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Yao A, Gao L, Zhang J, Cheng JM, Kim DH. Frailty as an Effect Modifier in Randomized Controlled Trials: A Systematic Review. J Gen Intern Med 2024:10.1007/s11606-024-08732-8. [PMID: 38592606 DOI: 10.1007/s11606-024-08732-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/15/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The effect of clinical interventions may vary by patients' frailty status. Understanding treatment effect heterogeneity by frailty could lead to frailty-guided treatment strategies and reduce overtreatment and undertreatment. This systematic review aimed to examine the effect modification by frailty in randomized controlled trials (RCTs) that evaluate pharmacological, non-pharmacological, and multicomponent interventions. METHODS We searched PubMed, Web of Science, EMBASE, and ClinicalTrial.gov, from their inception to 8 December 2023. Two reviewers independently extracted trial data and examined the study quality with senior authors. RESULTS Sixty-one RCTs that evaluated the interaction between frailty and treatment effects in older adults were included. Frailty was evaluated using different tools such as the deficit accumulation frailty index, frailty phenotype, and other methods. The effect of several pharmacological interventions (e.g., edoxaban, sacubitril/valsartan, prasugrel, and chemotherapy) varied according to the degree of frailty, whereas other treatments (e.g., antihypertensives, vaccinations, osteoporosis medications, and androgen medications) demonstrated consistent benefits across different frailty levels. Some non-pharmacological interventions had greater benefits in patients with higher (e.g., chair yoga, functional walking, physical rehabilitation, and higher dose exercise program) or lower (e.g., intensive lifestyle intervention, psychosocial intervention) levels of frailty, while others (e.g., resistance-type exercise training, moderate-intensive physical activity, walking and nutrition or walking) produced similar intervention effects. Specific combined interventions (e.g., hospital-based disease management programs) demonstrated inconsistent effects across different frailty levels. DISCUSSION The efficacy of clinical interventions often varied by frailty levels, suggesting that frailty is an important factor to consider in recommending clinical interventions in older adults. REGISTRATION PROSPERO registration number CRD42021283051.
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Affiliation(s)
- Aaron Yao
- VillageMD Research Institute, Chicago, IL, USA.
- Virginia Commonwealth University, Richmond, VA, USA.
| | | | - Jiajun Zhang
- Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Joyce M Cheng
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Sugimoto K, Rakugi H, Kojima T, Ishii S, Akishita M, Tamura Y, Araki A, Kozaki K, Senda K, Fukuoka H, Satake S, Arai H. Chapter 4 Frailty and specific diseases. Geriatr Gerontol Int 2020; 20 Suppl 1:25-37. [PMID: 32050299 DOI: 10.1111/ggi.13833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Ken Sugimoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Shinya Ishii
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshiaki Tamura
- Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine, Kyorin University, School of Medicine, Mitaka, Japan
| | - Kazuyoshi Senda
- Department of Clinical Research Promotion, Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hideki Fukuoka
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shosuke Satake
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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Vandenbroucke A, Luyten FP, Flamaing J, Gielen E. Pharmacological treatment of osteoporosis in the oldest old. Clin Interv Aging 2017; 12:1065-1077. [PMID: 28740372 PMCID: PMC5505539 DOI: 10.2147/cia.s131023] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The incidence of osteoporotic fractures increases with age. Consequently, the global prevalence of osteoporotic fractures will increase with the aging of the population. In old age, osteoporosis is associated with a substantial burden in terms of morbidity and mortality. Nevertheless, osteoporosis in old age continues to be underdiagnosed and undertreated. This may, at least partly, be explained by the fact that evidence of the antifracture efficacy of osteoporosis treatments comes mainly from randomized controlled trials in postmenopausal women with a mean age of 70-75 years. However, in the last years, subgroup analyses of these landmark trials have been published investigating the efficacy and safety of osteoporosis treatment in the very elderly. Based on this evidence, this narrative review discusses the pharmacological management of osteoporosis in the oldest old (≥80 years). Because of the high prevalence of calcium and/or vitamin D deficiency in old age, these supplements are essential in the management of osteoporosis in the elderly people. Adding antiresorptive or anabolic treatments or combinations, thereof, reduces the risk of vertebral fractures even more, at least in the elderly with documented osteoporosis. The reduction of hip fracture risk by antiresorptive treatments is less convincing, which may be explained by insufficient statistical power in some subanalyses and/or a higher impact of nonskeletal risk factors in the occurrence of hip fractures. Compared with younger individuals, a larger absolute risk reduction is observed in the elderly because of the higher baseline fracture risk. Therefore, the elderly will benefit more of treatment. In addition, current osteoporosis therapies also appear to be safe in the elderly. Although more research is required to further clarify the effect of osteoporosis drugs in the elderly, especially with respect to hip fractures, there is currently sufficient evidence to initiate appropriate treatment in the elderly with osteoporosis and osteoporotic fractures.
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Affiliation(s)
| | - F P Luyten
- Skeletal Biology and Engineering, Department of Development and Regeneration, KU Leuven.,Center for Metabolic Bone Disease, UZ Leuven
| | - J Flamaing
- Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - E Gielen
- Center for Metabolic Bone Disease, UZ Leuven.,Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
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4
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Cook MJ, Oldroyd A, Pye SR, Ward KA, Gielen E, Ravindrarajah R, Adams JE, Lee DM, Bartfai G, Boonen S, Casanueva F, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean ME, Pendleton N, Punab M, Vanderschueren D, Wu FC, O'Neill TW. Frailty and bone health in European men. Age Ageing 2017; 46:635-641. [PMID: 27852598 PMCID: PMC5859977 DOI: 10.1093/ageing/afw205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/21/2016] [Indexed: 11/14/2022] Open
Abstract
Background frailty is associated with an increased risk of fragility fractures. Less is known, however, about the association between frailty and bone health. Methods men aged 40-79 years were recruited from population registers in eight European centres for participation in the European Male Aging Study. Subjects completed a comprehensive assessment which included quantitative ultrasound (QUS) scan of the heel (Hologic-SAHARA) and in two centres, dual-energy bone densitometry (dual-energy x-ray absorptiometry, DXA). Frailty was defined based on an adaptation of Fried's phenotype criteria and a frailty index (FI) was constructed. The association between frailty and the QUS and DXA parameters was determined using linear regression, with adjustments for age, body mass index and centre. Results in total, 3,231 subjects contributed data to the analysis. Using the Fried categorisation of frailty, pre-frail and frail men had significantly lower speed of sound (SOS), broadband ultrasound attenuation (BUA) and quantitative ultrasound index (QUI) compared to robust men (P< 0.05). Similar results were seen using the FI after categorisation into 'high', 'medium' and 'low' levels of frailty. Using the Fried categorisation, frail men had lower femoral neck bone mineral density (BMD) compared to robust men (P < 0.05), but not lower lumbar spine BMD. Using the FI categorisation, a 'high' level of frailty (FI > 0.35) was associated with lower lumbar spine BMD (P < 0.05) when compared to those with low (FI < 0.2), but not lower femoral neck BMD. When analysed as a continuous variable, higher FI was linked with lower SOS, BUA and QUI (P < 0.05). Conclusions optimisation of bone health as well as prevention of falls should be considered as strategies to reduce fractures in frail older people.
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Affiliation(s)
- Michael J. Cook
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Address correspondence to: Michael J. Cook. Tel: (+44) 1612755499; Fax: (+44) 1613060547.
| | - Alexander Oldroyd
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Stephen R. Pye
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Kate A. Ward
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - Evelien Gielen
- Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | | | - Judith E. Adams
- Radiology and Manchester Academic Health Science Centre, The Royal Infirmary, The University of Manchester, Manchester, UK
| | - David M. Lee
- Cathie Marsh Institute for Social Research, School of Social Sciences, The University of Manchester, ManchesterM13 9PL, UK
| | - Gyorgy Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary
| | - Steven Boonen
- University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Felipe Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS), CIBER de Fisiopatologia Obesidad y Nutricion (CIBERobn), Instituto Salud Carlos III,Santiago de Compostela, Spain
| | - Gianni Forti
- Endocrine Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Aleksander Giwercman
- Scanian Andrology Centre, Department of Urology, Malmö University Hospital, University of Lund, Sweden
| | - Thang S. Han
- Egham & Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Institute of Cardiovascular Research, Royal Holloway, University of London (ICR2UL), Chertsey, UK
| | | | - Krzysztof Kula
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, Poland
| | | | - Neil Pendleton
- Division of Neuroscience and Experimental Psychology, University of Manchester, Salford Royal Hospital, Salford, UK
| | - Margus Punab
- Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia
| | - Dirk Vanderschueren
- Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Frederick C. Wu
- Andrology Research Unit,Centre for Endocrinology and Diabetes,University of Manchester, Manchester,UK
| | - Terence W. O'Neill
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
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Taylor BA, Bezuhly M, Brace M, Carter M, Hong P. Effect of strontium citrate on bone consolidation during mandibular distraction osteogenesis. Laryngoscope 2017; 127:E212-E218. [DOI: 10.1002/lary.26623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/13/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Benjamin A. Taylor
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery, Dalhousie University; Halifax Nova Scotia
| | - Michael Bezuhly
- Department of Surgery; IWK Health Centre; Halifax Nova Scotia
- Division of Plastic and Reconstructive Surgery; Dalhousie University; Halifax Nova Scotia
| | - Matthew Brace
- Division of Facial Plastic and Reconstructive Surgery; Department of Otolaryngology-Head and Neck Surgery, University of Toronto; Toronto Ontario Canada
| | - Michael Carter
- Division of Facial Plastic and Reconstructive Surgery; Department of Otolaryngology-Head and Neck Surgery, University of Toronto; Toronto Ontario Canada
| | - Paul Hong
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery, Dalhousie University; Halifax Nova Scotia
- Department of Surgery; IWK Health Centre; Halifax Nova Scotia
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6
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Blain H, Masud T, Dargent-Molina P, Martin F, Rosendahl E, van der Velde N, Bousquet J, Benetos A, Cooper C, Kanis J, Reginster J, Rizzoli R, Cortet B, Barbagallo M, Dreinhöfer K, Vellas B, Maggi S, Strandberg T, Alvarez M, Annweiler C, Bernard PL, Beswetherick N, Bischoff-Ferrari H, Bloch F, Boddaert J, Bonnefoy M, Bousson V, Bourdel-Marchasson I, Capisizu A, Che H, Clara J, Combe B, Delignieres D, Eklund P, Emmelot-Vonk M, Freiberger E, Gauvain JB, Goswami N, Guldemond N, Herrero Á, Joël ME, Jónsdóttir A, Kemoun G, Kiss I, Kolk H, Kowalski M, Krajcík Š, Kutsal Y, Lauretani F, Macijauskienė J, Mellingsæter M, Morel J, Mourey F, Nourashemi F, Nyakas C, Puisieux F, Rambourg P, Ramírez A, Rapp K, Rolland Y, Ryg J, Sahota O, Snoeijs S, Stephan Y, Thomas E, Todd C, Treml J, Adachi R, Agnusdei D, Body JJ, Breuil V, Bruyère O, Burckardt P, Cannata-Andia J, Carey J, Chan DC, Chapuis L, Chevalley T, Cohen-Solal M, Dawson-Hughes B, Dennison E, Devogelaer JP, Fardellone P, Féron JM, Perez A, Felsenberg D, Glueer C, Harvey N, Hiligsman M, Javaid M, Jörgensen N, Kendler D, Kraenzlin M, Laroche M, Legrand E, Leslie W, Lespessailles E, Lewiecki E, Nakamura T, Papaioannou A, Roux C, Silverman S, Henriquez M, Thomas T, Vasikaran S, Watts N, Weryha G. A comprehensive fracture prevention strategy in older adults: The European union geriatric medicine society (EUGMS) statement. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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7
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Blain H, Masud T, Dargent-Molina P, Martin FC, Rosendahl E, van der Velde N, Bousquet J, Benetos A, Cooper C, Kanis JA, Reginster JY, Rizzoli R, Cortet B, Barbagallo M, Dreinhöfer KE, Vellas B, Maggi S, Strandberg T. A comprehensive fracture prevention strategy in older adults: the European Union Geriatric Medicine Society (EUGMS) statement. Aging Clin Exp Res 2016; 28:797-803. [PMID: 27299902 DOI: 10.1007/s40520-016-0588-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 05/05/2016] [Indexed: 12/23/2022]
Abstract
Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest Group on Falls and Fracture Prevention of the European Union Geriatric Medicine Society, in collaboration with the International Association of Gerontology and Geriatrics for the European Region, the European Union of Medical Specialists, and the International Osteoporosis Foundation-European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people.
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8
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Blain H, Masud T, Dargent-Molina P, Martin FC, Rosendahl E, van der Velde N, Bousquet J, Benetos A, Cooper C, Kanis JA, Reginster JY, Rizzoli R, Cortet B, Barbagallo M, Dreinhöfer KE, Vellas B, Maggi S, Strandberg T. A Comprehensive Fracture Prevention Strategy in Older Adults: The European Union Geriatric Medicine Society (EUGMS) Statement. J Nutr Health Aging 2016; 20:647-52. [PMID: 27273355 PMCID: PMC5094892 DOI: 10.1007/s12603-016-0741-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest Group on Falls and Fracture Prevention of the European Union Geriatric Medicine Society (EUGMS), in collaboration with the International Association of Gerontology and Geriatrics for the European Region (IAGG-ER), the European Union of Medical Specialists (EUMS), the International Osteoporosis Foundation - European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people.
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Affiliation(s)
- H Blain
- H. Blain, Pôle de Gériatrie, Centre Antonin-Balmes, CHU de Montpellier, 39, avenue Charles-Flahault, 34395 Montpellier Cedex 5, France.Tel: +33 4 67 33 99 57. E-mail address:
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9
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Blain H, Rolland Y, Beauchet O, Annweiler C, Benhamou CL, Benetos A, Berrut G, Audran M, Bendavid S, Bousson V, Briot K, Brazier M, Breuil V, Chapuis L, Chapurlat R, Cohen-Solal M, Cortet B, Dargent P, Fardellone P, Feron JM, Gauvain JB, Guggenbuhl P, Hanon O, Laroche M, Kolta S, Lespessailles É, Letombe B, Mallet É, Marcelli C, Orcel P, Puisieux F, Seret P, Souberbielle JC, Sutter B, Trémollières F, Weryha G, Roux C, Thomas T. Usefulness of bone density measurement in fallers. Joint Bone Spine 2014; 81:403-8. [DOI: 10.1016/j.jbspin.2014.01.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
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10
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Rizzoli R, Reginster JY, Arnal JF, Bautmans I, Beaudart C, Bischoff-Ferrari H, Biver E, Boonen S, Brandi ML, Chines A, Cooper C, Epstein S, Fielding RA, Goodpaster B, Kanis JA, Kaufman JM, Laslop A, Malafarina V, Mañas LR, Mitlak BH, Oreffo RO, Petermans J, Reid K, Rolland Y, Sayer AA, Tsouderos Y, Visser M, Bruyère O. Quality of life in sarcopenia and frailty. Calcif Tissue Int 2013; 93:101-20. [PMID: 23828275 PMCID: PMC3747610 DOI: 10.1007/s00223-013-9758-y] [Citation(s) in RCA: 268] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 03/27/2013] [Indexed: 12/25/2022]
Abstract
The reduced muscle mass and impaired muscle performance that define sarcopenia in older individuals are associated with increased risk of physical limitation and a variety of chronic diseases. They may also contribute to clinical frailty. A gradual erosion of quality of life (QoL) has been evidenced in these individuals, although much of this research has been done using generic QoL instruments, particularly the SF-36, which may not be ideal in older populations with significant comorbidities. This review and report of an expert meeting presents the current definitions of these geriatric syndromes (sarcopenia and frailty). It then briefly summarizes QoL concepts and specificities in older populations and examines the relevant domains of QoL and what is known concerning QoL decline with these conditions. It calls for a clearer definition of the construct of disability, argues that a disease-specific QoL instrument for sarcopenia/frailty would be an asset for future research, and discusses whether there are available and validated components that could be used to this end and whether the psychometric properties of these instruments are sufficiently tested. It calls also for an approach using utility weighting to provide some cost estimates and suggests that a time trade-off study could be appropriate.
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Affiliation(s)
- René Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Doublier A, Farlay D, Jaurand X, Vera R, Boivin G. Effects of strontium on the quality of bone apatite crystals: a paired biopsy study in postmenopausal osteoporotic women. Osteoporos Int 2013; 24:1079-87. [PMID: 23108780 DOI: 10.1007/s00198-012-2181-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 09/28/2012] [Indexed: 11/25/2022]
Abstract
UNLABELLED In paired biopsies of osteoporotic women treated with either strontium ranelate or a placebo for 36 months, characteristics of bone apatite crystals were not influenced by the presence of strontium. The mean rate of substitutions of calcium by strontium ions was 4.5 %. INTRODUCTION The potential effect of strontium (Sr) on bone apatite crystals was investigated in paired biopsies of osteoporotic women treated with either strontium ranelate (SrRan) or a placebo for 36 months. METHODS In ten paired biopsies, crystallinity, apparent length and width/thickness of crystals, interplanar distances, and lattice parameters of unit cells were assessed by X-ray diffraction and selected area electron diffraction. RESULTS All these parameters, reflecting crystal and unit cell characteristics, were not influenced by the presence of Sr and were similar in SrRan and placebo groups after 36 months of treatment. The mean rate of substitutions of calcium by Sr ions was 4.5 %. CONCLUSION Overall, the quality of bone apatite crystals was maintained after 36 months of treatment with SrRan.
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12
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Yan J, Sun JF, Chu PK, Han Y, Zhang YM. Bone integration capability of a series of strontium-containing hydroxyapatite coatings formed by micro-arc oxidation. J Biomed Mater Res A 2013; 101:2465-80. [PMID: 23348908 DOI: 10.1002/jbm.a.34548] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/23/2012] [Accepted: 11/28/2012] [Indexed: 11/11/2022]
Abstract
Strontium-containing hydroxyapatites (Sr-HA) combine the desirable bone regenerative properties of hydroxyapatites (HA) with anabolic and anti-catabolic effects of strontium cations. In the present work, a series of Sr(y)HA [Sr(y)Ca(10-y)(PO4)6(OH)2; y = 0, 0.5, 1, 2] coatings on titanium are produced by micro-arc oxidation (MAO), and the effects of the in vivo osseointegration ability of the coatings are investigated by using a rabbit model. All samples are subjected to biomechanical, surface elemental, micro-CT and histological analysis after 4 and 12 weeks of healing. The obtained results show that the MAO-formed coatings exhibit a microporous network structure composed of Sr(y)HA/Sr(y)HA-Sr(x)Ca(1-x)TiO3/Sr(x)Ca(1-x)TiO3-TiO2 multilayers, in which the outer Sr(y)HA and intermediate Sr(y)HA-Sr(x)Ca(1-x)TiO3 layers have a nanocrystalline structure. All Sr-HA coated implants induce marked improvements in the behavior of bone formation, quantity and quality of bone tissue around the implants than the control HA implant and in particular, the 20%Sr-HA coating promotes early bone formation as identified by polyfluorochrome sequential labeling. The bone-to-implant contact is increased by 46% (p < 0.05) and the pull-out strength is increased by 103% over the HA group (p < 0.01). Extensive areas of mineralized tissue densely deposit on the 20%Sr-HA coating after biomechanical testing, and the greatest improvement of bone microarchitecture are observed around the 20%Sr-HA implant. The identified biological parameters successfully demonstrate the osteoconductivity of 20%Sr-HA surfaces, which results not only in an acceleration but also an improvement of bone-implant integration. The study demonstrates the immense potential of 20%Sr-HA coatings in dental and orthopedic applications.
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Affiliation(s)
- Jun Yan
- Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, No. 145 West Changle Road, Xi'an 710032, China
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Gielen E, Verschueren S, O'Neill TW, Pye SR, O'Connell MDL, Lee DM, Ravindrarajah R, Claessens F, Laurent M, Milisen K, Tournoy J, Dejaeger M, Wu FC, Vanderschueren D, Boonen S. Musculoskeletal frailty: a geriatric syndrome at the core of fracture occurrence in older age. Calcif Tissue Int 2012; 91:161-77. [PMID: 22797855 DOI: 10.1007/s00223-012-9622-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 04/27/2012] [Indexed: 12/19/2022]
Abstract
A progressive decline in physiologic reserves inevitably occurs with ageing. Frailty results from reaching a threshold of decline across multiple organ systems. By consequence, frail elderly experience an excess vulnerability to stressors and are at high risk for functional deficits and comorbid disorders, possibly leading to institutionalization, hospitalization and death. The phenotype of frailty is referred to as the frailty syndrome and is widely recognized in geriatric medical practice. Although frailty affects both musculoskeletal and nonmusculoskeletal systems, sarcopenia, which is defined as age-related loss of muscle mass and strength, constitutes one of the main determinants of fracture risk in older age and one of the main components of the clinical frailty syndrome. As a result, operational definitions of frailty and therapeutic strategies in older patients tend to focus on the consequences of sarcopenia.
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Affiliation(s)
- E Gielen
- Gerontology and Geriatrics Section, Department of Experimental Medicine, KU Leuven, Leuven, Belgium
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Lecart MP, Reginster JY. Current options for the management of postmenopausal osteoporosis. Expert Opin Pharmacother 2011; 12:2533-52. [PMID: 21916810 DOI: 10.1517/14656566.2011.618123] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Osteoporosis is a well-recognized disease with severe consequences if left untreated. The prevention of osteoporosis-associated fractures should include fall prevention, calcium supplementation and life-style advice, as well as pharmacological therapy using agents with proven antifracture efficacy. AREAS COVERED This manuscript offers an evidence-based critical assessment of the currently available efficacy data on all new chemical entities that have been granted a marketing authorization for the management of primary osteoporosis in women. EXPERT OPINION The availability of new therapeutic agents makes clinical decision making in osteoporosis more complex. Therapeutic decisions should be based on a balance between the benefits and risks of treatment, which must be carefully considered in each particular case, both by the physician and the patient. Indeed, no single agent is appropriate for all patients. Therefore, treatment decisions should be made on a tailor-made basis, taking into account all measures of treatment effect and risk, before making informed judgments about the best individual treatment option.
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Affiliation(s)
- Marie-Paule Lecart
- University of Liège, Bone and Cartilage Metabolism Research Unit, Department of Physical Medicine and Rehabilitation, Department of Geriatrics, CHU Centre Ville, Liège 4.000, Belgium
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Genuis SJ, Siy AKJ. Nutritional supplementation and dietary restriction in the resolution of enthesitis-related arthritis. JRSM SHORT REPORTS 2011; 2:32. [PMID: 21541080 PMCID: PMC3085976 DOI: 10.1258/shorts.2011.011012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Stephen J Genuis
- School of Human Development, University of Alberta , Edmonton , Canada
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