Risk factors for osteoporotic fractures and low bone density in pre and postmenopausal women

Skeletal muscle index together with body mass index is associated with secondary osteoporosis in patients with rheumatoid arthritis

OBJECTIVE

The objective of this study was to explore the associations of body mass index (BMI), fat mass index (FMI), skeletal mass index (SMI) and secondary osteoporosis (OP) in patients with rheumatoid arthritis (RA).

METHODS

The bone mineral density (BMD) at sites of the femur neck (Neck), total hip (Hip) and lumbar vertebrae 1-4 (L1-4) was measured by dual-energy X-ray absorptiometry. The skeletal muscle index, body fat percentage and mineral content were measured by biological electrical impedance for calculating BMI, FMI and SMI.

RESULTS

A total of 433 patient with RA and 158 healthy controls were enrolled. The BMDs at each site of the RA patients were lower compared with those of the healthy controls (p < 0.0001), and the prevalence of OP (36.1%, 160/443) and sarcopenia (65.2%, 288/443) in the RA patients were higher than those in the controls (12.7%, 20/158, p < 0.0001; 9.0%, 14/156, p < 0.0001). Significant differences in the BMD, FMI, SMI, mineral content, body fat percentage and skeletal muscle mass were found among the RA patients in the different BMI groups (p < 0.05). In RA patients with BMI < 18.5 kg/m2, the prevalence of OP in the RA patients with sarcopenia was similar to that in those without sarcopenia (44.4% vs. 66. 7%, χ2 = 0. 574, p = 0.449). In the RA patients with a normal BMI or who were overweight or obese, prevalence of OP in the RA patients with sarcopenia was significantly higher than that in the RA patients without sarcopenia (42.8% vs. 21.7%, χ2 = 10.951, p = 0.001; 61.1% vs. 13.0%, χ2 = 26.270, p < 0.0001). In the RA patients without sarcopenia, the prevalence of OP in the RA patients in the different BMI groups was different (p = 0.039). In the RA patients with sarcopenia, there was no significant difference in the prevalence of OP among the RA patients in the different BMI groups (p = 0. 128). The linear correlation analysis showed that the SMI in RA patients was positively correlated with the BMD of each site measured and BMI and FMI (p < 0.0001). However, there was a negative linear correlation between SMI and disease duration (p = 0.048). The logistic regression analysis found that SMI (OR = 0.569, p = 0.002, 95% CI 0.399-0.810), BMI (OR = 0.884, p = 0.01, 95% CI 0.805-0.971) and gender (1 = female, 2 = male) (OR = 0.097, p < 0.0001, 95% CI 0.040-0.236) were protective factors for OP in RA, while age (OR = 1.098, p < 0.0001, 95% CI 1.071-1.125) was the risk factor.

CONCLUSION

BMI and SMI are associated with the occurrence of OP in RA patients, and both SMI and BMI are important protective factors for OP secondary to RA.

What is known about osteoporosis research in Latin America?: A bibliometric analysis of three decades

Identifying the gaps in scientific production in a topic allows directing research in order to make better public investment decisions. Bibliometric data on osteoporosis in Latin America are very limited and unclear and, given the impact of this disease in this region, it is relevant to analyze the latest trends in the subject. The study approach was quantitative, observational-descriptive, cross-sectional. Data were collected from journals indexed in Scopus between 1990 and 2019, using a search strategy that included Medical Subject Headings terms for "Osteoporosis" and other related terms, as well as VOSviewer software to create cooperative and co-occurrence word maps. 3261 documents were analyzed, with an annual scientific production rate of 5% (163 documents), where 73.9% were original articles. The countries with the highest scientific production in osteoporosis were Brazil (55.2%) and Argentina (18%). Extra-regional cooperation was mainly with the United States (16.35%) and Spain (5.18%). Six of the 10 most productive countries had their own government agencies as the main funders. The National Council for Scientific and Technological Development was the institution that funded the most (n = 194). The term "osteoporosis" together with the terms "bone mineral density," "fractures," and "menopause" were the most frequently addressed subjects. Latin American scientific production in osteoporosis has shown a significant increase. However, in the last 3 years it has shown a slight reduction. Greater intraregional collaboration involving universities, institutions and health societies is needed.

Discordance in Secular Trends of Bone Mineral Density Measurements in Different Ages of Postmenopausal Women

BACKGROUND

Age-adjusted bone mineral density (BMD) in postmenopausal women decreases in developed countries whereas incidence of osteoporotic fracture decreases or remains stable. We investigated secular trends of bone density from 2008 to 2017 among different age groups of postmenopausal women.

METHODS

We analyzed BMD data obtained from health check-ups of 4,905 postmenopausal women during three survey cycles from 2008 to 2017. We divided them into 3 groups by age (50-59 years, 60-69 years, and 70 years or more) and observed the transition of lumbar and femoral BMD in each group, before and after adjusting for variables that may affect BMD.

RESULTS

Age-adjusted BMD, bone mineral content (BMC), and T-score demonstrated a declining trend over the survey period at lumbar spine (-2.8%), femur neck (-3.5%) and total femur (-4.3%), respectively. In the analysis for the age groups, the BMD, BMC, and T-score presented linear declining trend (-6.1%) in younger postmenopausal women while women aged over 70 or more showed linear increasing trends (+6.3%) at lumbar spine during the survey period. Femoral neck and total femur BMD demonstrated a declining linear trend only in the 50-59 and 60-69 years groups (-5.5%, -5.2%, respectively), but not in the 70 years or more group.

CONCLUSION

BMD in younger postmenopausal women has decreased considerably but has increased or plateaued in elderly women. This discordance of BMD trends among different age groups may contribute to decreased incidence of osteoporotic fracture despite a recent declining BMD trend in postmenopausal women.

Fourier-Transform Infrared Spectroscopy as a Screening Tool for Osteosarcopenia in Community-Dwelling Older Women

Osteosarcopenia is a complex geriatric syndrome characterized by the presence of both sarcopenia and osteopenia/osteoporosis. This condition increases rates of disability, falls, fractures, mortality, and mobility impairments in older adults. The purpose of this study was to analyze the Fourier-transform infrared (FTIR) spectroscopy diagnostic power for osteosarcopenia in community-dwelling older women (n = 64; 32 osteosarcopenic and 32 non-osteosarcopenia). FTIR is a fast and reproducible technique highly sensitive to biological tissues, and a mathematical model was created using multivariate classification techniques that denoted the graphic spectra of the molecular groups. Genetic algorithm and support vector machine regression (GA-SVM) was the most feasible model, achieving 80.0% of accuracy. GA-SVM identified 15 wave numbers responsible for class differentiation, in which several amino acids (responsible for the proper activation of the mammalian target of rapamycin) and hydroxyapatite (an inorganic bone component) were observed. Imaging tests and low availability of instruments that allow the observation of osteosarcopenia involve high health costs for patients and restrictive indications. Therefore, FTIR can be used to diagnose osteosarcopenia due to its efficiency and low cost and to enable early detection in geriatric services, contributing to advances in science and technology that are potential "conventional" methods in the future.

Model Selection and Identification of Osteoporosis Risk Factors in Women to Improve Their Healthcare

Osteoporosis is characterized by low bone mineral density leading to enhanced bone fragility and a consequent increase in fracture risk. The focus of this case-control study was to identify significant socioeconomic risk factors of osteoporosis in Pakistani women and examine how the risk increases for different levels of risk factors. A case-control study was conducted from November 2018 to August 2019 in two main hospitals in Faisalabad, Pakistan. Multiple logistic regression was used to explore the significant risk factors of osteoporosis and how the risk increases in cases (cases = 120) as compared to the control group (controls = 120) in the presence of these risk factors. The mean age ± standard deviation for cases and controls was 59.62 ± 10.75 and 54.27 ± 10.09, respectively. The minimum and maximum ages were 36 and 80 years, respectively. In addition to age, bone fracture, family history, regular physical activity, family size, use of meat, type of birth, breastfeeding, premature menopause, loss of appetite, and use of anticoagulants were significant risk factors with p-values less than 0.05. The risk prediction model with significant risk factors was a good fit with a p-value of 0.28, corresponding to the Hosmer-Lemeshow test value (χ2 = 9.78). This parsimonious model with Cox-Snell R2 = 0.50 (with a maximum value = 0.75) and Nagelkerke R2 = 0.66 showed an AUC of 0.924 as compared to the full model with all risk factors under study that exhibited an AUC of 0.949.

Controlling Nutritional Status score and postmenopausal osteoporosis

OBJECTIVE

This study investigated the association between CONUT score and postmenopausal osteoporosis.

METHODS

Postmenopausal women who were seen at an outpatient clinic in a tertiary hospital for routine gynecologic examination between January 2017 and June 2022 were included in the study. Based on their T-scores, a total of 423 women were divided into two groups. Group 1 included 216 women with osteoporosis (T-score < -2.5 SD), and group 2 included 207 women with normal bone mineral density (T-score > -1 SD). The formula for the CONUT score corresponds to collection of scores from albumin, total cholesterol, and total lymphocyte count. Higher scores indicate poorer nutritional control.

RESULTS

Mean age and mean age at menopause were similar in both groups. The duration of menopause, however, was higher in the women with osteoporosis (11.55 ± 6.82 vs 9.202 ± 6.14 y, P < 0.001). The 25-hydroxy vitamin D level was low in both groups. Body mass index of women with normal bone mineral density was higher than that of women with osteoporosis (31.54 ± 4.19 vs 28.52 ± 4.43 kg/m 2 , P < 0.001). The CONUT scores of the two groups were calculated and found to be higher in women with osteoporosis (3.180 ± 1.804 vs 0.391 ± 0.687, P < 0.001). According to the receiver operating characteristic curve analysis of the CONUT score for predicting osteoporosis, the area under the curve was calculated as 0.932, with a sensitivity of 86.6% and a specificity of 91.1% ( P < 0.001).

CONCLUSIONS

Diet plays an important role in the development of osteoporosis. In this study, it was shown that there is a relationship between CONUT score and osteoporosis.

The risk factors for subsequent fractures after distal radius fracture

INTRODUCTION

The purpose of this study was to evaluate the risk factors for subsequent fractures after distal radius fracture (DRF).

MATERIALS AND METHODS

We retrospectively reviewed 705 patients with DRF who performed dual-energy X-ray absorptiometry within six months before or after the DRF and followed more than 12 months. We identified patients with subsequent fractures and multivariate logistic regression analyses were conducted with demographic information, underlying disease status, and bone fragility parameters at the time of DRF to evaluate the risk factors for subsequent fractures.

RESULTS

Subsequent fractures occurred in 56 patients (7.9% of 705 patients) with 65 fractures at a mean time of 33.5 months after DRF. In multivariate logistic regression analysis, older age (OR 1.032; 95% CI, 1.001-1.064, p = 0.044), diabetes mellitus (DM) (OR 2.663; 95% CI, 1.429-4.963, p = 0.002) and previous fracture history (OR 1.917; 95% CI, 1.019-3.607, p = 0.043), and low total hip BMD (OR 1.410; 95% CI, 1.083-1.836, p = 0.011) were significant risk factors for the occurrence of subsequent fractures.

CONCLUSION

This study demonstrated that older age, DM, previous fracture history and low hip BMD are the risk factors for subsequent fractures after DRF. Active glycemic control would have a role in patients with DM and a more aggressive treat-to-target approach may be necessary for patients with low BMDs to prevent subsequent fractures after DRF.

Fragility fracture systems, Latin America perspective

Osteoporosis is a worldwide epidemic, affecting an average of 30% to 50% of those over 50 years of age in Latin America. Resulting from it is another epidemic, that of fragility fractures, which adversely affects morbidity and mortality of this population. Increasing in their incidence, fragility fractures are expected to occur in 1 in 3 women and 1 in 5 men over 50years of age during their lifetimes. Currently, there are diagnostic and management guidelines for fragility fractures in Latin American countries, especially those for hip and spine fractures. In general, in Latin America, the quality indicators and standards for the care of these fractures vary greatly according to the health system, being suboptimal in many situations. The organization of health services is different in the different countries throughout Latin America. Common underlying characteristics, however, include the distinctions that exist in care between public and private medicine and the lack of economic resources directed to public healthcare systems from the national levels. Several important changes have been implemented in recent years, with the collaboration between national organizations and international associations such as the Fragility Fracture Network and the International Osteoporosis Foundation, aimed at improving quality standards in care and rates of morbidity and mortality in patients treated thorough fragility fracture programs. The underregistration in these programs and absence of formal national registries also contribute to a lack of recognition of the size, scope, and severity of the problem.

Secular trends in hip fractures in adults over 50 years old: a retrospective analysis of hospital admissions to the Brazilian Public Health System from 2004 to 2013

This was a retrospective observational study to determine the secular trends in osteoporosis hip fractures in Brazil from 2004 to 2013. The fracture rates were stable for both sexes, and there was not a secular trend. Fractures were predominant in the South and Southeast Regions. The hip fracture rate was lower in this study than in other studies. These regional differences may be considered in the FRAX Brazil calibration.

PURPOSE

Hip fractures are well-known osteoporotic fractures with high mortality and morbidity. Epidemiological studies in Brazil on hip fractures are scarce, and the great majority have been performed in small populations from a few cities. None of these studies has analyzed the long-term hip fracture secular trends, which are important data for the promotion of public health actions.

METHODS

This was a retrospective observational study with a secular trend analysis in patients over 50 years old who were admitted to the Brazilian Public Health System from 2004 to 2013. We collected hospitalization data according to the ICD-10 for low-trauma hip fractures. The fracture rate was calculated when the patients were stratified by sex, age, and geographic region, and linear regression analysis was performed to evaluate the secular trends.

RESULTS

The hip fracture rate per 100,000 inhabitants was 59.69; the rate was 74.72 in females and 42.95 in males. The fracture rates were higher in the South and Southeast Regions and steadily increased with age, and the average ratio of women-to-men was 1.74. No secular trend was detected in the overall population. Surprisingly, the secular trend only increased in the South region from 2004 to 2013, and the secular trends were stable in the other regions.

CONCLUSION

Although the secular trend was similar to some worldwide studies, the hip fracture rate was lower than that previously observed in regional studies in Brazil. These regional differences may be considered in the FRAX Brazil calibration.

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.

Incidence of fractures in women in the post-menopause: a cohort study in primary care in southern Brazil

The incidences of total fracture, major fracture, and hip fractures in primary care in Southern Brazil were 22.3, 15.0, and 3.3 per 1000 person/year. The FRAX algorithm showed an adequate discriminatory capacity for the identification of these fractures.

OBEJECTIVE

Few studies are evaluating the incidence of fractures in Latin America and Brazil. This study aimed to estimate the incidence of bone fractures in postmenopausal women seen in primary care and evaluate the FRAX algorithm's performance in these women.

METHODS

A cohort study was carried out in the municipality of Santa Maria, Southern Brazil. Postmenopausal women aged 55 years and over who attended primary health care were included. The recruitment period was from March 1 to August 31, 2013, and the participants were followed for 5 years. The fracture risk was calculated using the FRAX algorithm. The reported incident fractures were confirmed by imaging studies or surgical reports.

RESULTS

Of the 1057 women recruited for the study, 854 were followed. They contributed to 2732 person/year. The mean follow-up time was 3.2 years (SD 1.05). The incidences of total fractures, major fractures, and hip fractures were 22.3, 15.0, and 3.3 per 1000 person/year. The most frequent fracture sites were the wrist, shoulder, and ribs. The fracture predictors were rheumatoid arthritis, previous fracture, and the use of glucocorticoids. The discriminatory capacity of incident fractures calculated by FRAX without the inclusion of BMD was AUC 0.730 (95% CI 0.570, 0.890) for hip fracture and AUC 0.691 (95% CI 0.598, 0.784) for major fractures.

CONCLUSION

The FRAX algorithm showed an adequate discriminatory capacity to identify incident fractures in primary care in our study. The incidence of fractures found in our study appears to be lower than that reported in North America and Europe.

Bone density and quality in patients treated with direct-acting oral anticoagulants versus warfarin

INTRODUCTION

Direct-acting oral anticoagulants (DOACs) are therapeutic alternatives to warfarin that act independently of vitamin K, thus not affecting bone matrix formation. The aim of this study was to compare bone mineral density (BMD) and microarchitecture in patients treated with DOACs versus warfarin.

METHODS

Cross-sectional, observational study in patients using oral anticoagulants for >1 year and a paired control group (CG). Based on the type of anticoagulant used, the patients were grouped into a DOAC (DOACG) or warfarin (WG) group. All patients filled out a questionnaire and underwent BMD evaluation and trabecular bone score (TBS) measurement.

RESULTS

In all, 150 patients were included (50 patients in each group). The mean age was 60.49 ± 7.48 years, and most participants were men (64%). The most frequent comorbidities were hypertension, dyslipidemia, and hyperglycemia (comparison between groups p > 0.05). Low bone mass was diagnosed in 42%, 50%, and 66% of the patients in the CG, DOACG, and WG, respectively (p = 0.012). On logistic regression analysis, BMD was associated with body mass index (BMI; odds ratio [OR] 0.846, 95% confidence interval [CI] 0.763-0.926, p = 0.001), creatinine level (OR 0.024, 95%CI 0.001-0.434, p = 0.017), and TBS value (OR 17.777, 95%CI 4.526-96.903, p = 0.000). The mean TBS decreased progressively from the CG to the DOACG and WG (1.328 ± 0.112, 1.264 ± 0.138, and 1.203 ± 0.112, respectively, p < 0.001). On multivariate linear regression, negative predictors of TBS included warfarin use (-0.06, 95%CI -0.11 to -0.02, p = 0.006), BMI (-0.01, 95%CI -0.01 to -0.00, p < 0.001), and hyperglycemia (-0.07, 95%CI -0.11 to -0.03, p = 0.003), while positive predictors were an active IPAQ classification (0.06, 95%CI 0.01-0.11, p = 0.029) and family history of hip fracture (0.07, 95%CI 0.01-0.14, p = 0.029).

CONCLUSION

Patients using anticoagulants have lower BMD and TBS values compared with controls. This negative effect on bone was more pronounced with warfarin, but was also seen with DOACs.

Rehabilitation in Osteoporosis - therapeutic chalenge?

Introduction. Osteoporosis is a disease of the entire skeleton, characterized by decrease bone mass and microarhitectural alterations of bone tissue, which result in increased bone fragility and predisposition to bone fractures. Materials and methods. Accesing standard medical databases: Medline, Embase, Database, Pubmed and the Cochrane Register of Controled Studies to review new pharmacological studies and non-pharmacological terapies in osteoporosis. Statistical analysis performed from the data extracted from the observation sheets from June 2019 to December 2019 by Dr. Liliana Stanciu. Results and discussions. The complex balneo-physical-kinetic treatment is an important link in the treatment of the disabling pathology for the patient, with an important clinical resonance. Conclusion. Osteoporosis is a pathology that decreases the patient’s quality of life. There are complementary therapies to pharmacological treatment with immediate and long lasting results. Keywords: mud, osteoporosis, balneal, hormones,

Factors associated with bone mineral density in adults: a cross-sectional population-based study

OBJECTIVE

This study aimed to analyze the association between lumbar spine, femoral neck, total hip bone mineral density (biophysical bone health assessment parameter), and sociodemographic, anthropometric, behavioral, and health condition factors in Brazilian adults.

METHOD

This is a cross-sectional, population-based study performed with individuals of both genders, aged between 20 and 59 (n=701). The dependent variables were evaluated by Dual Energy X-ray Absorptiometry. The independent variables were evaluated through a questionnaire, anthropometric evaluation and blood collection. The association between bone mineral density and the independent variables was evaluated by linear regression analysis. All analyses were stratified by gender.

RESULTS

Men presented higher bone mineral density than women. Bone mineral density was inversely associated with age range and directly associated with nutritional status in both genders and in the three bone sites analyzed. In addition, 25 Hydroxyvitamin D deficient status among men and contraceptive use among women were associated with lower bone mineral density, and a significant association was only found with lumbar spine bone mineral density in women.

CONCLUSION

The factors associated with bone health among men were age, skin color, nutritional status, and vitamin D status. For women, the associated factors with bone health were age, skin color, nutritional status and contraceptive use.

Balancing Altered Calcium Metabolism with Bone Health in Sarcoidosis

Abnormal calcium metabolism in sarcoidosis patients can lead to hypercalcemia, hypercalciuria, and kidney stones. Hypercalcemia in sarcoidosis is usually due to increased activity of 1α-hydroxylase in macrophages of pulmonary granulomata, resulting in low levels of 25-hydroxyvitamin D and high levels of calcitriol. Vitamin D supplementation may be dangerous for some sarcoidosis patients and is recommended only for those with decreased 25-hydroxyvitamin D and reduced or normal calcitriol level. Diagnosis, treatment of osteoporosis, and maintenance of bone health are complex issues for sarcoidosis patients. An approach to diagnosis and treatment of bone fragility is presented.

INDICATORS OF MORBIDITY AND MORTALITY BY FEMUR FRACTURES IN OLDER PEOPLE: A DECADE-LONG STUDY IN BRAZILIAN HOSPITALS

OBJECTIVE

To evaluate the profile of femur fractures in older adults in Brazil between 2008 and 2018.

METHODS

Population-based time series study with data from the Department of Informatics of the Unified Health System (Datasus), including 480,652 hospitalizations, of adults from 60 years and over, with hip fracture (ICD10-S72).

RESULTS

There was an increase of 76.9% in the hospitalization register (mean 5.87%/year) and an average incidence rate of 19.46 fractures for every 10,000 older adults. In total, 68% of hospitalizations were female, 28% from São Paulo. The average length of stay was 8.9 days, being higher in the Northern Region (11.8) and in the Federal District (18.7). Average mortality rate was 5%, being higher in men (5.45%) and over 80 years old. Northeast Region had the lowest mortality rate (3.54%). Southeast Region had the highest rate (5.53%). Total cost of hospitalizations was R$ 1.1 billion, with an average of R$ 100 million/year. Average cost per hospitalization was higher in the Southern Region (R$ 2,491.00).

CONCLUSION

Femoral fracture is an important cause of mortality among older adults, with a higher incidence in women but higher mortality in men, with high cost to the system and regional differences. Level of Evidence II, Economic and decision analyses - developing an economic or decision model.

The effect of bone cement distribution on clinical efficacy after percutaneous kyphoplasty for osteoporotic vertebral compression fractures

To evaluate the influence of various distributions of bone cement on the clinical efficacy of percutaneous kyphoplasty (PKP) in treating osteoporotic vertebrae compression fractures.A total of 201 OVCF patients (30 males and 171 females) who received PKP treatment in our hospital were enrolled in this study. According to the characteristic of cement distribution, patients were divided into 2 groups: group A ("H" shaped group), the filling pattern in vertebral body were 2 briquettes and connected with / without cement bridge; and group B ("O" shaped group), the filling pattern in vertebral body was a complete crumb and without any separation. Bone mineral density, volume of injected cement, radiographic parameters, and VAS scores were recorded and analyzed between the 2 groups.All patients finished at least a 1-year follow-up and both groups had significant improvement in radiographic parameters and clinical results. No significant differences in BMD, operation time, bleeding volume, or leakage of cement were observed between the 2 groups. Compared with group B, group A had a larger use of bone cement, lower proportion of unipedicular approach, and better VAS scores at 1 year after surgery.Both "H" and "O" shaped distribution pattern can improve radiographic data and clinical outcomes effectively. However, "H" shaped distribution can achieve better clinical recovery at short-term follow-up.

Diagnosis of osteoporosis in statin-treated patients is dose-dependent

Objective

Whether HMG-CoA-reductase inhibition, the main mechanism of statins, plays a role in the pathogenesis of osteoporosis, is not entirely known so far. Consequently, this study was set out to investigate the relationship of different kinds and dosages of statins with osteoporosis, hypothesising that the inhibition of the synthesis of cholesterol could influence sex-hormones and therefore the diagnosis of osteoporosis.

Methods

Medical claims data of all Austrians from 2006 to 2007 was used to identify all patients treated with statins to compute their daily defined dose averages of six different types of statins. We applied multiple logistic regression to analyse the dose-dependent risks of being diagnosed with osteoporosis for each statin individually.

Results

In the general study population, statin treatment was associated with an overrepresentation of diagnosed osteoporosis compared with controls (OR: 3.62, 95% CI 3.55 to 3.69, p<0.01). There was a highly non-trivial dependence of statin dosage with the ORs of osteoporosis. Osteoporosis was underrepresented in low-dose statin treatment (0–10 mg per day), including lovastatin (OR: 0.39, CI 0.18 to 0.84, p<0.05), pravastatin (OR: 0.68, 95% CI 0.52 to 0.89, p<0.01), simvastatin (OR: 0.70, 95% CI 0.56 to 0.86, p<0.01) and rosuvastatin (OR: 0.69, 95% CI 0.55 to 0.87, p<0.01). However, the exceeding of the 40 mg threshold for simvastatin (OR: 1.64, 95% CI 1.31 to 2.07, p<0.01), and the exceeding of a 20 mg threshold for atorvastatin (OR: 1.78, 95% CI 1.41 to 2.23, p<0.01) and for rosuvastatin (OR: 2.04, 95% CI 1.31 to 3.18, p<0.01) was related to an overrepresentation of osteoporosis.

Conclusion

Our results show that the diagnosis of osteoporosis in statin-treated patients is dose-dependent. Thus, osteoporosis is underrepresented in low-dose and overrepresented in high-dose statin treatment, demonstrating the importance of future studies’ taking dose-dependency into account when investigating the relationship between statins and osteoporosis.

Significant association factors of bone mineral density in Taiwan adults

Objective:

To examine the biofactors associated with bone mineral density (BMD) in southern Taiwanese adults.

Materials and Methods:

The medical records of 3242 adults who underwent health examinations between June 2014 and February 2018 at a regional hospital in southern Taiwan were reviewed. The data collected included health history, anthropomorphic characteristics, clinical laboratory results, biochemical parameters, and BMD. The data were used to identify the biofactors associated with BMD/T-scores at the lumbar spine and femoral neck by multivariate linear regression analysis with the stepwise method.

Results:

The mean age of the patients was 58.1 years, and 71.4% were male. Factors positively correlated with BMD and the T-score included body mass index (BMI), male gender, calcium, and creatinine. Age, alkaline phosphatase (ALP), triiodothyronine, serum thyroxine, low-density lipoprotein cholesterol, and a history of hyperlipidemia were negatively correlated with BMD and the T-score.

Conclusion:

The associated biofactors reported here were similar to and had similar relationships as the biofactors identified in previous literature reports. Not all of the sites examined for BMD were influenced by the same association factors, except for BMI, male gender, age, and ALP, implying that the bone remodeling processes that shape BMD involve a complex regulatory network and demonstrating that our extracted factors are the most useful for clinical practice.

Time since menopause, but not age, is associated with increased risk of osteoporosis

Objectives: This study aimed to determine whether estrogen deficiency is a sole risk factor for osteoporosis or is also associated with age, through indicators such as gender, age, and time since menopause. Methods: A cross-sectional study was conducted evaluating 938 postmenopausal women who underwent bone mineral densitometry. We collected the following data: age, ethnic group, body mass index, smoking, and time since menopause. These data were correlated to the presence of osteoporosis, according to the T-score of the femur and lumbar spine. Results: The prevalence of osteoporosis was 37.8%. Ethnic group (p = 0.47) and smoking habits (p = 0.19) were not associated with osteoporosis. In the group of women with osteoporosis, mean age was significantly higher (p < 0.001), mean body mass index was significantly lower (p < 0.001), and time since menopause was significantly higher (p < 0.001) than in the group of women with no osteoporosis. After multivariate analysis was performed, the only variables that remained independently associated with osteoporosis were body mass index and time since menopause. Higher body mass index was a protective factor (odds ratio = 0.80 [95% confidence interval 0.76; 0.84], p < 0.001). Time since menopause represented a risk factor for osteoporosis (odds ratio = 1.04 [1.02; 1.06], p < 0.001). When divided into categories, the risk increased after 20 years of menopause and gradually every 5 years. Conclusion: Time since menopause and body mass index were the most important factors associated with osteoporosis, confirming that estrogen deficiency, and not age, is the major cause of the disease.

High Bone Mineral Density of the Lumbar Spine Is Positively Associated with Breast Cancer

Objective

The objective of this study was to verify possible associations between bone mineral density (BMD) and breast cancer in recently diagnosed women in the Brazilian Mid-west region, considering the menopausal status of patients.

Methods

A case-control study was conducted with 142 cases of breast cancer and 234 controls matched by for age, body mass index (BMI), and menopausal status (pre- and postmenopause), performed in a university hospital in the Brazilian Mid-west. Lumbar spine (L1–L4), femoral neck, and total femur BMD were measured by the dual-energy X-ray absorptiometry (DXA) method. For association, a logistic regression analysis was used.

Results

Women in the highest lumbar spine BMD quartile presented had a higher chance of developing breast cancer (OR = 2.31; 1.02–5.25; p = 0.045), after adjusting for the confounding variables. Nonetheless, there were no statistically significant differences in the association between pre- and postmenopause in that quartile and breast cancer.

Conclusions

High lumbar spine BMD was positively associated with breast cancer in the total sample. In evaluating the BMD of the femoral neck and total femur, such an association was not observed.

A scorecard for osteoporosis in four Latin American countries: Brazil, Mexico, Colombia, and Argentina

The state of osteoporosis care in Latin America is not well known. The results of our scorecard indicate an urgent need to improve policy frameworks, service provision, and service uptake for osteoporosis in Brazil, Mexico, Colombia, and Argentina. The scorecard serves as an important marker to measure future progress.

PURPOSE

We developed a scorecard to summarize key indicators of the burden of osteoporosis and its management in Brazil, Mexico, Colombia, and Argentina. The goal of the scorecard is to reduce the risk of osteoporotic fractures by promoting healthcare policies that will improve patient access to timely diagnosis and treatment.

METHODS

We conducted a systematic review of osteoporosis. We also interviewed several key opinion leaders to gather information on government policy, access to fracture risk assessments, and access to medications. We then leveraged a peer-reviewed template, initially applied to 27 European countries, to synthesize the information into a scorecard for Latin America. We presented information according to four main categories: burden of disease, policy framework, service provision, and service uptake and used a traffic light color coding system to indicate high, intermediate, and low risk.

RESULTS

The systematic review included 108 references, of which 49 were specific to Brazil. The number of osteoporotic fractures in Brazil, Mexico, Colombia, and Argentina was forecasted to increase substantially (34% to 76% in each country) from 2015 to 2030. In general, policy frameworks, service provision, and service uptake were not structured to support current patients with osteoporosis and did not account for the future increases in fracture burden. Across all four countries, there was inadequate access to programs for secondary fracture prevention and only a small minority of patients received treatment for osteoporosis.

CONCLUSIONS

Osteoporosis management, including the rate of post-fracture care, is very poor in Brazil, Mexico, Colombia, and Argentina and needs to be strengthened. Improvements in the rates of care are necessary to curb the debilitating impact of osteoporotic fractures on patients and health systems.

Lack of association between dietary inflammatory index and low impact fractures in the Brazilian population: the Brazilian Osteoporosis Study (BRAZOS)

INTRODUCTION

Adequate nutrition, including intake of dietary calcium and vitamin D, is important to maintain bone health. Evidence suggests that a deficiency in micronutrients may contribute to bone loss during aging and exert generalized effects on chronic inflammation. Recently, the Dietary Inflammatory Index (DII) was developed to assess the inflammatory potential of individual diets. Our aim was to evaluate the DII in a representative sample and verify its association with low-impact fractures.

METHODS

Individuals from The Brazilian Osteoporosis Study (BRAZOS) database had their DII calculated. BRAZOS is an important cross-sectional epidemiological study carried out with a representative sample of men and women ≥40 years old. The research was conducted through in-home interviews administered by a trained team. Nutrition Database System for Research (NDSR) software was used to analyze data on the intake of nutrients, which were employed to calculate the DII using Statistical Analysis Software (SAS®) and Statistical Package for the Social Sciences (SPSS®) to assess its association with low-impact fractures.

RESULTS

A total of 2269 subjects had their DII score calculated using information from 24-h recall data. Males had lower DII than females (DII = 1.12 ± 1.04 vs DII = 1.24 ± 0.99, p = 0.012). Women taking statins had lower DII (DII = 0.65 ± 1.14 vs DII + 1.26 ± 0.98, p = 0.002), indicating a greater potential for diet-related anti-inflammatory effects.

CONCLUSION

Our findings suggest that women might have a pro-inflammatory diet pattern compared to men. However, we did not find any association between DII scores and low-impact fractures.

Disease burden of fractures among patients with osteoporosis in Japan: health-related quality of life, work productivity and activity impairment, healthcare resource utilization, and economic costs

Osteoporosis remains undertreated in Japan, and bone fractures are the most frequent complications imposing heavy burden on individuals and the community. This paper investigates the clinical and economic burden of fractures among osteoporosis patients in Japan. The Japan National Health and Wellness Survey 2012-2014 database was used for analysis. Respondents aged ≥ 50 years and indicated a physician diagnosis of osteoporosis (N = 1107) were categorized into three subgroups: no prior fracture (N = 693), single fracture (N = 242), and multiple (≥ 2) fractures (N = 172). Health-related quality of life (HRQoL), work productivity and activity impairment, healthcare resource utilization and associated direct and indirect costs were compared across three fracture subgroups adjusting for respondents' sociodemographic and clinical characteristics using generalized linear regression models. The estimated fracture prevalence among respondents with osteoporosis who were ≥ 50 years was 37.4%, of whom 41.5% had multiple fractures. Relative to osteoporosis respondents with no fracture and with single fracture, those with multiple fractures reported significant higher disability in HRQoL, more healthcare resource utilization, and were associated with higher direct costs. Improved treatment of fractures among osteoporosis patients is necessary and may help reduce the clinical and economic burden in this osteoporosis population.

Influence of Smoking on Bone Mineral Density in Elderly Men

Background:

Smoking has deleterious effects on bone mass and is associated with the subsequent development of osteoporosis, particularly in elderly participants. The purpose of this study was to determine the influence of smoking in the elderly male smokers.

Methods:

All male participants aged 60 years and older of the Amirkola cohort who performed bone densitometry entered the study. Bone mineral density (BMD) was measured at the lumbar spine (LS) and femoral neck (FN) using the dual-energy X-ray absorptiometry method. In statistical analysis, the smokers and nonsmokers were compared according to BMD, frequency of low bone mass defined as BMD T-score <−1 at either LS or FN, and the number of bone fractures. SPSS software version 18 was used for analysis.

Results:

A total of 203 smokers with mean smoking duration of 21.67 ± 17.7 years and the mean number of 36.4 + 15.8 cigarettes per day were compared with 408 nonsmokers. The mean BMD values in LS (0.90 ± 0.14 vs. 0.94 ± 0.19) and FN section (0.87 ± 0.13 vs. 0.89 ± 0.15) and also the frequency of bone fractures were significantly lower, and the frequency of low bone mass at either LS and FN was significantly higher in smokers (P = 0.014, 0.038, 0.003, and 0.004, respectively). In multiple logistic regression analysis, smoking was independently associated with low bone mass by odds ratio of = 2.27 (95% confidence interval: 1.49–3.44).

Conclusions:

These findings indicate a significant association between low bone mass and bone fracture at either LS or FN in the elderly male smokers.

Could obesity be considered as risk factor for non-vertebral low-impact fractures?

BACKGROUND

It has long been established that obesity plays a positive role against osteoporosis (OP) and low-impact fractures (Fx). However, more recent data has shown higher fracture risk in obese individuals. The aim of this study was to investigate the association between BMI, particularly obesity, OP and low-impact Fx in Brazilian women, as well as to evaluate the SAPORI (Sao Paulo Osteoporosis Risk Index) tool performance to identify low BMD according BMI category.

METHODS

A total of 6182 women aged over 40 years were included in this cross-sectional analysis using data from two large Brazilian studies. All participants performed hip and spine bone mineral density (BMD) measurements and answered a detailed questionnaire about the presence of clinical risk factors (CRFs) related to low BMD and risk fractures. The World Health Organization (WHO) criteria were used to define obesity.

RESULTS

Age-adjusted osteoporosis prevalence was 20.8, 33.6, 47 and 67.1% in obese, overweight, normal and underweight category, respectively. Obesity was present in 29,6% (1.830 women) in the study population and the likelihood of osteoporosis and low-impact Fx compared to a normal BMI in this subgroup was of 0.24 (95% CI 0.20-0.28; p < 0.001) and of 1.68 (95% CI 1.35-2.11; p < 0.001), respectively. However, the hip Fx likelihood was lower in obese compared with non-obese women (OR = 0.44; 95% CI 0.20-0.97). Using an originally validated cut-off, the SAPORI tool sensitivity was significantly hampered in overweight and obese women although the accuracy had remained suitable because of increasing in specificity.

CONCLUSIONS

The osteoporosis prevalence reduced as BMI increased and obesity was associated with low-impact Fx, regardless of the BMD measurements. Moreover, the SAPORI performance was impaired in obese women.

A modification and validation of quantitative morphometry classification system for osteoporotic vertebral compressive fractures in mainland Chinese

This study described a modified quantitative morphometry (mQM) system adapted to specific reference values for Mainland Chinese population. The mQM system is validated using the Genant Semiquantative system and is sensitive for detecting vertebral height changes and predicting cement leakage after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compressive fracture (OVCF).

INTRODUCTION

OVCF is a manifestation of osteoporosis. To improve clinical management of osteoporosis, the quantitative morphometry (QM) system has been widely used for the early diagnosis and precise classification of OVCF in developed countries. Here, we present an mQM system and validated its use in detecting OVCF in Mainland Chinese.

METHODS

Using our mQM system, the pre- and post-operative values of vertebral heights were measured and evaluated in 309 Mainland Chinese who received percutaneous kyphoplasty (PKP) as OVCF treatment. Measurements and classification of fractures from the mQM system were validated by comparing to values obtained by the Genant semiquantative (SQ) method. Moreover, we evaluated the sensitivity of the mQM system by its ability to detect restoration of vertebral heights and predict cement leakage after PKP.

RESULTS

The five classification of fractures, No deformity (ND), anterior wedge (AW), posterior wedge (PW), biconcavity (BC), and compression (CP), evaluated by the mQM method shared similar distribution characteristics compared to those obtained by the SQ method. In addition, mQM evaluation showed that the vertebra height of all fracture types showed significant restoration after PKP. The incidence of cement leakage was most common in CP (37.5%), followed by AW (31.6%), BC (26.5%), ND (23.7%), and PW (0.0%).

CONCLUSIONS

Our mQM system is suitable for classification of fractures, detection of vertebral height restoration, and correlation of cement leakage after PKP in Mainland Chinese population.

Bone densitometry status and its associated factors in peri and post menopausal females: A cross sectional study from a tertiary care centre in India

OBJECTIVE

Osteoporosis is a skeletal disorder characterized by diminished bone strength that increases the risk of fracture at instances of trivial trauma. Asians have a lower bone mass than the west. The present study was designed to add data from India on women above the age of 40 years with respect to low bone mineral density (BMD) and its associated high risk factors.

MATERIALS AND METHODS

After a written informed consent, a detailed history was taken. Basal metabolic index was recorded, and biochemical and endocrine tests were done, followed by dual X ray absorptiometry scan.

RESULTS

Average age of the study population was 46.54 years and BMI 26.58. The prevalence of osteopenia in the study was 36%, and that of osteoporosis, 4%; the overall prevalence of low BMD being 40%. Proportion of women with low BMD increased with advancing age and menopausal status. On endocrine evaluation, 53.44% cases with insufficient vitamin D, 62.5% with hyperparathyroidism, 100% with hypothyroidism, 75% with hyperthyroidism suffered from low BMD. Among chronic diseases, 75% women with diabetes, 33.3% with hypertension, 25% with deranged liver function and 50% with rheumatoid arthritis were found to have low BMD. 46.75% women with sun exposure less than one hour daily had poor bone mineralization. The proportion of women with normal BMD decreased from 84.09% to 43.33% with decrease in daily physical work. On logistic regression analysis, insufficient serum vitamin D concentrations, less physical work and inadequate sun exposure were found to be significantly associated with low BMD.

CONCLUSION

Low BMD is not a disorder confined to postmenopausal women alone. It is widely prevalent in women above 40 years of age. Screening women above 40 in the absence of any high risk factors has the potential of nipping this silent killer in the bud.

Multifactorial assessment of the risk of falls in low bone density older women

Abstract Introduction: Identifying effective assessment instruments for predicting falls, specifically in older women with low bone mineral density (BMD) that are more susceptible to fractures remains a challenge. Objective: To evaluate risk factors for falls at baseline, to identify the falls occurrence over six months of follow-up and to investigate the predictive validity of the Quickscreen Clinical Falls Risk Assessment for predicting multiple falls among low BMD older women. Methods: A methodological study with 110 older women with diagnosis of osteoporosis or osteopenia (70.26 ± 6.24 years). The presence of two or more of the eight risk factors assessed by the QuickScreen characterized the risk of falling (baseline) and monthly phone calls identified the occurrence of falls during the six months of follow-up. Results: The most prevalent falls risk factors were self-reported previous falls, polypharmacy and impairment in shifting weight and lateral instability. Most of the older women (67.3%) had two or more risk factors, 24.5% reported a single fall and 13.6% reported multiple falls over the six months. The QuickScreen (cutoff ≥ 2 risk factors) showed good sensitivity (73.3%) and high negative predictive value (88.89%) for predicting multiple falls among low BMD older women. Conclusions: The results indicated a high frequency of falls among low BMD older women. Additionally, the results highlighted that the QuickScreen instrument was able to predict multiple falls in the six months of follow-up among these older women.

Conservative Management of Osteoporotic Vertebral Fractures: A Prospective Study of Thirty Patients

Introduction

Osteoporotic vertebral fractures relate to poorer quality of life and higher long-term mortality. In a resource-poor setup, conservative management assumes great importance as primary means of treatment. We assess the clinico-pathological epidemiology of osteoporotic vertebral fractures and prospectively evaluate the effectiveness of conservative management in their treatment.

Materials & Methods   

Thirty consecutive patients, diagnosed with osteoporotic vertebral fracture, underwent the predetermined protocol of conservative treatment (bed rest, titrated analgesia, antiosteoporosis pharmacotherapy, bracing, and supervised physical therapy) after assessment of basic demographic data and clinical examination. They were evaluated every three months for nine months, using visual analog scale (VAS) for backpain, Oswestry Disability Index (ODI), and radiological and hematological parameters.

Results 

The mean age of the patients was 66.9 +/-7.6 years and the female: male ratio was 14:1. All (100%) women were postmenopausal and the mean time since menopause was 16.75 +/- 8.12 years. The presenting complaints were backpain (100%) and deformity (53.33%). Neurodeficit was noted in one (3.33%) patient. Higher age was correlated to greater vertebral collapse (p=0.001) and higher kyphotic angle (p=0.002). At nine months after treatment, there was a significant decrease in the VAS score (p<0.0001) and the ODI score (p<0.0001), with the final VAS score improving by 49.25% and the ODI score improving by 47.23% from the baseline. There was progressive increase in vertebral collapse (p=0.0474) with no change in kyphotic or scoliotic angles. With treatment there was a consistent increase in serum calcium (p<0.0001), phosphorous (p<0.0001), and vitamin D3 (p<0.0001) levels, and decrease in parathyroid hormone levels (p<0.0001).

Conclusions 

A multidisciplinary conservative treatment is effective as the primary treatment for patients with osteoporotic vertebral fractures. It alleviates pain, decreases disability, reduces morbidity, and is effective in preventing further progression of the disease process clinically, radiologically, and hematologically.

For the first fracture to be the last

Increased longevity has made progression in the number of fractures increasingly significant. Because hip fractures give rise to high morbidity and mortality rates and have high treatment costs, their occurrence is the most important marker of effectiveness in relation to osteoporosis treatment. In countries and systems that, especially over the last decade, have been investing in the prevention of osteoporosis and its consequences, the number of hip fractures has been decreasing. What these countries have in common is secondary prevention of fractures, i.e. to avoid subsequent fractures. Given that half of the patients who present hip fractures have had a previous fracture and that the treatments available have proven to be extremely efficient for decreasing subsequent fractures, a good proportion of hip fractures are preventable. It is within this scenario that orthopedists play a leading role.

Prevalence and Risk Factors of Osteoporosis in Women Referring to the Bone Densitometry Academic Center in Urmia, Iran

BACKGROUND

Osteoporosis is one of the fastest growing health problems around the world. Several factors can affect this silent disease. The current study aimed to determine the prevalence and risk factors of osteoporosis in women in Urmia, a city in northwestern Iran.

METHODS

This cross‑sectional study was performed on 360 non-pregnant women over the age of 15 who referred for bone density testing to the Urmia Imam Khomeini Academic Hospital. Data were collected by questionnaire, and bone mineral density of the femoral neck and lumbar spines L1- L4 was evaluated by dual X-ray absorptiometry.

RESULTS

The total prevalence of osteoporosis in this study was 42.2%; prevalence of osteoporosis among women 45 years old or less was 14.3% and over the age of 45 years was 50.7%. The factors such as level of education, history of bone fracture, disease history (rheumatoid arthritis, diabetes, high blood pressure), gravidity and parity values, duration of lactation (p<0.001), nutrition dimension of lifestyle (p=0.03), and green tea consumption (p=002) showed a statistically significant association with the bone mineral density. According to the regression model, age (OR=1.081), history of bone fracture (OR=2.75), and gravidity (OR=1.14) were identified as significant risk factors for osteoporosis, while the body mass index (OR=0.94) was identified as a protector against osteoporosis.

CONCLUSION

The prevalence of osteoporosis in this study was high, and findings showed that the advancement of age, lifestyle, and reproductive factors (especially gravidity and duration of lactation) were determining factors for osteoporosis .Appropriate educational programs and interventions could help to increase the women's peak bone mass therefore reducing their risk of developing osteoporosis.

Osteoporosis in primary care: an opportunity to approach risk factors

INTRODUCTION

Climacteric women are susceptible to a number of changes, among them osteoporosis. Osteoporosis is a disease characterized by low bone mass and susceptibility to fracture. Currently, this disease is a public health issue, being necessary to recognize its risk factors.

OBJECTIVES

Identify risk factors related to osteoporosis in women attending PROPIS/PROEX/UFMA, tracing a socio-demographic characterization and considering community lifestyles.

MATERIAL AND METHODS

This is a transversal retrospective clinical with a quantitative approach study conducted between March and June 2013 in São Luís-MA with 107 women treated at the Programa de Práticas de Integralidade em Saúde (PROPIS - Integrality Health Practice Program). The study was approved by the University Hospital Ethics Committee of UFMA under opinion no. 362/07. Data were tabulated and analyzed in the epidemiological Epi-Info(®) software, version 3.4.1.

RESULTS

The brown color was predominant, consensual relationships proved to be a protective factor and low education was a risk factor. The average age of the group with menopause was 54.1 years and without menopause was 31.3 years (p<0.0001). The average age of menopause was 43.7 years. The irregular menstrual cycle was a protective factor. The average number of pregnancies was 4.56 for the group with menopause and 2.45 for the group without menopause, with most births occurring normally (p<0.0001). Smoking, physical inactivity and caffeine intake were risk factors, while the absence of alcoholism and of soda intake were protective factors for the disease.

CONCLUSION

The patients followed the socioeconomic and demographic profile of Maranhão. Most had menarche and menopause in appropriate periods, showed no positive family history of osteoporosis, did not usually drink alcohol, were sedentary and the caffeine intake was high.

Influence of AIDS in collagen deposition and thickness of the bone marrow

Bone marrow abnormalities are frequently observed in individuals with AIDS. Dysplasia, the most common abnormality, is found in more than 50% of patients infected with the HIV. The aim of this study was to assess trabecular thickness and collagen content as well as cellularity in the bone marrow of patients with AIDS. Sixty bone marrow samples were collected from the sternum of autopsied patients with or without AIDS (n = 30, each). Cellularity and trabecular thickness was assessed by performing hematoxylin-eosin staining; picrosirius staining was used to evaluate collagen content. Morphometric analyses were performed by using a Zeiss KS300 system (Kontron-Zeiss). Patients with AIDS showed a significant reduction in trabecular bone thickness and an increase in collagen deposition. No statistically significant differences were observed in cellularity between the 2 groups. Therefore, reduced thickness and increased collagen deposition were observed in the trabeculae of the bone marrow of patients with AIDS due to possible interaction between cytokines and bone marrow components.

US White and Black Women Do Not Represent the Bone Mineral Density of Sub-Saharan Black Women

Reference populations from the United States (US) are often used around the world for representative measures of bone mineral density (BMD) by sex, age, and race. We examined BMD in adult black Zimbabwean women and compared it to that of US women (white and black). In a cross-sectional study, we recruited healthy black Zimbabwean women working at Parirenyatwa Hospital regardless of designation, who were not pregnant and had no diseases or medications known to affect BMD. Dual-energy X-ray absorptiometry scans of the left hip and lumbar spine (L1-L4) were performed for each participant by 1 operator, on 1 dual-energy X-ray absorptiometry machine. Results are presented for 289 participants aged 20-69 years, with a mean weight, height, and body mass index (BMI) of 71.7 ± 15.1 cm, 164.9 ± 6.3 kg, and 26.3 ± 5.3 kg/m(2), respectively. At 5% level of significance, age and BMD were weakly associated for the total lumbar spine (p ≤ 0.001) but not for the total hip (p = 0.890) and femur neck (p = 0.062). BMI and weight were positively correlated with BMD for all 3 sites (p ≤ 0.001). Compared to US white women, mean BMD for black Zimbabwean women in this study was 4.5%-7.4% lower for the lumbar spine but 2.0%-4.8% higher for the total hip and 0.2%-10.2% higher for the femur neck for 20-59 years. Compared to US black women, mean BMD for black Zimbabwean women was 9.1%-11.5% lower for the lumbar spine and 1.4%-8.1% lower for the total hip for 20-59 years. Black Zimbabwean women also had lower mean weight and BMI per decade age group as compared to US women. Differences in weight and BMI offer a possible explanation for the differences in BMD between black Zimbabwean women and US white and black women. Including adjustments for body frame when calculating Z-scores may accurately reflect BMD.

Factors affecting bone mineral density in postmenopausal women

This study aimed to determine the relationship between bone mineral density (BMD) and demographic, biochemical, and clinical features according to BMD measurement sites. The results indicated that BMD correlates negatively with menopause duration, parity, and history of fractures but positively correlates with obesity, physical activity, education, and serum ferritin.

PURPOSE/INTRODUCTION

Osteoporosis (OP) is an important cause of morbidity and mortality in the elderly people. The impacts of various factors on bone mineral density (BMD) differ across diverse population. We hypothesized that the influences of factors which affect BMD vary according to BMD measurement sites. The aim of this study was to determine the relationship between BMD in the femoral neck (FN) and lumbar spine (LS) with some common clinical, demographic, and biochemical parameters in postmenopausal women.

METHODS

In this cross-sectional case-control study, all postmenopausal women of the Amirkola Health and Ageing Project (AHAP) who performed bone densitometry were included. BMD at FN and LS was measured by DXA method. Data regarding clinical, demographic, and biochemical characteristics were provided. OP was diagnosed by the International Society for Clinical Densitometry criteria. Pearson correlation and multivariate regression analyses with simultaneous adjustment were performed to determine relationship.

RESULTS

Five hundred thirty-seven women with mean age of 67.9 ± 6.7 years and mean menopause duration (MD) of 15.8 ± 5.1 years were studied. MD correlated negatively with FN-BMD and LS-BMD g/cm(2) (r = -0.405, p = 0.001 and r = -0.217, p = 0.001). Body mass index (BMI) correlated positively with FN and LS-BMD g/cm(2) (r = 0.397, p = 0.001 and r = 0.311, p = 0.001). The association of MD with risk of FN-OP was stronger than LS-OP. Obesity and metabolic syndrome (MS) and higher serum ferritin reduced the risk of OP at both LS and FN similarly, whereas the impacts of parity, prior fracture, high level of education, and physical activity were significantly different across BMD measurement sites.

CONCLUSION

The results of this study indicated a significant association between OP and MD, obesity, parity, MS, history of fracture, serum ferritin, level of education, and physical activity. However, the direction and the strength of association varied across BMD measurement sites.

The relationship between bone mineral density and metabolic syndrome in peri- and post-menopausal Thai women

PURPOSES

To compare the bone mineral density (BMD) measured in the lumbar spine and femoral neck in peri- and post-menopausal Thai women with and without metabolic syndrome, and to determine which contributory factors associated with metabolic syndrome influence BMD.

METHODS

427 peri- or post-menopausal Thai women were screened against the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) for Asian populations' criteria for metabolic syndrome. The BMD of those with and without metabolic syndrome was compared, and potential relationships between the factors associated with metabolic syndrome and BMD were sought.

RESULTS

There was no difference in lumbar spine or femoral neck BMD between the groups (p = 0.605 and 0.415, respectively), but women with central obesity (waist circumference ≥80 cm, p = 0.004 and >88 cm, p = 0.002), low serum high-density lipoprotein cholesterol (HDL-C) concentration (p = 0.011) and a greater number of contributory factors to metabolic syndrome (p = 0.007) had significantly higher BMD at the femoral neck.

CONCLUSIONS

A diagnosis of metabolic syndrome did not correlate with either lumbar spine or femoral neck BMD. However, higher femoral neck BMD was significantly associated with increased waist circumference, low serum HDL-C concentration and the number of contributory factors to metabolic syndrome.

The epidemiology and management of postmenopausal osteoporosis: a viewpoint from Brazil

Brazil has an aging population, with an associated increase in the prevalence of chronic diseases. Postmenopausal osteoporosis is of particular concern because it leads to an increased risk of fractures, with subsequent negative impacts on health in older women. In recent years, efforts have been made to better understand the epidemiology of osteoporosis in Brazil, and to manage both direct and indirect costs to the Brazilian health care system. The reported prevalence of osteoporosis among postmenopausal women in Brazil varies from 15% to 33%, depending on the study methodology and the use of bone densitometry data or self-reporting by participants. A diagnosis of osteoporosis can be made on the basis of fractures occurring without significant trauma or on the basis of low bone mineral density measured by dual energy X-ray absorptiometry. To reduce the risk of osteoporosis, all postmenopausal women should be encouraged to maintain a healthy lifestyle, which includes physical activity and a balanced diet. Smoking and alcohol use should also be addressed. Special attention should be given to interventions to reduce the risk of falls, especially among older women. Calcium intake should be encouraged, preferably through diet. The decision to recommend calcium supplementation should be made individually because there is concern about a possible increased risk of cardiovascular disease associated with this treatment. Brazilian women obtain a minimal amount of vitamin D from their diet, and supplementation is warranted in women with little exposure to solar ultraviolet-B radiation. For women diagnosed with osteoporosis, some form of pharmacologic therapy should be initiated. Compliance with treatment should be monitored, and the treatment period should be individualized for each patient. The Brazilian government provides medication for osteoporosis through the public health system free of charge, but without proper epidemiological knowledge, the implementation of public health programs is impaired.

Risk factors and incidence of repeat osteoporotic fractures among the elderly in Taiwan: a population-based cohort study

The incidence of osteoporotic fracture (OF), a condition that leads to higher morbidity and mortality in the elderly, is increasing yearly worldwide. However, most studies of OF have focused on the epidemiology of initial fractures, mainly in female and white populations. This study aimed to explore the incidence and the risk factors for repeat osteoporotic fracture (ROF) in Taiwan.We performed a retrospective cohort study using the Taiwan National Health Insurance Database (NHIRD) from 1995 through 2011. Individuals aged 65 years or older who experienced an initial OF were included. The patients were followed until death, the end of registration in the NHIRD, ROF occurrence, or the end of the study period (December 31, 2011), whichever occurred first. The incidence of ROF over ≥ 5 years after the initial fracture was analyzed, and the risk factors for ROF were assessed using Cox proportional hazards models. The incidence rates of ROF were 950.5, 321.4, 158.7, 92.8, and 70.2 per 1000 person-years among subjects in their first, second, third, fourth, and fifth years after the initial OF, respectively. Nearly 45% of the subjects sustained a ROF in the first year after OF. ROF risk increased with age and Charlson Comorbidity Index (CCI) score. Greater risk for ROF was observed among female subjects and those who had suffered from hip and vertebral fracture at the first OF, had undergone OF-related surgery, and had received bone-related medications. The incidence of ROF in the Taiwanese elderly is higher during the first year after the initial OF, and ROF risk increases with age, female sex, high CCI score, and in those who have undergone OF-related surgery, sustained hip or vertebral fracture, and used bone-related medications.

[Factors associated with osteopenia and osteoporosis in women undergoing bone mineral density test]

The aim of this study was to determine the prevalence of osteopenia and osteoporosis in a female population, that had bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) in a specialized clinic in the south of Brazil. We conducted a cross-sectional study including 1,871 women that performed scans between January and December 2012. We conducted a logistic regression analysis with all independent variables and outcomes (osteopenia, osteoporosis and fracture risk). According to DXA results, 36.5% of women had normal BMD, 49.8% were diagnosed with osteopenia and 13.7% with osteoporosis. Menopause and age over 50 years old were risk factors for osteopenia and osteoporosis while prior hysterectomy and BMI greater than 25 were protective factors. For the outcome of fracture at any site the risk factors were age over 50 years old, osteopenia and osteoporosis (OR = 2.09, 95% CI:1,28-3, 40) and (OR = 2.49, 95% CI:1,65-3, 74), respectively.

The burden of osteoporosis in Brazil

Osteoporotic fractures impose severe physical, psychosocial, and financial burden both to the patient and the society. Studies on the prevalence of osteoporosis and fragility fractures in Brazil show a wide variation, due to differences in sample size, the population studied, and methodologies. Few studies have been conducted in Brazil about the cost-effectiveness analyses of different intervention options aimed at the diagnosis and treatment of osteoporosis. Investigation and treatment strategies based on cost-effectiveness and scientific evidence are essential in the preparation of public health policies with the ultimate goal of reducing the incidence of fractures and, consequently, the direct and indirect costs associated with them. This article reviews the Brazilian burden of osteoporosis in terms of the prevalence and fractures attributable to the disease, the costs related to the investigation and management, as well as the impact of osteoporosis on the population as a whole and on affected individuals.