Diet and exercise changes following bone densitometry in the Patient Activation After DXA Result Notification (PAADRN) study

Effects of a functional milk powder supplemented with rhizoma drynariae extracts on bone health in growing and ovariectomized rats: More effective for lumbar vertebrae?

Bone health is vital through all life stages and has become a growing public health concern. The role of rhizoma drynariae (RD) as a traditional Chinese medicine for bone injury recovery has been widely investigated. Still, there is little research related to RD as a functional component in food to improve calcium bioavailability and bone health. Milk powder is a daily vital food source of dietary calcium. The present study aimed to investigate and compare the effects of a functional milk powder reinforced with RD extracts (RDE) or vitamin D, vitamin K2, and calcium, or both, using Sprague-Dawley rats, with both low calcium growing rat model and low calcium ovariectomized (OVX) rat model. For growing rats, RDE increased bone mineral density (BMD) and improved the microstructure of bone trabecula in the femur and lumbar vertebrae. The levels of serum bone turnover markers C-telopeptide of type Ⅰ collagen (CTX-I), procollagen type Ⅰ amino-terminal peptide (PINP), and osteocalcin (BGP) were increased with RDE supplementation. The tartrate-resistant acid phosphatase staining suggested a decrease in the number of osteoclasts in the femur. Immunohistochemistry showed that the osteoclast-related protein RANKL was downregulated, and the osteogenic-associated proteins RUNX2 and OSX significantly increased in the lumbar vertebrae. Similarly, in OVX rats, RDE improved BMD and microstructure in lumbar vertebrae, and the levels of CTX-I, PINP, and BGP were also increased. In conclusion, the novel functional milk powder supplemented with RDE facilitated osteogenesis and inhibited osteoclast in rats at both stages, especially with lumbar vertebrae in growing rats. Our findings provide new prospects and a more precise target for enhancing bone health by incorporating RDE as a functional component in milk powder.

Effective communication regarding risk of fracture for individuals at risk of fragility fracture: a scoping review

Two scoping reviews were conducted to review recommendations and guidelines for communication regarding general health risk, and to investigate communication strategies regarding risk of fracture. Healthcare professionals are invited to apply these recommendations to optimize a patient-centered approach to reducing risk of fracture.

INTRODUCTION

To conduct a scoping review of the medical literature regarding recommendations and tools for effective communication between healthcare professionals and patients regarding general health risk and risk of fracture.

METHODS

The scoping review was divided into two parts to search for (1) studies presenting recommendations and guidelines for communication regarding general health risk; (2) studies investigating communication regarding risk of fracture for individuals at risk for fractures. Medline was searched in April 2020 to identify relevant studies.

RESULTS

The scoping review included 43 studies on communication with regard to general health risk and 25 studies about communication regarding risk of fracture. Recommendations for effective communication with regard to risk are presented. Communication of numeric data on risk should be adapted to the literacy and numeracy levels of the individual patient. Patient understanding of numerical data can be enhanced with appropriate use of visual aids (e.g., pie charts, icon arrays, bar charts, pictograms). The FRAX® tool is the most recommended and most used tool for assessing risk of fracture. Communication sent as individualized letters to patients following DXA scans has been studied, although patient understanding of their risk of fracture is often reported as low using this technique. Use of visual aids may improve patient understanding.

CONCLUSION

Healthcare professionals are encouraged to apply recommendations presented in this scoping review in their clinical practice. Patient understanding of risk of fracture should be confirmed by making sure that patients feel free to ask questions and express their concerns. This will contribute to an optimal patient-centered approach. Developing online tools to convert the probability of fracture into patient-friendly visual presentations could facilitate communication between healthcare professionals and patients about risk of fracture.