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Singh W, Kushwaha P. Potassium: A Frontier in Osteoporosis. Horm Metab Res 2024; 56:329-340. [PMID: 38346690 DOI: 10.1055/a-2254-8533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Osteoporosis is a significant public health concern, particularly in aging populations, leading to fractures, decreased mobility, and reduced quality of life. While calcium and vitamin D have long been recognized as essential for bone health, emerging research suggests that potassium may play a crucial role in maintaining bone density and preventing osteoporosis. This manuscript explores the relationship between potassium and osteoporosis, delving into the mechanisms, epidemiological evidence, and potential therapeutic implications of potassium in bone health. Furthermore, the manuscript discusses the sources of dietary potassium, its impact on bone metabolism, and the future directions in research and clinical practice regarding potassium's role in osteoporosis management.
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Kocijan R, Haschka J, Kraus DA, Pfender A, Frank S, Zwerina J, Behanova M. Perspectives on Fracture Liaison Service in Austria: clinical and economic considerations. Front Endocrinol (Lausanne) 2024; 15:1349579. [PMID: 38706701 PMCID: PMC11066262 DOI: 10.3389/fendo.2024.1349579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Osteoporosis is a widespread disease and affects over 500,000 people in Austria. Fragility fractures are associated with it and represent not only an individual problem for the patients, but also an enormous burden for the healthcare system. While trauma surgery care is well provided in Vienna, there is an enormous treatment gap in secondary prevention after osteoporotic fracture. Systematic approaches such as the Fracture Liaison Service (FLS) aim to identify patients with osteoporosis after fracture, to clarify diagnostically, to initiate specific therapy, and to check therapy adherence. The aim of this article is to describe the practical implementation and operational flow of an already established FLS in Vienna. This includes the identification of potential FLS inpatients, the diagnostic workup, and recommendations for an IT solution for baseline assessment and follow-up of FLS patients. We summarize the concept, benefits, and limitations of FLS and provide prospective as well as clinical and economic considerations for a city-wide FLS, managed from a central location. Future concepts of FLS should include artificial intelligence for vertebral fracture detection and simple IT tools for the implementation of FLS in the outpatient sector.
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Affiliation(s)
- Roland Kocijan
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of Oesterreichische Gesundheitskasse (OEGK) and Allgemeine Unfallversicherungsanstalt (AUVA) Trauma Center Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
- Metabolic Bone Diseases Unit, School of Medicine, Sigmund Freud University, Vienna, Austria
| | - Judith Haschka
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of Oesterreichische Gesundheitskasse (OEGK) and Allgemeine Unfallversicherungsanstalt (AUVA) Trauma Center Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Daniel Arian Kraus
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of Oesterreichische Gesundheitskasse (OEGK) and Allgemeine Unfallversicherungsanstalt (AUVA) Trauma Center Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Aaron Pfender
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of Oesterreichische Gesundheitskasse (OEGK) and Allgemeine Unfallversicherungsanstalt (AUVA) Trauma Center Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
- Metabolic Bone Diseases Unit, School of Medicine, Sigmund Freud University, Vienna, Austria
| | - Stefan Frank
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of Oesterreichische Gesundheitskasse (OEGK) and Allgemeine Unfallversicherungsanstalt (AUVA) Trauma Center Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
- AUVA Traumazentrum Wien, Standort Meidling Abteilung für Traumatologie, Vienna, Austria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of Oesterreichische Gesundheitskasse (OEGK) and Allgemeine Unfallversicherungsanstalt (AUVA) Trauma Center Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Martina Behanova
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of Oesterreichische Gesundheitskasse (OEGK) and Allgemeine Unfallversicherungsanstalt (AUVA) Trauma Center Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
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Tomczyk-Warunek A, Turżańska K, Posturzyńska A, Kowal F, Blicharski T, Pano IT, Winiarska-Mieczan A, Nikodem A, Dresler S, Sowa I, Wójciak M, Dobrowolski P. Influence of Various Strontium Formulations (Ranelate, Citrate, and Chloride) on Bone Mineral Density, Morphology, and Microarchitecture: A Comparative Study in an Ovariectomized Female Mouse Model of Osteoporosis. Int J Mol Sci 2024; 25:4075. [PMID: 38612883 PMCID: PMC11012416 DOI: 10.3390/ijms25074075] [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: 01/26/2024] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Osteoporosis stands out as a prevalent skeletal ailment, prompting exploration into potential treatments, including dietary strontium ion supplements. This study assessed the efficacy of supplementation of three strontium forms-strontium citrate (SrC), strontium ranelate (SrR), and strontium chloride (SrCl)-for enhancing bone structure in 50 female SWISS mice, aged seven weeks. In total, 40 mice underwent ovariectomy, while 10 underwent sham ovariectomy. Ovariectomized (OVX) mice were randomly assigned to the following groups: OVX (no supplementation), OVX + SrR, OVX + SrC, and OVX + SrCl, at concentrations equivalent to the molar amount of strontium. After 16 weeks, micro-CT examined trabeculae and cortical bones, and whole-bone strontium content was determined. Results confirm strontium administration increased bone tissue mineral density (TMD) and Sr content, with SrC exhibiting the weakest effect. Femur morphometry showed limited Sr impact, especially in the OVX + SrC group. This research highlights strontium's potential in bone health, emphasizing variations in efficacy among its forms.
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Affiliation(s)
- Agnieszka Tomczyk-Warunek
- Laboratory of Locomotor Systems Research, Department of Rehabilitation and Physiotherapy, Medical University of Lublin, 20-954 Lublin, Poland;
| | - Karolina Turżańska
- Department of Orthopaedics and Rehabilitation, Medical University of Lublin, 20-954 Lublin, Poland; (A.P.); (F.K.); (T.B.); (I.T.P.)
| | - Agnieszka Posturzyńska
- Department of Orthopaedics and Rehabilitation, Medical University of Lublin, 20-954 Lublin, Poland; (A.P.); (F.K.); (T.B.); (I.T.P.)
| | - Filip Kowal
- Department of Orthopaedics and Rehabilitation, Medical University of Lublin, 20-954 Lublin, Poland; (A.P.); (F.K.); (T.B.); (I.T.P.)
| | - Tomasz Blicharski
- Department of Orthopaedics and Rehabilitation, Medical University of Lublin, 20-954 Lublin, Poland; (A.P.); (F.K.); (T.B.); (I.T.P.)
| | - Inés Torné Pano
- Department of Orthopaedics and Rehabilitation, Medical University of Lublin, 20-954 Lublin, Poland; (A.P.); (F.K.); (T.B.); (I.T.P.)
| | - Anna Winiarska-Mieczan
- Department of Bromatology and Nutrition Physiology, Institute of Animal Nutrition and Bromatology, University of Life Sciences in Lublin, Akademicka St. 13, 20-950 Lublin, Poland;
| | - Anna Nikodem
- Department of Mechanics, Materials and Biomedical Engineering, Faculty of Mechanical Engineering, Wrocław University of Science and Technology, Wybrzeże Wyspiańskiego, 50-370 Wrocław, Poland;
| | - Sławomir Dresler
- Department of Analytical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland; (S.D.); (I.S.); (M.W.)
- Department of Plant Physiology and Biophysics, Institute of Biological Science, Maria Curie-Skłodowska University, 20-033 Lublin, Poland
| | - Ireneusz Sowa
- Department of Analytical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland; (S.D.); (I.S.); (M.W.)
| | - Magdalena Wójciak
- Department of Analytical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland; (S.D.); (I.S.); (M.W.)
| | - Piotr Dobrowolski
- Department of Functional Anatomy and Cytobiology, Maria Curie-Skłodowska University, 20-033 Lublin, Poland;
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Saad A, Jenko N, Petrou E, Ariyaratne S, Mehta JS, Djearaman MG, Rasul FT, Botchu R. Assessing bone density on MRI: comparison between routine MRI sequences and DEXA scans. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1498-1503. [PMID: 38055038 DOI: 10.1007/s00586-023-08021-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/07/2023] [Accepted: 10/22/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Magnetic Resonance Imaging (MRI) is frequently utilised to aid in the comprehensive assessment of back pain, while dual-energy x-ray absorptiometry (DEXA) is the gold standard test for the assessment of bone density. Assessing bone density on MRI could reduce costs and avoid exposing patients to ionising radiation. The aim of this paper is to investigate whether the relative signal intensity of vertebral bodies compared to other structures can detect osteoporosis on MRI. METHODS 100 patients that had undergone both a lumbar spine MRI and a DEXA scan were identified. The T1 and T2 signal intensity of L1-L4 vertebral bodies (VB), cerebro-spinal fluid (CSF), and psoas muscle were measured within a 1-cm2 region of interest (ROI), and the signal intensity ratios were calculated. The ratios were stratified as normal, osteopenic, or osteoporotic based on DEXA T-scores. RESULTS The T1 VB /T1 CSF ratio was significantly higher in the osteoporotic group than the normal and osteopenic groups (p < 0.001). The T1 VB /T1 CSF ratio had excellent discrimination (AUC = 0.841) for the presence of osteoporosis. The Pearson correlation coefficient between the DEXA T-score and the T1 VB/T1 CSF ratio was -0.474 (p < 0.001). The intra-observer (ICC = 0.910, 95% CI = 0.757-0.966) and inter-observer reliability (ICC = 0.927, 95% CI = 0.824-0.970) were excellent. In our cohort, a T1 VB / T1 CSF ratio of greater than 4 is 66.7% sensitive but 90.0% specific for the presence of osteoporosis. CONCLUSION A high T1 VB/T1 CSF ratio suggests osteoporosis on MRI. Prospective validation is needed to confirm these findings.
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Affiliation(s)
- A Saad
- Spinal Surgery, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - N Jenko
- Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK.
| | - E Petrou
- Radiology, University Hospitals Birmingham NHS Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - S Ariyaratne
- Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - J S Mehta
- Spinal Surgery, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - M G Djearaman
- Radiology, University Hospitals Birmingham NHS Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - F T Rasul
- Neurosurgery, University Hospital, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - R Botchu
- Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
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Sahota O, Narayanasamy M, Bastounis A, Paskins Z, Bishop S, Langley T, Gittoes N, Davis S, Baily A, Holmes M, Leonardi-Bee J. Bisphosphonate alternative regimens for the prevention of osteoporotic fragility fractures: BLAST-OFF, a mixed-methods study. Health Technol Assess 2024; 28:1-169. [PMID: 38634483 PMCID: PMC11056815 DOI: 10.3310/wypf0472] [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: 04/19/2024] Open
Abstract
Background Bisphosphonates are a class of medication commonly used to treat osteoporosis. Alendronate is recommended as the first-line treatment; however, long-term adherence (both treatment compliance and persistence) is poor. Alternative bisphosphonates are available, which can be given intravenously and have been shown to improve long-term adherence. However, the most clinically effective and cost-effective alternative bisphosphonate regimen remains unclear. What is the most cost-effective bisphosphonate in clinical trials may not be the most cost-effective or acceptable to patients in everyday clinical practice. Objectives 1. Explore patient, clinician and stakeholder views, experiences and preferences of alendronate compared to alternative bisphosphonates. 2. Update and refine the 2016 systematic review and cost-effectiveness analysis of bisphosphonates, and estimate the value of further research into their benefits. 3. Undertake stakeholder/consensus engagement to identify important research questions and further rank research priorities. Methods The study was conducted in two stages, stages 1A and 1B in parallel, followed by stage 2: • Stage 1A - we elicited patient and healthcare experiences to understand their preferences of bisphosphonates for the treatment of osteoporosis. This was undertaken by performing a systematic review and framework synthesis of qualitative studies, followed by semistructured qualitative interviews with participants. • Stage 1B - we updated and expanded the existing Health Technology Assessment systematic review and clinical and cost-effectiveness model, incorporating a more comprehensive review of treatment efficacy, safety, side effects, compliance and long-term persistence. • Stage 2 - we identified and ranked further research questions that need to be answered about the effectiveness and acceptability of bisphosphonates. Results Patients and healthcare professionals identified a number of challenges in adhering to bisphosphonate medication, balancing the potential for long-term risk reduction against the work involved in adhering to oral alendronate. Intravenous zoledronate treatment was generally more acceptable, with such regimens perceived to be more straightforward to engage in, although a portion of patients taking alendronate were satisfied with their current treatment. Intravenous zoledronate was found to be the most effective, with higher adherence rates compared to the other bisphosphonates, for reducing the risk of fragility fracture. However, oral bisphosphonates are more cost-effective than intravenous zoledronate due to the high cost of zoledronate administration in hospital. The importance of including patients and healthcare professionals when setting research priorities is recognised. Important areas for research were related to patient factors influencing treatment selection and effectiveness, how to optimise long-term care and the cost-effectiveness of delivering zoledronate in an alternative, non-hospital setting. Conclusions Intravenous zoledronate treatment was generally more acceptable to patients and found to be the most effective bisphosphonate and with greater adherence; however, the cost-effectiveness relative to oral alendronate is limited by its higher zoledronate hospital administration costs. Future work Further research is needed to support people to make decisions influencing treatment selection, effectiveness and optimal long-term care, together with the clinical and cost-effectiveness of intravenous zoledronate administered in a non-hospital (community) setting. Limitations Lack of clarity and limitations in the many studies included in the systematic review may have under-interpreted some of the findings relating to effects of bisphosphonates. Trial registration This trial is registered as ISRCTN10491361. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127550) and is published in full in Health Technology Assessment; Vol. 28, No. 21. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Opinder Sahota
- Department of Health Care for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Zoe Paskins
- School of Medicine, Keele University and Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK
| | - Simon Bishop
- Business School, University of Nottingham, Nottingham, UK
| | - Tessa Langley
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Neil Gittoes
- Centre for Endocrinology Diabetes and Metabolism, University of Birmingham, Birmingham, UK
| | - Sarah Davis
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ann Baily
- Lay Member, Nottingham Osteoporosis Society Patient Support group, Nottingham, UK
| | - Moira Holmes
- Lay Member, Nottingham Osteoporosis Society Patient Support group, Nottingham, UK
| | - Jo Leonardi-Bee
- School of Medicine, University of Nottingham, Nottingham, UK
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Sinakos E, Kachru N, Tsoulas C, Jeyakumar S, Smith NJ, Yehoshua A, Cholongitas E. Cost-effectiveness of switching from tenofovir disoproxil fumarate to tenofovir alafenamide versus entecavir for chronic hepatitis B patients in Greece. J Comp Eff Res 2024; 13:e230090. [PMID: 38317634 PMCID: PMC11044955 DOI: 10.57264/cer-2023-0090] [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: 06/05/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
Aim: This study assessed the clinical impact and cost-effectiveness of switching from tenofovir disoproxil fumarate (TDF) to either tenofovir alafenamide (TAF) or entecavir (ETV) in a Greek chronic hepatitis B (CHB) population. Patients & methods: A Markov model from the perspective of a third-party payer in Greece quantified the health and economic benefits of switching from TDF to either TAF or ETV over a lifetime horizon. Results: Over a lifetime, patients who switch from TDF to TAF versus patients who switch from TDF to ETV had an overall lower incidence of compensated cirrhosis (0.4% lower), decompensated cirrhosis (0.04% lower) and hepatocellular carcinoma (0.25% lower). Chronic kidney disease and end-stage renal disease were also lower in patients who switch to TAF; major osteoporotic fractures were similar for both groups. While total costs were higher for switching from TDF to TAF versus TDF to ETV due to the higher cost of TAF, switching from TDF to TAF versus ETV was cost effective with an incremental cost-effectiveness ratio of €17,113 per quality-adjusted life year. Conclusion: Switching from TDF to TAF in patients living with CHB is a cost effective strategy to reduce adverse liver disease outcomes, while improving bone- and renal-related safety outcomes.
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Affiliation(s)
- Emmanouil Sinakos
- 4th Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | | | | | - Evangelos Cholongitas
- First Department of Internal Medicine, Medical School of National & Kapodistrian University of Athens, Athens, Greece
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Tu JB, Liao WJ, Liu WC, Gao XH. Using machine learning techniques to predict the risk of osteoporosis based on nationwide chronic disease data. Sci Rep 2024; 14:5245. [PMID: 38438569 PMCID: PMC10912338 DOI: 10.1038/s41598-024-56114-1] [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: 11/22/2023] [Accepted: 03/01/2024] [Indexed: 03/06/2024] Open
Abstract
Osteoporosis is a major public health concern that significantly increases the risk of fractures. The aim of this study was to develop a Machine Learning based predictive model to screen individuals at high risk of osteoporosis based on chronic disease data, thus facilitating early detection and personalized management. A total of 10,000 complete patient records of primary healthcare data in the German Disease Analyzer database (IMS HEALTH) were included, of which 1293 diagnosed with osteoporosis and 8707 without the condition. The demographic characteristics and chronic disease data, including age, gender, lipid disorder, cancer, COPD, hypertension, heart failure, CHD, diabetes, chronic kidney disease, and stroke were collected from electronic health records. Ten different machine learning algorithms were employed to construct the predictive mode. The performance of the model was further validated and the relative importance of features in the model was analyzed. Out of the ten machine learning algorithms, the Stacker model based on Logistic Regression, AdaBoost Classifier, and Gradient Boosting Classifier demonstrated superior performance. The Stacker model demonstrated excellent performance through ten-fold cross-validation on the training set and ROC curve analysis on the test set. The confusion matrix, lift curve and calibration curves indicated that the Stacker model had optimal clinical utility. Further analysis on feature importance highlighted age, gender, lipid metabolism disorders, cancer, and COPD as the top five influential variables. In this study, a predictive model for osteoporosis based on chronic disease data was developed using machine learning. The model shows great potential in early detection and risk stratification of osteoporosis, ultimately facilitating personalized prevention and management strategies.
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Affiliation(s)
- Jun-Bo Tu
- Department of Orthopaedics, Xinfeng County People's Hospital, Jiangxi, 341600, Xinfeng, China
| | - Wei-Jie Liao
- Department of ICU, GanZhou People's Hospital, GanZhou, 341000, Jiangxi, China
| | - Wen-Cai Liu
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China.
| | - Xing-Hua Gao
- Department of Orthopaedics, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, 510180, China.
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Bennett MJ, Center JR, Perry L. Establishing consensus recommendations for long-term osteoporosis care for patients who have attended an Australian fracture liaison service: a Delphi study. Osteoporos Int 2024; 35:373-389. [PMID: 38267665 PMCID: PMC10867051 DOI: 10.1007/s00198-024-07014-7] [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: 08/27/2023] [Accepted: 01/01/2024] [Indexed: 01/26/2024]
Abstract
Coordinating healthcare activities between fracture liaison services (FLS) and primary care is challenging. Using a Delphi technique, we developed 34 consensus statements to support improved care coordination across this healthcare transition. PURPOSE Evidence supporting an optimal coordination strategy between fracture liaison services (FLS) and primary care is lacking. This study aimed to develop consensus statements to support consistency and benchmarking of clinical practice to improve coordination of care for patients transitioning from FLS to primary care following an osteoporotic fracture. METHODS A Delphi technique was used to develop consensus among a panel of experts, including FLS clinicians (medical and non-medical), general practitioners (GPs), and consumers. RESULTS Results of a preparatory questionnaire (n = 33) informed the development of 34 statements for review by expert panellists over two Delphi rounds (n = 25 and n = 19, respectively). The majority of participants were from New South Wales (82%), employed as FLS clinicians (78.8%) and working in metropolitan centres (60.6%). Consensus was achieved for 24/34 statements in round one and 8/10 statements in round two. All statements concerning patient education, communication, and the GP-patient relationship achieved consensus. Expert opinions diverged in some areas of clinician roles and responsibilities and long-term monitoring and management recommendations. CONCLUSION We found clear consensus among experts in many key areas of FLS integration with primary care. While experts agreed that primary care is the most appropriate setting for long-term osteoporosis care, overall confidence in primary care systems to achieve this was low. The role of (and responsibility for) adherence monitoring in a resource-limited setting remains to be defined.
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Affiliation(s)
- Michael J Bennett
- Department of Endocrinology, Prince of Wales Hospital, Randwick, NSW, Australia.
- Department of Endocrinology, The Sutherland Hospital, Caringbah, NSW, Australia.
- St George and Sutherland Clinical School, UNSW Medicine, Sydney, NSW, Australia.
- The Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.
| | - Jacqueline R Center
- The Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- St Vincent's Healthcare Clinical School, School of Clinical Medicine, UNSW, Sydney, NSW, Australia
| | - Lin Perry
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- Prince of Wales Hospital & Community Health Services, Randwick, NSW, Australia
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Surís X, Vela E, Larrosa M, Llargués E, Pueyo-Sánchez MJ, Cancio-Trujillo JM. Impact of major osteoporotic fractures on the use of healthcare resources in Catalonia, Spain. Bone 2024; 180:116993. [PMID: 38145863 DOI: 10.1016/j.bone.2023.116993] [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: 08/15/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES To estimate the impact of first major osteoporotic fractures (MOF) on health resource use and healthcare expenditures in people aged ≥50 years in Catalonia, Spain. DESIGN Observational, retrospective study. The Catalan Health Surveillance System (CHSS) registry was used to obtain sociodemographic, clinical and expenditure data from all public centres in Catalonia (Spain). SETTING AND PARTICIPANTS Males and females aged ≥50 years who sustained a first major osteoporotic fracture between January 1, 2018, and December 31, 2020. METHODS Data on admissions to the emergency department, hospitalization and skilled nursing facilities, primary and specialized care visits, nonemergency medical transport, outpatient rehabilitation and pharmacy prescriptions were retrieved for each patient. Monthly and yearly mean usage rates, expenditure in euros (€) and incremental costs one and two years after fracture were calculated. RESULTS There were 64,403 patients with first MOF: 47,555 females and 16,848 males with a mean age (standard deviation) of 76.5 (12.0) years. The average annual expenditure increased from €4564 in the year before to €12,331 in the year following a hip fracture. For forearm fractures, the expenditure increased from €2511 to €4251, for vertebral fractures from €4146 to €6659, for pelvic fractures from €4442 to €7124, for humerus fractures from €3058 to €5992, and for multiple fractures from €4598 to €12,028. The average cost for overall fractures experienced a 110.3 % increase. The leading cause of health expenditure in the year following MOF was hospital admission. Expenditure in the second year post-fracture returned to pre-fracture levels. The use of some healthcare resources, especially visits to emergency services, increased in the prefracture month. Male sex, older age and high previous comorbidities were associated with a higher expenditure. CONCLUSIONS In people with a first MOF, healthcare expenditure doubled during the first-year post-facture, mostly in relation to inpatient care. The healthcare resource use increased during the previous month. This increase could potentially be attributed to the worsening of pre-existing comorbidities.
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Affiliation(s)
- Xavier Surís
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain; Rheumatology Department, Hospital General de Granollers, Granollers, Spain; School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Catalan Health Service.
| | - Emili Vela
- Catalan Health Service; Knowledge and Information Unit; Digitalization for the Sustainability of the Healthcare System.
| | - Marta Larrosa
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain
| | - Esteve Llargués
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain; Internal Medicine Department, Hospital General de Granollers, Granollers, Spain.
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10
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Götze M, Ebelt H. [Prevalence, incidence and predictive factors of atrial fibrillation in geriatric patients-A prospective observational study]. Z Gerontol Geriatr 2024; 57:120-125. [PMID: 37084091 DOI: 10.1007/s00391-023-02177-0] [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: 11/01/2022] [Accepted: 03/02/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND QUESTION Atrial fibrillation (AF) is the most common cardiac arrhythmia in the total population, and previous studies have already reported the prevalence of AF; however, AF is of special importance in geriatric patients due to demographic changes. Therefore, the aim of this study was to determine how many geriatric patients have a history of AF (prevalence) and how often AF can be newly diagnosed during an inpatient stay (incidence). Additionally, predictive factors for the incidence of AF in geriatric patients are described. STUDY PARTICIPANTS AND METHODS In a monocentric prospective observational study from April 2021 to April 2022, all admissions to a geriatric clinic were included in the study. Data collection was carried out using the patients' digital files. As part of the admission routine, all patients had a 12-lead ECG recorded. Additionally, a 24‑h long-term electrocardiogram (LTECG) was used in a subset of patients depending on the clinical need. RESULTS A total of 1914 participants were included in the study. At the time of admission, 715 (37.4%) patients had a known history of AF. Of the remaining 1199 patients without a history of AF, AF could be newly detected in 73 cases (6.1%). Multivariate regression analysis identified age > 80 years (odds ratio, OR: 2.3) and heart failure (OR: 3.5) as significant risk factors for the incidence of AF (each p < 0.05). CONCLUSION Despite an already high prevalence, AF was newly diagnosed in 6% of patients during the stay at a geriatric clinic. Heart failure and age above 80 years were significantly associated with the presence of AF. This should be taken into account when screening for AF in this patient population.
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Affiliation(s)
- Markus Götze
- Fachklinik für Geriatrie, St. Elisabeth Krankenhaus, Bahnhofstraße 19, 99976, Lengenfeld unterm Stein, Deutschland.
| | - Henning Ebelt
- Klinik für Innere Medizin II, Katholisches Krankenhaus "St. Johann Nepomuk", Erfurt, Deutschland
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11
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Zhang YY, Xie N, Sun XD, Nice EC, Liou YC, Huang C, Zhu H, Shen Z. Insights and implications of sexual dimorphism in osteoporosis. Bone Res 2024; 12:8. [PMID: 38368422 PMCID: PMC10874461 DOI: 10.1038/s41413-023-00306-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/04/2023] [Accepted: 11/27/2023] [Indexed: 02/19/2024] Open
Abstract
Osteoporosis, a metabolic bone disease characterized by low bone mineral density and deterioration of bone microarchitecture, has led to a high risk of fatal osteoporotic fractures worldwide. Accumulating evidence has revealed that sexual dimorphism is a notable feature of osteoporosis, with sex-specific differences in epidemiology and pathogenesis. Specifically, females are more susceptible than males to osteoporosis, while males are more prone to disability or death from the disease. To date, sex chromosome abnormalities and steroid hormones have been proven to contribute greatly to sexual dimorphism in osteoporosis by regulating the functions of bone cells. Understanding the sex-specific differences in osteoporosis and its related complications is essential for improving treatment strategies tailored to women and men. This literature review focuses on the mechanisms underlying sexual dimorphism in osteoporosis, mainly in a population of aging patients, chronic glucocorticoid administration, and diabetes. Moreover, we highlight the implications of sexual dimorphism for developing therapeutics and preventive strategies and screening approaches tailored to women and men. Additionally, the challenges in translating bench research to bedside treatments and future directions to overcome these obstacles will be discussed.
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Affiliation(s)
- Yuan-Yuan Zhang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Na Xie
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Xiao-Dong Sun
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Edouard C Nice
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, 3800, Australia
| | - Yih-Cherng Liou
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, 117543, Republic of Singapore
| | - Canhua Huang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Huili Zhu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Department of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China.
| | - Zhisen Shen
- Department of Otorhinolaryngology and Head and Neck Surgery, The Affiliated Lihuili Hospital, Ningbo University, 315040, Ningbo, Zhejiang, China.
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12
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Khalid TY, Peters TJ, Pocock LV, Drew S, Hardcastle SA, Paskins Z, Davis S, Kariki EP, Clark EM. An online clinical decision tool to screen for vertebral fragility fractures (Vfrac) in older women presenting with back pain in general practice: protocol for a feasibility study in preparation for a future cluster randomised controlled trial. Arch Osteoporos 2024; 19:12. [PMID: 38321322 PMCID: PMC10847189 DOI: 10.1007/s11657-023-01364-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024]
Abstract
This feasibility study for a future definitive randomized trial assesses the use and acceptability of a new clinical decision tool to identify risk of a vertebral fracture and those who should be referred for spinal radiography in women aged 65 or over presenting to primary care with back pain. PURPOSE Approximately 12% of older adults have vertebral fragility fractures, but currently fewer than one-third are diagnosed, potentially limiting access to bone protection treatment. Vfrac is a vertebral fracture screening tool which classifies individuals into high or low risk of having a vertebral fracture, allowing targeting of spinal radiographs to high-risk individuals. The objective of this study was to investigate the feasibility of conducting a cluster randomized controlled trial to evaluate the use of an online version of Vfrac in primary care. METHODS The study will run in six general practices, with three given the Vfrac tool for use on older women (> 65 years) consulting with back pain and three using standard clinical processes for managing such back pain. Anonymised data covering a 12-month period will be collected from all sites on consultations by older women with back pain. Focus groups will be undertaken with healthcare professionals and patients on whom the tool was used to understand the acceptability of Vfrac and identify factors that impact its use. These patients will be sent a paper version of the Vfrac questionnaire to self-complete at home. Outputs of the self-completion Vfrac (high versus low risk) will be compared with the face-to-face Vfrac (high versus low risk), and agreement assessed using Cohen's kappa. RESULTS This study will evaluate the use and acceptability of Vfrac within primary care and determine if data on resource use can be collected accurately and comprehensively. CONCLUSIONS This article describes the protocol of the Vfrac feasibility study. TRIAL REGISTRATION ISRCTN18000119 (registered 01/03/2022) and ISRCTN12150779 (registered 10/01/2022).
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Affiliation(s)
- Tanzeela Y Khalid
- Musculoskeletal Research Unit, Translational Health Sciences, Learning and Research Building, Southmead Hospital, Bristol Medical School, University of Bristol, Bristol, BS10 5NB, UK.
| | - Tim J Peters
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Lucy V Pocock
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Drew
- Musculoskeletal Research Unit, Translational Health Sciences, Learning and Research Building, Southmead Hospital, Bristol Medical School, University of Bristol, Bristol, BS10 5NB, UK
| | - Sarah A Hardcastle
- Musculoskeletal Research Unit, Translational Health Sciences, Learning and Research Building, Southmead Hospital, Bristol Medical School, University of Bristol, Bristol, BS10 5NB, UK
- Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Zoe Paskins
- School of Medicine, Keele University, Staffordshire, UK
| | - Sarah Davis
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Eleni P Kariki
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Emma M Clark
- Musculoskeletal Research Unit, Translational Health Sciences, Learning and Research Building, Southmead Hospital, Bristol Medical School, University of Bristol, Bristol, BS10 5NB, UK
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13
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Wu Y, Yuan C, Han P, Guo J, Wang Y, Chen C, Huang C, Zheng K, Qi Y, Li J, Xue Z, Lu F, Liang D, Gao J, Li X, Guo Q. Discovery of potential biomarkers for osteoporosis using LC/GC-MS metabolomic methods. Front Endocrinol (Lausanne) 2024; 14:1332216. [PMID: 38298188 PMCID: PMC10828954 DOI: 10.3389/fendo.2023.1332216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024] Open
Abstract
Purpose For early diagnosis of osteoporosis (OP), plasma metabolomics of OP was studied by untargeted LC/GC-MS in a Chinese elderly population to find possible diagnostic biomarkers. Methods A total of 379 Chinese community-dwelling older adults aged ≥65 years were recruited for this study. The BMD of the calcaneus was measured using quantitative ultrasound (QUS), and a T value ≤-2.5 was defined as OP. Twenty-nine men and 47 women with OP were screened, and 29 men and 36 women were matched according to age and BMI as normal controls using propensity matching. Plasma from these participants was first analyzed by untargeted LC/GC-MS, followed by FC and P values to screen for differential metabolites and heatmaps and box plots to differentiate metabolites between groups. Finally, metabolic pathway enrichment analysis of differential metabolites was performed based on KEGG, and pathways with P ≤ 0.05 were selected as enrichment pathways. Results We screened metabolites with FC>1.2 or FC<1/1.2 and P<0.05 and found 33 differential metabolites in elderly men and 30 differential metabolites in elderly women that could be potential biomarkers for OP. 2-Aminomuconic acid semialdehyde (AUC=0.72, 95% CI 0.582-0.857, P=0.004) is highly likely to be a biomarker for screening OP in older men. Tetradecanedioic acid (AUC=0.70, 95% CI 0.575-0.818, P=0.004) is highly likely to be a biomarker for screening OP in older women. Conclusion These findings can be applied to clinical work through further validation studies. This study also shows that metabolomic analysis has great potential for application in the early diagnosis and recurrence monitoring of OP in elderly individuals.
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Affiliation(s)
- Yahui Wu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Chunhua Yuan
- Comprehensive surgical rehabilitation ward, Shanghai Health Rehabilitation Hospital, Shanghai, China
| | - Peipei Han
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jiangling Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yue Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Cheng Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- School of Health, Fujian Medical University, Fujian, China
| | - Chuanjun Huang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Kai Zheng
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yiqiong Qi
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Jiajin Li
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Zhengjie Xue
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Fanchen Lu
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Dongyu Liang
- Clinical Research Center, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jing Gao
- General Practice Clinic, Pujiang Community Health Service Center in Minhang District, Shanghai, China
| | - Xingyan Li
- Shanghai Hongkou District Jiangwan Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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14
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Michaëlsson K, Baron JA, Byberg L, Larsson SC, Melhus H, Gedeborg R. Declining hip fracture burden in Sweden 1998-2019 and consequences for projections through 2050. Sci Rep 2024; 14:706. [PMID: 38184745 PMCID: PMC10771431 DOI: 10.1038/s41598-024-51363-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 01/04/2024] [Indexed: 01/08/2024] Open
Abstract
We aimed to estimate the absolute and age-standardized number of hip fractures in Sweden during the past two decades to produce time trends and future projections. We used nationwide register data from 1998 to 2019 and a validated algorithm to calculate the annual absolute and age-standardized number of incident hip fractures over time. The total hip fracture burden was 335,399 incident events over the 22 years, with a change from 16,180 in 1998 to 13,929 in 2019, a 14% decrease. One decade after the index hip fracture event, 80% of the patients had died, and 11% had a new hip fracture. After considering the steady growth of the older population, the decline in the age-standardized number of hip fractures from 1998 through 2019 was 29.2% (95% CI 28.1-30.2%) in women and 29.3% (95% CI 27.5-30.7%) in men. With a continued similar reduction in hip fracture incidence, we can predict that 14,800 hip fractures will occur in 2034 and 12,000 in 2050 despite doubling the oldest old (≥ 80 years). Without an algorithm, a naïve estimate of the total number of hip fractures over the study period was 539,947, with a second 10-year hip fracture risk of 35%. We note an ongoing decline in the absolute and age-standardized actual number of hip fractures in Sweden, with consequences for future projections.
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Affiliation(s)
- Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden.
| | - John A Baron
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Liisa Byberg
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | - Susanna C Larsson
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Melhus
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Rolf Gedeborg
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
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15
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Zhu Q, Chen R, Kuang M, Zhang W, Wang D, Han S. Identification and characterization of extrachromosomal circular DNA in age-related osteoporosis. Aging (Albany NY) 2023; 15:15489-15503. [PMID: 38159253 PMCID: PMC10781488 DOI: 10.18632/aging.205388] [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: 08/15/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024]
Abstract
Extrachromosomal circular DNA (eccDNA) was once thought to mainly exist in tumour cells, although it was later shown to be ubiquitous in healthy tissues as well. However, the characteristics and properties of eccDNA in healthy tissue or non-cancer tissue are not well understood. This study first analyses the properties, possible formation mechanisms and potential functions of eccDNA in osteoporotic or normal bone tissue. We used circle-seq to demonstrate the expression spectrum of the eccDNA in the bone tissue. A bioinformatics analysis was performed for the differentially expressed eccDNA, and it enriched the Hippo signalling pathway, PI3K-Akt signalling pathway, Ras signal-ling pathway and other signalling pathways that are closely related to osteoporosis (OP). Then, we used real-time polymerase chain reaction and Sanger sequencing to assess human bone marrow mesenchymal stem cells and obtained the base sequence of the eccDNA cyclization site. Overall, eccDNAs in bone tissue are common and may play a significant role in pathways connected to age-related osteoporosis progression.
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Affiliation(s)
- Qingrun Zhu
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250014, Shandong, China
| | - Rudong Chen
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250014, Shandong, China
| | - Mingjie Kuang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250014, Shandong, China
| | - Wen Zhang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250014, Shandong, China
| | - Dachuan Wang
- Department of Orthopedics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong, China
| | - Shijie Han
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250014, Shandong, China
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16
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Goetze M, Knauf T, Ebelt H. Relationship between Pharmacological Treatment Strategy and Cognitive Function in Geriatric Patients with Atrial Fibrillation. J Clin Med 2023; 12:7724. [PMID: 38137793 PMCID: PMC10743707 DOI: 10.3390/jcm12247724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Background and question: Atrial fibrillation (AF) is the most common cardiac arrhythmia in the total population. The aim of this study is to determine how geriatric patients with AF are treated in terms of rhythm or rate control and whether a relationship between the type of treatment and Mini Mental Status (MMS) can be identified. METHODS In this monocentric, prospective, observational study, data including chronic medication as well as demographic parameters were collected from all patients in a geriatric department between April 2021 and April 2022. A 12-lead ECG as well as the Mini Mental Status were recorded for all patients as part of the admission routine, and a 24 h ECG was performed in selected patients on the basis of clinical indication. RESULTS At baseline, 715 out of 1914 patients (37.4%) had a known history of AF. Of these patients, 43 patients (6%) were on rhythm control therapy (RHY) and 672 (94%) were on rate control therapy (RATE). No difference in respect to MMS could be detected between RHY and RATE. However, linear regression analyses showed that age, HASBLED score, creatinine serum level, and an existing antiplatelet medication were associated with a negative influence on MMS, whereas oral anticoagulation (OAC) was associated with improved MMS, respectively (p < 0.05 for all). CONCLUSION The vast majority of geriatric patients with AF are treated with a rate control strategy. Oral anticoagulation is associated with better results in MMS, whereas patients who are treated with antiplatelet medication show worse results in MMS instead.
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Affiliation(s)
- Markus Goetze
- Department for Geriatrics, St. Elisabeth Hospital, Bahnhofstrasse 19, 99976 Lengenfeld unterm Stein, Germany;
| | - Tim Knauf
- Department of Medicine II, Catholic Hospital “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, Germany
| | - Henning Ebelt
- Department of Medicine II, Catholic Hospital “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, Germany
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17
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Arnold EL, Elarnaut F, Downes D, Evans JPO, Greenwood C, Rogers KD. Conical shell X-ray beam tomosynthesis and micro-computed tomography for microarchitectural characterisation. Sci Rep 2023; 13:21480. [PMID: 38057401 PMCID: PMC10700317 DOI: 10.1038/s41598-023-48851-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Abstract
Bone quality is commonly used to diagnose bone diseases such as osteoporosis, with many studies focusing on microarchitecture for fracture prediction. In this study a bovine distal femur was imaged using both micro-computed tomography (µCT) and tomosynthesis using focal construct geometry (FCG) for comparison of microarchitectural parameters. Six regions of interest (ROIs) were compared between the two imaging modalities, with both global and adaptive methods used to binarize the images. FCG images were downsampled to the same pixel size as the µCT images. Bone morphometrics were determined using BoneJ, for each imaging modality, binarization technique and ROI. Bone area/total area was found to have few significant differences between FCG and µCT (p < 0.05 for two of six ROIs). Fractal Dimension had only one significant difference (p < 0.05 for one of six ROIs) between µCT and downsampled FCG (where pixel size was equalized). Trabecular thickness and trabecular spacing were observed to follow trends as observed for the corresponding µCT images, although many absolute values were significantly different (p < 0.05 for between one and six ROIs depending on image types used). This study demonstrates the utility of tomosynthesis for measurement of microarchitectural morphometrics.
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Affiliation(s)
- Emily L Arnold
- Cranfield Forensic Institute, Cranfield University, Shrivenham, SN6 8LA, Wiltshire, UK.
| | - Farid Elarnaut
- Imaging Science Group, Nottingham Trent University, Rosalind Franklin Building, Nottingham, NG11 8NS, UK
| | - David Downes
- Imaging Science Group, Nottingham Trent University, Rosalind Franklin Building, Nottingham, NG11 8NS, UK
| | - J Paul O Evans
- Imaging Science Group, Nottingham Trent University, Rosalind Franklin Building, Nottingham, NG11 8NS, UK
| | - Charlene Greenwood
- School of Chemical and Physical Sciences, Keele University, Keele, ST5 5BJ, Staffordshire, UK
| | - Keith D Rogers
- Cranfield Forensic Institute, Cranfield University, Shrivenham, SN6 8LA, Wiltshire, UK
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18
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Abdulaziz D, Anastasiou AD, Panagiotopoulou V, Raif EM, Giannoudis PV, Jha A. Physiologically engineered porous titanium/brushite scaffolds for critical-size bone defects: A design and manufacturing study. J Mech Behav Biomed Mater 2023; 148:106223. [PMID: 37976684 DOI: 10.1016/j.jmbbm.2023.106223] [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: 09/13/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
Repairing critical-size bone defects still represents a critical clinical challenge in the field of trauma surgery. This study focuses on a physiological design and manufacturing of porous composite scaffold (titanium Ti with 10 % mole iron doped brushite DCPD-Fe3+) which can mimic the biomechanical properties of natural cortical bone, specifically for the purpose of repairing critical-size defects. To achieve this, the principle of design of experiments (DOE) was applied for investigating the impact of sintering temperature, mineral ratio, and volume fraction of porosity on the mechanical properties of the fabricated scaffolds. The fabricated scaffolds had open porosity up to 60 %, with pore size approximately between 100 μm and 850 μm. The stiffness of the porous composite scaffolds varied between 3.30 GPa and 20.50 GPa, while the compressive strength ranged from approximately 130 MPa-165 MPa at sintering temperatures equal to or exceeding 1000 °C. Scaffolds with higher porosity and mineral content demonstrated lower stiffness values, resembling natural bone. Numerical simulation was employed by Ansys Workbench to investigate the stress and strain distribution of a critical size defect in mid-shaft femur which was designed to be replaced with the fabricated scaffold. The fabricated scaffolds showed flexible biomechanical behaviour at the bone/scaffold interface, generating lower stress levels and indicating a better match with the femoral shaft stiffness. The experimental and numerical findings demonstrated promising applications for manufacturing a patient-specific bone scaffold for critical and potentially large defects for reducing stress shielding and minimizing non-union risk.
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Affiliation(s)
- Dina Abdulaziz
- School of Chemical and Process Engineering, University of Leeds, Leeds, LS2 9JT, UK.
| | - Antonios D Anastasiou
- Department of Chemical Engineering, University of Manchester, Manchester, M1 3AL, UK
| | | | - El Mostafa Raif
- Faculty of Medicine and Health, School of Dentistry, University of Leeds, Leeds, LS2 9JT, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Animesh Jha
- School of Chemical and Process Engineering, University of Leeds, Leeds, LS2 9JT, UK
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19
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Therkildsen J, Rohde PD, Nissen L, Thygesen J, Hauge EM, Langdahl BL, Boettcher M, Nyegaard M, Winther S. A genome-wide genomic score added to standard recommended stratification tools does not improve the identification of patients with very low bone mineral density. Osteoporos Int 2023; 34:1893-1906. [PMID: 37495683 PMCID: PMC10579117 DOI: 10.1007/s00198-023-06857-w] [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: 01/11/2023] [Accepted: 07/10/2023] [Indexed: 07/28/2023]
Abstract
The role of integrating genomic scores (GSs) needs to be assessed. Adding a GS to recommended stratification tools does not improve the prediction of very low bone mineral density. However, we noticed that the GS performed equally or above individual risk factors in discrimination. PURPOSE We aimed to investigate whether adding a genomic score (GS) to recommended stratification tools improves the discrimination of participants with very low bone mineral density (BMD). METHODS BMD was measured in three thoracic vertebrae using CT. All participants provided information on standard osteoporosis risk factors. GSs and FRAX scores were calculated. Participants were grouped according to mean BMD into very low (<80 mg/cm3), low (80-120 mg/cm3), and normal (>120 mg/cm3) and according to the Bone Health and Osteoporosis Foundation recommendations for BMD testing into an "indication for BMD testing" and "no indication for BMD testing" group. Different models were assessed using the area under the receiver operating characteristics curves (AUC) and reclassification analyses. RESULTS In the total cohort (n=1421), the AUC for the GS was 0.57 (95% CI 0.52-0.61) corresponding to AUCs for osteoporosis risk factors. In participants without indication for BMD testing, the AUC was 0.60 (95% CI 0.52-0.69) above or equal to AUCs for osteoporosis risk factors. Adding the GS to a clinical risk factor (CRF) model resulted in AUCs not statistically significant from the CRF model. Using probability cutoff values of 6, 12, and 24%, we found no improved reclassification or risk discrimination using the CRF-GS model compared to the CRF model. CONCLUSION Our results suggest adding a GS to a CRF model does not improve prediction. However, we noticed that the GS performed equally or above individual risk factors in discrimination. Clinical risk factors combined showed superior discrimination to individual risk factors and the GS, underlining the value of combined CRFs in routine clinics as a stratification tool.
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Affiliation(s)
- J Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark.
| | - P D Rohde
- Department of Health Science & Technology, Aalborg University, Selma Lagerløfs Vej 24, 9269, Gistrup, Denmark
| | - L Nissen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
- Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark
| | - J Thygesen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
- Department of Clinical Engineering, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - E-M Hauge
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
| | - B L Langdahl
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - M Boettcher
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
- Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark
| | - M Nyegaard
- Department of Health Science & Technology, Aalborg University, Selma Lagerløfs Vej 24, 9269, Gistrup, Denmark
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus, Denmark
| | - S Winther
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
- Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark
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20
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Javaid MK, Pinedo-Villanueva R, Shah A, Mohsin Z, Hiligsmann M, Motek-Soulié A, Fuggle NR, Halbout P, Cooper C. The Capture the Fracture® Partnership: an overview of a global initiative to increase the secondary fracture prevention care for patient benefit. Osteoporos Int 2023; 34:1827-1835. [PMID: 37418152 PMCID: PMC10579122 DOI: 10.1007/s00198-023-06759-x] [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: 07/04/2022] [Accepted: 04/03/2023] [Indexed: 07/08/2023]
Abstract
The Capture the Fracture® Partnership (CTF-P) is a unique collaboration between the International Osteoporosis Foundation, academic units and industry partners to enhance the implementation of effective, efficient fracture liaison services (FLSs) with a good patient experience. CTF-P has generated valuable resources for the specific countries as well as the broader FLS community to improve the initiation, effectiveness and sustainability of FLS in a wide range of healthcare settings.
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Affiliation(s)
- M K Javaid
- The Botnar Research Centre, NDORMS, University of Oxford, Old Rd, Headington, Oxford, OX3 7LD, United Kingdom.
| | | | - A Shah
- NDORMS, University of Oxford, Oxford, United Kingdom
| | - Z Mohsin
- NDORMS, University of Oxford, Oxford, United Kingdom
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health research Institute, Maastricht University, Maastricht, the Netherlands
| | - A Motek-Soulié
- International Osteoporosis Foundation, Nyon, Switzerland
| | - N R Fuggle
- MRC LEU, University of Southampton, Southampton, United Kingdom
| | - P Halbout
- International Osteoporosis Foundation, Nyon, Switzerland
| | - C Cooper
- NDORMS, University of Oxford, Oxford, United Kingdom
- MRC LEU, University of Southampton, Southampton, United Kingdom
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21
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Je M, Kang K, Yoo JI, Kim Y. The Influences of Macronutrients on Bone Mineral Density, Bone Turnover Markers, and Fracture Risk in Elderly People: A Review of Human Studies. Nutrients 2023; 15:4386. [PMID: 37892460 PMCID: PMC10610213 DOI: 10.3390/nu15204386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Osteoporosis is a health condition that involves weak bone mass and a deteriorated microstructure, which consequently lead to an increased risk of bone fractures with age. In elderly people, a fracture attributable to osteoporosis elevates mortality. The objective of this review was to examine the effects of macronutrients on bone mineral density (BMD), bone turnover markers (BTMs), and bone fracture in elderly people based on human studies. A systematic search was conducted in the PubMed®/MEDLINE® database. We included human studies published up to April 2023 that investigated the association between macronutrient intake and bone health outcomes. A total of 11 meta-analyses and 127 individual human studies were included after screening the records. Carbohydrate consumption seemed to have neutral effects on bone fracture in limited studies, but human studies on carbohydrates' effects on BMD or/and BTMs are needed. The human studies analyzed herein did not clearly show whether the intake of animal, vegetable, soy, or milk basic proteins has beneficial effects on bone health due to inconsistent results. Moreover, several individual human studies indicated an association between eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and osteocalcin. Further studies are required to draw a clear association between macronutrients and bone health in elderly people.
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Affiliation(s)
- Minkyung Je
- Department of Food and Nutrition, Gyeongsang National University, 501 Jinju-daero, Jinju 52828, Republic of Korea; (M.J.); (K.K.)
| | - Kyeonghoon Kang
- Department of Food and Nutrition, Gyeongsang National University, 501 Jinju-daero, Jinju 52828, Republic of Korea; (M.J.); (K.K.)
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Inha University Hospital, 27 Inhang-Ro, Incheon 22332, Republic of Korea;
| | - Yoona Kim
- Department of Food and Nutrition, Institute of Agriculture and Life Science, Gyeongsang National University, 501 Jinju-daero, Jinju 52828, Republic of Korea
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22
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Martínez-Aznar C, Mateo J, Ibarz E, Gracia L, Rosell J, Puértolas S. Biomechanical Behavior of Dynamic vs. Static Distal Locking Intramedullary Nails in Subtrochanteric Femur Fractures. Bioengineering (Basel) 2023; 10:1179. [PMID: 37892909 PMCID: PMC10604699 DOI: 10.3390/bioengineering10101179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE Hip fractures are one of the most frequent fractures presenting to the emergency department and orthopedic trauma teams. The aim of this study was to determine the best indication and therapeutic technique for subtrochanteric fractures and unifying criteria when choosing the most suitable type of nail. MATERIALS AND METHODS To analyze the influence of the material and the type of distal locking of intramedullary nails (static or dynamic), a femur model with a fracture in the subtrochanteric region stabilized with a long Gamma intramedullary nail was applied using finite element method (FEM) simulation. RESULTS The mechanical study shows that titanium nails allow for greater micromobility at the fracture site, which could act as a stimulus for the formation of callus and consolidation of the fracture. In the mechanical study, the type of distal locking mainly affects mobility at the fracture site and stress in the cortical bone around the distal screws, without in any case exceeding values that may compromise the viability of the assembly or that may result in detrimental effects (in terms of mobility at the fracture site) for the consolidation process. CONCLUSION Subtrochanteric fractures treated with titanium nail and static distal locking is safe and does not hinder consolidation.
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Affiliation(s)
- Carmen Martínez-Aznar
- Department of Orthopaedic Surgery and Traumatology, Reina Sofía Hospital, 31500 Tudela, Spain
| | - Jesús Mateo
- Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Elena Ibarz
- Department of Mechanical Engineering, University of Zaragoza, 50018 Zaragoza, Spain
- Aragón Institute for Engineering Research, 50018 Zaragoza, Spain
| | - Luis Gracia
- Department of Mechanical Engineering, University of Zaragoza, 50018 Zaragoza, Spain
- Aragón Institute for Engineering Research, 50018 Zaragoza, Spain
| | - Jorge Rosell
- Department of Mechanical Engineering, University of Zaragoza, 50018 Zaragoza, Spain
| | - Sergio Puértolas
- Department of Mechanical Engineering, University of Zaragoza, 50018 Zaragoza, Spain
- Aragón Institute for Engineering Research, 50018 Zaragoza, Spain
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23
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Kobayashi K, Sato K, Ando T, Ando K, Imura S. Impact of the COVID-19 Pandemic on Adherence to Denosumab Therapy: A Single Center Study. Asian Spine J 2023; 17:842-850. [PMID: 37408487 PMCID: PMC10622821 DOI: 10.31616/asj.2022.0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/26/2023] [Accepted: 02/21/2023] [Indexed: 07/07/2023] Open
Abstract
STUDY DESIGN A retrospective comparative study of denosumab therapy adherence before and during the coronavirus disease 2019 (COVID-19) pandemic. PURPOSE To evaluate the effect of the COVID-19 pandemic on denosumab therapy adherence in Japan. OVERVIEW OF LITERATURE Denosumab is a monoclonal antibody for osteoporosis treatment. Delayed denosumab injections are associated with reduced treatment responses, which was a concern during the COVID-19 pandemic. METHODS Participants included 376 patients who received denosumab (60 mg every 6 months) from January 2013 to June 2021. The time from therapy initiation to discontinuation was used to measure persistence, and that between initial and subsequent injections was used to determine adherence. The pandemic period was from March 2020 to December 2021. RESULTS Patients were divided into those treated after March 2020 (pandemic group, n=244) and those who discontinued treatment before March 2020 (non-pandemic group, n=132). Non-persistent cases accounted for 154, including 24 (20%), 64 (19%), and 66 (53%) aged ≤59 years, 60-79 years, and ≥80 years, respectively. The overall persistence rate at 78 months was 59.2%. Postponed cases were significantly lower in the non-pandemic group than in the pandemic group (8% vs. 15%, p =0.042). Postponement with a delay of 1-2 months did not significantly differ between the two groups, but with a significant difference for a delay of ≥3 months (0% vs. 36%, p =0.024). CONCLUSIONS Denosumab adherence remained constant but postponed cases significantly increased during the COVID-19 pandemic. Better communication by health providers on denosumab adherence and alternative administration may reduce dosing interruptions in similar pandemic situations.
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Affiliation(s)
- Kazuyoshi Kobayashi
- Department of Orthopaedics Surgery, Japan Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya,
Japan
| | - Koji Sato
- Department of Orthopaedics Surgery, Japan Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya,
Japan
| | - Toshihiro Ando
- Department of Orthopaedics Surgery, Japan Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya,
Japan
| | - Kei Ando
- Department of Orthopaedics Surgery, Japan Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya,
Japan
| | - Saori Imura
- Department of Nursing, Japan Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya,
Japan
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24
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Panahi N, Saeedi Moghaddam S, Fahimfar N, Rezaei N, Sanjari M, Rashidi MM, Shobeiri P, Larijani B, Ostovar A. Trend in global burden attributable to low bone mineral density in different WHO regions: 2000 and beyond, results from the Global Burden of Disease (GBD) study 2019. Endocr Connect 2023; 12:e230160. [PMID: 37578756 PMCID: PMC10503222 DOI: 10.1530/ec-23-0160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/14/2023] [Indexed: 08/15/2023]
Abstract
Background We aimed to document the current state of exposure to low bone mineral density (BMD) and trends in attributable burdens between 2000 and 2019 globally and in different World Health Organization (WHO) regions using the Global Burden of Disease (GBD) study 2019. Methods We reviewed the sex-region-specific summary exposure value (SEV) of low BMD and the all-ages numbers and age-standardized rates of disability-adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs), and deaths attributed to low BMD. We compared different WHO regions (Africa, the Eastern Mediterranean Region, Europe, Region of the Americas, Southeast Asia, and Western Pacific), age categories, and sexes according to the estimates of the GBD 2019 report. Results The global age-standardized SEV of low BMD is estimated to be 20.7% in women and 11.3% in men in 2019. Among the WHO regions, Africa had the highest age-standardized SEV of low BMD in women (28.8% (95% uncertainty interval 22.0-36.3)) and men (16.8% (11.5-23.8)). The lowest SEV was observed in Europe in both women (14.7% (9.9-21.0)) and men (8.0% (4.3-13.4)). An improving trend in the global rate of DALY, death, and YLL was observed during 2000-2019 (-5.7%, -4.7%, and -11.9% change, respectively); however, the absolute numbers increased with the highest increase observed in global YLD (70.9%) and death numbers (67.6%). Southeast Asia Region had the highest age-standardized rates of DALY (303.4 (249.2-357.2)), death (10.6 (8.5-12.3)), YLD (133.5 (96.9-177.3)), and YLL (170.0 (139-197.7)). Conclusions Overall, the highest-burden attributed to low BMD was observed in the Southeast Asia Region. Knowledge of the SEV of low BMD and the attributed burden can increase the awareness of healthcare decision-makers to adopt appropriate strategies for early screening, and also strategies to prevent falls and fragility fractures and their consequent morbidity and mortality.
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Affiliation(s)
- Nekoo Panahi
- Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Shobeiri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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25
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Eiter A, Kellerer JD. Long-term Outcomes in Orthogeriatric Co-management: a Literature Review. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023. [PMID: 37699512 DOI: 10.1055/a-2134-5803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Fragility fractures of the hip are one of the most important triggers of poor health outcomes in older adults. They often result in limitations in the ability of patients to care for themselves and mortality remains high. Orthogeriatric co-management may improve outcomes for this high-risk population. However, the impact on long-term results has not yet been definitively clarified. The purpose of this study was to present the influence of orthogeriatric co-management on mortality and self-care ability, as measured by the Barthel score, one year after hip fracture in people ≥ 60 years.A systematic literature search was performed in accordance with the process steps of identification, selection, and evaluation, with a systematic search of the MEDLINE, CINAHL Complete and Cochrane Library databases in the period from February to March 2022. Articles in English and German published between 2012 and 2022 were included. Twelve studies were finally used.Six studies demonstrated a statistically significant reduction in the one-year mortality rate. Only one of four studies evaluating self-care ability showed a significant improvement when the patient was treated on a specialised ward.Orthogeriatric co-management seems to be beneficial in positively influencing one-year mortality and self-care ability. In view of the heterogeneous results, the implementation of this care model can only be recommended to a limited extent.
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Affiliation(s)
- Andrea Eiter
- Institut für Pflegewissenschaft und Gerontologie, UMIT Tirol - Privatuniversität für Gesundheitswissenschaften und -technologie GmbH, Hall in Tirol, Österreich
| | - Jan Daniel Kellerer
- Institut für Pflegewissenschaft und Gerontologie, UMIT Tirol - Privatuniversität für Gesundheitswissenschaften und -technologie GmbH, Hall in Tirol, Österreich
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26
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Grassi L, Väänänen SP, Jehpsson L, Ljunggren Ö, Rosengren BE, Karlsson MK, Isaksson H. 3D Finite Element Models Reconstructed From 2D Dual-Energy X-Ray Absorptiometry (DXA) Images Improve Hip Fracture Prediction Compared to Areal BMD in Osteoporotic Fractures in Men (MrOS) Sweden Cohort. J Bone Miner Res 2023; 38:1258-1267. [PMID: 37417707 DOI: 10.1002/jbmr.4878] [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: 12/08/2022] [Revised: 06/15/2023] [Accepted: 07/04/2023] [Indexed: 07/08/2023]
Abstract
Bone strength is an important contributor to fracture risk. Areal bone mineral density (aBMD) derived from dual-energy X-ray absorptiometry (DXA) is used as a surrogate for bone strength in fracture risk prediction tools. 3D finite element (FE) models predict bone strength better than aBMD, but their clinical use is limited by the need for 3D computed tomography and lack of automation. We have earlier developed a method to reconstruct the 3D hip anatomy from a 2D DXA image, followed by subject-specific FE-based prediction of proximal femoral strength. In the current study, we aim to evaluate the method's ability to predict incident hip fractures in a population-based cohort (Osteoporotic Fractures in Men [MrOS] Sweden). We defined two subcohorts: (i) hip fracture cases and controls cohort: 120 men with a hip fracture (<10 years from baseline) and two controls to each hip fracture case, matched by age, height, and body mass index; and (ii) fallers cohort: 86 men who had fallen the year before their hip DXA scan was acquired, 15 of which sustained a hip fracture during the following 10 years. For each participant, we reconstructed the 3D hip anatomy and predicted proximal femoral strength in 10 sideways fall configurations using FE analysis. The FE-predicted proximal femoral strength was a better predictor of incident hip fractures than aBMD for both hip fracture cases and controls (difference in area under the receiver operating characteristics curve, ΔAUROC = 0.06) and fallers (ΔAUROC = 0.22) cohorts. This is the first time that FE models outperformed aBMD in predicting incident hip fractures in a population-based prospectively followed cohort based on 3D FE models obtained from a 2D DXA scan. Our approach has potential to notably improve the accuracy of fracture risk predictions in a clinically feasible manner (only one single DXA image is needed) and without additional costs compared to the current clinical approach. © 2023 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)
- Lorenzo Grassi
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Sami P Väänänen
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- Department of Applied Physics, University of Eastern Finland, Eastern Finland, Finland
| | - Lars Jehpsson
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Östen Ljunggren
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Björn E Rosengren
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Magnus K Karlsson
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
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27
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Chen J, Liao X, Gan J. Review on the protective activity of osthole against the pathogenesis of osteoporosis. Front Pharmacol 2023; 14:1236893. [PMID: 37680712 PMCID: PMC10481961 DOI: 10.3389/fphar.2023.1236893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023] Open
Abstract
Osteoporosis (OP), characterized by continuous bone loss and increased fracture risk, has posed a challenge to patients and society. Long-term administration of current pharmacological agents may cause severe side effects. Traditional medicines, acting as alternative agents, show promise in treating OP. Osthole, a natural coumarin derivative separated from Cnidium monnieri (L.) Cusson and Angelica pubescens Maxim. f., exhibits protective effects against the pathological development of OP. Osthole increases osteoblast-related bone formation and decreases osteoclast-related bone resorption, suppressing OP-related fragility fracture. In addition, the metabolites of osthole may exhibit pharmacological effectiveness against OP development. Mechanically, osthole promotes osteogenic differentiation by activating the Wnt/β-catenin and BMP-2/Smad1/5/8 signaling pathways and suppresses RANKL-induced osteoclastogenesis and osteoclast activity. Thus, osthole may become a promising agent to protect against OP development. However, more studies should be performed due to, at least in part, the uncertainty of drug targets. Further pharmacological investigation of osthole in OP treatment might lead to the development of potential drug candidates.
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Affiliation(s)
- Jincai Chen
- Department of Orthopedics, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Xiaofei Liao
- Department of Pharmacy, Ganzhou People’s Hospital, Ganzhou, China
| | - Juwen Gan
- Department of Pulmonary and Critical Care Medicine, Ganzhou People’s Hospital, Ganzhou, China
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28
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Ek S, Meyer AC, Sääf M, Hedström M, Modig K. Secondary fracture prevention with osteoporosis medication after a fragility fracture in Sweden remains low despite new guidelines. Arch Osteoporos 2023; 18:107. [PMID: 37516714 PMCID: PMC10386957 DOI: 10.1007/s11657-023-01312-z] [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: 11/29/2022] [Accepted: 07/11/2023] [Indexed: 07/31/2023]
Abstract
This national register study investigated osteoporosis medication prescriptions for secondary fracture prevention among older Swedish adults. Although prescription proportions are increasing for both men and women, they remain low, especially among individuals aged 90 and older. Improved Fracture Liaison Services could increase the prescription proportions and should be bolstered. PURPOSE Despite clear guidelines for secondary fracture prevention among older adults, it seems undertreatment persists. We aimed to describe secondary fracture prevention with medical osteoporosis treatment in the older Swedish population. Specifically, how prescription has changed over time and if these patterns differ in sociodemographic subgroups. METHODS Between 2007 and 2020, osteoporosis medication use was studied among all Swedish residents aged 70 and older who had a fragility fracture in the previous 5 years. Previous fragility fractures were defined as fractures of the humerus, wrist, hip, or vertebrae. Osteoporosis medication was defined as any prescription of bone-enhancing medications (including bisphosphonates and denosumab). RESULTS Osteoporosis medication increased over the study period, especially among men. Prescription among individuals 90 + was consistently two- to threefold lower compared to 70-79- and 80-89-year-olds. In 2018-2020, 8-17% of women and 5-9% of men, depending on age, received osteoporosis medication. At the beginning of the study period, women with higher education were more likely to be prescribed osteoporosis medication, though this difference decreased over time. Prescription of vitamin D and/or calcium as the only treatment was more common than osteoporosis medications throughout the study period. CONCLUSION Despite increasing prescription proportions, medical treatment for secondary fracture prevention remains low. In addition, it is more common to be prescribed vitamin D or calcium than osteoporosis medication after a fragility fracture, contrary to current guidelines. These results indicate that there is room for improvement for Fracture Liaison Services in Sweden.
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Affiliation(s)
- Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Anna C Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Sääf
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Hedström
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Trauma and Reparative Medicine Theme (TRM), Karolinska University Hospital, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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29
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Cui W, Li D, Jiang Y, Gao Y. Effects of exercise based on ACSM recommendations on bone mineral density in individuals with osteoporosis: a systematic review and meta-analyses of randomized controlled trials. Front Physiol 2023; 14:1181327. [PMID: 37528896 PMCID: PMC10389279 DOI: 10.3389/fphys.2023.1181327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose: To analyze the effects of different exercise dose on lumbar spine and femoral neck bone mineral density (BMD) in individuals with osteoporosis (OP). Design: A systematic search was conducted in four electronic databases, namely, PubMed, Embase, Web of Science, and Cochrane, with the topic of the impact of exercise on BMD in individuals with OP. Randomized controlled trials comparing exercise intervention with no intervention were identified, and changes in lumbar spine and femoral neck BMD were reported and evaluated using standardized mean difference (SMD) and 95% confidence interval (95% CI). The intervention measures in the studies were evaluated and categorized as high adherence with the exercise testing and prescription recommendations for individuals with OP developed by the American College of Sports Medicine (ACSM) or low/uncertainty adherence with ACSM recommendations. A random effects model was used to conduct meta-analyses and compare the results between subgroups. Results: A total of 32 studies involving 2005 participants were included in the analyses, with 14 studies categorized as high adherence with ACSM recommendations and 18 studies categorized as low or uncertain adherence. In the analyses of lumbar spine BMD, 27 studies with 1,539 participants were included. The combined SMD for the high adherence group was 0.31, while the combined SMD for the low or uncertain adherence group was 0.04. In the analyses of femoral neck BMD, 23 studies with 1,606 participants were included. The combined SMD for the high adherence group was 0.45, while the combined SMD for the low or uncertain adherence group was 0.28. Within resistance exercise, the subgroup with high ACSM adherence had a greater impact on lumbar spine BMD compared to the subgroup with low or uncertain ACSM adherence (SMD: 0.08 > -0.04). Similarly, for femoral neck BMD, resistance exercise with high ACSM adherence had a higher SMD compared to exercise with low or uncertain ACSM adherence (SMD: 0.49 > 0.13). Conclusion: The results suggest that exercise interventions with high adherence to ACSM recommendations are more effective in improving lumbar spine and femoral neck BMD in individuals with OP compared to interventions with low or uncertain adherence to ACSM recommendations. Systematic Review Registration: PROSPERO, identifier CRD42023427009.
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Affiliation(s)
- Wenlai Cui
- School of Dance and Martial Arts, Capital University of Physical Education and Sports, Beijing, China
| | - Dong Li
- Department of International Cultural Exchange, Chodang University, Muan County, Republic of Korea
| | - Yueshuai Jiang
- School of Dance and Martial Arts, Capital University of Physical Education and Sports, Beijing, China
| | - Yang Gao
- School of Dance and Martial Arts, Capital University of Physical Education and Sports, Beijing, China
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Zwart M, Azagra-Ledesma R, Saez M, Aguyé-Batista A, Díaz-Herrera MA, Tranche-Iparraguirre S. Predictive capacity of FRAX in a spanish region with a hip fracture rate close to the national mean. BMC Musculoskelet Disord 2023; 24:577. [PMID: 37454058 DOI: 10.1186/s12891-023-06670-w] [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: 03/22/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND It is known that standardized incidence rates of hip fracture vary among older people in Spain. So far, the results published on the validation of the FRAX® tool in Spain have suggested that the major osteoporotic fractures (MOFs) risk in our country is underestimated. These studies have practically been based on Spanish cohorts evaluated in Catalonia, a higher hip fracture rate area. The purpose of this study is to analyse the ability of the FRAX® in a Spanish mid-fracture rate population. METHODS Study design: Retrospective cohort study. MEASURES MOFs: hip, humerus, wrist, spine fractures. Risk of fracture assessed by calculating odds ratios (ORs). Predictive capacity of FRAX® according to the osteoporotic fractures observed between 2009 and 2018 (ObsFr) to predicted by FRAX® without densitometry in 2009 (PredFr) ratio. RESULTS 285 participants (156 women, 54.7%) with a mean ± SD of 61.5 ± 14 years. Twenty-four people sustained 27 fractures (15 MOFs). Significant ORs were observed for an age ≥ 65 (2.92; 95% CI, 1.07-7.96), female sex (3.18; 95% CI, 1.24-8.16), rheumatoid arthritis (0.62; 95% CI, 2.03-55.55), proton pump (2.71; 95% CI, 1.20-6.09) and serotonin reuptake (2.51; 95% CI, 1.02-6.16) inhibitors. The ObsFr/PredFr ratio in women were 1.12 (95% CI, 0.95-1.29) for MOFs and 0.47 (95% CI, 0-0.94) for hip fractures. Men had a ratio of 0.57 (95% CI, 0.01-1.14) for MOF, no hip fractures were observed. The ratios for the overall group were 1.29 (95% CI, 1.12-1.48) for MOFs and 0.70 (95% CI, 0.22-1.17) for hip fractures. CONCLUSIONS FRAX® accurately predicted MOFs in women population with a hip fracture incidence rate close to the national mean compared to previous studies conducted in higher incidence regions in Spain.
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Affiliation(s)
- Marta Zwart
- Medicina de Familia. Centro de Atención Primaria Can Gibert del Pla, Institut Català de la Salut (ICS), C/ Sant Sebastià 50, Girona, 17006, Spain
- Departamento de Medicina, Universitat de Girona (UdG), C/ Emili Grahit 77, Campus Centro, Girona, 17003, Spain
- GROICAP. Unitat Suport a la Recerca (USR) Girona-IDIAP Jordi Gol, Girona, 17003, Spain
| | - Rafael Azagra-Ledesma
- Medicina de Familia. Centro de Atención Primaria Badía del Vallés, Institut Català de la Salut (ICS). C/ Bètica s/n, Badia del Vallès, Barcelona, 08214, Spain.
- Departamento de Medicina, Universitat Autònoma de Barcelona, Avda Can Domènech, Bellaterra, Barcelona, 08193, Spain.
- Fundación PRECIOSA para la Investigación, 08210 Barberà del Valles, Barcelona, Spain.
| | - Marc Saez
- Bioestadística. Universitat de Girona (UdG), C/de la Universitat de Girona 10, Campus de Montilivi, Girona, 17003, Spain
- Grup de Recerca en Estadística, Econometria i Salut (GRECS), UdG y CIBER de Epidemiologia y Salud Pública (CIBERESP), Girona, 17003, Spain
| | - Amada Aguyé-Batista
- GROICAP. Unitat Suport a la Recerca (USR) Girona-IDIAP Jordi Gol, Girona, 17003, Spain
- Departamento de Medicina, Universitat Autònoma de Barcelona, Avda Can Domènech, Bellaterra, Barcelona, 08193, Spain
- Medicina de Familia. Centro de Atención Primaria Granollers Vallés Oriental, Institut Català de la Salut (ICS). C/ Museu 19, Granollers, Barcelona, 08401, Spain
| | - Miguel Angel Díaz-Herrera
- GROICAP. Unitat Suport a la Recerca (USR) Girona-IDIAP Jordi Gol, Girona, 17003, Spain
- Departamento de Medicina. Universitat Autònoma de Barcelona. Avda de Can Domènech, Bellaterra, Barcelona, 08193, Spain
- Enfermería. Unidad de Heridas Complejas Atención Primaria Metropolitana Sur. Institut Català de la Salut, Av. Mare de Déu de Bellvitge 3., Hospitalet de Llobregat. Barcelona, 08907, Spain
- Medicina de Familia. Centro de Salud El Cristo, Servicio Asturiano de Salud. C/ Álvaro Flórez Estrada 21, Oviedo, Asturias, 33006, Spain
| | - Salvador Tranche-Iparraguirre
- Comisión de Docencia. Hospital Universitario General de Catalunya-Grupo Quironsalud, C/ Pedro Pons 1, Sant Cugat del Vallès-Barcelona, 08195, Spain
- President of Sociedad Española de Medicina Familiar y Comunitaria (SemFYC), Barcelona, Spain
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Deng M, Wang Z, Luo J, Cao H, Li Y, Chen L, Liu G. CircZNF367 promotes osteoclast differentiation and osteoporosis by interacting with FUS to maintain CRY2 mRNA stability. J Orthop Surg Res 2023; 18:492. [PMID: 37434265 DOI: 10.1186/s13018-023-03955-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/23/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Osteoporosis, characterized by reduced bone mass and deterioration of bone quality, is a significant health concern for postmenopausal women. Considering that the specific role of circRNAs in osteoporosis and osteoclast differentiation remains poorly understood, this study aims to shed light on their involvement in these processes to enhance our understanding and potentially contribute to improved treatment strategies for osteoporosis. METHODS An osteoporotic model was constructed in vivo in ovariectomized mouse. In vitro, we induced osteoclast formation in bone marrow-derived macrophages (BMDMs) using M-CSF + RANKL. To assess osteoporosis in mice, we conducted HE staining. We used MTT and TRAP staining to measure cell viability and osteoclast formation, respectively, and also evaluated their mRNA and protein expression levels. In addition, RNA pull-down, RIP and luciferase reporter assays were performed to investigate interactions, and ChIP assay was used to examine the impact of circZNF367 knockdown on the binding between FUS and CRY2. RESULTS We observed increased expression of CircZNF367, FUS and CRY2 in osteoporotic mice and M-CSF + RANKL-induced BMDMs. Functionally, knocking down circZNF367 inhibited osteoporosis in vivo. Furthermore, interference with circZNF367 suppressed osteoclast proliferation and the expression of TRAP, NFATc1, and c-FOS. Mechanistically, circZNF367 interacted with FUS to maintain CRY2 mRNA stability. Additionally, knocking down CRY2 rescued M-CSF + RANKL-induced osteoclast differentiation in BMDMs promoted by circZNF367 and FUS. CONCLUSION This study reveals that the circZNF367/FUS axis may accelerate osteoclasts differentiation by upregulating CRY2 in osteoporosis and suggests that targeting circZNF367 may have potential therapeutic effects on osteoporosis.
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Affiliation(s)
- Mingsi Deng
- Department of Stomatology, The Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, People's Republic of China
- Department of Orthodontics, Changsha Stomatology Hospital, Changsha, 410005, Hunan, People's Republic of China
| | - Zhengguang Wang
- Department of Spine Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, People's Republic of China
| | - Jia Luo
- Changsha Blood Center, Changsha, 410001, Hunan, People's Republic of China
| | - Heng Cao
- The Department of Wound Joint Surgery, Affiliated Hospital of Yiyang Medical College, Yiyang, 413000, Hunan, People's Republic of China
| | - Yong Li
- Department of Emergency, The Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, People's Republic of China
| | - Liangjian Chen
- Department of Stomatology, The Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, People's Republic of China
| | - Gengyan Liu
- Department of Orthopedics, The Third Xiangya Hospital, Central South University, No.138, Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, People's Republic of China.
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Roselló-Añón A, Chiappe C, Valverde-Vázquez MR, Sangüesa-Nebot MJ, Gómez-Cabrera MC, Pérez-Martínez G, Doménech-Fernández J. [Translated article] Pilot study to determine the association between gut microbiota and fragility hip fracture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T279-T289. [PMID: 36878282 DOI: 10.1016/j.recot.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/07/2023] [Indexed: 03/07/2023] Open
Abstract
INTRODUCTION Hip fractures are the most common cause of hospital admission to orthopaedic departments in Europe and they generate a major health problem. Therefore, it is of great interest to identify additional risk factors that will help us to better understand the pathophysiology of these fractures and improve our preventive capacity. There is sufficient data to support the theory of modulation of bone mass by gut microbiota (osteomicrobiology); however, there is a lack of human clinical studies directly linking microbiota to hip fracture risk. MATERIAL AND METHODS Observational, analytical, case-control study. The sample consisted of 50 patients and it was distributed as follows: 25 elderly patients with fragility hip fracture and 25 subjects without fracture. The intestinal microbiota was determined by DNA extraction from stool samples and 16S ribosomal DNA sequencing after generation of gene libraries. RESULTS Alpha diversity revealed an elevation of the estimators for the taxonomic class level in the hip fracture group. The orders Bacteroidales, Oscillospirales, Lachnospirales, Peptostreptococcales-Tissierellales and Enterobacterales were the dominant orders in both groups. In patients with fracture, a significant percentage increase in the orders Bacteroidales (p<.001) and Peptostreptococcales-Tissierellales (p<.005) was observed, as well as a decrease in the orders Lachnospirales (p<.001) compared to controls. CONCLUSIONS This study has found an association between a specific microbiota in elderly patients with fragility hip fracture. These findings open the door to new strategies to prevent hip fractures. Modification of the microbiota through probiotics may prove to be an effective method to reduce the risk of hip fracture.
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Affiliation(s)
- A Roselló-Añón
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, Spain.
| | - C Chiappe
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, Spain
| | - M R Valverde-Vázquez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, Spain
| | - M J Sangüesa-Nebot
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, Spain
| | - M C Gómez-Cabrera
- Departamento de Fisiología, Facultad de Medicina, Universidad de Valencia, CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - G Pérez-Martínez
- Laboratory of Lactic acid Bacteria and Probiotics, Department of Food Biotechnology, Instituto de Agroquímica y Tecnología de Alimentos, Consejo Superior de Investigaciones Científicas (CSIC), Valencia, Spain
| | - J Doménech-Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, Spain; Universidad Católica de Valencia, Valencia, Spain
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Roselló-Añón A, Chiappe C, Valverde-Vázquez MR, Sangüesa-Nebot MJ, Gómez-Cabrera MC, Pérez-Martínez G, Doménech-Fernández J. Pilot study to determine the association between gut microbiota and fragility hip fracture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:279-289. [PMID: 36642372 DOI: 10.1016/j.recot.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/02/2023] [Accepted: 01/07/2023] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Hip fractures are the most common cause of hospital admission to orthopaedic departments in Europe and they generate a major health problem. Therefore, it is of great interest to identify additional risk factors that will help us to better understand the pathophysiology of these fractures and improve our preventive capacity. There is sufficient data to support the theory of modulation of bone mass by gut microbiota (osteomicrobiology); however, there is a lack of human clinical studies directly linking microbiota to hip fracture risk. MATERIAL AND METHODS Observational, analytical, case-control study. The sample consisted of 50 patients and it was distributed as follows: 25 elderly patients with fragility hip fracture and 25 subjects without fracture. The intestinal microbiota was determined by DNA extraction from stool samples and 16S ribosomal DNA sequencing after generation of gene libraries. RESULTS Alpha diversity revealed an elevation of the estimators for the taxonomic class level in the hip fracture group. The orders Bacteroidales, Oscillospirales, Lachnospirales, Peptostreptococcales-Tissierellales and Enterobacterales were the dominant orders in both groups. In patients with fracture, a significant percentage increase in the orders Bacteroidales (p<.001) and Peptostreptococcales-Tissierellales (p<.005) was observed, as well as a decrease in the orders Lachnospirales (p<.001) compared to controls. CONCLUSIONS This study has found an association between a specific microbiota in elderly patients with fragility hip fracture. These findings open the door to new strategies to prevent hip fractures. Modification of the microbiota through probiotics may prove to be an effective method to reduce the risk of hip fracture.
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Affiliation(s)
- A Roselló-Añón
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, España.
| | - C Chiappe
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, España
| | - M R Valverde-Vázquez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, España
| | - M J Sangüesa-Nebot
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, España
| | - M C Gómez-Cabrera
- Departamento de Fisiología, Facultad de Medicina, Universidad de Valencia, CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, España
| | - G Pérez-Martínez
- Laboratory of Lactic acid bacteria and Probiotics, Department of Food Biotechnology, Instituto de Agroquímica y Tecnología de Alimentos, Consejo Superior de Investigaciones Científicas (CSIC), Valencia, España
| | - J Doménech-Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, España; Universidad Católica de Valencia, Valencia, España
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Li J, Viceconti M, Li X, Bhattacharya P, Naimark DMJ, Osseyran A. Cost-Effectiveness Analysis of CT-Based Finite Element Modeling for Osteoporosis Screening in Secondary Fracture Prevention: An Early Health Technology Assessment in the Netherlands. MDM Policy Pract 2023; 8:23814683231202993. [PMID: 37900721 PMCID: PMC10605708 DOI: 10.1177/23814683231202993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 08/20/2023] [Indexed: 10/31/2023] Open
Abstract
Objective. To conduct cost-utility analyses for Computed Tomography To Strength (CT2S), a novel osteoporosis screening service, compared with dual-energy X-ray absorptiometry (DXA), treat all without screening, and no screening methods for Dutch postmenopausal women referred to fracture liaison service (FLS). CT2S uses CT scans to generate femur models and simulate sideways fall scenarios for bone strength assessment. Methods. Early health technology assessment (HTA) was adopted to evaluate CT2S as a novel osteoporosis screening tool for secondary fracture prevention. We constructed a 2-dimensional simulation model considering 4 strategies (no screening, treat all without screening, DXA, CT2S) together with screening intervals (5 y, 2 y), treatments (oral alendronate, zoledronic acid), and discount rate scenarios among Dutch women in 3 age groups (60s, 70s, and 80s). Strategy comparisons were based on incremental cost-effectiveness ratios (ICERs), considering an ICER below €20,000 per QALY gained as cost-effective in the Netherlands. Results. Under the base-case scenario, CT2S versus DXA had estimated ICERs of €41,200 and €14,083 per QALY gained for the 60s and 70s age groups, respectively. For the 80s age group, CT2S was more effective and less costly than DXA. Changing treatment from weekly oral alendronate to annual zoledronic acid substantially decreased CT2S versus DXA ICERs across all age groups. Setting the screening interval to 2 y increased CT2S versus DXA ICERs to €100,333, €55,571, and €15,750 per QALY gained for the 60s, 70s, and 80s age groups, respectively. In all simulated populations and scenarios, CT2S was cost-effective (in some cases dominant) compared with the treat all strategy and cost-saving (more effective and less costly) compared with no screening. Conclusion. CT2S was estimated to be potentially cost-effective in the 70s and 80s age groups considering the willingness-to-pay threshold of the Netherlands. This early HTA suggests CT2S as a potential novel osteoporosis screening tool for secondary fracture prevention. Highlights For postmenopausal Dutch women who have been referred to the FLS, direct access to CT2S may be cost-effective compared with DXA for age groups 70s and 80s, when considering the ICER threshold of the Netherlands. This study positions CT2S as a potential novel osteoporosis-screening tool for secondary fracture prevention in the clinical setting.A shorter screening interval of 2 y increases the effectiveness of both screening strategies, but the ICER of CT2S compared with DXA also increased substantially, which made CT2S no longer cost-effective for the 70s age group; however, it remains cost-effective for individuals in their 80s.Annual zoledronic acid treatment with better adherence may contribute to a lower cost-effectiveness ratio when comparing CT2S to DXA screening and the treat all strategies for all age groups.
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Affiliation(s)
- Jieyi Li
- Amsterdam Business School, University of Amsterdam, Amsterdam, Netherland
| | - Marco Viceconti
- Department of Industrial Engineering, University of Bologna, Bologna, Italy
| | - Xinshan Li
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Pinaki Bhattacharya
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - David M. J. Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Anwar Osseyran
- Amsterdam Business School, University of Amsterdam, Amsterdam, Netherland
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Wang CY, Yang TH, Fu SH, Hwang JS, Chen HM, Lin JW, Hsu CC, Chang YF, Wu CH, Chan DC, Yang RS. Constraining in reimbursement criteria and the adherence to anti-osteoporosis medications (AOMs) in Taiwan: Urbanization makes the difference. J Formos Med Assoc 2023; 122 Suppl 1:S45-S54. [PMID: 37271714 DOI: 10.1016/j.jfma.2023.05.012] [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: 12/30/2022] [Revised: 04/10/2023] [Accepted: 05/11/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND The Bureau of National Health Insurance in Taiwan implemented a new reimbursement scheme incorporating bone mineral density (BMD) criteria on Jan. 1, 2011. This study aimed to investigate a real-life 11-year secular trend of adherence in new AOMs users and evaluated the change of adherence to AOMs therapy in different urbanization areas after reimbursement criteria were restrained. METHODS We used Taiwan's National Health Insurance Research Database to identify new AOMs users as our study population. The AOMs in this study included denosumab, zoledronate, ibandronate, alendronate, raloxifene, and risedronate. The first prescription date of AOMs was defined as the cohort entry date. The adherence rates within one year after initiation were assessed. RESULTS High adherence (≥75%) in the first year increased markedly after the new reimbursement scheme in 2011, changing from 31.8% in 2008, and 41.7% in 2011 to 54.2% in 2018. On the other hand, low adherence (<25%) decreased from 38.8% in 2008 to 14.6% in 2018. In addition, the switchers increased from 5.9% in 2008 to 9.3% in 2018, indicating a more flexible choice of AOMs. The proportion of high adherence to AOMs was highest in high-urbanization areas, and the proportion increased about two times from 30% in 2008 to 60% in 2018. CONCLUSION The implementation of new reimbursement criteria in 2011 was associated with increased adherence to AOMs and the increase was most apparent in high-urbanization areas.
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Affiliation(s)
- Chen-Yu Wang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan
| | - Tsung-Han Yang
- Department of Orthopedics, NTU BioMedical Park Hospital, NTUH Hsin-Chu Branch, Hsin-Chu, Taiwan; Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shau-Huai Fu
- Department of Orthopedics, National Taiwan University Hospital Yunlin Branch, Douliu, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jawl-Shan Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung Univeristy, Taoyuan, Taiwan
| | - Ho-Min Chen
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Jou-Wei Lin
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliu, Yunlin County, Taiwan
| | - Chih-Cheng Hsu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan
| | - Yin-Fan Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsing Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Rong-Sen Yang
- Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan.
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Tibert N, Ponzano M, Brien S, Funnell L, Gibbs JC, Jain R, Keller H, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio L. Non-pharmacological management of osteoporotic vertebral fractures: Patient perspectives and experiences. Clin Rehabil 2023; 37:713-724. [PMID: 36510450 DOI: 10.1177/02692155221144370] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To understand perceptions on rehabilitation after vertebral fracture, non-pharmacological strategies, and virtual care from the perspective of individuals living with vertebral fractures. DESIGN AND SETTING We conducted semi-structured interviews online and performed a thematic and content analysis from a post-positivism perspective. PARTICIPANTS Ten individuals living with osteoporotic vertebral fractures (9F, 1 M, aged 71 ± 8 years). RESULTS Five themes emerged: pain is the defining limitation of vertebral fracture recovery; delayed diagnosis impacts recovery trajectory; living with fear; being dissatisfied with fracture management; and "getting back into the game of life" using non-pharmacological strategies. CONCLUSION Participants reported back pain and an inability to perform activities of daily living, affecting psychological and social well-being. Physiotherapy, education, and exercise were considered helpful and important to patients; however, issues with fracture identification and referral limited the use of these options. Participants believed that virtual rehabilitation was a feasible and effective alternative to in-person care, but perceived experience with technology, cost, and individualization of programs as barriers.
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Affiliation(s)
- Nicholas Tibert
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
| | | | | | | | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, ON, Canada
| | - Heather Keller
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, ON, Canada
| | | | - Suzanne N Morin
- 5620McGill University, Montréal, QC, Canada
- Research Institute of McGill University Health Centre, Montréal, QC, Canada
| | | | - Zach Weston
- 8431Wilfrid Laurier University, Waterloo, ON, Canada
| | | | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, ON, Canada
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Sato K, Iwabuchi M, Endo T, Miura T, Ito T, Shirado O. Cumulated ambulation score in hospitalized patients with osteoporotic vertebral fractures is an important predictor of returning home: a retrospective cohort study. Arch Osteoporos 2023; 18:52. [PMID: 37081159 DOI: 10.1007/s11657-023-01249-3] [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: 11/19/2022] [Accepted: 04/18/2023] [Indexed: 04/22/2023]
Abstract
Osteoporotic vertebral fractures are recognized as a serious problem in the aging society. In this study, we found that the cumulated ambulation score predicts returning home in patients with osteoporotic vertebral fractures. The cumulated ambulation score is an important piece of information in determining the destination of patients with osteoporotic vertebral fractures. PURPOSE Osteoporotic vertebral fractures are a serious problem affecting the health status of the elderly, and if they require inpatient treatment, they may have difficulty deciding where to discharge. The study's purpose is to investigate whether the cumulated ambulation scores predict returning home for hospitalized osteoporotic vertebral fractures patients. METHODS The subjects were 120 osteoporotic vertebral fractures patients aged 65 years or older who were admitted to our hospital between April 2015 and March 2022. The cumulated ambulation scores for all subjects were measured in the 3-days right after admission. A multivariable analysis was performed with the dependent variable as whether the patient returned home and the independent variable as the cumulated ambulation score. Three models were created from the measured cumulated ambulation score, and each model was analyzed as an independent variable (model 1; score on the 1st day, model 2; total score on the 2-days, model 3; total score on the 3-days). RESULTS The length of hospitalization for the osteoporotic vertebral fracture's patients were 11.8 ± 5.3 days, and 80 (66.7%) returned home. Multivariable analysis showed that cumulated ambulation score was a predictor of returning home (model 1, odds ratio: 3.151, 95% confidence interval: 2.074-5.203; model 2, odds ratio: 2.234, 95% confidence interval: 1.685-3.187; model 3, odds ratio: 1.929, 95% confidence interval: 1.535-2.599). CONCLUSION The cumulated ambulation score of patients with osteoporotic vertebral fractures right after admission is a factor that affected returning home and is useful in determining where patients are discharged.
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Affiliation(s)
- Keita Sato
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, AMEC (Aizu Medical Center), Fukushima Medical University, 21-2, Tanisawa-Aza-Maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan.
| | - Masumi Iwabuchi
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, AMEC (Aizu Medical Center), Fukushima Medical University, 21-2, Tanisawa-Aza-Maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
| | - Tatsuya Endo
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, AMEC (Aizu Medical Center), Fukushima Medical University, 21-2, Tanisawa-Aza-Maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
| | - Takuya Miura
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, AMEC (Aizu Medical Center), Fukushima Medical University, 21-2, Tanisawa-Aza-Maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
| | - Toshikazu Ito
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, AMEC (Aizu Medical Center), Fukushima Medical University, 21-2, Tanisawa-Aza-Maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
- Hokkaido Chitose College of Rehabilitation, Hokkaido, Japan
| | - Osamu Shirado
- Departments of Rehabilitation / Orthopaedic and Spinal Surgery, AMEC (Aizu Medical Center), Fukushima Medical University, 21-2, Tanisawa-Aza-Maeda, Kawahigashi, Aizuwakamatsu, Fukushima, 969-3492, Japan
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Valenzuela-Martínez S, Ramírez-Expósito MJ, Carrera-González MP, Martínez-Martos JM. Physiopathology of Osteoporosis: Nursing Involvement and Management. Biomedicines 2023; 11:biomedicines11041220. [PMID: 37189837 DOI: 10.3390/biomedicines11041220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Osteoporosis is a major public health problem today. We are facing an aging society where the average life expectancy continues to increase. Osteoporosis affects more than 30% of postmenopausal women due to hormonal changes that occur during this time. Postmenopausal osteoporosis is therefore of particular concern. The aim of this review is to identify the etiology, pathophysiology, diagnosis and treatment of this disease and lay the foundation for the role nurses should play in preventing postmenopausal osteoporosis. Several risk factors are associated with osteoporosis. In addition to age and sex, genetics, ethnicity, diet, or the presence of other disorders determine the development of this disease. The key factors include exercise, a balanced diet, and high levels of vitamin D. This is primarily from a solar source, and infancy is the time when future bone formation is greatest. There are now medications that can complement these preventive measures. The work of nursing staff is not only prevention, but also early detection and early treatment. In addition, imparting information and knowledge about the disease to the population is key to preventing an osteoporosis epidemic. In this study, a detailed description is provided of the biological and physiological disease, the preventive measures currently being researched, the information currently available to the population, and how health professionals address osteoporosis from a preventive perspective.
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Affiliation(s)
- Sandra Valenzuela-Martínez
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Campus Universitario Las Lagunillas, 23009 Jaén, Spain
| | - María Jesús Ramírez-Expósito
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Campus Universitario Las Lagunillas, 23009 Jaén, Spain
| | - María Pilar Carrera-González
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Campus Universitario Las Lagunillas, 23009 Jaén, Spain
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC) IMIBIC Building, Reina Sofia University Hospital, Av. Menéndez Pidal, s/n, 14004 Córdoba, Spain
| | - José Manuel Martínez-Martos
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Campus Universitario Las Lagunillas, 23009 Jaén, Spain
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Biebl J, Lüke P, Azad SC. [Chronic musculoskeletal pain syndromes in the elderly]. MMW Fortschr Med 2023; 165:60-68. [PMID: 37016240 DOI: 10.1007/s15006-023-2395-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Affiliation(s)
- Johanna Biebl
- LMU Klinikum, Campus Großhadern, MUM - Muskuloskelettales Universitätszentrum München, Marchioninistr. 15, 81377, München, Deutschland
| | - Philipp Lüke
- LMU Klinikum, Campus Großhadern, Klinik für Anaesthesiologie, Interdisziplinäre Schmerzambulanz und Tagesklinik, Marchioninistr. 15, 81377, München, Deutschland
| | - Shahnaz Christina Azad
- LMU Klinikum, Campus Großhadern, Klinik für Anaesthesiologie, Marchioninistr. 15, 81377, München, Deutschland.
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Gens L, Marchionatti E, Steiner A, Stoddart MJ, Thompson K, Mys K, Zeiter S, Constant C. Surgical technique and comparison of autologous cancellous bone grafts from various donor sites in rats. J Orthop Res 2023; 41:834-844. [PMID: 35953282 DOI: 10.1002/jor.25429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/29/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Abstract
Autologous cancellous bone graft is the gold standard in large bone defect repair. However, studies using autologous bone grafting in rats are rare. To determine the feasibility of autologous cancellous bone graft harvest from different anatomical donor sites (humerus, ilium, femur, tibia, and tail vertebrae) in rats and compare their suitability as donor sites, a total of 13 freshly euthanized rats were used to describe the surgical technique, determine the cancellous bone volume and microstructure, and compare the cancellous bone collected quantitatively and qualitatively. It was feasible to harvest cancellous bone grafts from all five anatomical sites with the humerus and tail being more surgically challenging. The microstructural analysis using micro-computed tomography showed a significantly lower bone volume fraction, bone mineral density, and trabecular thickness of the humerus and iliac crest compared to the femur, tibia, and tail vertebrae. The harvested weight and volume did not differ between the donor sites. All donor sites apart from the femur yielded primary osteogenic cells confirmed by the presence of alkaline phosphatase and Alizarin Red S stain. Bone samples from the iliac crest showed the most consistent outgrowth of osteoprogenitor cells. In conclusion, the tibia and iliac crest may be the most favorable donor sites considering the surgical approach. However, due to the differences in microstructure of the cancellous bone and the consistency of outgrowth of osteoprogenitor cells, the donor sites may have different healing properties, that need further investigation in an in vivo study.
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Affiliation(s)
- Lena Gens
- AO Research Institute Davos, Davos, Switzerland
| | - Emma Marchionatti
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Adrian Steiner
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | | | - Karen Mys
- AO Research Institute Davos, Davos, Switzerland
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Intertrochanteric Femoral Fractures: A Comparison of Clinical and Radiographic Results with the Proximal Femoral Intramedullary Nail (PROFIN), the Anti-Rotation Proximal Femoral Nail (A-PFN), and the InterTAN Nail. Medicina (B Aires) 2023; 59:medicina59030559. [PMID: 36984560 PMCID: PMC10054110 DOI: 10.3390/medicina59030559] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Background and Objectives: The aim of this study was to evaluate retrospectively the radiological and functional outcomes of closed reduction and internal fixation for intertrochanteric femoral fractures (IFF) using three different proximal femoral nails (PFN). Materials and Methods: In total, 309 individuals (143 males and 166 females) who underwent surgery for IFF using a PFN between January 2018 and January 2021 were included in the study. Our surgical team conducted osteosynthesis using the A-PFN® (TST, Istanbul, Turkey) nail, the PROFIN® (TST, Istanbul, Turkey), and the Trigen InterTAN (Smith & Nephew, Memphis, TN, USA) nail. The PFNs were compared based on age, gender, body mass index (BMI), length of stay (LOS) in intensive care, whether to be admitted to intensive care, mortality in the first year, amount of transfusion, preoperative time to surgery, hospitalisation time, duration of surgery and fluoroscopy, fracture type and reduction quality, complication ratio, and clinical and radiological outcomes. The patients’ function was measured with the Harris Hip Score (HHS) and the Katz Index of Independence in Activities of Daily Living (ADL). Results: Pain in the hip and thigh is the most common complication, followed by the V-effect. The Z-effect was seen in 5.7% of PROFIN patients. A-PFN was shown to have longer surgical and fluoroscopy durations, lower HHS values, and much lower Katz ADL Index values compared to the other two PFNs. The V-effect occurrence was significantly higher in the A-PFN group (36.7%) than in the InterTAN group. The V-effect was seen in 33.1% of 31A2-type fractures but in none of the 31A3-type fractures. Conclusions: InterTAN nails are the best choice for IFFs because they have high clinical scores after surgery, there is no chance of Z-effect, and the rate of V-effect is low.
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Bruhn R, Pedersen AB, Heide-Jørgensen U, Ehrenstein V. Epidemiology of male osteoporosis in Denmark (1996-2018). Osteoporos Int 2023; 34:935-942. [PMID: 36912928 DOI: 10.1007/s00198-023-06720-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
UNLABELLED Osteoporosis in men may be underdiagnosed. One in four men in Denmark will develop osteoporosis after age of 50 years, with fracture as a common presenting symptom. PURPOSE The aim of this study was to describe epidemiology of male osteoporosis in Denmark. METHODS In this nationwide registry-based cohort study, we identified men with osteoporosis, 50 years or older, residing in Denmark, during the years 1996-2018. Osteoporosis was defined as one of the following: a hospital diagnosis of osteoporosis; a hospital diagnosis of osteoporosis fracture; or an outpatient dispensing of an anti-osteoporosis medication. We reported annual incidence and prevalence and described the distribution of fractures, comorbidities, socioeconomic status, and initiation of anti-osteoporosis therapy among men with osteoporosis. Selected characteristics were also described among men without osteoporosis of similar age. RESULTS There were 171,186 men fulfilling the study criteria for osteoporosis. The overall age-standardized incidence rate of osteoporosis was 8.6 per 1000 person-years (95% confidence interval (CI), 8.5-8.6), varying between 7.7 and 9.7, while the prevalence increased from 4.3% (95% CI, 4.2-4.3) to 7.1% (95% CI, 7.0-7.1) during the 22-year period. The remaining-lifetime risk of developing osteoporosis after age of 50 years was close to 30%. The proportion of men initiating anti-osteoporosis treatment within 1 year of diagnosis increased from 6.9% to 29.8%. Men with osteoporosis had more comorbidities and redeemed more medication than did men without osteoporosis of similar age. CONCLUSION Osteoporosis among men may be undertreated despite increasing treatment initiation.
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Affiliation(s)
- Rasmus Bruhn
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Alma Becic Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
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Tan CW, Sahota O. A 3-year retrospective analysis of patients admitted with clinical vertebral fragility fractures across hospitals in England, UK. Osteoporos Int 2023; 34:607-611. [PMID: 36607407 PMCID: PMC9908666 DOI: 10.1007/s00198-022-06647-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
UNLABELLED Our database aimed to assess the impact of vertebral fragility fractures (VFFs) on hospitalisation in England. The results showed that admissions secondary to VFF are increasing annually, more significantly in patients aged 75 years and over. Vertebral augmentation has been showed to reduce length of stay in hospital. INTRODUCTION Vertebral fragility fractures (VFFs) are the most common osteoporotic fracture. VFF can result in significant pain requiring hospitalisation. However, there are little data on patient numbers, hospital bed days, and costs, contributed to by these patients. METHODOLOGY We report a retrospective analysis of patients aged 55 years and over admitted to hospitals across England from 2017 to 2019. ICD-10 classifications for VFF and OPCS codes were used to identify admissions and patients who had undergone vertebral augmentation (VA). RESULTS There were 99,370 patients (61% female) admitted during this period, with 64,370 (65%) patients aged over 75 years. There was a 14.3% average increase in admissions annually. Patients aged over 75 years accounted for 1.5 million bed days, costing £465 million (median length of stay (MLOS) 14.4 days). In comparison, those aged 55-74 years, accounted for 659,000 bed days, costing £239 million (MLOS 10.7 days). The majority of patients (84%) were admitted under a non-surgical speciality and were primarily older (median age 76.8 vs 67.6 years, MLOS 8.2 vs 6.0 days), compared to those admitted to surgical wards 1755 patients underwent vertebral augmentation (VA) (1.8% of the total cohort). The median age of patients undergoing VA was 73.3 years, with 775 (44.2%) of these were aged 75 years and over. In comparison, the median age of patients managed conservatively (non-surgically) was 75.7 years, with 63,595 patients (65.1%) aged 75 years and over. The MLOS and cost per patient admission were lower in the VA group compared to those managed non-surgically. CONCLUSION Hospitalised VFF patients represented a significant number, cost, and use of bed days. Those undergoing VA had a significantly shorter length of stay. Further studies are necessary to define those who may benefit from early VA.
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Affiliation(s)
- Chia Wei Tan
- Healthcare of the Older People, QMC, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - Opinder Sahota
- Healthcare of the Older People, QMC, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
- Centre for Spinal Studies and Surgery, QMC, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham, UK
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He D, Pan C, Zhao Y, Wei W, Qin X, Cai Q, Shi S, Chu X, Zhang N, Jia Y, Wen Y, Cheng B, Liu H, Feng R, Zhang F, Xu P. Exome-wide screening identifies novel rare risk variants for bone mineral density. Osteoporos Int 2023; 34:965-975. [PMID: 36849660 DOI: 10.1007/s00198-023-06710-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023]
Abstract
UNLABELLED Bone mineral density (BMD) is an independent risk factor of osteoporosis-related fractures. We performed gene-based burden tests to assess the association between rare variants and BMD, and identified several BMD candidate genes. PURPOSE BMD is highly heritable and a major predictor of osteoporotic fractures, but its genetic basis remains unclear. We aimed to identify rare risk variants contributing to BMD. METHODS Utilizing the newly released UK Biobank 200,643 exome dataset, we conducted a gene-based exome-wide association study in males and females, respectively. First, 100,639 males and 117,338 females with BMD values were included in the polygenic risk scores (PRS) analysis. Among individuals with lower 30% PRS, cases were individuals with top 10% BMD, and individuals with bottom 10% BMD were the controls. Considering the effects of vitamin D (VD), individuals with the highest 30% VD concentration were selected for VD-BMD analysis. After quality control, 741 males and 697 females were included in the BMD analysis, and 717 males and 708 females were included in the VD-BMD analysis. The variants were annotated by ANNOVAR software, then BMD and VD-BMD qualified variants were imported into the SKAT R-package to perform gene-based burden tests, respectively. RESULTS The gene-based burden test of the exonic variants identified genome-wide candidate associations in ANKRD18A (P = 1.60 × 10-5, PBonferroni adjust = 2.11 × 10-3), C22orf31 (P = 3.49 × 10-4, PBonferroni adjust = 3.17 × 10-2), and SPATC1L (P = 1.09 × 10-5, PBonferroni adjust = 8.80 × 10-3). For VD-BMD analysis, three genes were associated with BMD, such as NIPAL1 (P = 1.06 × 10-3, PBonferroni adjust = 3.91 × 10-2). CONCLUSIONS Our study suggested that rare variants contribute to BMD, providing new sights for broadening the genetic structure of BMD.
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Affiliation(s)
- D He
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an Jiaotong University, Xi'an, China
| | - C Pan
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an Jiaotong University, Xi'an, China
| | - Y Zhao
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an Jiaotong University, Xi'an, China
| | - W Wei
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an Jiaotong University, Xi'an, China
| | - X Qin
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an Jiaotong University, Xi'an, China
| | - Q Cai
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an Jiaotong University, Xi'an, China
| | - S Shi
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an Jiaotong University, Xi'an, China
| | - X Chu
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an Jiaotong University, Xi'an, China
| | - N Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an Jiaotong University, Xi'an, China
| | - Y Jia
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an Jiaotong University, Xi'an, China
| | - Y Wen
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an Jiaotong University, Xi'an, China
| | - B Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an Jiaotong University, Xi'an, China
| | - H Liu
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Xi'an Jiaotong University, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an Jiaotong University, Xi'an, China
| | - R Feng
- Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - F Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an Jiaotong University, Xi'an, China.
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education of China, Xi'an Jiaotong University, Xi'an, China.
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an Jiaotong University, Xi'an, China.
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
| | - P Xu
- Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, China.
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Sobczak-Jaskow H, Kochańska B, Drogoszewska B. Composition and Properties of Saliva in Patients with Osteoporosis Taking Antiresorptive Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4294. [PMID: 36901300 PMCID: PMC10002130 DOI: 10.3390/ijerph20054294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
UNLABELLED The aim of this study was to examine how the composition and properties of saliva change in people with osteoporosis who have received antiresorptive (AR) treatment, compared to patients with osteoporosis who have not yet received this treatment. METHODS The study population consisted of 38 patients with osteoporosis using AR drugs (Group I) and 16 patients with osteoporosis who had never used AR drugs (Group II). The control group consisted of 32 people without osteoporosis. Laboratory tests included determination of pH and concentrations of Ca, PO4, total protein, lactoferrin, lysozyme, sIgA, IgA, cortisol, neopterin, activity of amylase at rest, and stimulated saliva. The buffering capacity of stimulated saliva was also determined. RESULTS There were no statistically significant differences between the saliva of Group I and Group II. No statistically significant correlation was found between the amount of time using AR therapy (Group I) and the tested parameters of the saliva. Significant differences were found between Group I and the control group. The concentrations of PO4, lysozyme, and cortisol were higher, while concentrations of Ca ions, sIgA, and neopterin were lower, in comparison to the control group. The significant differences between Group II and the control group were smaller, and they concerned only the concentrations of lysozyme, cortisol, and neopterin. CONCLUSIONS The saliva of people with osteoporosis subjected to AR therapy and those not subjected to AR therapy did not show statistically significant differences in terms of the examined parameters of the saliva. However, the saliva of patients with osteoporosis taking and not taking AR drugs was significantly different compared to the saliva of the control group.
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Affiliation(s)
- Hanna Sobczak-Jaskow
- Department of Maxillofacial Surgery, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Barbara Kochańska
- Department of Conservative Dentistry, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Barbara Drogoszewska
- Department of Maxillofacial Surgery, Medical University of Gdansk, 80-210 Gdansk, Poland
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Debiève M, Castiaux L, van Maanen A, Magremanne M. Medication-related osteonecrosis of the jaw, a risk to reassess in osteoporotic patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101316. [PMID: 36273739 DOI: 10.1016/j.jormas.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The use of antiresorptive drugs concerns many medical specialties either in relation to their prescription for osteoporosis or cancer, or in relation to the treatment of their side effects. In the literature, less than 10% of medication-related osteonecrosis of the jaw are related to patients treated for osteoporosis, while 90% are found in patients treated for cancer. Despite the increasing number of osteoporotic patients taking high doses of antiresorptive drugs, only few studies describe this topic. The main aim of this study was to highlight the occurrence of medication-related osteonecrosis of the jaw in osteoporotic patients compared to cancer patients. The second aim was to highlight risk factors in the two groups, to try to understand the high number of osteoporotic patients in our population. MATERIALS AND METHODS A retrospective study was conducted between December 2004 and March 2021 to identify all cases of medication-related osteonecrosis of the jaw in our department with emphasis on the osteoporotic population. Demographic, systemic and local risk factors were collected as well as the type, dose and duration of the anti-resorptive drugs treatment. Evolution and follow-up were also recorded. RESULTS One hundred sixty five patients presented with medication-related osteonecrosis of the jaw, of whom 67 (40,6%) were osteoporotic. Seventeen (25,4%) patients were males and 50 females (74,6%). Risk factors were tobacco consumption (28,4%), anemia (20,9%), alcohol consumption (19,4%). Use of corticoids or anticoagulant/antithrombotic therapy was related in 20,9% and 16,4%, respectively. The mean age at MRONJ diagnosis was 74,4 (50-98). The mean follow up time was 23,7 months (1-110). CONCLUSION Unlike the literature where medication-related osteonecrosis of the jaw in osteoporotic patients represents less than 10%, the rate in our series was much higher and represents 40% of the patients. This highlights the importance of a complete dental examination before and during antiresorptive drugs treatment, even in the case of osteoporotic patients.
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Affiliation(s)
- M Debiève
- Department of Oral and Maxillo-Facial Surgery, Cliniques Universitaires Saint Luc, 1200 Brussels, Belgium.
| | - L Castiaux
- Department of Oral and Maxillo-Facial Surgery, Cliniques Universitaires Saint Luc, 1200 Brussels, Belgium
| | - A van Maanen
- Statistical Support Unit, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 200 Brussels, Belgium; Institut Roi Albert II, Cancérologie et Hématologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium
| | - M Magremanne
- Department of Oral and Maxillo-Facial Surgery, Cliniques Universitaires Saint Luc, 1200 Brussels, Belgium; Institut Roi Albert II, Cancérologie et Hématologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium
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47
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Deng Y, Wang Y, Shi Q, Jiang Y. Identification of hub genes associated with osteoporosis development by comprehensive bioinformatics analysis. Front Genet 2023; 14:1028681. [PMID: 36911390 PMCID: PMC9999471 DOI: 10.3389/fgene.2023.1028681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/05/2023] [Indexed: 02/25/2023] Open
Abstract
Osteoporosis (OP) is a systemic bone disease caused by various factors, including, the decrease of bone density and quality, the destruction of bone microstructure, and the increase of bone fragility. It is a disease with a high incidence in a large proportion of the world's elderly population. However, osteoporosis lacks obvious symptoms and sensitive biomarkers. Therefore, it is extremely urgent to discover and identify disease-related biomarkers for early clinical diagnosis and effective intervention for osteoporosis. In our study, the Linear Models for Microarray Data (LIMMA) tool was used to screen differential expressed genes from transcriptome sequencing data of OP blood samples downloaded from the GEO database, and cluster Profiler was used for enriching analysis of differently expressed genes. In order to analyzed the relevance of gene modules, clinical symptoms, and the most related module setting genes associated with disease progression, we adapted Weighted Gene Co-expression Network Analysis (WGCNA) to screen and analyze the related pathways and relevant molecules. We used the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database to construct protein interaction network of key modules, and Cytoscape software was used to complete network visualization and screen of core genes in the network. Various plug-in algorithms of cytoHubba were used to identify key genes of OP. Finally, correlation analysis and single-gene gene probe concentration analysis (GSEA) analysis were performed for each core gene. Results of a total of 8 key genes that were closely related to the occurrence and development of OP were screened out, which provided a brand-new idea for the clinical diagnosis and early prevention of OP. Quantitative real-time PCR (qRT-PCR) was performed for validation, the expression levels of CUL1, PTEN and STAT1 genes in the OS group were significantly higher than in the non-OS groups. Receiver operating characteristic analysis demonstrated that CUL1, PTEN and STAT1 displayed considerable diagnostic accuracy for OS.
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Affiliation(s)
- Yuxuan Deng
- Department of Endocrinology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yunyun Wang
- Academic Affairs Office, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qing Shi
- Department of Endocrinology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yanxia Jiang
- Department of Endocrinology, First Affiliated Hospital of Nanchang University, Nanchang, China
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Hettchen M, Willert S, von Stengel S, Kohl M, Kemmler W. Effects of the "Spinomed active" orthosis on chronic back pain in kyphotic women with osteoporotic vertebral fractures three months and older: A randomized controlled study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1038269. [PMID: 36618579 PMCID: PMC9811681 DOI: 10.3389/fpain.2022.1038269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
Vertebral fractures are frequent clinical consequences of osteoporosis. Considering the demographic change in Europe, the number of vertebral fractures will quite likely increase during the next decades. Apart from pharmaceutic agents and physiotherapy, spinal orthoses are established elements of conservative therapy for vertebral (body) fractures. Recent studies on acute vertebral fractures reported positive effects on back pain, kyphosis and functional disabilities, but the efficacy of active strengthening spinal orthoses in vertebral fractures ≥6 months remains to be established. Eighty hyperkyphotic, community-dwelling women ≥65 years with chronic back pain and vertebral fractures occurred ≥3 months ago were randomly allocated to a group which wore the "Spinomed active" orthoses 2 × 2-3 h/d for 16 weeks (SOG: n = 40) or an untreated control group (CG: n = 40). Study outcomes were back pain intensity, kyphosis angle, trunk strength, back pain induced- and general function and disability, functional ability (chair-rise test) and respiratory function. We applied an intention-to-treat analysis; data were consistently adjusted for baseline values applying an ANCOVA. Observing a compliance of 82 ± 14% with the wearing protocol, we determined large and significant favorable effects for back pain (p = .008), back pain-induced physical disability (p < .001) and kyphosis angle (p < .001). We also demonstrated positive effects on trunk strength (p = .049), functional ability (p = .062) and general function and disability (p = .057), although not all of the parameters reach significance. No relevant changes were observed for respiratory function. After a few further individual adjustments of the orthosis (n = 2), no adverse effects were reported. In summary, the present study provided evidence for the efficacy of an active strengthening spinal orthosis ("Spinomed active") in people with vertebral fractures ≥6 months. Based on our results, we recommend expanding the application of the "Spinomed active" orthosis, which was previously validated for acute vertebral fractures, also to older hyperkyphotic women with osteoporotic vertebral fractures ≥3 months.
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Affiliation(s)
- Matthias Hettchen
- Institute of Medical Physics,Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Sebastian Willert
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Simon von Stengel
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Matthias Kohl
- Department of Medicine and Life Sciences, University of Furtwangen, Schwenningen, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics,Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany,Institute of Radiology, University Hospital Erlangen, Erlangen, Germany,Correspondence: Wolfgang Kemmler
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49
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O 'Sullivan D, Silke C, Whelan B, McGowan B, O 'Sullivan M, McCabe JP, Heaney F, Armstrong C, Gsel AM, Connaughton B, Carey JJ. Osteoporotic fracture admissions compared to other major medical admissions in Irish public hospitals. Arch Osteoporos 2022; 18:12. [PMID: 36527534 DOI: 10.1007/s11657-022-01199-2] [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: 02/10/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Multinational reports suggest Ireland has one of the greatest illness burdens related to osteoporosis. Hospital care represents the costliest portion of health services. We found public hospital bed days for fragility fractures in Ireland increased by 43% between 2008 and 2017 which exceeded those for other common diseases. INTRODUCTION Recent multinational reports suggest Ireland has one of the greatest illness burdens related to osteoporosis, manifesting clinically as fragility fractures (FF). International reports show that FF incidence, rate of hospital admission and cost are similar or greater than those for breast cancer, myocardial infarction and stroke. Studies addressing the illness burden of osteoporosis in Ireland are few, and none compares fragility fractures to other common chronic diseases. METHODS A retrospective analysis of national administrative data for all public hospital admissions was performed on adults aged 50 years and older from January 2008 to December 2017. RESULTS In 2017, public hospital bed days for FF totalled 249,887 outnumbering Chronic Obstructive Pulmonary Disease (COPD): 131,897; 6 solid cancers (CA): 118,098; myocardial infarction (MI): 83,477; and diabetes mellitus (DM): 31,044. Bed days for FF increased by 43% between 2008 and 2017, in contrast to a 32%, 28% and 31% reduction for CA, MI and DM, respectively, and a 12% increase for COPD. Public hospital bed days for FF in 2016 were greater than MI, stroke, atrial fibrillation and chest pain combined but less than a combination of COPD, pneumonia and lower respiratory tract infection. CONCLUSION Osteoporotic fractures represent a large and rapidly increasing illness burden amongst older Irish adults, with substantial care requirements and the resulting onus on our healthcare system. Urgent action is needed to address this public health issue and the services for those at risk of fracture.
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Affiliation(s)
- D O 'Sullivan
- Department of Trauma and Orthopaedics, Galway University Hospitals, Galway, Ireland
| | - C Silke
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Ireland
| | - B Whelan
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Ireland
| | - B McGowan
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
| | - M O 'Sullivan
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Ireland
| | - J P McCabe
- Department of Trauma and Orthopaedics, Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
| | - F Heaney
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - C Armstrong
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - A M Gsel
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - B Connaughton
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - J J Carey
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland.
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
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50
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Najafi M, Najafi M, Keshtkar AA, Sedaghat M, Khalilifard AR, Larijani B, Hamidi Z. QUS characteristics in Normal Population: a Mini Review and our experience. J Diabetes Metab Disord 2022; 21:1635-1640. [PMID: 36404808 PMCID: PMC9672166 DOI: 10.1007/s40200-022-01113-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 06/08/2022] [Accepted: 08/13/2022] [Indexed: 11/29/2022]
Abstract
Objectives Quantitative ultrasound (QUS) is a bone densitometry method that is less expensive and more portable than DXA. It is also noninvasive. QUS parameters include speed of sound (SOS), broad band ultrasound attenuation (BUA), and stiffness index (SI). This study defined normal values of QUS parameters in Iranian men and women. Methods QUS of heels measured in 258 Iranian men and women, aged 20-76 y/o. They were participants of Iranian Multicenter Osteoporosis study (IMOS), selected by randomized sampling. QUS device was an Achilles+ (GE-Lunar) device. Results Percentiles of SI (2.5%, 50%, and 97.5%) determined. We found a good agreement between the Iranian reference values and western reference (used by device) value in defining normal and osteoporotic people (κ = 0.875). Conclusion Results from this study suggest that QUS of the heel may be a good method for diagnosis of low bone mass in different regions.
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Affiliation(s)
- Maryam Najafi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Minoo Najafi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Abbas Ali Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mojtaba Sedaghat
- Department of Community Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Ali Reza Khalilifard
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Bagher Larijani
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Zohreh Hamidi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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