Predicting fracture risk in osteoporosis: the use of fracture prediction tools in an osteoporosis clinic population

Comparison of fracture risk calculators in elderly fallers: a hospital-based cross-sectional study

OBJECTIVE

Elderly patients presenting with falls are known to carry an extremely high risk of future fragility fractures. Current osteoporosis guidelines recommend using fracture risk calculators such as FRAX, QFracture or Garvan to guide management. However, they differ considerably in their inputs and may therefore provide contrasting risk estimations in certain individuals. In this study, we compare these risk calculators in a high-risk cohort of elderly patients admitted to hospital with falls.

DESIGN

Hospital-based cross-sectional study.

SETTING

Secondary care, London, UK.

PARTICIPANTS

Data from 120 consecutive elderly patients who had falls presenting to a single hospital over 4 months were collected. 10-year major and hip fracture risks were calculated using FRAX, QFracture and Garvan. 1-year major and hip fracture risks from QFracture were assessed against prospective incidence of fracture.

RESULTS

Median 10-year major fracture risk was: FRAX 19.5%, QFracture 26.0%, Garvan 32.5%. Median 10-year hip fracture risk was: FRAX 9.6%, QFracture 21.1%, Garvan 6.5%. Correlation between FRAX and QFracture was r=0.672 for major, r=0.676 for hip fracture (both p<0.0001); FRAX and Garvan r=0.778 (p<0.0001) for major, r=0.128 (p=0.206) for hip fracture; QFracture and Garvan r=0.658 (p<0.0001) for major, r=0.318 (p<0.001) for hip fracture. QFracture 1-year predicted major and hip fracture rates were 1.8% and 1.2%, respectively, compared with actual rates of 2.1% and 0%, respectively.

CONCLUSIONS

Although strong correlations between calculators were observed in the study cohort, there were differences of up to 13% between estimated risks. QFracture captured several elderly-specific inputs not considered by other calculators and so projected higher fracture risk than the other calculators. QFracture provided 1-year fracture risks that were comparable with the prospective observed fracture incidence in the cohort. This study has important clinical implications for the use of fracture risk calculators to guide treatment decisions, particularly in the high-risk cohort of elderly patients admitted to hospital following falls.

Global Public Interests and Dynamic Trends in Osteoporosis From 2004 to 2019: Infodemiology Study

Background

With the prolonging of human life expectancy and subsequent population aging, osteoporosis (OP) has become an important public health issue.

Objective

This study aimed to understand the global public search interests and dynamic trends in “osteoporosis” using the data derived from Google Trends.

Methods

An online search was performed using the term “osteoporosis” in Google Trends from January 1, 2004, to December 31, 2019, under the category “Health.” Cosinor analysis was used to test the seasonality of relative search volume (RSV) for “osteoporosis.” An analysis was conducted to investigate the public search topic rising in RSV for “osteoporosis.”

Results

There was a descending trend of global RSV for “osteoporosis” from January 2004 to December 2014, and a slowly increasing trend from January 2015 to December 2019. Cosinor analysis showed significant seasonal variations in global RSV for “osteoporosis” (P=.01), with a peak in March and a trough in September. In addition, similar decreasing trends of RSV for “osteoporosis” were found in Australia, New Zealand, Ireland, and Canada from January 2004 to December 2019. Cosinor test revealed significant seasonal variations in RSV for “osteoporosis” in Australia, New Zealand, Canada, Ireland, UK, and USA (all P<.001). Furthermore, public search rising topics related to “osteoporosis” included denosumab, fracture risk assessment tool, bone density, osteopenia, osteoarthritis, and risk factor.

Conclusions

Our study provided evidence about the public search interest and dynamic trends in OP using web-based data, which would be helpful for public health and policy making.

Evaluation of two tools for the early screening of osteoporosis in postmenopausal Chinese women with type 2 diabetes mellitus

Objective

To evaluate two osteoporosis screening tools, the osteoporosis self-assessment tool for Asians (OSTA) and the osteoporosis screening tool for Chinese (OSTC), in postmenopausal Chinese women with type 2 diabetes mellitus (T2DM).

Methods

This retrospective study enrolled postmenopausal female patients with T2DM. Bone mineral density at the lumbar spine (L1–4) and left femoral neck was measured using dual-energy X-ray absorptiometry (DXA). The OSTA and OSTC scores were calculated and compared with bone mineral density at the two anatomical sites.

Results

A total of 404 patients with T2DM were enrolled in this study. The detection rates for osteoporosis in the lumbar spine (L1–L4) and left femoral neck by DXA were 22.5% (91 of 404 patients) and 21.8% (88 of 404 patients), respectively; 14.4% (58 of 404 patients) and 18.1% (73 of 404 patients) by OSTA, respectively; and 21.5% (87 of 404 patients) at both sites by OSTC. At the femoral neck, the areas under the curve (AUC) of OSTA and OSTC for predicting osteoporosis were 0.73 and 0.78, respectively. The sensitivity and specificity for OSTA were 64.9% and 72.7%, respectively; and for OSTC, they were 64.2% and 79.5%, respectively.

Conclusions

The OSTC assessment tool was superior to OSTA for osteoporosis screening in postmenopausal Chinese women with T2DM.

Recommended care received by geriatric hip fracture patients: where are we now and where are we heading?

INTRODUCTION

Despite the availability of clinical guidelines on the prevention and treatment of geriatric hip fractures, the percentage of recommended care received by patients is low. We conducted an importance-performance analysis for prioritizing interventions to improve the in-hospital management of these patients.

MATERIALS AND METHODS

A secondary data analysis was conducted on the in-hospital treatment of 540 geriatric hip fracture patients in 34 hospitals in Belgium, Italy, and Portugal. First, we assessed the level of expert consensus on the process indicators composing international guidelines on hip fracture treatment. Second, guideline adherence on in-hospital care was evaluated within and across hospitals. Third, an importance-performance analysis was conducted, linking expert consensus to guideline adherence.

RESULTS

Level of expert consensus was high (above 75%) for 12 of 22 process indicators identified from the literature. There is large between and within hospital variation in guideline adherence for these indicators and for none of the 540 patients were all 22 process indicators adhered to. Importance-performance analysis demonstrated that three indicators that had a high level of expert consensus also had a high level of adherence (above 80%). Nine indicators, most of which have been previously linked to patient outcomes, had a high level of expert consensus but a consistently low level of adherence across hospitals and are identified as priority areas for improvement.

CONCLUSIONS

Guideline adherence for the treatment of geriatric hip fracture patients is remarkably suboptimal. Importance-performance analysis is a useful strategic approach to assist practitioners and healthcare managers to improve the quality of care.

Dual roles of QOA-8a in antiosteoporosis: a combination of bone anabolic and anti-resorptive effects

Osteoporotic treatments have largely depended on antiresorptive or anabolic drugs; but the former also suppresses new bone formation, and the latter only includes human parathyroid hormone. There is no drug that has a dual effect to inhibit bone resorption and to stimulate bone formation simultaneously. Here, we report a small molecule, a quinoxaline derivative of oleanolic acid (QOA-8a) that plays such dual roles in osteoblasts and osteoclasts in the treatment of osteoporosis. Osteoclast differentiation was induced by incubation of primary mouse bone marrow-derived macrophages in the presence of RANKL and M-CSF, treatment with QOA-8a dose-dependently inhibited the osteoclast formation with an IC50 value of 0.098 μmol/L. QOA-8a also directly acted on osteoblasts, and stimulated new bone formation in murine calvarial bones in vitro and in vivo. In an OVX rat model, administration of QOA-8a (1, 5 mg·kg-1·d-1, po) for 16 weeks effectively prevented OVX-induced bone loss, accompanied by decreased serum levels of the bone resorption marker CTX-1 and increased serum levels of osteoblast marker N-MID-OT. Meaningfully, our preliminary study revealed that QOA-8a down-regulated the ERK1/2 signal in osteoclasts and up-regulated the signal in osteoblasts. QOA-8a showed dual functions in both animal and human osteoclastogenesis and osteoblastogenesis. Our results demonstrate that QOA-8a might serve as a lead compound with a dual function of bone anabolic and anti-resorptive effects in the development of anti-osteoporosis agents.

Measuring the musculoskeletal aging phenotype

The world is aging. The population aged over sixty years worldwide is predicted to rise from 841 million in 2013 to more than 2 billion by 2050. Musculoskeletal (MSK) disease is a significant burden on the aging population, contributing 7.5% of the disease burden in those aged over 60 years. MSK diseases have a pronounced effect on disability level and independence in old age, with a consequent significant public health burden and impact on quality of later life. As numbers of older individuals and their disease burden increase, it is important to examine MSK disease in older life in detail. The musculoskeletal aging phenotype comprises four often interwoven key elements - osteoporosis, osteoarthritis, sarcopenia and frailty - and this review will focus on these four themes. It is crucial that we are able to accurately measure each phenotype in order that we might identify those individuals at greatest risk of developing these conditions, and design trials of therapeutic agents that might impact their development. Accurate measurement of the musculoskeletal aging phenotype is necessary firstly to document the burden of each condition, and then to enable factors to be identified which may accelerate or retard their development or progression. In some areas of MSK disease, this work is more advanced (osteoporosis); in other areas (sarcopenia) the field is currently very rapidly evolving. We will explore the tools currently used to measure the musculoskeletal aging phenotype and how they compare, as well as highlight areas where more work is needed.