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Kusukawa T, Maruo K, Toi M, Yamaura T, Hatano M, Nagao K, Oishi H, Horinouchi Y, Arizumi F, Kishima K, Yoshie N, Tachibana T. Subsequent Domino Osteoporotic Vertebral Fractures Adversely Affect Short-Term Health-Related Quality of Life: A Prospective Multicenter Study. Medicina (B Aires) 2023; 59:medicina59030590. [PMID: 36984591 PMCID: PMC10051345 DOI: 10.3390/medicina59030590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Background and Objectives: Conservative treatment is the gold standard for acute osteoporotic vertebral fractures (AOVFs). However, the treatment strategy for multiple AOVFs remains unknown. We conducted a prospective study using magnetic resonance imaging (MRI) to investigate how rapidly subsequent osteoporotic vertebral fractures (OVFs) occur as domino OVFs within 3 months. This study aimed to assess the incidence and impact of domino OVFs on quality of life (QOL) following conservative treatment for initial AOVFs. Materials and Methods: A prospective multicenter cohort study was conducted at eight hospitals. The included patients were those with AOVFs occurring within 3 weeks, aged >60 years, and diagnosed using MRI. All patients were treated conservatively and underwent MRI after 3 months. Subsequent domino OVFs were defined as newly occurring OVFs within 3 months. Patient characteristics, types of conservative treatment, and patient-reported outcomes, including a visual analogue scale (VAS), the Oswestry disability index (ODI), and the Japanese Orthopaedic Association back pain evaluation questionnaire (JOABPEQ), were evaluated and compared between the domino OVF and non-domino OVF groups. Results: A total of 227 patients were analyzed. The mean age was 80.1 ± 7.3 years and 78% were female. Subsequent domino OVFs were observed in 31 (13.6%) patients within 3 months. An increasing number of prevalent OVFs were significantly associated with domino OVFs (p = 0.01). No significant differences in bone mineral density, type of brace, and anti-osteoporosis medications were found between the two groups. The JOABPEQ (excluding social function), ODI, and VAS were significantly improved after 3 months. Patients with domino OVFs at 3 months had poorer JOABPEQ social life function, ODI, and VAS than those with non-domino OVFs. Conclusions: In this study, the incidence of domino OVFs was 13.6% within 3 months. Domino OVFs had a negative impact on QOL at 3 months and were associated with prevalent OVFs.
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Affiliation(s)
- Tomoyuki Kusukawa
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya 663-8131, Japan
- Correspondence: (T.K.); (K.M.); Tel.: +81-798-45-6452 (T.K.)
| | - Keishi Maruo
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya 663-8131, Japan
- Department of Orthopaedic Surgery, Miyoshi Hospital, Miyoshi 778-0005, Japan
- Department of Orthopaedic Surgery, Daiwa Central Hospital, Osaka 557-0025, Japan
- Department of Orthopaedic Surgery, Goushi Hospital, Nagasu Nishidori 660-0807, Japan
- Correspondence: (T.K.); (K.M.); Tel.: +81-798-45-6452 (T.K.)
| | - Masakazu Toi
- Department of Orthopaedic Surgery, Miyoshi Hospital, Miyoshi 778-0005, Japan
| | - Tetsuto Yamaura
- Department of Orthopaedic Surgery, Harima Hospital, Asahi Aioi 678-0031, Japan
- Department of Orthopaedic Surgery, Osaka Minato Central Hospital, Osaka 552-0003, Japan
| | - Masaru Hatano
- Department of Orthopaedic Surgery, Daiwa Central Hospital, Osaka 557-0025, Japan
| | - Kazuma Nagao
- Department of Orthopaedic Surgery, Osaka Minato Central Hospital, Osaka 552-0003, Japan
- Department of Orthopaedic Surgery, Takarazuka City Hospital, Takarazuka 665-0827, Japan
| | - Hayato Oishi
- Department of Orthopaedic Surgery, Takarazuka City Hospital, Takarazuka 665-0827, Japan
| | - Yutaka Horinouchi
- Department of Orthopaedic Surgery, Sasayama Medical Center, Hyogo Medical University, Tamba-Sasayama 669-2321, Japan
| | - Fumihiro Arizumi
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya 663-8131, Japan
| | - Kazuya Kishima
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya 663-8131, Japan
| | - Norichika Yoshie
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya 663-8131, Japan
- Department of Orthopaedic Surgery, Osaka Minato Central Hospital, Osaka 552-0003, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya 663-8131, Japan
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Yamaura T, Maruo K, Arizumi F, Kishima K, Yoshie N, Kusukawa T, Tachibana T. Adjacent vertebral Hounsfield unit value of acute osteoporotic vertebral fracture is a risk factor for concomitant domino osteoporotic vertebral fractures. J Orthop Sci 2022; 28:536-542. [PMID: 35248445 DOI: 10.1016/j.jos.2022.02.001] [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: 11/02/2021] [Revised: 01/15/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Most patients with acute osteoporotic vertebral fracture (AOVF) are successfully treated conservatively. However, the optimal management method and prognosis for multiple AOVFs are unclear. This study aimed to investigate the prevalence of multiple AOVFs and identify the associated risk factors. METHODS This study enrolled 134 hospitalized patients (mean age 83 ± 7.6 years, 66% women) with AOVF treated conservatively between 2017 and 2020. The fractures were diagnosed by magnetic resonance imaging (MRI). The AOVFs were divided into two groups; single osteoporotic vertebral fractures (OVF) and domino OVFs (at least two OVFs). The adjacent vertebral Hounsfield unit values (HU) of the OVF and dual x-ray absorptiometry (DXA) of the lumbar spine or hip were used to evaluate the bone mineral density (BMD). Logistic regression analysis was performed to identify the risk factors for domino OVFs. RESULTS Domino OVFs were noted in 21 (15.7%) of 134 patients. There were 10 cases of adjacent level and 11 cases of remote level. The BMI (18.5 ± 4.2 vs. 21.2 ± 4.6, p = 0.025) and adjacent vertebral HU value of OVF (57.3 ± 17.5 vs. 76.6 ± 24.1, p = 0.008) were significantly lower in the domino OVFs group than in the single OVF group. Logistic regression analysis revealed the adjacent vertebral HU value of the OVF as an independent risk factor for domino OVFs, (odds ratios (OR) 0.96, p = 0.012). The domino OVF group had a significantly higher decline in gait ability (76% vs. 48%, p = 0.017). CONCLUSIONS The adjacent vertebral HU value of AOVF is a useful tool for evaluating BMD for domino OVFs. The optimal treatment for osteoporosis should be considered to prevent subsequent domino OVFs.
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Affiliation(s)
- Tetsuto Yamaura
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan; Department of Orthopaedic Surgery, JCHO Osaka Minato Central Hospital, Osaka, Japan
| | - Keishi Maruo
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Fumihiro Arizumi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuya Kishima
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Norichika Yoshie
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tomoyuki Kusukawa
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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Kuriakose C, Cherian KE, Jebasingh F, Kapoor N, Asha HS, Jose A, Thomas N, Paul TV. The prevalence of vertebral fractures among Indian perimenopausal women and its association with ovarian biomarkers. J Bone Miner Metab 2022; 40:142-149. [PMID: 34532782 DOI: 10.1007/s00774-021-01266-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is dearth of data on prevalent vertebral fractures in perimenopausal women in India and limited literature on the utility of FSH, AMH and estradiol in evaluating bone health them. The objective was to study the prevalence of vertebral fractures (VF) and to assess the utility of FSH, estradiol and AMH in predicting them in Indian perimenopausal women MATERIALS AND METHODS: It was a cross-sectional study. Perimenopausal women aged 40-49 years underwent assessment for prevalent vertebral fractures, bone mineral density (BMD) and trabecular bone score (TBS). Utility of serum FSH, estradiol and AMH in predicting prevalent vertebral fractures was also assessed. RESULTS A total of 300 perimenopausal women with mean (SD) age of 43.2 (2.8) years was recruited and 18% had moderate-severe VF. Mean (SD) serum AMH was lower in perimenopausal women with VF as compared to those without fractures [0.752 (0.594) vs 1.023 (0.704) P = 0.006]. AMH showed significant positive correlation with TBS (r = 0.3; P < 0.001) and BMD at the femoral neck (r = 0.2; P < 0.001) and lumbar spine (r = 0.3; P < 0.001).On ROC analysis, AMH demonstrated good performance in predicting prevalent VF with an AUC of 0.800 (95% CI 0.705-0.880) and a sensitivity of 85% and specificity of 60% at a cut-off of 1.12 ng/mL. On an exploratory multivariate logistic regression analysis, AMH significantly predicted prevalent fractures with an adjusted OR (OR) of 1.85 (95% CI: 1.03-3.00; P = 0.04). The performance of FSH and estradiol in predicting prevalent fractures was sub-optimal. CONCLUSION About one-fifth of the study subjects had prevalent vertebral fractures. AMH may be a menstrual cycle independent biomarker and may reflect bone loss in perimenopausal women. Further prospective studies are needed to validate these findings.
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Affiliation(s)
- Cijoy Kuriakose
- Departments of Endocrinology, Christian Medical College and Hospital, Vellore, India
| | | | - Felix Jebasingh
- Departments of Endocrinology, Christian Medical College and Hospital, Vellore, India
| | - Nitin Kapoor
- Departments of Endocrinology, Christian Medical College and Hospital, Vellore, India
| | - Hesarghatta S Asha
- Departments of Endocrinology, Christian Medical College and Hospital, Vellore, India
| | - Arun Jose
- Clinical Biochemistry, Christian Medical College and Hospital, Vellore, India
| | - Nihal Thomas
- Departments of Endocrinology, Christian Medical College and Hospital, Vellore, India
| | - Thomas V Paul
- Departments of Endocrinology, Christian Medical College and Hospital, Vellore, India
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Blank RD. Practical management of fracture risk among peri- and postmenopausal women. Fertil Steril 2020; 112:782-790. [PMID: 31731932 DOI: 10.1016/j.fertnstert.2019.09.038] [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: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 12/27/2022]
Abstract
Fractures and their consequences are the clinically important manifestation of osteoporosis; preventing fractures is the primary goal of management. Effective management is achievable given present knowledge and tools but is seldom prescribed. This review will cover the individual and social burden of fracture, essential information about fracture risk and its estimation, an approach to patient care emphasizing specific information to elicit and therapeutic strategies to pursue, and existing gaps in knowledge and important questions for future research.
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Affiliation(s)
- Robert D Blank
- Medical College of Wisconsin, Wauwatosa, Wisconsin; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.
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Yamauchi K, Adachi A, Kameyama M, Murakami M, Sato Y, Kato C, Kato T. A risk factor associated with subsequent new vertebral compression fracture after conservative therapy for patients with vertebral compression fracture: a retrospective observational study. Arch Osteoporos 2020; 15:9. [PMID: 31897621 DOI: 10.1007/s11657-019-0679-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/15/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Lumbar BMD and functional recovery in the acute period were independently strongly associated with subsequent new VCF after hospital conservative therapy for patients with new fragility VCFs. Functional recovery was related with age, pain intensity during first month after hospitalization, VCF past history and multiple new VCFs. PURPOSE This study aimed to determine the factors independently associated with the subsequent vertebral compression fracture (VCF) after hospital conservative therapy in patients with new fragility VCFs and parameters related with functional recovery in the acute period. METHODS Subsequent VCF (n = 37) was defined as patients who sustained a new VCF within 9 months after new VCF, whereas patients without a new VCF were classified as non-subsequent VCF (n = 179). Logistic regression analysis was performed to determine independent factors associated with the subsequent VCF, including patients' characteristics, past histories, number of new VCFs, bone mineral density (BMD), lumbar sagittal alignment, fractured vertebral body height, spine muscle mass, pain intensity, corset types, medications for osteoporosis and pain relief, recovery ratio of functional independence measure (FIM) and bone union. Correlation coefficients were accessed between the FIM recovery ratio and continuous variable parameters, while intergroup comparisons or analysis of variance was conducted to examine significant differences in the FIM recovery ratio for categorical variable parameters. RESULTS Lumbar BMD, FIM recovery ratio at the first month after hospitalization and segmental Cobb angle were significantly independently associated with subsequent VCF (odds ratio: 27.8, 9.6 and 1.1, respectively). The FIM recovery ratio was moderately negatively correlated with age and pain intensity and was significantly worse in patients with multiple new VCFs or past history of VCF. CONCLUSIONS Conservative therapies focused on lumbar BMD, functional recovery and pain relief in the acute period may be useful in preventing subsequent VCF.
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Affiliation(s)
- Koun Yamauchi
- Department of Orthopedic Surgery, Akita hospital, 2-6-12 Takara, Chiryu City, Aichi, 472-0056, Japan.
| | - Asami Adachi
- Department of Radiology, Akita Hospital, Chiryu, Aichi, Japan
| | - Manato Kameyama
- Department of Rehabilitation, Akita Hospital, Chiryu, Aichi, Japan
| | | | - Yoshihiro Sato
- Department of Rehabilitation, Akita Hospital, Chiryu, Aichi, Japan
| | - Chisato Kato
- Department of Orthopedic Surgery, Akita hospital, 2-6-12 Takara, Chiryu City, Aichi, 472-0056, Japan
| | - Takayuki Kato
- Department of Orthopedic Surgery, Akita hospital, 2-6-12 Takara, Chiryu City, Aichi, 472-0056, Japan
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Deng M, Zeng XJ, He LC, Leung JCS, Kwok AWL, Griffith JF, Kwok T, Leung PC, Wáng YXJ. Osteoporotic Vertebral Fracture Prevalence in Elderly Chinese Men and Women: A Comparison of Endplate/Cortex Fracture-Based and Morphometrical Deformity-Based Methods. J Clin Densitom 2019; 22:409-419. [PMID: 29307693 DOI: 10.1016/j.jocd.2017.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 11/16/2022]
Abstract
This study aims to evaluate endplate/cortex fracture (ECF)-based method for detecting osteoporotic vertebral fracture (VF) in elderly Chinese population (age ≥ 65 years). The radiographs of 1954 elderly Chinese men (mean: 72.3 years) and 1953 elderly Chinese women (mean: 72.5 years) were evaluated according to Genant's morphometrical vertebral deformity (VD) severity criteria, as well as identified VF according to ECF without necessary requirement of VD. According to ECF, grade-1, -2, and -3 VF prevalence was 1.89%, 1.74%, and 2.25% in men, and 3.33%, 3.07%, and 5.89% in women, respectively. In men and women, 15.7% (35 of 223) and 34.5% (48 of 139) of vertebrae with VD grade-1 deformity were ECF(+, with fracture), respectively. In men and women, 89.7% (35 of 39) and 66.7% (48 of 72) of vertebrae with ECF grade-1 fracture had VD grade-1 deformity. For grade-1 change, ECF(+) subjects tended to have a lower BMD than the VD(+) subjects. In subjects with VD grade-2 deformity, those who were also EC (+) tended to have a lower BMD than those were ECF(-). In all grades, VD(-) and ECF(-) subjects tended to have highest BMD, whereas VD(+) and ECF(+) subjects tended to have lowest BMD. ECF may be more specific for assessing mild VF than the criteria based on vertebral deformity.
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Affiliation(s)
- Min Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Xian Jun Zeng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lai-Chang He
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jason 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
| | - Anthony 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
| | - James 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
| | - Timothy 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
| | - Ping Chung 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
| | - Yì Xiáng 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.
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Miner MM, Heidelbaugh J, Paulos M, Seftel AD, Jameson J, Kaplan SA. The Intersection of Medicine and Urology: An Emerging Paradigm of Sexual Function, Cardiometabolic Risk, Bone Health, and Men's Health Centers. Med Clin North Am 2018; 102:399-415. [PMID: 29406067 DOI: 10.1016/j.mcna.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Men's mental health and how they think about their health are critical to the future of men's health. Poor health choice patterns are established under age 50, when men are twice as likely to die than women. As the future of medicine focuses on quality and value, a better understanding of the social determinants of men's health will identify areas for improvement. The presentation of a man to a clinician's office with a sexual health complaint presents an opportunity for more complete evaluation. The future of men's health will be well served by integrated men's health centers that focus on the entire man.
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Affiliation(s)
- Martin M Miner
- Department of Family Medicine and Urology, The Men's Health Center, The Miriam Hospital, The Warren Alpert Medical School of Brown University, 164 Summitt Avenue, Providence, RI 02906, USA.
| | - Joel Heidelbaugh
- Departments of Family Medicine and Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mark Paulos
- Departments of Internal Medicine and Urology, Men's Health Center, The Miriam Hospital, The Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Allen D Seftel
- Division of Urology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Jason Jameson
- Division of Urology, Mayo Clinic, Scottsdale, AZ, USA
| | - Steven A Kaplan
- Benign Urologic Diseases and The Men's Health Program, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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Lems WF, Raterman HG. Critical issues and current challenges in osteoporosis and fracture prevention. An overview of unmet needs. Ther Adv Musculoskelet Dis 2017; 9:299-316. [PMID: 29201155 DOI: 10.1177/1759720x17732562] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/29/2017] [Indexed: 12/31/2022] Open
Abstract
Osteoporosis is a silent disease with increasing prevalence due to the global ageing population. Decreased bone strength and bone quality is the hallmark of osteoporosis which leads to an increased risk of fragility fractures in elderly. It has been estimated that approximately ~50% of women will suffer during their lifetime from an osteoporotic fracture. This must be considered as a major health concern, as it has previously been established that fragility fracture has been associated with decreased quality of life due to increased disability, more frequent hospital admission and most importantly, osteoporotic fractures have been related to an augmented mortality risk. Anti-osteoporotic drugs are available for improving bone quality. Although there is access to these therapeutic options, there remain multiple unmet needs in the field of osteoporosis and fracture care, for example, the primary prevention of osteoporosis in young individuals (to reach a high peak bone mass), the optimization of the use of imaging techniques [dual-energy X-ray absorptiometry (DXA), vertebral fracture assessment (VFA) and new techniques measuring bone quality], the use of nonmedical treatment options and surgical techniques of fracture healing. In this review, we will discuss topics that play a role in the occurrence and prevention of fractures, and we give an overview of and insight into the critical issues and challenges around osteoporosis and fracture prevention.
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Affiliation(s)
- Willem F Lems
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Centre and Reade, P.O. Box 7057 1007 MB Amsterdam, The Netherlands
| | - Hennie G Raterman
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Centre and Reade, North West Clinics, Alkmaar, The Netherlands
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Cheung EY, Tan KC, Cheung CL, Kung AW. Osteoporosis in East Asia: Current issues in assessment and management. Osteoporos Sarcopenia 2016; 2:118-133. [PMID: 30775478 PMCID: PMC6372753 DOI: 10.1016/j.afos.2016.07.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 06/27/2016] [Accepted: 07/01/2016] [Indexed: 12/31/2022] Open
Abstract
The greatest burden of hip fractures around the world is expected to occur in East Asia, especially China. However, there is a relative paucity of information on the epidemiology and burden of fractures in East Asia. Osteoporosis is greatly under-diagnosed and under-treated, even among the highest-risk subjects who have already suffered fractures. The accessibility to bone densitometry, the awareness of the disease by professionals and the public, and the use and reimbursement of drugs are some of the areas which need improvement especially. Cost-effective analysis on screening strategy and intervention thresholds based on local epidemiology data and economic status are available only in Japan. In addition, clinical risk factor models for the assessment of fracture probability may be ethnic specific. Further research is needed to develop a cost-effective risk assessment strategy to identify high-risk individuals for screening and treatment based on local data. Moreover, inadequate calcium and vitamin D intake is still an issue faced by this region.
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Affiliation(s)
- Elaine Y.N. Cheung
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kathryn C.B. Tan
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ching-Lung Cheung
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
- Centre for Genomic Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Annie W.C. Kung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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Kwok AWL, Gong JS, Wang YXJ, Leung JCS, Kwok T, Griffith JF, Leung PC. Prevalence and risk factors of radiographic vertebral fractures in elderly Chinese men and women: results of Mr. OS (Hong Kong) and Ms. OS (Hong Kong) studies. Osteoporos Int 2013; 24:877-85. [PMID: 22707064 DOI: 10.1007/s00198-012-2040-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 05/14/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED This study investigated the prevalence of radiographic vertebral fractures using Genant's semiquantitative (SQ) scoring system in elderly Chinese men (n = 2,000; mean age, 72.4 years) and women (n = 2,000; mean age, 72.6 years). Vertebral deformities had similar prevalence in elderly men (14.9 %) and women (16.5 %). Majority of the deformities in men were mild (9.9 %, grade = 1). The prevalence of vertebral fractures (grade ≥ 2) was 5.0 % among men and 12.1 % among women. INTRODUCTION Vertebral fracture is a serious consequence of osteoporosis and is often under-diagnosed. Researches on different ethnicities and territories to estimate the prevalence of vertebral fractures and to identify the risk factors are necessary. METHODS Mr. OS (Hong Kong) and Ms. OS (Hong Kong) represent the first large-scale cohort studies ever conducted on bone health in elderly Chinese men (n = 2,000) and women (n = 2,000). The current study investigated the prevalence of radiographic vertebral fractures in these subjects using Genant's SQ scoring system and identified risk factors for vertebral fractures. RESULTS The radiographs of all men (mean age, 72.4 years) and women (mean age, 72.6 years) were obtained. Six hundred twenty-seven subjects (15.7 %) had at least one vertebral deformity (SQ grade ≥ 1), including 297 men (14.9 %) and 330 women (16.5 %, p = 0.151). Three hundred forty-two participants (8.6 %) were defined as having at least one vertebra fracture (SQ grade ≥ 2), consisted of 100 men (5.0 %) and 242 women (12.1 %, p < 0.001). Older age, lower bone mineral density, lower physical activity, lower grip strength, fracture history, and low back pain were significantly associated with higher vertebral fracture rate for both men and women. CONCLUSION Vertebral deformity had similar prevalence in older men and women, while vertebral fracture was more common in women. Majority of deformities in men was mild. The vertebral deformity prevalence of women from this study is similar to previous reports of other East Asian women and Latin American women.
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Affiliation(s)
- A W L Kwok
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR, China
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Kim YM, Demissie S, Genant HK, Cheng X, Yu W, Samelson EJ, Kiel DP, Bouxsein ML. Identification of prevalent vertebral fractures using CT lateral scout views: a comparison of semi-automated quantitative vertebral morphometry and radiologist semi-quantitative grading. Osteoporos Int 2012; 23:1007-16. [PMID: 21927924 PMCID: PMC3584446 DOI: 10.1007/s00198-011-1774-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 08/11/2011] [Indexed: 11/27/2022]
Abstract
UNLABELLED We compared vertebral fracture assessment by semi-automated quantitative vertebral morphometry measurements with the conventional semi-quantitative (SQ) grading using lateral CT scout views. The semi-automated morphometry method showed good to excellent agreement with the visual SQ grading by radiologists for identification of vertebral fractures. INTRODUCTION Semi-automated quantitative vertebral morphometry (QM) measurements may enhance management of osteoporosis patients by providing an efficient means to identify vertebral fractures (VFx). We compared identification of prevalent VFx by semi-automated QM to SQ grading. METHODS A non-radiologist performed semi-automated QM from CT lateral scout views in 200 subjects (102 men, 98 women, 65.8 ± 8.9 years) selected from the Framingham Heart Study Multidetector CT Study. VFx were classified in the QM approach based on using Genant's criteria for deformities, and compared with conventional SQ grading performed by experienced radiologists as the gold standard. The kappa (k) statistics, percent agreement (% Agree), sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) were computed. RESULTS Among 200 subjects, 57 had mild and 41 had moderate or severe VFx by visual SQ grading. Per-person analyses showed excellent agreement between the two methods, with k = 0.780. The % Agree ranged from 86.7% to 91.2%, the SE was 81.3%-96%, and the SP was 86.5%-92%. Among 2,588 vertebrae analyzed, 107 had mild and 49 had moderate or severe VFx by visual SQ grading. Per-vertebra analyses revealed good agreement, with k = 0.580. Agreement between the methods tended to be highest in L1-L4 region. Agreement and validity measures were higher when only moderate and severe fractures were included. CONCLUSION The semi-automated quantitative vertebral morphometry measurements from CT lateral scout views provided good to excellent agreement with the standard SQ grading for assessment of prevalent vertebral fractures.
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Affiliation(s)
- Y. M. Kim
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA. Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA. Department of Internal Medicine, Mizmedi Hospital, Seoul, South Korea
| | - S. Demissie
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - H. K. Genant
- Synarc and University of California San Francisco, San Francisco, CA, USA
| | - X. Cheng
- Department of Radiology, Peking University, Jishuitan Hospital, Beijing, China
| | - W. Yu
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - E. J. Samelson
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA. Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - D. P. Kiel
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA. Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - M. L. Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA. Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
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Blank RD. Official Positions for FRAX® clinical regarding prior fractures from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®. J Clin Densitom 2011; 14:205-11. [PMID: 21810526 PMCID: PMC6819950 DOI: 10.1016/j.jocd.2011.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Accepted: 05/21/2011] [Indexed: 10/17/2022]
Abstract
The 2010 Position Development Conference addressed four questions related to the impact of previous fractures on 10-year fracture risk as calculated by FRAX(®). To address these questions, PubMed was searched on the keywords "fracture, epidemiology, osteoporosis." Titles of retrieved articles were reviewed for an indication that risk for future fracture was discussed. Abstracts of these articles were reviewed for an indication that one or more of the questions listed above was discussed. For those that did, the articles were reviewed in greater detail to extract the findings and to find additional past work and citing works that also bore on the questions. The official positions and the supporting literature review are presented here. FRAX(®) underestimates fracture probability in persons with a history of multiple fractures (good, A, W). FRAX(®) may underestimate fracture probability in individuals with prevalent severe vertebral fractures (good, A, W). While there is evidence that hip, vertebral, and humeral fractures appear to confer greater risk of subsequent fracture than fractures at other sites, quantification of this incremental risk in FRAX(®) is not possible (fair, B, W). FRAX(®) may underestimate fracture probability in individuals with a parental history of non-hip fragility fracture (fair, B, W). Limitations of the methodology include performance by a single reviewer, preliminary review of the literature being confined to titles, and secondary review being limited to abstracts. Limitations of the evidence base include publication bias, overrepresentation of persons of European descent in the published studies, and technical differences in the methods used to identify prevalent and incident fractures. Emerging topics for future research include fracture epidemiology in non-European populations and men, the impact of fractures in family members other than parents, and the genetic contribution to fracture risk.
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Affiliation(s)
- Robert D Blank
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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