1
|
Barik S, Kumar V. Male Osteoporosis and Frailty. Indian J Orthop 2023; 57:237-244. [PMID: 38107814 PMCID: PMC10721747 DOI: 10.1007/s43465-023-01027-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/12/2023] [Indexed: 12/19/2023]
Abstract
It is estimated that 50% women and 20% of men over the age of 50 years will have an osteoporosis-related fracture in their remaining life. Although, Osteoporosis is generally thought to be a disease affecting females, more than a third of hip fractures occur in males due to reduced bone strength. Along with Osteoporosis, the other pathological process which occurs simultaneously is Sarcopenia. It is defined as age-related atrophy of skeletal muscle mass that reduces muscle strength, function, and quality of life. This chapter discusses the various aspects of the disease process in the males including its classification, clinical features, diagnosis and treatment.
Collapse
Affiliation(s)
- Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | - Vishal Kumar
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| |
Collapse
|
2
|
Liu J, Tang Y, Feng Z, Chen Y, Zhang X, Xia Y, Geng B. Metabolic associated fatty liver disease and bone mineral density: a cross-sectional study of the National Health and Nutrition Examination Survey 2017-2018. Osteoporos Int 2023; 34:713-724. [PMID: 36719471 DOI: 10.1007/s00198-023-06687-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Abstract
UNLABELLED This research is a cross-sectional study based on the participants aged 50 years and older from National Health and Nutrition Examination Survey (NHANES) database. The metabolic associated fatty liver disease (MAFLD) population has higher BMD and a lower risk of osteoporosis than those without MAFLD. INTRODUCTION MAFLD is a new definition presented by panel of experts based on non-alcoholic fatty liver disease in 2020. However, the link between MAFLD and bone mineral density (BMD) is uncertain. Thus, the present study aimed to investigate the relationship between MAFLD and BMD. METHODS This cross-sectional study included subjects aged ≥ 50 years from the National Health and Nutrition Examination Survey 2017-2018. Multivariate linear regression models were performed to investigate the association between MAFLD and BMD. Moreover, the relationship between MAFLD and osteoporosis was assessed using multiple logistic regression models. RESULTS Finally, 817 participants (non-MAFLD, n = 436; MAFLD, n = 381) were included in the final analysis. The results demonstrated that participants with MAFLD showed higher femoral BMDs than those without MAFLD, especially among males aged ≥ 50 years and females aged ≥ 65 years. Moreover, the results showed that obese men (BMI ≥ 30 kg/m2) with MAFLD had higher femoral BMDs than the control group according to subgroup analyses stratified by BMI, but this trend was not present in women. In addition, multiple logistic regression models showed that participants with MAFLD had no increased risks of osteoporosis. CONCLUSION The present study found that the MAFLD population has higher BMD and a lower risk of osteoporosis than those without MAFLD. Because the present study was a cross-sectional study, we could not identify the cause-effect relation between MAFLD and BMD. Therefore, additional research needs to be performed to explore the influences of MAFLD on bone metabolism in the future.
Collapse
Affiliation(s)
- Jinmin Liu
- Department of Orthopaedics, Lanzhou University Second Hospital, #82 Cuiyingmen, Lanzhou, 730000, Gansu, China
- Orthopaedics Key Laboratory of Gansu Province, Lanzhou, Gansu, China
- Orthopaedic Clinical Research Center of Gansu Province, Lanzhou, Gansu, China
| | - Yuchen Tang
- Department of Orthopaedics, Lanzhou University Second Hospital, #82 Cuiyingmen, Lanzhou, 730000, Gansu, China
- Orthopaedics Key Laboratory of Gansu Province, Lanzhou, Gansu, China
- Orthopaedic Clinical Research Center of Gansu Province, Lanzhou, Gansu, China
| | - Zhiwei Feng
- Department of Orthopaedics, Lanzhou University Second Hospital, #82 Cuiyingmen, Lanzhou, 730000, Gansu, China
- Orthopaedics Key Laboratory of Gansu Province, Lanzhou, Gansu, China
- Orthopaedic Clinical Research Center of Gansu Province, Lanzhou, Gansu, China
| | - Yi Chen
- Department of Orthopaedics, Lanzhou University Second Hospital, #82 Cuiyingmen, Lanzhou, 730000, Gansu, China
- Orthopaedics Key Laboratory of Gansu Province, Lanzhou, Gansu, China
- Orthopaedic Clinical Research Center of Gansu Province, Lanzhou, Gansu, China
| | - Xiaohui Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, #82 Cuiyingmen, Lanzhou, 730000, Gansu, China
- Orthopaedics Key Laboratory of Gansu Province, Lanzhou, Gansu, China
- Orthopaedic Clinical Research Center of Gansu Province, Lanzhou, Gansu, China
| | - Yayi Xia
- Department of Orthopaedics, Lanzhou University Second Hospital, #82 Cuiyingmen, Lanzhou, 730000, Gansu, China
- Orthopaedics Key Laboratory of Gansu Province, Lanzhou, Gansu, China
- Orthopaedic Clinical Research Center of Gansu Province, Lanzhou, Gansu, China
| | - Bin Geng
- Department of Orthopaedics, Lanzhou University Second Hospital, #82 Cuiyingmen, Lanzhou, 730000, Gansu, China.
- Orthopaedics Key Laboratory of Gansu Province, Lanzhou, Gansu, China.
- Orthopaedic Clinical Research Center of Gansu Province, Lanzhou, Gansu, China.
| |
Collapse
|
3
|
Ivanova S, Petkova V. Specificity of clinical trials of some osteoporosis medicines. PHARMACIA 2022. [DOI: 10.3897/pharmacia.69.e79258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Clinical trials of medicinal products related to the prevention and treatment of osteoporosis cover all activities, operations, methods and means for obtaining summary data and their interpretation in order to reveal the nature of the procedures, as well as certain relationships and dependencies of interest imposed the relevant study. The main objectives of the analysis are to characterize the relationships and dependencies, to measure the significance of these relationships, to model statistically significant relationships and dependencies. An important condition for conducting the statistical analysis is that the data are comparable, i.e. to be based on unambiguously defined features and criteria for their internal content.
Objective: This work covers a documentary analysis of conducted clinical trials of drugs for the treatment of osteoporosis, as well as an analysis of the conducted clinical trials of the drug.
Denosumab.
Methods: Gathering primary empirical information, allowing for: objectification of certain facts; for retrospective study of events and phenomena in a long period; allows to determine the direction of development of the process of clinical trials and processes. The applied statistical analysis covers activities, operations, methods and means for obtaining summary data and for their interpretation in order to reveal the nature of the procedures, as well as certain connections and dependencies.
Results: Studies show that clinical trials of osteoporosis products have the following limitations: gender differentiation – although the disease occurs in both sexes, studies in female patients are more common, patients are required to are in menopause, in some studies it is required as including criteria – the presence of a fracture due to osteoporosis, the age characteristic of patients is on average 45–80 years. All analyzed drugs show a positive effect on the state of bone density and bone structure.
Conclusion: All analyzed medicinal products show a positive effect on the state of bone density and bone structure but the process is irreversible, so early prevention associated with early diagnosis would lead to earlier treatment measures in the early stages of the disease, which in turn, it would lead to long-term savings in indirect and difficult-to-estimate costs for society as a whole.
Collapse
|
4
|
Zhao J, Liu L, Lv S, Wang C, Yue H, Zhang Z. PFN1 Gene Polymorphisms and the Bone Mineral Density Response to Alendronate Therapy in Postmenopausal Chinese Women with Low Bone Mass. Pharmgenomics Pers Med 2022; 14:1669-1678. [PMID: 34992429 PMCID: PMC8711734 DOI: 10.2147/pgpm.s344818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Alendronate is a widely used anti-osteoporotic drug. PFN1 gene is a newly identified early-onset Paget’s disease pathogenic gene. The purpose of this study is to study whether the genetic variations in this gene affect the clinical efficacy of alendronate in postmenopausal Chinese women with low bone mass. Patients and Methods Seven single nucleotide polymorphisms in PFN1 gene were genotyped. A total of 500 postmenopausal women with osteoporosis or osteopenia were included. All participants were treated with weekly alendronate 70 mg for 12 months. A total of 466 subjects completed the follow-up. Bone mineral density (BMD) of lumbar spine, femoral neck and total hip were measured at baseline and after treatment. Results After 12 months of treatment, the BMD of lumbar spine, femoral neck and total hip all increased significantly (all P < 0.001), with an average increase of 4.72 ± 5.31%, 2.08 ± 4.45%, and 2.42 ± 3.46%, respectively. At baseline, there were no significant differences in BMD at lumbar spine, femoral neck and total hip between different genotype groups (P > 0.05). We failed to identify any significant association between the genotypes or haplotypes of PFN1 and the BMD response to alendronate therapy. Conclusion Genetic polymorphisms of PFN1 may not be a major contributor to the therapeutic response to alendronate treatment in Chinese women with low bone mass.
Collapse
Affiliation(s)
- Jiao Zhao
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Li Liu
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Shanshan Lv
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Chun Wang
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Hua Yue
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Zhenlin Zhang
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| |
Collapse
|
5
|
Braten LC, Johnston RV, Suter C, Saku S, Järvinen T, Buchbinder R. Pharmacological therapies for the prevention of fractures in men. Hippokratia 2021. [DOI: 10.1002/14651858.cd014707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Lars Christian Braten
- Research and Communication Unit for Musculoskeletal Health (FORMI); Oslo University Hospital; Oslo Norway
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology; Cabrini Health; Melbourne Australia
| | - Renea V Johnston
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology; Cabrini Health; Melbourne Australia
| | - Cyrill Suter
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Sami Saku
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Teppo Järvinen
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology; Cabrini Health; Melbourne Australia
| |
Collapse
|
6
|
Jadzic J, Mijucic J, Nikolic S, Djuric M, Djonic D. The comparison of age- and sex-specific alteration in pubic bone microstructure: A cross-sectional cadaveric study. Exp Gerontol 2021; 150:111375. [PMID: 33940115 DOI: 10.1016/j.exger.2021.111375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The burden of age-associated fragility fracture of the pelvis has gradually amplified over the years. Commonly used clinical tools cannot fully explain age-associated fracture risk increase, and microstructural analysis could be required to elucidate pubic bone strength decline in elderly. MATERIAL AND METHODS The study sample encompassed 46 pubic bones obtained from cadaveric donors divided into a young women (<45 years, n = 11), aged women (>60 years, n = 11), young men (<45 years, n = 12) and aged men group (>60 years, n = 12). Micro-computed tomography was used to evaluate the cortical and trabecular microstructure of pubic bone samples. RESULTS Apart from age-associated loss in quantitative trabecular parameters, significant alteration of micro-CT parameters that more closely reflect internal trabecular microarchitectural complexity may contribute to pubic bone strength decline in men and women of advanced age (p < 0.05). Additionally, decreased cortical thickness and increased Ct.Po, Po.Dm and Po.N were found in the anterior and posterior cortical surface of pubic bone samples from the aged individuals (p < 0.05). The more pronounced alteration was noted in aged female donors, illustrated in a significant deterioration trend of the Tb.N, Tb.Sp, and thinner posterior cortical surface with decreased pore spacing (p < 0.05). CONCLUSION Our data suggest that age-associated deterioration in trabecular and cortical pubic bone micro-architecture could unravel a morphological basis for decreased pubic bone strength and increased pubic bone fragility, which leads to fracture predilection in the elderly women. Thus, the individual fracture risk assessment should be advised in the elderly, with a particular accent on aged women.
Collapse
Affiliation(s)
- Jelena Jadzic
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovana Mijucic
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slobodan Nikolic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Djuric
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Djonic
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| |
Collapse
|
7
|
Mohammed AO, Kaklamanos EG. Effect of ovariectomy-induced osteoporosis on the amount of orthodontic tooth movement: a systematic review of animal studies. Eur J Orthod 2021; 43:672-681. [PMID: 33866368 DOI: 10.1093/ejo/cjab013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Understanding the impact of osteopenia and osteoporosis on orthodontic tooth movement could be of benefit to the orthodontist, but research in humans presents practical and ethical problems. The ovariectomized animal model could provide useful information on osteoporosis. OBJECTIVE To compare the amount of tooth movement during or after the application of orthodontic forces between ovariectomized animals and control or sham-operated subjects. SEARCH METHODS Unrestricted searches in seven databases and manual searching of the reference lists in relevant studies were performed up to February 2021 (PubMed, Central, Cochrane Database of Systematic Reviews, Scopus, Web of Science, Arab World Research Source, ProQuest Dissertations, and Theses Global). SELECTION CRITERIA We searched for studies quantitatively comparing the amount of tooth movement during or after the application of orthodontic forces between ovariectomized animals and control or sham-operated subjects. DATA COLLECTION AND ANALYSIS Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. Exploratory synthesis and meta-regression were carried out using the random effects model. RESULTS Thirteen studies were finally selected and no specific concerns regarding bias were identified. During the active period, ovariectomy was associated with a statistically significant acceleratory effect on the rate of orthodontic tooth movement compared to non-treated rats (3 weeks; 4 studies, 0.15 mm more movement in the ovariectomized rats; 95 per cent confidence interval: 0.10-0.19; P = 0.000). Exploratory meta-regression showed that this difference could increase over time. Following force discontinuation, no statistically significant differences were observed [3 weeks; 1 study (median ± SE), Ovariectomy group: 0.30 ± 0.04 mm; Sham operation group: 0.18 ± 0.03; P = 0.1558]. CONCLUSIONS Ovariectomy-induced osteoporosis may affect the rate of orthodontic tooth movement. Although animal studies should be approached with caution regarding their translational potential, the safe practice would suggest that one should consider potential implications. REGISTRATION PROSPERO (CRD42018118003).
Collapse
Affiliation(s)
- Ayesha O Mohammed
- Dubai Health Authority, Dubai, United Arab Emirates.,Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Eleftherios G Kaklamanos
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| |
Collapse
|
8
|
Wáng YXJ, Lentle BC. Radiographic osteoporotic vertebral fractures in elderly men: a brief review focusing on differences between the sexes. Quant Imaging Med Surg 2020; 10:1863-1876. [PMID: 32879863 PMCID: PMC7417751 DOI: 10.21037/qims-2020-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 06/28/2020] [Indexed: 12/16/2022]
Abstract
Bone loss occurs in both sexes as a result of ageing but is exacerbated in women by the hormonal changes associated with menopause. Unlike in women, secondary osteoporosis occurs in almost half of men diagnosed with osteoporosis. Moreover, vertebral fractures (VFs) seen in elderly men may more likely be the result of high energy trauma. The osteoporotic vertebral fracture (OVF) radiograph diagnosis criteria for women may not be directly applicable for men. Particular attention should be paid to the mid-thoracic level where over-diagnosis commonly occurs. For wedge-shaped vertebral deformities (VDs) or VDs with anterior height reduction only, a diagnosis of OVF requires great caution, as they are poorly correlated to bone mineral density (BMD). For age-matched subjects, it is likely that elderly men's prevalent radiographic OVFs are approximately half of the elderly women's. This male-female ratio is very similar to other clinical fractures such as those occurring at the hip. Even so, the clinical relevance of OVF in elderly men may be less than that of elderly women. On the other hand, for elderly men with hip BMD-based osteoporosis, the OVF risk is as high as that of osteoporotic women. Elderly Chinese men have a lower OVF prevalence than age-matched Caucasian men.
Collapse
Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Brian C. Lentle
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
9
|
Wáng YXJ, Che-Nordin N, Deng M, Griffith JF, Leung JCS, Kwok AWL, Leung PC, Kwok TCY. Elderly males with or without existing osteoporotic vertebral fracture have much lower future vertebral fracture risk than elderly females: the MrOS (Hong Kong) year-4 follow-up spine radiograph study. Osteoporos Int 2019; 30:2505-2514. [PMID: 31478068 DOI: 10.1007/s00198-019-05136-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
UNLABELLED MrOS (Hong Kong)'s year-4 follow-up shows, for subjects at baseline without vertebral deformity (VD) and endplate or/and cortex fracture (ECF), the VD progression/new VD rate during follow-up in males was half of our paired MsOS (Hong Kong) study's results. For those with VD or ECF, the VD progression/new VD was less than one sixth of females' rate. INTRODUCTION This study documents MrOS (Hong Kong)'s year-4 follow-up, and the results are compared with the MsOS (Hong Kong) study. Of elderly females with Genant's grade-0, -1, -2, and -3 VD, at year-4 follow-up, 4.6%, 8%, 10.6%, and 28.9% had at least one VD progression or incident VD, respectively. METHODS Spine radiographs of 1500 Chinese males with baseline (mean age 71.7 years, range 65-91 years) and year-4 follow-up were evaluated according to Genant's VD criteria and ECF (non-existent, ECF0; or existent, ECF1). Grade-2 VDs were divided into mild (VD2m, 25-34% height loss) and severe (VD2s, 34-40% height loss) subgroups. Study subjects were graded into eight categories: VD0/ECF0, VD1/ECF0, VD2m/ECF0, VD0/ECF1, VD1/ECF1, VD2m/ECF1, VD2s/ECF1, and VD3/ECF1. With an existing VD, a further height loss of ≥ 15% was a VD progression. A new VD incident was a change from grade-0 to grade-2/3, or to grade-1 with ≥ 10% height loss. RESULTS Of subjects with Genant's grade-0, 2.05% (25/1219) developed at least one VD progression or/and new VD, while of subjects with Genant's grade-1, -2, and -3 VD, only 2% (3/149), 3.1% (3/96), and 2.8% (1/36) developed at least one VD progression/new VD, respectively. Among the three ECF0 groups, there was a significant difference in new ECF incidence, with VD0/ECF0 being the lowest and VD2m/ECF0 being the highest. CONCLUSION VD progression/new VD is much less common in elderly men than in elderly women. Vertebrae with VD had a higher risk of developing ECF.
Collapse
Affiliation(s)
- Y X J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China.
| | - N Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - M Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - J F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - J C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - A W L Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - P C Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - T C Y Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| |
Collapse
|
10
|
Wallace TC, Bailey RL, Blumberg JB, Burton-Freeman B, Chen CYO, Crowe-White KM, Drewnowski A, Hooshmand S, Johnson E, Lewis R, Murray R, Shapses SA, Wang DD. Fruits, vegetables, and health: A comprehensive narrative, umbrella review of the science and recommendations for enhanced public policy to improve intake. Crit Rev Food Sci Nutr 2019; 60:2174-2211. [DOI: 10.1080/10408398.2019.1632258] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Taylor C. Wallace
- Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA
- Think Healthy Group, Inc., Washington, DC, USA
| | - Regan L. Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | - Jeffrey B. Blumberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Britt Burton-Freeman
- Center for Nutrition Research, Institute for Food Safety and Health, Illinois Institute of Technology, Bedford Park, Illinois, USA
| | - C-y. Oliver Chen
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
- Biofortis Research, Merieux NutriSciences, Addison, Illinois, USA
| | | | - Adam Drewnowski
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Shirin Hooshmand
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Elizabeth Johnson
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Richard Lewis
- Bone and Body Composition Laboratory, College of Family and Consumer Sciences, University of Georgia, Athens, Georgia, USA
| | - Robert Murray
- College of Education and Human Ecology, The Ohio State University, Columbus, Ohio, USA
| | - Sue A. Shapses
- Department of Nutritional Sciences, Rutgers University, New Brunswick, New Jersey, USA
| | | |
Collapse
|
11
|
Abstract
The consumption of high-Ca, high-protein dairy foods (i.e. milk, cheese, yogurt) is advocated for bone health across the lifespan to reduce the risk of low-trauma fractures. However, to date, the anti-fracture efficacy of dairy food consumption has not been demonstrated in randomised controlled trials but inferred from cross-sectional and prospective studies. The anti-fracture efficacy of dairy food consumption is plausible, but testing this requires a robust study design to ensure outcomes are suitably answering this important public health question. The evidence of skeletal benefits of dairy food consumption is equivocal, not because it may not be efficacious but because the study design and execution are often inadequate. The key issues are compliance with dietary intervention, dropouts, sample sizes and most importantly lack of deficiency before intervention. Without careful appraisal of the design and execution of available studies, precarious interpretations of outcomes may be made from these poorly designed or executed studies, without consideration of how study design may be improved. Dairy food interventions in children are further hampered by heterogeneity in growth: in particular sex and maturity-related differences in the magnitude, timing, location and surface-specific site of bone accrual. Outcomes of studies combining children of different sexes and maturity status may be masked or exaggerated by these differences in growth, so inaccurate conclusions are drawn from results. Until these critical issues in study design are considered in future dairy food interventions, the anti-fracture efficacy of dairy food consumption may remain unknown and continue to be based on conjecture.
Collapse
|
12
|
Alvarenga JC, Boyd SK, Pereira RMR. The relationship between estimated bone strength by finite element analysis at the peripheral skeleton to areal BMD and trabecular bone score at lumbar spine. Bone 2018; 117:47-53. [PMID: 30219479 DOI: 10.1016/j.bone.2018.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 09/03/2018] [Accepted: 09/12/2018] [Indexed: 01/16/2023]
Abstract
Bone strength, estimated by finite element (FE) analysis based on high resolution peripheral quantitative computed tomography (HR-pQCT) images is an important contributor to understanding risk of fracture. However, it is a peripheral device and cannot be evaluated in vivo at lumbar spine L1-L4. The aim of this study was to investigate if the axial bone quality can be predicted by strength measurements of peripheral bone. Peripheral bone microarchitecture, areal bone mineral density (aBMD) and trabecular bone score (TBS) were measured in adults individuals (n = 262, 60 years and older; 63% women). Stiffness and failure load were estimated by FE analysis at HR-pQCT images at radius and tibia. Areal BMD and TBS were measured by dual energy X-ray absorptiometry (DXA) at L1-L4. Correlations between peripheral and axial data were estimated for each gender adjusted by age, weight, and height. Areal BMD L1-L4 resulted in weak to moderate significant correlations with stiffness and failure load at radius (women: R2 = 0.178, p < 0.05 and R2 = 0.187, p < 0.001, respectively; men: R2 = 0.454 and R2 = 0.451, p < 0.001, respectively) and at tibia (women: R2 = 0.211 and R2 = 0.216, p < 0.001, respectively; men: R2 = 0.488 and R2 = 0.502, p < 0.001, respectively). TBS showed a very weak or no correlation with stiffness and failure load at radius (women: R2 = 0.148 and R2 = 0.150, p < 0.05, respectively; men: R2 = 0.108 and R2 = 0.106, p < 0.05, respectively) and at tibia (women: R2 = 0.146 and R2 = 0.150, p < 0.05, respectively; men: R2 = 0.072 and R2 = 0.078, respectively). These data suggest that aBMD L1-L4 was better explained by peripheral bone strength characteristics than the TBS, mainly in men and tibia is generally the site with a better relationship.
Collapse
Affiliation(s)
- Jackeline C Alvarenga
- Bone Laboratory Metabolism, Rheumatology Division, Faculdade Medicina FMUSP da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Rosa M R Pereira
- Bone Laboratory Metabolism, Rheumatology Division, Faculdade Medicina FMUSP da Universidade de Sao Paulo, Sao Paulo, Brazil.
| |
Collapse
|
13
|
Zaidi M, Lizneva D, Kim SM, Sun L, Iqbal J, New MI, Rosen CJ, Yuen T. FSH, Bone Mass, Body Fat, and Biological Aging. Endocrinology 2018; 159:3503-3514. [PMID: 30085049 PMCID: PMC6134257 DOI: 10.1210/en.2018-00601] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/24/2018] [Indexed: 12/11/2022]
Abstract
The Study of Women's Health Across the Nation has taught us that impending ovarian failure during late perimenopause is associated with a sharp rise in serum FSH, which coincides with the most rapid rate of bone loss and the onset of visceral adiposity. At this time in a woman's life, serum estrogen levels are largely unaltered, so the hypothesis that hypoestrogenemia is the sole cause of bone loss and visceral obesity does not offer a full explanation. An alternative explanation, arising from animal models and human data, is that both physiologic aberrations, obesity and osteoporosis, arise at least in part from rising FSH levels. Here, we discuss recent findings on the mechanism through which FSH exerts biological actions on bone and fat and review clinical data that support a role for FSH in causing osteoporosis and obesity. We will also provide a conceptual framework for using a single anti-FSH agent to prevent and treat both osteoporosis and obesity in women across the menopausal transition.
Collapse
Affiliation(s)
- Mone Zaidi
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Correspondence: Mone Zaidi, MD, PhD, Mount Sinai Bone Program, Endocrinology, Box 1055, One Gustave L. Levy Place, New York, New York 10029. E-mail:
| | - Daria Lizneva
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Reproductive Health Protection, Scientific Center of Family Health and Human Reproduction, Irkutsk, Russian Federation
| | - Se-Min Kim
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Li Sun
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jameel Iqbal
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria I New
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Tony Yuen
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
14
|
Lizneva D, Yuen T, Sun L, Kim SM, Atabiekov I, Munshi LB, Epstein S, New M, Zaidi M. Emerging concepts in the epidemiology, pathophysiology, and clinical care of osteoporosis across the menopausal transition. Matrix Biol 2018; 71-72:70-81. [PMID: 29738833 DOI: 10.1016/j.matbio.2018.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 02/08/2023]
Abstract
Bone loss in women accelerates during perimenopause, and continues into old age. To-date, there has been little progress made in stratifying for fracture risk in premenopausal and early postmenopausal women. Epidemiologic data suggests that changes in serum FSH could predict decrements in bone mass during peri- and postmenopause. In bone, FSH stimulates osteoclast formation by releasing osteoclastogenic cytokines. Here, we address the evidence for bone loss across the menopausal transition, discuss strategies for detection and treatment of early postmenopausal osteoporosis, and describe the role FSH plays in physiology and likely in pathophysiology of early postmenopausal bone loss.
Collapse
Affiliation(s)
- Daria Lizneva
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Reproductive Health Protection, Scientific Center of Family Health and Human Reproduction, Irkutsk, Russian Federation.
| | - Tony Yuen
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Li Sun
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Se-Min Kim
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ihor Atabiekov
- Department of Reproductive Health Protection, Scientific Center of Family Health and Human Reproduction, Irkutsk, Russian Federation
| | - Lubna Bashir Munshi
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sol Epstein
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria New
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mone Zaidi
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
15
|
van der Velde RY, Bours SPG, Wyers CE, Lems WF, Geusens PPMM, van den Bergh JPW. Effect of implementation of guidelines on assessment and diagnosis of vertebral fractures in patients older than 50 years with a recent non-vertebral fracture. Osteoporos Int 2017; 28:3017-3022. [PMID: 28748385 PMCID: PMC5624971 DOI: 10.1007/s00198-017-4147-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 07/04/2017] [Indexed: 11/30/2022]
Abstract
UNLABELLED We evaluated the impact of a new Dutch guideline on systematic implementation of densitometric Vertebral Fracture Assessment (VFA) in patients with a recent non-vertebral fracture. Systematic implementation resulted in a significant increase of VFA, diagnosis of vertebral fractures (VFs), and percentage of patients eligible for treatment. INTRODUCTION VFs are underdiagnosed although they are important predictors of fracture risk, independent of age and bone mineral density (BMD). The Dutch guideline on osteoporosis and fracture prevention recommends VFA in all patients aged >50 years with a recent non-VF. Our aim was to evaluate the effect of systematic implementation of densitometric VFA in patients with a recent non-VF at the fracture liaison service (FLS). METHODS VFA was performed on lateral images of the spine using dual-energy X-ray absorptiometry (DXA) and graded according to Genant using Spine Analyzer software. RESULTS We evaluated 582 patients before and 484 after implementation (mean age 67 and 66 years; 71 and 74% women, respectively). Performing VFA increased from 4.6 to 97.1% (p < 0.001) and the diagnosis of VFs from 2.2 to 26.2% for grade ≥ 1 (p < 0.001) and from 0.9 to 14.7% for grade ≥ 2 (p < 0.001). Prevalence of VFs increased with age (5.2% in 50-59-year olds to 27.8% in 80+-year olds, p < 0.001), but was similar for both genders, non-VF locations, and BMD. Including patients with osteopenia and a VF increased the percentage of patients eligible for treatment by a quarter, from 31.0% in the pre-guideline to 38.4% in the post-guideline cohort. CONCLUSIONS Systematic guideline implementation resulted in a significant increase of VFA, diagnosis of VFs, and percentage of patients eligible for treatment. VFA contributes to documenting the high prevalence of VFs in patients visiting the FLS with a non-VF in both genders, at any age, non-VF location, and BMD.
Collapse
Affiliation(s)
- R Y van der Velde
- Department of Internal Medicine, VieCuri Medical Centre for North Limburg, Tegelseweg 210, 5912 BL, Venlo, The Netherlands.
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht UMC, Maastricht, The Netherlands.
| | - S P G Bours
- Department of Rheumatology, CAPHRI, Maastricht UMC, Maastricht, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Centre for North Limburg, Tegelseweg 210, 5912 BL, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht UMC, Maastricht, The Netherlands
| | - W F Lems
- Department of Rheumatology, VU Medical Centre, Amsterdam, The Netherlands
| | - P P M M Geusens
- Department of Rheumatology, CAPHRI, Maastricht UMC, Maastricht, The Netherlands
- Biomedical Research Centre, University of Hasselt, Hasselt, Belgium
| | - J P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre for North Limburg, Tegelseweg 210, 5912 BL, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht UMC, Maastricht, The Netherlands
- Biomedical Research Centre, University of Hasselt, Hasselt, Belgium
| |
Collapse
|
16
|
Androgen deprivation in prostate cancer and the long-term risk of fracture. Actas Urol Esp 2017; 41:491-496. [PMID: 28259363 DOI: 10.1016/j.acuro.2017.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To determine the rate of bone mass loss and the risk of fracture induced by androgen deprivation therapy in patients with prostate cancer. MATERIAL AND METHODS Prospective study in 2 phases. In the first phase, demographic variables, FRAX®, bone mineral density and clinical fractures were collected, before starting the therapy and up to 1 year after ending the therapy. In the second phase, we conducted a telephone interview a mean of 8.5 years after the start of the study to assess new fractures. RESULTS We included 150 patients with a mean age of 67 years and a mean therapy duration of 24 months. Before starting the treatment, 62 patients (41%) showed osteoporosis or low bone mass in the densitometry. After the first year of treatment, the bone mineral density decreased a mean of 3.7% and 2.1% in the lumbar spine and femoral neck, respectively. At the end of the second and third year, the loss rate was lower. During the first phase of the study, 4 patients (2.7%) experienced a fracture. In the telephone interviews with 80 patients (53%), only 1 had experienced a fracture. CONCLUSIONS In the patients with prostate cancer and androgen deprivation therapy, greater bone loss occurred during the first year. When the treatment did not exceed 2 years, the absolute risk of fracture was low, and clinical fractures were uncommon in the short and long term.
Collapse
|
17
|
Loures MAR, Zerbini CAF, Danowski JS, Pereira RMR, Moreira C, Paula APD, Castro CHM, Szejnfeld VL, Mendonça LMC, Radominiski SC, Bezerra MC, Simões R, Bernardo WM. Guidelines of the Brazilian Society of Rheumatology for the diagnosis and treatment of osteoporosis in men. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57 Suppl 2:497-514. [PMID: 28800970 DOI: 10.1016/j.rbre.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/24/2017] [Indexed: 02/07/2023] Open
Abstract
Osteoporosis, a metabolic disease characterized by low bone mass, deterioration of the bone tissue microarchitecture and increased susceptibility to fractures, is commonly regarded as a women's health problem. This point of view is based on the fact that compared with men, women have lower bone mineral density and longer lifespans and lose bone mass faster, especially after menopause, due to a marked decrease in serum estrogen levels. However, in the last 20 years, osteoporosis in men has become recognized as a public health problem due to the occurrence of an increasingly higher number of fragility fractures. Approximately 30% of all hip fractures occur in men. Recent studies show that the probability of fracture due to hip, vertebral or wrist fragility in Caucasian men older than fifty years, for the rest of their lives, is approximately 13% versus a 40% probability of fragility fractures in women. Men show bone mass loss and fractures later than women. Although older men have a higher risk of fracture, approximately half of all hip fractures occur before the age of 80. Life expectancy is increasing for both sexes in Brazil and worldwide, albeit at a higher rate for men than for women. This Guideline was based on a systematic review of the literature on the prevalence, etiology, diagnosis and treatment of osteoporosis in men.
Collapse
Affiliation(s)
- Marco Antônio R Loures
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Universidade Estadual de Maringá (UEM), Hospital Universitário, Maringá, PR, Brazil.
| | - Cristiano Augusto F Zerbini
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Centro Paulista de Investigação Clínica (CEPIC), São Paulo, SP, Brazil
| | - Jaime S Danowski
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Hospital Israelita Albert Sabin, Unidade de Reumatologia, Rio de Janeiro, RJ, Brazil
| | - Rosa Maria R Pereira
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, São Paulo, SP, Brazil
| | - Caio Moreira
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Ana Patrícia de Paula
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Secretaria de Saúde do Distrito Federal (SES-DF), Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS), Brasília, DF, Brazil; Universidade de Brasília (UnB), Faculdade de Ciências da Saúde (FS), Brasília, DF, Brazil
| | - Charlles Heldan M Castro
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Vera Lúcia Szejnfeld
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Setor de Doenças Osteometabólicas, São Paulo, SP, Brazil
| | - Laura Maria C Mendonça
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Programa de Residência Médica de Reumatologia, Rio de Janeiro, RJ, Brazil
| | - Sebastião C Radominiski
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Mailze C Bezerra
- Sociedade Brasileira de Reumatologia (SBR), Comissão de Doenças Osteometabólicas e Osteoporose, São Paulo, SP, Brazil; Hospital Geral de Fortaleza (HGF), Ambulatório de Osteoporose e Doenças Osteometabólicas, Fortaleza, CE, Brazil
| | - Ricardo Simões
- Associação Médica Brasileira (AMB), Projeto Diretrizes, São Paulo, SP, Brazil
| | | |
Collapse
|
18
|
Loures MAR, Zerbini CAF, Danowski JS, Pereira RMR, Moreira C, Paula APD, Castro CHM, Szejnfeld VL, Mendonça LMC, Radominiski SC, Bezerra MC, Simões R, Bernardo WM. Diretrizes da Sociedade Brasileira de Reumatologia para diagnóstico e tratamento da osteoporose em homens. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
19
|
Bienz M, Saad F. Androgen-deprivation therapy and bone loss in prostate cancer patients: a clinical review. BONEKEY REPORTS 2015; 4:716. [PMID: 26131363 DOI: 10.1038/bonekey.2015.85] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/08/2015] [Indexed: 12/31/2022]
Abstract
Androgen-deprivation therapy (ADT) has become a standard of care in the management of advanced prostate cancer or as an adjunct therapy. However, ADT is associated with a well-known deleterious effect on bone health, resulting in a decrease in bone-mass density (BMD) and increased risk for fracture. With the longer life expectancy of prostate cancer patients, improvement of the quality of life has become increasingly important. Therefore, adequate screening, prevention and treatment of BMD loss is paramount. Zoledronic acid and denosumab have shown promising results in recent studies, which has led to the Food and Drug Administration approval of these treatment options in various settings throughout the course of the disease, including the prevention of ADT-associated bone loss. This review focuses on the various parameters that impact BMD loss in men initiating ADT, on the specific effect of ADT on bone health and on various lifestyle modifications and treatment options such as bisphosphonates, osteoclast-targeted therapy and selective estrogen-receptor modulators that have shown promising results in recent studies.
Collapse
Affiliation(s)
- Marc Bienz
- Faculty of Medicine, University of Montreal , Montreal, Canada
| | - Fred Saad
- Department of Urology, University of Montreal Hospital Center , Montreal, Canada
| |
Collapse
|
20
|
Manthripragada AD, O'Malley CD, Gruntmanis U, Hall JW, Wagman RB, Miller PD. Fracture incidence in a large cohort of men age 30 years and older with osteoporosis. Osteoporos Int 2015; 26:1619-27. [PMID: 25616508 DOI: 10.1007/s00198-015-3035-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/11/2015] [Indexed: 10/24/2022]
Abstract
UNLABELLED In this large retrospective study of men with presumed osteoporosis, we estimate the rate of osteoporosis-related fractures in men age ≥30 years. Our results suggest that spine and hip fractures continue to be a considerable disease burden for osteoporotic men of all ages. INTRODUCTION The purposes of this study were to describe a cohort of men with presumed osteoporosis and estimate the incidence rates of fractures by age. METHODS Using US administrative claims data, we identified 43,813 men ≥30 years old with an osteoporosis diagnosis or use of an osteoporosis medication. Men were followed for a minimum of 12 months after diagnosis or treatment of osteoporosis (index date), until the earliest of fracture (hip, spine, pelvis, distal femur, humerus, wrist, forearm), disenrollment, or study end date. RESULTS During the study period, there were 3834 first fractures following the index date and 3303 fractures in the 6-month period prior to the diagnosis/treatment of osteoporosis. Incidence rates of osteoporosis-related fracture, estimated from the index date onward, increased with age, although did not significantly differ from one another in younger age groups (30-49 and 50-64 years). Spine fractures had the highest incidence rate in men across all age groups, increasing from 10.8 per 100,000 person-years (p-yrs) (95% confidence interval (CI) 9.1, 12.7), 12.2 per 100,000 p-yrs (95% CI 11.2, 13.3), and 15.3 per 100,000 p-yrs (95% CI 13.8, 16.9) in men 30-49, 50-64, and 65-74 years to 33.4 per 100,000 p-yrs (95% CI 31.5, 35.4) in men ≥75 years. Hip fractures were the second most common, with the incidence rate reaching 16.2 per 100,000 (95% CI 14.9, 17.6) in the ≥75-year group. CONCLUSION These incidence rates suggest that spine and hip fractures are a considerable disease burden for men of all ages diagnosed and/or treated for osteoporosis.
Collapse
|
21
|
James H, Aleksic I, Bienz MN, Pieczonka C, Iannotta P, Albala D, Mariados N, Mouraviev V, Saad F. Comparison of fracture risk assessment tool score to bone mineral density for estimating fracture risk in patients with advanced prostate cancer on androgen deprivation therapy. Urology 2014; 84:164-8. [PMID: 24976229 DOI: 10.1016/j.urology.2013.12.071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 08/30/2013] [Accepted: 12/18/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate the risk of fracture (Fracture Risk Assessment Tool [FRAX] algorithm) because of the development of osteoporosis in prostate cancer patients undergoing androgen deprivation therapy (ADT) for patients who would otherwise not have been identified for treatment by the T score. METHODS This study includes men undergoing ADT for prostate cancer at our urology group. Clinical data were collected via chart review. Subjects were evaluated for fracture risk using country specific (for the United States of America) World Health Organization's FRAX. The FRAX calculations were then compared to fracture risk as determined by T score, for a subset of our cohort that received dual-energy X-ray absorptiometry. RESULTS Our cohort consisted of 613 patients on ADT, 94 of which had a dual-energy X-ray absorptiometry scan. The FRAX algorithm identified 61.6% patients requiring therapy without bone mass density (BMD), 46.8% with BMD, and 19.14% with T score alone. In addition, positive correlation was found between FRAX with and without BMD as well as T score and FRAX with BMD and without BMD. CONCLUSION Our data indicate that many patients who were not found at significant risk for fracture with T score were in fact found to be at risk with the FRAX calculation. The largest proportion of patients was found to be at risk through the FRAX calculation without BMD, followed by FRAX with BMD, followed by T score alone. The utility of FRAX is beneficial in identifying patients that may benefit from effective bone-tropic treatment modalities.
Collapse
Affiliation(s)
- Herbert James
- Associated Medical Professionals of New York, Syracuse, NY
| | | | | | | | - Peter Iannotta
- Associated Medical Professionals of New York, Syracuse, NY
| | - David Albala
- Associated Medical Professionals of New York, Syracuse, NY
| | - Neil Mariados
- Associated Medical Professionals of New York, Syracuse, NY
| | | | - Fred Saad
- Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| |
Collapse
|
22
|
Sim IW, Ebeling P, Buchbinder R. Bisphosphonates for preventing and treating osteoporosis in men. Hippokratia 2014. [DOI: 10.1002/14651858.cd011074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Ie-Wen Sim
- The University of Melbourne; NorthWest Academic Centre; Level 3, Western Centre of Health Research and Education, Sunshine Hospital 176 Furlong Road, St Albans Victoria Australia 3021
| | - Peter Ebeling
- The University of Melbourne; NorthWest Academic Centre; Level 3, Western Centre of Health Research and Education, Sunshine Hospital 176 Furlong Road, St Albans Victoria Australia 3021
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash Department of Clinical Epidemiology, Cabrini Hospital; Suite 41, Cabrini Medical Centre 183 Wattletree Road Malvern Victoria Australia 3144
| |
Collapse
|
23
|
Validation of the Quality-of-Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-26) in Korean population. Rheumatol Int 2014; 34:919-27. [PMID: 24414743 DOI: 10.1007/s00296-013-2942-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/30/2013] [Indexed: 12/20/2022]
Abstract
We aimed to evaluate the reliability and validity of the adapted Korean version of the Quality-of-Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-26). Translation/retranslation of the English version of QUALEFFO was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the visual analog scale measure of pain, QUALEFFO-26 and the previously validated Short Form-36 (SF-36) were mailed to 162 consecutive patients with osteoporosis. Factor analysis and reliability assessment by kappa statistics of agreement for each item, the intraclass correlation coefficient and Cronbach's α were conducted. Construct validity was also evaluated by comparing the responses of QUALEFFO-26 with the responses of SF-36 using Pearson's correlation coefficient. Factor analysis extracted 3 factors. All items had a kappa statistics of agreement greater than 0.6. The QUALEFFO-26 showed good test/retest reliability (QUALEFFO-26: 0.8271). Internal consistency of Cronbach's α was found to be very good (QUALEFFO-26: 0.873). The Korean version of QUALEFFO-26 showed good significant correlation with SF-36 total score and with single SF-36 domains scores. The adapted Korean version of the QUALEFFO-26 was successfully translated and showed acceptable measurement properties and, as such, is considered suitable for outcome assessments in the Korean-speaking patients with osteoporosis.
Collapse
|
24
|
Abstract
Over the last decade, the increasingly significant problem of osteoporosis in men has begun to receive much more attention than in the past. In particular, recent observations from large scale population studies in males led to an advance in the understanding of morphologic basis of growth, maintenance and loss of bone in men, as well as new insights about the pathophysiology and treatment of this disorder. While fracture risk consistently increases after age 65 in men (with up to 50 % of cases due to secondary etiologies), osteoporosis and fractures may also occur in young or middle aged males in the absence of an identifiable etiology. For this category (so called idiopathic osteoporosis), there are still major gaps in knowledge, particularly concerning the etiology and the clinical management. This article provides a summary of recent developments in the acquisition and maintenance of bone strength in men, as well as new insights about the pathogenesis, diagnosis, and treatment of idiopathic osteoporosis.
Collapse
Affiliation(s)
- Luigi Gennari
- Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Bracci, 53100, Siena, Italy,
| | | |
Collapse
|
25
|
Low rates of bone mineral density measurement in Medicare beneficiaries with prostate cancer initiating androgen deprivation therapy. Support Care Cancer 2013; 22:537-44. [PMID: 24146343 DOI: 10.1007/s00520-013-2008-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 10/01/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Men with prostate cancer who undergo androgen deprivation therapy (ADT) are at risk for bone loss and fractures. Our objective was to determine if Medicare beneficiaries with prostate cancer in the state of Texas underwent DXA scans when initiating ADT. METHODS We identified men diagnosed with prostate cancer between 2005 and 2007 in the Texas Cancer Registry/Medicare linked database, and who received parenteral ADT or orchiectomy. We identified DXA claims within 1 year before or 6 months after starting ADT. We examined use of bone conservation agents in the subgroup of patients enrolled in Medicare Part D. Multivariate logistic regression models were used to examine determinants of DXA use. RESULTS The analysis included 2,290 men (2,262 parenteral ADT, 28 orchiectomy); 197 (8.6 %) underwent DXA within 1 year before and 6 months after starting ADT. Men aged 75 years or older were more likely to undergo DXA than men aged 66-74 years (OR 1.5; 95 % CI 1.1-2.1). Those living in small urban areas were less likely to undergo DXA than those in big areas (OR 0.40; 95 % CI 0.19-0.82). Of the 1,060 men enrolled in Medicare part D, 59 (5.6 %) received bone conservation agents when starting ADT; 134 (12.6 %) either received bone conservation agents or underwent DXA. CONCLUSIONS Fewer than one in ten Medicare beneficiaries with prostate cancer initiating ADT underwent a DXA exam. Variation in utilization was also related to residence area size. Further research is needed to identify whether the use of DXA in patients with prostate cancer receiving ADT will result in fracture prevention.
Collapse
|
26
|
Sim IW, Ebeling PR. Treatment of osteoporosis in men with bisphosphonates: rationale and latest evidence. Ther Adv Musculoskelet Dis 2013; 5:259-67. [PMID: 24101947 DOI: 10.1177/1759720x13500861] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Osteoporosis in men contributes to significant morbidity and mortality. Hip fractures in men are associated with greater mortality compared with women, with a mortality rate of up to 37.5% within a year following the fracture. Its timely diagnosis and treatment are therefore essential. However, despite one-third of all hip fractures worldwide occurring in men, osteoporosis in men remains an immensely under-recognized and undertreated public health problem. Bisphosphonates are well studied first-line treatments for postmenopausal women with osteoporosis and have been shown to reduce fragility fractures at all clinically important sites (vertebral, nonvertebral, hip and wrist). However, the majority of studies of oral or intravenous bisphosphonate therapy in men with osteoporosis report effects on surrogate markers, including bone mineral density (BMD) and biochemical bone turnover markers, rather than on fragility fractures. Oral or intravenous bisphosphonate therapy increases spinal, total hip and femoral neck BMD compared with placebo in men with osteoporosis. Both bone resorption and bone formation markers are decreased following bisphosphonate therapy, with the onset of the decrease in bone formation markers being delayed. In a study of intravenous zoledronic acid given to older men and women following a hip fracture, any clinical vertebral and nonvertebral fractures were all reduced compared with placebo infusions. In addition, mortality was reduced in patients who received zoledronic acid. Recent studies in men with osteoporosis have increasingly reported reductions in incident vertebral fractures with oral or intravenous bisphosphonate therapy, although all studies have been underpowered to detect effects on nonvertebral and hip fracture outcomes. Bisphosphonates have a role as monotherapy, as consolidative therapy after a course of teriparatide therapy, or in combination with testosterone replacement in men with hypogonadism and osteoporosis. Bisphosphonate therapy is validated and important in the treatment of osteoporosis in men.
Collapse
Affiliation(s)
- Ie-Wen Sim
- NorthWest Academic Centre, Department of Endocrinology, University of Melbourne, Western Health & Southern Health, St Albans, Victoria, Australia
| | | |
Collapse
|
27
|
Examining the impact of reimbursement on referral to bone density testing for older adults: 8 years of data from the Barwon Statistical Division, Australia. Arch Osteoporos 2013; 8:152. [PMID: 24072727 DOI: 10.1007/s11657-013-0152-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/06/2013] [Indexed: 02/03/2023]
Abstract
UNLABELLED In 2007, Medicare Australia revised rei:mbursement guidelines for dual energy X-ray absorptiometry (DXA) for Australians aged ≥70 years; we examined whether these changes increased DXA referrals in older adults. Proportions of DXA referrals doubled for men and tripled for women from 2003 to 2010; however, rates of utilization remained low. INTRODUCTION On April 1, 2007 Medicare Australia revised reimbursement guidelines for DXA for Australians aged ≥70 year; changes that were intended to increase the proportion of older adults being tested. We examined whether changes to reimbursement increased DXA referrals in older adults, and whether any sex differences in referrals were observed in the Barwon Statistical Division. METHODS Proportions of DXA referrals 2003-2010 based on the population at risk ascertained from Australian Census data and annual referral rates and rate ratios stratified by sex, year of DXA, and 5-year age groups. Persons aged ≥70 years referred to the major public health service provider for DXA clinical purposes (n = 6,096; 21 % men). RESULTS DXA referrals. Proportions of DXA referrals for men doubled from 0.8 % (2003) to 1.8 % (2010) and tripled from 2.0 to 6.3 % for women (all p < 0.001). For 2003-2006, referral ratios of men/women ranged between 1:1.9 and 1:3.0 and for 2007-2010 were 1:2.3 to 1:3.4. Referral ratios <2007:≥2007 were 1:1.7 for men aged 70-79 years (p < 0.001), 1:1.2 for men aged 80-84 years (p = 0.06), and 1:1.3 for men 85+ years (p = 0.16). For women, the ratios <2007:≥2007 were 1:2.1 (70-79 years), 1.1.5 (80-84 years), and 1:1.4 (85+ years) (all p < 0.001). CONCLUSIONS DXA referral ratios were 1:1.6 (men) and 1:1.8 (women) for 2007-2010 vs. 2003-2006; proportions of referrals doubled for men and tripled for women from 2003 to 2010. Overall, rates of DXA utilization remained low. Policy changes may have had minimal influence on referral; thus, ongoing evaluation over time is warranted.
Collapse
|
28
|
Abstract
Bone health is affected in patients with prostate cancer, both by the disease and its treatment. Metastases to bone leads to pain, fractures, and spinal cord compression; bone loss due to androgen deprivation therapy (ADT) leads to osteoporosis and its complications. Both these scenarios are a major cause of morbidity and adversely affect the quality of life of these patients. Maintaining an optimum bone health throughout the natural course of prostate cancer is an important aspect in the management of this disease. An understanding of the complex interplay between osteoclasts, osteoblasts, receptor activator of nuclear factor κB (RANK), and various other tyrosine kinases involved in the pathophysiology of bone metastases is essential. Zoledronic acid (ZA), an intravenously administered bisphosphonate, and Denosumab, a subcutaneously administered inhibitor of nuclear factor B ligand (RANKL), have already been approved by Food and Drug Administration (FDA) for their use in treatment of bone metastases. This article discusses the pathophysiology of bone metastases and bone loss due to ADT in prostate cancer, role of biomarkers, newer modalities of imaging, World Health Organization (WHO)/FRAX nomogram in evaluation of these patients, utility of currently available drugs and evidence supporting their use, and newer therapeutic agents like alpha-emitting Radium-223, endothelin-A receptor antagonists (Atrasentan and Zibotentan) and the proto-oncogene tyrosine-protein kinase (SRC) inhibitor, Dasatinib.
Collapse
Affiliation(s)
- Gagan Prakash
- Department of Urooncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | |
Collapse
|
29
|
Sritara C, Ongphiphadhanakul B, Chailurkit L, Yamwong S, Ratanachaiwong W, Sritara P. Serum uric acid levels in relation to bone-related phenotypes in men and women. J Clin Densitom 2013; 16:336-340. [PMID: 22727551 DOI: 10.1016/j.jocd.2012.05.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 05/17/2012] [Accepted: 05/18/2012] [Indexed: 12/21/2022]
Abstract
Serum uric acid levels have recently been found to be associated with bone mineral density (BMD) in elderly males. The purpose of the present study was to investigate the relationship between bone-related phenotypes and serum uric acid levels in young and middle-aged males and females. Subjects consisted of 1320 males and 485 females aged 25-54 yr. Bone densitometry and quantitative ultrasonometry (QUS) were performed on each subject. Serum uric acid and biochemical markers of bone turnover were measured in fasting serum samples. When adjusted for covariates including age, body weight, and serum creatinine in multiple linear regression models, it was found that there was a positive association between uric acid levels and BMD in males at the lumbar spine (p < 0.05). The association between uric acid levels and BMD was found in females after controlling for age, body weight, and serum creatinine at the femoral neck, but in the opposite direction (p < 0.05). Uric acid levels were related to the stiffness index (SI) as assessed by QUS in males, independent of age, body weight, and serum creatinine (p < 0.05). No association between uric acid and SI in females was found. The present study demonstrated a positive association in males between serum uric acid levels and BMD, and SI from QUS, suggesting a beneficial influence of uric acid on both the quantity and quality of bone in males.
Collapse
Affiliation(s)
- Chanika Sritara
- Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Boonsong Ongphiphadhanakul
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Laor Chailurkit
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sukit Yamwong
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wipa Ratanachaiwong
- Medical and Health Office, Electricity Generating Authority of Thailand, Nonthaburi, Thailand
| | - Piyamitr Sritara
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
30
|
Scialla JJ. Choices in kidney transplantation in type 1 diabetes: are there skeletal benefits of the endocrine pancreas? Kidney Int 2013; 83:356-8. [PMID: 23446255 PMCID: PMC3589985 DOI: 10.1038/ki.2012.438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Previously, recipients of a simultaneous pancreas-kidney transplant versus a kidney transplant alone were thought to have higher fracture risk. Using a large US registry, Nikkel et al. observed lower rates of fracture hospitalization among patients with type 1 diabetes after simultaneous pancreas-kidney compared with kidney transplantation alone, particularly among men. It is not known whether the apparent benefit of simultaneous pancreas-kidney transplantation is due to improved bone strength or fewer falls, but these findings may influence transplant decision making.
Collapse
Affiliation(s)
- Julia J Scialla
- Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 815, Miami, Florida 33136, USA.
| |
Collapse
|
31
|
Ryken TC, Hadley MN, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Theodore N, Walters BC. Management of Acute Combination Fractures of the Atlas and Axis in Adults. Neurosurgery 2013; 72 Suppl 2:151-8. [DOI: 10.1227/neu.0b013e318276ee55] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Timothy C. Ryken
- Iowa Spine & Brain Institute, University of Iowa, Waterloo/Iowa City, Iowa
| | - Mark N. Hadley
- Division of Neurological Surgery and Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bizhan Aarabi
- Department of Neurosurgery and University of Maryland, Baltimore, Maryland
| | - Sanjay S. Dhall
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Daniel E. Gelb
- Department of Orthopaedics, University of Maryland, Baltimore, Maryland
| | - R. John Hurlbert
- Department of Clinical Neurosciences, University of Calgary Spine Program, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Curtis J. Rozzelle
- Division of Neurological Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicholas Theodore
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Beverly C. Walters
- Division of Neurological Surgery and Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Neurosciences, Inova Health System, Falls Church, Virginia
| |
Collapse
|
32
|
Lee JS, Lee HS, Shin JK, Goh TS, Son SM. Prediction of sagittal balance in patients with osteoporosis using spinopelvic parameters. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1053-8. [PMID: 23354778 DOI: 10.1007/s00586-013-2672-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/21/2012] [Accepted: 01/13/2013] [Indexed: 01/06/2023]
Abstract
PURPOSE Little data is available on the relationships between sagittal balance and spinopelvic parameters in osteoporosis. We analyzed sagittal spinopelvic parameters in osteoporotic patients. METHODS In this prospective study, the patient and control groups comprised 124 osteoporotic patients and 40 controls. Average age was 72.4 ± 6.8 in the osteoporosis group and 42.7 ± 12.5 in the control group, which was significantly different (P < 0.001). Osteoporotic patients were allocated to two groups by sagittal vertical axis, namely, a sagittal balance group (n = 56) and a sagittal imbalance group (n = 68). All 164 study subjects underwent whole spine lateral radiography, which included hip joints. The radiographic parameters investigated were sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis. Statistical analysis was performed to identify significant differences between the two groups. RESULTS Osteoporotic patients and controls were found to be significantly different in terms of sagittal vertical axis, sacral slope, pelvic tilt, lumbar lordosis, and thoracic kyphosis. However, no significant difference was observed between patients and controls in terms of pelvic incidence (P > 0.05). Significant differences were found between the balance and imbalance groups in terms of age, lumbar spine bone mineral density (LSBMD), femoral neck BMD (FNBMD), visual analogue scale (VAS) score, sacral slope, and pelvic incidence. Correlation analysis revealed significant relationships between sagittal parameters and osteoporosis. Stepwise logistic regression analysis revealed that FNBMD and pelvic incidence contributed significantly to sagittal balance. CONCLUSION Sagittal spinopelvic parameters were found to be significantly different in patients and normal controls. Significant relationships were found between sagittal spinopelvic parameters in osteoporotic patients. In particular, low FNBMD and high pelvic incidence were significant parameters in determination of sagittal balance in osteoporotic patients.
Collapse
Affiliation(s)
- Jung Sub Lee
- Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University School of Medicine, 1-10 Ami-Dong, Seo-Gu, Busan, 602-739, Republic of Korea.
| | | | | | | | | |
Collapse
|
33
|
Funaro M, Bolyakov A, Gimenez E, Herman M, Paduch DA. Low Testosterone—An Important Predictor of Low Mineral Bone Density in Young Men—Our Own Experience and a Review of Literature. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/asm.2013.33a003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
34
|
Herrera A, Lobo-Escolar A, Mateo J, Gil J, Ibarz E, Gracia L. Male osteoporosis: A review. World J Orthop 2012; 3:223-34. [PMID: 23362466 PMCID: PMC3557324 DOI: 10.5312/wjo.v3.i12.223] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 11/19/2012] [Accepted: 12/06/2012] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis in men is a heterogeneous disease that has received little attention. However, one third of worldwide hip fractures occur in the male population. This problem is more prevalent in people over 70 years of age. The etiology can be idiopathic or secondary to hypogonadism, vitamin D deficiency and inadequate calcium intake, hormonal treatments for prostate cancer, use of toxic and every disease or drug use that alters bone metabolism.Risk factors such as a previous history of fragility fracture should be assessed for the diagnosis. However, risk factors in men are very heterogeneous. There are significant differences in the pharmacological treatment of osteoporosis between men and women fundamentally due to the level of evidence in published trials supporting each treatment. New treatments will offer new therapeutic prospects. The goal of this work is a revision of the present status knowledge about male osteoporosis.
Collapse
|
35
|
Ferrari S, Bianchi ML, Eisman JA, Foldes AJ, Adami S, Wahl DA, Stepan JJ, de Vernejoul MC, Kaufman JM. Osteoporosis in young adults: pathophysiology, diagnosis, and management. Osteoporos Int 2012; 23:2735-48. [PMID: 22684497 DOI: 10.1007/s00198-012-2030-x] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 05/14/2012] [Indexed: 01/08/2023]
Abstract
Postmenopausal osteoporosis is mainly caused by increased bone remodeling resulting from estrogen deficiency. Indications for treatment are based on low areal bone mineral density (aBMD, T-score ≤ -2.5), typical fragility fractures (spine or hip), and more recently, an elevated 10-year fracture probability (by FRAX®). In contrast, there is no clear definition of osteoporosis nor intervention thresholds in younger individuals. Low aBMD in a young adult may reflect a physiologically low peak bone mass, such as in lean but otherwise healthy persons, whereas fractures commonly occur with high-impact trauma, i.e., without bone fragility. Furthermore, low aBMD associated with vitamin D deficiency may be highly prevalent in some regions of the world. Nevertheless, true osteoporosis in the young can occur, which we define as a T-score below -2.5 at spine or hip in association with a chronic disease known to affect bone metabolism. In the absence of secondary causes, the presence of fragility fractures, such as in vertebrae, may point towards genetic or idiopathic osteoporosis. In turn, treatment of the underlying condition may improve bone mass as well. In rare cases, a bone-specific treatment may be indicated, although evidence is scarce for a true benefit on fracture risk. The International Osteoporosis Foundation (IOF) convened a working group to review pathophysiology, diagnosis, and management of osteoporosis in the young, excluding children and adolescents, and provide a screening strategy including laboratory exams for a systematic approach of this condition.
Collapse
Affiliation(s)
- S Ferrari
- Division of Bone Diseases, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
In men, prostate cancer is the most common non-cutaneous malignancy and the second most common cause of cancer death. Skeletal complications occur at various points during the disease course, either due to bone metastases directly, or as an unintended consequence of androgen deprivation therapy (ADT). Bone metastases are associated with pathologic fractures, spinal cord compression, and bone pain and can require narcotics or palliative radiation for pain relief. ADT results in bone loss and fragility fractures. This review describes the biology of bone metastases, skeletal morbidity, and recent advances in bone-targeted therapies to prevent skeletal complications of prostate cancer.
Collapse
|
37
|
Boeing H, Bechthold A, Bub A, Ellinger S, Haller D, Kroke A, Leschik-Bonnet E, Müller MJ, Oberritter H, Schulze M, Stehle P, Watzl B. Critical review: vegetables and fruit in the prevention of chronic diseases. Eur J Nutr 2012; 51:637-63. [PMID: 22684631 PMCID: PMC3419346 DOI: 10.1007/s00394-012-0380-y] [Citation(s) in RCA: 996] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 05/09/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Vegetables and fruit provide a significant part of human nutrition, as they are important sources of nutrients, dietary fibre, and phytochemicals. However, it is uncertain whether the risk of certain chronic diseases can be reduced by increased consumption of vegetables or fruit by the general public, and what strength of evidence has to be allocated to such an association. METHODS Therefore, a comprehensive analysis of the studies available in the literature and the respective study results has been performed and evaluated regarding obesity, type 2 diabetes mellitus, hypertension, coronary heart disease (CHD), stroke, cancer, chronic inflammatory bowel disease (IBD), rheumatoid arthritis (RA), chronic obstructive pulmonary disease (COPD), asthma, osteoporosis, eye diseases, and dementia. For judgement, the strength of evidence for a risk association, the level of evidence, and the number of studies were considered, the quality of the studies and their estimated relevance based on study design and size. RESULTS For hypertension, CHD, and stroke, there is convincing evidence that increasing the consumption of vegetables and fruit reduces the risk of disease. There is probable evidence that the risk of cancer in general is inversely associated with the consumption of vegetables and fruit. In addition, there is possible evidence that an increased consumption of vegetables and fruit may prevent body weight gain. As overweight is the most important risk factor for type 2 diabetes mellitus, an increased consumption of vegetables and fruit therefore might indirectly reduces the incidence of type 2 diabetes mellitus. Independent of overweight, there is probable evidence that there is no influence of increased consumption on the risk of type 2 diabetes mellitus. There is possible evidence that increasing the consumption of vegetables and fruit lowers the risk of certain eye diseases, dementia and the risk of osteoporosis. Likewise, current data on asthma, COPD, and RA indicate that an increase in vegetable and fruit consumption may contribute to the prevention of these diseases. For IBD, glaucoma, and diabetic retinopathy, there was insufficient evidence regarding an association with the consumption of vegetables and fruit. CONCLUSIONS This critical review on the associations between the intake of vegetables and fruit and the risk of several chronic diseases shows that a high daily intake of these foods promotes health. Therefore, from a scientific point of view, national campaigns to increase vegetable and fruit consumption are justified. The promotion of vegetable and fruit consumption by nutrition and health policies is a preferable strategy to decrease the burden of several chronic diseases in Western societies.
Collapse
Affiliation(s)
- Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
| | | | - Achim Bub
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
| | - Sabine Ellinger
- Department of Nutrition and Food Science, University of Bonn, Bonn, Germany
| | - Dirk Haller
- Nutrition and Food Research Centre, Chair for the Biofunctionality of Food, Technical University of Munich, Freising-Weihenstephan, Germany
| | - Anja Kroke
- Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany
| | | | - Manfred J. Müller
- Institute of Human Nutrition and Food Science, Christian-Albrechts-University Kiel, Kiel, Germany
| | | | - Matthias Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
| | - Peter Stehle
- Department of Nutrition and Food Science, University of Bonn, Bonn, Germany
| | - Bernhard Watzl
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
| |
Collapse
|
38
|
Waterloo S, Nguyen T, Ahmed LA, Center JR, Morseth B, Nguyen ND, Eisman JA, Søgaard AJ, Emaus N. Important risk factors and attributable risk of vertebral fractures in the population-based Tromsø study. BMC Musculoskelet Disord 2012; 13:163. [PMID: 22935050 PMCID: PMC3489722 DOI: 10.1186/1471-2474-13-163] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 08/27/2012] [Indexed: 11/23/2022] Open
Abstract
Background Vertebral fractures, the most common type of osteoporotic fractures, are associated with increased risk of subsequent fracture, morbidity, and mortality. The aim of this study was to examine the contribution of important risk factors to the variability in vertebral fracture risk. Methods Vertebral fracture was ascertained by VFA method (DXA, GE Lunar Prodigy) in 2887 men and women, aged between 38 and 87 years, in the population-based Tromsø Study 2007/2008. Bone mineral density (BMD; g/cm2) at the hip was measured by DXA. Lifestyle information was collected by questionnaires. Multivariable logistic regression model, with anthropometric and lifestyle factors included, was used to assess the association between each or combined risk factors and vertebral fracture risk. Population attributable risk was estimated for combined risk factors in the final multivariable model. Results In both sexes, age (odds ratio [OR] per 5 year increase: 1.32; 95% CI 1.19-1.45 in women and 1.21; 95% CI 1.10-1.33 in men) and BMD (OR per SD decrease: 1.60; 95% CI 1.34-1.90 in women and1.40; 95% CI 1.18-1.67 in men) were independent risk factors for vertebral fracture. At BMD levels higher than 0.85 g/cm2, men had a greater risk of fracture than women (OR 1.52; 95% CI 1.14-2.04), after adjusting for age. In women and men, respectively, approximately 46% and 33% of vertebral fracture risk was attributable to advancing age (more than 70 years) and low BMD (less than 0.85 g/cm2), with the latter having a greater effect than the former. Conclusions These data confirm that age and BMD are major risk factors for vertebral fracture risk. However, in both sexes the two factors accounted for less than half of fracture risk. The identification of individuals with vertebral fracture is still a challenge.
Collapse
Affiliation(s)
- Svanhild Waterloo
- Department of Community Medicine, University of Tromsø, Tromsø, Norway.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Gale CR, Dennison EM, Edwards M, Sayer AA, Cooper C. Symptoms of anxiety or depression and risk of fracture in older people: the Hertfordshire Cohort Study. Arch Osteoporos 2012; 7:59-65. [PMID: 23225282 PMCID: PMC3736098 DOI: 10.1007/s11657-012-0080-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 03/10/2012] [Indexed: 02/03/2023]
Abstract
UNLABELLED The aim of this study was to examine the prospective association between symptoms of anxiety and depression and risk of fracture in older people. Results showed that men, but not women, with probable anxiety at baseline had an increased risk of fracture. INTRODUCTION The use of psychotropic drugs has been linked with an increased risk of fracture in older people, but there are indications that the conditions for which these drugs were prescribed may themselves influence fracture risk. The aim of this study was to investigate the relation between symptoms of anxiety and depression and risk of fracture in older people. The study design is a prospective cohort study. METHODS One thousand eighty-seven men and 1,050 women aged 59-73 years completed the Hospital Anxiety and Depression Scale (HADS). Data on incident fracture during an average follow-up period of 5.6 years were collected through interview and a postal questionnaire. RESULTS Compared to men with no or few symptoms of anxiety (score ≤7 on the HADS anxiety subscale), men with probable anxiety (score ≥11) had an increased risk of fracture: After adjustment for age and potential confounding factors, the odds ratio (OR) (95 % confidence interval) was 4.03 (1.55, 10.5). There were no associations between levels of anxiety and fracture risk in women. Few men or women had probable depression at baseline (score ≥11 on the HADS depression subscale). Amongst men with possible depression (score 8-10), there was an increased risk of fracture that was of borderline significance: multivariate-adjusted OR 3.57 (0.99, 12.9). There was no association between possible depression and fracture risk in women. CONCLUSIONS High levels of anxiety in older men may increase their risk of fracture. Future research needs to replicate this finding in other populations and investigate the underlying mechanisms.
Collapse
Affiliation(s)
- Catharine R Gale
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
| | | | | | | | | |
Collapse
|
40
|
Macdonald JH, Evans SF, Davies HL, Wilson S, Davie MWJ, Sharp CA. Matched-cohort study of body composition, physical function, and quality of life in men with idiopathic vertebral fracture. Arthritis Care Res (Hoboken) 2012; 64:92-100. [PMID: 22213725 DOI: 10.1002/acr.20580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the effect of 6 years of routine management on body composition, physical functioning, and quality of life, and their interrelationships, in men with idiopathic vertebral fracture. METHODS Twenty men with idiopathic vertebral fracture (patients: mean ± SD age 58 ± 6 years) were age and height matched to 28 healthy controls with no known disease. The primary outcome was skeletal muscle mass (appendicular lean mass by dual x-ray absorptiometry) assessed at 2 visits (0 and 6 years). Physical functioning and quality of life domains were assessed by the Senior Fitness Test and Short Form 36 (SF-36) questionnaire at visit 2 only. Data were analyzed by repeated-measures analysis of variance, independent t-tests, and correlation. RESULTS At visit 1, appendicular lean mass was 9% lower in patients than controls. Although patients better maintained appendicular lean mass between visits (interaction P = 0.016), at visit 2 appendicular lean mass remained 5% lower in patients than controls. Furthermore, patients' appendicular lean mass change was correlated with femoral neck bone density change (r = 0.507, P = 0.023). Physical function tests were 13-27% lower in patients compared with controls (P = 0.056 to 0.003), as were SF-36 quality of life physical domains (13-26% lower; P = 0.028 to <0.001). CONCLUSION Despite an association between changes in muscle mass and bone density, routine management of men with idiopathic vertebral fracture does not address muscle loss. Combined with the observation of reduced physical functioning and quality of life, this study identifies novel targets for intervention in men with idiopathic vertebral fracture.
Collapse
Affiliation(s)
- Jamie H Macdonald
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, Gwynedd, UK.
| | | | | | | | | | | |
Collapse
|
41
|
Saylor PJ, Lee RJ, Smith MR. Emerging therapies to prevent skeletal morbidity in men with prostate cancer. J Clin Oncol 2011; 29:3705-14. [PMID: 21860001 PMCID: PMC3675709 DOI: 10.1200/jco.2010.34.4994] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 06/23/2011] [Indexed: 11/20/2022] Open
Abstract
Skeletal morbidity is a prominent burden to men with advanced prostate cancer throughout the natural history of the disease. Bone metastases can cause pain and greatly elevate the risk for fractures and other structural complications. Distinct from the problem of metastases, treatment-related osteoporosis and associated fragility fractures are potential complications of androgen-deprivation therapy. Bone-targeted therapies for prostate cancer have therefore been the focus of considerable research and drug development efforts. The osteoclast is a validated therapeutic target in the management of prostate cancer. Osteoclast inhibition with zoledronic acid (a bisphosphonate) or with denosumab (a monoclonal antibody to RANK ligand) reduces risk for skeletal events in men with castration-resistant prostate cancer metastatic to bone. Osteoclast inhibition with any of several bisphosphonates improves bone mineral density, a surrogate for osteoporotic fracture risk. Denosumab and toremifene (a selective estrogen receptor modulator) have each been shown to reduce osteoporotic fracture risk among men receiving androgen-deprivation therapy. Beta-emitting radiopharmaceuticals reduce pain due to metastatic disease. Investigations involving alpha-emitting radium-223, endothelin-A receptor antagonists atrasentan and zibotentan, proto-oncogene tyrosine-protein kinase (SRC) inhibitor dasatinib, and tyrosine kinase inhibitor cabozantinib (XL184) are ongoing in clinical trials and are also discussed.
Collapse
Affiliation(s)
- Philip J Saylor
- Division of Hematology-Oncology, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7E, Boston, MA 02114, USA.
| | | | | |
Collapse
|
42
|
Pattern of bone mineral density in idiopathic male osteoporosis. Rheumatol Int 2011; 32:3093-6. [DOI: 10.1007/s00296-011-2076-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 08/21/2011] [Indexed: 10/17/2022]
|
43
|
Factors associated with vertebral fractures in men treated with androgen deprivation therapy for prostate cancer. J Urol 2011; 186:482-6. [PMID: 21679977 DOI: 10.1016/j.juro.2011.03.111] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Indexed: 11/22/2022]
Abstract
PURPOSE Androgen deprivation therapy for prostate cancer causes accelerated loss of bone mineral density and is associated with increased fracture risk. We evaluated risk factors associated with vertebral fractures among men enrolled in a fracture prevention trial. MATERIALS AND METHODS Analysis included men receiving androgen deprivation therapy for prostate cancer and enrolled in a phase III fracture prevention trial. All men were 70 years old or older or had a low bone mineral density (T-score less than -1.5 for the lumbar spine or total hip). We analyzed demographic and laboratory characteristics of men with and those without vertebral fractures at study entry. RESULTS Of the 1,244 subjects 162 (13.0%) had a vertebral fracture at baseline. The 2 factors significantly associated with vertebral fractures were white race (p=0.028 compared with nonwhite race) and osteoporosis (p=0.002 for osteoporosis at any site, p=0.053 for osteoporosis at the spine, p=0.002 for osteoporosis at the hip). Lower bone mineral density was also significantly associated with vertebral fractures when analyzed as a continuous variable. Factors not associated with vertebral fractures included age, country of residence, androgen deprivation therapy duration at baseline, androgen deprivation therapy mode, body mass index, testosterone, estradiol, C-telopeptide, bone specific alkaline phosphatase and osteocalcin. Results were similar in analyses limited to men 70 years old or older. CONCLUSIONS White race and low bone mineral density were significantly associated with vertebral fractures in this study of men treated with androgen deprivation for prostate cancer. These observations should inform the assessment and management of fracture risk among such men.
Collapse
|
44
|
Fratzl-Zelman N, Roschger P, Misof BM, Nawrot-Wawrzyniak K, Pötter-Lang S, Muschitz C, Resch H, Klaushofer K, Zwettler E. Fragility fractures in men with idiopathic osteoporosis are associated with undermineralization of the bone matrix without evidence of increased bone turnover. Calcif Tissue Int 2011; 88:378-87. [PMID: 21318401 DOI: 10.1007/s00223-011-9466-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 01/11/2011] [Indexed: 10/18/2022]
Abstract
The pathogenesis of primary osteoporosis in younger individuals is still elusive. An important determinant of the biomechanical competence of bone is its material quality. In this retrospective study we evaluated bone material quality based on quantitative backscattered electron imaging to assess bone mineralization density distribution (BMDD) in bone biopsies of 25 male patients (aged 18-61 years) who sustained fragility fractures but were otherwise healthy. BMDD of cancellous bone was compared with previously established adult reference data. Complementary information was obtained by bone histomorphometry. The histomorphometric results showed a paucity of osteoblasts and osteoclasts on the bone surface in the majority of patients. BMDD revealed a significant shift to lower mineralization densities for cancellous bone values: CaMean (weighted mean Ca content, -5.9%), CaPeak (mode of the BMDD, -5.6%), and CaHigh (portion of fully mineralized bone, -76.8%) were decreased compared to normative reference; CaWidth (heterogeneity in mineralization, +18.5%) and CaLow (portion of low mineralized bone, +68.8; all P < 0.001) were significantly increased. The shift toward lower mineral content in the bone matrix in combination with reduced indices of bone formation and bone resorption suggests an inherent mineralization defect leading to undermineralized bone matrix, which might contribute to the susceptibility to fragility fractures of the patients. The alteration in bone material might be related to osteoblastic dysfunction and seems fundamentally different from that in high bone turnover osteoporosis with a negative bone balance.
Collapse
Affiliation(s)
- Nadja Fratzl-Zelman
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, 1140 Vienna, Austria.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Laroche M. Heterogeneity of biological bone markers in idiopathic male osteoporosis. Rheumatol Int 2011; 32:2101-4. [PMID: 21499877 DOI: 10.1007/s00296-011-1930-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 03/27/2011] [Indexed: 11/29/2022]
Abstract
In men with idiopathic osteoporosis, histomorphometric studies reported both increased resorption and decreased remodeling. We aimed at examine bone remodeling in these patients by biological marker measurement. We compared pre-treatment carboxy-terminal cross-linking telopeptide of type I collagen (CTX) and bone alkaline phosphatase (bALP) levels in 49 men, mean age 59 ± 14 year, with idiopathic osteoporosis with fractures (40 patients) or osteoporosis diagnosed by densitometry (9 patients) with 50 age-matched controls. The influence of baseline remodeling level on alendronate efficacy was studied. Bone remodeling markers (CTX and bALP) did not significantly differ between patients and controls and were correlated in both groups. There was no correlation between these markers, vitamin D and PTH levels. Twenty-one patients underwent repeat densitometry after 1 year of alendronate (70 mg/week). Mean annual BMD increase, spine +4.1 ± 3.9%, and hip +1.5 ± 1.2% showed no correlation with baseline CTX. Bone remodeling is very heterogeneous and formation and resorption remain biologically coupled in both idiopathic male osteoporosis and controls. Baseline remodeling level does not affect the action of alendronate on BMD.
Collapse
Affiliation(s)
- Michel Laroche
- Centre de Rhumatologie, CHU Purpan, 1 Place du Dr Baylac, 31059, Toulouse Cedex, France.
| |
Collapse
|
46
|
Otmar R, Henry MJ, Kotowicz MA, Nicholson GC, Korn S, Pasco JA. Patterns of treatment in Australian men following fracture. Osteoporos Int 2011; 22:249-54. [PMID: 20229198 DOI: 10.1007/s00198-010-1204-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 02/03/2010] [Indexed: 01/25/2023]
Abstract
UNLABELLED This study aimed to describe treatment initiation rates for men who had recently sustained a fracture. Most (75.9%) men potentially eligible for subsidised treatment at the time of fracture remained untreated even after a subsequent fracture. INTRODUCTION This study aimed to describe treatment initiation rates for men who had recently sustained a fracture. METHODS The study was conducted as part of the Geelong Osteoporosis Study in south-eastern Australia. Men in the study area who had sustained an incident fracture in the period July 2006 to December 2007 were identified from hospital radiology reports. A self-report questionnaire was sent to eligible participants approximately 12 months after fracture. Respondents were asked for details of medications prescribed for 'osteoporosis/fracture/low bone mass' before and after fracture, and where applicable, reasons for cessation of treatment. We analysed the results for 109 men aged 50 years and older who had sustained fracture in the study period. RESULTS Most (75.9%) men potentially eligible for subsidised treatment at the time of fracture remained untreated. Of the 87 men who were untreated, nine had osteoporosis at the hip and/or spine and 29 (26.6%) reported having sustained a low trauma prior fracture. CONCLUSIONS Our findings are consistent with previously published data showing low rates of treatment initiation in men eligible for osteoporosis treatment. There appear to be barriers involving participants' and medical practitioners' knowledge, beliefs and attitudes regarding osteoporosis and treatment, as well as in the doctor-patient partnership in osteoporosis management. Establishment of clinical pathways for fracture management beyond orthopaedic care may be one of a range of appropriate responses.
Collapse
Affiliation(s)
- R Otmar
- Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, PO Box 281, Geelong, 3220, Australia
| | | | | | | | | | | |
Collapse
|
47
|
Saylor PJ, Kaufman DS, Michaelson MD, Lee RJ, Smith MR. Application of a fracture risk algorithm to men treated with androgen deprivation therapy for prostate cancer. J Urol 2010; 183:2200-5. [PMID: 20399451 DOI: 10.1016/j.juro.2010.02.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Indexed: 11/16/2022]
Abstract
PURPOSE Osteoporosis causes morbidity and mortality in men. The National Osteoporosis Foundation recommends fracture risk assessment with the online WHO/FRAX tool. Although androgen deprivation therapy for prostate cancer increases fracture risk, there is limited information about which men require preventative drug therapy. We applied the WHO/FRAX tool to men treated with androgen deprivation therapy for prostate cancer. MATERIALS AND METHODS Information was collected from a practice cohort of men treated with gonadotropin-releasing hormone agonists, and included age, height, weight, history of gonadotropin-releasing hormone agonist treatment, dual energy x-ray absorptiometry results, prior bone targeted therapy and clinical risk factors for fracture. Subjects were evaluated with the WHO/FRAX algorithm (http://www.shef.ac.uk/FRAX/). RESULTS A total of 363 men treated with androgen deprivation therapy (median age 72 years) were evaluated. By the FRAX algorithm with clinical information (no dual energy x-ray absorptiometry data) the 3% hip fracture risk threshold for treatment was exceeded by 51.2% of the men (median risk 3.1%). When subjects were grouped by age the treatment threshold was reached by 3.3% of those younger than 70 years, 76.6% of those 70 to 79 years old and by 98.8% of those 80 years old or older. Using FRAX with bone mineral density data in the 93 patients who underwent bone mineral density testing the median 10-year hip fracture risk was 0.9% and the treatment threshold was exceeded by 15% of these subjects. CONCLUSIONS In this cohort of men receiving androgen deprivation therapy the prevalence of risk sufficient to necessitate drug therapy was high and was strongly influenced by age. The WHO/FRAX algorithm identifies a greater proportion of men for treatment than the traditional threshold of T score -2.5 or less.
Collapse
Affiliation(s)
- Philip J Saylor
- Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
| | | | | | | | | |
Collapse
|
48
|
Abstract
PURPOSE OF REVIEW The review is timely given recent advances regarding mechanisms of androgen action on bone cells and in humans. Osteoporosis in men is an important public health problem. An improved understanding of the role of androgens in the pathophysiology of bone loss will lead to new treatments. RECENT FINDINGS Androgen receptors are present in most bone cells. Testosterone acts on bone both directly via the androgen receptor and indirectly, following aromatization, via the oestrogen receptor. During skeletal modelling, ERalpha is critical for longitudinal bone growth. For periosteal growth and bone expansion, androgen receptor activation has a positive effect, whereas ERalpha activation is inhibitory. During skeletal remodelling, both receptor pathways generate similar and additive effects on bone.Androgen deficiency is a common secondary cause of osteoporosis in men and should be treated with testosterone, particularly in symptomatic men. However, lack of efficacy data for testosterone in osteoporosis means it is less useful as a first-line treatment in men with age-related declines in testosterone and osteoporosis, when other agents such as bisphosphonates and parathyroid hormone are effective. SUMMARY Randomized, placebo-controlled trials of testosterone therapy in men with age-related declines in testosterone and osteoporosis are needed, and should carefully evaluate potential risks, as well as its efficacy in reducing fractures and other health benefits.
Collapse
Affiliation(s)
- Peter R Ebeling
- Department of Medicine (RMH/WH), The University of Melbourne, Western Hospital, Footscray, Victoria, Australia.
| |
Collapse
|
49
|
Busse B, Hahn M, Schinke T, Püschel K, Duda GN, Amling M. Reorganization of the femoral cortex due to age-, sex-, and endoprosthetic-related effects emphasized by osteonal dimensions and remodeling. J Biomed Mater Res A 2010; 92:1440-51. [PMID: 19360886 DOI: 10.1002/jbm.a.32432] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cortical remodeling is of particular importance to femoral strength. However, osteonal morphology and its quantitative changes are still poorly understood. Therefore, osteons as the cortexes basic structural units should serve for histomorphometrical assessment of reorganization mechanisms. Total hip replacement (THR) cases as well as relevant controls were investigated to gain insight into changes within stress shielded as well as age- and sex-associated bone with emphasis on the underlying osseous cell interactions. Control (n = 23) and THR (lifetime Ø14 months, n = 8) femora were prepared to grinding specimen. Osteon density (On.Dn.), osteon area (On.Ar.), haversian canal area (H.Ar.), osteon mean wall thickness (MWT), and cortical porosity (Ct.Po.) were evaluated periosteal and endosteal. Osteonal activity (OA) was determined by mineralization differentiation of active and quiescent osteons. Sex- and age-related differences in osteonal remodeling were evident in controls. Females showed age-dependent increases of H.Ar. during concomitant changes of On.Ar. and MWT resulting in elevated Ct.Po. at the entire cortex. Males showed this occurrence only periosteal. Increased OA and therefore higher remodeling rates were found in females above 70 years. THR led to decreased On.Dn. at the entire cortex. Periosteal increased OA represented increased periprosthetic remodeling resulting in elevated H.Ar., which enhanced Ct.Po.. Massive losses of endosteal circular osteonal structures following THR are reflected in a spongy reorganized cortex leading to increased Ct.Po.. Imbalances in osteoblast-osteoclast interactions whose intensity is related to the respective cortex regions occur in both stress shielded and aging bone and may thus contribute to implant failure and fracture risk.
Collapse
Affiliation(s)
- Björn Busse
- Center for Biomechanics & Skeletal Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | | | | | | | | | | |
Collapse
|
50
|
Saylor PJ, Smith MR. Bone health and prostate cancer. Prostate Cancer Prostatic Dis 2010; 13:20-7. [PMID: 19901958 PMCID: PMC2900632 DOI: 10.1038/pcan.2009.50] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 09/20/2009] [Indexed: 11/09/2022]
Abstract
Bone metastases are a substantial burden to men with advanced prostate cancer as they often cause pain and can cause fractures and spinal cord compression. Osteoblasts and osteoclasts are both pathologically activated in the setting of prostate cancer bone metastases. As osteoclast activation is associated with disease progression, skeletal complications and death, osteoclast-targeted therapies are a rational approach to disease management. Zoledronic acid is standard of care for castration-resistant prostate cancer with bone metastases as it reduces the risk for skeletal-related events. Additional trials are needed to better define the ideal dose, frequency and duration of zoledronic acid therapy. No bisphosphonate has yet been shown to prevent bone metastases or to benefit men with androgen-sensitive disease. Denosumab is an experimental osteoclast-targeted monoclonal antibody against receptor activator of nuclear factor-kappaB ligand. Two ongoing phase III trials are expected to define its efficacy in preventing bone metastases and disease-related skeletal events in men with prostate cancer. Androgen-deprivation therapy (ADT) for prostate cancer is associated with osteoporosis and fragility fractures. Several bisphosphonates have been shown to improve bone mineral density in men receiving ADT. Two recent phase III trials have shown that denosumab and toremifene reduce the incidence of fragility fractures in these men. The World Health Organization has developed a fracture risk assessment model (FRAX) for the general population to guide the selection of patients who may benefit from pharmacotherapy. In the absence of a prostate cancer-specific algorithm, we advocate the use of FRAX for men receiving ADT.
Collapse
Affiliation(s)
- P J Saylor
- Department of Oncology, Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA.
| | | |
Collapse
|