) in a real-life setting and assessed the impact on treatment and diagnostic workflow. HealthVCF was used to identify moderate and severe vertebral compression fractures (VCF) at a Danish hospital. Around 10,000 CT scans were processed by the HealthVCF and CT scans positive for VCF formed both the baseline and 6-months follow-up cohort. To determine performance of the algorithm 1000 CT scans were evaluated by specialized radiographers to determine performance of the algorithm. Sensitivity was 0.68 (CI 0.581-0.776) and specificity 0.91 (CI 0.89-0.928). At 6-months follow-up, 18% of the 538 patients in the retrospective cohort were dead, 78 patients had been referred for a DXA scan, while 25 patients had been diagnosed with osteoporosis. A higher mortality rate was seen in patients not known with osteoporosis at baseline compared to patients known with osteoporosis at baseline, 12.8% versus 22.6% (p = 0.003). Patients receiving bisphosphonates had a lower mortality rate (9.6%) compared to the rest of the population (20.9%) (p = 0.003). HealthVCF demonstrated a poorer performance than expected, and the tested version is not generalizable to the Danish population. Based on its specificity, the HealthVCF can be used as a tool to prioritize resources in opportunistic identification of VCF's. Implementing such a tool on its own only resulted in a small number of new diagnoses of osteoporosis and referrals to DXA scans during a 6-month follow-up period. To increase efficiency, the HealthVCF should be integrated with Fracture Liaison Services (FLS).
Collapse
Affiliation(s)
| | - Mette Friberg Hitz
- Research Unit, Medical Department, Zealand University Hospital, Koege, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Koege, Denmark
| |
Collapse
|
2
|
Mancuso S, Mattana M, Giammancheri F, Russello F, Carlisi M, Santoro M, Siragusa S. Bone damage and health-related quality of life in Hodgkin lymphoma survivors: closing the gaps. Front Oncol 2024; 14:1201595. [PMID: 38406804 PMCID: PMC10884223 DOI: 10.3389/fonc.2024.1201595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 01/16/2024] [Indexed: 02/27/2024] Open
Abstract
In the recent decades, remarkable successes have been recorded in the treatment of Hodgkin's lymphoma to the point that today it represents one of the neoplasms with the highest rates of cure and with the highest life expectancy. Nonetheless, this raises the concern for the health of long- term survivors. Late side effects of treatments in synergy with other risk factors expose survivors to increased morbidity and impaired quality of life. In the complexity of the topics concerning these last aspects, an area of growing interest is that of bone damage that follows Hodgkin Lymphoma and its treatments. In this narrative review, we conducted our work through assessment of available evidence focusing on several aspects linking bone damage and quality of life with Hodgkin lymphoma and its treatments. At present, the problem of osteopenia and osteoporosis in Hodgkin lymphoma survivors is a theme for which awareness and knowledge need to be implemented.
Collapse
Affiliation(s)
- Salvatrice Mancuso
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Division of Hematology, University of Palermo, Palermo, Italy
| | | | | | | | | | | | | |
Collapse
|
3
|
Tan CW, Arlachov Y, Czernicki M, Bishop S, Pasku D, Drummond A, Podlasek A, Sahota O. Spinal medial branch nerve root block (MBNB) intervention compared to standard care-vertebroplasty (VP) for the treatment of painful osteoporotic vertebral fractures in frail, older hospitalised patients: a feasibility study. Arch Osteoporos 2023; 18:126. [PMID: 37831315 DOI: 10.1007/s11657-023-01336-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
Our study aimed to assess the feasibility outcomes comparing spinal medial branch nerve root block intervention to standard care vertebroplasty for the treatment of painful osteoporotic vertebral fractures in frail, hospitalised older patients. We found the study to be feasible and now propose a clinical effectiveness, cost effectiveness and safety evaluation. INTRODUCTION Vertebroplasty (VP) is a key-hole procedure involving injection of bone cement into a fractured vertebral body, to reduce pain and increase vertebral body stability, although it is associated with a small risk of complications, particularly in frail, older hospitalised patients. Medial branch spinal nerve block (MBNB) may be an alternative treatment to alleviate pain symptoms, with less complications; however, no study has prospectively compared the clinical effectiveness, cost-effectiveness and safety of MBNB to VP, in frail, older hospitalised patients. The aim of our study was to conduct a 1st stage feasibility study, exploring recruitment, retention and several outcomes measures (means and SDs), together with qualitative interviews to assess participant and clinician views, to inform a definitive larger study. METHODS We conducted a two-arm feasibility randomised controlled trial with participants allocated to continue with routine surgical care-VP or MBNB treatment, with an embedded qualitative study. Data was collected at baseline, week 1, 4, and week 8. RESULTS Out of 40 eligible patients, 30 (75%) consented to take part in the study. The overall median time from randomisation to intervention was 3 days, IQR 1-7 days, 5 (1-7) days for VP and 2 (1-3) days for MBNB. Median (IQR) length of hospital stay for the VP group was 20 (8) days and for the MBNB 15(22) days. The proportion of completeness of outcome data collection at weeks 1, 4 and 8 was at least 77%: 14 (100%), 12 (85.7%) and 11(78.9%) for VP and 13 (100%), 12 (92.3%) and 10 (76.8%) for MBNB, respectively. There were no significant difference in the clinical outcomes or adverse events between the two groups. DISCUSSION Our study was feasible in achieving is target recruitment, participants adhered to the randomisation and at least 77% completeness of data at the 8 week end-point (target 75%). We now plan to conduct a definitive clinical effectiveness, cost effectiveness and safety outcome study, comparing VP to MBNB in frail, older patients hospitalised with an acute vertebral osteoporotic fracture.
Collapse
Affiliation(s)
- Chia Wei Tan
- Healthcare of the Older People, QMC, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Yuriy Arlachov
- Department of Radiology, QMC, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Michal Czernicki
- Department of Anaesthesia, QMC, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Simon Bishop
- Nottingham University Business School, Jubilee Campus, Nottingham, NG8 1BB, UK
| | - Dritan Pasku
- Centre for Spinal Studies and Surgery, QMC, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Avril Drummond
- School of Health Sciences, B236, Medical School, QMC, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Anna Podlasek
- Healthcare of the Older People, QMC, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Opinder Sahota
- Healthcare of the Older People, QMC, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
- Centre for Spinal Studies and Surgery, QMC, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
- National Institute for Health Research (NIHR) Nottingham, Biomedical Research Centre (BRC), Nottingham, UK.
| |
Collapse
|
4
|
Xia W, Liu Q, Lv J, Zhang Z, Wu W, Xie Z, Chen J, He L, Dong J, Hu Z, Lin Q, Yu W, Wei F, Wang J. Prevalent vertebral fractures among urban-dwelling Chinese postmenopausal women: a population-based, randomized-sampling, cross-sectional study. Arch Osteoporos 2022; 17:120. [PMID: 36070158 PMCID: PMC9452427 DOI: 10.1007/s11657-022-01158-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/22/2022] [Indexed: 02/03/2023]
Abstract
In this population-based, cross-sectional study, we investigated vertebral fracture (VF) prevalence among Chinese postmenopausal women. We found 14.7% of population had VFs, which increased with age. Age ≥ 65 years, hip fracture, and densitometric osteoporosis were significantly associated with VFs. The prevalence of osteoporosis was remarkably high. PURPOSE To investigate VF prevalence among Chinese postmenopausal women in this population-based, randomized-sampling, cross-sectional study. METHODS The investigator obtained lists of women from communities. Randomization was performed using SAS programming based on age group in each region. Postmenopausal women aged ≥ 50 years in the urban community were included. The investigator interviewed subjects to collect self-reported data and measured BMD. Spine radiographs were adjudicated by Genant's semi-quantitative method. VFs were defined as fractures of at least one vertebra classified by Genant's score 1-3 and were analyzed using descriptive statistics. RESULTS A total of 31,205 women listed for randomized sampling from 10 Tier-3 hospitals at 5 regions. Of 2634 women in the full analysis set, 14.7% (388/2634, 95% CI: 13.4, 17.1) had prevalent VFs. VF prevalence increased with age (Cochran-Armitage test p < 0.0001) and was significantly higher in women aged ≥ 65. VF prevalence did not differ between North (14.4%, 95% CI: 12.5, 16.4) and South China (15.1%, 95% CI: 13.3, 17.1). In women with no prior VFs, prevalent VFs were 12.4% (95% CI: 11.2, 13.7). Age ≥ 65 years (OR: 2.57, 95% CI: 1.91, 3.48), hip fracture (OR: 2.28, 95% CI: 1.09, 4.76), and densitometric osteoporosis (OR: 2.52, 95% CI: 1.96, 3.22) were significantly associated with prevalent VFs. Prevalence of osteoporosis was 32.9% measured by BMD and 40.8% using NOF/IOF clinical diagnosis criteria. CONCLUSION VFs are prevalent among Chinese postmenopausal women who were ≥ 50 years and community-dwelled. Osteoporosis prevalence is remarkable when fragile fractures were part of clinical diagnosis.
Collapse
Affiliation(s)
- Weibo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | - Qiang Liu
- Shanxi Dayi Hospital, Taiyuan, Shanxi, China.
| | - Jinhan Lv
- The People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Zhenlin Zhang
- Department of Osteoporosis and Bone Disease, The Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Wen Wu
- Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Zhongjian Xie
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, China
| | - Jianting Chen
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liang He
- Beijing Jishuitan Hospital, Beijing, China
| | - Jian Dong
- Fudan University Zhongshan Hospital, Shanghai, China
| | - Zhenming Hu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiang Lin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Fang Wei
- Medical Affairs & Outcomes Research, Organon China, Shanghai, China
| | - Jue Wang
- Global Medical and Scientific Affairs, Merck Research Laboratories, MSD China, Shanghai, China
| |
Collapse
|
5
|
Okuda R, Osaki M, Saeki Y, Okano T, Tsuda K, Nakamura T, Morio Y, Nagashima H, Hagino H. Effect of coordinator-based osteoporosis intervention on quality of life in patients with fragility fractures: a prospective randomized trial. Osteoporos Int 2022; 33:1445-1455. [PMID: 35195752 DOI: 10.1007/s00198-021-06279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
UNLABELLED We examined the effects of the coordinator-based intervention on quality of life (QOL) in the aftermath of a fragility fracture, as well as factors predictive of post-fracture QOL. The coordinator-based interventions mitigated the decrease in QOL. Secondary fracture after primary fracture, however, was a significant predictor of lower QOL. PURPOSE This study aimed to determine the effects of the coordinator-based intervention on QOL in the aftermath of a fragility fracture, as well as factors predictive of post-fracture QOL, in an Asian population. METHODS Patients with new fractures in the intervention group received the coordinator-based intervention by a designated nurse certified as a coordinator, within 3 months of injury. QOL was evaluated using the Japanese version of the EuroQol 5 Dimension 5 Level (EQ-5D-5L) scale before the fracture (through patient recollections) and at 0.5, 1, and 2 years after the primary fracture. RESULTS Data for 141 patients were analyzed: 70 in the liaison intervention (LI) group and 71 in the non-LI group. Significant intervention effects on QOL were observed at 6 months after the fracture; the QOL score was 0.079 points higher in the LI group than in the non-LI group (p=0.019). Further, the LI group reported significantly less pain/discomfort at 2 years after the fracture, compared to the non-LI group (p=0.037). In addition, secondary fractures were found to significantly prevent improvement and maintenance of QOL during the recovery period (p=0.015). CONCLUSION Short-term intervention effects were observable 6 months after the primary fracture, with the LI group mitigated the decrease in QOL. Few patients in the LI group reported pain/discomfort 2 years after the fracture, but there is uncertainty regarding its clinical significance. Secondary fracture after initial injury was a significant predictor of lower QOL after a fracture.
Collapse
Affiliation(s)
- R Okuda
- School of Health Science, Faculty of Medicine, Tottori University, 86 Nishi-Cho, Yonago, Tottori, 683-8503, Japan.
| | - M Osaki
- Rehabilitation Division, Tottori University Hospital, Yonago, Tottori, Japan
| | - Y Saeki
- Orthopedic Surgery Hospital Ward, Tottori University Hospital, Yonago, Tottori, Japan
| | - T Okano
- Department of Orthopedic Surgery, San-in Rosai Hospital, Yonago, Tottori, Japan
| | - K Tsuda
- Department of Orthopedic Surgery, Saiseikai Sakaiminato General Hospital, Sakaiminato, Tottori, Japan
| | - T Nakamura
- Department of Orthopedic Surgery, Hakuai Hospital, Yonago, Tottori, Japan
| | - Y Morio
- Department of Orthopedic Surgery, Misasa Onsen Hospital, Misasa, Tottori, Japan
| | - H Nagashima
- Department of Orthopedic Surgery, Tottori University, Yonago, Tottori, Japan
| | - H Hagino
- School of Health Science, Faculty of Medicine, Tottori University, 86 Nishi-Cho, Yonago, Tottori, 683-8503, Japan
- Rehabilitation Division, Tottori University Hospital, Yonago, Tottori, Japan
| |
Collapse
|
6
|
Banefelt J, Timoshanko J, Söreskog E, Ortsäter G, Moayyeri A, Åkesson KE, Spångéus A, Libanati C. Total Hip Bone Mineral Density as an Indicator of Fracture Risk in Bisphosphonate-Treated Patients in a Real-World Setting. J Bone Miner Res 2022; 37:52-58. [PMID: 34585781 PMCID: PMC9298264 DOI: 10.1002/jbmr.4448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/08/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
Bone mineral density (BMD) is an established measure used to diagnose patients with osteoporosis. In clinical trials, change in BMD has been shown to provide a reliable estimate of fracture risk reduction, and achieved BMD T-score has been shown to reflect the near-term risk of fracture. We aimed to test the association between BMD T-score and fracture risk in patients treated for osteoporosis in a real-world setting. This retrospective, observational cohort study included Swedish females aged ≥55 years who had a total hip BMD measurement at one of three participating clinics. Patients were separated into two cohorts: bisphosphonate-treated and bisphosphonate-naïve prior to BMD measurement, stratified by age and prior nonvertebral fracture status. The primary outcome was cumulative incidence of clinical fractures within 24 months of BMD measurement, with other fracture types included as secondary outcomes. Associations between T-score and fracture risk were estimated using proportional hazards regression and restricted cubic splines. A total of 15,395 patients were analyzed: 11,973 bisphosphonate-naïve and 3422 bisphosphonate-treated. In the 24 months following BMD measurement, 6.3% (95% confidence interval [CI], 5.9-6.7) of bisphosphonate-naïve and 8.4% (95% CI, 7.5-9.4) of bisphosphonate-treated patients experienced a clinical fracture. Strong inverse relationships between BMD T-score and fracture incidence were observed in both cohorts. Among bisphosphonate-naïve patients, this relationship appeared to plateau around T-score -1.5, indicating smaller marginal reductions in fracture risk above this value; bisphosphonate-treated patients showed a more consistent marginal change in fracture risk across the evaluated T-scores (-3.0 to -0.5). Trends remained robust regardless of age and prior fracture status. This real-world demonstration of a BMD-fracture risk association in both bisphosphonate-naïve and bisphosphonate-treated patients extends evidence from clinical trials and recent meta-regressions supporting the suitability of total hip BMD as a meaningful outcome for the clinical management of patients with osteoporosis. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
| | | | - Emma Söreskog
- Quantify Research, Stockholm, Sweden.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Kristina E Åkesson
- Department of Clinical Sciences, Malmö Lund University, Malmö, Sweden.,Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - Anna Spångéus
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Acute Internal Medicine and Geriatrics and Department of Endocrinology, Linköping University Hospital, Linköping, Sweden
| | | |
Collapse
|
7
|
Suri A, Jones BC, Ng G, Anabaraonye N, Beyrer P, Domi A, Choi G, Tang S, Terry A, Leichner T, Fathali I, Bastin N, Chesnais H, Taratuta E, Kneeland BJ, Rajapakse CS. Vertebral Deformity Measurements at MRI, CT, and Radiography Using Deep Learning. Radiol Artif Intell 2022; 4:e210015. [PMID: 35146432 DOI: 10.1148/ryai.2021210015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/12/2021] [Accepted: 10/22/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE To construct and evaluate the efficacy of a deep learning system to rapidly and automatically locate six vertebral landmarks, which are used to measure vertebral body heights, and to output spine angle measurements (lumbar lordosis angles [LLAs]) across multiple modalities. MATERIALS AND METHODS In this retrospective study, MR (n = 1123), CT (n = 137), and radiographic (n = 484) images were used from a wide variety of patient populations, ages, disease stages, bone densities, and interventions (n = 1744 total patients, 64 years ± 8, 76.8% women; images acquired 2005-2020). Trained annotators assessed images and generated data necessary for deformity analysis and for model development. A neural network model was then trained to output vertebral body landmarks for vertebral height measurement. The network was trained and validated on 898 MR, 110 CT, and 387 radiographic images and was then evaluated or tested on the remaining images for measuring deformities and LLAs. The Pearson correlation coefficient was used in reporting LLA measurements. RESULTS On the holdout testing dataset (225 MR, 27 CT, and 97 radiographic images), the network was able to measure vertebral heights (mean height percentage of error ± 1 standard deviation: MR images, 1.5% ± 0.3; CT scans, 1.9% ± 0.2; radiographs, 1.7% ± 0.4) and produce other measures such as the LLA (mean absolute error: MR images, 2.90°; CT scans, 2.26°; radiographs, 3.60°) in less than 1.7 seconds across MR, CT, and radiographic imaging studies. CONCLUSION The developed network was able to rapidly measure morphometric quantities in vertebral bodies and output LLAs across multiple modalities.Keywords: Computer Aided Diagnosis (CAD), MRI, CT, Spine, Demineralization-Bone, Feature Detection Supplemental material is available for this article. © RSNA, 2021.
Collapse
Affiliation(s)
- Abhinav Suri
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Brandon C Jones
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Grace Ng
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Nancy Anabaraonye
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Patrick Beyrer
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Albi Domi
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Grace Choi
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Sisi Tang
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Ashley Terry
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Thomas Leichner
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Iman Fathali
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Nikita Bastin
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Helene Chesnais
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Elena Taratuta
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Bruce J Kneeland
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| | - Chamith S Rajapakse
- Departments of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
| |
Collapse
|
8
|
Singer AJ, Liu J, Yan H, Stad RK, Gandra SR, Yehoshua A. Treatment patterns and long-term persistence with osteoporosis therapies in women with Medicare fee-for-service (FFS) coverage. Osteoporos Int 2021; 32:2473-2484. [PMID: 34095966 PMCID: PMC8608759 DOI: 10.1007/s00198-021-05951-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/05/2021] [Indexed: 11/15/2022]
Abstract
UNLABELLED Osteoporosis, a chronic disease, requires long-term therapy. In Medicare-insured women, denosumab persistence was higher than oral bisphosphonate persistence over up to 3 years of follow-up. Longer-term persistence was higher among women who persisted in the first year of therapy. INTRODUCTION Osteoporosis, a chronic, progressive disease, requires long-term therapy; this study assessed long-term persistence with anti-resorptive therapies in postmenopausal women. METHODS This retrospective cohort study used administrative claims for women with data in the 100% Medicare osteoporosis sample who initiated (index date) denosumab, oral/intravenous (IV) bisphosphonate, or raloxifene between 2011 and 2014 and who had ≥ 1 year (zoledronic acid: 14 months) of pre-initiation medical/pharmacy coverage (baseline). Persistence was assessed from index date through end of continuous coverage, post-index evidence of censoring events (e.g., incident cancer), death, or end of study (December 31, 2015). RESULTS The study included 318,419 oral bisphosphonate users (78% alendronate), 145,056 denosumab users, 48,066 IV bisphosphonate users, and 31,400 raloxifene users; mean age ranged from 75.5 years (raloxifene) to 78.5 years (denosumab). In women with at least 36 months of follow-up (denosumab N = 25,107; oral bisphosphonates N = 79,710), more denosumab than oral bisphosphonate initiators were persistent at 1 year (73% vs. 39%), 2 years (50% vs. 25%), and 3 years (38% vs. 17%). Persistence decreased over time for all treatment groups, with denosumab users having the highest persistence in every follow-up time interval at or after 18 months. Women using denosumab, oral bisphosphonates, or raloxifene who persisted in a given year were more likely to remain persistent through the subsequent year. CONCLUSIONS Denosumab users persisted longer with therapy than women using other anti-resorptive medications, including oral bisphosphonates. Early persistence may predict long-term persistence. Overall persistence with osteoporosis medications is suboptimal and may impact fracture risk. Efforts to improve first year persistence are needed.
Collapse
Affiliation(s)
- A J Singer
- MedStar Georgetown University Hospital and Georgetown University Medical Center, Washington, DC, USA
| | - J Liu
- Chronic Disease Research Group (CDRG), Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - H Yan
- Chronic Disease Research Group (CDRG), Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - R K Stad
- Global Health Economics, Amgen, Inc., Thousand Oaks, CA, USA
| | - S R Gandra
- Global Health Economics, Amgen, Inc., Thousand Oaks, CA, USA
| | - A Yehoshua
- Global Health Economics, Amgen, Inc., Thousand Oaks, CA, USA.
| |
Collapse
|
9
|
Shah A, Wu F, Jones G, Cicuttini F, Toh LS, Laslett LL. The association between incident vertebral deformities, health-related quality of life and functional impairment: a 10.7-year cohort study. Osteoporos Int 2021; 32:2247-2255. [PMID: 34009448 DOI: 10.1007/s00198-021-06004-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/10/2021] [Indexed: 11/24/2022]
Abstract
UNLABELLED We aimed to describe longitudinal changes in health-related quality of life (HRQoL) measures associated with incident vertebral deformities (VDs) over 10.7 years. Incident VDs are associated with clinically significant functional impairment in men, and reduction in overall HRQoL in older women. Increasing severity and number of incident VDs are associated with clinically meaningful functional impairment in men, but not women. INTRODUCTION To describe associations between incident VD and changes in HRQoL and functional ability in older adults over 10.7 years. METHODS Participants (n = 780) underwent whole-body dual-energy X-ray absorptiometry (DXA) scans at baseline, 2.5, 5.1 and 10.7 years later. VD was defined as ≥ 25% reduction in anterior height relative to posterior height of vertebrae from T4 to L4. An incident VD was defined as a new VD at any follow-up visit. Assessment of Quality of Life (AQoL-4D) questionnaire and Health Assessment Questionnaire-Disability Index (HAQ-DI) were used to assess HRQoL and functional impairment. Changes in AQoL and HAQ-DI associated with incident VD were analysed using multilevel mixed-effects linear regression. Log binomial regression was used to examine clinically relevant changes and effects of severity and number of VD. RESULTS The incidence of VD was 37% over 10.7 years. In women, incident VDs were associated with annual reduction in AQoL utility score (β = -0.005, 95% CI -0.008 to -0.002). Men had increased risk of clinically significant reduction in HAQ-DI (IRR = 1.76, 95% CI 1.07-2.89). Men had increased risk of clinically important functional impairment with increasing severity (IRR 1.76, 95% CI 1.04-2.95 for mild vs IRR 1.98, 95% CI 1.13-3.47 for moderate to severe VD) as well as number of incident VD (IRR 1.85, 95% CI 1.17-2.93 for one vs IRR 1.88, 95% CI 0.94-3.78 for ≥ 2 VDs). Such associations were not observed in women. CONCLUSIONS Incident VDs are associated with clinically significant functional impairment in men, and reduction in overall HRQoL in older women. Increasing severity and number of incident VDs are associated with clinically meaningful functional impairment in men, but not women.
Collapse
Affiliation(s)
- A Shah
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
| | - F Wu
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | | | - L S Toh
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - L L Laslett
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| |
Collapse
|
10
|
Hadji P, Schweikert B, Kloppmann E, Gille P, Joeres L, Toth E, Möckel L, Glüer CC. Osteoporotic fractures and subsequent fractures: imminent fracture risk from an analysis of German real-world claims data. Arch Gynecol Obstet 2021; 304:703-712. [PMID: 34247254 PMCID: PMC8325652 DOI: 10.1007/s00404-021-06123-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
Purpose In osteoporosis, prior fracture is a strong predictor of subsequent fracture. This study aimed to assess the imminent risk of subsequent fracture following an initial fracture in osteoporosis patients in Germany, and to identify clinical and demographic characteristics that are independently associated with subsequent fracture risk. Methods In this retrospective, observational cohort study using German real-world claims data, male and female patients aged ≥ 50 years with osteoporosis who experienced an initial (“index”) hip/femur, vertebral, forearm/wrist/hand or shoulder/upper arm fracture between 2010 and 2014 were included. The incidence and timing of subsequent fractures during a 1-year follow-up period were analyzed. Independent risk factors for subsequent fracture were identified by multivariate regression analysis. Results A total of 18,354 patients (mean age: 77 years; standard deviation: 9.8) were included. Of these, 2918 (15.9%) suffered a subsequent fracture during the 1-year follow-up period. The incidence of subsequent fracture was higher following an index vertebral fracture (18.0%) than after an index forearm/wrist/hand fracture (14.1%) or index hip/femur fracture (12.1%). Subsequent 1-year fracture incidence was generally higher in older patients. Index fracture type, age, epilepsy/use of antiepileptics, and heart failure were all independently associated with subsequent fracture risk. Conclusion Osteoporosis patients in Germany are at imminent risk of subsequent fracture during the first year following an initial fracture. They should be targeted for immediate post-fracture treatment to reduce the risk of further fractures, especially in the presence of specific risk factors such as old age or index vertebral fracture. Supplementary Information The online version contains supplementary material available at 10.1007/s00404-021-06123-6.
Collapse
Affiliation(s)
- Peyman Hadji
- Frankfurt Center of Bone Health, Philipps-University of Marburg, Frankfurt, Germany
| | | | | | | | | | | | - Luis Möckel
- UCB Pharma, Monheim, Germany
- HSD Hochschule Döpfer GmbH, University of Applied Sciences, Cologne, Germany
| | - Claus-C Glüer
- Biomedical Imaging Section, Department of Radiology and Neuroradiology, Universitätskrankenhaus Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Germany.
- Department of Radiology and Neuroradiology, Molecular Imaging North Competence Center, Am Botanischen Garten 14, 24118, Kiel, Germany.
| |
Collapse
|
11
|
Umehara T, Inukai A, Kuwahara D, Kaneyashiki R, Kaneguchi A, Tsunematsu M, Kakehashi M. Factors Affecting Quality of Life at Discharge among Patients with Osteoporotic Vertebral Fractures. South Med J 2021; 114:252-259. [PMID: 33787941 DOI: 10.14423/smj.0000000000001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aimed to identify factors, including physical functions and activities that affect quality of life (QOL) at discharge among patients with osteoporotic vertebral fractures. METHODS Patients with osteoporotic vertebral fractures were included in our prospective cohort study. Multiple regression analysis was performed to determine the predictors of QOL at discharge using two models: model 1, basic medical information and physical functions at admission, and model 2, basic medical information, physical function, and activity after 4 weeks of admission. RESULTS Multiple regression analysis (standard partial regression coefficients) using model 1 identified L2 to L4 bone mineral density (-0.2), Visual Analog Scale for pain during activity at admission (-0.31), and Revised Hasegawa Dementia Scale (HDS-R) score at admission (0.64) as factors affecting QOL at discharge. Multiple regression analysis using model 2 identified HDS-R at admission (0.64), Pain Catastrophizing Scale score at 4 weeks (-0.34), and knee extension muscle strength at 4 weeks (0.28) as factors affecting QOL at discharge. CONCLUSIONS Our results suggest that if patients have high bone mineral density, intense pain, and low cognitive function at admission, then low QOL at discharge will be predicted; however, improvement of pain catastrophizing and knee extension muscle strength during first the 4 weeks of admission may be able to improve QOL at discharge. Because patients in this study were Japanese only, it is important to exercise caution when applying our results to other populations.
Collapse
Affiliation(s)
- Takuya Umehara
- From the Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Hiroshima, the Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, and the Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ayaka Inukai
- From the Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Hiroshima, the Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, and the Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Daisuke Kuwahara
- From the Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Hiroshima, the Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, and the Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryo Kaneyashiki
- From the Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Hiroshima, the Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, and the Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akinori Kaneguchi
- From the Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Hiroshima, the Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, and the Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Miwako Tsunematsu
- From the Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Hiroshima, the Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, and the Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masayuki Kakehashi
- From the Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Hiroshima, the Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, and the Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
12
|
Szulc P. Impact of Bone Fracture on Muscle Strength and Physical Performance-Narrative Review. Curr Osteoporos Rep 2020; 18:633-645. [PMID: 33030682 DOI: 10.1007/s11914-020-00623-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Low muscle strength and poor physical performance are associated with high risk of fracture. Many studies assessed clinical and functional outcomes of fractures. Fewer studies analyzed the impact of fractures on muscle strength and physical performance. RECENT FINDINGS Vertebral fractures (especially multiple and severe ones) are associated with back pain, back-related disability, lower grip strength, lower strength of lower limbs, lower gait speed, and poor balance. Patients with hip fracture have slower gait and lower quadriceps strength. Non-vertebral fractures were associated with lower strength of the muscles adjacent to the fracture site (e.g., grip strength in the case of distal radius fracture, knee extensors in the case of patellar fracture) and poor physical function dependent on the muscles adjacent to the fracture site (e.g., limited range of motion of the shoulder in the case of humerus fracture, gait disturbances in the case of the ankle fracture). Individuals with a fracture experience a substantial deterioration of muscle strength and physical performance which exceeds that related to aging and is focused on the period close to the fracture occurrence. After fracture, muscle strength increased and physical performance improved. The rate of normalization depended partly on the therapeutic approach and on the rehabilitation program. A subgroup of patients, mainly the elderly, never returns to the pre-fracture level of physical performance. The permanent decline of physical function after fracture may be related to the limitation of movements due to pain, low physical activity, poor health before the fracture, and reduced efficacy of retraining after immobilization.
Collapse
Affiliation(s)
- Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
| |
Collapse
|
13
|
Kato S, Terada N, Niwa O. Activities of Daily Living after Surgical Treatment for Osteoporotic Vertebral Fracture with or without Diffuse Idiopathic Skeletal Hyperostosis: A Retrospective Single-Institutional Study. Asian Spine J 2020; 14:847-856. [PMID: 32460468 PMCID: PMC7788374 DOI: 10.31616/asj.2019.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/30/2020] [Indexed: 11/29/2022] Open
Abstract
Study Design This investigation was a retrospective observational study. Purpose The aim of this study was to evaluate whether having diffuse idiopathic skeletal hyperostosis (DISH) as a comorbidity affects the patient’s ability to perform activities of daily living (ADL) after surgical treatment for osteoporotic vertebral fracture (OVF). Overview of Literature A few studies have extensively evaluated elderly patients with comorbidities such as DISH and OVF-induced persistent back pain and their ability to perform ADL postoperatively. Methods In this study, 63 patients (21 men and 42 women) who underwent surgical treatment for OVF were enrolled. Of these patients, 26 had DISH (D+) and 37 did not have DISH (D-). Patient demographic characteristics and surgical, clinical, and radiological findings were compared between those with and without DISH. The change in their ability to perform ADL after surgery was also evaluated. Results Age, number of comorbidities, and 1-year mortality rate were significantly higher in the D+ group (p<0.05). Postoperative Visual Analog Scale (VAS) scores were significantly higher in patients with impaired (n=6, p=0.04) abilities to perform ADL, and improvements in VAS scores were significantly higher in patients with unchanged abilities to perform ADL (n=54, p=0.03) after surgery. The average postoperative VAS scores were 2.2 for the D+ group and 2.3 for the D- group, which were not significantly different. Conclusions The frequency of OVF with DISH was higher in elderly men with multiple comorbidities and contributed to a higher 1-year mortality rate than those in patients without DISH. However, preoperative and postoperative VAS scores and improvements in VAS scores were similar between those with and without DISH. Postoperative impaired ability to perform ADL was associated with old age, high postoperative VAS scores, and little improvements in VAS scores, which were limitedly influenced by DISH. Surgical treatment of OVF combined with DISH is effective and appropriate for elderly patients.
Collapse
Affiliation(s)
- Shinichi Kato
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University School of Medicine, Nagoya, Japan
| | - Nobuki Terada
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University School of Medicine, Nagoya, Japan
| | - Osamu Niwa
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University School of Medicine, Nagoya, Japan
| |
Collapse
|
14
|
Söreskog E, Ström O, Spångéus A, Åkesson KE, Borgström F, Banefelt J, Toth E, Libanati C, Charokopou M. Risk of major osteoporotic fracture after first, second and third fracture in Swedish women aged 50 years and older. Bone 2020; 134:115286. [PMID: 32070789 DOI: 10.1016/j.bone.2020.115286] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/16/2020] [Accepted: 02/14/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Osteoporosis affects approximately one in five European women and leads to fragility fractures, which result in poor health, social and economic consequences. Fragility fractures are a strong risk factor for subsequent major osteoporotic fracture (MOF), with risk of MOF being elevated in the 1-2 years following an earlier fracture, a concept described as "imminent risk". This study examines risk of subsequent MOF in patients with one, two or three prior fractures by age and type of fracture. METHODS In this retrospective, observational cohort study, Swedish women aged ≥50 years with ≥1 any clinical fragility fracture between July 1, 2006 and December 31, 2012 were identified from Sweden's National Patient Register. Each patient was age- and sex-matched to three controls without history of fracture. Group 1 women included those with one fragility fracture during the study period; Group 2 included those with two fragility fractures; and Group 3 included those with three fragility fractures. "Index fracture" was defined as the first fracture during the study period for Group 1; the second for Group 2; and the third for Group 3. Patients in each cohort and matched controls were followed for up to 60 months or until subsequent MOF (hip, vertebra, forearm, humerus), death or end of data availability. RESULTS 231,769 women with at least one fracture were included in the study and therefore constituted Group 1; of these, 39,524 constituted Group 2 and of those, 7656 constituted Group 3. At five years, cumulative incidence of subsequent MOF was higher in patients with a history of fracture as compared to controls (Group 1: 20.7% vs 12.3%; Group 2: 32.0% vs 15.3%). Three-year cumulative incidence for Group 3 was 12.1% (vs 10.7% for controls). After adjusting for baseline covariates, risk of subsequent MOF was highest within 0-24 months following an index fracture, then decreased but remained elevated as compared to controls. Having two prior fractures, vertebral fractures and younger age at time of index fracture were associated with greater relative risk. CONCLUSIONS Women with a history of osteoporotic fracture are at increased risk of subsequent fracture, which is highest during the first 24 months following a fracture. Younger women and those with vertebral fractures are at greatest relative risk, suggesting that treatment should target these patients and be timely enough to impact the period of imminent risk.
Collapse
Affiliation(s)
- Emma Söreskog
- Quantify Research, Hantverkargatan 8, SE-112 21 Stockholm, Sweden.
| | - Oskar Ström
- Quantify Research, Hantverkargatan 8, SE-112 21 Stockholm, Sweden; Karolinska Institutet, Medical Management Centre, SE-171 77 Stockholm, Sweden.
| | - Anna Spångéus
- Linköping University, Sandbäcksgatan 7, SE-581 83 Linköping, Sweden.
| | - Kristina E Åkesson
- Lund University, Skåne University Hospital, Inga Marie Nilssons gata 22, SE-205 02 Malmö, Sweden.
| | - Fredrik Borgström
- Quantify Research, Hantverkargatan 8, SE-112 21 Stockholm, Sweden; Karolinska Institutet, Medical Management Centre, SE-171 77 Stockholm, Sweden.
| | - Jonas Banefelt
- Quantify Research, Hantverkargatan 8, SE-112 21 Stockholm, Sweden.
| | - Emese Toth
- UCB Pharma, Allée de la Recherche, 60 1070 Brussels, Belgium.
| | - Cesar Libanati
- UCB Pharma, Allée de la Recherche, 60 1070 Brussels, Belgium.
| | - Mata Charokopou
- UCB Pharma, Allée de la Recherche, 60 1070 Brussels, Belgium.
| |
Collapse
|
15
|
Toth E, Banefelt J, Åkesson K, Spångeus A, Ortsäter G, Libanati C. History of Previous Fracture and Imminent Fracture Risk in Swedish Women Aged 55 to 90 Years Presenting With a Fragility Fracture. J Bone Miner Res 2020; 35:861-868. [PMID: 31914206 PMCID: PMC9328134 DOI: 10.1002/jbmr.3953] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/12/2019] [Accepted: 12/28/2019] [Indexed: 11/24/2022]
Abstract
The term "fracture cascade" refers to the sequence of fragility fractures resulting from the increased fracture risk that occurs with aging and following fractures. Here, we evaluate the sequence of previous fractures in women aged 55 to 90 years presenting with a fragility fracture and subsequent (12 to 24 months) fracture incidence. In this retrospective, observational study, women aged 55 to 90 years with an "index" fragility fracture in 2013 were identified from Swedish national registries. A history of previous fractures (2001 to 2012) and osteoporosis treatment was used to characterize fracture cascade patterns. Cumulative incidence of new fractures within 12 to 24 months following the index fracture, based on index fracture type and age, were used to describe the risk of subsequent fractures. A total of 35,146 women with a mean age of 73.8 years were included (7180 hip, 2786 clinical vertebral, and 25,180 nonhip/nonvertebral [NHNV] index fractures); 38% of women with hip, 38% with clinical vertebral, and 25% with NHNV index fractures had one or more previous fractures. Across all index fracture types, the proportion of women with any previous fracture increased with age; 34% to 46% of index hip or clinical vertebral fractures in women ≥70 years were not their first fracture. Following any index fracture, cumulative incidence of a new fracture over 24 months was over 11% (index clinical vertebral 18%; index hip 14%). Osteoporosis treatment rates were low both in patients with (27%) and without (18%) a previous fracture. These descriptive data demonstrate that almost one-third of women aged 55 to 90 years suffering a new fracture have had a previous fragility fracture. Fracture location influences incidence and type of subsequent fracture during the 24 months following a fragility fracture, with clinical vertebral fractures carrying the greatest imminent fracture risk. These data highlight the clinical impact and need for early, effective treatment soon after any fragility fracture. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
Collapse
|
16
|
Homagk L, Hellweger A, Hofmann GO. [Hybrid stabilization and geriatric complex treatment of type A spinal fractures]. Chirurg 2020; 91:878-885. [PMID: 32157333 DOI: 10.1007/s00104-020-01136-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Approximately 200,000 spinal fractures occur each year in Germany. The decimated stability of the vertebra often leads to type A fractures with a substantial influence by osteoporosis. A mobility preserving and gentle treatment has clear advantages compared to conservative treatment. The hybrid stabilization as a combination of minimally invasive dorsal stabilization and vertebral augmentation has become an established method. In the period from July 2014 to June 2015 a total of 205 spinal operations were documented. In the group of very old patients more than 80% were treated for a geriatric type A vertebral fracture, 24 with hybrid stabilization, 5 by percutaneous bisegmental, 22 by kyphoplasty stabilization and 13 by percutaneous polysegmental procedures. Furthermore, these 4 groups were also considered with respect to the treatment in geriatric trauma centers (GTC). The 4 forms of treatment achieved a mean remuneration of 11,238.77 €. For the individual treatment form of kyphoplasty there was an increase in the remuneration of 4276.54 €, when patients undergo geriatric complex treatment and the remuneration is according to the diagnosis-related groups (DRG) classification I34Z. In the field of operative treatment of geriatric vertebral fractures, the augmentative procedures of kyphoplasty and vertebroplasty are well-established but an injury-related involvement of adjacent spinal segments and continuity fractures are frequent occurrences so that a bisegmental hybrid stabilization is advantageous. In addition, the perioperative stress in hybrid stabilization is only negligibly longer so that hybrid stabilization and geriatric complex treatment can be recommended as the new standard in spinal surgery for the treatment of type A fractures in aged patients.
Collapse
Affiliation(s)
- L Homagk
- Praxisklinik Dr. Homagk - MVZ GmbH, Schillerstraße 14, 06667, Weißenfels, Deutschland.
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Asklepios Kliniken, Weißenfels, Deutschland.
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum der Friedrich-Schiller-Universität, Jena, Deutschland.
| | - A Hellweger
- Praxisklinik Dr. Homagk - MVZ GmbH, Schillerstraße 14, 06667, Weißenfels, Deutschland
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Asklepios Kliniken, Weißenfels, Deutschland
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum der Friedrich-Schiller-Universität, Jena, Deutschland
| | - G O Hofmann
- Praxisklinik Dr. Homagk - MVZ GmbH, Schillerstraße 14, 06667, Weißenfels, Deutschland
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Asklepios Kliniken, Weißenfels, Deutschland
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum der Friedrich-Schiller-Universität, Jena, Deutschland
| |
Collapse
|
17
|
Suehiro D, Nishio A, Kawai J, Fukami K, Ohnishi M. Effects of corn syrup solids containing maltobionic acid (maltobionic acid calcium salt) on bone resorption in healthy Japanese adult women: A randomized double-blind placebo-controlled crossover study. Food Sci Nutr 2020; 8:1030-1037. [PMID: 32148811 PMCID: PMC7020302 DOI: 10.1002/fsn3.1387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/06/2019] [Accepted: 11/09/2019] [Indexed: 11/09/2022] Open
Abstract
Maltobionic acid is known to have an inhibitory effect on the differentiation of osteoclasts, and it has also been reported in an intervention trial that ingestion of corn syrup solids containing maltobionic acid maintained and increased the bone density of postmenopausal women. However, there is no information on whether maltobionic acid improves bone metabolism in humans. Therefore, we evaluated the influence of corn syrup solids containing maltobionic acid (maltobionic acid calcium salt) on bone resorption markers in healthy Japanese women. Forty-one individuals were selected from 68 participants and assigned to two groups: 21 individuals in the test food antecedent group and 20 individuals in the placebo food antecedent group; individuals in the first group ingested 4 g of corn syrup solids containing maltobionic acid, and subjects in the second group ingested 4 g of placebo (hydrous crystalline maltose and calcium carbonate) for 4 weeks. Bone resorption marker levels (DPD and u-NTx) were evaluated by urinalysis. Forty subjects completed the study, and no adverse events related to the test food were observed. Fourteen subjects were excluded prior to the efficacy analysis because of conflict with the control criteria; the remaining 33 subjects were analyzed. Consumption of corn syrup solids containing maltobionic acid was maintained; DPD and u-NTx values were improved (p < .05). These results indicate that corn syrup solids containing maltobionic acid might contribute to suppress bone resorption and improve bone metabolism in postmenstrual women. (UMIN-CTR ID: UMIN000034257; Foundation: San-ei Sucrochemical Co., Ltd.).
Collapse
Affiliation(s)
| | - Ayaka Nishio
- Graduate School of Bioscience and BiotechnologyChubu UniversityKasugaiJapan
| | - Junya Kawai
- College of Bioscience and BiotechnologyChubu UniversityKasugaiJapan
| | - Ken Fukami
- San‐ei Sucrochemical Co., Ltd.ChitaJapan
| | - Motoko Ohnishi
- Graduate School of Bioscience and BiotechnologyChubu UniversityKasugaiJapan
- College of Bioscience and BiotechnologyChubu UniversityKasugaiJapan
| |
Collapse
|
18
|
Vertebral fractures and spinopelvic parameters in patients with osteoporosis. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.674311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
19
|
Beall DP, Chambers MR, Thomas S, Amburgy J, Webb JR, Goodman BS, Datta DK, Easton RW, Linville D, Talati S, Tillman JB. Prospective and Multicenter Evaluation of Outcomes for Quality of Life and Activities of Daily Living for Balloon Kyphoplasty in the Treatment of Vertebral Compression Fractures: The EVOLVE Trial. Neurosurgery 2020; 84:169-178. [PMID: 29547939 PMCID: PMC6354561 DOI: 10.1093/neuros/nyy017] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 02/06/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Osteoporotic and neoplastic vertebral compression fractures (VCF) are common and painful, threatening quality of life and increasing risk of morbidity and mortality. Balloon kyphoplasty is a percutaneous option for treating painful cancer- and osteoporosis-related VCFs, supported by 2 randomized trials demonstrating efficacy benefits of BKP over nonsurgical care. OBJECTIVE To investigate 12-mo disability, quality of life, and safety outcomes specifically in a Medicare-eligible population, representing characteristic patients seen in routine clinical practice. METHODS A total of 354 patients with painful VCFs were enrolled at 24 US sites with 350 undergoing kyphoplasty. Four coprimary endpoints—Numerical Rating Scale (NRS) back pain, Oswestry Disability Index (ODI), Short Form-36 Questionnaire Physical Component Summary (SF-36v2 PCS), EuroQol-5-Domain (EQ-5D)—were evaluated for statistically significant improvement 3 mo after kyphoplasty. Data were collected at baseline, 7 d, and 1, 3, 6, and 12 mo (www.clinicaltrials.gov registration NCT01871519). RESULTS At the 3-mo primary endpoint, NRS improved from 8.7 to 2.7 and ODI improved from 63.4 to 27.1; SF-36 PCS was 24.2 at baseline improving to 36.6, and EQ-5D improved from 0.383 to 0.746 (P < .001 for each). These outcomes were statistically significant at every follow-up time point. Five device-/procedure-related adverse events, intraoperative asymptomatic balloon rupture, rib pain, and aspiration pneumonia, and a new VCF 25 d postprocedure, and myocardial infarction 105 d postprocedure were reported and each resolved with proper treatment. CONCLUSION This large, prospective, clinical study demonstrates that kyphoplasty is a safe, effective, and durable procedure for treating patients with painful VCF due to osteoporosis or cancer.
Collapse
Affiliation(s)
- Douglas P Beall
- Department of Radiology, Clinical Radiology of Oklahoma, Edmond, Oklahoma.,Interventional Spine Services, The Spine Fracture Institute, Edmond, Oklahoma
| | - M R Chambers
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sam Thomas
- Allegheny College, Meadville, Pennsylvania
| | - John Amburgy
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - James R Webb
- Dr James Webb & Associates' Osteoporosis Institute, Tulsa, Oklahoma
| | - Bradly S Goodman
- Alabama Clinical Therapeutics, LLC, Birmingham, Alabama.,Alabama Ortho Spine and Sports, Birmingham, Alabama
| | | | | | - Douglas Linville
- Scoliosis & Spine Surgery Clinic of Memphis, PLLC, Memphis, Tennessee
| | | | | |
Collapse
|
20
|
Merlijn T, Swart KM, van Schoor NM, Heymans MW, van der Zwaard BC, van der Heijden AA, Rutters F, Lips P, van der Horst HE, Niemeijer C, Netelenbos JC, Elders PJ. The Effect of a Screening and Treatment Program for the Prevention of Fractures in Older Women: A Randomized Pragmatic Trial. J Bone Miner Res 2019; 34:1993-2000. [PMID: 31220365 PMCID: PMC6900199 DOI: 10.1002/jbmr.3815] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/27/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Abstract
Population screening for fracture risk may reduce the fracture incidence. In this randomized pragmatic trial, the SALT Osteoporosis Study (SOS), we studied whether screening for fracture risk and subsequent treatment in primary care can reduce fractures compared with usual care. A total of 11,032 women aged 65 to 90 years with ≥1 clinical risk factor for fractures were individually randomized to screening (n = 5575) or usual care (n = 5457). Participants in the screening group underwent a screening program, including bone densitometry and vertebral fracture assessment. Participants with a high 10-year fracture probability (FRAX) or a vertebral fracture were offered treatment with anti-osteoporosis medication by their general practitioner. Incident fractures as reported by questionnaires were verified with medical records. Follow-up was completed by 94% of the participants (mean follow-up = 3.7 years). Of the 5575 participants in the screening group, 1417 (25.4%) had an indication for anti-osteoporosis medication. Screening and subsequent treatment had no statistically significant effect on the primary outcome fracture (hazard ratio [HR] = 0.97; 95% confidence interval [CI] 0.87-1.08), nor on the secondary outcomes osteoporotic fractures (HR = 0.91; 95% CI 0.81-1.03), major osteoporotic fractures (HR = 0.91; 95% CI 0.80-1.04), hip fractures (HR = 0.91; 95% CI 0.71-1.15), falls (odds ratio [OR] = 0.91; 95% CI 0.72-1.15), or mortality (HR = 1.03; 95% CI 0.91-1.17). Post hoc explorative finding suggested that screening might be most effective after a recent fracture (HR = 0.65; 95% CI 0.44-0.96 for major osteoporotic fractures and HR = 0.38; 95% CI 0.18-0.79 for hip fractures). The results of this study might have been compromised by nonparticipation and medication nonadherence in the screening group. Overall, this study does not provide sufficient indications to consider screening for fracture prevention. However, we cannot exclude its clinical relevance to reduce (major) osteoporotic fractures and hip fractures because of the relatively small number of women with a treatment indication in the intervention group. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Thomas Merlijn
- Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Karin Ma Swart
- Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Stichting Artsen Laboratorium en Trombosedienst, Koog aan de Zaan, Netherlands
| | - Natasja M van Schoor
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Martijn W Heymans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Babette C van der Zwaard
- Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Jeroen Bosch Ziekenhuis, Department of Orthopaedics, 's-Hertogenbosch, Netherlands
| | - Amber A van der Heijden
- Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Femke Rutters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Paul Lips
- Amsterdam UMC, Vrije Universiteit Amsterdam, Internal Medicine, Endocrine Section, Amsterdam, Netherlands
| | - Henriëtte E van der Horst
- Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Christy Niemeijer
- Stichting Artsen Laboratorium en Trombosedienst, Koog aan de Zaan, Netherlands
| | - J Coen Netelenbos
- Amsterdam UMC, Vrije Universiteit Amsterdam, Internal Medicine, Endocrine Section, Amsterdam, Netherlands
| | - Petra Jm Elders
- Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| |
Collapse
|
21
|
Lewis JR, Eggermont CJ, Schousboe JT, Lim WH, Wong G, Khoo B, Sim M, Yu M, Ueland T, Bollerslev J, Hodgson JM, Zhu K, Wilson KE, Kiel DP, Prince RL. Association Between Abdominal Aortic Calcification, Bone Mineral Density, and Fracture in Older Women. J Bone Miner Res 2019; 34:2052-2060. [PMID: 31310354 DOI: 10.1002/jbmr.3830] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/11/2019] [Accepted: 07/17/2019] [Indexed: 12/12/2022]
Abstract
Although a relationship between vascular disease and osteoporosis has been recognized, its clinical importance for fracture risk evaluation remains uncertain. Abdominal aortic calcification (AAC), a recognized measure of vascular disease detected on single-energy images performed for vertebral fracture assessment, may also identify increased osteoporosis risk. In a prospective 10-year study of 1024 older predominantly white women (mean age 75.0 ± 2.6 years) from the Perth Longitudinal Study of Aging cohort, we evaluated the association between AAC, skeletal structure, and fractures. AAC and spine fracture were assessed at the time of hip densitometry and heel quantitative ultrasound. AAC was scored 0 to 24 (AAC24) and categorized into low AAC (score 0 and 1, n = 459), moderate AAC (score 2 to 5, n = 373), and severe AAC (score >6, n = 192). Prevalent vertebral fractures were calculated using the Genant semiquantitative method. AAC24 scores were inversely related to hip BMD ( r s = -0.077, p = 0.013), heel broadband ultrasound attenuation ( r s = -0.074, p = 0.020), and the Stiffness Index ( r s = -0.073, p = 0.022). In cross-sectional analyses, women with moderate to severe AAC were more likely to have prevalent fracture and lumbar spine imaging-detected lumbar spine fractures, but not thoracic spine fractures (Mantel-Haenszel test of trend p < 0.05). For 10-year incident clinical fractures and fracture-related hospitalizations, women with moderate to severe AAC (AAC24 score >1) had increased fracture risk (HR 1.48; 95% CI, 1.15 to 1.91; p = 0.002; HR 1.46; 95% CI, 1.07 to 1.99; p = 0.019, respectively) compared with women with low AAC. This relationship remained significant after adjusting for age and hip BMD for clinical fractures (HR 1.40; 95% CI, 1.08 to 1.81; p = 0.010), but was attenuated for fracture-related hospitalizations (HR 1.33; 95% CI, 0.98 to 1.83; p = 0.073). In conclusion, older women with more marked AAC are at higher risk of fracture, not completely captured by bone structural predictors. These findings further support the concept that vascular calcification and bone pathology may share similar mechanisms of causation that remain to be fully elucidated © 2019 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Joshua R Lewis
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Medical School, The University of Western Australia, Perth, WA, Australia.,Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | | | - John T Schousboe
- Park Nicollet Osteoporosis Center and HealthPartners Institute, Minneapolis, MN, USA, and Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Wai H Lim
- Medical School, The University of Western Australia, Perth, WA, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Germaine Wong
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Ben Khoo
- Medical School, The University of Western Australia, Perth, WA, Australia.,Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Physics, University of Western Australia, Nedlands, WA, Australia
| | - Marc Sim
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Medical School, The University of Western Australia, Perth, WA, Australia
| | - MingXiang Yu
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Department of Endocrinology & Metabolism, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jonathan M Hodgson
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Medical School, The University of Western Australia, Perth, WA, Australia
| | - Kun Zhu
- Medical School, The University of Western Australia, Perth, WA, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Douglas P Kiel
- Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Richard L Prince
- Medical School, The University of Western Australia, Perth, WA, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| |
Collapse
|
22
|
Gold T, Williams SA, Weiss RJ, Wang Y, Watkins C, Carroll J, Middleton C, Silverman S. Impact of fractures on quality of life in patients with osteoporosis: a US cross-sectional survey. J Drug Assess 2019; 8:175-183. [PMID: 31692954 PMCID: PMC6818103 DOI: 10.1080/21556660.2019.1677674] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022] Open
Abstract
Objective: To evaluate the impact of osteoporosis-related fractures on health-related quality of life (HRQoL). Methods: Data were obtained from the 2016 Adelphi US Osteoporosis Disease Specific Programme™, a cross-sectional survey of physicians and their male and female patients with osteoporosis. Patient-reported outcomes (PRO) measures included the European Quality of Life 5 Domains (EQ-5D), European Quality of Life Visual Analog Scale (EQ-VAS), and Osteoporosis Assessment Questionnaire short-version (OPAQ-SV; physical, emotional, and symptom domains). Associations between PRO scores and the number and site of fractures were evaluated using ANOVA. Multivariate analyses were conducted using linear regression. Results: Physicians provided records for 1848 patients with osteoporosis. Of these, 981 (53.1%) completed the patient survey, data for the number of fractures were available for 935/981 (95.3%), and 185/935 (19.8%) had a history of fracture. Experiencing fractures significantly influenced scores on all PRO measures (p < .0001). Hip and spine fractures were associated with the greatest reduction in most PRO scores. The number of fractures, age, body mass index, and Charlson Comorbidity Index (CCI) were significantly associated with PRO measures (p < .05) in multivariate analyses. In patients with a fracture, fracture site, CCI, gender (EQ-5D and EQ-VAS), and age (OPAQ-SV physical only) were significantly associated with PRO measures. Conclusions: In patients with osteoporosis, fractures are associated with lower HRQoL and lower overall health status. Fracture history, fracture site, age, and comorbidity burden significantly influence HRQoL in individuals with osteoporosis. These data suggest the need for interventions to reduce the risk of fractures in patients with osteoporosis.
Collapse
Affiliation(s)
- T Gold
- Duke University Medical Center, Duke University, Durham, NC, USA
| | | | | | | | | | | | | | - Stuart Silverman
- Cedars-Sinai, Los Angeles, CA, USA.,University of California Los Angeles Medical Center, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
23
|
Hiligsmann M, Williams SA, Fitzpatrick LA, Silverman SS, Weiss R, Reginster JY. Cost-effectiveness of sequential treatment with abaloparatide vs. teriparatide for United States women at increased risk of fracture. Semin Arthritis Rheum 2019; 49:184-196. [DOI: 10.1016/j.semarthrit.2019.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/20/2018] [Accepted: 01/08/2019] [Indexed: 12/19/2022]
|
24
|
Kunitoki K, Mutoh T, Tatewaki Y, Takano Y, Yamamoto S, Shimomura H, Nakagawa M, Arai H, Taki Y. Clinical Utility of a Semiquantitative Method Using Lumbar Radiography as a Screening Tool for Osteoporosis in Elderly Subjects. Med Sci Monit 2019; 25:6928-6934. [PMID: 31520579 PMCID: PMC6759497 DOI: 10.12659/msm.917035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Osteoporosis is a major global public health problem in the current aging era. Osteoporosis is often diagnosed only after patients have a fracture that causes a severe decline in ability to perform activities of daily life. Although the current criterion standard for diagnosing osteoporosis is dual-energy X-ray absorptiometry (DXA), this modality remains less prevalent among general practitioners in geriatric medicine. The aim of this study was to determine the diagnostic utility of visual inspection of lumbar radiography in detecting bone mineral density (BMD) decline. Material/Methods We retrospectively reviewed medical data of 78 patients who underwent both lateral lumbar radiography and DXA. Board-certified radiologists determined the clinical grade of each patient’s condition according to the semiquantitative (SQ) method of lumbar fracture assessment. We compared the grades and young adult means of BMD in the lumbar spine and hips as measured using DXA. Results BMD of the femoral neck was significantly lower in patients with severe osteoporosis (grades 2 and 3 as classified using the SQ method) than in those with mild osteoporosis (grades 0 and 1; P<0.05). A receiver operating characteristic curve analysis showed that the SQ method can help predict the decrease in BMD (young adult mean score of <70%) in the femoral neck with moderate accuracy (sensitivity, 0.621; specificity, 0.829; area under the curve, 0.742). Conclusions These results suggest that lateral lumbar radiography can provide useful information about bone mineral status and can serve as a tool for osteoporosis screening by general practitioners.
Collapse
Affiliation(s)
- Keiko Kunitoki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Tatsushi Mutoh
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Yasuko Tatewaki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Yumi Takano
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shuzo Yamamoto
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hideo Shimomura
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Kousei Sendai Clinic, Sendai, Miyagi, Japan
| | - Manabu Nakagawa
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Kousei Sendai Clinic, Sendai, Miyagi, Japan
| | - Hiroyuki Arai
- Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Yasuyuki Taki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Miyagi, Japan
| |
Collapse
|
25
|
Hopman WM, Berger C, Joseph L, Morin SN, Towheed T, Anastassiades T, Adachi JD, Hanley DA, Prior JC, Goltzman D. Longitudinal assessment of health-related quality of life in osteoporosis: data from the population-based Canadian Multicentre Osteoporosis Study. Osteoporos Int 2019; 30:1635-1644. [PMID: 31069440 DOI: 10.1007/s00198-019-05000-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/22/2019] [Indexed: 01/22/2023]
Abstract
UNLABELLED Little is known about the association between health-related quality of life (HRQOL) and osteoporosis in the absence of fracture, and how HRQOL may change over time. This study provides evidence of substantially reduced HRQOL in women and men with self-reported and/or BMD-confirmed osteoporosis, even in the absence of fragility fracture. INTRODUCTION Fragility fractures have a detrimental effect on the health-related quality of life (HRQOL) of those with osteoporosis. Less is known about the association between HRQOL and osteoporosis in the absence of fracture. METHODS Canadian Multicentre Osteoporosis Study participants completed the SF-36, a detailed health questionnaire and measures of bone mineral density (BMD) at baseline and follow-up. We report the results of participants ≥ 50 years with 10-year follow-up. Self-reported osteoporosis at baseline and BMD-based osteoporosis at follow-up were ascertained. Multivariable linear regression models were developed for baseline SF-36 domains, component summaries, and change over time, adjusting for relevant baseline information. RESULTS Baseline data were available for 5266 women and 2112 men. Women in the osteoporosis group had substantially lower SF-36 baseline scores, particularly in the physically oriented domains, than those without osteoporosis. A similar but attenuated pattern was evident for the men. After 10-year follow-up (2797 women and 1023 men), most domain scores dropped for women and men regardless of osteoporosis status, with the exception of mentally-oriented ones. In general, a fragility fracture was associated with lower SF-36 scores and larger declines over time. CONCLUSIONS This study provides evidence of substantially reduced HRQOL in women and men with self-reported and/or BMD-confirmed osteoporosis, even in the absence of fragility fracture. HRQOL should be thoroughly investigated even prior to fracture, to develop appropriate interventions for all stages of the disease.
Collapse
Affiliation(s)
- W M Hopman
- Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, Ontario, Canada.
- Department of Public Health Sciences, Faculty of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - C Berger
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - L Joseph
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - S N Morin
- Department of Medicine, McGill University, Montréal, QC, Canada
| | - T Towheed
- Division of Rheumatology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - T Anastassiades
- Division of Rheumatology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - D A Hanley
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada
| | - J C Prior
- Department of Medicine/Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - D Goltzman
- Department of Medicine, McGill University, Montréal, QC, Canada
| | | |
Collapse
|
26
|
Uemura Y, Taguri M, Kawahara T, Chiba Y. Simple methods for the estimation and sensitivity analysis of principal strata effects using marginal structural models: Application to a bone fracture prevention trial. Biom J 2019; 61:1448-1461. [PMID: 31652011 DOI: 10.1002/bimj.201800038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/04/2019] [Accepted: 06/19/2019] [Indexed: 11/08/2022]
Abstract
In randomized clinical trials, it is often of interest to estimate the effect of treatment on quality of life (QOL), in addition to those on the event itself. When an event occurs in some patients prior to QOL score assessment, investigators may compare QOL scores between patient subgroups defined by the event after randomization. However, owing to postrandomization selection bias, this analysis can mislead investigators about treatment efficacy and result in paradoxical findings. The recent Japanese Osteoporosis Intervention Trial (JOINT-02), which compared the benefits of a combination therapy for fracture prevention with those of a monotherapy, exemplifies the case in point; the average QOL score was higher in the combination therapy arm for the unfractured subgroup but was lower for the fractured subgroup. To address this issue, principal strata effects (PSEs), which are treatment effects estimated within subgroups of individuals stratified by potential intermediate variable, have been discussed in the literature. In this paper, we describe a simple procedure for estimating the PSEs using marginal structural models. This procedure utilizes SAS code for the estimation. In addition, we present a simple sensitivity analysis method for examining the resulting estimates. The analyses of JOINT-02 data using these methods revealed that QOL scores were higher in the combination therapy arm than in the monotherapy arm for both subgroups.
Collapse
Affiliation(s)
- Yukari Uemura
- Biostatistics Section, Department of Data Science, Center for Clinical Sciences, National Center for Global Health and Medicine, Shinjyuku-ku, Tokyo, Japan.,Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Masataka Taguri
- Department of Science, Yokohama City University School of Data Science, Kanazawa-ku, Yokohama, Japan.,Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tachikawa, Tokyo, Japan
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yasutaka Chiba
- Clinical Research Center, Kindai University Hospital, Osakasayama, Osaka, Japan
| |
Collapse
|
27
|
Abstract
Approximately 20% of men and women aged 50 years or older will present with a vertebral fragility fracture - a prevalence that steadily increases with age. The condition may be associated with severe pain and disability, significant reductions in overall quality of life, mobility, social participation, sleep quality and increased fear for the future. There is, however, no current consensus on what constitutes the best management of symptomatic vertebral fractures. Moreover, evidence supporting common treatment approaches is scarce and often of poor quality. The lack of adequate management of VFF and associated osteoporosis and the burden of this condition to patient and society are estimated to increase substantially in coming years as recurrent, disabling episodes are set to occur. This chapter will address these issues, including a discussion on existing care pathways for vertebral fragility fractures, and an overview of the evidence supporting recommendations of the main international clinical practice guidelines.
Collapse
Affiliation(s)
- Manuela L Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Royal North Shore Hospital, Sydney Medical School, The University of Sydney, Sydney, Australia.
| | - Lyn March
- Institute of Bone and Joint Research, The Kolling Institute, Royal North Shore Hospital, Sydney Medical School, The University of Sydney, Sydney, Australia
| |
Collapse
|
28
|
Kitaguchi K, Kashii M, Ebina K, Sasaki S, Tsukamoto Y, Yoshikawa H, Murase T. Effects of Weekly Teriparatide Administration for Vertebral Stability and Bony Union in Patients with Acute Osteoporotic Vertebral Fractures. Asian Spine J 2019; 13:763-771. [PMID: 31000686 PMCID: PMC6774000 DOI: 10.31616/asj.2018.0311] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/07/2019] [Indexed: 12/12/2022] Open
Abstract
Study Design An open-label, non-randomized prospective study. Purpose Teriparatide (TPTD) is known to be an antiosteoporotic agent that may accelerate the healing of fractures. This study was designed to investigate the effect of once-weekly TPTD administration on vertebral stability and bony union after acute osteoporotic vertebral fracture (OVF). Overview of Literature Once-weekly TPTD administration can lead to early vertebral stability and promote bony union of fractured vertebrae in patients with severe osteoporosis. Methods Forty-eight subjects with acute OVF were assigned to receive activated vitamin D3 and calcium supplementation or onceweekly subcutaneous injection of TPTD (56.5 μg) in combination with activated vitamin D3 and calcium supplementation for 12 weeks. Vertebral stability was assessed using lateral plain radiography. Vertebral height at the anterior location (VHa) and the difference in VHa {ΔVHa=VHa (supine position)−VHa (weight-bearing position)} were measured at baseline and 12 weeks after starting treatment. Bony union was defined as the absence of a vertebral cleft or abnormal motion (ΔVHa >2 mm). Results Although not significant, ΔVHa, indicating vertebral stability, tended to be lower in the TPTD group at 12 weeks (p =0.17). As for subjects with severe osteoporosis, ΔVHa at 12 weeks was significantly lower in the TPTD group than in the control group (mean ΔVHa: control group, 3.1 mm (n=15); TPTD group, 1.4 mm (n=16); p =0.02). The rate of bony union was significantly higher in the TPTD group than in the control group (control group, 40%; TPTD group, 81%; p =0.03). Conclusions Once-weekly TPTD administration may facilitate early bony union after acute OVF accompanied by severe osteoporosis.
Collapse
Affiliation(s)
- Kazuma Kitaguchi
- Department of Orthopedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.,Department of Orthopedic Surgery, Faculty of Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masafumi Kashii
- Department of Orthopedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.,Department of Orthopedic Surgery, Faculty of Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kosuke Ebina
- Department of Orthopedic Surgery, Faculty of Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Satoru Sasaki
- Department of Orthopedic Surgery, Kyoritsu Hospital, Kawanishi, Japan
| | - Yasunori Tsukamoto
- Department of Orthopedic Surgery, North Osaka Police Hospital, Ibaraki, Japan
| | - Hideki Yoshikawa
- Department of Orthopedic Surgery, Faculty of Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsuyoshi Murase
- Department of Orthopedic Surgery, Faculty of Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| |
Collapse
|
29
|
Zhu RS, Kan SL, Ning GZ, Chen LX, Cao ZG, Jiang ZH, Zhang XL, Hu W. Which is the best treatment of osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty, or non-surgical treatment? A Bayesian network meta-analysis. Osteoporos Int 2019; 30:287-298. [PMID: 30635698 DOI: 10.1007/s00198-018-4804-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/06/2018] [Indexed: 12/12/2022]
Abstract
UNLABELLED The aim of the current study was to use a Bayesian network meta-analysis to evaluate the relative benefits and risks of balloon kyphoplasty (BK), percutaneous vertebroplasty (PVP), and non-surgical treatment (NST) for patients with osteoporotic vertebral compression fractures (OVCFs). The results demonstrate that for pain and functional status, PVP was significantly better than NST, while the three treatments did not significantly differ in other outcomes. INTRODUCTION BK, PVP, and NST are widely used to treat OVCFs, but preferable treatment is unknown. The aim of the current study was to use a Bayesian network meta-analysis to evaluate the relative benefits and risks of BK, PVP, and NST for patients with OVCFs. METHODS PubMed, EMBASE, and the Cochrane Library were screened. Based on the preplanned eligibility criteria, we screened and included randomized controlled trials that compared BK, PVP, and NST in treating patients with OVCFs. The risk of bias for individual studies was appraised. The data were pooled using a Bayesian network meta-analysis and a traditional direct comparison meta-analysis. RESULTS Of the 1057 relevant studies, 15 were eligible and included. Compared with NST, PVP significantly reduced pain, Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ). The comparative efficacy of BK and PVP was similar for pain (mean difference (MD) 0.51, 95% credible interval (CrI) - 0.35 to 1.4), ODI (MD 0.11, 95% CrI - 13 to 13), and RMDQ (MD 1.2, 95% CrI - 2.7 to 5.4). The European Quality of Life-5 Dimensions (EQ-5D) and Physical Component Summary subscales of the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36 PCS) did not differ significantly. There were also no substantial differences in the risks of subsequent vertebral fractures, adjacent vertebral fractures, and re-fractures at the treated level across all comparators. The results of pairwise meta-analyses were almost consistent with those of network meta-analyses. The treatment ranking indicated that PVP had the highest probability of being the most effective for pain, ODI, RMDQ, and EQ-5D. BK had the highest probability of improving SF-36 PCS and of reducing the risk of subsequent vertebral fractures and re-fractures at the treated level. NST was ranked first in preventing adjacent vertebral fractures. CONCLUSION PVP was the most effective method for improving pain, functional status, and quality of life (based on EQ-5D). BK emerged as the best intervention for decreasing the risk of subsequent vertebral fractures and re-fractures at the treated level. NST could be ranked first in reducing adjacent vertebral fractures. The future directions of OVCFs treatment will depend on the outcomes of additional and larger randomized trials in comparing BK with PVP.
Collapse
Affiliation(s)
- R-S Zhu
- Department of Spine Surgery, Tianjin Union Medical Center, 190 Jieyuan Road, Hongqiao District, Tianjin, China
| | - S-L Kan
- Department of Spine Surgery, Tianjin Union Medical Center, 190 Jieyuan Road, Hongqiao District, Tianjin, China
| | - G-Z Ning
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, China
| | - L-X Chen
- Institute of Bone and Joint Research, The Kolling institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Z-G Cao
- Department of Spine Surgery, Tianjin Union Medical Center, 190 Jieyuan Road, Hongqiao District, Tianjin, China
| | - Z-H Jiang
- Department of Spine Surgery, Tianjin Union Medical Center, 190 Jieyuan Road, Hongqiao District, Tianjin, China
| | - X-L Zhang
- Department of Spine Surgery, Tianjin Union Medical Center, 190 Jieyuan Road, Hongqiao District, Tianjin, China.
| | - W Hu
- Department of Spine Surgery, Tianjin Union Medical Center, 190 Jieyuan Road, Hongqiao District, Tianjin, China.
| |
Collapse
|
30
|
Prince RL, Lewis JR, Lim WH, Wong G, Wilson KE, Khoo BC, Zhu K, Kiel DP, Schousboe JT. Adding Lateral Spine Imaging for Vertebral Fractures to Densitometric Screening: Improving Ascertainment of Patients at High Risk of Incident Osteoporotic Fractures. J Bone Miner Res 2019; 34:282-289. [PMID: 30395687 DOI: 10.1002/jbmr.3595] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/27/2018] [Accepted: 09/22/2018] [Indexed: 11/10/2022]
Abstract
The current diagnosis of osteoporosis is limited to a T-score ≤-2.5. However, asymptomatic vertebral fractures (VF) are known to predict a high risk of subsequent fractures and pharmaceutical intervention is known to reduce future fracture risk in these individuals. In a prospective, population-based cohort of ambulant older women, we sought to evaluate the role of VF detection by screening densitometric lateral spine imaging (LSI) for VF at time of bone density testing to the effect on the magnitude of fracture risk. A total of 1084 women (mean age 75 years ± SD 3 years) had baseline LSI that identified 100 (9%) women with VFs and 89 (8%) with femoral neck (FN) T-score osteoporosis ≤-2.5. Follow-up identified incident clinical spine fracture in 73 (7%), 305 (28%) with any fracture-related hospitalization, and 121 (11%) with a hip fracture-related hospitalization. Compared with those without baseline VF, in those with baseline VF, relative risk (RR) for incident clinical spine, hip, and any fracture were 3.46 (95% confidence interval [CI] 2.14-5.60, p < 0.001); 1.72 (95% CI 1.09-2.71, p = 0.02), and 1.4 (95% CI 1.07-1.84, p = 0.02), respectively. In 675 (62%) of women with femoral neck osteopenia (T-score <-1 to >-2.5), 61 (9%) also had a VF. Compared with those without baseline VF, RR for any incident fragility fractures and fractures at spine and hip in those with baseline VF were 1.6 (95% CI 1.2-2.1, p < 0.01), 3.9 (95% CI 2.2-6.9, p < 0.01), and 1.6 (95% CI 0.9-2.8, p = 0.10), respectively. On basis of the prognosis, older women with LSI VF with osteopenia should be diagnosed with osteoporosis and should be considered for pharmaceutical intervention. © 2018 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Richard L Prince
- Medical School, University of Western Australia, Perth, Australia.,Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Joshua R Lewis
- Medical School, University of Western Australia, Perth, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Wai H Lim
- Medical School, University of Western Australia, Perth, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Germaine Wong
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | | | - Ben C Khoo
- Medical School, University of Western Australia, Perth, Australia.,Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kun Zhu
- Medical School, University of Western Australia, Perth, Australia.,Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Douglas P Kiel
- Institute for Aging Research, Hebrew Senior Life, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John T Schousboe
- Park Nicollet Osteoporosis Center and HealthPartners Institute, and Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
31
|
Al-Sari UA, Tobias JH, Clark EM. Impact of mild and moderate/severe vertebral fractures on physical activity: a prospective study of older women in the UK. Osteoporos Int 2019; 30:155-166. [PMID: 30194466 DOI: 10.1007/s00198-018-4692-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/28/2018] [Indexed: 02/08/2023]
Abstract
UNLABELLED Little is known about the long-term impact of vertebral fractures on physical activity. There is also uncertainty over the clinical significance of mild vertebral fracture. We showed that women with moderate/severe but not mild vertebral fracture do less walking duration and housework than those without fracture after 5.4 years of follow-up. INTRODUCTION Little is known about the long-term impact of vertebral fractures on physical activities. There is also uncertainty over the clinical significance of mild fracture. Therefore, the aim of this study was to evaluate the prospective association between vertebral fracture and future physical activity. METHODS This is a 5-year prospective study of a mixed community and secondary care cohort of women aged > 50 from the UK. Vertebral fractures were identified at baseline on radiographs or DXA-based Vertebral Fracture Assessment by a Quantitative Morphometric approach and defined as moderate/severe (≥ 25% height decrease) or mild (20-24.9% height decrease). Physical activity data were collected 5.4 years later by self-completion questionnaires. Multivariable logistic regression was used to determine the association between presence of fracture and various physical activities while adjusting for potential confounders. RESULTS Two hundred eighty-six women without, 58 with mild, and 69 with moderate/severe fracture were recruited. Those with mild and moderate/severe fracture were older than women without fracture and had more concomitant diseases at baseline. At 5.4 years follow-up, women with moderate/severe fracture self-reported shorter walking duration compared to those without fracture, even after adjusting for potential confounders (OR 2.96, 95%CI 1.11-7.88, P = 0.030). No independent association was seen between the presence of mild fractures and reduced physical activity at follow-up. CONCLUSION This is the first study of older women from the UK that explored the prospective association between vertebral fracture and physical activity duration. Moderate/severe fractures were associated with reduced walking duration. Mild fractures had no impact on future physical ability.
Collapse
Affiliation(s)
- U A Al-Sari
- Academic Rheumatology, Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Westbury-on-Trym, Bristol, BS10 5NB, UK.
- Department of Medicine, College of Medicine, Wasit University, Kut, Iraq.
| | - J H Tobias
- Academic Rheumatology, Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - E M Clark
- Academic Rheumatology, Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Westbury-on-Trym, Bristol, BS10 5NB, UK
| |
Collapse
|
32
|
Ciubean AD, Ungur RA, Irsay L, Ciortea VM, Borda IM, Onac I, Vesa SC, Buzoianu AD. Health-related quality of life in Romanian postmenopausal women with osteoporosis and fragility fractures. Clin Interv Aging 2018; 13:2465-2472. [PMID: 30584286 PMCID: PMC6284528 DOI: 10.2147/cia.s190440] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Osteoporosis is a common skeletal disorder characterized by decreased bone mass and increased susceptibility to fractures, which are associated with pain and decrease in physical function, social function, and well-being, which are all aspects of quality of life (QoL). The purpose of this study was to evaluate the burden of osteoporosis and fragility fractures in Romanian postmenopausal women from Cluj County using the 36-Item Short Form Health Survey (SF-36) and Quality of life questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) questionnaires. Materials and methods An analytical cross-sectional study on 364 postmenopausal women was carried out between June 2016 and August 2017 in the Clinical Rehabilitation Hospital in Cluj-Napoca, Cluj County, Romania. Data were collected by interview and from the medical documents: clinical and demographic data, personal medical history, risk factors for osteoporosis, and bone mineral density at the lumbar spine and femur. The patients included in the study were asked to complete the Romanian versions of the SF-36 and QUALEFFO-41 questionnaires. Results Women with osteoporosis had significantly lower scores in the SF-36 domains (P<0.001) than healthy controls. In the osteoporosis group, a significant association was found in the SF-36 pain domain, where women with a history of fracture had higher scores (P=0.035). As for QUALEFFO-41, a statistical significance was found in the total score (P<0.05), revealing a significantly lower QoL in osteoporotic women with a history of fracture. Conclusion The SF-36 scores registered a loss of QoL in women with osteoporosis. The QUALEFFO-41 total score was significantly lower in the osteoporosis associated with fracture, revealing a lower health-related QoL in these patients.
Collapse
Affiliation(s)
- Alina Deniza Ciubean
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Rehabilitation, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania,
| | - Rodica Ana Ungur
- Department of Rehabilitation, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania, .,Department of Rehabilitation Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania,
| | - Laszlo Irsay
- Department of Rehabilitation, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania, .,Department of Rehabilitation Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania,
| | - Viorela Mihaela Ciortea
- Department of Rehabilitation, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania, .,Department of Rehabilitation Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania,
| | - Ileana Monica Borda
- Department of Rehabilitation, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania, .,Department of Rehabilitation Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania,
| | - Ioan Onac
- Department of Rehabilitation, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania, .,Department of Rehabilitation Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania,
| | - Stefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anca Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
33
|
Kanda J, Izumo N, Furukawa M, Shimakura T, Yamamoto N, E Takahashi H, Asakura T, Wakabayashi H. Effects of the calcineurin inhibitors cyclosporine and tacrolimus on bone metabolism in rats. Biomed Res 2018; 39:131-139. [PMID: 29899188 DOI: 10.2220/biomedres.39.131] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Immunosuppressive therapy is considered as one of the factors inducing to the onset of osteoporosis after organ transplantation. Chronic immunosuppressive therapy after transplantation is required for organ transplant patients, and it is important to prevent the occurrence of osteoporotic fractures to maintain the quality of life in patients. In this study, we examined the effects of cyclosporine and tacrolimus on bone metabolism in rats. Five-week-old male Wistar rats were treated orally with 15 mg/kg cyclosporine or 1.5 mg/kg tacrolimus daily for 4 weeks. Each of cyclosporine and tacrolimus significantly reduced the bone strength of the femoral mid-diaphysis and bone mineral density of the tibia and femur. Bone histomorphometry showed that the administration of both drugs resulted in a decrease in bone volume, number and thickness of trabeculae, and an increase in trabecular separation. Bone formation parameters such as osteoid volume, osteoblast surface, mineralizing surface, mineral apposition rate, and bone formation rate significantly increased in the cyclosporine-treated group. Bone resorption parameters such as eroded surface, osteoclast surface, and osteoclast number significantly increased in both the cyclosporine- and the tacrolimus- treated groups. These results showed that cyclosporine increases both bone formation and bone resorption, leading to a high-turnover bone loss, and that tacrolimus increases bone resorption without affecting bone formation, leading to bone loss.
Collapse
Affiliation(s)
- Junkichi Kanda
- Department of Clinical Pharmacotherapy, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences
| | - Nobuo Izumo
- General Health Medical Center Yokohama University of Pharmacy
| | - Megumi Furukawa
- General Health Medical Center Yokohama University of Pharmacy
| | | | - Noriaki Yamamoto
- Niigata Bone Science Institute, Niigata Rehabilitation Hospital.,Division of Orthopedic Surgery, Niigata Rehabilitation Hospital
| | | | - Toshinari Asakura
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences
| | - Hiroyuki Wakabayashi
- Department of Clinical Pharmacotherapy, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences
| |
Collapse
|
34
|
Vertebral Augmentation is Superior to Nonoperative Care at Reducing Lower Back Pain for Symptomatic Osteoporotic Compression Fractures: A Meta-Analysis. Clin Spine Surg 2018; 31:339-344. [PMID: 29901504 DOI: 10.1097/bsd.0000000000000670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a systematic review and meta-analysis. OBJECTIVE This study's goal was to (i) assess the clinical outcomes with and without vertebral augmentation (VA) for osteoporotic vertebral compression fractures (VCFs) with versus without correlating signs and symptoms; and (ii) acute (symptoms <3 mo duration) and subacute VCFs (3-6 mo duration) versus chronic VCFs (>6 mo). SUMMARY OF BACKGROUND DATA Previously, a randomized controlled trial in the New England Journal of Medicine concluded that vertebroplasty for osteoporotic VCFs provided no clinical benefit over sham surgery. However, the VCFs examined had no clinical correlation with symptom, physical examination, or imaging (magnetic resonance imaging/bone scan) findings. Nonetheless, the randomized controlled trial resulted in a reduction in VA performed in the United States. Currently, no consensus exists on VA versus nonoperative care for symptomatic VCFs (SVFs). MATERIALS AND METHODS A literature search was conducted for studies on VA and conservative management for VCFs. Meta-analysis was performed using the random-effects model. The primary outcome was improvement in lower back pain visual analog score. SVFs were defined as radiographic VCF with clinical correlation. Radiographic-alone VCF (RVF) was defined as radiographic VCF without clinical correlation. RESULTS Thirteen studies totaling 1467 patients with minimum 6-month follow-up were found. Pain reduction was greater with VA over conservative management for SVFs (P<0.000001) and equivalent for RVFs (P=0.22). Subanalysis for acute/subacute SVFs and chronic SVFs showed that VA was superior to nonoperative care (P=0.0009 and 0.04, respectively). No difference was observed in outcomes between VA and nonoperative care for chronic RVF (P=0.22). CONCLUSIONS VA is superior to nonoperative care in reducing lower back pain for osteoporotic VCFs with correlating signs and symptoms. VA had no benefit over nonoperative care for chronic VCFs that lacked clinical correlation. Lower back pain has many etiologies and patients should be clinically assessed before recommending VA.
Collapse
|
35
|
Early versus delayed kyphoplasty for thoracolumbar osteoporotic vertebral fractures: The effect of timing on clinical and radiographic outcomes and subsequent compression fractures. Clin Neurol Neurosurg 2018; 173:176-181. [DOI: 10.1016/j.clineuro.2018.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/23/2018] [Accepted: 07/28/2018] [Indexed: 12/20/2022]
|
36
|
Shen GY, Ren H, Tang JJ, Qiu T, Zhang ZD, Zhao WH, Yu X, Huang JJ, Liang D, Yao ZS, Yang ZD, Jiang XB. Effect of osteoporosis induced by ovariectomy on vertebral bone defect/fracture in rat. Oncotarget 2017; 8:73559-73567. [PMID: 29088726 PMCID: PMC5650281 DOI: 10.18632/oncotarget.20611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/06/2017] [Indexed: 12/30/2022] Open
Abstract
Osteoporotic vertebral fracture (OVF) is a worldwide health concern and lacks sufficient basic studies. Suitable animal models should be the foundation for basic study and treatment of OVF. There have been few studies on the development of animal models of osteoporotic vertebral bone defects. OVF models using various animal species should be developed to evaluate the therapeutic strategy in preclinical testing. We developed an OVF model in rats. Rat osteoporosis was induced by ovariectomy (OVX), and 3 months after OVX, a 3 mm diameter hemispheric vertebral bone defect was developed in lumbar vertebra 6 (L6). Sagittal plain X-rays of the rats, their bone quantity, bone microarchitecture, and histomorphology were analyzed: 3 months after OVX, rats showed significantly lower bone quantity, relative bone volume, and total volume bone mineral density. After the vertebral bone defect had developed for 16 weeks, no significant indication of self-healing could be observed from the sagittal plain X-rays, three-dimensional images, and histomorphology. These results indicate that the rat model of osteoporotic vertebral bone defect, induced by OVX and a 3 mm diameter hemispheric vertebral bone defect, can sufficiently mimic OVF patients in clinic and provide a sound basis for subsequent studies.
Collapse
Affiliation(s)
- Geng-Yang Shen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hui Ren
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jing-Jing Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting Qiu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi-Da Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen-Hua Zhao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiang Yu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jin-Jing Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De Liang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhen-Song Yao
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi-Dong Yang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Bing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Laboratory Affiliated to National Key Discipline of Orthopaedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
37
|
Abstract
Fracture is the outcome of concern in osteoporosis, and fracture reduction is the primary goal of osteoporosis treatment. Fracture risk assessment is a critical component in osteoporosis management. The earlier approach of deciding on whether to treat solely based on bone mineral density (BMD) T-scores has been supplanted by employing the concept of absolute risk over medium time periods and more encompassing integration of clinical risk factors with or without BMD into robust fracture risk assessment tools. Fracture risk estimation allows for identifying high-risk patient groups not only at a health system and population-based level and thereby allowing allocation of financial resources to the people most at risk, but also at an individual level for the clinician to involve the patient in shared decision-making processes for treatment. The process of fracture risk assessment involves several steps including performing a thorough history and physical examination, assessing BMD, doing radiological assessment for vertebral fractures, and laboratory evaluation to rule out secondary contributors to osteoporosis. The data thus obtained can be input into any one of several fracture risk assessment tools that are now available. The decision on which tool to use can be made on the background of country-specific guidelines, although it is imperative that the physician be aware of the limitations inherent to whichever tool is chosen. This article aims to provide a brief overview of why fracture risk estimation is important and the methods that can be employed for it by the physician in clinical practice.
Collapse
Affiliation(s)
- Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore.
| |
Collapse
|
38
|
Imai T, Tanaka S, Kawakami K, Miyazaki T, Hagino H, Shiraki M. Health state utility values and patient-reported outcomes before and after vertebral and non-vertebral fractures in an osteoporosis clinical trial. Osteoporos Int 2017; 28:1893-1901. [PMID: 28265719 DOI: 10.1007/s00198-017-3966-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
Abstract
UNLABELLED We assessed the health state utility value (HSUV) reductions associated with vertebral fractures using data collected in the Japanese Osteoporosis Intervention Trial-03 (JOINT-03). Our analysis revealed that assessment of HSUVs after morphometric vertebral fracture is important to capture the burden of vertebral fractures. INTRODUCTION Evaluation of the HSUV after fracture is important to calculate the quality-adjusted life years (QALYs) of osteoporosis patients, which is essential information in the context of health economic evaluation. METHODS JOINT-03 study patients were aged ≥65 years and treated with risedronate and vitamin K2 or risedronate alone. Radiographic information and patient-reported outcomes measured by EQ-5D and a visual analogue scale (VAS) were assessed at registration and followed up after 6, 12, and 24 months. According to differences among the dates of these assessments and the radiographic information, we classified the follow-up HSUVs calculated based on EQ-5D results into before or after fracture categories regardless of clinical symptoms. RESULTS Among 2922 follow-up HSUVs, 201 HSUVs were categorized as HSUVs that were observed after incident vertebral fractures on X-ray films. The median time from the detection of an incident vertebral fracture until the EQ-5D assessment was 53 days (25th percentile, 0 day; 75th percentile, 357 days). The impact of incident vertebral fractures on HSUVs was quantified as -0.03. Among the five health profile domains on the EQ-5D, an incident vertebral fracture had significant effects on anxiety/depression, self-care, and usual activities. CONCLUSIONS The results suggest that incident morphometric vertebral fracture was associated with impairment of the HSUV for patients with osteoporosis not only immediately but also several months after the fracture.
Collapse
Affiliation(s)
- T Imai
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, 606-8501, Japan
| | - S Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, 606-8501, Japan
| | - K Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, 606-8501, Japan.
| | - T Miyazaki
- Public Health Research Foundation, Tokyo, Japan
| | - H Hagino
- School of Health Science, Tottori University Faculty of Medicine, Tottori, Japan
| | - M Shiraki
- Department of Internal Medicine, Research Institute and Practice for Involutional Diseases, Nagano, Japan
| | | |
Collapse
|
39
|
Kerr C, Bottomley C, Shingler S, Giangregorio L, de Freitas HM, Patel C, Randall S, Gold DT. The importance of physical function to people with osteoporosis. Osteoporos Int 2017; 28:1597-1607. [PMID: 28265717 PMCID: PMC5391375 DOI: 10.1007/s00198-017-3911-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/03/2017] [Indexed: 11/18/2022]
Abstract
There is increasing need to understand patient outcomes in osteoporosis. This article discusses that fracture in osteoporosis can lead to a cycle of impairment, driven by complex psychosocial factors, having a profound impact on physical function/activity which accumulates over time. More information is required on how treatments impact physical function. INTRODUCTION There is increasing need to understand patient-centred outcomes in osteoporosis (OP) clinical research and management. This multi-method paper provides insight on the effect of OP on patients' physical function and everyday activity. METHODS Data were collected from three sources: (1) targeted literature review on OP and physical function, conducted in MEDLINE, Embase and PsycINFO; (2) secondary thematic analysis of transcripts from patient interviews, conducted to develop a patient-reported outcome instrument. Transcripts were re-coded to focus on OP impact on daily activities and physical function for those with and without fracture history; and (3) discussions of the literature review and secondary qualitative analysis results with three clinical experts to review and interpret the importance and implications of the findings. RESULTS Results suggest that OP, particularly with fracture, can have profound impacts on physical function/activity. These impacts accumulate over time through a cycle of impairment, as fracture leads to longer term detriments in physical function, including loss of muscle, activity avoidance and reduced physical capacity, which in turn leads to greater risk of fracture and potential for further physical restrictions. The cycle of impairment is complex, as other physical, psychosocial and treatment-related factors, such as comorbidities, fears and beliefs about physical activity and fracture risk influence physical function and everyday activity. CONCLUSION More information on how treatments impact physical function would benefit healthcare professionals and persons with OP in making treatment decisions and improving treatment compliance/persistence, as these impacts may be more salient to patients than fracture incidence.
Collapse
Affiliation(s)
- C Kerr
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA
| | - C Bottomley
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA
| | - S Shingler
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA
| | - L Giangregorio
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, ON, Canada
- Research Institute for Aging, Waterloo, ON, Canada
| | - H M de Freitas
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA.
- Mapi, Translation and Innovation Hub Building, 80 Wood Lane, White City, London, W12 0BZ, UK.
| | - C Patel
- ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA
| | - S Randall
- National Osteoporosis Foundation, 251 18th Street South, Suite 630, Arlington, VA, 22202, USA
| | - D T Gold
- Duke University Medical Center, Durham, NC, 27710, USA
| |
Collapse
|
40
|
Lee JM, Lee YS, Kim YB, Park SW, Kang DH, Lee SH. What Effects Does Necrotic Area of Contrast-Enhanced MRI in Osteoporotic Vertebral Fracture Have on Further Compression and Clinical Outcome? J Korean Neurosurg Soc 2017; 60:181-188. [PMID: 28264238 PMCID: PMC5365295 DOI: 10.3340/jkns.2016.0707.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/19/2016] [Accepted: 11/17/2016] [Indexed: 01/25/2023] Open
Abstract
Objective The objective of this study was to analyze the correlation between further compression and necrotic area in osteoporotic vertebral fracture (OVF) patients with contrast-enhanced magnetic resonance imaging (CEMRI). In addition, we investigated the radiological and clinical outcome according to the range of the necrotic area. Methods Between 2012 and 2014, the study subjects were 82 OVF patients who did not undergo vertebroplasty or surgical treatment. The fracture areas examined on CEMRI at admission were defined as edematous if enhancement was seen and as necrotic if no enhancement was seen. The correlation between further compression and the necrotic and edematous areas of CEMRI, age, and bone mineral density was examined. Also, necrotic areas were classified into those with less than 25% (non-necrosis group) and those with more than 25% (necrosis group) according to the percentages of the entire vertebral body. For both groups, further compression and the changes in wedge and kyphotic angles were examined at admission and at 1 week, 3 months, and 6 months after admission, while the clinical outcomes were compared using the visual analog scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status grade. Results Further compression was 14.78±11.11% at 1 month and 21.75±14.43% at 6 months. There was a very strong correlation between the necrotic lesion of CEMRI and further compression (r=0.690, p<0.001). The compression of the necrosis group was 33.52±12.96%, which was higher than that of the non-necrosis group, 14.96±10.34% (p<0.005). Also, there was a statistically significantly higher number of intervertebral cleft development and surgical treatments being performed in the necrosis group than in the non-necrosis group (p<0.005). Moreover, there was a statistical difference in the decrease in the height of the vertebral body, and an increase was observed in the kyphotic change of wedge angle progression. There was also a difference in the VAS and ECOG performance scales. Conclusion The necrotic area of CEMRI in OVF had a strong correlation with further compression over time. In addition, with increasing necrosis, intervertebral clefts occurred more frequently, which induced kyphotic changes and resulted in poor clinical outcomes. Therefore, identifying necrotic areas by performing CEMRI on OVF patients would be helpful in determining their prognosis and treatment course.
Collapse
Affiliation(s)
- Ja Myoung Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Seok Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Baeg Kim
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dong Ho Kang
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Shin Heon Lee
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| |
Collapse
|
41
|
Kan SL, Yuan ZF, Chen LX, Sun JC, Ning GZ, Feng SQ. Which is best for osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty or non-surgical treatment? A study protocol for a Bayesian network meta-analysis. BMJ Open 2017; 7:e012937. [PMID: 28093431 PMCID: PMC5253565 DOI: 10.1136/bmjopen-2016-012937] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Osteoporotic vertebral compression fractures (OVCFs) commonly cause both acute and chronic back pain, substantial spinal deformity, functional disability and decreased quality of life and increase the risk of future vertebral fractures and mortality. Percutaneous vertebroplasty (PVP), balloon kyphoplasty (BK) and non-surgical treatment (NST) are mostly used for the treatment of OVCFs. However, which treatment is preferred is unknown. The purpose of this study is to comprehensively review the literature and ascertain the relative efficacy and safety of BK, PVP and NST for patients with OVCFs using a Bayesian network meta-analysis. METHODS AND ANALYSIS We will comprehensively search PubMed, EMBASE and the Cochrane Central Register of Controlled Trials, to include randomided controlled trials that compare BK, PVP or NST for treating OVCFs. The risk of bias for individual studies will be assessed according to the Cochrane Handbook. Bayesian network meta-analysis will be performed to compare the efficacy and safety of BK, PVP and NST. The quality of evidence will be evaluated by GRADE. ETHICS AND DISSEMINATION Ethical approval and patient consent are not required since this study is a meta-analysis based on published studies. The results of this network meta-analysis will be submitted to a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER CRD42016039452; Pre-results.
Collapse
Affiliation(s)
- Shun-Li Kan
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhi-Fang Yuan
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Ling-Xiao Chen
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Jing-Cheng Sun
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Guang-Zhi Ning
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Shi-Qing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
42
|
Cho YH, Um MJ, Kim SJ, Kim SA, Jung H. Raloxifene Administration in Women Treated with Long Term Gonadotropin-releasing Hormone Agonist for Severe Endometriosis: Effects on Bone Mineral Density. J Menopausal Med 2016; 22:174-179. [PMID: 28119898 PMCID: PMC5256355 DOI: 10.6118/jmm.2016.22.3.174] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 08/22/2016] [Accepted: 09/19/2016] [Indexed: 11/10/2022] Open
Abstract
Objectives To evaluate the efficacy of raloxifene in preventing bone loss associated with long term gonadotropin-releasing hormone agonist (GnRH-a) administration. Methods Twenty-two premenopausal women with severe endometriosis were treated with leuprolide acetate depot at a dosage of 3.75 mg/4 weeks, for 48 weeks. Bone mineral density (BMD) was evaluated at admission, and after 12 treatment cycles. Results At cycle 12 of GnRH-a plus raloxifene treatment, lumbar spine, trochanter femoral neck, and Ward's BMD differed from before the treatment. A year after treatment, the lumbar spine and trochanter decreased slightly, but were not significantly different. Conclusions Our study shows that the administration of GnRH-a plus raloxifene in pre-menopausal women with severe endometriosis, is an effective long-term treatment to prevent bone loss.
Collapse
Affiliation(s)
- Young Hwa Cho
- Department of Obstetrics and Gynecology, Cheomdan Hospital, Gwangju, Korea
| | - Mi Jung Um
- Department of Obstetrics and Gynecology, Chosun University Hospital, Gwangju, Korea
| | - Suk Jin Kim
- Department of Obstetrics and Gynecology, Chosun University Hospital, Gwangju, Korea
| | - Soo Ah Kim
- Department of Obstetrics and Gynecology, Chosun University Hospital, Gwangju, Korea.; Department of Obstetrics and Gynecology, Chosun University School of Medicine, Gwangju, Korea
| | - Hyuk Jung
- Department of Obstetrics and Gynecology, Chosun University Hospital, Gwangju, Korea.; Department of Obstetrics and Gynecology, Chosun University School of Medicine, Gwangju, Korea
| |
Collapse
|
43
|
Grbovic V, Skevin AJ, Ilic KP, Tomic AL, Nurkovic J, Jeremic D, Djordjevic D. Correlations Between Clinical Parameters and Health-Related Quality of Life in Postmenopausal Osteoporotic Women. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2016. [DOI: 10.1515/sjecr-2016-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The purpose of this study was to assess the correlation between health-related quality of life (HRQoL) and clinically relevant osteodensitometric and biochemical parameters in postmenopausal osteoporotic women. Bone mineral density (BMD) and T scores of the lumbar vertebrae and femoral neck were assessed in 100 osteoporotic women (56 without previous fractures and 44 with previous fractures) using dual x-ray absorptiometry. The Fracture Risk Assessment Tool (FRAX) index for major osteoporotic and hip fractures was calculated based on demographic data and hip BMD. Venous blood samples were taken from each subject for biochemical analysis (serum calcium, phosphorus, alkaline phosphatase and vitamin D levels). HRQoL was assessed using the QUALEFFO-41 questionnaire (domains: Health perception, Pain, and Physical, Social and Mental function). Basic participant characteristics (age, menopause length, body mass index, smoking habits, hereditary tendency towards fracture, fracture history) correlated with some of the QUALEFFO-41 domains, but the correlation coefficients were low (r<0.3), except in the case of the correlation between Pain and fracture history (r=0.638). Of the six variables included in the multiple regression model, fracture history was shown to be the most significant predictor with respect to the following three QUALEFFO-41 domains: Pain (b=20.511), Social function (b=2.548) and Health perception (b=3.185). Correlation analysis showed that after adjustment for basic characteristics, BMD and T score of the femoral neck and Pain (r=0.331 and r=0.449, respectively), Social function (r=0.422 and r=0.419) and Health perception (r=0.434 for T score of the femoral neck) exhibited the strongest correlations. Vitamin D was negatively correlated with Mental function, while the other biochemical parameters exhibited variable correlations with the QUALEFFO- 41 domains (r≈0.2-0.5). Our study confirmed the previously established relationship between BMD of the femoral neck and HRQoL in patients with osteoporosis and demonstrated correlations between various blood bone metabolism parameters and HRQoL that have not been previously investigated.
Collapse
Affiliation(s)
- Vesna Grbovic
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Aleksandra Jurisic Skevin
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Katarina Parezanovic Ilic
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Aleksandra Lucic Tomic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Jasmin Nurkovic
- Department of Biomedical Sciences, State University of Novi Pazar, Serbia
| | - Dejan Jeremic
- Department of Anatomy, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Dusica Djordjevic
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| |
Collapse
|
44
|
Szulc P, Feyt C, Chapurlat R. High risk of fall, poor physical function, and low grip strength in men with fracture-the STRAMBO study. J Cachexia Sarcopenia Muscle 2016; 7:299-311. [PMID: 27239407 PMCID: PMC4864191 DOI: 10.1002/jcsm.12066] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/22/2015] [Accepted: 07/31/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Several studies assessed the association of prevalent fractures with muscle mass, strength, and physical capacity in men. Clinical impact of these associations is not clear, and they could be influenced by confounders. Our aim was to assess the association of the prevalent fractures with muscle strength, physical function, and the risk of subsequent falls in older men after adjustment for muscle mass and potential confounders. METHODS In a cohort of 890 men aged 50 and older, we assessed appendicular skeletal muscle mass (ASM) by DXA, grip strength, physical function (chair stands, static, and dynamic balance). Relative ASM (RASM) was calculated as ASM / (height)(2). Then, 813 men aged 60 and over were followed up prospectively for 5 years and 144 sustained >1 incident falls. All the analyses were adjusted for lifestyle factors, co-morbidities, and hormones known to influence muscle and physical function. RESULTS Low leisure physical activity, very high occupational physical activity, Parkinson's disease, diabetes mellitus, low apparent free testosterone concentration (AFTC), as well as Grade 2 and 3 vertebral fractures and multiple fractures were associated with lower grip strength when adjusted for confounders including upper limb RASM. Low leisure physical activity, very high occupational physical activity, diabetes mellitus, prior stroke, low AFTC and 25-hydroxycholecalciferol, high C-reactive protein, vertebral fractures, and non-vertebral fractures were associated with poor physical function (lowest quintile of the score of tests) when adjusted for confounders including lower limb RASM. Grade 2 and 3 and multiple vertebral fractures were associated with twofold higher risk of multiple falls after adjustment for confounders. Men having multiple fractures had a twofold higher risk of multiple falls after adjusting for confounders. In multivariable models, risk of falls increased proportionally to the increasing severity and number of vertebral fractures as well as to the increasing number of all fractures. CONCLUSIONS In older men, Grade 2 and 3 vertebral fractures and multiple vertebral and non-vertebral fractures are associated with lower grip strength, poor physical function, and higher risk of multiple falls after adjustment for multiple confounders. This suggests a real direct association. One fracture can initiate a vicious circle leading to another fracture; thus, patients with fractures need physical therapy regardless of their general health status.
Collapse
Affiliation(s)
- Pawel Szulc
- INSERM UMR 1033 Hôpital Edouard Herriot University of Lyon Lyon France
| | - Clément Feyt
- INSERM UMR 1033 Hôpital Edouard Herriot University of Lyon Lyon France
| | - Roland Chapurlat
- INSERM UMR 1033 Hôpital Edouard Herriot University of Lyon Lyon France
| |
Collapse
|
45
|
Crandall CJ, LaMonte MJ, Snively BM, LeBoff MS, Cauley JA, Lewis CE, Wallace R, Li W, Chen Z, Robbins JA, Wactawski-Wende J. Physical Functioning Among Women Aged 80 Years and Older With Previous Fracture. J Gerontol A Biol Sci Med Sci 2016; 71 Suppl 1:S31-41. [PMID: 26858323 PMCID: PMC4861138 DOI: 10.1093/gerona/glv060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/08/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The oldest old are the fastest growing segment of the elderly population. Little is known regarding the associations of fracture history with physical functioning assessed after age 80. METHODS Among 33,386 women surviving to age 80 years (mean ± SD years 84.6 ± 3.4), we examined the relationship between history of incident fracture after entry into the Women's Health Initiative (follow-up 15.2 ± 1.3 years) and their physical functioning assessed using the RAND-36 instrument most proximal to 2012 end of follow-up. RESULTS Baseline mean (±SD) physical function score was 82 (± 18). After adjustment for demographic and medical characteristics, fracture at each site, including hip, upper limb, lower limb, and central body, was associated with significantly lower subsequent physical functioning (all p < .001). Hip, upper leg, spine, and pelvis fractures were particularly related with lower physical functioning scores, 11.7 (95% CI: 10.3, 13.1), 10.5 (8.8, 12.3), 9.8 (8.9, 10.8), and 8.7 (7.2, 10.2) units lower, respectively, compared with women without fracture (each p < .0001). Compared with women without central site fracture, women with central site fractures also had lower physical functioning scores (10.0 [9.3, 10.8] units lower]; p < .0001). In case-only analysis of fractures, older age, less than 1 year since fracture, one or more additional sites fractured, history of cardiovascular disease or cancer, higher body mass index, and no alcohol intake in the past 3 months also were independent predictors of lower physical functioning score (all p < .05). CONCLUSIONS Among women surviving to 80 years and older, prior fracture is associated with lower current physical functioning, regardless of anatomical site of fracture, independent of other major predictors of disability.
Collapse
Affiliation(s)
- Carolyn J Crandall
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles.
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo, the State University of New York
| | - Beverly M Snively
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Meryl S LeBoff
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Cora E Lewis
- Department of Medicine, University of Alabama, Birmingham
| | | | - Wenjun Li
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester
| | - Zhao Chen
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson
| | - John A Robbins
- Department of Medicine, Center for Healthcare Policy and Research, UC Davis Medical Center, Sacramento, California
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, the State University of New York
| |
Collapse
|
46
|
Abstract
Vertebral fractures are one of the most common fractures associated with skeletal fragility and can cause as much morbidity as hip fractures. However, the epidemiology of vertebral fractures differs from that of osteoporotic fractures at other skeletal sites in important ways, largely because only one quarter to one-third of vertebral fractures are recognized clinically at the time of their occurrence and otherwise require lateral spine imaging to be recognized. This article first reviews the prevalence and incidence of clinical and radiographic vertebral fractures in populations across the globe and secular trends in the incidence of vertebral fracture over time. Next, associations of vertebral fractures with measures of bone mineral density and bone microarchitecture are reviewed followed by associations of vertebral fracture with various textural measures of trabecular bone, including trabecular bone score. Finally, the article reviews clinical risk factors for vertebral fracture and the association of vertebral fractures with morbidity, mortality, and other subsequent adverse health outcomes.
Collapse
Affiliation(s)
- John T Schousboe
- Park Nicollet Osteoporosis Center, Park Nicollet Clinic, HealthPartners, Minneapolis, MN, USA; Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MD, USA.
| |
Collapse
|
47
|
ASA III osteoporotic fracture in 62 patients treated with vertebroplasty under local anesthesia. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 26:47-52. [PMID: 26377662 DOI: 10.1007/s00590-015-1700-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 09/01/2015] [Indexed: 02/07/2023]
Abstract
Vertebroplasty is a minimally invasive procedure that may be performed under either local or general anesthesia. In this study, we aimed at assessing the outcomes of the vertebroplasty performed under local anesthesia in patients at high risk of general anesthesia. Vertebroplasty was performed under local anesthesia in the treatment of a total of 62 patients (68 vertebrae in total) with osteoporotic vertebral fractures between 2011 and 2013. None of the patients had a history of trauma. Patients who were classified as ASA III during the preoperative examinations were included in the study. VAS scores were evaluated before the surgery, on the first postoperative day, and in week 1 and in month 1 after the surgery. The average age was 77.5 years (age range 53-102). An average of 2 cc of cement was injected to 22 patients (35.5 %), and an average of 3 cc of cement was injected to 40 patients (64.5 %). The mean VAS scores were 7.52 (6-9) before the procedure, 3.55 (2-5) on the first day, 2.03 (0-4) in week 1 and 0.87 (0-2) in month 1 postoperatively. Asymptomatic cement embolism was detected in one patient. No other complications were observed in the study group. Vertebroplasty performed under local anesthesia is an effective and safe procedure in terms of pain control and early ambulation and is bereft of the complications associated with general anesthesia.
Collapse
|
48
|
Liu X, Wei D, Zhong J, Ma M, Zhou J, Peng X, Ye Y, Sun G, He D. Electrospun Nanofibrous P(DLLA-CL) Balloons as Calcium Phosphate Cement Filled Containers for Bone Repair: in Vitro and in Vivo Studies. ACS APPLIED MATERIALS & INTERFACES 2015; 7:18540-18552. [PMID: 26258872 DOI: 10.1021/acsami.5b04868] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The spinal surgeon community has expressed significant interest in applying calcium phosphate cement (CPC) for the treatment of vertebral compression fractures (VCFs) and minimizing its disadvantages, such as its water-induced collapsibility and poor mechanical properties, limiting its clinical use. In this work, novel biodegradable electrospun nanofibrous poly(d,l-lactic acid-ϵ-caprolactone) balloons (ENPBs) were prepared, and the separation, pressure, degradation, and new bone formation behaviors of the ENPBs when used as CPC-filled containers in vitro and in vivo were systematically analyzed and compared. CPC could be separated from surrounding bone tissues by ENPBs in vitro and in vivo. ENPB-CPCs (ENPBs serving as CPC-filled containers) exerted pressure on the surrounding bone microenvironment, which was enough to crush trabecular bone. Compared with the CPC implantation, ENPB-CPCs delayed the degradation of CPC (i.e., its water-induced collapsilibity). Finally, possible mechanisms behind the in vivo effects caused by ENPB-CPCs implanted into rabbit thighbones and pig vertebrae were proposed. This work suggests that ENPBs can be potentially applied as CPC-filled containers in vivo and provides an experimental basis for the clinical application of ENPBs for the treatment of VCFs. In addition, this work will be of benefit to the development of polymer-based medical implants in the future.
Collapse
Affiliation(s)
- Xunwei Liu
- Department of Medical Imaging, Jinan Military General Hospital , No. 25 Shifan Road, Jinan 200050, Shandong Province, People's Republic of China
| | - Daixu Wei
- National Engineering Research Center for Nanotechnology , No. 28 East Jiangchuang Road, Minhang District, Shanghai 200241, People's Republic of China
| | - Jian Zhong
- National Engineering Research Center for Nanotechnology , No. 28 East Jiangchuang Road, Minhang District, Shanghai 200241, People's Republic of China
| | - Mengjia Ma
- School of Materials Science and Engineering, Shanghai Jiao Tong University , No. 800 Dongchuang Road, Minhang District, Shanghai 200240, People's Republic of China
| | - Juan Zhou
- National Engineering Research Center for Nanotechnology , No. 28 East Jiangchuang Road, Minhang District, Shanghai 200241, People's Republic of China
| | - Xiangtao Peng
- Department of Medical Imaging, Jinan Military General Hospital , No. 25 Shifan Road, Jinan 200050, Shandong Province, People's Republic of China
| | - Yong Ye
- Department of Medical Imaging, Jinan Military General Hospital , No. 25 Shifan Road, Jinan 200050, Shandong Province, People's Republic of China
| | - Gang Sun
- Department of Medical Imaging, Jinan Military General Hospital , No. 25 Shifan Road, Jinan 200050, Shandong Province, People's Republic of China
| | - Dannong He
- National Engineering Research Center for Nanotechnology , No. 28 East Jiangchuang Road, Minhang District, Shanghai 200241, People's Republic of China
- School of Materials Science and Engineering, Shanghai Jiao Tong University , No. 800 Dongchuang Road, Minhang District, Shanghai 200240, People's Republic of China
| |
Collapse
|
49
|
Guo JB, Zhu Y, Chen BL, Xie B, Zhang WY, Yang YJ, Yue YS, Wang XQ. Surgical versus non-surgical treatment for vertebral compression fracture with osteopenia: a systematic review and meta-analysis. PLoS One 2015; 10:e0127145. [PMID: 26020950 PMCID: PMC4447413 DOI: 10.1371/journal.pone.0127145] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/12/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Surgical and non-surgical interventions are the two categories for treatment of vertebral compression fractures (VCFs). However, there is clinical uncertainty over optimal management. This study aimed to examine the safety and effectiveness of surgical management for treatment of VCFs with osteopenia compared with non-surgical treatment. METHODS We conducted a systematic search through electronic databases from inception to June 2014, with no limits on study data or language. Randomized controlled trials (RCTs) evaluating surgical versus non-surgical interventions for treatment of patients with VCFs due to osteopenia were considered. Primary outcomes were pain and adverse effects. A random-effects model was used to calculate the pooled mean difference (MD) or risk ratios with 95% confidence interval (CI). RESULTS Sixteen reports (11 studies) met the inclusion criteria, and provided data for the meta-analysis with a total of 1,401 participants. Compared with conservative treatment, surgical treatment was more effective in reducing pain (short-term: MD -2.05, 95% CI -3.55 to -0.56, P=0.007; mid-term: MD -1.70, 95% CI -2.78 to -0.62, P=0.002; long-term: MD -1.24, 95% CI -2.20 to -0.29, P=0.01) and disability on the Roland-Morris Disability score (short-term: MD -4.97, 95% CI -8.71 to -1.23, P=0.009), as well as improving quality of life on the Short-Form 36 Physical Component Summary score (short-term: MD 5.53, 95% CI 1.45 to 9.61, P=0.008) and the Quality of Life Questionnaire of the European Foundation for Osteoporosis score (short-term: MD -5.01, 95% CI -8.11 to -1.91, P=0.002). Indirect comparisons between vertebroplasty and kyphoplasty found no evidence that the treatment effect differed across the two interventions for any outcomes assessed. Compared with the sham procedure, surgical treatment showed no evidence of improvement in pain relief and physical function. Based on these two comparisons, no significant difference between groups was noted in the pooled results for adverse events. CONCLUSION Compared to conservative treatment, surgical treatment was more effective in decreasing pain in the short,mid and long terms. However, no significant mid- and long-term differences in physical function and quality of life was observed. Little good evidence is available for surgical treatment compared with that for sham procedure. PV and BK are currently used to treat VCFs with osteopenia, with little difference in treatment effects. Evidence of better quality and from a larger sample size is required before a recommendation can be made. SYSTEMATIC REVIEW REGISTRATION http://www.crd.york.ac.uk/PROSPERO PROSPERO registration number: CRD42013005142.
Collapse
Affiliation(s)
- Jia-Bao Guo
- Second School of Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yi Zhu
- Second School of Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Bing-Lin Chen
- Department of sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Bin Xie
- Second School of Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Wen-Yi Zhang
- Second School of Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yu-Jie Yang
- Second School of Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yu-Shan Yue
- Second School of Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Xue-Qiang Wang
- Department of sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| |
Collapse
|
50
|
Braun SI, Kim Y, Jetton AE, Kang M, Morgan DW. Prediction of bone mineral density and content from measures of physical activity and sedentary behavior in younger and older females. Prev Med Rep 2015; 2:300-5. [PMID: 26844085 PMCID: PMC4721477 DOI: 10.1016/j.pmedr.2015.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Little is known regarding the extent to which physical activity (PA) and sedentary behavior (SB) influence bone mineral content (BMC) and bone mineral density (BMD) in females across the lifespan. METHODS Data from 2232 females aged 12 years and older collected as part of the 2007-2008 National Health and Nutrition Examination Survey were analyzed. Categories of PA and SB were used to predict femoral and spinal BMD and BMC in four age groups (G1: 12-17; G2: 18-39; G3: 40-64; G4: ≥ 65 years). Self-reported PA categories included sufficient moderate-to-vigorous recreational PA (S-MVRPA) and insufficient MVRPA (I-MVRPA). RESULTS G1 females who accumulated S-MVRPA displayed greater femoral and spinal BMC and BMD compared to G1 females who displayed I-MVRPA. For G4 females, higher levels of SB were associated with lower femoral BMC and BMD. CONCLUSIONS These findings highlight the importance of engaging in sufficient moderate-to-vigorous physical activity during adolescence and reducing sedentary behavior in older adults to improve bone health in females.
Collapse
Affiliation(s)
- Saori I Braun
- Department of Health and Human Performance, Middle Tennessee State University, 1301 E. Main St., Murfreesboro, TN 37132, USA
| | - Youngdeok Kim
- Department of Health and Human Performance, Middle Tennessee State University, 1301 E. Main St., Murfreesboro, TN 37132, USA
| | - Amy E Jetton
- Department of Biology, Middle Tennessee State University, 1301 E. Main St., Murfreesboro, TN 37132, USA
| | - Minsoo Kang
- Department of Health and Human Performance, Middle Tennessee State University, 1301 E. Main St., Murfreesboro, TN 37132, USA
| | - Don W Morgan
- Department of Health and Human Performance, Middle Tennessee State University, 1301 E. Main St., Murfreesboro, TN 37132, USA
| |
Collapse
|