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Tai TW, Tsai YL, Shih CA, Li CC, Chang YF, Huang CF, Cheng TT, Hwang JS, Lu TH, Wu CH. Refracture risk and all-cause mortality after vertebral fragility fractures: Anti-osteoporotic medications matter. J Formos Med Assoc 2023; 122 Suppl 1:S65-S73. [PMID: 37120337 DOI: 10.1016/j.jfma.2023.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Osteoporotic vertebral fractures may predict the future occurrence of fractures and increase mortality. Treating underlying osteoporosis may prevent second fractures. However, whether anti-osteoporotic treatment can reduce the mortality rate is not clear. The aim of this population study was to identify the degree of decreased mortality following the use of anti-osteoporotic medication after vertebral fractures. METHODS We identified patients who had newly diagnosed osteoporosis and vertebral fractures from 2009 to 2019 using the Taiwan National Health Insurance Research Database (NHIRD). We used national death registration data to determine the overall mortality rate. RESULTS There were 59,926 patients with osteoporotic vertebral fractures included in this study. After excluding patients with short-term mortality, patients who had previously received anti-osteoporotic medications had a lower refracture rate as well as a lower mortality risk (hazard ratio (HR): 0.84, 95% confidence interval (CI): 0.81-0.88). Patients receiving treatment for more than 3 years had a much lower mortality risk (HR: 0.53, 95% CI: 0.50-0.57). Patients who used oral bisphosphonates (alendronate and risedronate, HR: 0.95, 95% CI: 0.90-1.00), intravenous zoledronic acid (HR: 0.83, 95% CI: 0.74-0.93), and subcutaneous denosumab injections (HR: 0.71, 95% CI: 0.65-0.77) had lower mortality rates than patients without further treatment after vertebral fractures. CONCLUSION In addition to fracture prevention, anti-osteoporotic treatments for patients with vertebral fractures were associated with a reduction in mortality. A longer duration of treatment and the use of long-acting drugs was also associated with lower mortality.
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Affiliation(s)
- Ta-Wei Tai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Lun Tsai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Chun Li
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yin-Fan Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Feng Huang
- Division of Family Medicine, En Chu Kong Hospital, New Taipei City, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jawl-Shan Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chih-Hsing Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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2
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Ide H, Akehi Y, Fukuhara S, Ohira S, Ogawa S, Kataoka T, Kumagai H, Kobayashi K, Komiya A, Shigehara K, Syuto T, Soh J, Tanabe M, Taniguchi H, Chiba K, Matsushita K, Mitsui Y, Yoneyama T, Shirakawa T, Fujii Y, Kumano H, Ueshiba H, Amano T, Sasaki H, Maeda S, Mizokami A, Suzuki K, Horie S. Summary of the clinical practice manual for late-onset hypogonadism. Int J Urol 2023; 30:422-430. [PMID: 36757880 DOI: 10.1111/iju.15160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/15/2023] [Indexed: 02/10/2023]
Abstract
Testosterone plays an important role in maintaining both physical and mental function. Age-related testosterone depletion contributes to the development of angina, arteriosclerosis, obesity, metabolic syndrome, dementia, frailty, and a range of other conditions. A condition involving age-related testosterone depletion and the associated clinical symptoms is defined as late-onset hypogonadism (LOH). LOH is treated by testosterone replacement therapy. Indications for testosterone replacement therapy are determined by evaluating symptoms and signs.
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Affiliation(s)
- Hisamitsu Ide
- Department of Urology, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Yuko Akehi
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Shinichiro Fukuhara
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shin Ohira
- Department of Urology, Kawasaki Medical School, Okayama, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoya Kataoka
- Department of Clinical Pharmaceutics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Hiroshi Kumagai
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Ko Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Akira Komiya
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Takahiro Syuto
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Jintetu Soh
- Department of Urology, Japanese Red Cross Society Kyoto Daini, Kyoto, Japan
| | - Makito Tanabe
- Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Koji Chiba
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazuhito Matsushita
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yozo Mitsui
- Department of Urology, Toho University School of Medicine, Tokyo, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Tomoya Shirakawa
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroaki Kumano
- Faculty of Human Sciences, Waseda University, Saitama, Japan
| | - Hajime Ueshiba
- Division of Diabetes, Metabolism and Endocrinology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Toshiyasu Amano
- Department of Urology, Nagano Red Cross Hospital, Nagano, Japan
| | - Haruaki Sasaki
- Department of Urology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Seiji Maeda
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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3
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Tai TW, Hwang JS, Li CC, Hsu JC, Chang CW, Wu CH. The Impact of Various Anti-Osteoporosis Drugs on All-Cause Mortality After Hip Fractures: A Nationwide Population Study. J Bone Miner Res 2022; 37:1520-1526. [PMID: 35689432 DOI: 10.1002/jbmr.4627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/24/2022] [Accepted: 06/04/2022] [Indexed: 12/27/2022]
Abstract
Anti-osteoporosis treatment following hip fractures may reduce the overall mortality rate. However, the effects of different drugs on mortality is still unclear. This population-based cohort study aimed to identify the degree of reduced mortality after various anti-osteoporosis regimens following hip fracture surgery. We conducted this cohort study to identify patients with newly diagnosed osteoporosis and hip fractures from 2009 to 2017 using the Taiwan National Health Insurance Research Database (NHIRD). The subsequent use of anti-osteoporosis medication following hip fracture surgery was collected and analyzed. National death registration records were retrieved to determine mortality. A total of 45,226 new cases of osteoporotic hip fracture were identified. Compared with patients who did not receive further treatment, patients who had ever used oral bisphosphonates (alendronate and risedronate, hazard ratio [HR] 0.81; 95% confidence interval [CI], 0.78-0.84), ibandronate (HR 0.76; 95% CI, 0.67-0.86), zoledronic acid (HR 0.70; 95% CI, 0.64-0.76), and denosumab (HR 0.64; 95% CI, 0.60-0.68) showed lower all-cause mortality rates. Patients treated with bisphosphonates had a lower mortality risk than those treated with selective estrogen receptor modulators (HR 0.81; 95% CI, 0.75-0.87). Patients treated with zoledronic acid showed a lower mortality risk than those treated with oral bisphosphonates (HR 0.89; 95% CI, 0.82-0.97). However, patients receiving denosumab and zoledronic acid did not show a significant difference in mortality (HR 0.94; 95% CI, 0.85-1.03). Different anti-osteoporosis treatments for postsurgical patients were associated with different levels of decline in mortality. Generally, longer durations of drug use were associated with lower mortality. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Ta-Wei Tai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jawl-Shan Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Chun Li
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jason C Hsu
- International PhD Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan.,Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan.,Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Chih-Wei Chang
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsing Wu
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Li CC, Hsu JC, Liang FW, Chang YF, Chiu CJ, Wu CH. The association between osteoporosis medications and lowered all-cause mortality after hip or vertebral fracture in older and oldest-old adults: a nationwide population-based study. Aging (Albany NY) 2022; 14:2239-2251. [PMID: 35232893 PMCID: PMC8954959 DOI: 10.18632/aging.203927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/15/2022] [Indexed: 11/29/2022]
Abstract
Background: Osteoporotic fracture is a common public-health problem in ageing societies. Although post-fracture usage of osteoporosis medications may reduce mortality, recent results have been inconsistent. We aimed to examine associations between osteoporosis medication and mortality in older adults, particularly oldest-old adults (>=85 years old). Methods: Participants aged 65 years old and older newly diagnosed with both osteoporosis and hip or vertebral fractures within 2009-2017 were recruited from the records of 23,455,164 people in Taiwan National Health Insurance Research Database (NHIRD). Osteoporosis medication exposure was calculated after the first-time ambulatory visit with newly diagnosed osteoporosis. Mortality and its specific causes were ascertained from Cause of Death Data. Patients were followed until death or censored at the end of 2018. Results: A total of 87,935 participants aged 65 years old and over (73.4% female), with a mean 4.13 follow-up years, were included. Taking medication was associated with significantly lower risk of mortality (hip fracture HR 0.75, vertebral fracture HR 0.74), even in the oldest-old adults (hip fracture HR 0.76, vertebral fracture HR 0.72), where a longer duration of taking osteoporosis medication was associated with lower all-cause mortality. Specific causes of mortality were also significantly lower for participants taking osteoporosis medication (cancer HR 0.84 in hip fracture, 0.75 in vertebral fracture; cardiovascular disease HR 0.85 in hip fracture, 0.91 in vertebral fracture). Conclusions: Osteoporosis medication after hip or vertebral fracture may reduce mortality risk in older adults, notably in oldest-old adults. Encouraging the use of post-fracture osteoporosis medication in healthcare policies is warranted.
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Affiliation(s)
- Chia-Chun Li
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jason C Hsu
- International PhD Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan.,Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan.,Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei, Taiwan.,Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Fu-Wen Liang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yin-Fan Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Ju Chiu
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsing Wu
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Fluck B, Yeong K, Lisk R, Watters H, Robin J, Fluck D, Fry CH, Han TS. Changes in Characteristics and Outcomes of Patients Undergoing Surgery for Hip Fractures Following the Initiation of Orthogeriatric Service: Temporal Trend Analysis. Calcif Tissue Int 2022; 110:185-195. [PMID: 34448887 PMCID: PMC8784364 DOI: 10.1007/s00223-021-00906-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Abstract
The Blue Book published by the British Orthopaedic Association and British Geriatrics Society, together with the introduction of National Hip Fracture Database Audit and Best Practice Tariff, have been influential in improving hip fracture care. We examined ten-year (2009-2019) changes in hip fracture outcomes after establishing an orthogeriatric service based on these initiatives, in 1081 men and 2891 women (mean age = 83.5 ± 9.1 years). Temporal trends in the annual percentage change (APC) of outcomes were identified using the Joinpoint Regression Program v4.7.0.0. The proportions of patients operated beyond 36 h of admission fell sharply during the first two years: APC = - 53.7% (95% CI - 68.3, - 5.2, P = 0.003), followed by a small rise thereafter: APC = 5.8% (95% CI 0.5, 11.3, P = 0.036). Hip surgery increased progressively in patients > 90 years old: APC = 3.3 (95% CI 1.0, 5.8, P = 0.011) and those with American Society of Anaesthesiologists grade ≥ 3: APC = 12.4 (95% CI 8.8, 16.1, P < 0.001). There was a significant decline in pressure ulcers amongst patients < 90 years old: APC = - 17.9 (95% CI - 32.7, 0.0, P = 0.050) and also a significant decline in mortality amongst those > 90 years old: APC = - 7.1 (95% CI - 12.6, - 1.3, P = 0.024). Prolonged length of stay (> 23 days) declined from 2013: APC = - 24.6% (95% CI - 31.2, - 17.4, P < 0.001). New discharge to nursing care declined moderately over 2009-2016 (APC = - 10.6, 95% CI - 17.2, - 2.7, P = 0.017) and sharply thereafter (APC = - 47.5%, 95%CI - 71.7, - 2.7, P = 0.043). The rate of patients returning home was decreasing (APC = - 2.9, 95% CI - 5.1, - 0.7, P = 0.016), whilst new discharge to rehabilitation was increasing (APC = 8.4, 95% CI 4.0, 13.0; P = 0.002). In conclusion, the establishment of an orthogeriatric service was associated with a reduction of elapsed time to hip surgery, a progressive increase in surgery carried out on high-risk adults and a decline in adverse outcomes.
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Affiliation(s)
- Ben Fluck
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, TW20 0EX, Surrey, UK
| | - Keefai Yeong
- Department of Orthogeriatrics, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Radcliffe Lisk
- Department of Orthogeriatrics, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Hazel Watters
- Department of Orthogeriatrics, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, TW20 0EX, Surrey, UK.
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6
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Tai TW, Li CC, Huang CF, Chan WP, Wu CH. Treatment of osteoporosis after hip fracture is associated with lower all-cause mortality: A nationwide population study. Bone 2022; 154:116216. [PMID: 34571203 DOI: 10.1016/j.bone.2021.116216] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/11/2021] [Accepted: 09/21/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Mortality after osteoporotic hip fractures is high. Postoperative care is as important as surgery itself to prevent a second fracture and improve outcomes, and the effect of anti-osteoporosis treatment after hip fractures on overall mortality is controversial. This nationwide population study aimed to determine whether anti-osteoporosis treatment might reduce overall mortality after hip fracture surgery. METHODS We conducted this cohort study using the National Health Insurance Research Database (NHIRD) of Taiwan to identify patients admitted for surgery due to hip fractures from 2008 to 2018. The subsequent use and duration of anti-osteoporotic medication and other parameters were analyzed, and national death registration records were retrieved to investigate mortality. RESULTS A total of 59,943 patients admitted for hip fracture surgery were identified. The 22,494 patients (37.5%) who received anti-osteoporotic medication showed a lower all-cause mortality rate compared with the 37,449 patients (62.5%) who did not receive further treatment (hazard ratio (HR): 0.69, 95% confidence interval (CI): 0.67-0.70, p < 0.0001). Patients who received anti-osteoporotic medication for more than 1, 2, and 3 years exhibited propotional reductions in all-cause mortality (HR & 95%CI: 0.57 (0.54-0.60), 0.42 (0.38-0.46), and 0.29 (0.26-0.33) respectively). CONCLUSION Anti-osteoporosis treatment was associated with lower all-cause mortality after hip fracture surgery. A longer duration of treatment was also associated with lower mortality. Postoperative treatment for osteoporosis is crucial for patients with hip fracture.
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Affiliation(s)
- Ta-Wei Tai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Chun Li
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Feng Huang
- Department of Family Medicine, National Yang Ming Chiao Tung University Hospital, I-Lan, Taiwan
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Chih-Hsing Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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7
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Park CW, Lim SJ, Moon YW, Choi SH, Shin MH, Min YK, Yoon BK, Park YS. Fracture recurrence in hip fracture with menopausal hormone therapy versus risedronate: a clinical trial. Climacteric 2021; 24:408-414. [PMID: 34240673 DOI: 10.1080/13697137.2021.1915271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES An open-label, randomized trial was conducted to examine the effects of risedronate versus menopausal hormone therapy (MHT) in postmenopausal women with recent hip fracture. METHODS Among 1165 eligible women, 281 were recruited and randomly assigned to receive oral risedronate (35 mg/week) or percutaneous estradiol gel (1.5 mg/day) plus oral micronized progesterone (100 mg/day) for 4 years. The primary end point was recurrent fracture and the secondary end points were mortality and bone mineral density (BMD). RESULTS Kaplan-Meier analyses showed no significant differences in fracture recurrence and mortality between the two groups. The incidence of any new fracture per 100 person-years (PY) was 8.63 in the risedronate group and 12.86 in the MHT group (p = 0.180); that of clinical fracture was 4.75 and 6.99, respectively (p = 0.265); and that of asymptomatic vertebral fracture was 4.87 and 5.58, respectively (p = 0.764). The respective incidence of death per 100 PY was 3.58 and 4.40 (p = 0.503). BMD increased comparably at the lumbar spine in both groups. BMD at the total hip did not change in the risedronate group, but increased significantly by 2.8% in the MHT group. CONCLUSIONS MHT might not differ from risedronate in the prevention of secondary fractures and death among postmenopausal women with recent hip fracture.
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Affiliation(s)
- C-W Park
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - S-J Lim
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Y-W Moon
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - S-H Choi
- Department of Radiology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - M-H Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Y-K Min
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - B-K Yoon
- Department of Obstetrics, Gynecology and Women's Health, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Y-S Park
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
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8
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Dobre R, Niculescu DA, Petca RC, Popescu RI, Petca A, Poiană C. Adherence to Anti-Osteoporotic Treatment and Clinical Implications after Hip Fracture: A Systematic Review. J Pers Med 2021; 11:jpm11050341. [PMID: 33923261 PMCID: PMC8146075 DOI: 10.3390/jpm11050341] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 12/18/2022] Open
Abstract
The role of anti-osteoporotic treatment as part of the secondary prevention after hip fracture in terms of mortality and re-fracture risk has been studied, and the results are promising. Decreased treatment adherence and compliance is a problem that needs to be addressed by healthcare professionals. A systematic review of the literature was performed using the PubMed database with terms that included hip fracture, mortality, second fracture, and specific anti-osteoporotic treatment. We included 28 articles, 21 regarding mortality and 20 re-fracture rates in hip fracture patients. All studies showed lower mortality after hip fracture associated with anti-osteoporotic treatment, mostly bisphosphonate agents. The re-fracture risk is still debatable, since conflicting data were found. Although most of the studies showed notable effects on mortality and re-fracture rates associated with anti-osteoporotic treatment, we still need more data to validate the actual results.
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Affiliation(s)
- Ramona Dobre
- “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.N.); (R.-C.P.); (R.-I.P.); (A.P.); (C.P.)
- Department of Endocrinology, National Institute of Endocrinology CI Parhon, 011853 Bucharest, Romania
- Correspondence: ; Tel.: +40-770-597590
| | - Dan Alexandru Niculescu
- “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.N.); (R.-C.P.); (R.-I.P.); (A.P.); (C.P.)
- Department of Endocrinology, National Institute of Endocrinology CI Parhon, 011853 Bucharest, Romania
| | - Răzvan-Cosmin Petca
- “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.N.); (R.-C.P.); (R.-I.P.); (A.P.); (C.P.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 050659 Bucharest, Romania
| | - Răzvan-Ionuț Popescu
- “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.N.); (R.-C.P.); (R.-I.P.); (A.P.); (C.P.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 050659 Bucharest, Romania
| | - Aida Petca
- “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.N.); (R.-C.P.); (R.-I.P.); (A.P.); (C.P.)
- Department of Obstetrics and Gynecology, Elias University Hospital, 011461 Bucharest, Romania
| | - Cătălina Poiană
- “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.N.); (R.-C.P.); (R.-I.P.); (A.P.); (C.P.)
- Department of Endocrinology, National Institute of Endocrinology CI Parhon, 011853 Bucharest, Romania
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9
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Abstract
Bisphosphonates are first line agents used to treat osteoporosis and reduce fracture rate. They bind to areas of exposed calcium in the skeleton and cause osteoclast apoptosis, thereby leading to a reduction in remodelling rates. They are also used to decrease skeletal complications of some cancers including a reduction in bone metastases. Following the landmark randomised controlled trial of zoledronate post hip fracture (HORIZON) in which an unexpected survival benefit was found, there has been increasing interest in their potential ability to increase lifespan. This review will consider the clinical evidence for their effect on mortality in both the osteoporosis and non-osteoporosis settings, the latter including studies in intensive care, cancer and cardiovascular disease. Where evidence exists, this review will briefly discuss some of the postulated mechanisms for this survival benefit.
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Affiliation(s)
- Jacqueline R Center
- Bone Biology, Garvan Institute of Medical Research, Sydney, Australia; St Vincent's Hospital Clinical School, Faculty of Medicine, UNSW Sydney, Australia.
| | | | - Dana Bliuc
- Bone Biology, Garvan Institute of Medical Research, Sydney, Australia; St Vincent's Hospital Clinical School, Faculty of Medicine, UNSW Sydney, Australia
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10
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Abstract
BACKGROUND Bone health is underdiagnosed and undermanaged in men. Bone loss occurs in men with hypogonadism and in aging men. Thus, patients with a diagnosis of late-onset hypogonadism (LOH) are at risk of osteoporosis and osteoporotic fractures. OBJECTIVES To provide an update on research data and clinical implications regarding bone health in men with LOH by reviewing literature articles on this issue. MATERIALS AND METHODS A thorough search of listed publications in PubMed on bone health in older men with hypogonadism was performed, and other articles derived from these publications were further identified. RESULTS Late-onset Hypogonadism may be associated with reduced bone mineral density (BMD). In a pathophysiological perspective, the detrimental effects of testosterone (T) deficiency on BMD are partly ascribed to relative estrogen deficiency and both serum T and serum estradiol (E2) need to be above 200 ng/dL and 20 pg/mL to prevent bone loss. The effects of exogenous T on BMD are controversial, but most of the studies confirm that testosterone replacement therapy (TRT) increases BMD and prevents further bone loss in men with hypogonadism. No data are available on TRT and the prevention of fractures. DISCUSSION AND CONCLUSION In men with documented LOH, a specific clinical workup should be addressed to the diagnosis of osteoporosis in order to program subsequent follow-up and consider specific bone active therapy. TRT should be started according to guidelines of male hypogonadism while keeping in mind that it may also have positive effects also on bone health in men with LOH.
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Affiliation(s)
- Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
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11
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González-Quevedo D, Bautista-Enrique D, Pérez-Del-Río V, Bravo-Bardají M, García-de-Quevedo D, Tamimi I. Fracture liaison service and mortality in elderly hip fracture patients: a prospective cohort study. Osteoporos Int 2020; 31:77-84. [PMID: 31511912 DOI: 10.1007/s00198-019-05153-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/29/2019] [Indexed: 01/02/2023]
Abstract
UNLABELLED Osteoporosis is a metabolic disorder that results in increased bone fragility and risk of fractures. Hip fracture is the most important fragility fracture. Fracture Liaison Service (FLS) is a secondary prevention model which identifies patients at risk for fragility fractures. The introduction of an intensive FLS model could decrease 1-year-mortality of hip fracture patients. INTRODUCTION Hip fractures are a clinical manifestation of osteoporosis, and these patients are at risk of premature death and suffering subsequent fractures. FLS is an approach for secondary facture prevention by identifying patients with fragility fractures and initiating the appropriate treatment. Our objective is to analyze the effect of the FLS model over the first-year mortality rates following a hip fracture. METHODS We conducted a prospective cohort study on patients over 60 years of age who suffered a hip fracture during two consecutive years, before and after the implementation of the FLS in our center (i.e., between January 2016 and December 2017). Patients' information was withdrawn from our local computerized database. Patients were followed for 1 year after the hip fracture. Mortality and re-fracture rates were compared between the two groups using a multivariate Cox proportional hazard model. RESULTS A total of 724 individuals were included in this study (i.e., 357 before FLS implementation and 367 after FLS implementation). Anti-osteoporotic drugs were more frequently prescribed after FLS implementation [275 (74.9%) vs 44 (12.3%); p < 0.01]. A total of 74 (20.2%) patients after FLS implementation and 92 (25.8%) individuals before FLS implementation (p = 0.07) died during the follow-up period. A second fracture occurred in 17 (4.6%) patients after FLS implementation and 13 (3.6%) individuals before FLS implementation (p = 0.50). Patients who were treated with anti-osteoporotic drugs after the implementation of the FLS protocol had a lower 1-year mortality compared with patients managed before the implementation of the FLS protocol (treated or not treated with anti-osteoporotic drugs) [adjusted hazard ratio (HR) 0.66; 95% confidence interval (CI) 0.47-0.94; p < 0.05]. CONCLUSIONS We did not observe significant 1-year-mortality differences following a hip fracture between patients treated before the implementation of an FLS protocol and patients treated after its implementation. The application of the FLS did not affect the risk of suffering a second osteoporotic fracture. However, patients treated with anti-osteoporotic drugs in an FLS context had a lower mortality rate compared with patients managed before the implementation of the FLS. LEVEL OF CLINICAL EVIDENCE 2.
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Affiliation(s)
- D González-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain.
| | - D Bautista-Enrique
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - V Pérez-Del-Río
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - M Bravo-Bardají
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - D García-de-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - I Tamimi
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
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12
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Singh S, Whitehurst DG, Funnell L, Scott V, MacDonald V, Leung PM, Friesen K, Feldman F. Breaking the cycle of recurrent fracture: implementing the first fracture liaison service (FLS) in British Columbia, Canada. Arch Osteoporos 2019; 14:116. [PMID: 31776684 DOI: 10.1007/s11657-019-0662-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/21/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Fractures occurring with very little trauma are often caused by osteoporosis and can lead to disability. This study demonstrates that a coordinator working with an orthopaedic team can significantly increase the number of individuals receiving appropriate treatments during their after-fracture care to prevent future fractures from occurring. PURPOSE Well-implemented Fracture Liaison Service (FLS) programs increase appropriate investigation and treatment for osteoporosis after low trauma fracture. This research evaluates the effectiveness of the first FLS program implemented in British Columbia (BC), Canada. METHODS A controlled before-and-after study was conducted. The intervention was an FLS program implemented at an orthopaedic outpatient clinic at Peace Arch Hospital in BC. Eligible patients were those over the age of 50 years with a low trauma fracture of the hip, pelvis, vertebra, wrist or humerus. A nurse practitioner FLS coordinator identified, investigated and initiated treatment in patients based on their future fracture risk. The primary outcome was the percentage of all patients at high-risk to refracture, who achieved at least one of the following outcomes: (1) started on osteoporosis medication, (2) referred to an osteoporosis consultant or (3) assessed for treatment change if they were already on osteoporosis medication at the time of the fracture. Secondary outcomes included the rate of bone density testing, referral to fall prevention programs and change in health-related quality of life over 6 months. RESULTS A total of 195 patients participated in the study (65 in the usual care group, 130 in the FLS group). Average age was 70.5 years (standard deviation 11.5), and 84% of participants were female. In the FLS group, 77.8% of high-risk patients achieved the primary outcome compared with 22.9% in the usual care group. CONCLUSION In BC, the implementation of an FLS program improved investigation and treatment for osteoporosis after low trauma fracture.
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Affiliation(s)
- Sonia Singh
- Fraser Health Authority, Surrey, British Columbia, Canada. .,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. .,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - David Gt Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | | | - Vicky Scott
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Pet-Ming Leung
- Fraser Health Authority, Surrey, British Columbia, Canada
| | | | - Fabio Feldman
- Fraser Health Authority, Surrey, British Columbia, Canada.,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
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13
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Bliuc D, Tran T, van Geel T, Adachi JD, Berger C, van den Bergh J, Eisman JA, Geusens P, Goltzman D, Hanley DA, Josse R, Kaiser S, Kovacs CS, Langsetmo L, Prior JC, Nguyen TV, Center JR. Reduced Bone Loss Is Associated With Reduced Mortality Risk in Subjects Exposed to Nitrogen Bisphosphonates: A Mediation Analysis. J Bone Miner Res 2019; 34:2001-2011. [PMID: 31402509 DOI: 10.1002/jbmr.3816] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/24/2019] [Accepted: 06/02/2019] [Indexed: 12/12/2022]
Abstract
Bisphosphonates, potent antiresorptive agents, have been found to be associated with mortality reduction. Accelerated bone loss is, in itself, an independent predictor of mortality risk, but the relationship between bisphosphonates, bone loss, and mortality is unknown. This study aimed to determine whether the association between bisphosphonates and mortality is mediated by a reduction in the rate of bone loss. Participants from the population-based Canadian Multicentre Osteoporosis Study were followed prospectively between1996 and 2011. Comorbidities and lifestyle factors were collected at baseline and bone mineral density (BMD) at baseline and at years 3 (for those aged 40 to 60 years), 5, and 10. Rate of bone loss was calculated using linear regression. Information on medication use was obtained yearly. Bisphosphonate users grouped into nitrogen bisphosphonates (nBP; alendronate or risedronate) and etidronate and non-users (NoRx) were matched by propensity score, including all baseline factors as well as time of treatment. Cox's proportional hazards models, unadjusted and adjusted for annual rate of bone loss, were used to determine the association between nBP and etidronate versus NoRx. For the treatment groups with significant mortality risk reduction, the percent of mortality reduction mediated by a reduction in the rate of bone loss was estimated using a causal mediation analysis. There were 271 pairs of nBP and matched NoRx and 327 pairs of etidronate and matched NoRx. nBP but not etidronate use was associated with significant mortality risk reduction (hazard ratios [HR] = 0.61 [95% confidence interval 0.39-0.96] and 1.35 [95% CI 0.86-2.11] for nBP and etidronate, respectively). Rapid bone loss was associated with more than 2-fold increased mortality risk compared with no loss. Mediation analysis indicated that 39% (95% CI 7%-84%) of the nBP association with mortality was related to a reduction in the rate of bone loss. This finding provides an insight into the mechanism of the relationship between nBP and survival benefit in osteoporotic patients. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Dana Bliuc
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,St Vincent's Clinical School, UNSW Sydney
| | - Thach Tran
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,St Vincent's Clinical School, UNSW Sydney
| | - Tineke van Geel
- Máxima Medical Center, Department of Data & Analytics, MB Veldhoven, Netherlands
| | | | - Claudie Berger
- CaMos National Coordinating Centre, McGill University, Montreal, Canada
| | - Joop van den Bergh
- Maastricht University Medical Center, Research School Nutrim, Department of Internal Medicine, Subdivision of Rheumatology, Maastricht, Netherlands.,VieCuri Medical Centre of Noord-Limburg, Department of Internal Medicine, Venlo, Netherlands
| | - John A Eisman
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Máxima Medical Center, Department of Data & Analytics, MB Veldhoven, Netherlands.,Clinical School, St Vincent's Hospital, Faculty of Medicine, UNSW Australia, Sydney, Australia.,School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia.,St Vincent's Clinical School, UNSW Sydney
| | - Piet Geusens
- University Hasselt, Biomedical Research Institute, Hasselt, Belgium
| | - David Goltzman
- Department of Medicine, McGill University, Montreal, Canada
| | - David A Hanley
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Robert Josse
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | | | - Lisa Langsetmo
- School of Public Health, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - Jerilynn C Prior
- Department of Medicine and Endocrinology, University of British Columbia, Vancouver, Canada
| | - Tuan V Nguyen
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Clinical School, St Vincent's Hospital, Faculty of Medicine, UNSW Australia, Sydney, Australia.,School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia.,School of Biomedical Engineering, University of Technology, Sydney (UTS), Australia.,St Vincent's Clinical School, UNSW Sydney
| | - Jacqueline R Center
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Clinical School, St Vincent's Hospital, Faculty of Medicine, UNSW Australia, Sydney, Australia.,St Vincent's Clinical School, UNSW Sydney
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14
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Abstract
IMPORTANCE Previous studies have reported that drug treatments, particularly treatment with bisphosphonates, is associated with reduced overall mortality rates in addition to decreased fracture risk. If so, drug treatments should be recommended for this reason alone, regardless of a patient's risk of fracture. OBJECTIVE To assess whether randomized clinical trials demonstrate that treatment with bisphosphonates, particularly zoledronate, is associated with reduced mortality rates. DATA SOURCES Science Direct, MEDLINE, Embase, and the Cochrane Library were searched for randomized placebo-controlled clinical trials of drug treatments for osteoporosis published after 2009 and published or in press before April 19, 2019. Conference abstracts from annual osteoporosis society meetings were also included in the search. STUDY SELECTION Included studies were clinical trials that (1) were randomized and placebo-controlled; (2) studied drug treatments with proven antifracture efficacy; (3) used agents at the approved dose for treatment of osteoporosis; and (4) had a duration of 1 year or more. Abstracts from the literature searches were reviewed for inclusion and exclusion criteria, and mortality rate data were abstracted from the article by 1 researcher and validated by a second. A total of 2045 records were screened; 38 (1.8%) were included in the meta-analyses. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist was followed for abstracting data and assessing data quality and validity. Data were pooled using random-effects models, and between-study variability was assessed using the I2 index. The risk of bias for each study was assessed, and funnel plots and Egger and Begg statistics were used to evaluate publication bias. MAIN OUTCOMES AND MEASURES Associations of all drug treatments, particularly bisphosphonate and zoledronate treatments, with overall mortality. RESULTS Of 38 clinical trials that included 101 642 unique participants, 38 were included in the meta-analyses of all drug treatments (45 594 participants randomized to placebo; 56 048 to treatment); 21 clinical trials, of bisphosphonate treatments (20 244 participants randomized to placebo; 22 623 to treatment); and 6 clinical trials, of zoledronate treatments (6944 participants randomized to placebo; 6926 to treatment). No significant association was found between all drug treatments for osteoporosis and overall mortality rate (risk ratio [RR], 0.98; 95% CI, 0.91-1.05; I2 = 0%). Clinical trials of bisphosphonate treatment (RR, 0.95; 95% CI, 0.86-1.04) showed no significant association with overall mortality. Also, clinical trials of zoledronate treatment (RR, 0.88; 95% CI, 0.68-1.13) showed no association with overall mortality rate; however, evidence existed for heterogeneity of the results (I2 = 48.2%). CONCLUSIONS AND RELEVANCE Results of this meta-analysis suggest that bisphosphonate treatment may not be associated with reduced overall mortality rates in addition to decreased fracture risk and should only be recommended to reduce fracture risk. Additional trials are needed to clarify whether treatment with zoledronate reduces mortality rates.
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Affiliation(s)
- Steven R Cummings
- San Francisco Coordinating Center, San Francisco, California.,California Pacific Medical Center Research Institute, San Francisco.,Department of Medicine, University of California San Francisco, San Francisco.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco
| | - Li-Yung Lui
- San Francisco Coordinating Center, San Francisco, California.,California Pacific Medical Center Research Institute, San Francisco
| | - Richard Eastell
- Sheffield Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Isabel E Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco
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15
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Yu SF, Cheng JS, Chen YC, Chen JF, Hsu CY, Lai HM, Ko CH, Chiu WC, Su YJ, Cheng TT. Adherence to anti-osteoporosis medication associated with lower mortality following hip fracture in older adults: a nationwide propensity score-matched cohort study. BMC Geriatr 2019; 19:290. [PMID: 31660863 PMCID: PMC6819351 DOI: 10.1186/s12877-019-1278-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 09/12/2019] [Indexed: 01/31/2023] Open
Abstract
Background We investigated the association of anti-osteoporosis medication with mortality risk in older adults with hip fractures and evaluated the influence of medication adherence on mortality. Methods We conducted a population-based cohort study and identified a total of 13,123 patients aged 65 years or older with hip fracture from the Taiwan National Health Insurance Database during the period 2001–2010. Individuals with (n = 2092) and without (n = 2092) receiving anti-osteoporosis medication were matched using propensity score matching (1:1 ratio). The 1-, 3- and 5-year survival rates after the index fracture were compared between patients with and without treatment. In the treated group, survival rate was compared between those with good and non-adherence. Good adherence was defined as the medication possession ratio of ≥80% and non-adherence as a ratio < 80%. Results The 1-, 3- and 5-year mortality rates were significantly lower in the treated vs. the non-treated group (all p < 0.0001). In the treated group, the estimated 1-, 3- and 5-year survival rates were higher in those with good adherence than in those with non-adherence (all p < 0.0001). Regarding all-cause mortality, the adjusted hazard ratio in the treated vs. the non-treated group was 0.63 (95% confidence interval 0.58–0.68, p < 0.0001). The good adherence subgroup showed a significantly lower mortality risk than that in the non-adherence subgroup (hazard ratio 0.41, 95% confidence interval 0.32–0.51, p < 0.0001). Conclusions The 1-, 3- and 5-year survival rates were significantly higher in patients receiving anti-osteoporosis medication than in the untreated group. All-cause mortality rates were lower in patients with good adherence to anti-osteoporosis medication.
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Affiliation(s)
- Shan-Fu Yu
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jur-Shan Cheng
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ying-Chou Chen
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jia-Feng Chen
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chung-Yuan Hsu
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Han-Ming Lai
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Hua Ko
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Chan Chiu
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Jih Su
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung, 833, Taiwan. .,Chang Gung University College of Medicine, Taoyuan, Taiwan.
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16
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Hills JM, Khan I, Archer KR, Sivaganesan A, Daryoush J, Hong DY, Dahir KM, Devin CJ, Stephens B. Metabolic and Endocrine Disorders in Pseudarthrosis. Clin Spine Surg 2019; 32:E252-7. [PMID: 30730424 DOI: 10.1097/BSD.0000000000000788] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVE Establish 1-year patient-reported outcomes after spine surgery for symptomatic pseudarthrosis compared with other indications. In the subgroup of pseudarthrosis patients, describe preexisting metabolic and endocrine-related disorders, and identify any new diagnoses or treatments initiated by an endocrine specialist. SUMMARY OF BACKGROUND Despite surgical advances in recent decades, pseudarthrosis remains among the most common complications and indications for revision after fusion spine surgery. A better understanding of the outcomes after revision surgery for pseudarthrosis and risk factors for pseudarthrosis are needed. METHODS Using data from our institutional spine registry, we retrospectively reviewed patients undergoing elective spine surgery between October 2010 and November 2016. Patients were stratified by surgical indication (pseudarthrosis vs. not pseudarthrosis), and 1-year outcomes for satisfaction, disability, quality of life, and pain were compared. In a descriptive subgroup analysis of pseudarthrosis patients, we identified preexisting endocrine-related disorders, frequency of endocrinology referral, and any new diagnoses and treatments initiated through the referral. RESULTS Of 2721 patients included, 169 patients underwent surgery for pseudarthrosis. No significant difference was found in 1-year satisfaction between pseudarthrosis and nonpseudarthrosis groups (77.5% vs. 83.6%, respectively). A preexisting endocrine-related disorder was identified in 82% of pseudarthrosis patients. Endocrinology referral resulted in a new diagnosis or treatment modification in 58 of 59 patients referred. The most common diagnoses identified included osteoporosis, vitamin D deficiency, diabetes, hyperlipidemia, sex-hormone deficiency, and hypothyroidism. The most common treatments initiated through endocrinology were anabolic agents (teriparatide and abaloparatide), calcium, and vitamin D supplementation. CONCLUSIONS Patients undergoing revision spine surgery for pseudarthrosis had similar 1-year satisfaction rates to other surgical indications. In conjunction with a bone metabolic specialist, our descriptive analysis of endocrine-related disorders among patients with a pseudarthrosis can guide protocols for workup, indications for endocrine referral, and guide prospective studies in this field.
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17
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Bliuc D, Tran T, van Geel T, Adachi JD, Berger C, van den Bergh J, Eisman JA, Geusens P, Goltzman D, Hanley DA, Josse RG, Kaiser S, Kovacs CS, Langsetmo L, Prior JC, Nguyen TV, Center JR. Mortality risk reduction differs according to bisphosphonate class: a 15-year observational study. Osteoporos Int 2019; 30:817-828. [PMID: 30607457 DOI: 10.1007/s00198-018-4806-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/11/2018] [Indexed: 11/26/2022]
Abstract
UNLABELLED In this prospective cohort of 6120 participants aged 50+, nitrogen-bisphosphonates but not non-nitrogen bisphosphonates were associated with a significant 34% mortality risk reduction compared to non-treated propensity score matched controls. These findings open new avenues for research into mechanistic pathways. INTRODUCTION Emerging evidence suggests that bisphosphonates (BP), first-line treatment of osteoporosis, are associated with reduced risks for all-cause mortality. This study aimed to determine the association between different BP types and mortality risk in participants with or without a fracture. METHODS A prospective cohort study of users of different BPs matched to non-users by propensity score (age, gender, co-morbidities, fragility fracture status) and time to starting the BP medication from the population-based Canadian Multicentre Osteoporosis Study from nine Canadian centres followed from 1995 to 2013. Mortality risk for bisphosphonate users vs matched non-users was assessed using pairwise multivariable Cox proportional hazards models. RESULTS There were 2048 women and 308 men on BP and 1970 women and 1794 men who did not receive medication for osteoporosis. The relationship between BP and mortality risk was explored in three separate 1:1 propensity score-matched cohorts of BP users and no treatment (etidronate, n = 599, alendronate, n = 498, and risedronate n = 213). Nitrogen BP (n-BP) (alendronate and risedronate) was associated with lower mortality risks [pairwise HR, 0.66 (95% CI, 0.48-0.91)] while the less potent non-n-BP, etidronate, was not [pairwise HR: 0.89 (95% CI, 0.66-1.20)]. A direct comparison between n-BP and etidronate (n = 340 pairs) also suggested a better survival for n-BP [paired HR, 0.47 (95%CI, (95% CI, 031-0.70)] for n-BP vs. etidronate]. CONCLUSION Compared to no treatment, nitrogen but not non-nitrogen bisphosphonates appear to be associated with better survival.
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Affiliation(s)
- D Bliuc
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.
| | - T Tran
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia
| | - T van Geel
- Maastricht University Medical Center, Research School CAPHRI, Care and Public Health Research Institute, Maastricht, The Netherlands
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - C Berger
- CaMos National Coordinating Centre, McGill University, Montreal, Quebec, Canada
| | - J van den Bergh
- Research School Nutrim, Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Centre of Noord-Limburg, Venlo, The Netherlands
| | - J A Eisman
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
| | - P Geusens
- Maastricht University Medical Center, Research School CAPHRI, Care and Public Health Research Institute, Maastricht, The Netherlands
- Biomedical Research Institute, University Hasselt, Hasselt, Belgium
| | - D Goltzman
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - D A Hanley
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - R G Josse
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - S Kaiser
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - C S Kovacs
- Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - L Langsetmo
- School of Public Health, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - J C Prior
- Department of Medicine and Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada
| | - T V Nguyen
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia
- Clinical School, Faculty of Medicine, St Vincent's Hospital, UNSW, Sydney, Australia
- School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia
| | - J R Center
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia
- Clinical School, Faculty of Medicine, St Vincent's Hospital, UNSW, Sydney, Australia
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18
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Pan PJ, Lin PH, Tang GJ, Lan TY. Comparisons of mortality and rehospitalization between hip-fractured elderly with outpatient rehabilitation and those without: A STROBE-compliant article. Medicine (Baltimore) 2018; 97:e0644. [PMID: 29742704 PMCID: PMC5959428 DOI: 10.1097/md.0000000000010644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Geriatric patients with hip fractures have high mortality. This study aimed to compare the mortality and rehospitalization of recipient and nonrecipient of outpatient rehabilitation in hip-fractured elderly.This retrospective cohort study used nationwide claims data in Taiwan and included 3585 senior citizen patients admitted for hip fractures between January 1, 2005, and December 31, 2012. Patients were divided into the recipient (717) and nonrecipient (2868) of outpatient rehabilitation during the first 3 months after hospital discharge. Each patient was followed up for 1 year. Mortality rates of hip-fractured elderly after discharge during the first 3-month period in different groups were analyzed with Chi-square test. Cox proportional hazards regression model was employed for both death and rehospitalization risk analyses.The mortality rate of the rehabilitation group was lower than that of the nonrehabilitation group (12.69% vs 16.70%, P < .05). A more beneficial effect was observed for patients receiving continuous rehabilitation. The rehabilitation group had a lower adjusted risk of death [hazard ratio (HR) = 0.74; 95% confidence interval (95% CI): 0.59-0.94] than that of the nonrehabilitation group. However, the rehabilitation group was at a higher risk of rehospitalization (HR = 1.37; 95% CI: 1.22-1.55).Hip-fractured elderly receiving outpatient rehabilitation have a lower risk of death but a higher risk of rehospitalization than those not receiving rehabilitation within 1 year after fracture.
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Affiliation(s)
- Po-Jung Pan
- Department of Physical Medicine and Rehabilitation, National Yang-Ming University Hospital
- Department of Medicine, National Yang-Ming University, Taipei
| | - Pin-Hsun Lin
- Department of Medical Affairs, Kuang Tien General Hospital, Taichung
| | - Gau-Jun Tang
- Institute of Hospital & Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Tzuo-Yun Lan
- Institute of Hospital & Health Care Administration, National Yang-Ming University, Taipei, Taiwan
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Abstract
Aims The aim of this study was to compare the rate of mortality and causes of death in Korean patients who undergo surgery for a fracture of the hip, up to 11 years after the injury, with a control group from the general population. Materials and Methods National cohort data from Korean Health Insurance Review and Assessment Service – National Sample Cohort were used. A ratio of 1:4 matched patients with a fracture who underwent surgery (3383, fracture group) between 2003 and 2012, and controls (13 532) were included. The matches were processed for age, gender, income, and region of residence. We also undertook analyses of subgroups according to age and gender. The mean follow-up was 4.45 years (1 to 11). Results The prevalence of hypertension, diabetes, and stroke was significantly higher in the fracture group and dyslipidemia in the controls. Both crude and adjusted hazard ratios (HR) for the rate of mortality in the fracture group were > 2 (crude HR 2.03, 95% confidence interval (CI) 1.91 to 2.17, p < 0.001; adjusted HR 2.07, 95% CI 1.94 to 2.21, p < 0.001). The HRs were also > 2 for both men and women, and for both those aged ≥ 50 years and < 50 years. However, for those aged < 50 years, they were insignificant. The rates of mortality due to all 11 major causes of death classified following Korean standard classification of diseases were significantly higher in the fracture group compared with the control group, except those in the mental and behavioral disorders category. Conclusion The rate of mortality in the fracture group was significantly higher than in the control group up to 11 years after the surgery. The rate of death due to almost every major cause was significantly higher in the fracture group compared with the control group. Cite this article: Bone Joint J 2018;100-B:436–42.
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Affiliation(s)
- H. G. Choi
- Department of Otorhinolaryngology, Hallym
Data Science Laboratory, Hallym University College of Medicine, 22
Gwanpyeong-ro, 170 Beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, South
Korea
| | - Y. B. Lee
- Department of Orthopaedic Surgery, Hallym
University Sacred Heart Hospital, 22 Gwanpyeong-ro, 170
Beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, South
Korea
| | - S. H. Rhyu
- Department of Orthopaedic Surgery, Hallym
University Sacred Heart Hospital, 22 Gwanpyeong-ro, 170
Beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, South
Korea
| | - B. C. Kwon
- Department of Orthopaedic Surgery, Hallym
University Sacred Heart Hospital, 22 Gwanpyeong-ro, 170
Beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, South
Korea
| | - J. K. Lee
- Department of Orthopaedic Surgery, Hallym
University Sacred Heart Hospital, 22 Gwanpyeong-ro, 170
Beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, South
Korea
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20
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Edwards BJ, Sun M, Zhang X, Holmes HM, Song J, Khalil P, Karuturi M, Shah JB, Dinney CP, Gagel RF, Valero V, Champlin RE, Tripathy D, Murphy WA. Fractures frequently occur in older cancer patients: the MD Anderson Cancer Center experience. Support Care Cancer 2017; 26:1561-1568. [PMID: 29197959 DOI: 10.1007/s00520-017-3962-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE AND INTRODUCTION A growing number of cancer patients are older adults aged 65 years and older. Patients with cancer are at increased risk for developing osteoporosis, falls, and fractures. We sought to identify the incidence of fractures in older adults who underwent cancer care between January 2013 and December 2015. METHODS A comprehensive geriatric assessment was performed, and bone densitometry was measured at baseline, with a 2-year follow-up. RESULTS In this study, among 304 patients with gastrointestinal, urologic, breast, lung, and gynecologic cancers we evaluated, and who completed the bone density testing (n = 199), 80% had osteoporosis or low bone mass (osteopenia). There was a higher prevalence of osteoporosis in cancer patients (40 vs. 16%, p = 0.05) than in population studies. Vitamin D insufficiency (< 30 ng/ml) was identified in 49% of tested cases (n = 245). Risk factors for low bone mass or osteoporosis were advanced age (p = 0.05), malnutrition (p = 0.04), and frailty (p = 0.01). Over the following 2 years (median follow-up 18 months), there was an incidence of fractures of 110 per 1000 person-years, or 2.8 times higher than reported in individuals without cancer. Risk factors for fractures included advanced age (70-79 vs. 60-69 years, p = 0.05) and frailty (p = 0.03). CONCLUSION Most older cancer patients studied have osteoporosis or low bone mass, resulting in an almost 3-fold increase in fracture risk as compared to epidemiologic studies. Bone health issues are commonly seen in older cancer patients, we recommend universal bone density testing. The initiation of antiresorptive treatment when findings are of osteopenia or osteoporosis will reduce the risk of fractures.
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Affiliation(s)
- Beatrice J Edwards
- Geriatric Medicine, Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, 1400 Pressler, unit 1465, Houston, TX, 77030, USA.
| | - Ming Sun
- Geriatric Medicine, Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, 1400 Pressler, unit 1465, Houston, TX, 77030, USA
| | - Xiaotao Zhang
- Geriatric Medicine, Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, 1400 Pressler, unit 1465, Houston, TX, 77030, USA
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, University of Texas McGovern Medical School, Houston, TX, USA
| | - Juhee Song
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Khalil
- Geriatric Medicine, Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, 1400 Pressler, unit 1465, Houston, TX, 77030, USA
| | - Meghan Karuturi
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jay B Shah
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Colin P Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert F Gagel
- Geriatric Medicine, Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, 1400 Pressler, unit 1465, Houston, TX, 77030, USA
| | - Vicente Valero
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Debasish Tripathy
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William A Murphy
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Gonnelli S, Caffarelli C, Iolascon G, Bertoldo F, Letizia Mauro G, Patti A, Nuti R. Prescription of anti-osteoporosis medications after hospitalization for hip fracture: a multicentre Italian survey. Aging Clin Exp Res 2017; 29:1031-7. [PMID: 27943127 DOI: 10.1007/s40520-016-0681-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Literature data indicate that the proportion of patients with recent hip fracture who receive a prescription for anti-osteoporotic drugs is low and does not seem to increase over time. This study aimed to obtain data on the prescription for anti-osteoporotic drugs in Italian patients discharged after a recent hip fracture and to assess which variables could have influenced the decision for prescribing osteoporosis medication. METHODS A total of four Italian centres located in four different geographical areas (Siena, Verona, Naples and Palermo) participated in this retrospective study. In each centre, experienced clinicians gathered the data of up to 200 consecutive patients discharged after a recent low-trauma hip fracture. The analysis was carried out on 697 patients (540 women and 157 men; mean age 81.9 ± 8.6 years). RESULTS The percentage of patients who were receiving any type of treatment for osteoporosis before the hip fracture was 8.8% (ranging from 2.4% in Naples to 17.4% in Verona). After the index hip fracture, only 23.2% of patients (namely 10.5% of men and 27.2% of women) received prescription for any pharmacological treatments for osteoporosis. Both female gender and previous use of medications for osteoporosis were positively associated with the likelihood of receiving prescription for anti-osteoporotic treatment at discharge. CONCLUSIONS This study showed that less than 25% of the elderly Italian patients discharged after a hip fracture received a prescription for any type of treatment for osteoporosis and highlights the urgent need for implementing new strategies in the management of hip fracture patients.
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Abstract
Background The purpose of this prospective, open-label, observational study was to assess the fracture preventing effect of Maxmarvil® tablets (alendronate 5 mg + calcitriol 0.5 µg) in patients with osteoporosis and to evaluate the change in bone mineral density (BMD) at the minimum 1-year follow-up. Methods In this multicenter observational study, 691 patients with osteoporosis (aged 50 years or older) were treated with alendronate 5 mg + calcitriol 0.5 µg/day during their normal course of care. Patients were assessed at baseline and at 6 and 12 months. Baseline characteristics (including age, gender, concomitant disease, and baseline fractures) were evaluated. Results From among the 848 participants, 149 individuals were lost to follow-up at the time of the study and 8 people had died. The 691 participants (54 men and 637 women) finished the follow-up study and completed the questionnaire. The mean age of the participants was 71.5 years (range, 50–92 years; mean age, 72.3 years for men and 71.4 years for women). Osteoporotic fracture occurred in 19 patients (2.7%). BMD of the lumbar spine and hip was improved by 5% and 1.5% at the latest follow-up. At the latest follow-up, 24 patients (3.5%) complained of drug-related complications such as dyspepsia, constipation, and nausea. Conclusions This prospective observational study demonstrated that alendronate 5 mg + calcitriol 0.5 µg/day had a preventive effect on osteoporotic fracture and it increased the BMD of the lumbar spine by 5% at the latest follow-up.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ye-Yeon Won
- Department of Orthopaedic Surgery, Ajou University College of Medicine, Suwon, Korea
| | - Kyu-Hyun Yang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Bum Kim
- Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon, Korea
| | - Ju-Hyung Yoo
- Department of Orthopaedic Surgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Dong-Soo Kim
- Department of Orthopaedic Surgery, Chungbuk National University College of Medicine, Cheongju, Korea
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Shi ZY, Zhang XG, Li CW, Liu K, Liang BC, Shi XL. Effect of Traditional Chinese Medicine Product, QiangGuYin, on Bone Mineral Density and Bone Turnover in Chinese Postmenopausal Osteoporosis. Evid Based Complement Alternat Med 2017; 2017:6062707. [PMID: 28512501 PMCID: PMC5415859 DOI: 10.1155/2017/6062707] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/10/2017] [Accepted: 04/03/2017] [Indexed: 12/03/2022]
Abstract
Introduction. The aim of this study was to investigate the efficacy of herbal formula QiangGuYin (QGY) in postmenopausal women. Materials and Methods. A total of 240 participants from six clinical centers were randomly to receive alendronate 70 mg/week, QGY granules 20 g/day, and placebo. Primary end points were BMD changes over 6 and 12 months; secondary end points were bone turnover markers changes at 3, 6, 9, and 12 months. Safety was monitored by clinical adverse events reported during the follow-up. Results. Of 240 women recruited, 218 completed the study. Significant BMD increases from baseline were observed over 6 and 12 months at each observed part both in QGY and alendronate compared with placebo (p < 0.01). Alendronate-treated subjects had significant decreases in β-CTX compared to QGY-treated subjects at each time point assessed (p < 0.01). Reduction in t-P1NP was only observed in the QGY group at 3 and 6 months (-23.81% and -3.07%, resp.). No significant difference was observed in the overall incidence of clinical adverse events among the alendronate group and the QGY group (5.0% versus 7.5%, p = 0.513). Conclusion. 1-Year treatment with QGY demonstrated a safe statistical increase in BMD and new balance may be rebuilt after 9 months. This trail is registered with ChiCTR-POC-16008026.
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Affiliation(s)
- Zhen-Yu Shi
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Xin-Gen Zhang
- Department of Orthopedics and Traumatology, Rongjun Hospital of Zhejiang, Jiaxing, Zhejiang 314001, China
| | - Chun-Wen Li
- Department of Diagnostics of Traditional Chinese Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Kang Liu
- Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang 310005, China
| | - Bo-Cheng Liang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Xiao-Lin Shi
- Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang 310005, China
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Sugie-Oya A, Takakura A, Takao-Kawabata R, Sano H, Shimazu Y, Isogai Y, Yamaguchi A, Ishizuya T. Comparison of treatment effects of teriparatide and the bisphosphonate risedronate in an aged, osteopenic, ovariectomized rat model under various clinical conditions. J Bone Miner Metab 2016; 34:303-14. [PMID: 26104116 DOI: 10.1007/s00774-015-0670-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
Teriparatide and bisphosphonates are osteoporosis medications that increase bone mineral density (BMD) and prevent fracture, but each has a different mechanism of action. Teriparatide promotes bone formation, while bisphosphonates suppress bone resorption. In the clinical setting, however, drug selection is not always tailored to the particular clinical condition of the patient or mechanism of action of the drug. We compared the effects of teriparatide and the bisphosphonate risedronate on bone metabolism using two ovariectomized rat models to elucidate the optimal use of these two drugs in the clinical setting. We first performed dose-finding experiments to determine the equivalent effective doses of each drug (5.6 and 3.0 µg/kg for teriparatide and risedronate, respectively). We then compared the effects of these doses on bone metabolism after subcutaneous administration three times weekly for 4 months starting either the day after ovariectomy (preventive study) or 12 months after ovariectomy (therapeutic study). The increase in proximal tibial BMD under the physical conditions that increased bone turnover at 1 to 2 months after ovariectomy was greater in the risedronate group than in the teriparatide group. In contrast, the increases in lumbar vertebral BMD and bone strength under the physical conditions that significantly decreased BMD and bone strength at 12 months after ovariectomy were greater in the teriparatide group than in the risedronate group. The present study provides important information on the selection of antiosteoporotic drugs, including teriparatide and risedronate, in treatment protocols tailored to the clinical conditions of patients and drug mechanisms.
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Affiliation(s)
- Ayano Sugie-Oya
- Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka, 410-2321, Japan.
| | - Aya Takakura
- Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka, 410-2321, Japan
| | - Ryoko Takao-Kawabata
- Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka, 410-2321, Japan
| | - Hiroko Sano
- Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka, 410-2321, Japan
| | - Yukari Shimazu
- Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka, 410-2321, Japan
| | - Yukihiro Isogai
- Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka, 410-2321, Japan
| | - Akira Yamaguchi
- Department of Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshinori Ishizuya
- Pharmaceuticals Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka, 410-2321, Japan
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Abstract
BACKGROUND Early identification of hip fracture (HF) patients bearing an increased risk for a contralateral occurrence would allow providing preventive measures timely. OBJECTIVES To summarize the available evidence describing risk scores, prognostic instruments, or (groups of) parameters predicting contralateral HFs at the time point of the first fracture. Methods/Systematic Review: Articles were identified through searches in MEDLINE and Scopus from inception to April 2014, checking of reference lists of the included studies and reviews. One reviewer assessed all articles for inclusion and abstracted the data. Uncertain cases were discussed and decided with a second reviewer. Salient study and population characteristics were abstracted for each article. Studies reporting the association of a set of risk factors for second HFs were further examined and compared. The number of studies reporting on a risk parameter was assessed. RESULTS Searches identified 3560 records, and 47 studies were included in this review. There was a large spectrum of study designs, patient populations, and follow-up periods. Among 11 studies reporting on a set of parameters, female gender was assessed most commonly (7 times), followed by age (5) and parameters of general health, vision, and stroke (each 4 times). We were unable to depict stringent patterns of risk parameters to be used for decision making in clinical practice. CONCLUSIONS The findings of this article call for a conjoint effort to achieve an expert consensus regarding a critical set of parameters for a risk instrument identifying patients bearing an increased risk for contralateral HFs early.
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Affiliation(s)
- Maria A Moll
- Medical University of Innsbruck, Innsbruck, Austria
| | | | - Alexander Joeris
- AO Clinical Investigation and Documentation, Dübendorf, Switzerland
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Xu L, Sun W, Qin X, Zhu X, Qiu Y, Zhu Z. The reliability and validity of the simplified Chinese version of Male QUALEFFO-26. Rheumatol Int 2015; 36:489-94. [PMID: 26693934 DOI: 10.1007/s00296-015-3410-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
Abstract
The aim of the study was to investigate the reliability and validity of Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-26) in male osteoporosis patients from Chinese population. The simplified Chinese version of Male QUALEFFO-26 was translated and adapted on the basis of QUALEFFO-31, which was assigned to the cases and controls together with SF-36. Reliability was assessed using the intra-class correlation coefficient (ICC) and Cronbach's α. Validity was assessed with Pearson's correlation analysis between the similar domains of the two questionnaires. Receiver operating characteristics (ROC) curve analysis was carried out to determine the ability of male QUALEFFO-26 to discriminate between cases and controls. The ICC was 0.83 for pain domain, 0.79 for mental domain and 0.81 for physical function. Cronbach's α of each domain ranged from 0.82 to 0.89. Pearson correlation coefficients indicated significantly high correlations between corresponding domains of QUALEFFO-26 and SF-36, with r ranging from -0.523 to -0.832. ROC analysis showed that all the domains of QUALEFFO-26 were significantly predictive of vertebral deformity, with the values of AUC ranging from 0.68 to 0.84. The simplified Chinese version of Male QUALEFFO-26 was a valid, reliable and repeatable instrument showing favorable psychometric characteristics. The questionnaire can be used in male osteoporosis patients from Chinese population.
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Affiliation(s)
- Leilei Xu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Weixiang Sun
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Xiaodong Qin
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Xiufen Zhu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Yong Qiu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Zezhang Zhu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
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Nurmi-Lüthje I, Lüthje P, Kaukonen JP, Kataja M. Positive Effects of a Sufficient Pre-fracture Serum Vitamin D Level on the Long-Term Survival of Hip Fracture Patients in Finland: A Minimum 11-Year Follow-Up. Drugs Aging 2015; 32:477-86. [DOI: 10.1007/s40266-015-0267-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Xie Z, Burge R, Yang Y, Du F, Lu T, Huang Q, Ye W, Xu W. Posthospital Discharge Medical Care Costs and Family Burden Associated with Osteoporotic Fracture Patients in China from 2011 to 2013. J Osteoporos 2015; 2015:258089. [PMID: 26221563 DOI: 10.1155/2015/258089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives. This study collected and evaluated data on the costs of outpatient medical care and family burden associated with osteoporosis-related fracture rehabilitation following hospital discharge in China. Materials and Methods. Data were collected using a patient questionnaire from osteoporosis-related fracture patients (N = 123) who aged 50 years and older who were discharged between January 2011 and January 2013 from 3 large hospitals in China. The survey captured posthospital discharge direct medical costs, indirect medical costs, lost work time for caregivers, and patient ambulatory status. Results. Hip fracture was the most frequent fracture site (62.6%), followed by vertebral fracture (34.2%). The mean direct medical care costs per patient totaled 3,910¥, while mean indirect medical costs totaled 743¥. Lost work time for unpaid family caregivers was 16.4 days, resulting in an average lost income of 3,233¥. The average posthospital direct medical cost, indirect medical cost, and caregiver lost income associated with a fracture patient totaled 7,886¥. Patients' ambulatory status was negatively impacted following fracture. Conclusions. Significant time and cost of care are placed on patients and caregivers during rehabilitation after discharge for osteoporotic fracture. It is important to evaluate the role and responsibility for creating the growing and inequitable burden placed on patients and caregivers following osteoporotic fracture.
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Abstract
The rates of incident osteoporotic fractures seem to be stabilizing; however, fragility fractures are still associated with considerable disability, costs and an increased risk of mortality, which is particularly the case for fractures of the hip and vertebra. Mortality is usually highest during the first year after fracture; however, a notably increased mortality risk might persist for several years after the event. In addition to its efficacy in the prevention of new and recurrent osteoporotic fractures, medical treatment has been associated with improved survival after osteoporotic fractures. Observational studies and randomized controlled clinical trials have reported increased survival in patients with a fracture who are treated with bisphosphonates. Rates of medical treatment in patients with osteoporosis remain low, and although the rationale for the putative increase in survival is unclear, this emerging evidence might help further justify the use of medical treatment after fracture. However, further work is needed before medical therapy for mortality prevention in patients with osteoporotic fractures is accepted.
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Affiliation(s)
- Sebastian E Sattui
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 820 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294, USA
| | - Kenneth G Saag
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 820 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294, USA
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Kendler DL, Macarios D, Lillestol MJ, Moffett A, Satram-Hoang S, Huang J, Kaur P, Tang ET, Wagman RB, Horne R. Influence of patient perceptions and preferences for osteoporosis medication on adherence behavior in the Denosumab Adherence Preference Satisfaction study. Menopause 2014; 21:25-32. [PMID: 23676636 DOI: 10.1097/GME.0b013e31828f5e5d] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study aims to evaluate patient perceptions of subcutaneous denosumab or oral alendronate in postmenopausal women with or at risk for osteoporosis and how these perceptions influence adherence. METHODS Postmenopausal women with low bone mass were randomized to denosumab 60 mg every 6 months for 1 year (treatment period 1 [TP1]) followed by alendronate 70 mg once weekly for 1 year (treatment period 2 [TP2]), or vice versa. Beliefs about Medicines Questionnaire data were collected at baseline and at 6, 12, 18, and 24 months; a necessity-concerns differential (NCD) was calculated for each time point. Logistic regression analyses were performed to evaluate the influences of baseline characteristics on nonadherence. RESULTS Participants included 250 women (alendronate/denosumab, n = 124; denosumab/alendronate, n = 126). During TP1, the NCD at month 6 was higher with denosumab than with alendronate (P = 0.0076). In TP2, the NCD was higher for women switched to denosumab than for women switched to alendronate at 6 months (P = 0.0126) and 12 months (P = 0.4605). Denosumab was preferred to alendronate regardless of treatment sequence (P < 0.0001). Covariate analysis revealed that higher TP2 baseline necessity scores were associated with lower odds of nonadherence (P = 0.0055), whereas higher concerns about medication scores were associated with higher odds of nonadherence (P = 0.0247). Higher NCD scores were also associated with lower odds of nonadherence (P = 0.0015). CONCLUSIONS Participants preferred denosumab to alendronate while on treatment and had more positive perceptions of denosumab than alendronate. These perceptions were associated with better adherence.
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Liu M, Goss PE, Ingle JN, Kubo M, Furukawa Y, Batzler A, Jenkins GD, Carlson EE, Nakamura Y, Schaid DJ, Chapman JAW, Shepherd LE, Ellis MJ, Khosla S, Wang L, Weinshilboum RM. Aromatase inhibitor-associated bone fractures: a case-cohort GWAS and functional genomics. Mol Endocrinol 2014; 28:1740-51. [PMID: 25148458 DOI: 10.1210/me.2014-1147] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Bone fractures are a major consequence of osteoporosis. There is a direct relationship between serum estrogen concentrations and osteoporosis risk. Aromatase inhibitors (AIs) greatly decrease serum estrogen levels in postmenopausal women, and increased incidence of fractures is a side effect of AI therapy. We performed a discovery case-cohort genome-wide association study (GWAS) using samples from 1071 patients, 231 cases and 840 controls, enrolled in the MA.27 breast cancer AI trial to identify genetic factors involved in AI-related fractures, followed by functional genomic validation. Association analyses identified 20 GWAS single nucleotide polymorphism (SNP) signals with P < 5E-06. After removal of signals in gene deserts and those composed entirely of imputed SNPs, we applied a functional validation "decision cascade" that resulted in validation of the CTSZ-SLMO2-ATP5E, TRAM2-TMEM14A, and MAP4K4 genes. These genes all displayed estradiol (E2)-dependent induction in human fetal osteoblasts transfected with estrogen receptor-α, and their knockdown altered the expression of known osteoporosis-related genes. These same genes also displayed SNP-dependent variation in E2 induction that paralleled the SNP-dependent induction of known osteoporosis genes, such as osteoprotegerin. In summary, our case-cohort GWAS identified SNPs in or near CTSZ-SLMO2-ATP5E, TRAM2-TMEM14A, and MAP4K4 that were associated with risk for bone fracture in estrogen receptor-positive breast cancer patients treated with AIs. These genes displayed E2-dependent induction, their knockdown altered the expression of genes related to osteoporosis, and they displayed SNP genotype-dependent variation in E2 induction. These observations may lead to the identification of novel mechanisms associated with fracture risk in postmenopausal women treated with AIs.
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Affiliation(s)
- Mohan Liu
- Division of Clinical Pharmacology (M.L., L.W., R.M.W.), Department of Molecular Pharmacology and Experimental Therapeutics; Departments of Oncology (J.N.I.) and Health Sciences Research (A.B., G.D.J., E.E.C., D.J.S.); and Division of Endocrinology (S.K.), Mayo Clinic, Rochester, Minnesota 55905; Massachusetts General Hospital (P.E.G.), Harvard University, Boston, Massachusetts 02114; Rikagaku Kenkyūsho Center for Integrative Medical Science (M.K., Y.F.), Yokohama, Japan 230-0045; School of Medicine (Y.N.), Chicago University, Chicago, Illinois 60637; National Cancer Institute of Canada Clinical Trials Group (J.-A.W.C., L.E.S.), Kingston, Ontario, Canada K7L 3N6; and Division of Oncology (M.J.E.), Department of Medicine, Washington University School of Medicine, St Louis, Missouri 63110
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Diamantopoulos AP, Hoff M, Hochberg M, Haugeberg G. Predictors of short- and long-term mortality in males and females with hip fracture - a prospective observational cohort study. PLoS One 2013; 8:e78169. [PMID: 24205145 DOI: 10.1371/journal.pone.0078169] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/16/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hip fracture is associated with increased mortality. Our aim was to study potential risk factors, including osteoporosis, associated with short- and long-term mortality in a prospectively recruited cohort of fragility hip fracture patients. METHODOLOGY/PRINCIPAL FINDINGS Fragility hip fracture patients aged >50 years admitted to a county hospital in Southern Norway in 2004 and 2005 were consecutively identified and invited for assessment. Patients with high energy or pathological fractures, patients with confusion, serious infections or who were non-residents in the catchment area were excluded. As part of a clinical routine, data were collected using questionnaires. Standardized bone density measurements of lumbar spine and hip were performed. Potential predictors of hip fracture mortality were tested using univariate and multivariate logistic regression analysis. A total of 432 hip fracture patients (129 males and 303 females) were prospectively identified. Among them 296 (85 males and 211 females) patients [mean age 80.7 (SD 9.1)] were assessed at the Osteoporosis center. Variables independently associated with short-term mortality (after 1 year) were in females older age [Odds Ratio (OR) 6.95] and in males older age (OR 5.74) and pulmonary disease (OR 3.20), whereas no associations were observed with mortality for 3 months after the fragility hip fracture. Variables independently associated with 5 years mortality in males was osteoporosis (OR 3.91) and older age (OR 6.95), and in females was dementia (OR 4.16) and older age (OR 2.80). CONCLUSION Apart from known predictors as age and comorbidity osteoporosis in our study was identified as a potential independent predictor of long-term hip fracture mortality in males. This is of particular importance as treatment with bisphosphonates after hip fracture has been shown to reduce hip fracture mortality and may be a clinical target to reduce the burden of the disease. Further studies however are needed to confirm the validity of this finding.
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Chiu CK, Kuo MC, Yu SF, Su BYJ, Cheng TT. Adherence to osteoporosis regimens among men and analysis of risk factors of poor compliance: a 2-year analytical review. BMC Musculoskelet Disord 2013; 14:276. [PMID: 24060442 PMCID: PMC3849144 DOI: 10.1186/1471-2474-14-276] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 09/17/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To investigate adherence and patient-specific factors associated with poor compliance with osteoporosis regimens among men. METHODS In this retrospective chart review study, we collected data on male patients with osteoporosis treated in accordance with therapeutic recommendations. Adherence was determined by the compliance and persistence of those patients who had been dispensed an osteoporosis regimen after an index prescription. All osteoporosis regimens were considered equivalent for the purpose of investigating adherence. RESULTS The prescriptions of 333 males met the inclusion criteria for data collection. The mean age was 68.6 ± 10.4 years. The median medication possession ratio (MPR, %) at years 1 and 2 was 90.1% (interquartile range (IQR) 19-100) and 53.7% (IQR 10.4-100), respectively; 52.3% of male patients at year 1 and 37.5% at year 2 had good compliance (defined as a MPR≧80%). The 1- and 2-year persistence rates were 45.9% and 30.0%, respectively. Patient-specific factors associated with poor compliance (MPR < 80%) during year 1 were first prescriptions given by orthopedists (odds ratio (OR) = 2.67; 95% confidence interval (CI) = 1.58-4.53; adjusted OR = 2.30, 95% CI = 1.26-4.22, p = 0.007). Male patients with rheumatoid arthritis (RA) (OR = 0.22, 95% CI = 0.06-0.78, adjusted OR = 0.19, 95% CI = 0.04-0.81, p = 0.025) and baseline bone mineral density (BMD) measurements (OR = 0.52, 95% CI = 0.32-0.85; adjusted OR = 0.51; 95% CI = 0.28-0.93, p = 0.029) were less likely to have poor compliance. CONCLUSIONS Adherence to osteoporosis regimens in males was suboptimal in our study. Poor compliance was more likely in prescription of the first anti-osteoporotic regimen by an orthopedist. Men with RA and BMD measurements before therapy had a lower risk of non-adherence. Healthcare professionals need to target patients with specific factors to improve adherence to osteoporotic regimens.
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Affiliation(s)
- Chun-Kai Chiu
- Division of Rheumatology, Allergy and Immunology, E-DA Hospital, I-Shou University, 1 ,Yi-Da Road, Jiau-shu Tsuen, Yan-chau Shiang, Kaohsiung, Taiwan
| | - Ming-Chun Kuo
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shan-Fu Yu
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No 123, Ta-Pei Road, Niaosung, Kaohsiung 833, Taiwan
| | - Ben Yu-Jih Su
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No 123, Ta-Pei Road, Niaosung, Kaohsiung 833, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No 123, Ta-Pei Road, Niaosung, Kaohsiung 833, Taiwan
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Abstract
UNLABELLED We determined the incidence of second hip fracture and evaluated whether compliant users of bisphosphonate had a lower incidence of second hip fracture after prior hip fracture. INTRODUCTION Bisphosphonate has been used to prevent osteoporotic fracture and is recommended for the secondary prevention after hip fracture. However, little is known regarding secondary prevention after first hip fracture. Our purpose was to determine the incidence of second hip fracture and to evaluate whether compliant use of bisphosphonate can reduce the risk of second hip fracture. METHODS Eight hundred twenty-six patients who sustained the first hip fracture from May 2003 to October 2011 were retrospectively evaluated. The incidence of second hip fracture was compared between compliant users of bisphosphonate and nonusers. RESULTS Seventy-one (8.6 %) patients suffered a second hip fracture at mean 30.0 months (SD 24.6, range 1 to 90 months) after the initial hip fracture. The cumulative incidence of second hip fracture was 5.1 % (42/826) at 2 years and 8.6 % (71/826) at 8 years. The incidence of second hip fracture was 4.2 % (12/283) in compliant users and 10.9 % (59/543) in nonusers (p = 0.001). CONCLUSIONS Compliant use of bisphosphonate is effective in the prevention of second hip fractures.
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Affiliation(s)
- Y-K Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam 463-707, South Korea
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Edwards BJ, Bunta AD, Lane J, Odvina C, Rao DS, Raisch DW, McKoy JM, Omar I, Belknap SM, Garg V, Hahr AJ, Samaras AT, Fisher MJ, West DP, Langman CB, Stern PH. Bisphosphonates and nonhealing femoral fractures: analysis of the FDA Adverse Event Reporting System (FAERS) and international safety efforts: a systematic review from the Research on Adverse Drug Events And Reports (RADAR) project. J Bone Joint Surg Am 2013; 95:297-307. [PMID: 23426763 PMCID: PMC3748968 DOI: 10.2106/jbjs.k.01181] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the United States, hip fracture rates have declined by 30% coincident with bisphosphonate use. However, bisphosphonates are associated with sporadic cases of atypical femoral fracture. Atypical femoral fractures are usually atraumatic, may be bilateral, are occasionally preceded by prodromal thigh pain, and may have delayed fracture-healing. This study assessed the occurrence of bisphosphonate-associated nonhealing femoral fractures through a review of data from the U.S. FDA (Food and Drug Administration) Adverse Event Reporting System (FAERS) (1996 to 2011), published case reports, and international safety efforts. METHODS We analyzed the FAERS database with use of the proportional reporting ratio (PRR) and empiric Bayesian geometric mean (EBGM) techniques to assess whether a safety signal existed. Additionally, we conducted a systematic literature review (1990 to February 2012). RESULTS The analysis of the FAERS database indicated a PRR of 4.51 (95% confidence interval [CI], 3.44 to 5.92) for bisphosphonate use and nonhealing femoral fractures. Most cases (n = 317) were attributed to use of alendronate (PRR = 3.32; 95% CI, 2.71 to 4.17). In 2008, international safety agencies issued warnings and required label changes. In 2010, the FDA issued a safety notification, and the American Society for Bone and Mineral Research (ASBMR) issued recommendations about bisphosphonate-associated atypical femoral fractures. CONCLUSIONS Nonhealing femoral fractures are unusual adverse drug reactions associated with bisphosphonate use, as up to 26% of published cases of atypical femoral fractures exhibited delayed healing or nonhealing.
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Affiliation(s)
- Beatrice J. Edwards
- Bone Health and Osteoporosis Center, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair, Suite 1350, Chicago, IL 60611
| | - Andrew D. Bunta
- Bone Health and Osteoporosis Center, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair, Suite 1350, Chicago, IL 60611
| | - Joseph Lane
- Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021
| | - Clarita Odvina
- University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390
| | - D. Sudhaker Rao
- Division of Endocrinology, Diabetes, and Bone and Mineral Metabolism, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202
| | - Dennis W. Raisch
- Department of Pharmacy Practice and Administrative Sciences, Nursing/Pharmacy Building, Room B94, University of New Mexico, Albuquerque, NM 87131
| | - June M. McKoy
- Division of Geriatric Medicine, Feinberg School of Medicine, Northwestern University, 645 North Michigan, Suite 630, Chicago, IL 60611
| | - Imran Omar
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair, Suite 800, Chicago, IL 60611
| | - Steven M. Belknap
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair, Suite 1600, Chicago, IL 60611
| | - Vishvas Garg
- Department of Pharmacy Practice and Administrative Sciences, Nursing/Pharmacy Building, Room B94, University of New Mexico, Albuquerque, NM 87131
| | - Allison J. Hahr
- Division of Endocrinology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 645 North Michigan, Suite 530, Chicago, IL 60611
| | - Athena T. Samaras
- Robert H. Lurie Comprehensive Cancer Center, 676 North Saint Clair, Suite 1600, Chicago, IL 60611
| | - Matthew J. Fisher
- Division of Geriatric Medicine, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair, Suite 1600, Chicago, IL 60611
| | - Dennis P. West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair, Suite 1600, Chicago, IL 60611
| | - Craig B. Langman
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Box MS37, 225 East Chicago Avenue, Chicago, IL 60611
| | - Paula H. Stern
- Department of Molecular Pharmacology and Biological Chemistry, Feinberg School of Medicine, Northwestern University, 645 North Michigan, Suite 630, Chicago, IL 60611
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Ringe JD, Farahmand P. Improved real-life adherence of 6-monthly denosumab injections due to positive feedback based on rapid 6-month BMD increase and good safety profile. Rheumatol Int 2013; 34:727-32. [PMID: 23334374 DOI: 10.1007/s00296-012-2663-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/28/2012] [Indexed: 01/12/2023]
Abstract
Almost 50 % of osteoporosis (OP) patients discontinue bisphosphonate (BP) therapy within 1-2 years after the start of their treatment. Denosumab's longer dosing interval with its administration every 6 months (Q6M) as a subcutaneous (sc) injection might result in a better real-life treatment adherence and persistence than weekly or monthly oral BP treatment regimen. The objectives of this open, investigator-initiated, prospective, observational, single-center study were to evaluate adherence with denosumab 60 mg sc every 6 months (Q6M) (Prolia(®)) injections in osteoporotic patients in a routine clinical care setting and to describe whether positive feedback to OP patients based on measured bone mineral density (BMD) increases and good safety profile have an impact on patients' real-life adherence. Results indicate that the rarity of adverse events and reduced dosage frequency together with the consistency of rapid and highly significant increases in BMD already after 6 months of denosumab therapy used as a positive reinforcement during doctor-patient interactions had a significant, positive impact on osteoporotic patient's adherence to continue with the 6-monthly sc denosumab injections.
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Affiliation(s)
- J D Ringe
- West German Osteoporosis Center (WOZ), Medizin. Klinik 4, Klinikum Leverkusen, University of Cologne, Am Gesundheitspark 11, 51375, Leverkusen, Germany,
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Abstract
The incidence of osteoporotic fractures increases exponentially in later life, in parallel with the progression of frailty and the risk of dying. Several pharmacologic therapies are now available that reduce the risk of fragility fractures. Data from observational studies report that osteoporotic fractures are associated with an increased risk of dying, particularly in the first few years after an event, and that, in osteoporotic populations, bisphosphonate therapy is associated with a reduced risk of death. Data emerging from randomised controlled trials suggest that drugs which significantly reduce fracture risk might also prolong survival in osteoporotic populations. Further research into the nature, magnitude and mechanisms of the effects of osteoporosis treatments on mortality is required, but in the interim, clinicians and their patients should consider the available data in their deliberations about the use of these medications.
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Affiliation(s)
- A Grey
- Department of Medicine, University of Auckland, Auckland, New Zealand.
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Bondo L, Eiken P, Abrahamsen B. Analysis of the association between bisphosphonate treatment survival in Danish hip fracture patients-a nationwide register-based open cohort study. Osteoporos Int 2013; 24:245-52. [PMID: 22638712 DOI: 10.1007/s00198-012-2024-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED Bisphosphonate (BP) users have decreased mortality, but this could be due to channeling bias. National healthcare data on hip fracture showed lower mortality in patients who were treated prior to fracture or began treatment after fracture. Reduced mortality after only one prescription filled points to the importance of patient factors. INTRODUCTION Use of bisphosphonates has been found to be associated with decreased mortality even when adjusted for sex, frailty, bone mineral density and comorbidity, but BP may chiefly be initiated in patients with osteoporosis whose life expectancy is judged to be good. Our aim was to investigate the association between BP initiated before or after a hip fracture with mortality, and any modifying effects of comorbid conditions and recurrent fracture. METHODS This register-based cohort study used prescription and mortality information for Danish patients born ≤1945 experiencing a hip fracture between 1/Jan/1999 and 31/Dec/ 2002 (N = 42,076). Patients who began BP after hip fracture were compared with hip fracture patients who remained alive at the time when their matched index case began treatment. RESULTS Patients who used BP prior to their hip fracture (4.6 %) had significantly lower 3-month mortality (adjusted odds ratio, OR, 0.68; 0.59-0.77). Patients who began BP after the fracture (2.6 %) had significantly decreased mortality, both for patients who filled only one prescription (adjusted hazard ratio, HR 0.84; 0.73-0.95) and for patients who filled multiple prescriptions HR 0.73 (0.61-0.88). There was a significant interaction by gender with no significant risk reduction in men. CONCLUSION This national dataset shows significantly and substantially improved survival in women who receive BP before or after their hip fracture. However, the observation of a reduction in mortality in patients who filled only one prescription for a BP suggests that patient factors may account for a considerable part of the survival advantage observed with BPs.
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Affiliation(s)
- L Bondo
- Department of Medicine and Endocrinology F, Gentofte Hospital, 2900, Hellerup, Denmark
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Valizadeh M, Mazloomzadeh S, Golmohammadi S, Larijani B. Mortality after low trauma hip fracture: a prospective cohort study. BMC Musculoskelet Disord 2012; 13:143. [PMID: 22883372 PMCID: PMC3512527 DOI: 10.1186/1471-2474-13-143] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 07/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various risk of mortality due to hip fracture has been reported by different studies. There is scarce controlled study on hip fracture mortality from developing countries and no data from Middle East region. The objective of this study is to determine mortality and its risk factors one year after low trauma hip fracture. METHODS One hundred and two patients after hip fracture not caused by high impact injuries or local bone diseases followed up prospectively for one year. Control group consisted of sex and age matched patients admitted to ophthalmology ward for eye surgery. Data about comorbidity obtained from both groups at baseline. Functional state and health-related quality of life for the participants were measured using RDRS-2 and SF-36 questionnaires, respectively. RESULTS The overall survival was 83% in cases and 92% in controls (log rank test 3.62, df = 1, P = 0.057). Early mortality within the first 6 months of observation was significantly higher in patients than controls (13 in patients vs. 2 in controls) (log rank test 8.84, df = 1, P = 0.003). The risk of mortality in the first year after fracture was significantly and independently associated with age and baseline RDRS score. By the end of follow-up, in the patient group, 55.4% of survivors were able to walk without any assistance and 10.8% were not able to walk. CONCLUSIONS The risk of mortality within the first 6 months of observation was significantly and independently associated with low trauma hip fracture. However, age and baseline RDRS score were independent predictors of mortality in the first year following hip fracture.
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Affiliation(s)
- Majid Valizadeh
- Metabolic disease research center, Zanjan University of Medical Sciences, Iran
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Abstract
The occurrence of a fragility fracture is an opportunity to recognize osteoporosis and begin treatment to reduce the risk of another fracture. However, selecting the treatment may have an impact on the incident fracture and this requires careful consideration of the patient and the treatment choices. There is no consensus regarding the management of osteoporosis at the time of an incident fracture. This review will consider the treatment options after a fragility fracture.
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Affiliation(s)
- S Bobo Tanner
- Divisions of Rheumatology, Allergy & Immunology, Vanderbilt University Medical Center, Nashville, TN 37203, USA.
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Nurmi-Lüthje I, Sund R, Juntunen M, Lüthje P. Post-hip fracture use of prescribed calcium plus vitamin D or vitamin D supplements and antiosteoporotic drugs is associated with lower mortality: a nationwide study in Finland. J Bone Miner Res 2011; 26:1845-53. [PMID: 21351147 DOI: 10.1002/jbmr.375] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We previously found a positive association between calcium plus vitamin D and antiosteoporotic drugs and survival among hip fracture patients. Our aim was to verify this observation using a nationwide database. A retrospective cohort of home-discharged hip fracture patients aged 50 years or older (n = 23,615) was enrolled from the national database. Primary exposure was medical treatment for osteoporosis, and the outcome was all-cause mortality. Cumulative mortalities were calculated using the Kaplan-Meier estimator. The relationship between mortality and medication purchases was modeled using Cox's proportional hazards regression with time-dependent covariates for medication use. One in 4 women and 1 in 10 men with a hip fracture were treated for osteoporosis in Finland. Unadjusted 1-year mortality was lower among patients who purchased calcium plus vitamin D or vitamin D supplements and antiosteoporotic drugs than among those who did not purchase these medications [hazard ratio (HR) = 0.74, 95% confidence interval (CI) 0.67-0.81]. The difference in unadjusted cumulative mortality remained in favor of the drug users for at least 5 years. Among men, the use of calcium plus vitamin D or vitamin D supplements was associated with lower 1-year mortality even after adjustments for observed confounders (HR = 0.74, 95% CI 0.56-0.97). Among women, the use of antiosteoporotic drugs was associated with lower mortality (HR = 0.79, 95% CI 0.67-0.93). There was a tendency to even better survival in both genders if calcium plus vitamin D or vitamin D supplements and antiosteoporotic drugs were used simultaneously, the HR being 0.72 (95% CI 0.50-1.03) in men and 0.62 (95% CI 0.50-0.76) in women.
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Affiliation(s)
- Ilona Nurmi-Lüthje
- Center for Injury and Violence Prevention, Health Center of Kouvola, Kouvola, Finland.
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Ebetino FH, Hogan AML, Sun S, Tsoumpra MK, Duan X, Triffitt JT, Kwaasi AA, Dunford JE, Barnett BL, Oppermann U, Lundy MW, Boyde A, Kashemirov BA, McKenna CE, Russell RGG. The relationship between the chemistry and biological activity of the bisphosphonates. Bone 2011; 49:20-33. [PMID: 21497677 DOI: 10.1016/j.bone.2011.03.774] [Citation(s) in RCA: 275] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 03/29/2011] [Accepted: 03/29/2011] [Indexed: 11/20/2022]
Abstract
The ability of bisphosphonates ((HO)(2)P(O)CR(1)R(2)P(O)(OH)(2)) to inhibit bone resorption has been known since the 1960s, but it is only recently that a detailed molecular understanding of the relationship between chemical structures and biological activity has begun to emerge. The early development of chemistry in this area was largely empirical and based on modifying R(2) groups in a variety of ways. Apart from the general ability of bisphosphonates to chelate Ca(2+) and thus target the calcium phosphate mineral component of bone, attempts to refine clear structure-activity relationships had led to ambiguous or seemingly contradictory results. However, there was increasing evidence for cellular effects, and eventually the earliest bisphosphonate drugs, such as clodronate (R(1)=R(2)=Cl) and etidronate (R(1)=OH, R(2)=CH(3)), were shown to exert intracellular actions via the formation in vivo of drug derivatives of ATP. The observation that pamidronate, a bisphosphonate with R(1)=OH and R(2)=CH(2)CH(2)NH(2), exhibited higher potency than previously known bisphosphonate drugs represented the first step towards the later recognition of the critical importance of having nitrogen in the R(2) side chain. The synthesis and biological evaluation of a large number of nitrogen-containing bisphosphonates took place particularly in the 1980s, but still with an incomplete understanding of their structure-activity relationships. A major advance was the discovery that the anti-resorptive effects of the nitrogen-containing bisphosphonates (including alendronate, risedronate, ibandronate, and zoledronate) on osteoclasts appear to result from their potency as inhibitors of the enzyme farnesyl pyrophosphate synthase (FPPS), a key branch-point enzyme in the mevalonate pathway. FPPS generates isoprenoid lipids utilized in sterol synthesis and for the post-translational modification of small GTP-binding proteins essential for osteoclast function. Effects on other cellular targets, such as osteocytes, may also be important. Over the years many hundreds of bisphosphonates have been synthesized and studied. Interest in expanding the structural scope of the bisphosphonate class has also motivated new approaches to the chemical synthesis of these compounds. Recent chemical innovations include the synthesis of fluorescently labeled bisphosphonates, which has enabled studies of the biodistribution of these drugs. As a class, bisphosphonates share common properties. However, as with other classes of drugs, there are chemical, biochemical, and pharmacological differences among the individual compounds. Differences in mineral binding affinities among bisphosphonates influence their differential distribution within bone, their biological potency, and their duration of action. The overall pharmacological effects of bisphosphonates on bone, therefore, appear to depend upon these two key properties of affinity for bone mineral and inhibitory effects on osteoclasts. The relative contributions of these properties differ among individual bisphosphonates and help determine their clinical behavior and effectiveness.
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Affiliation(s)
- Frank H Ebetino
- Warner Chilcott Ltd., Discovery, Research & Development, Dundalk, Ireland.
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Abstract
The first full publications on the biological effects of the diphosphonates, later renamed bisphosphonates, appeared in 1969, so it is timely after 40years to review the history of their development and their impact on clinical medicine. This special issue of BONE contains a series of review articles covering the basic science and clinical aspects of these drugs, written by some of many scientists who have participated in the advances made in this field. The discovery and development of the bisphosphonates (BPs) as a major class of drugs for the treatment of bone diseases has been a fascinating story, and is a paradigm of a successful journey from 'bench to bedside'. Bisphosphonates are chemically stable analogues of inorganic pyrophosphate (PPi), and it was studies on the role of PPi as the body's natural 'water softener' in the control of soft tissue and skeletal mineralisation that led to the need to find inhibitors of calcification that would resist hydrolysis by alkaline phosphatase. The observation that PPi and BPs could not only retard the growth but also the dissolution of hydroxyapatite crystals prompted studies on their ability to inhibit bone resorption. Although PPi was unable to do this, BPs turned out to be remarkably effective inhibitors of bone resorption, both in vitro and in vivo experimental systems, and eventually in humans. As ever more potent BPs were synthesised and studied, it became apparent that physico-chemical effects were insufficient to explain their biological effects, and that cellular actions must be involved. Despite many attempts, it was not until the 1990s that their biochemical actions were elucidated. It is now clear that bisphosphonates inhibit bone resorption by being selectively taken up and adsorbed to mineral surfaces in bone, where they interfere with the action of the bone-resorbing osteoclasts. Bisphosphonates are internalised by osteoclasts and interfere with specific biochemical processes. Bisphosphonates can be classified into at least two groups with different molecular modes of action. The simpler non-nitrogen containing bisphosphonates (such as etidronate and clodronate) can be metabolically incorporated into non-hydrolysable analogues of ATP, which interfere with ATP-dependent intracellular pathways. The more potent, nitrogen-containing bisphosphonates (including pamidronate, alendronate, risedronate, ibandronate and zoledronate) are not metabolised in this way but inhibit key enzymes of the mevalonate/cholesterol biosynthetic pathway. The major enzyme target for bisphosphonates is farnesyl pyrophosphate synthase (FPPS), and the crystal structure elucidated for this enzyme reveals how BPs bind to and inhibit at the active site via their critical N atoms. Inhibition of FPPS prevents the biosynthesis of isoprenoid compounds (notably farnesol and geranylgeraniol) that are required for the post-translational prenylation of small GTP-binding proteins (which are also GTPases) such as rab, rho and rac, which are essential for intracellular signalling events within osteoclasts. The accumulation of the upstream metabolite, isopentenyl pyrophosphate (IPP), as a result of inhibition of FPPS may be responsible for immunomodulatory effects on gamma delta (γδ) T cells, and can also lead to production of another ATP metabolite called ApppI, which has intracellular actions. Effects on other cellular targets, such as osteocytes, may also be important. Over the years many hundreds of BPs have been made, and more than a dozen have been studied in man. As reviewed elsewhere in this issue, bisphosphonates are established as the treatments of choice for various diseases of excessive bone resorption, including Paget's disease of bone, the skeletal complications of malignancy, and osteoporosis. Several of the leading BPs have achieved 'block-buster' status with annual sales in excess of a billion dollars. As a class, BPs share properties in common. However, as with other classes of drugs, there are obvious chemical, biochemical, and pharmacological differences among the various BPs. Each BP has a unique profile in terms of mineral binding and cellular effects that may help to explain potential clinical differences among the BPs. Even though many of the well-established BPs have come or are coming to the end of their patent life, their use as cheaper generic drugs is likely to continue for many years to come. Furthermore in many areas, e.g. in cancer therapy, the way they are used is not yet optimised. New 'designer' BPs continue to be made, and there are several interesting potential applications in other areas of medicine, with unmet medical needs still to be fulfilled. The adventure that began in Davos more than 40 years ago is not yet over.
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Affiliation(s)
- R Graham G Russell
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Oxford NIHR Biomedical Research Unit, The Oxford University Institute of Musculoskeletal Sciences, The Botnar Research Centre, Headington, Oxford, UK.
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Abstract
CONTEXT Osteoporotic fractures are associated with premature mortality. Antiresorptive treatment reduces refracture but mortality reduction is unclear. OBJECTIVE The objective of the study was to examine the effect of osteoporosis treatment [bisphosphonates (BP), hormone therapy (HT), and calcium ± vitamin D only (CaD)] on mortality risk. DESIGN This was a prospective cohort study (April 1989 to May 2007). SETTING The study was conducted with community-dwelling elderly (aged 60+ yr) subjects in Dubbo, a semiurban city, Australia. SUBJECTS Subjects included 1223 and 819 women and men in the Dubbo Osteoporosis Epidemiology Study. MAIN OUTCOME MEASURE Mortality according to treatment group was recorded. RESULTS There were 325 (BP, n = 106; HT, n = 77; CaD, n = 142) women and 37 men (BP, n = 15; CaD, n = 22) on treatment. In women, mortality rates were lower with BP 0.8/100 person-years (0.4, 1.4) and HT 1.2/100 person-years (0.7, 2.1) but not CaD 3.2/100 person-years (2.5, 4.1) vs. no treatment 3.5/100 person-years (3.1, 3.8). Accounting for age, fracture occurrence, comorbidities, quadriceps strength, and bone mineral density, mortality risk remained lower for women on BP [hazard ratio (HR) 0.3 (0.2, 0.6)] but not HT [HR 0.8 (0.4, 1.8)]. For 429 women with fractures, mortality risk was still reduced in the BP group [adjusted HR 0.3 (0.2, 0.7)], not accounted for by a reduction in subsequent fractures. In men, lower mortality rates were observed with BP but not CaD [BP 1.0/100 person-years (0.3, 3.9) and CaD 3.1/100 person-years (1.5, 6.6) vs. no treatment 4.3/100 person-years (3.9, 4.8)]. After adjustment, mortality was similar, although not significant [HR 0.5 (0.1, 2.0)]. CONCLUSIONS Osteoporosis therapy appears to reduce mortality risk in women and possibly men.
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Affiliation(s)
- Jacqueline R Center
- Garvan Institute of Medical Research, and St Vincent’s Hospital, Sydney, New South Wales, Australia.
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Beaupre LA, Morrish DW, Hanley DA, Maksymowych WP, Bell NR, Juby AG, Majumdar SR. Oral bisphosphonates are associated with reduced mortality after hip fracture. Osteoporos Int 2011; 22:983-91. [PMID: 21052642 DOI: 10.1007/s00198-010-1411-2] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 09/01/2010] [Indexed: 10/18/2022]
Abstract
UNLABELLED Intravenous bisphosphonates reduce mortality following hip fracture. We determined whether new use of oral bisphosphonates was also associated with reductions in mortality in 209 hip fracture patients. Oral bisphosphonate exposure led to relative reduction of 8% per month of use (p = 0.001) or about a 60% reduction in mortality per year of use. INTRODUCTION Intravenous bisphosphonates reduce mortality following hip fracture. Using prospectively collected long-term data from a randomized trial of osteoporosis quality improvement for hip fracture, we determined whether new use of oral bisphosphonates was associated with reductions in mortality or the composite outcome of death or new fracture. METHODS Originally, 220 hip fracture patients were randomized to case manager (n = 110) or usual care followed by facilitated bone mineral density (BMD) testing (n = 110) interventions. All were eligible for bisphosphonate treatment. Post-randomization, we followed patients for 3 years and ascertained bisphosphonate treatment, medication adherence and persistence, all-cause mortality, and new clinical fractures. Proportional hazards analyses with time-varying treatment status were undertaken. RESULTS The final study cohort included 209 patients: 136 (65%) females, 104 (50%) older than 75 years, 90 (43%) with poor self-reported health, and 38 (18%) underweight. Of these, 76 (36%) had a previous fracture before hip fracture and 132 (81%) had low BMD. A total of 101 (46%) patients started oral bisphosphonates and 65 (64%) remained on treatment at the final evaluation. Overall, 24 (11%) patients died, 19 (9%) had new fractures, and 42 (20%) reached the composite outcome of death or fracture. Compared to no treatment, bisphosphonate exposure was independently associated with reduced mortality (17[16%] vs. 7[7%]; adjusted hazard ratio (aHR) = 0.92 per month treated; 95%CI, 0.88-0.97) and composite endpoints (28[26%] vs. 5[15%]; aHR = 0.94 per month treated; 95%CI, 0.91-0.97). CONCLUSION Like intravenous bisphosphonates after hip fracture, our study suggests that oral bisphosphonates may be associated with reductions in all-cause mortality.
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Affiliation(s)
- L A Beaupre
- Department of Physical Therapy, University of Alberta, 1F1.52 WMC, 8440 112 ST, Edmonton, AB T6G2B7, Canada.
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Abstract
Patients with osteoporosis have an increased risk of sustaining fractures because of the low bone mineral density (BMD) and altered bone micro-architecture which are characteristic features of the disease. Although a good correlation exists between BMD and fracture risks, many other factors influence this relationship. While there is consensus that patients with osteoporosis should be investigated and treated, the issue is much less clear for patients with osteopenia. Because osteopenia is so prevalent, it would be unrealistic to treat all patients with this condition. Therefore, there is a need to identify those patients who are at risk of sustaining a fracture and would benefit most from the available therapy. Providing treatment to the appropriate risk group would not only reduce the number of fractures, but could also reduce the adverse effects associated with treatment, as treating patients earlier could shorten the treatment time. The availability of tools to select patients at risk of fracture should change the impact of the disease.
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Affiliation(s)
- Ronald C Hamdy
- Quillen Chair of Geriatrics, East Tennessee State University, PO Box 70429, Johnson City, TN 37614, USA.
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Abstract
Nonvertebral fractures form the bulk of osteoporotic fractures and yet, other than hip fractures, are often dismissed, particularly in the younger age groups. Thus, less than 30% of women with osteoporotic fractures and less than 10% of men worldwide are receiving appropriate treatment. This article discusses the incidence, cost, and consequences of nonvertebral fractures. Recent evidence suggests these fractures form the bulk of costs to the community and herald an increased risk of refracture and premature mortality that applies to all types of nonvertebral, and not just hip, fractures.
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Abstract
AIM The objective of this article is to evaluate the relationship between the changes in prescriptions of antiosteoporotic drugs (mainly the rapid fall in the use of bisphosphonates [BPs]) and standardized hip fracture (HF) rates over the period 2005-2008 in the Australian Capital Territory (ACT). METHODS Annual sex- and age-specific HF rates (per 100,000 population) were determined and standardized using the Australian 2006 population census. Data on the annual prescriptions of BPs (mainly alendronate and risedronate), strontium ranelate, and hormone replacement therapy were obtained from the Australian Pharmaceutical Benefits Scheme (PBS) and Repatriation Australian Pharmaceutical Benefits Scheme (RPBS) databases. RESULTS In the ACT, the peak annual number of prescriptions for BPs was observed in 2006. Following reports linking osteonecrosis of the jaw with BP use, the number of BP prescriptions dropped by 14% in 2007-2008 compared with 2005, when the lowest HF rates were recorded. The reduction in BP prescriptions coincided with increased HF rates in females in 2007 (+22.6%) and in 2008 (+25.2%) compared with 2005; in males, HF incidence declined by 6.6% and 16.7%, respectively. The proportion of filled prescriptions for strontium ranelate, risedronate, and alendronate in 2007-2008 was 1:8.4:15.5, indicating that BPs were the dominant antiosteoporotic drugs. There was an inverse statistically significant relationship between the total annual number of BP prescriptions and standardized HF incidence rates for the 10-year period 1999-2008. CONCLUSION Although currently there is no clear understanding of factors contributing to changing HF epidemiology, the available evidence suggests that much of the decline in HF rates is due to the use of BPs. The fall in the use of BPs is associated with an increase in HF rates in females, indicating that BPs should still be considered the first-line medications for the prevention and treatment of osteoporosis. Our results need to be confirmed in other populations and countries.
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Affiliation(s)
- Alex Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia.
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Kang HY, Yang KH, Kim YN, Moon SH, Choi WJ, Kang DR, Park SE. Incidence and mortality of hip fracture among the elderly population in South Korea: a population-based study using the national health insurance claims data. BMC Public Health 2010; 10:230. [PMID: 20438644 PMCID: PMC2874780 DOI: 10.1186/1471-2458-10-230] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 05/04/2010] [Indexed: 11/30/2022] Open
Abstract
Background The lack of epidemiologic information on osteoporotic hip fractures hampers the development of preventive or curative measures against osteoporosis in South Korea. We conducted a population-based study to estimate the annual incidence of hip fractures. Also, we examined factors associated with post-fracture mortality among Korean elderly to evaluate the impact of osteoporosis on our society and to identify high-risk populations. Methods The Korean National Health Insurance (NHI) claims database was used to identify the incidence of hip fractures, defined as patients having a claim record with a diagnosis of hip fracture and a hip fracture-related operation during 2003. The 6-month period prior to 2003 was set as a 'window period,' such that patients were defined as incident cases only if their first record of fracture was observed after the window period. Cox's proportional hazards model was used to investigate the relationship between survival time and baseline patient and provider characteristics available from the NHI data. Results The age-standardized annual incidence rate of hip fractures requiring operation over 50 years of age was 146.38 per 100,000 women and 61.72 per 100,000 men, yielding a female to male ratio of 2.37. The 1-year mortality was 16.55%, which is 2.85 times higher than the mortality rate for the general population (5.8%) in this age group. The risk of post-fracture mortality at one year is significantly higher for males and for persons having lower socioeconomic status, living in places other than the capital city, not taking anti-osteoporosis pharmacologic therapy following fracture, or receiving fracture-associated operations from more advanced hospitals such as general or tertiary hospitals. Conclusion This national epidemiological study will help raise awareness of osteoporotic hip fractures among the elderly population and hopefully motivate public health policy makers to develop effective national prevention strategies against osteoporosis to prevent hip fractures.
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Affiliation(s)
- Hye-Young Kang
- Graduate School of Public Health, Institute of Health Services Research, Yonsei University, Seoul, South Korea.
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