Value of Osteoporosis Self-assessment Tools for Asians (OSTA) with or without Brown's clinical risk factors in detection of postmenopausal osteoporosis

Influence of type 2 diabetes microangiopathy on bone mineral density and bone metabolism: A meta-analysis

Background

Diabetic microangiopathy is a type of vascular dysfunction. The effect of type 2 diabetes microangiopathy (DMA) on bone mineral density (BMD) and bone metabolism is still unclear.

Objective

A meta-analysis was performed to investigate the effects of microangiopathy on BMD and bone metabolism in type 2 diabetic patients.

Methods

We searched the PubMed, Embase, Cochrane Library and CNKI databases to identify observational studies investigating the effects of type 2 diabetes microangiopathy on BMD or bone metabolism. The time limit for the literature retrieval was from the establishment of the database to September 25, 2021. The Newcastle–Ottawa scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) scale were used to evaluate the quality of the studies. RevMan 5.3 software was used for the data analysis. Stata 14.0 was used to quantitatively evaluate the publication bias of the outcome indicators.

Results

In total, 12 observational studies were included, including 7 cohort studies, 4 case–control studies and 1 cross-sectional study. In total, 2,500 patients with type 2 diabetes were included. Among them, 1,249 patients had microangiopathy (DMA group), and 1,251 patients did not have microangiopathy (control group). The results of the meta-analysis showed that the BMDs of the femoral neck (SMD = −1.34, 95% CI = −2.22 to −0.45, P = 0.003), lumbar spine (SMD = −0.69, 95% CI = −1.31 to −0.08, P = 0.03) and Ward's triangle (SMD = −2.84, 95% CI = −4.84 to −0.83, P = 0.006) in the DMA group were lower than those in the control group. In the comparison of the bone metabolism indexes, the contents of N-terminal propeptide of type I procollagen (P1NP) (SMD = 0.18, 95% CI = 0.03 to 0.32, P = 0.02), osteocalcin (SMD = 6.97, 95% CI = 3.46 to 10.48, P < 0. 0001), parathyroid hormone (PTH) (SMD = 0.38, 95% CI = 0.03 to 0.73, P = 0.03) and C-telopeptide of type 1 collagen (CTX) (SMD = 0.39, 95% CI = 0.03 to 0.75, P = 0.03) in serum from the DMA group were higher than those in serum from the control group. The serum content of 25-hydroxyvitamin D₃ (25(OH)D₃) (SMD = −0.63, 95% CI = −1.19 to −0.07, P = 0.03) in the DMA group was lower than that in the control group. There was no significant difference in serum alkaline phosphatase (ALP), calcium or phosphorus between the two groups (P > 0.05).

Conclusions

Type 2 diabetes microangiopathy can reduce the lumbar spine, femoral neck and Ward's triangle BMD and has a higher risk of osteoporosis or osteoporosis fractures. The levels of P1NP, PTH, CTX and OC in the serum of patients with type 2 diabetes microangiopathy are higher, and the lower 25(OH)D₃ content may be a mechanism by which DMA destroys bone metabolism balance.

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The effect of type 2 diabetes microangiopathy on bone mineral density and bone metabolism is still unclear.

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Type 2 diabetes microangiopathy can reduce the lumbar spine, femoral neck and Ward's triangle BMD.

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Type 2 diabetes microangiopathy has a higher risk of osteoporosis or osteoporosis fractures.

Performance of the Osteoporosis Self-Assessment Tool for Asians (OSTA) in Screening Osteoporosis Among Middle-Aged and Old Women in the Chengdu Region of China

The purpose of this study was to assess the performance of an osteoporosis self-assessment tool for Asians (OSTA) for screening middle-aged and old healthy women in the Chengdu region of China. OSTA scores were used to evaluate the effect of age on the development of osteoporosis. A total of 15,752 healthy women older than 40 yr, who reside in the Chengdu region, were assigned to 9 age groups divided by 5-yr intervals. Bone mineral density of the lumbar vertebrae, L1-L4, and the left hip was measured with a GE Lunar Prodigy advance dual-energy X-ray absorptiometry system (GE Healthcare, Cincinnati, OH). All subjects were classified into 3 categories according to OSTA cutoff values. The OSTA values used to define the categories were ≥-1, >-4 and <-1, and ≤-4. The accuracy of the OSTA index was compared with T-scores measured by dual-energy X-ray absorptiometry at various skeletal sites. All statistical analyses were performed using SPSS, version 17.0 (SPSS, Inc., Chicago, IL). The detection rate of osteoporosis and osteopenia at the lumbar vertebrae and the femur was found to increase with age. Furthermore, the sensitivity of OSTA value for detection of osteoporosis also gradually enhanced with subject age. In contrast, the specificity gradually decreased with age. The sensitivity and negative predictive value of the OSTA index for detecting osteoporosis gradually increased with higher OSTA cutoff values, and the specificity and positive predictive value appeared to gradually decline. It was concluded that the OSTA is a useful screening tool to detect osteoporosis in middle-aged and old women in the Chengdu region of China. Furthermore, specific OSTA cutoff values should be selected for screening individuals who belong to different age groups.

Systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for osteoporosis or low bone density

We performed a systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for DXA-determined osteoporosis or low bone density. Commonly evaluated risk instruments showed high sensitivity approaching or exceeding 90% at particular thresholds within various populations but low specificity at thresholds required for high sensitivity. Simpler instruments, such as OST, generally performed as well as or better than more complex instruments.

INTRODUCTION

The purpose of the study is to systematically review the performance of clinical risk assessment instruments for screening for dual-energy X-ray absorptiometry (DXA)-determined osteoporosis or low bone density.

METHODS

Systematic review and meta-analysis were performed. Multiple literature sources were searched, and data extracted and analyzed from included references.

RESULTS

One hundred eight references met inclusion criteria. Studies assessed many instruments in 34 countries, most commonly the Osteoporosis Self-Assessment Tool (OST), the Simple Calculated Osteoporosis Risk Estimation (SCORE) instrument, the Osteoporosis Self-Assessment Tool for Asians (OSTA), the Osteoporosis Risk Assessment Instrument (ORAI), and body weight criteria. Meta-analyses of studies evaluating OST using a cutoff threshold of <1 to identify US postmenopausal women with osteoporosis at the femoral neck provided summary sensitivity and specificity estimates of 89% (95%CI 82-96%) and 41% (95%CI 23-59%), respectively. Meta-analyses of studies evaluating OST using a cutoff threshold of 3 to identify US men with osteoporosis at the femoral neck, total hip, or lumbar spine provided summary sensitivity and specificity estimates of 88% (95%CI 79-97%) and 55% (95%CI 42-68%), respectively. Frequently evaluated instruments each had thresholds and populations for which sensitivity for osteoporosis or low bone mass detection approached or exceeded 90% but always with a trade-off of relatively low specificity.

CONCLUSIONS

Commonly evaluated clinical risk assessment instruments each showed high sensitivity approaching or exceeding 90% for identifying individuals with DXA-determined osteoporosis or low BMD at certain thresholds in different populations but low specificity at thresholds required for high sensitivity. Simpler instruments, such as OST, generally performed as well as or better than more complex instruments.