Health-related Quality of Life in Accordance with Fracture History and Comorbidities in Korean Patients with Osteoporosis

Association Between Air Pollution and Osteoporosis with High-Risk Populations: A Narrative Review

PURPOSE OF REVIEW

Air pollution has been raised as a novel risk factor for osteoporosis, which impose a huge burden on both individuals and society. Thus, summarizing and discussing previous results on the association between ambient air pollution and osteoporosis can be informative in synthesizing the current evidence and improving relevant action plans.

RECENT FINDINGS

Recent studies reported that long-term exposure to ambient air pollution is associated with an increased risk of osteoporosis and related outcomes; however, the studied populations, air pollutants, areas, and results on high-risk populations are heterogeneous. Among air pollutants, long-term exposure to PM2.5 showed an association with osteoporosis or osteoporosis-related fracture in general. Recent scientific evidence indicates that ambient air pollution is a potential risk factor for osteoporosis and related outcomes. Further research is warranted on how air pollution impacts these outcomes including for high-risk populations with consistent effect modifiers, and analytic methodologies.

Prevalence, Characteristics, and Associated Risk Factors of Wrist Fractures in Americans Above 50: The Cross-Sectional NHANES Study

SUMMARY

By analyzing data from NHANES, we aimed to evaluate the prevalence, characteristics, and associated factors of wrist fractures in Americans aged 50 and above.

INTRODUCTION

Wrist fractures, whose prevalence increases with age, are one of the most common fractures in the United States. However, epidemiological studies on the prevalence of wrist fractures of certain ages were limited.

METHODS

The data of Americans aged 50 or above from 2013-2014 and 2017-2018 in NHANES were extracted and analyzed.

RESULTS

The prevalence of wrist fractures among Americans whose age was 50 or above was 12%, which was similar between men and women (men 12.8% vs. women 11.4%, p = 0.267). Among those who had experienced their first wrist fracture, 17.8% of the population experienced a second wrist fracture. The top two causes of the first wrist fracture were a fall from a standing height (56%) or a hard fall (34.8%). The prevalence of wrist fractures was higher in men than in women (13.7% versus 8.7%, p = 0.023) aged < 60, but higher in women than in men aged ≥ 60 (11.8% versus 14.3%, p = 0.007). Multivariate analysis showed that obesity, frequent drinking, current smoking, high serum phosphate level, non-Hispanic white women, and osteoporosis were independently associated with wrist fractures. Stratified by race, osteoporosis, frequent drinking, and high serum phosphate level were risk factors for wrist fractures in all races. As for Mexican Americans, non-Hispanic whites, and other races including multi-racial, current smoking was a risk factor of wrist factures. Furthermore, obesity was positively associated with wrist fractures in Mexican Americans, other Hispanics, and non-Hispanic whites.

CONCLUSION

The prevalence of wrist fractures in Americans aged 50 and above was 12%. Falling from a standing height was the main cause of the first wrist fracture. Frequent drinking, current smoker, high serum phosphate level, osteoporosis, obesity, and non-Hispanic women were more likely to experience wrist fractures.

Quality of life of Latin-American individuals with type 2 diabetes mellitus: A systematic review

OBJECTIVE

Diabetes mellitus is a serious public health problem that causes a decrease in the patients' quality of life. The present study was aimed to analyze the quality of life of patients with diabetes mellitus in Latin-American population through a systematic review, using the two instruments of greater validity and reliability at international level, SF-36 and WHOQOL.

METHODS

We performed extensive searches in Redalyc, SciELO, PubMed, Scopus and Web of Science databases. To delimit our search, we only included countries that are members of the Latin American Association of Diabetes. We identified 2168 articles, where 35 were considered relevant for this systematic review.

RESULTS

Our results showed that patients that regularly receive guidance and treatment to control the diabetes, showed better quality of life; in contrast, patients with foot ulcers or comorbidities showed the worse quality of life.

CONCLUSION

The current literature analysis suggests that this disease greatly influences in the quality of life of the patients.

Sarcopenia and Hip-Structure Analysis Variables in Korean Elderly Population

The purpose of this study is comparing the hip-structure analysis (HSA) variables with the skeletal muscle index (SMI) in elderly patients with sarcopenia using nationwide representative data on the Republic of Korea (ROK). The survey data were collected from household interviews and direct standardized physical examinations conducted in specially equipped mobile examination centers. The data were collected in 2008 from 9744 participants. Patients under 65 years of age who were without data on the skeletal-muscle-mass and HSA variables were excluded. After these exclusions, a total of 744 participants (293 men and 451 women) were ultimately analyzed. The HSA measurements of the hip-bone geometry were analyzed using dual-energy X-ray absorptiometry. The appendicular SMI is defined as the sum of the arm and leg SMIs. Sarcopenia is defined according to the criteria for the Asia Working Group for Sarcopenia as SMIs of less than 5.4 kg/m2 and 7.0 kg/m2 for women and men, respectively. In the entire population, SMI was found to be positively correlated to HSA variables. After adjusting for age, body mass index, and energy intake in both the women and men groups, a statistically significant difference became evident in all variables between the SMI and the HSA. The present study suggests that skeletal-muscle loss negatively affects hip-bone-strength indices in elderly sarcopenia patients. Implementing strategies to increase SMI in the elderly population may be useful for reducing the vulnerability to hip fracture.

Trends in the Diagnosis of Osteoporosis in Patients with Distal Radius Fractures Based on a National Claims Database

Background

A history of osteoporotic fractures is strongly associated with the subsequent osteoporotic fractures. To prevent subsequent fractures, the diagnosis and treatment of osteoporosis following osteoporotic fractures are very important. A distal radius fracture (DRF) is the second most common type of osteoporotic fracture in South Korea. We analyzed the rate of osteoporosis diagnosis within 6 months post-DRF.

Methods

We used data from the Korean Health Insurance Review and Assessment Service nationwide claims database from 2010 to 2016. International Classification of Diseases, 10th revision codes and procedures codes were used to identify patients aged over 50 years with newly diagnosed DRFs; the osteoporosis assessments of these patients were then analyzed. We used Cochran-Armitage trend test to examine trends in osteoporosis diagnosis.

Results

A search of database identified 77,209 DRFs in patient aged above 50 years of age from 2011 to 2016. Among these patients, only 19,305 (25.0%) underwent diagnostic examination for osteoporosis. The number of osteoporosis examinations increased slightly, but not significantly, every year (P=0.061).

Conclusions

Clinicians who treat DRFs shoulder also evaluated patients for osteoporosis after DRFs.

Evaluation of the increased risk of spine fracture in patients with mood disorder compared with matched controls: a longitudinal follow-up study using a national sample cohort in Korea

OBJECTIVE

To evaluate the risk of spine fracture in patients with mood disorder using a nationwide cohort.

DESIGN

A longitudinal follow-up study.

SETTING

Claims data for the population ≥20 years of age were collected from 2002 to 2013 for the Korean National Health Insurance Service-National Sample Cohort.

PARTICIPANTS

A total of 60 140 individuals with mood disorder were matched with 240 560 individuals (control group) for age, sex, income, region of residence and osteoporosis.

INTERVENTIONS

In both the mood disorder and control groups, the history of spine fracture was evaluated. The International Classification of Diseases 10th Revision codes for mood disorder (F31-F39) and spine fracture (S220 and S320) were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

The univariable and multivariable HRs and 95% CIs of spine fracture for patients with mood disorder were analysed using a stratified Cox proportional hazards model. Subgroup analyses were conducted according to the history of osteoporosis, age and sex.

RESULTS

Approximately 3.3% (2011/60 140) of patients in the mood disorder group and 2.8% (6795/240 560) of individuals in the control group had spine fracture (p<0.001). The mood disorder group demonstrated a higher adjusted HR for spine fracture than the control group (multivariable HR=1.10, 95% CI 1.04 to 1.15, p<0.001). The participants without osteoporosis showed a higher HR of mood disorder for spine fracture than the control participants (multivariable HR=1.25, 95% CI 1.14 to 1.37, p<0.001). According to age and sex, this result was consistent in subgroups of women aged 20-39 and 40-59 years and men aged ≥60 years.

CONCLUSION

The risk of spine fracture was increased in patients with mood disorder. The potential risk of spine fracture needs to be evaluated when managing patients with mood disorder.

Impact of fractures on quality of life in patients with osteoporosis: a US cross-sectional survey

Objective: To evaluate the impact of osteoporosis-related fractures on health-related quality of life (HRQoL). Methods: Data were obtained from the 2016 Adelphi US Osteoporosis Disease Specific Programme™, a cross-sectional survey of physicians and their male and female patients with osteoporosis. Patient-reported outcomes (PRO) measures included the European Quality of Life 5 Domains (EQ-5D), European Quality of Life Visual Analog Scale (EQ-VAS), and Osteoporosis Assessment Questionnaire short-version (OPAQ-SV; physical, emotional, and symptom domains). Associations between PRO scores and the number and site of fractures were evaluated using ANOVA. Multivariate analyses were conducted using linear regression. Results: Physicians provided records for 1848 patients with osteoporosis. Of these, 981 (53.1%) completed the patient survey, data for the number of fractures were available for 935/981 (95.3%), and 185/935 (19.8%) had a history of fracture. Experiencing fractures significantly influenced scores on all PRO measures (p < .0001). Hip and spine fractures were associated with the greatest reduction in most PRO scores. The number of fractures, age, body mass index, and Charlson Comorbidity Index (CCI) were significantly associated with PRO measures (p < .05) in multivariate analyses. In patients with a fracture, fracture site, CCI, gender (EQ-5D and EQ-VAS), and age (OPAQ-SV physical only) were significantly associated with PRO measures. Conclusions: In patients with osteoporosis, fractures are associated with lower HRQoL and lower overall health status. Fracture history, fracture site, age, and comorbidity burden significantly influence HRQoL in individuals with osteoporosis. These data suggest the need for interventions to reduce the risk of fractures in patients with osteoporosis.

Effects of Hip Structure Analysis Variables on Hip Fracture: A Propensity Score Matching Study

The purpose of this retrospective study was to compare the hip structural analysis (HSA) levels of patients with those of a hip fracture group. All patients with an initial hip fracture who were older than or equal to 65 years old and admitted to our hospital between March 2018 and January 2019 were eligible for this study. During the study period, 134 hip fracture patients aged 65 years and older were admitted to the study institution, and a total of 51 hip fracture patients were ultimately assigned to the patient group. Age, sex, body mass index (BMI), skeletal muscle index (SMI), and vitamin D were matched in the two groups (hip fracture (HF) group vs. non-hip fracture group) using propensity score matching (PSM) without any statistical differences. Following propensity score matching, 51 patients in the HF group and 51 patients in the non-HF group were included in the study, respectively. Hip axis length (p = 0.031), neck-shaft angle (p = 0.043), width of intertrochanter (p = 0.005), and femur shaft (p = 0.01) were found to be significantly higher in the HF group (107.31 (mean) ± 9.55 (standard deviation, SD), 131.11 ± 5.29, 5.57 ± 0.58, and 3.05 ± 0.23, respectively) than in the non-HF group (102.07 ± 14.15, 128.85 ± 5.81, 5.29 ± 0.38, and 2.92 ± 0.23, respectively). However, cross-sectional area (CSA) of femur neck (p = 0.005) and femur shaft (p = 0.01) as well as cortical thickness (CT) of femur neck (p = 0.031) and femur shaft (p = 0.031) were found to be significantly lower in the HF group (1.93 ± 0.44, 3.18 ± 0.83, 0.11 ± 0.02, and 0.38 ± 0.09, respectively) than in the non-HF group (2.12 ± 0.46, 3.57 ± 0.78, 0.13 ± 0.03, and 0.47 ± 0.11, respectively). The HSA showed excellent sensitivity (82.4% to 90.2%). HSA is an important factor in predicting the occurrence of hip fracture. Therefore, not only should bone mineral density (BMD) be considered clinically, but it is also important to look closely at HSA for risk of hip fracture.

Health state utility values of osteoporotic fractures among Korean women

Objectives: This study aimed to investigate health state utility values in eight health states related to osteoporosis and osteoporotic fractures using time trade-off (TTO) technique among postmenopausal Korean women.Methods: Scenarios describing eight health states including osteoporosis and hip, vertebral, post-hip, post-vertebral, ankle, humerus, and wrist fractures were developed and presented to 500 female participants aged 45 to 59 years who were selected with probability proportionate to age group and region for this investigation. Each health states valuation was derived using the trade-off (TTO) technique. Ten years of a given health state was traded off with a shorter length of time in full health.Results: Mean scores of each state were calculated. Osteoporosis scored the highest (0.669 ± 0.155), followed by wrist fracture (0.656 ± 0.151). Hip (0.298 ± 0.158) and vertebral (0.298 ± 0.160) fractures were found to be the worst health states. Post-hip (0.446 ± 0.159) and post-vertebral fractures (0.455 ± 0.160) were also considered undesirable states. All fractures were associated with disutilities, ranging from a mean of -0.013 to -0.371. These values were statistically significant (p < 0.0001). Hip and vertebral fractures are among the most serious consequences of osteoporotic fractures.Conclusions: The vertebral and hip fractures marked the lowest utility scores among post-menopausal women in Korea.

Denosumab Treatment Improved Health-Related Quality of Life in Osteoporosis: A Prospective Cohort Study

Improving patient health-related quality of life (HRQOL) and prevention of bone fracture are important components of the treatment of osteoporosis. Our aim in this study was to evaluate the effect of denosumab treatment in improving HRQOL among patients with osteoporosis. Our analysis was based on 332 patients with osteoporosis, followed for 24 months. All patients received denosumab (60 mg) subcutaneously every 6 months. Bone mineral density (BMD) was assessed at the distal radius, with serum concentration of calcium, phosphate, P1NP, and TRACP5b also measured. HRQOL assessment included pain (visual analogue scale [VAS]) and the EQ-5D questionnaire. A multivariate analysis was performed to identify the possible confounders associated with deterioration in the EQ-5D utility score in response to denosumab treatment. Denosumab treatment yielded a 3.4% increase in BMD at 24 months. Serum levels of TRACP5b and P1NP decreased significantly, from baseline, at 6 months, with no effect on calcium and phosphate levels. Pain VAS and EQ-5D utility score improved significantly, from baseline, at 6 months, with the EQ-5D utility score correlating with the BMD at all time points of measurement over the 24-month period of observation. Knee osteoarthritis and multiple comorbidities were significantly associated with a worse HRQOL in response to denosumab treatment. Denosumab treatment increased BMD, with improvements in BMD correlating with improved HRQOL, supporting a possible benefit of using denosumab for the treatment of osteoporosis. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

The efficacy and safety of herbal medicine BHH10 in postmenopausal women with osteoporosis: study protocol for a phase II, multicenter, randomized, double-blinded, placebo-controlled clinical trial

Background

Osteoporosis is becoming more prevalent in aging societies worldwide, and the economic burden attributable to osteoporotic fractures is substantial. The medications presently available to treat osteoporosis have side effects, and the development of safer and more effective treatments is urgently needed. The aim of this study is to evaluate the efficacy and safety of BHH10, a traditional Korean herbal medicine, in the treatment of postmenopausal osteoporosis.

Methods/Design

This is a phase II, multicenter, randomized, double-blinded, placebo-controlled clinical trial and will include 168 postmenopausal women aged 55 years and older with osteoporosis. The participants will be recruited competitively from two sites of the Acupuncture and Moxibustion Department of Kyung Hee University Hospital of Korean Medicine, either Hoegidong or Gangdong in Seoul, Korea. Participants will be assigned randomly to one of two groups, the BHH10 group or the placebo group, in a 1:1 ratio, and will have five scheduled visits. Participants will take two tablets of BHH10 or placebo three times daily for 12 weeks. The primary efficacy outcome is the change in bone mineral density at the lumbar spine (L1–4) between baseline (visit 1) and 12 weeks after randomization (visit 5). Other outcome variables include changes in bone turnover markers, the Deficiency Syndrome of the Kidney Index, EuroQol five-dimension questionnaire score, and laboratory parameters, as well as adverse events.

Discussion

To our knowledge, this will be the first clinical trial to assess the efficacy and safety of BHH10 in postmenopausal women with osteoporosis. It is anticipated that the results will contribute to the development of traditional herbal medicines that can be used to treat osteoporosis in postmenopausal women in Korea. If the superiority of BHH10 over placebo is demonstrated, this study could provide the foundation for a phase III clinical trial. The results of the study will be published in a peer-reviewed journal.

Trial registration

Clinical Research Information Service, KCT0001842. Registered on 14 March 2016.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2854-6) contains supplementary material, which is available to authorized users.

Long-Term Dietary Intake of Chia Seed Is Associated with Increased Bone Mineral Content and Improved Hepatic and Intestinal Morphology in Sprague-Dawley Rats

Chia seeds (Salvia hispanica) provide an unusually high content of α-linolenic acid with several potential health benefits, but few studies have examined the long-term intake of n-3 fatty acid-rich plant foods such as chia. In this work, we investigated some of the effects of a diet containing 10% chia seeds versus a conventional isocaloric diet for 10 and 13 months on body measurements, musculoskeletal system, the liver, and the intestines of 20 male Sprague-Dawley rats assigned into two groups. The n-6/n-3 ratios for the control and chia diets were 7.46 and 1.07, respectively. For the first 10 months of the diet, the body parameters and weights were similar, but at 13 months, the bone mineral content (BMC) of the chia-fed rats was significantly higher than that of the controls whether in total or proximal areas of the left tibia. Also, significant positive correlations were found between the age of the chia group and the bone mineral density, BMC, weight of the musculoskeletal system, final body weight, and skin weight. Liver and intestinal examinations showed improved morphology associated with lower lipid deposit in hepatocytes and increased intestinal muscle layers and crypt size in the chia group. This study provides new data suggesting the potential benefits associated with the long-term intake of chia seeds.

Prevalence of Osteoporosis in Korean Patients with Chronic Obstructive Pulmonary Disease and Their Health-related Quality of Life According to the Korea National Health and Nutrition Examination Survey 2008-2011

BACKGROUND

In this study, we evaluated the prevalence of osteoporosis, risk factors associated with osteoporosis, and health-related quality of life (HRQOL) in clinically stable chronic obstructive pulmonary disease (COPD) patients.

METHODS

A total of 1,081 COPD patients were recruited from the Korea National Health and Nutrition Examination Survey (KNHANES) from July 2008 to May 2011. Bone mineral densities at the lumbar spine, femoral neck, and total proximal femur were measured using dual energy X-ray absorptiometry. HRQOL was assessed using the EuroQOL-5 dimensions (EQ-5D) questionnaire. To identify factors associated with osteoporosis and HRQOL in patients with COPD, multivariate regression analyses was performed.

RESULTS

Of the 1,081 COPD patients, 191 (17.7%) were diagnosed with osteoporosis. There were significant differences in age, sex, smoking status, education level, house income, and body mass index (BMI) between the osteoporotic and non-osteoporotic groups. COPD patients with osteoporosis had significantly lower EQ-5D scores than the controls. In multivariate analyses, older age (odds ratio [OR]=1.10, P<0.001) was risk factor for osteoporosis. And patients of male sex (OR=0.06, P<0.001), high house income (OR=0.75, P=0.045), and high BMI (OR=0.74, P<0.001) were less likely to have osteoporosis. In addition, osteoporosis was associated with poor HRQOL (β=-0.21, P=0.023).

CONCLUSIONS

The prevalence of osteoporosis in COPD patients based on the 2008 to 2011 KNHANES data were relatively lower than that in physician-diagnosed COPD patients. In these COPD patients, older age, female sex, low household income, and low BMI increased the risk for osteoporosis.