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Courtney M, Hession E, Johnston C, Sheehy N. Measurement of lumbar vertebral body attenuation at PET-CT is a reliable method of diagnosing osteoporosis. Clin Radiol 2025; 82:106810. [PMID: 39892217 DOI: 10.1016/j.crad.2025.106810] [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: 11/01/2024] [Revised: 12/17/2024] [Accepted: 01/06/2025] [Indexed: 02/03/2025]
Abstract
AIM This study investigates the potential of positron emission tomography-computed tomography (PET-CT) as a reliable tool for the diagnosis of osteoporosis, using attenuation values as a marker for bone mineral density (BMD) assessment. MATERIALS AND METHODS We retrospectively identified 305 patients who underwent both PET-CT and dual-energy X-ray absorptiometry (DEXA) within a six-month interval at a tertiary healthcare centre. Attenuation values were measured from the first lumbar vertebra (L1) on noncontrast CT images acquired during PET-CT scans. These values were then compared with corresponding DEXA T-scores to determine their diagnostic performance. Statistical analyses, including one-way Analysis of Variance (ANOVA), Pearson correlation, and receiver operating characteristic (ROC) curve analysis were employed to assess the correlation between PET-CT attenuation values and DEXA-defined osteoporosis. RESULTS The mean Hounsfield units (HU) differed significantly between groups classified by DEXA as osteoporosis, osteopenia, or normal BMD (P < 0.001). A strong correlation was found between HU and DEXA T-scores (Pearson coefficient = 0.65). Using logistic regression, we identified HU thresholds of 120 for 90% sensitivity and 98 for 90% specificity. The optimal balanced threshold was 109 HU, achieving both 80% sensitivity and specificity. The ROC curve for the model showed an area under the curve (AUC) of 0.88, indicating high diagnostic accuracy. CONCLUSION PET-CT can effectively screen for osteoporosis, offering a noninvasive, opportunistic diagnostic tool that requires no additional radiation exposure or resources. This study establishes 109 HU as the optimal threshold for diagnosing osteoporosis on PET-CT, providing a significant opportunity for early intervention and improved patient care.
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Affiliation(s)
- M Courtney
- St. James's Hospital, Radiology Department, Dublin, Ireland.
| | - E Hession
- St. James's Hospital, Radiology Department, Dublin, Ireland
| | - C Johnston
- St. James's Hospital, Radiology Department, Dublin, Ireland
| | - N Sheehy
- St. James's Hospital, Radiology Department, Dublin, Ireland
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Fathalla AM, Chiang C, Audehm R, Gorelik A, Chang S, Yates CJ, Snow S, Barmanray R, Price S, Collins L, Wark JD. Developing and Evaluating an Interactive, Case-Based, Web-Based Active Learning Tool for Primary Care Physicians (Community Fracture Capture Learning Hub): Protocol for an Acceptability and Engagement Study. JMIR Res Protoc 2025; 14:e57511. [PMID: 39999431 PMCID: PMC11897679 DOI: 10.2196/57511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 11/01/2024] [Accepted: 01/15/2025] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND The lack of osteoporosis treatment initiation after fragility fractures is a significant gap, especially in primary care. It is unclear whether barriers for primary care physicians (PCPs) arise from uncertainty about investigations, treatment initiation, or medication side effects. Key questions remain about whether active learning platforms improve treatment initiation rates better than passive methods and how PCP demographics affect learning outcomes. With PCPs increasingly using web-based platforms for continuing professional development due to time constraints and heavy workloads, an interactive community fracture capture (CFC) tool may serve as an effective alternative to in-person learning. Our CFC pilot study tested this new program's design and content, showing promising potential. OBJECTIVE We aim to evaluate the interactive, case-based, web-based CFC Learning Hub, examining user acceptance and engagement with the platform, focusing on participants' interactions, satisfaction levels, and overall experience. METHODS Participating PCPs are recruited through Praxhub, a web-based medical education platform, and provide electronic consent for data use after deidentification. They have been allocated into small groups (12-20 members) and join the CFC Learning Hub, a secure web-based community. This hub includes a web-based discussion forum with participant-contributed case studies and a knowledge repository. Over the 6-week program, participants will receive weekly modules with instructions, resources, discussion threads, and quizzes, along with interactive discussions moderated by experienced PCPs and physicians. The platform also hosts web-based surveys that, in combination with platform analytics, allow assessment of baseline knowledge gaps, level of activity or engagement, and improvements following the course completion. This study protocol demonstrates the creation and proposed evaluation of the CFC Learning Hub, featuring an interactive, case-based, small-group web-based learning platform equipped with flexibly scheduled, tailored modules to address the fracture treatment gap within the community. Both qualitative (via thematic analysis) and quantitative (by using 2-tailed paired t tests, Wilcoxon signed rank tests, and multivariable regression analysis) analyses will be used to assess levels of engagement and acceptance and changes in PCPs' knowledge and confidence after engagement with the CFC Learning Hub. RESULTS Recruitment of participants started in May 2022. Data collection, analysis, and reporting will be completed following the completion of four 6-week cycles of the program. CONCLUSIONS The study described in this protocol will provide important insights into the function and effectiveness of the CFC Learning Hub. This information will guide the expansion of the program. This initiative offers a simple digital solution for promoting current bone health practices tailored to PCPs' needs and thereafter to expand the rollout of the e-learning hub and implementation of fracture liaison models at a primary care level in Australia and elsewhere. Future applications may extend to other clinical areas and professions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57511.
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Affiliation(s)
- Ahmed M Fathalla
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Cherie Chiang
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne Health, Melbourne, Australia
| | - Ralph Audehm
- Department of General Practice and Primary care, University of Melbourne, Melbourne, Australia
| | - Alexandra Gorelik
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shanton Chang
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Christopher J Yates
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne Health, Melbourne, Australia
| | | | - Rahul Barmanray
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne Health, Melbourne, Australia
| | - Sarah Price
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Obstetric Medicine, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Lucy Collins
- Department of Endocrinology, Royal Children's Hospital, Melbourne, Australia
| | - John D Wark
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
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Xue Y, Shi K, Dai W, Ma C, Li J. Prediction of subsequent vertebral fracture after percutaneous vertebral augmentation using MRI-based vertebral bone quality and CT-based Hounsfield units: a retrospective cross-sectional study. Sci Rep 2025; 15:3524. [PMID: 39875435 PMCID: PMC11775309 DOI: 10.1038/s41598-025-86721-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 01/13/2025] [Indexed: 01/30/2025] Open
Abstract
Subsequent vertebral fracture (SVF) is a common and refractory complication after percutaneous vertebral augmentation (PVA) for osteoporotic vertebral compression fracture (OVCF). Computed tomography (CT)-based Hounsfeld units (HU) and magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score can evaluate osteoporosis quantitatively, hyperlipidemia(HLP) might affect measurement result of VBQ score. The primary objective of this study is to compare the predictive capabilities of HU and VBQ for SVF, and to clarify the impact of hyperlipidemia on the predictive abilities. This study included consecutive 341 patients with OVCF who were treated with PVA from March 1, 2020, to December 31, 2022. A multivariate logistic regression analysis was used to determine the relationship between HU and VBQ and SVF. ROC curves were plotted to calculate area under curve (AUC), and hoc analysis and Youden index was used to determine cut-off values of HU and VBQ. Compared with the non-SVF group, VBQ (4.69 ± 0.35 vs. 4.14 ± 0.41, P < 0.001) was higher and HU (58.2 ± 13.81 vs. 81.2 ± 16.68, P < 0.001) was lower in the SVF group. On multivariate logistic regression analysis, higher VBQ (odds ratio (OR) = 23.47,P < 0.001) and lower HU (OR = 0.93,P < 0.001) are independent predictors for SVF. The AUC using VBQ for predicting SVF was 0.84, the cut-off was 4.28. The AUC using HU for predicting SVF was 0.85, the cut-off was 64.40. In the HLP group, the AUC of VBQ was comparable with that of HU for SVF prediction, however, the sensitivity was lower in the HLP group (0.50 vs. 0.83). Furthermore, the AUC value of VBQ with HLP was lower than that of VBQ without HLP (0.78 vs. 0.90, P = 0.017). These findings demonstrated that both VBQ and HU can accurately predict the occurrence of SVF after PVA. HLP might cause a false increase of VBQ value, using HU could better assess bone quality and predict SVF occurrence when HLP is present.
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Affiliation(s)
- Youdi Xue
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, #199 Jiefang South Road, Xuzhou, 221009, JiangSu Province, China
| | - Kun Shi
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, #199 Jiefang South Road, Xuzhou, 221009, JiangSu Province, China
| | - Weixiang Dai
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, #199 Jiefang South Road, Xuzhou, 221009, JiangSu Province, China
| | - Chao Ma
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, #199 Jiefang South Road, Xuzhou, 221009, JiangSu Province, China
| | - Jie Li
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, #199 Jiefang South Road, Xuzhou, 221009, JiangSu Province, China.
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Everhart AO, Brito JP, Clarke BL, Herrin J, Karaca-Mandic P, Kennel KA, Parimi N, Rosen CJ, Takagi M, McCoy RG. Trends in Osteoporosis Drug Therapy Receipt Among Commercial and Medicare Advantage Enrollees in the United States, 2011-2022. J Clin Endocrinol Metab 2025:dgae840. [PMID: 39811927 DOI: 10.1210/clinem/dgae840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Indexed: 01/16/2025]
Abstract
CONTEXT A national assessment of osteoporosis drug therapy (ODT) use can inform the extent of underdiagnosis and undertreatment of osteoporosis. OBJECTIVE The aim was to describe trends in ODT use by age, sex, fragility fracture, and documented osteoporosis. METHODS This was a retrospective analysis of patient-quarter observations for adults aged ≥50 years with commercial or Medicare Advantage health insurance in the OptumLabs Data Warehouse between 2011 and 2022. The primary outcome was the proportion of patient-quarter observations with ODT use stratified by age, sex, fragility fracture, and documented osteoporosis. Cuzick tests were performed to assess trends ODT use. RESULTS Analysis of 166 673 420 patient-quarter observations revealed that over 70% of patients with fragility fractures did not have documented osteoporosis. Among women aged ≥65 years with documented osteoporosis, ODT fill rates increased between 2011 and 2022 from 36.3% to 50.1% for women without fragility fractures (P < .001) and from 30.8% to 43.7% for women with fragility fractures (P < .001). However, ODT fill rates declined (9.2% to 7.4% between 2011 and 2022) for women with fragility fractures and no documented osteoporosis (P = .015). Similar trends were observed among women aged 50-64 years and men. CONCLUSION ODT use for patients with documented osteoporosis has increased but remains low. Low rates of ODT use for patients with fragility fractures in the absence of documented osteoporosis suggests that underdiagnosis of osteoporosis contributes to underuse of ODTs.
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Affiliation(s)
- Alexander O Everhart
- Division of General Medicine and Geriatrics, John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
- Center for Advancing Health Services, Policy & Economics Research, Washington University in St. Louis, St. Louis, MO 63110, USA
- Optum Labs, Eden Prairie, MN 55344, USA
| | - Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA
| | - Bart L Clarke
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Pinar Karaca-Mandic
- Department of Finance, Carlson School of Management, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kurt A Kennel
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Nehu Parimi
- Division of Endocrinology, Diabetes, & Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Division of Endocrinology, Baltimore Veterans Affairs Medical Center, Baltimore, MD 21201, USA
| | - Clifford J Rosen
- Center for Clinical and Translational Research, Maine Health Institute for Research, Scarborough, ME 04074, USA
| | - Mark Takagi
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA
| | - Rozalina G McCoy
- Division of Endocrinology, Diabetes, & Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Institute for Health Computing, University of Maryland, North Bethesda, MD 20852, USA
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Narayanan R, Tarawneh OH, Trenchfield D, Meade MH, Lee Y, Opara O, McCurdy MA, Pineda N, Kaye LD, Alhassan F, Vo M, Mangan JJ, Canseco JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. Preoperative Hounsfield Units Predict Pedicle Screw Loosening in Osteoporotic Patients Following Short-Segment Lumbar Fusion. Spine (Phila Pa 1976) 2024; 49:1722-1728. [PMID: 38556736 DOI: 10.1097/brs.0000000000004995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/23/2024] [Indexed: 04/02/2024]
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVE (1) To determine if vertebral HU values obtained from preoperative CT predict postoperative outcomes following one to three level lumbar fusion and (2) to investigate whether decreased BMD values determined by HU predict cage subsidence and screw loosening. SUMMARY OF BACKGROUND DATA In light of suboptimal screening for osteoporosis, vertebral computerized tomography (CT) Hounsfield Units (HU), have been investigated as a surrogate for bone mineral density (BMD). MATERIALS AND METHODS In this retrospective study, adult patients who underwent one to three level posterior lumbar decompression and fusion (PLDF) or transforaminal lumbar interbody and fusion (TLIF) for degenerative disease between the years 2017 and 2022 were eligible for inclusion. Demographics and surgical characteristics were collected. Outcomes assessed included 90-day readmissions, 90-day complications, revisions, patient-reported outcomes (PROMs), cage subsidence, and screw loosening. Osteoporosis was defined as HU of ≤110 on preoperative CT at L1. RESULTS We assessed 119 patients with a mean age of 59.1, of whom 80.7% were white and 64.7% were nonsmokers. The majority underwent PLDF (63%) compared with TLIF (37%), with an average of 1.63 levels fused. Osteoporosis was diagnosed in 37.8% of the cohort with a mean HU in the osteoporotic group of 88.4 compared with 169 in nonosteoporotic patients. Although older in age, osteoporotic individuals did not exhibit increased 90-day readmissions, complications, or revisions compared with nonosteoporotic patients. A significant increase in the incidence of screw loosening was noted in the osteoporotic group with no differences observed in subsidence rates. On multivariable linear regression osteoporosis was independently associated with less improvement in visual analog scale (VAS) scores for back pain. CONCLUSIONS Osteoporosis predicts screw loosening and increased back pain. Clinicians should be advised of the importance of preoperative BMD optimization as part of their surgical planning and the utility of vertebral CT HU as a tool for risk stratification. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Rajkishen Narayanan
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Wang XY, Yun SM, Liu WF, Wang YK, Pan S, Xu YJ. Opportunistic Assessment of Hip Fracture Risk Based on Chest CT. Orthop Surg 2024. [PMID: 39224927 DOI: 10.1111/os.14224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/01/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE Hip fracture (HF) has been described as the "last fracture of life" in the elderly, so the assessment of HF risk is extremely important. Currently, few studies have examined the relationship between imaging data from chest computed tomography (CT) and HF. This study demonstrated that pectoral muscle index (PMI) and vertebral body attenuation values could predict HF, aiming to opportunistically assess the risk of HF in patients without bone mineral density (BMD) based on chest CT for other diseases. METHODS In the retrospective study, 800 participants who had both BMD and chest CT were enrolled from January 2021 to January 2024. After exclusion, 472 patients were finally enrolled, divided into the healthy control (HC) group and the HF group. Clinical data were collected, and differences between the two groups were compared. A predictive model was constructed based on the PMI and CT value of the fourth thoracic vertebra (T4HU) by logistic regression analysis, and the predictive effect of the model was analyzed by using the receiver operating characteristic (ROC) curve. Finally, the clinical utility of the model was analyzed using decision curve analysis (DCA) and clinical impact curves. RESULTS Both PMI and T4HU were lower in the HF group than in the HC group (p < 0.05); low PMI and low T4HU were risk factors for HF. The predictive model incorporating PMI and T4HU on the basis of age and BMI had excellent diagnostic efficacy with an area under the curve (AUC) of 0.865 (95% confidence interval [CI]: 0.830-0.894, p < 0.01), sensitivity and specificity of 0.820 and 0.754, respectively. The clinical utility of the model was validated using calibration curves and DCA. The AUC of the predictive model incorporating BMD based on age and BMI was 0.865 (95% CI: 0.831-0.895, p < 0.01), with sensitivity and specificity of 0.698 and 0.711, respectively. There was no significant difference in diagnostic efficacy between the two models (p = 0.967). CONCLUSIONS PMI and T4HU are predictors of HF in patients. In the absence of dual-energy x-ray absorptiometry (DXA), the risk of HF can be assessed by measuring the PMI and T4HU on chest CT examination due to other diseases, and further treatment can be provided in time to reduce the incidence of HF.
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Affiliation(s)
- Xiong Yi Wang
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Si Min Yun
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Feng Liu
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Ke Wang
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Sheng Pan
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - You Jia Xu
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Wang M, Seibel MJ. Secondary fracture prevention in primary care: a narrative review. Osteoporos Int 2024; 35:1359-1376. [PMID: 38652313 PMCID: PMC11281980 DOI: 10.1007/s00198-024-07036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/28/2024] [Indexed: 04/25/2024]
Abstract
The global burden of osteoporosis continues to rise with an ageing population. Untreated osteoporotic fractures not only heighten the risk of subsequent fractures but are associated with excess mortality. Although primary care guidelines consistently stress the importance of secondary fracture prevention, fewer than 20% of patients are appropriately treated for osteoporosis following an initial osteoporotic fracture. This worldwide phenomenon is known as the osteoporosis care gap. This literature review examines the barriers to secondary fracture prevention in primary care and evaluates the effectiveness of targeted primary care interventions. Common themes emerged from the majority of qualitative studies, including a need for improved communication between the hospital team and primary care, better defined responsibilities and osteoporosis-directed education for the primary care physicians. Quantitative studies demonstrated that most targeted, intensive interventions aimed at educating patients and their primary care physician about osteoporosis treatment significantly increased rates of investigation and treatment. Greater uptake of models of secondary fracture prevention in primary care is urgently needed to address the osteoporosis care gap.
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Affiliation(s)
- Mawson Wang
- Bone Research Program, ANZAC Research Institute, The University of Sydney at Concord Campus, Hospital Rd, Gate 3, Concord, NSW, Australia.
- Department of Endocrinology and Metabolism, Concord Hospital, Sydney Local Health District, Concord, NSW, Australia.
| | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, The University of Sydney at Concord Campus, Hospital Rd, Gate 3, Concord, NSW, Australia
- Department of Endocrinology and Metabolism, Concord Hospital, Sydney Local Health District, Concord, NSW, Australia
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Betancur JF, Pérez LE, Bolaños-López JE, Bernal V. High and very high risk of osteoporotic fracture in Colombia, 2003-2022: identifying diagnostic and treatment gaps. Arch Osteoporos 2024; 19:52. [PMID: 38898155 DOI: 10.1007/s11657-024-01409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
This study examined the clinical characteristics and refracture rates of Colombian patients with high- and very high-risk osteoporosis. This reveals osteoporosis diagnoses and treatment gaps. Only 5.3% of the patients were diagnosed with osteoporosis at discharge and 70.5% had refractures. This finding underscores the need for national policies to enhance osteoporosis prevention and treatment. PURPOSE This study aimed to assess the clinical features and refracture rates among patients with high- and very-high-risk osteoporosis in Colombia, highlighting diagnostic and treatment gaps. METHODS A retrospective observational study was conducted using the medical records of patients aged ≥ 50 years who experienced fragility fractures between 2003 and 2022. Clinical and demographic characteristics at the time of the initial fracture were analyzed, as well as the subsequent imminent risk (refracture rate) and the diagnosis and treatment gap. RESULTS 303.982 fragility fractures occurred, and only 5.3% of patients were diagnosed with osteoporosis upon discharge. The most prevalent index fractures were forearm, vertebral, rib, and hip. Only 17.8% of the cohort had a matched osteoporosis diagnosis, indicating a low healthcare capture. Among the diagnosed patients, 10.08% were classified as high- and very high-risk of fracture, predominantly women with a mean age of 73 years. Comorbidities included diabetes, Sjögren's syndrome, and heart failure. The prevalence of osteoporosis has increased significantly from 2004 to 2022, possibly due to improved detection methods, an aging population, or a combination of both. Despite this increase, treatment delay was evident. Refractures affected 70.5% of the patients, with forearm, hip, humerus, and vertebral fractures being the most common, with a mean time of refracture of 7 months. CONCLUSION Significant delays were observed in the diagnosis and treatment of fragility fractures. Colombia's government and health system must address osteoporosis by implementing national policies that prioritize osteoporosis and fragility fracture prevention and reduce delays in diagnosis and treatment.
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Affiliation(s)
- Juan Felipe Betancur
- Internal Medicine Investigation Unit, Centro de Investigaciones Clínicas SURA, Medellín, Colombia.
| | - Luz Eugenia Pérez
- Gestora Metodológica Grupo de Investigación Clínica y Ensayos Clínicos SURA, Medellín, Colombia
| | | | - Verónica Bernal
- Investigation Unit, Grupo de Investigación Clínica y Ensayos Clínicos SURA, Medellín, Colombia
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Wang XY, Pan S, Liu WF, Wang YK, Yun SM, Xu YJ. Vertebral HU value and the pectoral muscle index based on chest CT can be used to opportunistically screen for osteoporosis. J Orthop Surg Res 2024; 19:335. [PMID: 38845012 PMCID: PMC11157924 DOI: 10.1186/s13018-024-04825-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Existing studies have shown that computed tomography (CT) attenuation and skeletal muscle tissue are strongly associated with osteoporosis; however, few studies have examined whether vertebral HU values and the pectoral muscle index (PMI) measured at the level of the 4th thoracic vertebra (T4) are strongly associated with bone mineral density (BMD). In this study, we demonstrate that vertebral HU values and the PMI based on chest CT can be used to opportunistically screen for osteoporosis and reduce fracture risk through prompt treatment. METHODS We retrospectively evaluated 1000 patients who underwent chest CT and DXA scans from August 2020-2022. The T4 HU value and PMI were obtained using manual chest CT measurements. The participants were classified into normal, osteopenia, and osteoporosis groups based on the results of dual-energy X-ray (DXA) absorptiometry. We compared the clinical baseline data, T4 HU value, and PMI between the three groups of patients and analyzed the correlation between the T4 HU value, PMI, and BMD to further evaluate the diagnostic efficacy of the T4 HU value and PMI for patients with low BMD and osteoporosis. RESULTS The study ultimately enrolled 469 participants. The T4 HU value and PMI had a high screening capacity for both low BMD and osteoporosis. The combined diagnostic model-incorporating sex, age, BMI, T4 HU value, and PMI-demonstrated the best diagnostic efficacy, with areas under the receiver operating characteristic curve (AUC) of 0.887 and 0.892 for identifying low BMD and osteoporosis, respectively. CONCLUSIONS The measurement of T4 HU value and PMI on chest CT can be used as an opportunistic screening tool for osteoporosis with excellent diagnostic efficacy. This approach allows the early prevention of osteoporotic fractures via the timely screening of individuals at high risk of osteoporosis without requiring additional radiation.
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Affiliation(s)
- Xiong-Yi Wang
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Sheng Pan
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Wei-Feng Liu
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Yi-Ke Wang
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Si-Min Yun
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - You-Jia Xu
- Department of Osteoporosis, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China.
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Zhang J, Luo X, Zhou R, Guo C, Xu K, Qu G, Zou L, Yao W, Lin S, Zhang Z. The Suitable Population for Opportunistic Low Bone Mineral Density Screening Using Computed Tomography. Clin Interv Aging 2024; 19:807-815. [PMID: 38751857 PMCID: PMC11095516 DOI: 10.2147/cia.s461018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
Objective To explore the suitable population of CT value for predicting low bone mineral density (low-BMD). Methods A total of 1268 patients who underwent chest CT examination and DXA within one-month period retrospectively analyzed. The CT attenuation values of trabecular bone were measured in mid-sagittal plane from thoracic vertebra 7 (T7). Receiver operating characteristic (ROC) curves were used to evaluate the ability to diagnose low-BMD. Results The AUC for diagnosing low BMD was larger in women than in men (0.894 vs 0.744, p < 0.05). The AUC increased gradually with the increase of age but decreased gradually with the increase in height and weight (p < 0.05). In females, when specificity was adjusted to approximately 90%, a threshold of 140.25 HU has a sensitivity of 69.3%, which is higher than the sensitivity of 36.5% in males for distinguishing low-BMD from normal. At the age of 70 or more, when specificity was adjusted to approximately 90%, a threshold of 126.31 HU has a sensitivity of 76.1%, which was higher than that of other age groups. Conclusion For patients who had completed chest CTs, the CT values were more effective in predicting low-BMD in female, elderly, lower height, and lower weight patients.
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Affiliation(s)
- Jiongfeng Zhang
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Xiaohui Luo
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Ruiling Zhou
- Department of Dermatology, Jiangxi Provincial Dermatology Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Chong Guo
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Kai Xu
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Gaoyang Qu
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Le Zou
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Wenye Yao
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Shifan Lin
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Zhiping Zhang
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
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Zhang B, Chen Z, Yan R, Lai B, Wu G, You J, Wu X, Duan J, Zhang S. Development and Validation of a Feature-Based Broad-Learning System for Opportunistic Osteoporosis Screening Using Lumbar Spine Radiographs. Acad Radiol 2024; 31:84-92. [PMID: 37495426 DOI: 10.1016/j.acra.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023]
Abstract
RATIONALE AND OBJECTIVES Osteoporosis is primarily diagnosed using dual-energy X-ray absorptiometry (DXA); yet, DXA is significantly underutilized, causing osteoporosis, an underdiagnosed condition. We aimed to provide an opportunistic approach to screen for osteoporosis using artificial intelligence based on lumbar spine X-ray radiographs. MATERIALS AND METHODS In this institutional review board-approved retrospective study, female patients aged ≥50 years who received both X-ray scans and DXA of the lumbar vertebrae, in three centers, were included. A total of 1180 cases were used for training and 145 cases were used for testing. We proposed a novel broad-learning system (BLS) and then compared the performance of BLS models using radiomic features and deep features as a source of input. The deep features were extracted using ResNet18 and VGG11, respectively. The diagnostic performances of these BLS models were evaluated with the area under the curve (AUC), sensitivity, and specificity. RESULTS The incidence rate of osteoporosis in the training and test sets was 35.9% and 37.9%, respectively. The radiomic feature-based BLS model achieved higher testing AUC (0.802 vs. 0.654 vs. 0.632, both P = .002), sensitivity (78.2% vs. 56.4% vs. 50.9%), and specificity (82.2% vs. 74,4% vs. 75.6%) than the two deep feature-based BLS models. CONCLUSION Our proposed radiomic feature-based BLS model has the potential to expand osteoporosis screening to a broader population by identifying osteoporosis on lumbar spine X-ray radiographs.
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Affiliation(s)
- Bin Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613 Huangpu West Road, Tianhe District, Guangzhou, Guangdong 510627, China (B.Z., R.Y., J.Y., X.W., S.Z.)
| | - Zhangtianyi Chen
- College of Information Science and Technology, Jinan University, Guangzhou, Guangdong, China (Z.C., B.L., G.W., J.D.)
| | - Ruike Yan
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613 Huangpu West Road, Tianhe District, Guangzhou, Guangdong 510627, China (B.Z., R.Y., J.Y., X.W., S.Z.)
| | - Bifan Lai
- College of Information Science and Technology, Jinan University, Guangzhou, Guangdong, China (Z.C., B.L., G.W., J.D.)
| | - Guangheng Wu
- College of Information Science and Technology, Jinan University, Guangzhou, Guangdong, China (Z.C., B.L., G.W., J.D.)
| | - Jingjing You
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613 Huangpu West Road, Tianhe District, Guangzhou, Guangdong 510627, China (B.Z., R.Y., J.Y., X.W., S.Z.)
| | - Xuewei Wu
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613 Huangpu West Road, Tianhe District, Guangzhou, Guangdong 510627, China (B.Z., R.Y., J.Y., X.W., S.Z.)
| | - Junwei Duan
- College of Information Science and Technology, Jinan University, Guangzhou, Guangdong, China (Z.C., B.L., G.W., J.D.); Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Jinan University, Guangzhou, Guangdong, China (J.D.)
| | - Shuixing Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613 Huangpu West Road, Tianhe District, Guangzhou, Guangdong 510627, China (B.Z., R.Y., J.Y., X.W., S.Z.).
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12
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Billington EO, Miyagishima RC, Hasselaar C, Arain M. Women's perspectives regarding osteoporosis, fracture risk, and pharmacologic treatment: a cross-sectional study. Osteoporos Int 2023; 34:2069-2076. [PMID: 37608123 DOI: 10.1007/s00198-023-06890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/15/2023] [Indexed: 08/24/2023]
Abstract
We assessed women's perspectives regarding early preventative therapy for osteoporosis. More than a third of early menopausal women were concerned about bone loss and future fractures, and approximately half were willing to take an intravenous or oral bisphosphonate around the time of menopause to preserve bone health. PURPOSE Bisphosphonate medications can prevent the substantial bone loss that occurs during early menopause, but little is known about whether women would accept bisphosphonate treatment at this time in their life, when imminent fracture risk is low. We assessed women's perspectives regarding bone loss, fracture risk, and preventative pharmacotherapy in early menopause. METHODS In this cross-sectional study, Canadian women aged ≥ 45 years were recruited via Facebook advertisement to complete an electronic survey. Primary outcome was the proportion of early menopausal respondents (≤ 5 years since final menstrual period) who were worried about bone loss and fractures. Secondary outcomes were the proportion of early menopausal women willing to accept pharmacologic intervention aimed at preventing either bone loss or future fractures. We compared responses between early menopausal women and older women (> 5 years since final menstrual period). RESULTS 2033 women responded to the Facebook advertisement, 1195 eligible women (aged: 45 to 89 years) started the survey, and 966 completed it. Among early menopausal respondents (N = 98), 38 (42%) were worried about future fractures and 9 of 25 (36%) who had a prior bone mineral density scan were worried about their results. A total of 42 (47%) were willing to start medication to prevent fractures, and 48 (54%) would start medication to prevent bone loss. Responses were comparable between early menopausal women and older women. CONCLUSION Menopausal women are concerned about bone loss and fractures. Many women would consider early menopausal pharmacotherapy, with the goals of preserving bone health and lowering their risk of fractures.
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Affiliation(s)
- Emma O Billington
- Cumming School of Medicine, Division of Endocrinology & Metabolism, University of Calgary, Richmond Road Diagnostic & Treatment Centre, Room 18118, 1820 Richmond Road SW, Calgary, AB, Canada.
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada.
| | | | - Charley Hasselaar
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada
| | - Mubashir Arain
- Health Systems Knowledge & Evaluation, Alberta Health Services, Alberta, Canada
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Ye K, Xing Y, Zou D, Zhou F, Zhang Z, Du G, Tian Y. Positive correlation between the proximal femur Hounsfield units from routine CT and DXA results. J Orthop Res 2023; 41:2648-2656. [PMID: 37211875 DOI: 10.1002/jor.25630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/30/2023] [Accepted: 05/16/2023] [Indexed: 05/23/2023]
Abstract
To determinate the correlation between the proximal femur Hounsfield unit (HU) value and dual-energy X-ray absorptiometry (DXA) results, and to identify its feasibility for opportunistic screening osteoporosis. A total of 680 patients underwent computed tomography (CT) containing proximal femur and DXA test within 6 months between 2010 and 2020 in our hospital. The CT HU value of four axial slices of the proximal femur were measured. The measurements were compared with the DXA results by Pearson correlation coefficient. Receiver operator characteristic curve were generated to identify the best cutoff for diagnosing osteoporosis. These 680 consecutive patients included 165 male and 515 female; the average age was 63.66 ± 11.36 years old, the mean interval time between two examinations was 45.43 days. The most representative CT HU value measurement was the 5-mm slice measurement. The average CT HU value was 59.3 ± 36.5 HU, and the differences among the three DXA defined bone mineral density (BMD) categories were significant (all p < 0.001). The Pearson correlation analysis showed that the proximal femur CT values had strong positive correlation with femoral neck T-score, femoral neck BMD and total hip BMD (r = 0.777, r = 0.748, r = 0.746, respectively; all p < 0.001). The area under the curve for CT value for diagnosing osteoporosis was 0.893 (p < 0.001), the best cutoff was 67 HU with 84% sensitivity, 80% specificity, 92% positive predictive value and 65% negative predictive value. Proximal femur CT values had good positive correlation with DXA results, which could be used to opportunistic screening for potential osteoporosis patient.
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Affiliation(s)
- Kaifeng Ye
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Yong Xing
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Da Zou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Fang Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Zhishan Zhang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Guohong Du
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Yun Tian
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
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14
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Pu M, Zhang B, Zhu Y, Zhong W, Shen Y, Zhang P. Hounsfield Unit for Evaluating Bone Mineral Density and Strength: Variations in Measurement Methods. World Neurosurg 2023; 180:e56-e68. [PMID: 37544597 DOI: 10.1016/j.wneu.2023.07.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE To assess the consistency and accuracy of various measurements of the Hounsfield unit (HU) in lumbar vertebrae. METHODS The study reviewed lumbar spine computed tomography images of 60 postmenopausal women aged >50 years. A total of 240 vertebrae were measured and analyzed for the variations of HU values in different sections and regions. Investigated the relationship between HU values of the lumbar spine under different measurements and dual-energy X-ray absorptiometry results and the ability to identify patients with osteoporosis. RESULTS HU values measured in midsagittal (r = 0.763), midcoronal (r = 0.768), and midaxial (r = 0.786) sections exhibited a strong positive correlation with dual-energy X-ray absorptiometry T-scores. HU values measured in midsagittal and midaxial sections of the vertebral body were in good agreement (P > 0.1), but decreased in the midcoronal (P < 0.001). HU values in the middle of the vertebral body were significantly higher than in the near end plate (P < 0.001). HU values varied between L1 and L4 vertebrae, but all had a good ability to identify osteoporosis and did not differ significantly in screening ability (P > 0.05). CONCLUSIONS An averaged HU value in axial multilevel is a comprehensive assessment of vertebral bone density. Using the HU value of the lumbar spine can help identify patients with osteoporosis, and the screening ability does not differ significantly across vertebral segments.
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Affiliation(s)
- Mengyang Pu
- Department of Orthopedics, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing Province, Zhejiang, China; Department of Orthopedics, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Bo Zhang
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Ying Zhu
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wentao Zhong
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yixin Shen
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Peng Zhang
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
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15
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Luo X, Zhang J, Dai Z, Gong X, Qu G, Li J, Zhang Z. Hounsfield units on abdominal computed tomography: a new tool for predicting osteoporosis. Acta Radiol 2023; 64:2841-2848. [PMID: 37644799 DOI: 10.1177/02841851231190795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Osteoporosis can cause bone fractures and disability, but early diagnosis faces challenges. Our proposed diagnostic indicators offer a new approach for early detection, which benefits early identification. PURPOSE To determine the most appropriate threshold for predicting osteoporosis in patients with each section of vertebral body. MATERIAL AND METHODS A retrospective analysis of 210 patients, including 646 vertebrae, who had both abdominal computed tomography (CT) and dual-energy X-ray absorptiometry (DXA) within six months. The correlation between DXA T-score and CT Hounsfield units (HU) values was tested by Pearson. The area under the curve (AUC) was calculated using the threshold obtained from the regression equation. RESULTS The thresholds matching the T-score of -2.5 were 85, 95, 85, and 90 HU for the upper axial plane of the vertebral body (Lau), the middle axial plane of the vertebral body (Lam), the lower axial plane of the vertebral body (Lad), and the mid-sagittal plane of the vertebral body (Lsm), respectively. Defining osteoporosis using CT as Lau ≤ 85, Lam ≤ 95, Lad ≤ 85, or Lsm ≤ 90 HU had a specificity of 88.1% (116/134) and sensitivity of 90.8% (69/76) for distinguishing DXA osteoporosis of the lumbar spine in 210 patients. T-score ≤-2.5 defined as Lau ≤85 or Lam ≤95 or Lad ≤85 or Lsm ≤90 HU had a specificity of 85.9% (275/320) and sensitivity of 82.8% (270/326) for DXA T-score ≤-2.5 in 646 lumbar vertebrae. CONCLUSION CT HU values obtained based on different sections of the vertebral body in abdominal CT can be used as a supplementary measure to assess osteoporosis.
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Affiliation(s)
- Xiaohui Luo
- Department of Orthopedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Medical Department of Graduate School, Nanchang University, Nanchang, PR China
| | - Jiongfeng Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Medical Department of Graduate School, Nanchang University, Nanchang, PR China
| | - Zhengzai Dai
- Department of Orthopedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Medical Department of Graduate School, Nanchang University, Nanchang, PR China
| | - Xiang Gong
- Graduate School, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Gaoyang Qu
- Medical Department of Graduate School, Nanchang University, Nanchang, PR China
| | - Juncheng Li
- Department of Orthopedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Medical Department of Graduate School, Nanchang University, Nanchang, PR China
| | - Zhiping Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, PR China
- Medical Department of Graduate School, Nanchang University, Nanchang, PR China
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16
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Zhang J, Luo X, Zhou R, Dai Z, Guo C, Qu G, Li J, Zhang Z. The axial and sagittal CT values of the 7th thoracic vertebrae in screening for osteoporosis and osteopenia. Clin Radiol 2023; 78:763-771. [PMID: 37573241 DOI: 10.1016/j.crad.2023.07.006] [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: 03/18/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 08/14/2023]
Abstract
AIM To evaluate the difference in computed tomography (CT) attenuation value of different planes of the 7th thoracic vertebra and investigate the efficacy of axial and sagittal vertebral CT measurements in predicting osteoporosis. MATERIALS AND METHODS Patients who underwent routine chest CT and dual-energy X-ray absorptiometry (DXA) within 1 month were included in this retrospective study. The CT attenuation values of different planes were compared. Logistic regression and receiver operating characteristic (ROC) were used to analyse the difference of each plane in the diagnosis of osteoporosis. RESULTS The study included 1,338 patients (mean age of 61.9±11.9; 54% female). The CT attenuation values decreased successively in the normal group, osteopenia group, and osteoporosis group. The paired t-test results showed that the mid-axial measurements were greater than mid-sagittal measurements, with a mean difference of 9 HU, the difference was statistically significant (p<0.001, 95% confidence interval [CI] = 7.8-10.1). For each one-unit reduction in mid-sagittal CT attenuation value, the risk of osteopenia or osteoporosis increased by 3.6%. To distinguish osteoporosis from non-osteoporosis (osteopenia + normal), the sensitivity was 90% and the specificity was 52.4% at the mid-sagittal threshold of 113.7 HU. CONCLUSIONS The CT attenuation values of mid-sagittal plane have higher diagnostic efficacy than axial planes in predicting osteoporosis. For patients with a sagittal CT attenuation value of <113.7 HU in the T7, further DXA examination is warranted.
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Affiliation(s)
- J Zhang
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China; Medical Department of Graduate School, Nanchang University, Nanchang, Jiangxi 330006, China; Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China
| | - X Luo
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China; Medical Department of Graduate School, Nanchang University, Nanchang, Jiangxi 330006, China; Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China
| | - R Zhou
- Medical Department of Graduate School, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Z Dai
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China; Medical Department of Graduate School, Nanchang University, Nanchang, Jiangxi 330006, China; Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China
| | - C Guo
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China; Medical Department of Graduate School, Nanchang University, Nanchang, Jiangxi 330006, China; Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China
| | - G Qu
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China; Medical Department of Graduate School, Nanchang University, Nanchang, Jiangxi 330006, China; Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China
| | - J Li
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China; Medical Department of Graduate School, Nanchang University, Nanchang, Jiangxi 330006, China; Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China
| | - Z Zhang
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China; Nanchang Key Laboratory of Orthopaedics, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, China.
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Mahaisavariya C, Vanitcharoenkul E, Kitcharanant N, Chotiyarnwong P, Unnanuntana A. Exploring the osteoporosis treatment gap after fragility hip fracture at a Tertiary University Medical Center in Thailand. BMC Geriatr 2023; 23:70. [PMID: 36737708 PMCID: PMC9898992 DOI: 10.1186/s12877-023-03778-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND (1) To evaluate the prescription rate of anti-osteoporosis medication, and (2) to identify factors associated with patients not receiving anti-osteoporosis medication or, when prescribed, not persisting with medication 1 year after hip fracture treatment. METHODS We retrospectively reviewed the medical records of all fragility hip fracture patients admitted to the orthopedic unit of the Faculty of Medicine Siriraj Hospital, Mahidol University, between July 1, 2016, and December 31, 2019. We identified patients who did not receive anti-osteoporosis medication both 6 months and 1 year after fracture treatment. Patients who did not receive the medication 1 year after their treatment were enrolled and interviewed using a no-treatment questionnaire. RESULTS In total, 530 patients with fragility hip fractures were eligible (mean age, 79.0 years), and most (74.5%) were women. Only 148 patients (31.6%) received anti-osteoporosis medication 1 year after hip fracture. Logistic regression analysis identified predictors for not receiving the medication: male sex (OR 1.8; 95% CI 1.1-3.0), Charlson comorbidity index score ≥ 5 (OR 1.5; 95% CI 1.0-2.3), and secondary school education or below (OR 2.0; 95% CI 1.2-3.3). The main reason for not receiving the medication was that healthcare providers neither discussed nor initiated pharmacological treatment for osteoporosis (48.2%). When the medication was prescribed, non-persistence primarily stemmed from transportation difficulties that resulted in patients missing follow-ups (50.0%). CONCLUSIONS Improved physician attitudes toward anti-osteoporosis medications might enhance the treatment rate. Developing a follow-up team and facilitating access to medications (eg, courier delivery to patients) would promote therapy compliance. TRIAL REGISTRATIONS The protocol for the first phase and second phase was approved by the Siriraj Institutional Review Board of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (COA no. Si 180/2021) and for the second phase, patients-informed consent forms used in the cross-sectional component were approved by the Siriraj Institutional Review Board of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (COA no. Si 180/2021). The research was registered with the Thai Clinical Trials Registry (TCTR number: 20210824002). The study was conducted in accordance with the Declaration of Helsinki. Each patient (or a relative/caregiver) provided informed consent in writing or by telephone to participate in this second study phase.
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Affiliation(s)
- Chantas Mahaisavariya
- grid.10223.320000 0004 1937 0490Golden Jubilee Medical Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekasame Vanitcharoenkul
- grid.10223.320000 0004 1937 0490Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Nitchanant Kitcharanant
- grid.7132.70000 0000 9039 7662Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pojchong Chotiyarnwong
- grid.10223.320000 0004 1937 0490Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Ding BTK, Lim HF, Johari F, Kunnasegaran R. An Orthopaedic Surgeon Led Osteoporosis (OSLO) Model of Care reduces early recurrent fracture rates and improves treatment compliance in patients treated for osteoporotic fractures. Osteoporos Int 2023; 34:299-307. [PMID: 36409358 DOI: 10.1007/s00198-022-06595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022]
Abstract
UNLABELLED This study aims to evaluate the efficacy of an Orthopaedic Surgeon Led Osteoporosis Model of Care (OSLO-MoC) in improving care of patients with primary osteoporotic fractures. The OSLO-MOC has shown to be effective in improving osteoporotic medication initiation and compliance and reducing secondary fracture rates in patients. PURPOSE This study aims to evaluate the efficacy of an Orthopaedic Surgeon Led Osteoporosis Model of Care (OSLO-MoC) as compared to a Case Manager Led Osteoporosis Model of Care (CMLO-MoC) in reducing early osteoporotic re-fracture rates and treatment compliance in patients. METHODS This was a single centre, retrospective, comparative cohort study of all patients screened and treated for secondary osteoporotic fracture prevention from the 2008 to 2018 at an orthopaedic surgical unit. From the 2008 to 2013, patients were recruited under the CMLO-MoC and from 2014 to 2018, under the OSLO-MOC. Logistics regression analysis was used to identify significant predictors such as OSLO-MOC implementation, gender, ethnicity, marital status and education level for patient recruitment, treatment compliance and secondary fracture rates at 12-month follow-up. RESULTS Over a 10-year period, 7388 patients were screened of which 2855 patients were eligible for analysis. A total of 1234 patients were recruited under CMLO-MoC and 1621 patients under OSLO-MOC. Implementation of the OSLO-MOC was associated with greater patient recruitment, OR 1.26 (95%CI 1.06-1.49, P = 0.007). Of the 2855 patients recruited, OSLO-MOC implementation, OR 2.61 (95%CI 2.03-3.36, P < 0.001), and a higher level of education, OR 1.428 (95%CI 1.02-1.43, P = 0.037), were associated with improved compliance to medication at 12 months. OSLO-MOC implementation was the only factor associated with reduced risk of secondary fractures at 12 months, OR 0.14 (95%CI 0.03-0.66, P = 0.013). CONCLUSION The OSLO-MOC has shown to be effective in reducing the rate of re-fracture and osteoporotic medication initiation and compliance of patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Benjamin Tze Keong Ding
- Department of Orthopaedic Surgery, Woodlands Health, 2 Yishun Central 2, Tower E, S768024, Singapore, Singapore.
| | - Hai Fon Lim
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, S768828, Singapore, Singapore
| | - Fadzleen Johari
- Nursing Specialty, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, S308433, Singapore, Singapore
| | - Remesh Kunnasegaran
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, S308433, Singapore, Singapore
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19
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Zhang J, Zhou R, Luo X, Dai Z, Qu G, Li J, Wu P, Yuan X, Li J, Jiang W, Zhang Z. Routine chest CT combined with the osteoporosis self-assessment tool for Asians (OSTA): a screening tool for patients with osteoporosis. Skeletal Radiol 2022; 52:1169-1178. [PMID: 36520217 DOI: 10.1007/s00256-022-04255-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The osteoporosis self-assessment tool for Asians (OSTA) is a common screening tool for osteoporosis. The seventh thoracic CT (CT-T7) Hounsfield unit (HU) measured by chest CT correlates with osteoporosis. This study aimed to investigate the diagnostic value of OSTA alone, CT-T7 alone, or the combination of OSTA and CT-T7 in osteoporosis. MATERIALS AND METHODS In this study, 1268 participants were grouped into 586 men and 682 women. We established multiple linear regression models by combining CT-T7 and OSTA. Receiver operating characteristic (ROC) curves were used to evaluate the ability to diagnose osteoporosis. RESULTS In the male group, the mean age was 59.02 years, and 108 patients (18.4%) had osteoporosis. In the female group, the mean age was 63.23 years, and 308 patients (45.2%) had osteoporosis. By ROC curve comparison, the CT-T7 (male, AUC = 0.789, 95% CI 0.745-0.832; female, AUC = 0.835, 95% CI 0.805-0.864) in the diagnosis of osteoporosis was greater than the OSTA (male, AUC = 0.673, 95% CI 0.620-0.726; female, AUC = 0.775, 95% CI 0.741-0.810) in both the male and female groups (p < 0.001). When OSTA was combined with CT, the equation of multiple linear regression (MLR) was obtained as follows: female = 3.020-0.028*OSTA-0.004*CT-T7. In the female group, it was found that the AUC of MLR (AUC = 0.853, 95% CI 0.825-0.880) in the diagnosis of osteoporosis was larger than that of CT-T7 (p < 0.01). When the MLR was 2.65, the sensitivity and specificity were 53.9% and 90%, respectively. CONCLUSION For a patient who has completed chest CT, CT-T7 (HU) combined with OSTA is recommended to identify the high-risk population of osteoporosis, and it has a higher diagnostic value than OSTA alone or CT-T7 alone, especially among females. For a female with MLR greater than 2.65, further DXA examination is needed.
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Affiliation(s)
- Jiongfeng Zhang
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Ruiling Zhou
- Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xiaohui Luo
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Zhengzai Dai
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Gaoyang Qu
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Juncheng Li
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Pengyun Wu
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xuhui Yuan
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Jiayu Li
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Wei Jiang
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.,Medical Department of Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Zhiping Zhang
- Department of Orthopedics, The First Hospital of Nanchang, The Third Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, China.
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20
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Hoit G, Whelan DB, Atrey A, Ravi B, Ryan G, Bogoch E, Davis AM, Khoshbin A. Association of age, sex and race with prescription of anti-osteoporosis medications following low-energy hip fracture in a retrospective registry cohort. PLoS One 2022; 17:e0278368. [PMID: 36454910 PMCID: PMC9714945 DOI: 10.1371/journal.pone.0278368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Initiation of anti-osteoporosis medications after hip fracture lowers the risk of subsequent fragility fractures. Historical biases of targeting secondary fracture prevention towards certain groups may result in treatment disparities. We examined associations of patient age, sex and race with anti-osteoporosis medication prescription following hip fracture. METHODS A cohort of patients with a hip fracture between 2016-2018 was assembled from the American College of Surgeons National Surgical Quality Improvement Program registry. Patients on anti-osteoporosis medications prior to admission were excluded. Multivariable logistic regression was used to determine adjusted associations between patient age, sex and race and their interactions with prescription of anti-osteoporosis medications within 30 days of surgery. RESULTS In total, 12,249 patients with a hip fracture were identified with a median age of 82 years (IQR: 73-87), and 67% were female (n = 8,218). Thirty days postoperatively, 26% (n = 3146) of patients had been prescribed anti-osteoporosis medication. A significant interaction between age and sex with medication prescription was observed (p = 0.04). Male patients in their 50s (OR:0.75, 95%CI:0.60-0.92), 60s (OR:0.81, 95%CI:0.70-0.94) and 70s (OR:0.89, 95%CI:0.81-0.97) were less likely to be prescribed anti-osteoporosis medication compared to female patients of the same age. Patients who belonged to minority racial groups were not less likely to receive anti-osteoporosis medications than patients of white race. INTERPRETATION Only 26% of patients were prescribed anti-osteoporosis medications following hip fracture, despite consensus guidelines urging early initiation of secondary prevention treatments. Given that prescription varied by age and sex, strategies to prevent disparities in secondary fracture prevention are warranted.
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Affiliation(s)
- Graeme Hoit
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Daniel B. Whelan
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Unity Health – St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Amit Atrey
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Unity Health – St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gareth Ryan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Earl Bogoch
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Unity Health – St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Aileen M. Davis
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Amir Khoshbin
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Unity Health – St. Michael’s Hospital, Toronto, Ontario, Canada
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21
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Yang G, Wang H, Wu Z, Shi Y, Zhao Y. Prediction of osteoporosis and osteopenia by routine computed tomography of the lumbar spine in different regions of interest. J Orthop Surg Res 2022; 17:454. [PMID: 36243720 PMCID: PMC9571421 DOI: 10.1186/s13018-022-03348-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background We aimed to investigate the utility of Hounsfield units (HU) obtained from different regions of interest in opportunistic lumbar computed tomography (CT) to predict osteoporosis coupling with data of dual-energy X-ray absorptiometry (DXA).
Methods A total of 100 patients who attended a university hospital in Shanghai, China, and had undergone CT and DXA tests of the lumbar spine within 3 months were included in this retrospective review. Images were reviewed on axial sections, and regions of interest (ROI) markers were placed on the round, oval, anterior, left, and right of the L1–L4 vertebra to measure the HU. The mean values of CT HU were then compared to the bone mineral density (BMD) measured by DXA. Receiver operator characteristic curves were generated to determine the threshold for diagnosis and its sensitivity and specificity values.
Results The differences in CT HU of different ROI based on DXA definitions of osteoporosis, osteopenia, and normal individuals were statistically significant (p < 0.01). The HU values of the different ROI correlated well with the BMD values (Spearman coefficient all > 0.75, p < 0.01). The threshold for diagnosing osteoporosis varies from 87 to 111 HU in different ROIs, and the threshold for excluding osteoporosis or osteopenia is 99–125 HU. Conclusion This is the first study on osteoporosis diagnosis of different ROI with routine CT lumbar scans. There is a strong correlation between CT HU of different ROI in the lumbar spine and BMD, and HU measurements can be used to predict osteoporosis.
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Affiliation(s)
- Guangyue Yang
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai, Pudong New Area, 201203, China
| | - Hansong Wang
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai, Pudong New Area, 201203, China.,Sichuan Province Orthopaedic Hospital, No. 132, West Section 1, First Ring Road, Chengdu, Sichuan Province, China
| | - Zhufeng Wu
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai, Pudong New Area, 201203, China
| | - Yinyu Shi
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai, Pudong New Area, 201203, China
| | - Yongfang Zhao
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai, Pudong New Area, 201203, China.
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22
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Thomas T, Tubach F, Bizouard G, Crochard A, Maurel F, Perrin L, Collin C, Roux C, Paccou J. The Economic Burden of Severe Osteoporotic Fractures in the French Healthcare Database: The FRACTOS Study. J Bone Miner Res 2022; 37:1811-1822. [PMID: 36203366 PMCID: PMC9828635 DOI: 10.1002/jbmr.4720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 01/12/2023]
Abstract
Osteoporosis carries a high medical, economic, and societal burden principally because of the risk of severe fractures. The objective of this cost-of-illness study was to describe health resource utilization and associated costs in all patients aged ≥50 years hospitalized for a severe osteoporotic fracture over a 6-year period (2009 to 2014) in France. Data were extracted from the French national healthcare database (SNDS) on all health care resource utilization between the index date (date of hospitalization for first fracture during the enrollment period) and study end (December 31, 2016) or until the patient died. Costing was restricted to direct costs and determined from the payer perspective. Variables related to costs were identified through multivariate logistic regression analysis. A total of 356,895 patients were included (median follow-up 39.1 months). In the year after the index fracture, 36,622 patients (10.5%) were rehospitalized for a fracture-related reason. Only 18,474 (5.3%) underwent bone densitometry and 58,220 (16.7%) received a specific treatment. The total annual per capita osteoporosis-related cost in the year after the index severe osteoporotic fracture was €18,040 (from €8598 for multiple ribs to €21,085 for hip fracture) of which €17,905 was incurred by fracture-related costs. The cost incurred by management of osteoporosis was €135. Over years 2 to 5, the mean annual per capita costs of fracture treatment (€806, mostly attributable to the treatment of refractures) continued to dominate those of osteoporosis management (€99). Total annual cost of care was €1260 million (year 2014). Variables associated with higher cost were older age, male sex, site of fracture, a history of prior osteoporotic fracture, and the number of refracture events. The 5-year cost of severe osteoporotic fractures to the French health care system is high and mostly attributable to the treatment of refractures. Improved fracture prevention measures in patients with osteoporosis is crucial to reduce the economic burden of the disease. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Thierry Thomas
- Department of Rheumatology, University Hospital of Saint-Étienne, INSERM U1059, Lyon University, Saint-Etienne, France
| | - Florence Tubach
- Department of Public Health, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | | | | | | | | | | | - Christian Roux
- Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris Centre, INSERM, Unités Mixtes de Recherche (UMR) 1153, Université de Paris, Paris, France
| | - Julien Paccou
- Department of Rheumatology, CHU Lille, MABlab ULR 4490, Lille University, Lille, France
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23
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Talevski J, Sanders KM, Lal A, Watts JJ, Beauchamp A, Duque G, Borgström F, Kanis JA, Svedbom A, Brennan-Olsen SL. A micro-costing analysis of post-fracture care pathways: results from the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS). Osteoporos Int 2022; 33:1895-1907. [PMID: 35701629 PMCID: PMC9463215 DOI: 10.1007/s00198-022-06460-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/01/2022] [Indexed: 11/05/2022]
Abstract
UNLABELLED This study identified the costs and health-related quality of life impacts of several post-fracture multidisciplinary care pathways specific to individual skeletal site (hip, distal forearm, vertebrae, humerus). These care pathways may assist healthcare providers in allocating resources for osteoporotic fractures in more effective and cost-efficient ways. INTRODUCTION This micro-costing study was undertaken to provide the estimated healthcare costs of several fracture site-specific health service use pathways associated with different trajectories of health-related quality of life (HRQoL) 12-months post-fracture. METHODS The study included 4126 adults aged ≥ 50 years with a fragility fracture (1657 hip, 681 vertebrae, 1354 distal forearm, 434 humerus) from the International Costs & Utilities Related to Osteoporotic fractures Study (ICUROS). ICUROS participants were asked to recall the frequency and duration (where applicable) of their health and community care service use at 4- and 12-month follow-up visits. Patient-level costs were identified and aggregated to determine the average cost of healthcare use related to the fracture in each care pathway (presented in Australian 2021 dollars). Mean cost differences were calculated and analysed using a one-way analysis of variance (ANOVA) and post hoc Bonferroni correction to determine any statistically significant differences. RESULTS The total direct cost of fractures was estimated at $89564, $38926, $18333, and $38461AUD per patient for hip, vertebral, wrist, and humeral participants, respectively. A Kruskal-Wallis test yielded a statistically significant difference in cost values between most care pathways (p < 0.001). Of the 20 care pathways, those associated with recovery of HRQoL had lower mean costs per patient across each fracture site. CONCLUSIONS This study identified the costs and HRQoL impacts of several multidisciplinary care pathways for individual fracture sites based on the health service utilization of an international cohort of older adults. These care pathways may assist healthcare providers in allocating resources for fragility fractures in more effective and cost-efficient ways.
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Affiliation(s)
- J Talevski
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia.
- School of Rural Health, Monash University, Warragul, VIC, Australia.
| | - K M Sanders
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - A Lal
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - J J Watts
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - A Beauchamp
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
- School of Rural Health, Monash University, Warragul, VIC, Australia
| | - G Duque
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
| | - F Borgström
- Quantify Research, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | | | - S L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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24
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Aypak C, Bircan MA, Özdemir A. Anti-osteoporotic Drug Utilization Rates for Secondary Prevention Among Patients with Osteoporotic Fractures. Rambam Maimonides Med J 2022; 13:RMMJ.10473. [PMID: 35701156 PMCID: PMC9345764 DOI: 10.5041/rmmj.10473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Anti-osteoporotic drugs (AOD) are essential for secondary prevention of osteoporotic fracture (OF) in patients with established osteoporosis. However, data about AOD utilization rates are scarce among patients with OF. This study was therefore aimed at determining the AOD utilization rates among those particularly vulnerable patients. MATERIALS AND METHODS This cross-sectional study followed the medical records of patients with OF starting from their first OF diagnosis date. Each patient's preventive osteoporosis treatments (vitamin D, calcium+vitamin D) and AOD utilization rate were recorded for a 12-month period following OF diagnosis. RESULTS A total of 210 patients (168 females, mean age: 67.8±11.9 years; 42 males, mean age 62.4±16.1 years) were enrolled in the study. Of these, 65.7% (n=138) did not use any medication for primary protection against osteoporosis before OF diagnosis. The ratio of patients not using any type of medication for secondary prevention after OF increased from 26.5% to 51% during a 12-month period. In addition, by one year following diagnosis, AOD usage rate had decreased from 62.3% to 41.3%. CONCLUSION The AOD usage rates for secondary prevention of OF were insufficient, and cessation rates were high. Identification of factors associated with decreased AOD utility rates will provide important information for guiding patient follow-up in order to reduce the occurrence of OF.
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Affiliation(s)
- Cenk Aypak
- To whom correspondence should be addressed. E-mail:
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25
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Screening for osteoporosis using L1 vertebral density on abdominal CT in an Australian population. Clin Radiol 2022; 77:e540-e548. [PMID: 35550303 DOI: 10.1016/j.crad.2022.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/05/2022] [Indexed: 11/21/2022]
Abstract
AIM To assess the utility of osteoporosis screening using abdominal computed tomography (CT) versus dual-energy X-ray absorptiometry (DXA) T-scores as the reference. MATERIALS AND METHODS Patients ≥30 years undergoing abdominal CT and DXA within 12 months were assessed retrospectively. Bone mineral density (BMD) was measured using axial CT attenuation at L1, correlating with DXA T-scores. Sensitivity, specificity, area under the curve (AUC), and odds ratio (OR) were calculated. RESULTS The study cohort comprised 407 CT-DXA pairs (58.2% women). The prevalence of osteoporosis was 11.8%. L1 density and T-score were significantly correlated in both women (r=0.35, p<0.001) and men (r=0.15, p=0.04). The AUC to distinguish osteoporosis from osteopenia and normal BMD was 0.64 (95% CI: 0.56-0.71). In women, a threshold of 190 HU detected T-scores ≤ -2.5 with a negative predictive value (NPV) of 94.4% (OR=4.4, p<0.01). In the entire cohort, a threshold of 180 HU detected T-scores ≤ -2.5 with a NPV of 96.2% (OR=4.7, p<0.01). CONCLUSIONS CT L1 attenuation correlates with L1 DXA T-scores. Density values < 190 and 180 HU increased the probability of an osteoporosis diagnosis in Australian women and the overall cohort, respectively. Opportunistic screening for osteoporosis using abdominal CT is feasible, enabling identification of at-risk subjects for formal DXA imaging, thereby improving treatment initiation and reducing fracture risk.
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Brox WT. CORR Insights®: Comparative Interrupted Time Series Analysis of Long-term Direct Medical Costs in Patients With Hip Fractures and a Matched Cohort: A Large-database Study. Clin Orthop Relat Res 2022; 480:903-904. [PMID: 34962499 PMCID: PMC9007209 DOI: 10.1097/corr.0000000000002097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/01/2021] [Indexed: 01/31/2023]
Affiliation(s)
- W Timothy Brox
- Volunteer Associate Clinical Professor, University of California at San Francisco, Fresno, Fresno, CA, USA
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27
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Launois R, Cabout E, Benamouzig D, Velpry L, Briot K, Alliot F, Perrin L, Grange L, Sellami R, Touboul C, Joubert JM, Roux C. Barriers and Expectations for Patients in Post-Osteoporotic Fracture Care in France: The EFFEL Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:571-581. [PMID: 35365301 DOI: 10.1016/j.jval.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/12/2021] [Accepted: 10/10/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to quantify the relative importance of barriers to better secondary prevention of osteoporotic fractures and of care expectations expressed by patients with osteoporotic fractures in France. METHODS A qualitative exploration of potential barriers to care and expectations was undertaken through a systematic literature review and in-depth patients interviews. A list of 21 barriers and 21 expectations was identified. These were presented to 324 subjects with osteoporotic fractures, identified in a representative sample of the French population, in the form of best-worst scaling questionnaires. Patients rated the relative importance of the attributes, and arithmetic mean importance scores were calculated and ranked. A Bayesian hierarchical model was also performed to generate a relative importance score. Latent class analysis was performed to identify potential subgroups of patients with different response profiles. RESULTS A total of 7 barriers were rated as the most important, relating to awareness of osteoporosis and coordination of care. The highest-ranked barrier, "my fracture is not related to osteoporosis," was significantly more important than all the others (mean importance score 0.45; 95% confidence interval 0.33-0.56). A similar ranking of attributes was obtained with both the arithmetic and the Bayesian approach. For expectations, no clear hierarchy of attributes was identified. Latent class analysis discriminated 3 classes of respondents with significant differences in response profiles (the educated environmentalists, the unaware, and the victims of the system). CONCLUSIONS Better quality of care of osteoporosis and effective secondary fracture prevention will require improvements in patient education, training of healthcare professionals, and coordination of care.
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Affiliation(s)
| | - Elise Cabout
- Health Economic Assessment Network, Paris, France
| | - Daniel Benamouzig
- French National Center for Scientific Research, Paris, France; Sciences Po, Center of the Sociology of Organizations, Paris, France
| | - Livia Velpry
- Sociology and Anthropology Department, Paris 8 University, Paris, France
| | - Karine Briot
- Rhumatology Department, Cochin Hospital, Paris, France
| | | | | | - Laurent Grange
- Rhumatology Department, Grenobles Alpes University Hospital, Echirolles, France
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Adami G, Fassio A, Gatti D, Viapiana O, Benini C, Danila MI, Saag KG, Rossini M. Osteoporosis in 10 years time: a glimpse into the future of osteoporosis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221083541. [PMID: 35342458 PMCID: PMC8941690 DOI: 10.1177/1759720x221083541] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/07/2022] [Indexed: 12/21/2022] Open
Abstract
Patients living with osteoporosis are projected to increase dramatically in the
next decade. Alongside the forecasted increased societal and economic burden, we
will live a crisis of fractures. However, we will have novel pharmacological
treatment to face this crisis and, more importantly, new optimized treatment
strategies. Fracture liaison services will be probably implemented on a large
scale worldwide, helping to prevent additional fractures in high-risk patients.
In the next decade, novel advances in the diagnostic tools will be largely
available. Moreover, new and more precise fracture risk assessment tools will
change our ability to detect patients at high risk of fractures. Finally, big
data and artificial intelligence will help us to move forward into the world of
precision medicine. In the present review, we will discuss the future
epidemiology and costs of osteoporosis, the advances in early and accurate
diagnosis of osteoporosis, with a special focus on biomarkers and imaging tools.
Then we will examine new and refined fracture risk assessment tools, the role of
fracture liaison services, and a future perspective on osteoporosis
treatment.
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Affiliation(s)
- Giovanni Adami
- Rheumatology Unit, University of Verona, Pz Scuro 10, 37134 Verona, Italy
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | | | | | - Maria I. Danila
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kenneth G. Saag
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, AL, USA
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Spiegl U, Bork H, Grüninger S, Maus U, Osterhoff G, Scheyerer MJ, Pieroh P, Schnoor J, Heyde CE, Schnake KJ. Osteoporotic Fractures of the Thoracic and Lumbar Vertebrae: Diagnosis and Conservative Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:670-677. [PMID: 34342263 PMCID: PMC8727857 DOI: 10.3238/arztebl.m2021.0295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/12/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevalence of osteoporotic vertebral body fractures in Europe is 18-26%. Although most of these injuries can be treated conservatively, the underlying concepts have not been defined clearly or uniformly. In this article, we present the current state of the evidence on the diagnosis and conservative treatment of osteoporotic fractures of the thoracic and lumbar vertebrae. METHODS A systematic review of the literature up to May 2020 was carried out in the PubMed and Web of Science Core Collection databases. 549 articles were identified, of which 36 were suitable for inclusion in the review. Articles were sought in the areas of diagnosis, provision of physical aids, pharmacotherapy, physiotherapy, and treatments from the realm of alternative medicine. RESULTS The primary diagnostic technique was conventional x-ray in two planes (with the patient standing, if possible), which had 51.3% sensitivity and 75% specificity. If a fracture was suspected, magnetic resonance imaging (MRI) of the entire spine and regional computed tomography (CT) were carried out. The overall state of the evidence on treatment is poor; the best available evidence is for exercise therapy and physiotherapy, which are supported by three level I and four level II studies. Improvements were seen mainly in mobility and a reduced fear of falling. The use of an active orthosis can be useful as well. No evidence was found on the use of drugs or alternative medicine exclusively in the conservative treatment of osteoporotic vertebral body fractures. CONCLUSION It is reasonable to evaluate instability with imaging repeatedly, at regular intervals, over a period of six months. There is still a lack of reliable data on the optimal intensity and duration of physiotherapy, and on the use of orthoses.
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Affiliation(s)
- Ulrich Spiegl
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany; Rehabilitation Center, St. Josef-Stift Sendenhorst, Sendenhorst, Germany; Department of Orthopedic and Trauma Surgery, University Hospital of the Paracelsus Medical University (PMU), Nuremberg site, Nürnberg, Germany; Department of Orthopedic and Trauma Surgery, Special Orthopedic Surgery, Osteology (DVO, German Osteology Society), University Hospital of Düsseldorf, Düsseldorf, Germany; Department of Orthopedics and Trauma Surgery, University Hospital Cologne, Cologne, Germany; Department of Anesthesiology and Intensive Care Medicine, Paul Gerhardt Stift Hospital, Lutherstadt Wittenberg, Germany; Interdisciplinary Center for Spine and Scoliosis therapy. Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
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Skjødt MK, Ernst MT, Khalid S, Libanati C, Cooper C, Delmestri A, Rubin KH, Javaid MK, Martinez-Laguna D, Toth E, Prieto-Alhambra D, Abrahamsen B. The treatment gap after major osteoporotic fractures in Denmark 2005-2014: a combined analysis including both prescription-based and hospital-administered anti-osteoporosis medications. Osteoporos Int 2021; 32:1961-1971. [PMID: 33721032 PMCID: PMC8510950 DOI: 10.1007/s00198-021-05890-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/11/2021] [Indexed: 12/11/2022]
Abstract
UNLABELLED This study demonstrates a substantial and persistent anti-osteoporosis treatment gap in men and women ≥50 years old who sustained major osteoporotic fracture(s) between 2005 and 2014 in Denmark. This was not substantially reduced by including hospital-administered anti-osteoporosis treatments. Strengthened post-fracture organization of care and secondary fracture prevention is highly needed. INTRODUCTION The purpose of this study was to evaluate the Danish anti-osteoporosis treatment gap from 2005 to 2014 in patients sustaining a major osteoporotic fracture (MOF), and to assess the impact of including hospital-administered anti-osteoporosis medications (AOM) on the treatment gap among these patients. METHODS In this retrospective, registry-based study, we included men and women aged 50 years or older and living in Denmark, who sustained at least one MOF between 2005 and 2014. We applied a repeated cross-sectional design to generate cohorts of patients sustaining a first MOF, hip, vertebral, humerus, or forearm fracture, respectively, within each calendar year. We evaluated the treatment gap as the proportion of patients within each cohort not receiving treatment with AOM within 1 year of the fracture. Hospital-administered AOM was identified by SKS code. RESULTS The treatment gap among MOF patients decreased from 85% in 2005 to 79% in 2014. The gap was smaller among hip and vertebral fracture patients as compared to humerus and forearm fracture patients, and it was smaller in women than in men. The use of hospital-administered AOM was relatively uncommon, with a maximum of 0.9% of MOF patients initiating hospital-administered AOM (in 2012). We observed substantial variations in this proportion between fracture types and gender. Hospital-administered AOM was most commonly used among vertebral fracture patients. CONCLUSION A significant treatment gap among patients sustaining a major osteoporotic fracture was present throughout our analysis, and including hospital-administered AOM did not significantly improve the treatment gap assessment. Improved secondary fracture prevention is urgently needed.
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Affiliation(s)
- M K Skjødt
- Department of Medicine, Hospital of Holbaek, Smedelundsgade 60, DK-4300, Holbaek, Denmark.
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark.
| | - M T Ernst
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - S Khalid
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | | | - C Cooper
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, England, UK
| | - A Delmestri
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | - K H Rubin
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - M K Javaid
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | - D Martinez-Laguna
- GREMPAL Research Group, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), CIBERFES, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - E Toth
- UCB Pharma, Anderlecht, Belgium
| | - D Prieto-Alhambra
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | - B Abrahamsen
- Department of Medicine, Hospital of Holbaek, Smedelundsgade 60, DK-4300, Holbaek, Denmark
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
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Pekonen SR, Kopra J, Kröger H, Rikkonen T, Sund R. Regional and gender-specific analyses give new perspectives for secular trend in hip fracture incidence. Osteoporos Int 2021; 32:1725-1733. [PMID: 33712877 PMCID: PMC8387269 DOI: 10.1007/s00198-021-05906-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
UNLABELLED In this study, we found that regional disparity in incidence of hip fractures has converged. Also, annual hip fracture risk ratios between genders have systematically diminished over time. INTRODUCTION Several studies have reported secular trends in hip fracture incidence, but knowledge about the possible causes is limited. We studied potential explanations by examining spatio-temporal epidemiology of the fractures and estimating relative risks between genders. METHODS This observational study was based on all inpatient hospital discharges in 1972-2018 in Finland. We divided the data by gender, 5-year age groups and Finnish sub-regions and estimated gender and age standardized spatio-temporal rates of hip fractures by using a Bayesian age-period-cohort model. RESULTS In 1972, women's hip fracture incidence was 1.2-1.3 times higher in western and coastal Finland compared to eastern and inland areas. Also, women had approximately 1.7 times higher average risk to get a hip fracture compared to men. Today, the hip fracture differences between the areas have converged to insignificant and the relative risk between genders has diminished to 1.2. Age-specific relative risks indicate greater hip fracture risk for younger men and older women, and the women's risk increases beyond the risk of men at age 65 which is ten years later than in the beginning of the study period. CONCLUSION Incidence of hip fracture has converged significantly between regions and genders. Especially factors related with socioeconomic development and increased frailty and longevity seem to be important. The hip fracture incidence rate ratio between women and men has systematically decreased in time, and more attention should be paid to hip fracture risk in men in the future.
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Affiliation(s)
- S.-R. Pekonen
- grid.9668.10000 0001 0726 2490School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - J. Kopra
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - H. Kröger
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
- grid.410705.70000 0004 0628 207XDepartment of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - T. Rikkonen
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - R. Sund
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
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McArthur C, Hillier L, Ioannidis G, Adachi JD, Giangregorio L, Hirdes J, Papaioannou A. Developing a Fracture Risk Clinical Assessment Protocol for Long-Term Care: A Modified Delphi Consensus Process. J Am Med Dir Assoc 2021; 22:1726-1734.e8. [PMID: 32972869 DOI: 10.1016/j.jamda.2020.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/21/2020] [Accepted: 08/13/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To develop a fracture risk Clinical Assessment Protocol (CAP) based on long-term care (LTC) fracture prevention recommendations and an embedded fracture risk assessment tool. DESIGN A modified Delphi consensus approach including 2 survey rounds and a face-to-face meeting was implemented to reach consensus on matching of LTC fracture prevention guideline statements to Fracture Risk Scale (FRS) risk levels. SETTING AND PARTICIPANTS A national panel of recognized experts in osteoporosis, fractures, and long-term care, including an LTC resident and family members. METHODS Round 1 survey respondents (n = 24) were provided the LTC fracture prevention guidelines matched to FRS risk levels and were asked whether they agreed the guideline was appropriate for the risk level (yes, no, I don't know, I agree with some but not all of it) and to provide comments. In round 2, guideline statements that did not achieve consensus (≥80% agreement) were revised consistent with comments provided in round 1 and respondents were asked again if they agreed with the guideline statement. Statements that did not achieve consensus were to be discussed and resolved in an in-person meeting (n = 17). RESULTS In round 1 (75% response rate), consensus was achieved in 7/14 guideline statements. In round 2 (56% response rate), 5 statements were revised based on round 1 feedback and for 2 statements additional information was provided. Consensus was achieved in all but one statement related to the inappropriateness of pharmacologic therapy for residents with life expectancy less than 1 year. Following facilitated meeting discussions, consensus was obtained to revise the guideline statement to reflect that life expectancy was but one of several criteria that should be used to inform medication decisions. CONCLUSIONS AND IMPLICATIONS An evidence-based fracture risk CAP was developed that will be embedded in international routine clinical assessment tools to guide fracture prevention in LTC.
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Affiliation(s)
- Caitlin McArthur
- McMaster University, Hamilton, Ontario, Canada; GERAS Centre for Aging Research, Hamilton, Ontario, Canada.
| | | | - George Ioannidis
- McMaster University, Hamilton, Ontario, Canada; GERAS Centre for Aging Research, Hamilton, Ontario, Canada
| | | | - Lora Giangregorio
- University of Waterloo, Waterloo, Ontario, Canada; Schlegel-UW Research Institute for Aging, Hamilton, Ontario, Canada
| | - John Hirdes
- University of Waterloo, Waterloo, Ontario, Canada
| | - Alexandra Papaioannou
- McMaster University, Hamilton, Ontario, Canada; GERAS Centre for Aging Research, Hamilton, Ontario, Canada
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Ganda K. Fracture liaison services: past, present and future : Editorial relating to: The impact of Fracture Liaison Services on subsequent fractures and mortality: a systematic literature review and meta-analysis. Osteoporos Int 2021; 32:1461-1464. [PMID: 34272584 DOI: 10.1007/s00198-021-05982-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/28/2021] [Indexed: 10/20/2022]
Affiliation(s)
- K Ganda
- Department of Endocrinology, Concord Hospital, Sydney, Australia.
- Concord Clinical School, University of Sydney, Sydney, Australia.
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Liu CS, Feasel AL, Kline GA, Billington EO. Pharmacotherapy decisions among postmenopausal women attending a group medical consultation or a one-on-one specialist consultation at an osteoporosis center: an observational cohort study. Osteoporos Int 2021; 32:1421-1427. [PMID: 33462652 DOI: 10.1007/s00198-021-05823-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/04/2021] [Indexed: 12/21/2022]
Abstract
Group medical visits for osteoporosis can improve access to care while being highly accepted by patients. In this study, a similar proportion of women planned to initiate pharmacotherapy after attending a group or traditional one-on-one osteoporosis consultation, indicating that the group consultation model does not produce unexpected treatment decisions. INTRODUCTION Group medical consultations for osteoporosis are time-efficient and highly accepted by patients, but effects on treatment decisions are unknown. We aimed to compare women's decisions to initiate or decline osteoporosis pharmacotherapy after attending either a group or transitional one-on-one osteoporosis consultation. METHODS In this observational study, we prospectively evaluated postmenopausal women referred to an osteoporosis clinic who attended a group medical visit and compared their decisions regarding pharmacologic osteoporosis treatment with retrospective data from a cohort of women who attended a traditional consultation. Both consultation types involved interaction with a specialist physician, individualized fracture risk estimation (using FRAX®), and education regarding fracture consequences and available osteoporosis medications. Both forms of consultation emphasized shared decision-making; however, group consultation attendees did not receive personalized treatment recommendations from the physician. RESULTS We reviewed the records of 125 women (median age 63 years) who attended a group consultation and 83 women (median age 64 years) who attended a traditional consultation between 2016 and 2019. Twenty-four (19%) of the group cohort and 16 (19%) of the traditional cohort were at high 10-year risk of major osteoporotic fracture (FRAX® ≥ 20.0%). A similar proportion planned to initiate pharmacologic therapy after the group and traditional consultations (23% vs 16%, p = 0.22); these proportions were comparable among women at high risk (42% vs 50%, p = 0.75) and moderate risk (19% vs 15%, p = 0.77), but a higher proportion of low-risk women planned to initiate therapy after the group consultation (18% vs 0%, p = 0.009). CONCLUSION Patient decisions to initiate pharmacologic treatment made during a group visit are similar to those made during traditional one-on-one consultation. The group consultation model represents an alternative to one-on-one assessment for delivering osteoporosis consultative services.
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Affiliation(s)
- C S Liu
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A L Feasel
- Dr. David Hanley Osteoporosis Centre, Alberta Health Services, Richmond Road Diagnostic & Treatment Centre, Calgary, Alberta, Canada
| | - G A Kline
- Dr. David Hanley Osteoporosis Centre, Alberta Health Services, Richmond Road Diagnostic & Treatment Centre, Calgary, Alberta, Canada
- Division of Endocrinology & Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - E O Billington
- Dr. David Hanley Osteoporosis Centre, Alberta Health Services, Richmond Road Diagnostic & Treatment Centre, Calgary, Alberta, Canada.
- Division of Endocrinology & Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Roux C, Thomas T, Paccou J, Bizouard G, Crochard A, Toth E, Lemaitre M, Maurel F, Perrin L, Tubach F. Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study. JBMR Plus 2021; 5:e10507. [PMID: 34258503 PMCID: PMC8260818 DOI: 10.1002/jbm4.10507] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/17/2022] Open
Abstract
Severe osteoporotic fractures (hip, proximal humerus, pelvic, vertebral and multiple rib fractures) carry an increased risk of mortality. This retrospective cohort study in the French national healthcare database aimed to estimate refracture and mortality rates after severe osteoporotic fractures at different sites, and to identify mortality‐related variables. A total of 356,895 patients hospitalized for severe osteoporotic fracture between 2009 and 2014 inclusive were analyzed. The cohort was followed for 2 to 8 years up to the study end or until the patient died. Data were extracted on subsequent hospitalizations, refracture events, treatments, comorbidities of interest and survival. Time to refracture and survival were described using Kaplan‐Meier analysis by site of fracture and overall. Mortality risk factors were identified using a Cox model. Hip fractures accounted for 60.4% of the sample (N = 215,672). In the 12 months following fracture, 58,220 patients (16.7%) received a specific osteoporosis treatment, of whom 21,228 were previously treatment‐naïve. The 12‐month refracture rate was 6.3% (95% confidence interval [CI], 6.2%–6.3%), ranging from 4.0% (95% CI, 3.7%–4.3%) for multiple rib fractures to 7.8% (95% CI, 7.5%–8.1%) for pelvic fractures. Twelve‐month all‐cause mortality was 12.8% (95% CI, 12.7%–12.9%), ranging from 5.0% (95% CI, 4.7%–5.2%) for vertebral fractures to 16.6% (95% CI, 16.4%–16.7%) for hip fractures. Osteoporosis‐related mortality risk factors included fracture site, previous osteoporotic fracture (hazard ratio 1.21; 95% CI, 1.18–1.23), hip refracture (1.74; 95% CI, 1.71–1.77), and no prior osteoporosis treatment (1.24; 95% CI, 1.22–1.26). Comorbid cancer (3.15; 95% CI, 3.09–3.21) and liver disease (2.54; 95% CI, 2.40–2.68) were also strongly associated with mortality. In conclusion, severe osteoporotic fractures, including certain non‐hip nonvertebral fractures, carry a high burden in terms of mortality and refracture risk. However, most patients received no anti‐osteoporotic treatment. The findings emphasize the importance of better management of patients with severe fractures, and of developing effective strategies to reduce fracture risk in patients with osteoporosis. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Christian Roux
- Department of Rheumatology Cochin Hospital, Assistance Publique - Hôpitaux de Paris Centre, Institut National de la Santé et de la Recherche Médicale (INSERM) Unités Mixtes de Recherche (UMR) 1153, Université de Paris Paris France
| | - Thierry Thomas
- Department of Rheumatology Hôpital Nord, Centre Hospitalier Universitaire (CHU) Saint-Etienne, INSERM U1059, Lyon University Saint-Etienne France
| | - Julien Paccou
- Department of Rheumatology Lille University, CHU Lille, Marrow Adiposity and Bone Laboratory (MABlab) ULR 4490 Lille France
| | | | | | | | | | | | | | - Florence Tubach
- Department of Public Health, Pharmacoepidemiology Center (Cephepi) Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, CIC-1422 Paris France
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Kline GA, Morin SN, Lix LM, Leslie WD. Bone densitometry categories as a salient distracting feature in the modern clinical pathways of osteoporosis care: A retrospective 20-year cohort study. Bone 2021; 145:115861. [PMID: 33484888 DOI: 10.1016/j.bone.2021.115861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND It is unknown as to what factors typically drive osteoporosis therapy decisions in real-world practice. METHODS Retrospective, 20-year cohort study within the government health system of Manitoba including all women having bone densitometry (BMD) tests between 1996 and 2017. Osteoporosis prescription data was linked to registry data on fractures, clinical risk factors and BMD tests. We defined 6 possible treatment decisions by prescription data: no treatment, starting, stopping, continuing, drug hiatus and re-starting. For each decision, we tested the association between salient patient factors (age, glucocorticoid use, recent fracture, BMD hip or spine T-score ≤ -2.5, FRAX major osteoporotic fracture probability ≥20%) using multivariable logistic regression. The factors were rank-ordered by decreasing Wald χ2 statistic to determine the relative importance. RESULTS There were 64,181 women, 33.8% of whom started osteoporosis therapy. For patients who begin therapy after a first BMD, the rank-ordered multivariable logistic regression factor most strongly associated was the T-score ≤ -2.5 [OR of 7.59(95%CI 7.19-8.01, p < 0.001)]. This was followed by glucocorticoid use [OR 2.89(95%CI 2.59-3.22, p < 0.001)]. Increasing age and recent fracture (within 2 years) were weak predictors of therapy and high FRAX score associated with reduced odds of therapy [OR 0.80 (95%CI 0.74-0.88, p < 0.001)]. T-scores were the strongest factor predicting therapy stop/continuation/re-starting; age and prior fracture had weak or no associations. CONCLUSIONS Despite recommendations for fracture-risk-based approach to osteoporosis therapy, BMD T-score continues to be the dominant factor in actual practice. Age, prior fracture or global fracture risk are much less associated; it is possible that BMD T-score categories are therefore acting as a clinically salient distracting factor.
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Affiliation(s)
- Gregory A Kline
- Department of Medicine, Cumming School of Medicine, University of Calgary, Canada.
| | - Suzanne N Morin
- Department of Medicine, Faculty of Medicine, McGill University, Canada
| | - Lisa M Lix
- Department of Community Medicine, University of Manitoba, Canada
| | - William D Leslie
- Departments of Internal Medicine and Radiology, Rady College of Medicine, University of Manitoba, Canada
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Cotter EJ, Klosterman EL, Winzenried AE, Greiner JJ, Grogan BF. Osteoporosis Screening Is Often Indicated but Overlooked Prior to Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2021; 3:e659-e665. [PMID: 34195629 PMCID: PMC8220567 DOI: 10.1016/j.asmr.2021.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose To (1) report the percentage of patients undergoing rotator cuff repair (RCR) who were appropriately screened with dual-energy X-ray absorptiometry testing prior to surgery, if indicated, and (2) determine the percentage of patients properly prescribed osteoporosis medications within 6 months of surgery. Methods Consecutive patients aged 50 years or older who underwent elective RCR at a single tertiary-care center over a 1-year period were reviewed. Fracture risk was estimated using the Fracture Risk Assessment Tool (FRAX) with and without bone mineral density. The U.S. National Osteoporosis Foundation (NOF) criteria for screening and treatment were applied. Patients with acute fractures or revision surgery were excluded. Results Of the 218 patients included, 129 were women (58.1%). The mean age was 61.5 ± 7.2 years. One hundred thirty-one RCRs (60.1%) occurred within 3 months of injury. A total of 69 patients (31.7%) met the NOF criteria for bone mineral density screening. Of these patients, 23 (33.3%) were appropriately screened with a dual-energy X-ray absorptiometry scan. Primary care providers initiated bone health assessment in 18 of the 23 appropriately screened patients, with orthopaedic providers initiating the workup in 3 patients (13.0%). Thirty-two patients (14.7%) met the NOF criteria for pharmacologic management of osteoporosis. Of these patients, 5 (15.6%) were treated. Patients meeting the medication criteria were older (69.1 ± 7.7 years vs 60.2 ± 6.3 years, P < .001), had a lower body mass index (28.8 ± 6.1 vs 31.5 ± 6.5, P = .028), and had chronic rotator cuff tears (P = .015). Conclusions Patients aged 50 years or older undergoing RCR are often not appropriately screened for osteoporosis. Even when appropriately screened, only 15.6% of patients meeting the indications for pharmacologic intervention for bone health optimization were prescribed appropriate medications. Although bone health optimization may or may not affect surgical timing, patient encounters related to rotator cuff tears can be used as an opportunity for providers to initiate osteoporosis screening and treatment protocols. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Eric J Cotter
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Emma L Klosterman
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Alec E Winzenried
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Justin J Greiner
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Brian F Grogan
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
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Abernathy BR, Schroder LK, Bohn DC, Switzer JA. Low-Energy Pelvic Ring Fractures: A Care Conundrum. Geriatr Orthop Surg Rehabil 2021; 12:2151459320985406. [PMID: 33643677 PMCID: PMC7890705 DOI: 10.1177/2151459320985406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/05/2020] [Accepted: 12/02/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction: A need exists for improved care pathways for patients experiencing low-energy pelvic ring fractures. A review of the current literature was performed to understand the typical patient care and post-acute rehabilitation pathway within the US healthcare system. We also sought to summarize reported clinical outcomes worldwide. Significance: Low-energy pelvic ring fracture patients usually do not qualify for inpatient admission, yet they often require post-acute rehabilitative care. The Center for Medicare and Medicaid Services’ (CMS) 3-day rule is a barrier to obtaining financial coverage of this rehabilitative care. Results: Direct admission of some patients to post-acute care facilities has shown promise with decreased cost, improved patient outcomes, and increased patient satisfaction. Secondary fracture prevention programs may also improve outcomes for this patient population. Conclusions: Post-acute care innovation and secondary fracture prevention should be prioritized in the low-energy pelvic fragility fracture patient population. To demonstrate the effect and feasibility of these improved care pathways, further studies are necessary.
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Affiliation(s)
| | - Lisa K Schroder
- Department of Orthopedics, University of Minnesota, Minneapolis, MN, USA.,HealthPartners, Bloomington, MN, USA
| | - Deborah C Bohn
- Department of Orthopedics, University of Minnesota, Minneapolis, MN, USA.,TRIA Orthopedics, Bloomington, MN, USA
| | - Julie A Switzer
- Department of Orthopedics, University of Minnesota, Minneapolis, MN, USA.,HealthPartners, Bloomington, MN, USA.,Park Nicollet Methodist Hospital, St Louis Park, MN, USA
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Opportunistic screening for osteoporosis and osteopenia by routine computed tomography scan: A heterogeneous, multiethnic, middle-eastern population validation study. Eur J Radiol 2021; 136:109568. [PMID: 33545629 DOI: 10.1016/j.ejrad.2021.109568] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/30/2020] [Accepted: 01/20/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE We aimed define thresholds for HU values observed on opportunistic CT scans that suggest abnormal bone mineral density (BMD) in a heterogeneous Middle Eastern population. METHODS Consecutive patients who had undergone CT and dual-energy X-ray absorptiometry (DXA) test of the lumbar spine within 6 months were included in this retrospective study. Hounsfield units (HU) on lateral lumbar spine CT and BMD at the spine and hip on DXA were compared. Potential HU thresholds suggestive of abnormal BMD were established using receiver operating characteristic (ROC) analysis. RESULTS 246 patients (mean age of 64 ± 11.6 years; 83 % female) were included. On DXA, 27 % had osteoporosis, 56 % had osteopenia, and 17 % had normal BMD. To distinguish osteoporosis from non-osteoporosis (osteopenia, normal BMD), a threshold of HU160 had sensitivity 95 % and the balanced threshold was HU121 (sensitivity 74 %, specificity 61 %). To distinguish normal from abnormal BMD (osteoporosis, osteopenia), a threshold of HU110 had specificity 93 % and the balanced threshold was HU149 (sensitivity 76 %, specificity 74 %). CONCLUSIONS In a heterogeneous Middle-Eastern population, our study supports the reported correlation between HU values on lumbar spine CT and BMD on DXA. In this population, HU > 160 correlates with low probability of osteoporosis on DXA, and screening examination is not warranted unless a vertebral fracture is detected; for HU ≤ 110 there is high probability of abnormal (osteoporosis or osteopenia) BMD, DXA examination is warranted; Finally, for HU 110-160, there is an intermediate chance of abnormal BMD, DXA examination may be warranted in specific patients with other risk factors.
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Stephens JR, Caraccio D, Mabry DR, Stepanek KV, Jones MS, Hemsey DF, Moore CR. Implementation of a fracture liaison service for patients with hip fracture cared for on a hospital medicine service. Hosp Pract (1995) 2020; 49:41-46. [PMID: 33023365 DOI: 10.1080/21548331.2020.1832384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Hip fracture is a common and morbid condition. Prior studies have shown that the majority of patients with fragility fracture are not treated for underlying osteoporosis. Our hospitalist-led co-management service for patients with acute hip fracture had no system for evaluating and treating osteoporosis in this cohort. Our objective was to implement a fracture liaison service (FLS) to assist patients with acute hip fracture and assess subsequent impact on diagnosis and treatment of osteoporosis. METHODS We conducted a pre-post study design at our tertiary academic center, including patients >50 years old hospitalized with acute hip fracture. We implemented a FLS, whereby all patients received endocrinology consultation. Outcome measures included the proportion of patients evaluated for osteoporosis by time of hospital discharge, comparing pre-implementation (12 months) and post-implementation (9 months) cohorts. We also measured the proportions of patients evaluated for and offered treatment for osteoporosis within 3 months of discharge for patients with post-discharge encounters visible in the medical record. RESULTS We identified 167 patients before and 124 after FLS implementation. In univariate analysis, the proportion of patients evaluated for osteoporosis before discharge increased from 0.6% to 72.6% (p < 0.001) pre- vs. post-implementation. The proportion of patients offered osteoporosis treatment within 3 months after discharge increased from 25.3% to 46.3% (p = 0.01). In multivariate analysis, post-implementation patients had higher odds of osteoporosis evaluation while hospitalized (OR = 470.4, p < 0.001) and higher odds of being offered osteoporosis treatment within 3 months (OR = 2.8, p = 0.008). CONCLUSIONS Establishment of an FLS partnered with a hospitalist-led co-management service for patients with hip fracture was associated with significant improvements in the proportions of patients evaluated and offered treatment for osteoporosis. Wider adoption of this model has the potential to improve care for patients with hip fracture by narrowing the osteoporosis treatment gap.
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Affiliation(s)
- John R Stephens
- Department of Medicine, Division of Hospital Medicine, University of North Carolina School of Medicine , Chapel Hill, NC, USA
| | - Donald Caraccio
- Department of Medicine, Division of Endocrinology, University of North Carolina School of Medicine , Chapel Hill, NC, USA
| | - Dana R Mabry
- Department of Medicine, Division of Hospital Medicine, University of North Carolina School of Medicine , Chapel Hill, NC, USA
| | - Kelly V Stepanek
- Department of Medicine, Division of Hospital Medicine, University of North Carolina School of Medicine , Chapel Hill, NC, USA
| | - Morgan S Jones
- Department of Medicine, Division of Endocrinology, University of North Carolina School of Medicine , Chapel Hill, NC, USA
| | - David F Hemsey
- Department of Medicine, Division of Hospital Medicine, University of North Carolina School of Medicine , Chapel Hill, NC, USA
| | - Carlton R Moore
- Department of Medicine, Division of Hospital Medicine, University of North Carolina School of Medicine , Chapel Hill, NC, USA
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Group medical consultation for osteoporosis: a prospective pilot study of patient experience in Canadian tertiary care. Br J Gen Pract 2020; 70:e801-e808. [PMID: 33020167 DOI: 10.3399/bjgp20x713081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/07/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Delivery of patient-centred care is limited by physician time. Group medical consultations may save physician time without compromising patient experience. AIM To assess patient experience and specialist physician time commitment in a group consultation for osteoporosis. DESIGN AND SETTING Prospective pilot study at a tertiary osteoporosis centre in Canada between May 2016 and June 2019. METHOD The authors evaluated women referred for osteoporosis who chose a 2-hour group consultation instead of a one-to-one consultation. Group consultations were led by an osteoporosis nurse and specialist physician, and consisted of individualised fracture risk assessment and education regarding osteoporosis therapies, followed by a decision-making exercise to choose a treatment plan. Patients then followed up with their GPs to implement this plan. Patient experience was assessed via a questionnaire immediately and 3 months post-consultation, at which time GP satisfaction and patient treatment status were also surveyed. RESULTS Of 560 referrals received, 18 patients declined osteoporosis specialist assessment, 54 could not be contacted, 303 attended a one-to- one consultation, and 185 attended a group consultation. Mean participant age was 62.8 years (standard deviation [SD] 5.8) and the Fracture Risk Assessment Tool (FRAX) 10-year osteoporotic fracture risk was 13.0 (SD 7.0)%. Immediately post-consultation, 104 (97.2%) patients were satisfied and 102 (95.3%) felt included in decision making. Satisfaction was reported by 95/99 (96.0%) patients and 27/36 (75.0%) GPs. Treatment plans had been enacted by 90 (90.1%) patients. For a matched number of individual consultations, each group session conferred a specialist physician time savings of 5.5 hours. CONCLUSION Group consultations represent a satisfactory and time-efficient alternative to one-to-one consultations for select patients with osteoporosis.
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Skjødt MK, Khalid S, Ernst M, Rubin KH, Martinez-Laguna D, Delmestri A, Javaid MK, Cooper C, Libanati C, Toth E, Abrahamsen B, Prieto-Alhambra D. Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom. Osteoporos Int 2020; 31:1535-1544. [PMID: 32185437 PMCID: PMC7360649 DOI: 10.1007/s00198-020-05358-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/18/2020] [Indexed: 01/06/2023]
Abstract
UNLABELLED This paper demonstrates a large post-fracture anti-osteoporosis treatment gap in the period 2005 to 2015. The gap was stable in Denmark at around 88-90%, increased in Catalonia from 80 to 88%, and started to increase in the UK towards the end of our study. Improved post-fracture care is needed. INTRODUCTION Patients experiencing a fragility fracture are at high risk of subsequent fractures, particularly within the first 2 years after the fracture. Previous studies have demonstrated that only a small proportion of fracture patients initiate therapy with an anti-osteoporotic medication (AOM), despite the proven fracture risk reduction of such therapies. The aim of this paper is to evaluate the changes in this post-fracture treatment gap across three different countries from 2005 to 2015. METHODS This analysis, which is part of a multinational cohort study, included men and women, aged 50 years or older, sustaining a first incident fragility fracture. Using routinely collected patient data from three administrative health databases covering Catalonia, Denmark, and the United Kingdom, we estimated the treatment gap as the proportion of patients not treated with AOM within 1 year of their first incident fracture. RESULTS A total of 648,369 fracture patients were included. Mean age 70.2-78.9 years; 22.2-31.7% were men. In Denmark, the treatment gap was stable at approximately 88-90% throughout the 2005 to 2015 time period. In Catalonia, the treatment gap increased from 80 to 88%. In the UK, an initially decreasing treatment gap-though never smaller than 63%-was replaced by an increasing gap towards the end of our study. The gap was more pronounced in men than in women. CONCLUSION Despite repeated calls for improved secondary fracture prevention, an unacceptably large treatment gap remains, with time trends indicating that the problem may be getting worse in recent years.
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Affiliation(s)
- M K Skjødt
- Department of Medicine, Hospital of Holbaek, Holbaek, Region Zealand, Denmark
- Department of Medicine, Hospital of Slagelse, Slagelse, Region Zealand, Denmark
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - S Khalid
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
| | - M Ernst
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Public Health, Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - K H Rubin
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - D Martinez-Laguna
- GREMPAL Research Group, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), CIBERFES, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - A Delmestri
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
| | - M K Javaid
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
| | - C Cooper
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, England
| | | | - E Toth
- UCB Pharma, Anderlecht, Belgium
| | - B Abrahamsen
- Department of Medicine, Hospital of Holbaek, Holbaek, Region Zealand, Denmark.
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England.
| | - D Prieto-Alhambra
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
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Saka N, Nomura K, Amano H, Fujimoto K, Watanabe Y, Kawano H, Tanihara S. Coding and prescription rates of osteoporosis are low among distal radius fracture patients in Japan. J Bone Miner Metab 2020; 38:363-370. [PMID: 31792609 DOI: 10.1007/s00774-019-01067-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This study aimed to clarify the coding and prescription rates for osteoporosis in distal radius fracture patients and to investigate the associated factors to help prevent subsequent osteoporotic fracture. MATERIALS AND METHODS Between 2014-2015, among 294,374 eligible individuals (42% female) aged 50-75 years in a health insurance claims database, we identified 192 individuals (mean age: 59.8 years, 74% female), counted the coding of distal radius fracture (International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) code: S525, S526), and determined if the patient had been assigned the code for osteoporosis and been prescribed osteoporosis medications. Logistic regression was performed to identify factors related to each rate. RESULTS The osteoporosis coding rate and osteoporosis medication prescription rate were 17.2% (n = 33) and 10.9% (n = 21), respectively. Most codes were assigned ≤ 3 months after injury (88%) at the distal radius fracture treatment facilities (84.8%). Patients who were assigned the code for osteoporosis or treated with osteoporosis medications were older (p = 0.08, p = 0.02, respectively), female (p = 0.05, p = 0.06, respectively) and having comorbidity (p = 0.02, p = 0.07, respectively). After adjustment, being female and having comorbidity remained the independent factors for the assignment of the code for osteoporosis (OR: 3.30, 95%, CI: 1.08-10.07, OR: 2.77, 95% CI: 1.24-6.12, respectively). No factor remained significant for the osteoporosis prescription. Active vitamin D analogues were most frequently prescribed medication (67%) followed by bisphosphonates (48%). CONCLUSION The overall coding and prescription rates for osteoporosis after distal radius fracture were low, which suggested that physician adherence to the osteoporosis guideline was low.
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Affiliation(s)
- Natsumi Saka
- Department of Orthopaedics, Teikyo University School of Medicine, 1-2-11, Kaga, Itabashi, Tokyo, Japan
| | - Kyoko Nomura
- Department of Public Health, Akita University School of Medicine, 1-1 Tegatagakuenmachi, Akita, 010-8502, Japan
- Graduate School of Public Health, Teikyo University, 1-2-11, Kaga, Itabashi, Tokyo, Japan
| | - Hoichi Amano
- Graduate School of Public Health, Teikyo University, 1-2-11, Kaga, Itabashi, Tokyo, Japan
- Department of Social and Behavioral Sciences, Harvard. T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Kenichi Fujimoto
- Graduate School of Public Health, Teikyo University, 1-2-11, Kaga, Itabashi, Tokyo, Japan
| | - Yoshinobu Watanabe
- Department of Orthopaedics, Teikyo University School of Medicine, 1-2-11, Kaga, Itabashi, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedics, Teikyo University School of Medicine, 1-2-11, Kaga, Itabashi, Tokyo, Japan
| | - Shinichi Tanihara
- Graduate School of Public Health, Teikyo University, 1-2-11, Kaga, Itabashi, Tokyo, Japan.
- Department of Public Health, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
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Senay A, Perreault S, Delisle J, Morin SN, Fernandes JC. Performance of a Fracture Liaison Service in an Orthopaedic Setting: A Report of Key Indicators and Improvement of Longitudinal Outcomes. J Bone Joint Surg Am 2020; 102:486-494. [PMID: 31714470 DOI: 10.2106/jbjs.19.00185] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many Fracture Liaison Services (FLSs) have been successfully implemented, but very few incorporate systematic longitudinal follow-up. The objective of this study was to report on the performance of such an FLS using key performance indicators and longitudinal clinical outcomes. METHODS An FLS was implemented in 2 outpatient orthopaedic clinics. Men and women who were ≥40 years of age and had a recent fragility fracture were recruited. Participants were evaluated, treated when appropriate, and systematically followed over a 2-year period. Clinical data including chart review and questionnaires were collected. Medical services and hospitalization claims data were retrieved from administrative databases. The primary outcomes were the following key performance indicators: the numbers of investigated and treated patients, follow-up attendance, and the incidence of subsequent fractures. Secondary outcomes were the changes in bone turnover markers and quality of life, physical capacity, and pain scores between baseline and follow-up visits. RESULTS A total of 532 subjects with a mean age of 63.4 years were recruited; 85.7% were female. Bone mineral density results were collected for 472 subjects (88.7%) and a prescription for anti-osteoporosis medication was given to 86.6% of patients. Overall, 83.6% of patients attended at least 1 follow-up visit. The subsequent fracture incidence rate was 2.6 per 100 person-years (23 fractures). The mean level of type-I collagen C-telopeptide (CTX-1), a bone resorption marker, decreased >35%. Clinically important improvements of functional capacity scores (by 14.4% to 63.7%) and pain level (by 19.3% to 35.7%) were observed over time; however, the increase in quality-of-life scores was not clinically important (by 3% to 15.2%). CONCLUSIONS In this FLS, the rates of investigation, treatment, and participation were >80% over a 2-year period. The subsequent fragility fracture incidence rate was <3 per 100 person-years. These results suggest that an intensive FLS model of care, with a systematic longitudinal follow-up, is effective. A randomized controlled trial is needed to support these results. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andréa Senay
- Faculties of Pharmacy (A.S. and S.P.) and Medicine (J.C.F.), Université de Montréal, Montréal, Québec, Canada.,CIUSSS du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Sylvie Perreault
- Faculties of Pharmacy (A.S. and S.P.) and Medicine (J.C.F.), Université de Montréal, Montréal, Québec, Canada
| | - Josée Delisle
- CIUSSS du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,CIUSSS du Nord-de-l'Île-de-Montréal, Hôpital Jean-Talon, Montréal, Montréal, Québec, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Center for Outcomes and Evaluation, Montréal, Québec, Canada
| | - Julio C Fernandes
- Faculties of Pharmacy (A.S. and S.P.) and Medicine (J.C.F.), Université de Montréal, Montréal, Québec, Canada.,CIUSSS du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,CIUSSS du Nord-de-l'Île-de-Montréal, Hôpital Jean-Talon, Montréal, Montréal, Québec, Canada
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Frost SA, Kelly A, Gaudin J, Evoy LM, Wilson C, Marov L, El Haddad C, Center J, Eisman JA, Nguyen TV, Hassett G. Establishing baseline absolute risk of subsequent fracture among adults presenting to hospital with a minimal-trauma-fracture. BMC Musculoskelet Disord 2020; 21:133. [PMID: 32111200 PMCID: PMC7049191 DOI: 10.1186/s12891-020-3161-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background One in three women and one in five men are expected to experience a minimal-trauma-fracture after the age of 50-years, which increases the risk of subsequent fracture. Importantly, timely diagnosis and optimal treatment in the form of a fracture liaison service (FLS), has been shown to reduce this risk of a subsequent fracture. However, baseline risk of subsequent fracture among this group of FLS patients has not been well described. Therefore, this study aims to estimate absolute risk of subsequent fracture, among women and men aged 50-years or more, presenting to hospital with a minimal-trauma-fracture. Methods Women and men aged 50-years or more with a minimal-trauma-fracture, presenting to hospitals across the South Western Sydney Local Health District between January 2003 and December 2017 were followed to identify subsequent fracture presentations to hospital. Absolute risk of subsequent fracture was estimated, by taking into account the competing risk of death. Results Between January 2003 and December 2017–15,088 patients presented to the emergency departments of the five hospitals in the SWSLHD (11,149, women [74%]), with minimal-trauma-fractures. Subsequent fractures identified during the follow-up period (median = 4.5 years [IQR, 1.6–8.2]), occurred in 2024 (13%) patients. Death during the initial hospital stay, or during a subsequent hospital visit was recorded among 1646 patients (11%). Women were observed to have 7.1% risk of subsequent fracture after 1-year, following an initial fracture; and, the risk of subsequent fracture after 1-year was 6.2% for men. After 5-years the rate among women was 13.7, and 11.3% for men, respectively. Cumulative risk of subsequent fracture when initial fractures were classified as being at proximal or distal sites are also presented. Conclusion This study has estimated the baseline risk of subsequent fracture among women and men presenting to hospital with minimal trauma fractures. Importantly, this information can be used to communicate risk to patients deciding to attend an osteoporosis refracture prevention clinic, and highlight the need for screening, and initial of treatment when indicated, once a minimal-trauma-fracture has occurred.
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Affiliation(s)
- Steven A Frost
- SPHERE MSK Clinical Academic Group, Sydney, Australia. .,South Western Sydney Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia. .,Western Sydney University, Sydney, Australia. .,Faculty of Medicine, UNSW Sydney, Sydney, Australia. .,Garvan Institute of Medical Research, Darlinghurst, Australia. .,Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, South Western Sydney Local Health District (SWSLHD), Sydney, Australia.
| | - Ayano Kelly
- SPHERE MSK Clinical Academic Group, Sydney, Australia.,Liverpool Hospital, Sydney, Australia
| | - Julia Gaudin
- SPHERE MSK Clinical Academic Group, Sydney, Australia.,Liverpool Hospital, Sydney, Australia
| | | | | | | | - Carlos El Haddad
- Western Sydney University, Sydney, Australia.,Liverpool Hospital, Sydney, Australia.,Campbelltown Hospital, Sydney, Australia
| | - Jacqueline Center
- SPHERE MSK Clinical Academic Group, Sydney, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Garvan Institute of Medical Research, Darlinghurst, Australia
| | - John A Eisman
- SPHERE MSK Clinical Academic Group, Sydney, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Garvan Institute of Medical Research, Darlinghurst, Australia.,St Vincent's Hospital, Sydney, Australia.,School of Medicine, University of Notre Dame Australia, Sydney, Australia.,Visiting Professor, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Tuan V Nguyen
- SPHERE MSK Clinical Academic Group, Sydney, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Garvan Institute of Medical Research, Darlinghurst, Australia.,University of Technology Sydney, Sydney, NSW, Australia
| | - Geraldine Hassett
- SPHERE MSK Clinical Academic Group, Sydney, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Liverpool Hospital, Sydney, Australia
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CANSU A, ATASOY D, EYÜBOĞLU İ, KARKUCAK M. Diagnostic efficacy of routine contrast-enhanced abdominal CT for the assessment of osteoporosis in the Turkish population. Turk J Med Sci 2020; 50:110-116. [PMID: 31731334 PMCID: PMC7080366 DOI: 10.3906/sag-1906-34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/03/2019] [Indexed: 11/08/2022] Open
Abstract
Background/aim This study aimed to evaluate the diagnostic efficacy of vertebral Hounsfield unit (HU) values on routine contrast- enhanced abdominal computed tomography (CT) scans for the assessment of osteoporosis using dual-energy X-ray absorptiometry (DXA) T-scores as a reference standard. Materials and methods A total of 111 consecutive patients who underwent contrast-enhanced abdominal CT examination for any indication and DXA within a 6-month period were retrospectively analyzed. The CT attenuation values of trabecular bone in HUs were measured in axial and sagittal planes from lumbar vertebrae 1–4 (L1–L4). The correlation between the DXA T-scores and HU values measured on the CT scans was evaluated by Pearson’s correlation test. Areas under the curves (AUCs) were calculated by receiver operating characteristic analysis for diagnostic proficiency, and threshold values were determined. Paired t-test and Bland–Altman plot test were used to evaluate the correlation between axial and sagittal HU values. Results There was a strong correlation between the DXA T-scores and HU values of all the lumbar vertebrae (P < 0.001). The highest correlation was for the L3 vertebra; L3 was thus chosen for additional analyses. The mean axial and sagittal L3 attenuations were 133.7 HU and 131.9 HU, respectively. The axial measurements were not significantly different from the sagittal measurements, with a mean difference of 1.8 HU (P > 0.05). The L3 axial CT attenuation threshold for 90% sensitivity was 170 HU and that for 90% specificity was 102 HU for distinguishing osteoporosis from osteopenia and normal bone mineral density (BMD). To distinguish the low BMD group from the normal group, the L3 axial CT attenuation threshold for approximately 90% sensitivity was 102 HU and for 90% specificity was 165 HU. Conclusion The HUs derived from routine contrast-enhanced abdominal CT scans can be used for the evaluation of osteoporosis, without additional radiation exposure and cost.
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Affiliation(s)
- Ayşegül CANSU
- Department of Radiology, Faculty of Medicine, Karadeniz Technical University, TrabzonTurkey
| | - Dilara ATASOY
- Department of Radiology, Sivas Numune Hospital, SivasTurkey
| | - İlker EYÜBOĞLU
- Department of Radiology, Faculty of Medicine, Karadeniz Technical University, TrabzonTurkey
| | - Murat KARKUCAK
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Karadeniz Technical University, TrabzonTurkey
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Abrahamsen B, Laursen HVB, Skjødt MK, Jensen MH, Vestergaard P. Age at hip fracture and life expectancy in Denmark - Secular trends over two decades. Bone 2020; 130:115083. [PMID: 31622776 DOI: 10.1016/j.bone.2019.115083] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/13/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent improvements in the health of the oldest old coexist with a decline in hip fracture rates, in particular in women. We speculated that increased longevity with decreasing hip fracture rates would result in a delay in hip fracture. We conducted an analysis of time trends in the age at hip fracture, by type and gender, for the past two decades using national data. STUDY POPULATION AND METHODS We used data from the Danish Hospital Discharge Register (1996-2017) to analyse the age distribution of femoral neck (FN) and pertrochanteric fractures (PT), allowing only the first fracture at each of these two sites to contribute to the analysis in each calendar year. Demographics for the background population at risk including life expectancy tabulations, were also obtained. RESULTS The average age at FN fracture in women increased slowly but significantly by 0.035years - or 12.8 days - per calendar year [0.035, 95% CI (0.016; 0.054), p<0.001], resulting in an increase from 79.6 to 80.4 years. There were no significant changes in the age at FN fracture in men or the age at PT fracture in women and men. Further, increases in life expectancy were considerably faster than any change observed in the age at hip fracture. In 1996, the average age at FN or PT fracture exceeded the average life expectancy in both men and women whereas the opposite was the case from 2009 and onwards in men and 2015 and onwards in women. CONCLUSION This study demonstrates a significant change in the demographics of hip fractures in Denmark over the past two decades. We observed a significant increase in the age at FN fracture in women but not in men, with no significant increase in the age at IT fracture and PT fracture. This developed much more slowly, however, than the increase in life expectancy in both sexes observed over the same period of time. Taken together, these changes resulted in a large decrease in the female to male incidence rate ratio from 2.6 and 2.5 (FN and PT, respectively) to 1.9 and 1.7.Additional effort is required to prevent hip fractures to ensure that the increasing life expectancy is matched by a similar increase in hip-fracture free life expectancy.
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Affiliation(s)
- Bo Abrahamsen
- Open Patient Data Explorative Network, University of Southern Denmark, Institute of Clinical Resesarch, Odense, Denmark; Holbæk Hospital, Department of Medicine, Holbæk, Denmark; NDORMS, University of Oxford, Oxford, United Kingdom.
| | - Henrik V B Laursen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | | | - Morten H Jensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
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Billington EO, Feasel AL, Kline GA. At Odds About the Odds: Women's Choices to Accept Osteoporosis Medications Do Not Closely Agree with Physician-Set Treatment Thresholds. J Gen Intern Med 2020; 35:276-282. [PMID: 31625042 PMCID: PMC6957614 DOI: 10.1007/s11606-019-05384-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/22/2019] [Accepted: 09/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Osteoporosis guidelines recommend pharmacologic therapy based on 10-year risk of major osteoporotic fracture (MOF) and hip fracture, which may fail to account for patient-specific experiences and values. OBJECTIVE We aimed to determine whether patient decisions to initiate osteoporosis medication agree with guideline-recommended intervention thresholds. DESIGN AND PARTICIPANTS This prospective cohort study included women aged ≥ 45 with age-associated osteoporosis who attended a group osteoporosis self-management consultation at a tertiary osteoporosis center. INTERVENTION A group osteoporosis self-management consultation, during which participants received osteoporosis education and then calculated1 their 10-year MOF and hip fracture risk using FRAX and2 their predicted absolute fracture risk with therapy (assuming 40% relative reduction). Participants then made autonomous decisions regarding treatment initiation. MAIN MEASURES We evaluated agreement between treatment decisions and physician-set intervention thresholds (10-year MOF risk ≥ 20%, hip fracture risk ≥ 3%). KEY RESULTS Among 85 women (median [IQR] age 62 [58-67]), 27% accepted treatment (median [IQR] MOF risk, 15.1% [9.9-22.0]; hip fracture risk, 3.3% [1.3-5.3]), 46% declined (MOF risk, 9.5% [6.5-11.6]; hip fracture risk, 1.8% [0.6-2.3]), and 27% remained undecided (MOF risk, 14.0% [9.8-20.2]; hip fracture risk, 4.4% [1.7-4.9]). There was wide overlap in fracture risk between treatment acceptors and non-acceptors. Odds of accepting treatment were higher in women with prior fragility fracture (50% accepted; OR, 5.3; 95% CI, 1.9-15.2; p = 0.0015) and with hip fracture risk ≥ 3% (32% accepted; OR, 3.6; 95% CI, 1.4-9.2; p = 0.012), but not MOF risk ≥ 20% (47% accepted; OR, 3.0; 95% CI, 1.0-8.5; p = 0.105). CONCLUSIONS Informed decisions to start osteoporosis treatment are highly personal and not easily predicted using fracture risk. Guideline-recommended intervention thresholds may not permit sufficient consideration of patient preferences.
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Affiliation(s)
- Emma O Billington
- Division of Endocrinology & Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Dr. David Hanley Osteoporosis Centre, Alberta Health Services, Calgary, Alberta, Canada.
| | - A Lynn Feasel
- Dr. David Hanley Osteoporosis Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Gregory A Kline
- Division of Endocrinology & Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Dr. David Hanley Osteoporosis Centre, Alberta Health Services, Calgary, Alberta, Canada
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Cui Y, Lix LM, Yang S, Morin SN, Leslie WD. A population-based study of postfracture care in Manitoba, Canada 2000/2001-2014/2015. Osteoporos Int 2019. [PMID: 31267162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
UNLABELLED We previously found that population-based postfracture notification, which informed primary care physicians of their patient's recent fracture and suggested assessment for osteoporosis, led to an improvement in postfracture care in the context of a randomized controlled trial ( ClinicalTrials.gov identifier NCT00594789, fractures from late 2007 to mid-2010). Since June 2010, a province-wide postfracture notification program was implemented. This study was to (1) determine whether this program has resulted in sustained improvement in postfracture care and (2) test factors associated with receiving osteoporosis care. METHODS A retrospective matched cohort study was performed using population-based health administrative data in Manitoba, Canada. We selected individuals aged 50+ years with an incident major osteoporosis fracture (MOF; N = 18,541) in fiscal years 2000/2001 to 2013/2014 and controls without a MOF (N = 92,705) matched (5:1) on age, sex, and residential area. The Cochran-Armitage test tested for a linear trend in osteoporosis care outcomes for cases and controls. Logistic regressions were used to test characteristics associated with the likelihood of receiving osteoporosis care. RESULTS The percentage of individuals receiving DXA testing and/or osteoporosis medication increased in fracture cases (p < 0.001), but decreased in controls (p < 0.001). Odds ratios for osteoporosis care in years following the postfracture notification program were approximately double of those prior to the clinical trial. In addition to prior MOF (OR 9.03, 95% CI 8.60-9.48), factors associated with osteoporosis care included lower income (OR 0.72, 95% CI 0.67-0.78), glucocorticoid use (OR 4.37, 95% CI 3.72-5.14), diabetes diagnosis (OR = 0.74, 95% CI 0.68-0.80), and Charlson Comorbidity Index (indexes 1-2: OR 1.27, 95% CI 1.20-1.34; indexes 3-5: OR 1.26, 95% CI 1.13-1.40). CONCLUSIONS Adopting a population-based postfracture notification program led to sustained improvements in postfracture care.
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Affiliation(s)
- Y Cui
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - L M Lix
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - S N Morin
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - W D Leslie
- Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0W3, Canada.
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Abstract
Despite today's good diagnostic and therapeutic options for osteoporosis, the number of unidentified cases is very high and therapy is therefore usually inadequate. Frequently, the diagnosis of osteoporosis is made only after the occurrence of a fracture. The reason for this, apart from the costs incurred as well as the additional radiation exposure of the diagnostics, is certainly the limited availability of dual energy X‑ray absorptiometry (DEXA) as well as quantitative computed tomography (q-CT). In search of an alternative technique, Hounsfield units (HU) of the clinical CT examination proved to be ground-breaking: the results of previous investigations demonstrated a reliable correlation between the T values of the DEXA measurement and the HU of the same vertebral body. Due to the widespread use of clinical CT scans of the thorax and the abdomen for a variety of indications, it is expected that the number of unidentified cases of osteoporosis can be significantly reduced-without additional costs and radiation exposure associated with osteoporosis screening. In addition to osteoporosis diagnostics, the calculated HU may also provide better preoperative planning as well as predicting the further course of the disease. Thus, the risk for vertebral body fractures, screw loosening and cage sintering after ventral fusion operations can be sufficiently predicted. In this way, preoperative modifications to the surgical procedure can be made to reduce the risk of implant failure.
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