Impact of tuberculosis on the incidence of osteoporosis and osteoporotic fractures: a nationwide population-based cohort study

Progress in research on osteoporosis secondary to SARS-CoV-2 infection

The World Health Organization has declared that COVID-19 no longer constitutes a "public health emergency of international concern," yet the long-term impact of SARS-CoV-2 infection on bone health continues to pose new challenges for global public health. In recent years, numerous animal model and clinical studies have revealed that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to secondary osteoporosis. The mechanisms involved are related to the virus's direct effects on bone tissue, dysregulation of the body's inflammatory response, hypoxia, noncoding RNA imbalance, and metabolic abnormalities. Although these studies have unveiled the connection between SARS-CoV-2 infection and osteoporosis, current research is not comprehensive and in depth. Future studies are needed to evaluate the long-term effects of SARS-CoV-2 on bone density and metabolism, elucidate the specific mechanisms of pathogenesis, and explore potential interventions. This review aims to collate existing research literature on SARS-CoV-2 infection-induced secondary osteoporosis, summarize the underlying mechanisms, and provide direction for future research.

Epidemiologic characteristics and risk factors of Clostridioides difficile infection in patients with active tuberculosis in the Republic of Korea: a nationwide population-based study

BACKGROUND

The relationship between anti-tuberculosis (TB) agents and Clostridioides difficile infection (CDI) remains unclear. This study aimed to investigate the epidemiological characteristics and risk factors for CDI in patients with TB.

METHODS

This nationwide, population-based cohort study was conducted in the Republic of Korea (ROK) between January 2018 and December 2022. Data were extracted from the National Health Insurance Service-National Health Information Database. The risk factors for CDI in patients with TB were identified through multi-variate logistic regression analysis using a 1:4 greedy matching method based on age and sex.

RESULTS

During the study period, CDI developed in 2901 of the 131,950 patients with TB who were prescribed anti-TB agents. The incidence of CDI in patients with TB has increased annually in the ROK from 12.31/1000 in 2018 to 33.51/1000 in 2022. Oral metronidazole (81.94%) was the most common first-line treatment for CDI. The in-hospital mortality rate of patients with concomitant CDI and TB was 9.9%, compared with 6.9% in those with TB alone (P<0.0001). Multi-variate logistic regression analysis found intensive care unit admission, Charlson Comorbidity Index ≥3, antibiotic exposure, standard regimen, multi-drug-resistant TB and extrapulmonary TB to be significant risk factors for development of CDI in patients with TB.

CONCLUSION

CDI is uncommon in patients with TB, but it results in a significantly increased mortality rate. Patients being treated for TB should be monitored carefully for the development of CDI. Further clinical research is warranted to identify effective interventions for preventing and controlling CDI during TB treatment.

The Association Between Tuberculosis and Osteoporosis: A Systematic Review and Meta-Analysis

Recent research suggests that tuberculosis (TB) may pose a potential risk factor for osteoporosis, although the available evidence remains limited. This study aimed to comprehensively assess osteoporosis risk in TB patients through systematic review and meta-analysis methodology. Two investigators independently conducted a literature search using the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica Database (EMBASE) databases up to April 2024. Eligible longitudinal cohort studies had to evaluate the impact of active or a history of TB on the risk of osteoporosis and/or osteoporotic fractures. Point estimates and standard errors from each eligible study were pooled using DerSimonian and Laird's generic inverse variance method. Of 2,062 articles (1,765 from EMBASE and 297 from MEDLINE) reviewed, three retrospective cohort studies, comprising a total of 531,624 participants (174,726 patients with TB and 356,898 participants without TB), met the eligibility criteria and were included in the meta-analysis. The pooled analysis of three studies revealed an increased risk of osteoporosis among TB patients, with a pooled hazard ratio of 1.40 (95% CI, 1.26 - 1.57; I2 = 54%). The pooled analysis indicated that populations with TB also had a higher risk of osteoporotic fractures than populations without TB, with a pooled hazard ratio of 1.65 (95% CI, 1.26 - 2.15; I2 = 71%). Our systematic review and meta-analysis demonstrated a significantly increased risk of osteoporosis and osteoporotic fractures in patients with TB.

[Osteoporosis-Definition, risk assessment, diagnosis, prevention and treatment (update 2024) : Guidelines of the Austrian Society for Bone and Mineral Research]

BACKGROUND

Austria is among the countries with the highest incidence and prevalence of osteoporotic fractures worldwide. Guidelines for the prevention and management of osteoporosis were first published in 2010 under the auspices of the then Federation of Austrian Social Security Institutions and updated in 2017. The present comprehensively updated guidelines of the Austrian Society for Bone and Mineral Research are aimed at physicians of all specialties as well as decision makers and institutions in the Austrian healthcare system. The aim of these guidelines is to strengthen and improve the quality of medical care of patients with osteoporosis and osteoporotic fractures in Austria.

METHODS

These evidence-based recommendations were compiled taking randomized controlled trials, systematic reviews and meta-analyses as well as European and international reference guidelines published before 1 June 2023 into consideration. The grading of recommendations used ("conditional" and "strong") are based on the strength of the evidence. The evidence levels used mutual conversions of SIGN (1++ to 3) to NOGG criteria (Ia to IV).

RESULTS

The guidelines include all aspects associated with osteoporosis and osteoporotic fractures, such as secondary causes, prevention, diagnosis, estimation of the 10-year fracture risk using FRAX®, determination of Austria-specific FRAX®-based intervention thresholds, drug-based and non-drug-based treatment options and treatment monitoring. Recommendations for the office-based setting and decision makers and institutions in the Austrian healthcare system consider structured care models and options for osteoporosis-specific screening.

CONCLUSION

The guidelines present comprehensive, evidence-based information and instructions for the treatment of osteoporosis. It is expected that the quality of medical care for patients with this clinical picture will be substantially improved at all levels of the Austrian healthcare system.

Tuberculosis and osteoporotic fracture risk: development of individualized fracture risk estimation prediction model using a nationwide cohort study

Purpose

Tuberculosis (TB) is linked to sustained inflammation even after treatment, and fracture risk is higher in TB survivors than in the general population. However, no individualized fracture risk prediction model exists for TB survivors. We aimed to estimate fracture risk, identify fracture-related factors, and develop an individualized risk prediction model for TB survivors.

Methods

TB survivors (n = 44,453) between 2010 and 2017 and 1:1 age- and sex-matched controls were enrolled. One year after TB diagnosis, the participants were followed-up until the date of fracture, death, or end of the study period (December 2018). Cox proportional hazard regression analyses were performed to compare the fracture risk between TB survivors and controls and to identify fracture-related factors among TB survivors.

Results

During median 3.4 (interquartile range, 1.6-5.3) follow-up years, the incident fracture rate was significantly higher in TB survivors than in the matched controls (19.3 vs. 14.6 per 1,000 person-years, p < 0.001). Even after adjusting for potential confounders, TB survivors had a higher risk for all fractures (adjusted hazard ratio 1.27 [95% confidence interval 1.20-1.34]), including hip (1.65 [1.39-1.96]) and vertebral (1.35 [1.25-1.46]) fractures, than matched controls. Fracture-related factors included pulmonary TB, female sex, older age, heavy alcohol consumption, reduced exercise, and a higher Charlson Comorbidity Index (p < 0.05). The individualized fracture risk model showed good discrimination (concordance statistic = 0.678).

Conclusion

TB survivors have a higher fracture risk than matched controls. An individualized prediction model may help prevent fractures in TB survivors, especially in high-risk groups.

Demystifying the Risk Factors and Preventive Measures for Osteoporosis

Background

Osteoporosis is a major health problem, globally. It is characterized by structural bone weakness leading to an increased risk of fragility fractures. These fractures commonly affect the spine, hip and wrist bones. Consequently, Osteoporosis related proximal femur and vertebral fractures represent a substantial, growing social and economic burden on healthcare systems worldwide. Indentification of the risk factors, clinical risk assessment, utilization of risk assessment tools and appropriate management that play a crucial role in reducing the burden of Osteoporosis by tackling modifiable risk factors.

Methods

This chapter explores various risk factors that are associated with Osteoporosis and provides an overview of various clinical and diagnostic risk assessment tools with a particular emphasis on evidence-based strategies for their prevention.

Conclusion

The role of emerging technologies such as Artificial Intelligence (AI) and perspectives such as newer diagnostic modalities, monitoring and surveillance approaches in prevention of risk factors in the pathogenesis of Osteoporosis is highlighted.