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Nakai Y, Kumagai K, Ino Y, Akiyama T, Moriyama K, Takeda Y, Egashira K, Ohira T, Ryo A, Saito T, Inaba Y, Hirano H, Kimura Y. Use of data-independent acquisition mass spectrometry to identify an objective serum indicator of the need for osteoporotic therapeutic intervention. J Proteomics 2024; 300:105166. [PMID: 38574990 DOI: 10.1016/j.jprot.2024.105166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/21/2024] [Accepted: 03/31/2024] [Indexed: 04/06/2024]
Abstract
Osteoporosis is characterized by weakened bone microstructure and loss of bone mass. Current diagnostic criteria for osteoporosis are based on the T-score, which is a measure of bone mineral density. However, osteoporotic fragility fractures can occur regardless of the T-score, underscoring the need for additional criteria for the early detection of patients at fracture risk. To identify indicators of reduced bone strength, we performed serum proteomic analysis using data-independent acquisition mass spectrometry with serum samples from two patient groups, one with osteoporosis but no fractures and the other with osteopenia and fragility fractures. Collective evaluation of the results identified six serum proteins that changed to a similar extent in both patient groups compared with controls. Of these, extracellular matrix protein 1 (ECM1), which contributes to bone formation, showed the most significant increase in serum levels in both patient groups. An ELISA-based assay suggested that ECM1 could serve as a serum indicator of the need for therapeutic intervention; however, further prospective studies with a larger sample size are necessary to confirm these results. The present findings may contribute to the provision of early and appropriate therapeutic strategies for patients at risk of osteoporotic fractures. SIGNIFICANCE: This study aimed to identify objective serum indicators of the need for therapeutic intervention in individuals at risk of osteoporotic fracture. Comprehensive proteome analyses of serum collected from patients with osteoporosis but no fractures, patients with osteopenia and fragility fractures, and controls were performed by data-independent acquisition mass spectrometry. Collective evaluation of the proteome analysis data and ELISA-based assays identified serum ECM1 as a potential objective marker of the risk of fragility fractures in patients with osteoporosis or osteopenia. The findings are an important step toward the development of appropriate bone health management methods to improve well-being and maintain quality of life.
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Affiliation(s)
- Yusuke Nakai
- Advanced Medical Research Center, Yokohama City University, Yokohama 236-0004, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama 236-0004, Japan.
| | - Yoko Ino
- Advanced Medical Research Center, Yokohama City University, Yokohama 236-0004, Japan
| | - Tomoko Akiyama
- Advanced Medical Research Center, Yokohama City University, Yokohama 236-0004, Japan
| | - Kayano Moriyama
- Advanced Medical Research Center, Yokohama City University, Yokohama 236-0004, Japan
| | - Yuriko Takeda
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama 236-0004, Japan
| | - Kenji Egashira
- Advanced Medical Research Center, Yokohama City University, Yokohama 236-0004, Japan; R&D Headquarters, LION Corporation, Tokyo 132-0035, Japan
| | - Takashi Ohira
- Advanced Medical Research Center, Yokohama City University, Yokohama 236-0004, Japan; Department of Physiology and Regenerative Medicine, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Akihide Ryo
- Advanced Medical Research Center, Yokohama City University, Yokohama 236-0004, Japan
| | - Tomoyuki Saito
- Yokohama Brain and Spine Center, Yokohama 235-0012, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama 236-0004, Japan
| | - Hisashi Hirano
- Advanced Medical Research Center, Yokohama City University, Yokohama 236-0004, Japan
| | - Yayoi Kimura
- Advanced Medical Research Center, Yokohama City University, Yokohama 236-0004, Japan.
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Xu Z, Zhou Y, Wu X, Li H, Bian W. Bone health and awareness of osteoporosis in women aged 40 to 60 years in Jiaxing City, China. Medicine (Baltimore) 2024; 103:e38073. [PMID: 38728513 PMCID: PMC11081584 DOI: 10.1097/md.0000000000038073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
The objective of this study is to evaluate the pattern of bone mineral density (BMD) in native Jiaxing women, and to investigate their awareness of osteoporosis. A total of 538 native Jiaxing women aged 40 to 60 years were recruited from January 2022 to December 2023 when they had routine examinations in the physical examination center of Jiaxing Maternal and Child Health Hospital. The Chinese version of Osteoporosis Prevention and Cognition Tool was used to evaluate participants' cognitive level of osteoporosis. BMD of participants' lumbar spine (L1-L4) and left hip (Neck/Troch/Ward) was measured by dual-energy X-ray absorptiometry. The mean total score of the awareness about osteoporosis (general knowledge, complications, and prevention) was 22.08 ± 2.74, which was suboptimal. The higher the education level, the higher the score of awareness (P < .01). Medical staff had the highest awareness rate of osteoporosis and the farmer had the lowest. Lumber spine and hip BMD of all sites was significantly decreased with increasing age (P < .001). Premenopausal women had higher BMD than postmenopausal women at all lumbar spine and hip sites (P < .01). The overall frequency of osteoporosis was 10.8% in the lumbar spine, 8.6% in the total hip, and 17.7% in either site. Osteoporosis and osteopenia are highly prevalent among native Jiaxing women but their awareness of osteoporosis is inadequate. To reduce the prevalence of osteoporosis, especially among the unemployed, we should carry out effective health education through multimedia to raise their awareness of osteoporosis. In addition, menopausal hormone therapy should also be considered in menopausal women.
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Affiliation(s)
- Zhengfen Xu
- Department of Gynecology, Jiaxing Maternity and Child Health Care Hospital, College of Medicine, Jiaxing University, Jiaxing, China
| | - Ying Zhou
- Department of Gynecology, Jiaxing Maternity and Child Health Care Hospital, College of Medicine, Jiaxing University, Jiaxing, China
| | - Xiaojie Wu
- Department of Gynecology, Jiaxing Maternity and Child Health Care Hospital, College of Medicine, Jiaxing University, Jiaxing, China
| | - Huan Li
- Department of Nursing, Jiaxing Maternity and Child Health Care Hospital, College of Medicine, Jiaxing University, Jiaxing, China
| | - Wei Bian
- Department of Radiology, Jiaxing Maternity and Child Health Care Hospital, College of Medicine, Jiaxing University, Jiaxing, China
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Ebina K, Nagayama Y, Kashii M, Tsuboi H, Okamura G, Miyama A, Etani Y, Noguchi T, Hirao M, Miura T, Fukuda Y, Kurihara T, Nakata K, Okada S. An investigation of the differential therapeutic effects of romosozumab on postmenopausal osteoporosis patients with or without rheumatoid arthritis complications: a case-control study. Osteoporos Int 2024; 35:841-849. [PMID: 38296866 PMCID: PMC11031444 DOI: 10.1007/s00198-024-07019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/06/2024] [Indexed: 02/02/2024]
Abstract
The impact of ROMO on the width of anabolic windows and the increase in BMD was reduced in the RA group compared to the non-RA group, and this reduction was associated with correlations to RA-related factors. PURPOSE To investigate the effects of romosozumab (ROMO) in postmenopausal osteoporosis, with and without comorbid rheumatoid arthritis (RA). METHODS In this retrospective, case-controlled, multicenter study, 171 postmenopausal patients who did not receive oral glucocorticoid, comprising 59 in the RA group and 121 in the non-RA group, received uninterrupted ROMO treatment for 12 months. Propensity score matching was employed to ensure comparability in clinical backgrounds, resulting in 41 patients in each group. Baseline characteristics were as follows: overall (mean age, 76.3 years; T-score of lumbar spine (LS), - 3.0; 45.1% were treatment-naive for osteoporosis); RA group (anti-cyclic citrullinated peptide antibody (ACPA) positivity, 80.5%; titer, 206.2 U/ml; clinical disease activity index (CDAI), 13.6; health assessment questionnaire disability index (HAQ-DI), 0.9). Bone mineral density (BMD) and serum bone turnover markers were monitored over a 12-month period. RESULTS The rate of increase in the bone formation marker, PINP, and the rates of decrease in the bone resorption marker, TRACP-5b, exhibited a trend toward smaller changes in the RA group compared to the non-RA group, implying a smaller anabolic window. After 12 months, the RA group displayed lower BMD increases in the LS (9.1% vs. 12.6%; P = 0.013) and total hip (2.4% vs. 4.8%; P = 0.025) compared to the non-RA group. Multiple regression analysis in the all RA group (n = 59) for the association between RA-specific factors and 12-month BMD changes revealed negative correlations between ACPA titer and LS BMD and between HAQ-DI and femoral neck BMD. CONCLUSIONS The efficacy of ROMO may be attenuated by RA-related factors.
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Affiliation(s)
- Kosuke Ebina
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
- Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
| | - Yoshio Nagayama
- Nagayama Rheumatology and Orthopaedic Clinic, 4-3-25 Hiokisounishi-Machi, Higashi-Ku, Sakai, 599-8114, Japan
| | - Masafumi Kashii
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, 586-8521, Japan
| | - Hideki Tsuboi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Cho, Kita-Ku, Sakai, 591-8025, Japan
| | - Gensuke Okamura
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, 586-8521, Japan
| | - Akira Miyama
- Department of Orthopaedic Surgery, Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Yuki Etani
- Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Takaaki Noguchi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Makoto Hirao
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, 586-8521, Japan
| | - Taihei Miura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Yuji Fukuda
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Takuya Kurihara
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
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Nagai T, Ishikawa K, Tsuchiya K, Tani S, Dodo Y, Oshita Y, Sakamoto K, Kawate N, Kudo Y. Changes in Testing and Treatment Methods in Osteoporosis Care. J Osteoporos 2024; 2024:9629891. [PMID: 38659619 PMCID: PMC11042906 DOI: 10.1155/2024/9629891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024] Open
Abstract
Osteoporosis treatment plays a crucial role in preventing fractures, particularly in bedridden patients. We conducted a questionnaire survey presenting hypothetical clinical cases in 2015 and 2020 to investigate trends over a 5-year period. The target population included physicians working in clinics and hospitals within our neighbourhood. The cases were presented, and the questionnaire was administered in a confidential format. The orthopaedic surgeons were matched for age and practice, resulting in 74 cases being included in the analysis. Comparing the 2015 and 2020 results, we observed a notable increase in physicians who would perform "bone mineral density measurements of the lumbar spine and hip." Furthermore, there was a significant rise in the percentage of respondents willing to test for bone metabolic markers, such as serum type I collagen cross-linked N-telopeptide (NTX), procollagen I N-terminal propeptide (P1NP), and tartrate-resistant acid phosphatase 5b (TRACP-5b). Regarding therapeutic agents, bisphosphonates decreased in usage, whereas parathyroid hormone and romosozumab witnessed an increase. In conclusion, the percentage of physicians requesting bone mineral density measurements of the lumbar spine and hip increased over the five-year period. In addition, more physicians chose to utilise bone metabolic markers due to their ease of measurement through blood tests and reduced diurnal variation. Finally, there was a marked trend towards the administration of drugs capable of rapidly and effectively increasing bone mineral density at an early stage of treatment.
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Affiliation(s)
- Takashi Nagai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Koji Ishikawa
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Koki Tsuchiya
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Soji Tani
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Yusuke Dodo
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Yusuke Oshita
- Department of Orthopaedic, Showa University Northern Yokohama Hospital, Kanagawa, Yokohama, Japan
| | - Keizo Sakamoto
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Nobuyuki Kawate
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoshifumi Kudo
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
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Merra G, Dominici F, Gualtieri P, Capacci A, Cenname G, Esposito E, Dri M, Di Renzo L, Marchetti M. Role of vitamin K2 in bone-vascular crosstalk. INT J VITAM NUTR RES 2024; 94:143-152. [PMID: 36039403 DOI: 10.1024/0300-9831/a000761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vitamin K (VK) is a fat-soluble vitamin that is indispensable for the activation of vitamin K-dependent proteins (VKDPs). It has been shown to play an important role in the proper calcium deposit at the bone level, hindering that on the vascular walls. The deficiency of this vitamin in European populations is frequent and unknown. It is related to several factors, poor dietary intake, altered intestinal absorption or altered production by bacteria, indicating possible dysbiosis. For Vitamin K2 (VK2), there is currently no official reference daily intake (RDI). However, the effects of VK2 on the improvement of health in cardiovascular diseases, on bone metabolism, on chronic kidney diseases have been the subject of research in recent decades. The microbiota in the gastrointestinal tract plays an important role: Bacteroides are primarily capable of synthetizing very long chain forms of menaquinones and, in addition to the bacteria present in the intestinal flora, VK2 is also produced by bacteria used in food fermentation processes. This review provides an update on the current literature regarding the origin of VK2 and its implications in what is called the "calcium paradox", namely the lack of calcium in the bone and its storage in the wall of the vessel.
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Affiliation(s)
- Giuseppe Merra
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Dominici
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Paola Gualtieri
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Annunziata Capacci
- Department of Medical and Surgical Sciences, Agostino Gemelli General Hospital Foundation-IRCCS, Rome, Italy
| | - Giuseppe Cenname
- Comando Generale Arma Carabinieri, Direzione di Sanità, Rome, Italy
| | - Ernesto Esposito
- General Directorate, Department of Human Policies of Basilicata Region, Potenza, Italy
| | - Maria Dri
- Department of Surgical Sciences, School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marco Marchetti
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Nagai T, Miyagami M, Nakamura S, Sakamoto K, Ishikawa K, Okano I, Kasai F, Kudo Y, Kawate N. Relationship between sacral-abdominal wall distance, movement performance, and spinal alignment in osteoporosis: a retrospective study. BMC Geriatr 2024; 24:252. [PMID: 38475741 PMCID: PMC10936102 DOI: 10.1186/s12877-024-04865-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 03/02/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Aging is associated with muscle atrophy, as typified by sarcopenia. Loss of abdominal muscle strength can cause abdominal wall laxity. The purpose of this study was to investigate the relationship between the sacral vertebra-abdominal wall distance (SAD) and movement performance using a simple lateral spine X-ray image for measuring the SAD. METHODS In this retrospective study, we included women aged ≥ 65 years who were attending the outpatient clinic for osteoporosis at our hospital. A total of 287 patients (mean age ± SD, 76.8 ± 7.1 years) with measured SAD were included in the analysis. Patients were divided into two groups based on SAD cutoff (160 mm) and age (75 years), respectively. The patients were examined using the two-foot 20 cm rise test, 3 m Timed Up and Go (TUG) test, two-step test, open-eyed one-leg standing time, and spinal alignment. Normally distributed data are expressed as means (standard deviations) and non-normally distributed data as medians (interquartile range), depending on the results of the Kolmogorov-Smirnov test. Student's t-test and χ2 test were used for between-group comparisons. Regression analysis was performed with SAD as the objective variable. A two-sided p < 0.05 was considered statistically significant. RESULTS The shorter SAD group performed better in the two-step test, TUG test, and open-eyed one-leg standing time (p < 0.001) as well as in the two-foot 20 cm rise test (p < 0.01) compared to the longer SAD group. Spinal alignment was better in the shorter SAD group than in the longer SAD group, with a shorter sagittal vertical axis (p < 0.001), smaller pelvic tilt (p < 0.001), and greater sacral slope (p < 0.05). CONCLUSION SAD was associated with posterior pelvic tilt and movement performance parameters. In addition to testing for osteoporosis, movement performance parameters should be evaluated in women with osteoporosis who are aged ≥ 65 and have greater SAD (≥ 160 mm in this study). The SAD is a new assessment method, and further research is required to verify its validity and reproducibility. This is the first attempt to determine how age and SAD affect movement performance in older adults.
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Affiliation(s)
- Takashi Nagai
- Department of Rehabilitation Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, 142-8666, Tokyo, Japan.
- Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, 142-8666, Tokyo, Japan.
| | - Makoto Miyagami
- Department of Rehabilitation Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, 142-8666, Tokyo, Japan
| | - Shota Nakamura
- Department of Rehabilitation Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, 142-8666, Tokyo, Japan
| | - Keizo Sakamoto
- Department of Rehabilitation Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, 142-8666, Tokyo, Japan
| | - Koji Ishikawa
- Department of Rehabilitation Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, 142-8666, Tokyo, Japan
| | - Ichiro Okano
- Department of Rehabilitation Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, 142-8666, Tokyo, Japan
| | - Fumihito Kasai
- Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, 142-8666, Tokyo, Japan
| | - Yoshifumi Kudo
- Department of Rehabilitation Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, 142-8666, Tokyo, Japan
| | - Nobuyuki Kawate
- Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, 142-8666, Tokyo, Japan
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Schini M, Johansson H, Harvey NC, Lorentzon M, Kanis JA, McCloskey EV. An overview of the use of the fracture risk assessment tool (FRAX) in osteoporosis. J Endocrinol Invest 2024; 47:501-511. [PMID: 37874461 PMCID: PMC10904566 DOI: 10.1007/s40618-023-02219-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023]
Abstract
FRAX®, a simple-to-use fracture risk calculator, was first released in 2008 and since then has been used increasingly worldwide. By calculating the 10-year probabilities of a major osteoporotic fracture and hip fracture, it assists clinicians when deciding whether further investigation, for example a bone mineral density measurement (BMD), and/or treatment is needed to prevent future fractures. In this review, we explore the literature around osteoporosis and how FRAX has changed its management. We present the characteristics of this tool and describe the use of thresholds (diagnostic and therapeutic). We also present arguments as to why screening with FRAX should be considered. FRAX has several limitations which are described in this review. This review coincides with the release of a version, FRAXplus, which addresses some of these limitations.
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Affiliation(s)
- M Schini
- Department of Oncology & Metabolism, Metabolic Bone Centre, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK.
| | - H Johansson
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - M Lorentzon
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - E V McCloskey
- Department of Oncology & Metabolism, Metabolic Bone Centre, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
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Kato K, Yaginuma T, Kobayashi A, Nakashima A, Ohkido I, Yokoo T. Long-term effects of denosumab on bone mineral density and turnover markers in patients undergoing hemodialysis. J Bone Miner Metab 2024; 42:264-270. [PMID: 38512458 PMCID: PMC10982096 DOI: 10.1007/s00774-024-01505-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Denosumab, a fully human anti-RANKL monoclonal antibody, is a widely used osteoporosis treatment that is increasingly being used in patients undergoing dialysis; however, its long-term efficacy and safety in these patients remain unknown. MATERIALS AND METHODS This observational study comprised individuals aged ≥ 20 years undergoing hemodialysis and receiving denosumab. After denosumab administration, we analyzed the long-term changes in bone mineral density (BMD) and levels of bone turnover markers (BTMs) and calcium. RESULTS The study included 45 patients who have been receiving denosumab for a median duration of 3.8 (interquartile range, 2.5-6.7) years. Tartrate-resistant acid phosphatase 5b (TRACP-5b) levels decreased from a median of 595 (434-778) mU/dL at baseline to 200 (141-430) mU/dL after 6 months of denosumab administration (P < 0.001) and remained low thereafter. Similarly, bone-specific alkaline phosphatase (BAP) levels decreased from a median of 18.2 (15.9-25.8) μg/L at baseline to 12.4 (9.9-15.6) μg/L after 6 months (P < 0.001) and remained low thereafter. Meanwhile, BMD, as assessed with dual energy X-ray absorptiometry and measured at the distal 1/3 of the radius, did not decrease (0.465 ± 0.112 g/cm2 at baseline vs. 0.464 ± 0.112 g/cm2 after administration; P = 0.616). Regarding hypocalcemia, corrected calcium levels reached were the lowest at 7 days after administration and normalized within 30 days. CONCLUSION The study showed long-term suppression of TRACP-5b and BAP levels and sustaining BMD after denosumab administration over an extended period in patients undergoing hemodialysis.
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Affiliation(s)
- Kazuhiko Kato
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
- Division of Molecular Epidemiology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Arisa Kobayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Nakashima
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Ichiro Ohkido
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
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Tsai DJ, Lin C, Lin CS, Lee CC, Wang CH, Fang WH. Artificial Intelligence-enabled Chest X-ray Classifies Osteoporosis and Identifies Mortality Risk. J Med Syst 2024; 48:12. [PMID: 38217829 DOI: 10.1007/s10916-023-02030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/26/2023] [Indexed: 01/15/2024]
Abstract
A deep learning model was developed to identify osteoporosis from chest X-ray (CXR) features with high accuracy in internal and external validation. It has significant prognostic implications, identifying individuals at higher risk of all-cause mortality. This Artificial Intelligence (AI)-enabled CXR strategy may function as an early detection screening tool for osteoporosis. The aim of this study was to develop a deep learning model (DLM) to identify osteoporosis via CXR features and investigate the performance and clinical implications. This study collected 48,353 CXRs with the corresponding T score according to Dual energy X-ray Absorptiometry (DXA) from the academic medical center. Among these, 35,633 CXRs were used to identify CXR- Osteoporosis (CXR-OP). Another 12,720 CXRs were used to validate the performance, which was evaluated by the area under the receiver operating characteristic curve (AUC). Furthermore, CXR-OP was tested to assess the long-term risks of mortality, which were evaluated by Kaplan‒Meier survival analysis and the Cox proportional hazards model. The DLM utilizing CXR achieved AUCs of 0.930 and 0.892 during internal and external validation, respectively. The group that underwent DXA with CXR-OP had a higher risk of all-cause mortality (hazard ratio [HR] 2.59, 95% CI: 1.83-3.67), and those classified as CXR-OP in the group without DXA also had higher all-cause mortality (HR: 1.67, 95% CI: 1.61-1.72) in the internal validation set. The external validation set produced similar results. Our DLM uses CXRs for early detection of osteoporosis, aiding physicians to identify those at risk. It has significant prognostic implications, improving life quality and reducing mortality. AI-enabled CXR strategy may serve as a screening tool.
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Affiliation(s)
- Dung-Jang Tsai
- Department of Statistics and Information Science, Fu Jen Catholic University, New Taipei City, Taiwan, R.O.C
- Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chin Lin
- Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chia-Cheng Lee
- Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Wen-Hui Fang
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C..
- Department of Family and Community Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C..
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Krueger D, Tanner SB, Szalat A, Malabanan A, Prout T, Lau A, Rosen HN, Shuhart C. DXA Reporting Updates: 2023 Official Positions of the International Society for Clinical Densitometry. J Clin Densitom 2024; 27:101437. [PMID: 38011777 DOI: 10.1016/j.jocd.2023.101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Professional guidance and standards assist radiologic interpreters in generating high quality reports. Initially DXA reporting Official Positions were provided by the ISCD in 2003; however, as the field has progressed, some of the current recommendations require revision and updating. This manuscript details the research approach and provides updated DXA reporting guidance. METHODS Key Questions were proposed by ISCD established protocols and approved by the Position Development Conference Steering Committee. Literature related to each question was accumulated by searching PubMed, and existing guidelines from other organizations were extracted from websites. Modifications and additions to the ISCD Official Positions were determined by an expert panel after reviewing the Task Force proposals and position papers. RESULTS Since most DXA is now performed in radiology departments, an approach was endorsed that better aligns with standard radiologic reports. To achieve this, reporting elements were divided into required minimum or optional. Collectively, required components comprise a standard diagnostic report and are considered the minimum necessary to generate an acceptable report. Additional elements were retained and categorized as optional. These optional components were considered relevant but tailored to a consultative, clinically oriented report. Although this information is beneficial, not all interpreters have access to sufficient clinical information, or may not have the clinical expertise to expand beyond a diagnostic report. Consequently, these are not required for an acceptable report. CONCLUSION These updated ISCD positions conform with the DXA field's evolution over the past 20 years. Specifically, a basic diagnostic report better aligns with radiology standards, and additional elements (which are valued by treating clinicians) remain acceptable but are optional and not required. Additionally, reporting guidance for newer elements such as fracture risk assessment are incorporated. It is our expectation that these updated Official Positions will improve compliance with required standards and generate high quality DXA reports that are valuable to the recipient clinician and contribute to best patient care.
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Affiliation(s)
- Diane Krueger
- School of Medicine and Public Health, Osteoporosis Clinical Research Program, University of Wisconsin-Madison, Madison, WI, USA.
| | - S Bobo Tanner
- Department of Medicine, Divisions of Rheumatology, Allergy & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Auryan Szalat
- Osteoporosis Center, Internal Medicine Ward, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alan Malabanan
- Bone Health Clinic, Boston Medical Center, Boston, MA, USA
| | - Tyler Prout
- Radiology Department, University of Wisconsin, Madison, WI, USA
| | - Adrian Lau
- Division of Endocrinology and Metabolism, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Harold N Rosen
- Osteoporosis Prevention and Treatment Center, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christopher Shuhart
- Bone Health and Osteoporosis Center, Swedish Medical Group, Seattle, WA, USA
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Miyauchi A, Hamaya E, Shimauchi J, Yoshinaga Y, Nishi K. Effectiveness of romosozumab in patients with osteoporosis at high fracture risk: a Japanese real-world study. J Bone Miner Metab 2024; 42:77-89. [PMID: 38086988 DOI: 10.1007/s00774-023-01477-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/25/2023] [Indexed: 02/10/2024]
Abstract
INTRODUCTION To describe the real-world use of romosozumab in Japan, we conducted a chart review of > 1000 Japanese patients with osteoporosis (OP) at high risk of fracture, across multiple medical institutions. MATERIALS AND METHODS Treatment-naïve and prior OP-treatment patients who received romosozumab for 12 months followed by ≥ 6 months of sequential OP treatment were included. The primary objective described the baseline demographics and clinical characteristics; secondary objectives evaluated changes in bone mineral density (BMD) and bone turnover markers in all patients and effectiveness of romosozumab in a sub-group of treatment-naïve patients using the fracture risk assessment tool (FRAX®). RESULTS Of the 1027 patients (92.4% female), 45.0% were treatment-naïve. The mean ± SD age of treatment-naïve versus prior OP-treatment patients was 76.8 ± 8.5 and 77.1 ± 8.5 years. The most frequent prior OP treatment was bisphosphonates (45.0%). Romosozumab treatment for 12 months increased BMD at the lumbar spine in all groups; the median percent change from baseline in lumbar spine BMD was higher in the treatment-naïve (13.4%) versus prior OP-treatment group (bisphosphonates [9.2%], teriparatide [11.3%], denosumab [DMAb, 4.5%]). DMAb, bisphosphonates, or teriparatide after romosozumab maintained the BMD gains at all skeletal sites at month 18 in treatment-naïve patients. Most treatment-naïve patients were at high risk of fracture, BMD increased consistently with romosozumab regardless of the baseline fracture risk assessed by FRAX. CONCLUSION This large-scale, multicenter chart review provides clinically relevant insights into the profiles of patients initiating romosozumab, effectiveness of real-world romosozumab use, and sequential therapy in Japanese patients at high risk of fracture.
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Affiliation(s)
| | - Etsuro Hamaya
- Amgen K.K., Midtown Tower 9-7-1 Akasaka, Minato-ku, Tokyo, 107-6239, Japan.
| | | | - Yoko Yoshinaga
- Amgen K.K., Midtown Tower 9-7-1 Akasaka, Minato-ku, Tokyo, 107-6239, Japan
| | - Kiyoshi Nishi
- Amgen K.K., Midtown Tower 9-7-1 Akasaka, Minato-ku, Tokyo, 107-6239, Japan
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12
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Kanis JA, Johansson H, McCloskey EV, Liu E, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff-Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson-Hughes B, Diez-Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish-Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, Mellström D, Merlijn T, Nordström A, Nordström P, O'Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Vandenput L, Harvey NC, Lorentzon M, Leslie WD. Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX. Osteoporos Int 2023; 34:2027-2045. [PMID: 37566158 PMCID: PMC7615305 DOI: 10.1007/s00198-023-06870-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023]
Abstract
A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX. INTRODUCTION The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD). METHODS We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted β-coefficients. RESULTS A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72-2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69-2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63-2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62-2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination. CONCLUSION A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.
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Affiliation(s)
- J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
| | - H Johansson
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - E V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - E Liu
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - K E Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - F A Anderson
- GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - R Azagra
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Health Centre Badia del Valles, Catalan Institute of Health, Barcelona, Spain
- PRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain
| | - C L Bager
- Nordic Bioscience A/S, Herlev, Denmark
| | - C Beaudart
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Department of Health Services Research, University of Maastricht, Maastricht, the Netherlands
| | - H A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland
- Centre on Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
| | - E Biver
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - O Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, USA
| | - J R Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - R Chapurlat
- INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France
| | | | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK
| | - C J Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - S R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - J A P da Silva
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - B Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - A Diez-Perez
- Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
| | - A B Dufour
- Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - J A Eisman
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - P J M Elders
- Petra JM Elders Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S Ferrari
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Y Fujita
- Center for Medical Education and Clinical Training, Kindai University Faculty of Medicine, Osaka, Japan
| | - S Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | - C-C Glüer
- Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - I Goldshtein
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Goltzman
- Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
| | - V Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - J Hall
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - D Hans
- Interdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland
| | - M Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rheumatology, St Olavs Hospital, Trondheim, Norway
| | - R J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
| | - M Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - M Iki
- Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan
| | - S Ish-Shalom
- Endocrine Clinic, Elisha Hospital, Haifa, Israel
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - M K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - S Khosla
- Robert and Arlene Kogod Center on Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D P Kiel
- Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - W-P Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - F Koromani
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M A Kotowicz
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
- Department of Medicine -Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - H Kröger
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - T Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - O Lamy
- Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - A Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - B Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - K Lippuner
- Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden
| | - T Merlijn
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - A Nordström
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - P Nordström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - T W O'Neill
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - B Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - C Ohlsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - E S Orwoll
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - J A Pasco
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
- Department of Medicine -Western Health, The University of Melbourne, St Albans, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - F Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A-M Schott
- Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
| | - E J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - K Siggeirsdottir
- Icelandic Heart Association, Kopavogur, Iceland
- Janus Rehabilitation, Reykjavik, Iceland
| | - E M Simonsick
- Translational Gerontology Branch, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - E Sornay-Rendu
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - R Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - K M A Swart
- Petra JM Elders Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - J Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - D J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - N M van Schoor
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - T P van Staa
- Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Vila
- Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - N J Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - N C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
| | - M C Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Zwart
- PRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain
- Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- GROIMAP/GROICAP (research groups), Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Girona, Spain
| | - L Vandenput
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - M Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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13
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Webster J, Dalla Via J, Langley C, Smith C, Sale C, Sim M. Nutritional strategies to optimise musculoskeletal health for fall and fracture prevention: Looking beyond calcium, vitamin D and protein. Bone Rep 2023; 19:101684. [PMID: 38163013 PMCID: PMC10757289 DOI: 10.1016/j.bonr.2023.101684] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/20/2023] [Accepted: 05/04/2023] [Indexed: 01/03/2024] Open
Abstract
Falls and osteoporotic fractures are a major public health problem, particularly among older adults. A third of individuals aged 65 years and over fall at least once each year, with up to 20 % of these resulting in serious injury, including fracture. In conjunction with regular exercise, the importance of diet for musculoskeletal health has largely focused upon calcium, vitamin D, and protein, particularly in the context of preventing falls and fractures. Whilst there is evidence for the benefits of these nutrients for musculoskeletal health, other aspects of the diet remain largely underexplored. For example, vegetables are rich sources of macro- and micronutrients that are essential for muscle function and bone health, which are key factors in the prevention of falls and fractures. Recent work has highlighted the importance of nutrients such as vegetable-derived nitrate and vitamin K1 in optimising muscle strength, physical function, and bone quality. In the context of dietary patterns, vegan/plant-based diets have recently gained popularity due to perceived health benefits, animal welfare, or to tackle climate change. The elimination and/or substitution of animal-based products for plant foods (without careful planning and/or expert dietary guidance) could, however, have long-term negative musculoskeletal consequences; a trend uncovered by recent evidence. Within the overarching theme of nutrition for fall and fracture prevention in older populations, the aim of this review is to (i) summarise the current evidence for calcium, vitamin D and protein; (ii) describe the importance of vegetables and selected nutrients, such as nitrate and vitamin K1, for muscle function and bone structural integrity; and (iii) highlight current evidence around different dietary patterns (e.g., plant-based, diet quality, data driven approaches) and their impact on musculoskeletal health.
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Affiliation(s)
- James Webster
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Jack Dalla Via
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Christina Langley
- Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom
| | - Cassandra Smith
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Craig Sale
- Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom
| | - Marc Sim
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
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Sone T, Ohnaru K, Sugai T, Yamashita A, Okimoto N, Inoue T, Matsumoto T. The effects of abaloparatide on hip geometry and biomechanical properties in Japanese osteoporotic patients assessed using DXA-based hip structural analysis: results of the Japanese phase 3 ACTIVE-J trial. Arch Osteoporos 2023; 18:146. [PMID: 38030806 PMCID: PMC10687120 DOI: 10.1007/s11657-023-01344-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 11/01/2023] [Indexed: 12/01/2023]
Abstract
Daily subcutaneous injection of 80 μg abaloparatide increased bone mineral density in Japanese patients with osteoporosis at high fracture risk in the ACTIVE-J trial. Dual-energy X-ray absorptiometry-based hip structural analysis from ACTIVE-J data showed improved hip geometry and biomechanical properties with abaloparatide compared with placebo. PURPOSE Abaloparatide (ABL) increased bone mineral density (BMD) in Japanese patients with osteoporosis at high fracture risk in the ACTIVE-J trial. To evaluate the effect of ABL on hip geometry and biomechanical properties, hip structural analysis (HSA) was performed using ACTIVE-J trial data. METHODS Hip dual-energy X-ray absorptiometry scans from postmenopausal women and men (ABL, n = 128; placebo, n = 65) at baseline and up to week 78 were analyzed to extract bone geometric parameters at the narrow neck (NN), intertrochanteric region (IT), and proximal femoral shaft (FS). Computed tomography (CT)-based BMD and HSA indices were compared between baseline and week 78. RESULTS ABL treatment showed increased mean percent change from baseline to week 78 in cortical thickness at the NN (5.3%), IT (5.3%), and FS (2.9%); cross-sectional area at the NN (5.0%), IT (5.0%), and FS (2.6%); cross-sectional moment of inertia at the NN (7.6%), IT (5.1%), and FS (2.5%); section modulus at the NN (7.4%), IT (5.4%), and FS (2.4%); and decreased mean percent change in buckling ratio (BR) at the IT (- 5.0%). ABL treatment showed increased mean percent change in total volumetric BMD (vBMD; 2.7%) and trabecular vBMD (3.2%) at the total hip and decreased mean percent change in BR at femoral neck (- 4.1%) at week 78 vs baseline. All the changes noted here were significant vs placebo (P < 0.050 using t-test). CONCLUSION A 78-week treatment with ABL showed improvement in HSA parameters associated with hip geometry and biomechanical properties vs placebo. TRIAL REGISTRATION JAPIC CTI-173575.
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Affiliation(s)
- Teruki Sone
- Department of Nuclear Medicine, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Kazuhiro Ohnaru
- Department of Orthopedics, Traumatology & Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Takumi Sugai
- Division of Pharmaceutical Development and Production, Teijin Pharma Limited, Tokyo, Japan
| | - Akiko Yamashita
- Division of Pharmaceutical Development and Production, Teijin Pharma Limited, Tokyo, Japan
| | | | | | - Toshio Matsumoto
- Fujii Memorial Institute of Medical Sciences, Tokushima University, Tokushima, Japan
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15
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Lo JC, Yang W, Park-Sigal JJ, Ott SM. Osteoporosis and Fracture Risk among Older US Asian Adults. Curr Osteoporos Rep 2023; 21:592-608. [PMID: 37542683 PMCID: PMC10858302 DOI: 10.1007/s11914-023-00805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the current knowledge regarding osteoporosis and fracture among older US Asian adults. RECENT FINDINGS Asian adults have lower (areal) bone density than non-Hispanic White adults and thus are more likely to be diagnosed and treated for osteoporosis, despite their lower risk of hip fracture. The latter may relate to favorable characteristics in hip geometry, volumetric bone density, and bone microarchitecture; lower risk of falls; and other clinical factors. The fracture risk calculator FRAX accounts for the lower risk of hip fracture among US Asian adults. However, data on major osteoporotic fracture risk remain limited. Fracture rates also vary by Asian subgroup, which may have implications for fracture risk assessment. Furthermore, among women receiving bisphosphonate drugs, Asian race is a risk factor for atypical femur fracture, an uncommon complication associated with treatment duration. Recent clinical trial efficacy data pertaining to lower bisphosphonate doses and longer dosing intervals may be relevant for Asian adults. More research is needed to inform osteoporosis care of US Asian adults, including risk-benefit considerations and the optimal duration of bisphosphonate treatment. Greater evidence-based guidance for primary fracture prevention among US Asian adults will ensure health equity in the prevention of osteoporotic fractures.
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Affiliation(s)
- Joan C Lo
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
- The Permanente Medical Group, Oakland, CA, USA.
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Wei Yang
- The Permanente Medical Group, Oakland, CA, USA
- Department of Endocrinology, Kaiser Permanente San Jose Medical Center, San Jose, CA, USA
| | - Jennifer J Park-Sigal
- The Permanente Medical Group, Oakland, CA, USA
- Department of Endocrinology, Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA, USA
| | - Susan M Ott
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Hori M, Takahashi H, Kondo C, Matsuoka Y, Tsujita M, Nishihira M, Uchida K, Takeda A, Morozumi K, Maruyama S. Coexistence of Low Muscle Mass and Osteoporosis as a Predictor of Fragility Fractures in Long-Term Kidney Transplant Recipients. Am J Nephrol 2023; 54:489-497. [PMID: 37699366 DOI: 10.1159/000534019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/01/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Sarcopenia and osteoporosis are highly prevalent among kidney transplant recipients (KTRs). Although osteoporosis is known to increase fracture risk in KTRs, it is unclear whether sarcopenia or osteosarcopenia is associated with this increased risk. Thus, we aimed to investigate the association of the coexistence of low muscle mass (LMM) and osteoporosis with the risk of fracture in long-term KTRs. METHODS Exactly 342 stable KTRs underwent dual-energy X-ray absorptiometry and skeletal muscle mass index (SMI) measurement using bioelectrical impedance analysis. RESULTS LMM and osteoporosis were observed in 109 (31.9%) and 93 patients (27.2%), respectively. During a follow-up period of 5.1 years, 48 (14.0%) fractures occurred. KTRs with LMM had a higher fracture risk, but this was not significant (adjusted hazard ratio [aHR] 1.82, 95% confidence interval [CI] 0.94-3.50, p = 0.073). Similar results were obtained in KTRs with osteoporosis (aHR 1.84, 95% CI 0.96-3.47, p = 0.063). We divided the KTRs into four groups according to the presence of LMM and/or osteoporosis. The cumulative incidence rates of fractures were 13.0%, 11.1%, 10.5%, and 31.3% in the KTRs without both LMM and osteoporosis, those with LMM alone, those with osteoporosis alone, and those with both, respectively. The KTRs with both LMM and osteoporosis had a 2.92fold higher risk of fractures (95% CI 1.29-6.49; p = 0.010) than those without both LMM and osteoporosis. CONCLUSION Long-term KTRs with the coexistence of LMM and osteoporosis had an independently higher risk of fragility fractures than those without both LMM and osteoporosis. The combination of SMI and osteoporosis definitions can be used to identify KTRs with a high fracture risk.
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Affiliation(s)
- Mayuko Hori
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Japan
| | - Hiroshi Takahashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Chika Kondo
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Japan
| | - Yutaka Matsuoka
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Japan
| | - Makoto Tsujita
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Japan
| | | | - Kazuharu Uchida
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Japan
| | - Asami Takeda
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Japan
| | - Kunio Morozumi
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Nagai T, Kuroda T, Ishikawa K, Sakamoto K, Shirato N, Kudo Y. Pregnancy- and lactation-associated osteoporosis in the mother after the first and second children: A case report. Int J Surg Case Rep 2023; 109:108464. [PMID: 37437326 PMCID: PMC10362254 DOI: 10.1016/j.ijscr.2023.108464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION This study reports an unusual experience of a mother who may have developed birth-related osteoporosis after each of the births of her two children. PRESENTATION OF CASE A 31-year-old woman presented with lumbar back pain. She had given birth to her first child through vaginal delivery 4 months prior and was breastfeeding. Magnetic resonance imaging showed multiple fresh vertebral fractures, but continued breastfeeding resulted in further loss of bone density. The bone mineral density recovered after weaning. The patient gave birth to a second child three years after the first child's birth. She opted to discontinue breastfeeding after the detection of repeated instances of significant bone loss. No new vertebral fractures have occurred in the 9 years since the patient's initial visit to our clinic. DISCUSSION We describe a case where a mother experienced multiple episodes of rapid bone loss following childbirth. Bone health evaluation at an early stage following childbirth may be effective for preventing future bone fractures. CONCLUSION It is desirable to develop a team and guidelines for treating osteoporosis associated with pregnancy and lactation and for the next pregnancy and delivery.
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Affiliation(s)
- Takashi Nagai
- Department of Rehabilitation Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan; Department of Orthopedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.
| | - Takuma Kuroda
- Department of Orthopedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Koji Ishikawa
- Department of Orthopedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Keizo Sakamoto
- Department of Orthopedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Nahoko Shirato
- Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Yoshifumi Kudo
- Department of Orthopedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
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Fu Y, Ba L, Lü N, Yang H, Hong X, Zhou J, Sun Z. Burden of falls attributable to low bone mineral density among people aged 60 years and over in China from 1990 to 2019. Front Public Health 2023; 11:1204497. [PMID: 37448662 PMCID: PMC10338097 DOI: 10.3389/fpubh.2023.1204497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/31/2023] [Indexed: 07/15/2023] Open
Abstract
Objective Falls in older people have become a major public health, economic and societal problem. Osteoporosis predisposes older adults to high risk of falls, which were the most common outcome attributable to low bone mineral density (LBMD). In this study, we analyze the long-term trends in falls burden attributable to LBMD among people aged 60 years and over from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). Methods Data from GBD 2019 were used to assess the long-term trends in mortality and disability-adjusted life-year (DALY) rates by Joinpoint regression. The age-period-cohort (APC) model was used to evaluate the effects of age, period and cohort on mortality rate of falls attributable to LBMD. Results The mortality and DALYs rates of falls attributable to LBMD among people aged 60 years and over increased from 1990 to 2019, with average annual percentage changes (AAPCs) of 1.74% (95% CI: -1.47 to 2.01%) and 0.99% (95% CI: 0.80-1.19%), respectively. APC analysis revealed that the mortality rate due to LBMD significantly increased among the older people over the age of 75 years. The risk of falls mortality due to LBMD during the period of 1990-2019 initially declined but later elevated. An overall increasing risk for falls death attributable to LBMD was presented across birth cohorts, but in cohorts born after 1930, the upward trend has slowed down. The overall net drift per year attributable to LBMD was above 0. The corresponding results showed that the negative impact of period and cohort effects among males was more pronounced than those among females. Conclusions Falls attributable to LBMD remain an ongoing health burden in the older people in China, and the mortality has been on the rise from 1990 to 2019, especially among the older people aged 80+ years group. The prevention and treatment of LBMD should be emphasized, especially among males and oldest-old people. Furthermore, there is an urgent need to strengthen the implementation of system-wide, integrated and effective public health policies and other health interventions in China.
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Affiliation(s)
- Yali Fu
- Jiangsu Health Development Research Center, Nanjing, Jiangsu, China
- National Health Commission Key Laboratory of Contraceptives Adverse Reaction Surveillance, Nanjing, Jiangsu, China
- Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment, Nanjing, Jiangsu, China
| | - Lei Ba
- Jiangsu Health Development Research Center, Nanjing, Jiangsu, China
- National Health Commission Key Laboratory of Contraceptives Adverse Reaction Surveillance, Nanjing, Jiangsu, China
- Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment, Nanjing, Jiangsu, China
| | - Nianqing Lü
- Jiangsu Health Development Research Center, Nanjing, Jiangsu, China
- National Health Commission Key Laboratory of Contraceptives Adverse Reaction Surveillance, Nanjing, Jiangsu, China
- Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment, Nanjing, Jiangsu, China
| | - Huafeng Yang
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Xin Hong
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Jinyi Zhou
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Zhiming Sun
- Jiangsu Health Development Research Center, Nanjing, Jiangsu, China
- National Health Commission Key Laboratory of Contraceptives Adverse Reaction Surveillance, Nanjing, Jiangsu, China
- Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment, Nanjing, Jiangsu, China
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Yoshida K, Tanabe Y, Nishiyama H, Matsuda T, Toritani H, Kitamura T, Sakai S, Watamori K, Takao M, Kimura E, Kido T. Feasibility of Bone Mineral Density and Bone Microarchitecture Assessment Using Deep Learning With a Convolutional Neural Network. J Comput Assist Tomogr 2023; 47:467-474. [PMID: 37185012 PMCID: PMC10184800 DOI: 10.1097/rct.0000000000001437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES We evaluated the feasibility of using deep learning with a convolutional neural network for predicting bone mineral density (BMD) and bone microarchitecture from conventional computed tomography (CT) images acquired by multivendor scanners. METHODS We enrolled 402 patients who underwent noncontrast CT examinations, including L1-L4 vertebrae, and dual-energy x-ray absorptiometry (DXA) examination. Among these, 280 patients (3360 sagittal vertebral images), 70 patients (280 sagittal vertebral images), and 52 patients (208 sagittal vertebral images) were assigned to the training data set for deep learning model development, the validation, and the test data set, respectively. Bone mineral density and the trabecular bone score (TBS), an index of bone microarchitecture, were assessed by DXA. BMDDL and TBSDL were predicted by deep learning with a convolutional neural network (ResNet50). Pearson correlation tests assessed the correlation between BMDDL and BMD, and TBSDL and TBS. The diagnostic performance of BMDDL for osteopenia/osteoporosis and that of TBSDL for bone microarchitecture impairment were evaluated using receiver operating characteristic curve analysis. RESULTS BMDDL and BMD correlated strongly (r = 0.81, P < 0.01), whereas TBSDL and TBS correlated moderately (r = 0.54, P < 0.01). The sensitivity and specificity of BMDDL for identifying osteopenia or osteoporosis were 93% and 90%, and 100% and 94%, respectively. The sensitivity and specificity of TBSDL for identifying patients with bone microarchitecture impairment were 73% for all values. CONCLUSIONS The BMDDL and TBSDL derived from conventional CT images could identify patients who should undergo DXA, which could be a gatekeeper tool for detecting latent osteoporosis/osteopenia or bone microarchitecture impairment.
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Affiliation(s)
| | | | | | | | | | | | - Shinichiro Sakai
- Orthopedic Surgery, Ehime University Graduate School of Medicine
| | | | - Masaki Takao
- Orthopedic Surgery, Ehime University Graduate School of Medicine
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Takada J, Sato S, Arai K, Kito Y, Oshita Y, Saito K. Safety and effectiveness of once-yearly zoledronic acid in Japanese osteoporosis patients: three-year post-marketing surveillance. J Bone Miner Metab 2023; 41:268-277. [PMID: 36862212 PMCID: PMC9978276 DOI: 10.1007/s00774-023-01410-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/28/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Zoledronic acid (5 mg; ZOL), a once-yearly bisphosphonate, reduces osteoporotic fractures and increases bone mineral density (BMD). This 3-year post-marketing surveillance examined its real-world safety and effectiveness. MATERIALS AND METHODS This prospective, observational study included patients who started ZOL for osteoporosis. Data were assessed at baseline, 12, 24, and 36 months for safety and effectiveness. Treatment persistence, potentially related factors, and persistence before and after the COVID-19 pandemic started were also investigated. RESULTS The safety analysis and effectiveness analysis sets included 1406 and 1387 patients, respectively, with mean age of 76.5 years. Adverse reactions (ARs) occurred in 19.35% of patients, with an acute-phase reaction in 10.31, 1.01, and 0.55% after the first, second, and third ZOL infusions. Renal function-related ARs, hypocalcaemia, jaw osteonecrosis, and atypical femoral fracture occurred in 1.71, 0.43, 0.43, and 0.07% of patients, respectively. Three-year cumulative fracture incidences were 4.44% for vertebral, 5.64% for non-vertebral, and 9.56% for clinical fractures. BMD increased by 6.79, 3.14, and 1.78% at the lumbar spine, femoral neck, and total hip, respectively, after 3-year treatment. Bone turnover markers remained within reference ranges. Treatment persistence was 70.34% over 2 years and 51.71% over 3 years. Male, age ≥ 75 years, no previous medicines for osteoporosis, no concomitant medicines for osteoporosis, and inpatient at the first infusion were related to discontinuation. There was no significant difference in the persistence rate between before and after the COVID-19 pandemic (74.7% vs. 69.9%; p = 0.141). CONCLUSION This 3-year post-marketing surveillance confirmed the real-world safety and effectiveness of ZOL.
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Affiliation(s)
- Junichi Takada
- Osteoporosis Center, Sapporo Kotoni Orthopaedics, 1-30 Kotoni 4-4, Nishi-Ku, Sapporo, Hokkaido, 063-0814, Japan
- Health Sciences University of Hokkaido Hospital, Ainosato 2-5, Kita-Ku, Sapporo, Hokkaido, 002-8072, Japan
- Department of Orthopaedic Surgery, Sapporo Medical University, S-1, W-16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Shizu Sato
- Medical Affairs Department, Asahi Kasei Pharma Corporation, 1-1-2, Yurakucho, Chiyoda-Ku, Tokyo, 100-0006, Japan
| | - Kouichi Arai
- Medical Affairs Department, Asahi Kasei Pharma Corporation, 1-1-2, Yurakucho, Chiyoda-Ku, Tokyo, 100-0006, Japan
| | - Yoriko Kito
- Pharmacovigilance Department, Asahi Kasei Pharma Corporation, 1-1-2, Yurakucho, Chiyoda-Ku, Tokyo, 100-0006, Japan
| | - Yuko Oshita
- Pharmacovigilance Department, Asahi Kasei Pharma Corporation, 1-1-2, Yurakucho, Chiyoda-Ku, Tokyo, 100-0006, Japan
| | - Kazuko Saito
- Pharmacovigilance Department, Asahi Kasei Pharma Corporation, 1-1-2, Yurakucho, Chiyoda-Ku, Tokyo, 100-0006, Japan.
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Nagai T, Tomita K, Kubo K, Ikeda J, Kawasaki K, Inagaki K. A case report of effective intra-articular elcatonin administration in a patient with osteonecrosis of the lunate. Int J Surg Case Rep 2023; 105:108056. [PMID: 37001370 PMCID: PMC10090262 DOI: 10.1016/j.ijscr.2023.108056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Although corticosteroids are effective for bronchial asthma, they are associated with various side effects, such as osteonecrosis of the femoral head and tibial condyle and osteoporosis. Here, we report a patient who was on corticosteroids for a long period of time due to severe asthma, which was thought to have led to lunate osteonecrosis of both wrist joints. Calcitonin (elcatonin), an osteoporosis drug, was administered to the wrist joint. CASE PRESENTATION Allergy to anesthetics and various non-steroidal anti-inflammatory drugs (NSAIDs) made surgical treatment not possible and pain control difficult. In addition, pain in the wrist joint interfered with activities of daily living (ADLs). When calcitonin was administered intra-articularly into the wrist joint, the pain in the wrist joint was relieved and ADLs were improved. However, the pain-suppressing effect lasted only 1 week, and pain returned to the original state by the second week after treatment. Repeated injections were necessary every 2 weeks. CLINICAL DISCUSSION This is the first report of the effectiveness of intra-articular calcitonin in a patient with osteonecrosis of the lunate. This treatment may be applicable to patients with allergies to anesthesia and NSAIDs. CONCLUSION In the present case, calcitonin administered intra-articularly to the wrist appeared to be effective in pain control for steroid-induced lunate osteonecrosis.
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Affiliation(s)
- Takashi Nagai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo, Japan; Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan.
| | - Kazunari Tomita
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Kazutoshi Kubo
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Jun Ikeda
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Keikichi Kawasaki
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Katsunori Inagaki
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
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Abstract
Vitamin K, a cofactor for the γ-glutamyl carboxylase enzyme, is required for the post-translational activation of osteocalcin and matrix Gla protein, which play a key role in bone and muscle homeostasis. In vivo and in vitro models for osteoporosis and sarcopenia suggest the vitamin K could exert a positive effect in both conditions. In bone, it increases osteoblastogenesis, whilst decreases osteoclast formation and function. In muscle, it is associated with increased satellite cell proliferation and migration and might play a role in energy metabolism. Observational trials suggest that high levels of vitamin K are associated with increased bone mineral density and reduced fracture risk. However, interventional studies for vitamin K supplementation yielded conflicting results. Clinical trials in sarcopenia suggest that vitamin K supplementation could improve muscle mass and function. One of the main limitations on the vitamin K studies are the technical challenges to measure its levels in serum. Thus, they are obtained from indirect sources like food questionnaires, or levels of undercarboxylated proteins, which can be affected by other environmental or biological processes. Although current research appoints to a beneficial effect of vitamin K in bone and muscle, further studies overcoming the current limitations are required in order to incorporate this supplementation in the clinical management of patients with osteosarcopenia.
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Affiliation(s)
- N Alonso
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - A Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - E Fritz-Petrin
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - D Enko
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - M Herrmann
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
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Hattori K, Takahashi N, Kojima T, Imagama S. Predictive factors for achievement of treatment goals in patients with postmenopausal osteoporosis treated with denosumab. Mod Rheumatol 2023; 33:217-223. [PMID: 34939114 DOI: 10.1093/mr/roab129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To investigate efficacy of long-term treatment with denosumab and predictive factors for achievement of treatment goals in patients with postmenopausal osteoporosis (PMO). METHODS We enrolled 111 PMO patients who had T-scores ≤-2.5 either at the lumbar spine (L-) or femoral neck (FN-), who had never been treated for osteoporosis, and who could be followed for at least 3 years. We first evaluated changes in bone mineral density (BMD) for up to 7 years. We next defined the treatment goal as the achievement of a T-score >-2.5 at month 36 and performed multivariate analysis to identify predictive factors for achievement of the goal. RESULTS Lumbar spine- and femoral neck bone-mineral density increased yearly for 7 years. Among 87 patients with baseline L-T-scores ≤-2.5, better baseline L-T-scores predicted achievement of L-T-scores >-2.5 at month 36. The cut-off value for baseline L-T-score was -3.4. Among 76 patients with baseline FN-T-scores ≤-2.5, better baseline FN-T-scores predicted achievement of FN-T-scores >-2.5 at month 36. The cut-off value for baseline FN-T-scores was -2.8. CONCLUSIONS Long-term treatment with denosumab was effective in PMO patients. As better baseline T-score predicted achievement of T-scores >-2.5, early initiation of treatment will contribute to better outcome.
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Affiliation(s)
- Kyosuke Hattori
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Nobunori Takahashi
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toshihisa Kojima
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shiro Imagama
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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24
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Saito T, Mizobuchi M, Kato T, Suzuki T, Fujiwara Y, Kanamori N, Makuuchi M, Honda H. One-Year Romosozumab Treatment Followed by One-Year Denosumab Treatment for Osteoporosis in Patients on Hemodialysis: An Observational Study. Calcif Tissue Int 2023; 112:34-44. [PMID: 36287217 DOI: 10.1007/s00223-022-01031-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/10/2022] [Indexed: 01/07/2023]
Abstract
There is limited evidence on the use of romosozumab (ROMO) in the treatment of osteoporosis in patients on hemodialysis (HD); thus, we aimed to investigate this topic. This prospective, observational, single-center cohort study included 13 prior osteoporosis treatment-naïve patients on HD with osteoporosis. They first received ROMO once monthly for 12 months (210 mg; subcutaneously once every month). Thereafter, they received denosumab (DENO) for an additional 12 months (60 mg; subcutaneously once every 6 months). We examined the incidence of new fractures; treatment safety; and temporal changes in the bone mineral density (BMD), bone metabolism markers, and vascular calcification. No new cases of fractures were noted. The median one-year percentage changes (from the baseline) in the BMDs at the lumbar spine (LS), total hip (TH), and femoral neck (FN) were + 9.0%, + 2.5%, and + 4.7%, respectively. These changes were maintained for 24 months. The corresponding relative changes from the baseline to 24 months thereafter were + 14.9%, + 5.4%, and + 6.5%, respectively. The percentage changes in TH BMD and FN BMD were negatively correlated with baseline BMD. Coronary artery and thoracic aorta calcification scores increased slightly from baseline to 12 months thereafter. However, fatal events (cardiovascular disease-associated and all-cause deaths) did not occur during ROMO treatment. Effectiveness of ROMO was better in patients who had severe osteoporosis with low TH BMD, low FN BMD, and high tartrate-resistant acid phosphatase 5b level at ROMO initiation.
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Affiliation(s)
- Tomohiro Saito
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan.
| | - Masahide Mizobuchi
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Tadashi Kato
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Taihei Suzuki
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Yasuro Fujiwara
- Sannoudai Hospital, Isioka-Si, 4-1-38 Higasiishioka, Ibaraki, 315-0037, Japan
| | - Naoaki Kanamori
- Sannoudai Hospital, Isioka-Si, 4-1-38 Higasiishioka, Ibaraki, 315-0037, Japan
| | - Mikio Makuuchi
- Sannoudai Hospital, Isioka-Si, 4-1-38 Higasiishioka, Ibaraki, 315-0037, Japan
| | - Hirokazu Honda
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
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25
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Kanis JA, McCloskey EV, Harvey NC, Cooper C, Rizzoli R, Dawson-Hughes B, Maggi S, Reginster JY. The need to distinguish intervention thresholds and diagnostic thresholds in the management of osteoporosis. Osteoporos Int 2023; 34:1-9. [PMID: 36282342 DOI: 10.1007/s00198-022-06567-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/30/2022] [Indexed: 01/07/2023]
Abstract
This position paper of the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) addresses the rationale for separate diagnostic and intervention thresholds in osteoporosis. We conclude that the current BMD-based diagnostic criteria for osteoporosis be retained whilst clarity is brought to bear on the distinction between diagnostic and intervention thresholds.
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Affiliation(s)
- John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
- Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Rene Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland
| | - Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA
| | - Stefania Maggi
- Institute of Neuroscience, Aging Branch, CNR, Padua, Italy
| | - Jean-Yves Reginster
- WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Liege, Belgium
- Division of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liege, Belgium
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26
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Ohta T, Nagashima J, Fukuda W, Sasai H, Ishii N. Association of Knee Extensor Muscle Strength and Cardiorespiratory Fitness With Bone Stiffness in Japanese Adults: A Cross-sectional Study. J Epidemiol 2022; 32:543-550. [PMID: 33840650 PMCID: PMC9643791 DOI: 10.2188/jea.je20200581] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Knee extensor muscle strength and cardiorespiratory fitness (CRF) are major components of physical fitness. Because the interactive association of knee extensor muscle strength and CRF with bone health remains unclear, we aimed to investigate such association in Japanese adults. METHODS Altogether, 8,829 Japanese adults (3,731 men and 5,098 women) aged ≥45 years completed the maximum voluntary knee extension test, submaximal exercise test, medical examination, and a questionnaire on lifestyle habits. Using an osteo-sono assessment index, low bone stiffness tendency was defined as 80% under the young-adults mean. Multivariable odds ratios (ORs) and 95% confidence intervals (CIs) were calculated after confounder adjustment. RESULTS Overall, 542 men (14.5%) and 978 women (19.2%) had low bone stiffness tendency. We observed an inverse association between muscle strength and low bone stiffness tendency after adjustment for CRF in both sexes (P for linear trend <0.001). Compared with the lowest CRF, the multivariable ORs for low bone stiffness tendency in the highest CRF were 0.47 (95% CI, 0.36-0.62) for men and 1.05 (95% CI, 0.82-1.35) for post-menopausal women (P < 0.001 and P = 0.704, respectively). No interactive association between muscle strength and CRF for low bone stiffness tendency existed in both sexes and irrespective of menopausal status. CONCLUSION Knee extensor muscle strength and CRF were associated additively, not synergistically, with bone health. Maintaining high levels of both physical fitness components may improve musculoskeletal health in the cohort. The relationship between physical fitness and bone status should be longitudinally investigated in the future.
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Affiliation(s)
- Takahisa Ohta
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan,Yokohama Sports Medical Center, Nissan Stadium, Kanagawa, Japan,Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Junzo Nagashima
- Yokohama Sports Medical Center, Nissan Stadium, Kanagawa, Japan,Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Wataru Fukuda
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan,Yokohama Sports Medical Center, Nissan Stadium, Kanagawa, Japan,Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Naokata Ishii
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
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27
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Mizukami S, Arima K, Abe Y, Tomita Y, Nakashima H, Honda Y, Uchiyama M, Ookawachi T, Goto H, Hasegawa M, Sou Y, Kanagae M, Osaki M, Aoyagi K. Association between fat mass by bioelectrical impedance analysis and bone mass by quantitative ultrasound in relation to grip strength and serum 25-hydroxyvitamin D in postmenopausal Japanese women: the Unzen study. J Physiol Anthropol 2022; 41:7. [PMID: 35264253 PMCID: PMC8908611 DOI: 10.1186/s40101-022-00281-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background Whether fat mass or lean mass affects bone mass in postmenopausal women is controversial. This study aimed to explore the association between body composition measured by bioelectrical impedance analysis (BIA) and bone mass measured by quantitative ultrasound (QUS) in postmenopausal women in Japan. Methods We conducted a cross-sectional study, The Unzen Study, on 382 community-dwelling postmenopausal Japanese women (mean (standard deviation) age: 68.2 (7.2) years) who participated in periodic health examinations. The stiffness index (SI) was measured using QUS, and body composition (e.g., fat mass and muscle mass) was measured using BIA. Grip strength was measured. Fasting blood samples were collected, and 25-hydroxyvitamin D (25(OH)D), tartrate-resistant acid phosphatase-5b (TRACP-5b), and parathyroid hormone (PTH) levels were measured. Data on current smoking, alcohol consumption, exercise, and any comorbidities (heart disease, lung disease, stroke, or diabetes mellitus) were collected. Results The SI increased with increasing quartiles of fat mass and muscle mass (both p for trend < 0.001), respectively. There were positive correlations between SI and log (25(OH)D) or grip strength. Fat mass significantly correlated with grip strength. Multiple linear regression analysis showed that higher fat mass was independently and significantly associated with higher SI after adjusting for age, height, comorbidity, current smoking, alcohol consumption, exercise, log (25(OH)D), log (TRACP-5b), log (PTH), and grip strength (p = 0.001). In contrast, no association was observed between muscle mass and SI. Conclusions Fat mass, but not muscle mass, was a significant determinant of SI in community-dwelling postmenopausal Japanese women.
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28
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Saeki S, Yamamoto K, Tomizawa R, Meszaros S, Horvath C, Zoldi L, Szabo H, Tarnoki AD, Tarnoki DL, Ishida T, Honda C. Utilizing Graphical Analysis of Chest Radiographs for Primary Screening of Osteoporosis. Medicina (Kaunas) 2022; 58. [PMID: 36556967 DOI: 10.3390/medicina58121765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
Background and Objectives: Osteoporosis is a major risk of fractures, harming patients’ quality of life. Dual-energy X-ray absorptiometry (DXA), which can detect osteoporosis early, is too expensive to be conducted on a regular basis. Therefore, we aimed to evaluate a screening method using chest radiographs developed in Japan applied to another population. Materials and Methods: Fifty-five patients who had a chest radiograph and DXA and applied within three months of each test were recruited from the patient database of Semmelweis University (Budapest, Hungary). Graphical analysis of the chest radiographs was conducted to identify the ratio of the cortical bone in the clavicle of each patient. Two researchers performed the analysis, and multiple regression was conducted to determine the bone mineral density of each patient provided by DXA. Results: The Pearson correlation between two examiners’ determinations of the cortical bone ratio was 0.769 (p < 0.001). The multiple regression model proved to be statistically significant in identifying osteoporosis, but the model adopted for the Hungarian population was different compared to the Japanese population. Conclusions: This simple, economic Japanese graphical analysis method for chest radiographs may be feasible in detecting osteoporosis. Further studies with a larger population of patients with greater variety of ethnicity would be of value in improving the accuracy of this model.
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29
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Li H, Hu Y, Gan L, Wang Y. Observation of the clinical effectiveness of evidence-based nursing for patients with a vertebral osteoporotic fracture. J Back Musculoskelet Rehabil 2022; 36:517-523. [PMID: 36404532 DOI: 10.3233/bmr-220161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An osteoporotic fracture (OPF) can significantly affect patients' activities of daily living (ADLs). OBJECTIVE This study observed the effects of evidence-based nursing (EBN) on the occurrence of postoperative complications and ADLs in patients with a vertebral OPF. METHODS A total of 90 patients with vertebral OPF were divided into two groups. The conventional orthopedic nursing method was conducted for the control group, and the EBN model was delivered for the observation group. RESULTS Differences in the Barthel index (BI) score on the first day of admission were not statistically significant between the two groups. The BI scores on the day before discharge, compared with the day of admission, had improved in both groups. The BI score on the day before discharge was 83.67 ± 6.94 in the observation group, and the difference was statistically significant (P< 0.05) compared with the control group (76.56 ± 6.89). The rate of satisfaction with nursing in the observation group (100.0%) was significantly higher than in the control group (82.2%) (P< 0.05). The incidence of postoperative complications in the observation group (2.2%) was significantly lower than in the control group (24.4%) (P< 0.05). CONCLUSIONS The implementation of EBN in patients with vertebral OPF improved the postoperative ADLs, reduced the incidence of postoperative complications, and improved the patients' satisfaction with nursing.
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Affiliation(s)
- Hui Li
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.,Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ying Hu
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.,Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Lin Gan
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - YiXuan Wang
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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30
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Nagayama Y, Ebina K, Tsuboi H, Hirao M, Hashimoto J, Yoshikawa H, Okada S, Nakata K. Low serum albumin concentration is associated with increased risk of osteoporosis in postmenopausal patients with rheumatoid arthritis. J Orthop Sci 2022; 27:1283-1290. [PMID: 34696921 DOI: 10.1016/j.jos.2021.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/01/2021] [Accepted: 08/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The risk of osteoporosis in patients with rheumatoid arthritis (RA) is frequently overlooked, and investigating a simple indicator in routine care may be beneficial to motivate osteoporosis examination. The aim of this retrospective, case-controlled study was to identify the correlation between serum albumin concentrations and the prevalence of osteoporosis in postmenopausal patients with RA. METHODS This study enrolled 197 patients who underwent dual-energy X-ray absorptiometry of lumbar spine (LS) and proximal femur without osteoporosis treatment [mean age, 67.5 years; disease duration, 12.8 years; Disease Activity Score assessing 28 joints with C-reactive protein, 2.0; prednisolone dose, 4.9 mg/day (usage, 42.6%); and LS T-score, -1.9]. Patients were classified into 2 groups: osteoporosis, defined as ≥ 1 part bone mineral density T-score ≤ -2.5 or history of fragility fracture of the vertebra or proximal femur (121 patients), and non-osteoporosis (76 patients). Groups were then matched by propensity score using clinical backgrounds affecting bone metabolism. RESULTS In non-matched model, serum albumin concentration was significantly associated with osteoporosis-related factors such as aging, inflammation, physical disability, and glucocorticoid dose. Multivariate logistic regression revealed that serum albumin concentration was independently and significantly associated with osteoporosis risk (odds ratio = 0.22, 95% confidence interval = 0.08, 0.61, p = 0.0033). After propensity score matching, 57 patients for each group showed that in addition to the LS and femoral neck T-scores (p < 0.001), serum albumin concentrations (p = 0.01) remained lower in the osteoporosis group compared to non-osteoporosis group. Receiver operating characteristic curve analysis in non-matched model revealed that when cut-off value of serum albumin concentration for indicating osteoporosis was set at 4.2 g/dl, the area under the curve was 0.69, sensitivity 0.74, and specificity 0.58. CONCLUSIONS Low serum albumin concentration was significantly and independently associated with the prevalence of osteoporosis, which may be considered as one of the osteoporosis-related factors in postmenopausal patients with RA.
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Affiliation(s)
- Yoshio Nagayama
- Nagayama Rheumatology and Orthopaedic Clinic, 4-3-25 Hiokisounishi-machi, Higashi-ku, Sakai, 599-8114, Japan
| | - Kosuke Ebina
- Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hideki Tsuboi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025, Japan
| | - Makoto Hirao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Jun Hashimoto
- Department of Rheumatology, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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31
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Ebina K, Etani Y, Tsuboi H, Nagayama Y, Kashii M, Miyama A, Kunugiza Y, Hirao M, Okamura G, Noguchi T, Takami K, Goshima A, Miura T, Fukuda Y, Kurihara T, Okada S, Nakata K. Impact of the duration of previous osteoporosis treatment on the effect of romosozumab in patients with postmenopausal osteoporosis. Osteoporos Int 2022; 33:2441-2443. [PMID: 36066579 DOI: 10.1007/s00198-022-06545-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Kosuke Ebina
- Department of Musculoskeletal Regenerative Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Yuki Etani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Hideki Tsuboi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025, Japan
| | - Yoshio Nagayama
- Nagayama Rheumatology and Orthopaedic Clinic, 4-3-25 Hiokisounishi-machi, Higashi-ku, Sakai, 599-8114, Japan
| | - Masafumi Kashii
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Akira Miyama
- Department of Orthopaedic Surgery, Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Yasuo Kunugiza
- Department of Orthopaedic Surgery, Japan Community Health Care Organization, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, 573-8511, Japan
| | - Makoto Hirao
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - Gensuke Okamura
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025, Japan
| | - Takaaki Noguchi
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - Kenji Takami
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Atsushi Goshima
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Taihei Miura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yuji Fukuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Takuya Kurihara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
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Kanto A, Kotani Y, Murakami K, Tamaki J, Sato Y, Kagamimori S, Matsumura N, Iki M. Risk factors for future osteoporosis in perimenopausal Japanese women. Menopause 2022; 29:1176-1183. [PMID: 35969496 PMCID: PMC9512233 DOI: 10.1097/gme.0000000000002034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/10/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE The aims of this study were to investigate trends in bone mineral density (BMD) loss and related factors in early postmenopausal women in Japan, identify risk factors for future osteoporosis, and predict osteoporosis before it occurs. METHODS The study population consisted of women who were 50 to 54 years old at the time of the survey in 2002 or 2006. The study included a questionnaire and physical measurement findings (BMD, height, body weight [WT], body mass index [BMI], and handgrip strength). One hundred sixty-seven women continued to participate in the study and had BMD measurements at the 9- or 10-year follow-up of the Japanese Population-based Osteoporosis study. Statistical analyses were performed using Pearson correlation to examine each factor of physical measurement and BMD for lumbar spine (LS) and femoral neck (FN). The receiver operating characteristic curve of this data was also predictive of osteoporosis in 2011 for 2002 data; BMD at the age of 50 to 54 years was then used to predict the likelihood of being diagnosed with osteoporosis 9 and 10 years later. RESULTS At the baseline in 2002 and 2006, WT, BMI, height, and handgrip strength were positively correlated with BMD. The optimal cutoff values for BMD in 2006 to predict osteoporosis in 2016 were LS less than 0.834 g/cm 2 and FN less than 0.702 g/cm 2 . These data were also predictive of osteoporosis in 2011 for 2002 data; applying this to the 2002 data, LS/FN had a sensitivity of 92%/100%, a specificity of 87%/81%, a positive predictive value of 55%/48%, and a negative predictive value of 98%/100%. The larger WT and BMI also resulted in a greater decrease in BMD of FN after 9 or 10 years. CONCLUSIONS We have identified a cutoff value for BMD to predict future osteoporosis in menopausal women and found a negative correlation between WT and BMI in menopausal women and changes in BMD of the FN over the next 10 years.
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Affiliation(s)
- Akiko Kanto
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Yasushi Kotani
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Kosuke Murakami
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Junko Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Osaka Medical Pharmaceutical University, Osaka, Japan
| | - Yuho Sato
- Department of Human Life, Jin-ai University, Fukui, Japan
| | | | - Noriomi Matsumura
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Masayuki Iki
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
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Fujiwara S, Buchanan-Hughes A, Ng A, Page J, Adachi K, Li H. Real-world evaluation of osteoporotic fractures using the Japan Medical Data Vision database. Osteoporos Int 2022; 33:2205-2216. [PMID: 35779100 DOI: 10.1007/s00198-022-06472-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
UNLABELLED In Japanese patients who experienced an osteoporotic fracture, 10.8% and 18.6% had a subsequent fracture within 1 and 2 years of follow-up, respectively. Although the burden of hip and vertebral fractures has been reported widely, we found that patients with non-hip non-vertebral (NHNV) fractures had a 26% higher risk of subsequent fracture than patients with hip fractures; therefore, NHNV fractures should also be considered an important risk factor for subsequent fracture. INTRODUCTION To investigate imminent risk and odds of subsequent osteoporotic fractures and associated risk factors in patients who experienced an initial osteoporotic fracture. METHODS Patients aged ≥ 50 years with ≥ 1 osteoporotic fracture were analyzed from Japan's Medical Data Vision (MDV) database of claims from acute-care hospitals (January 2012-January 2017). Multivariable models were constructed to explore the impact of key comorbidities and medications on the subsequent fracture risk: Cox proportional hazards model for time to subsequent fracture and logistic regression models for odds of subsequent fracture within 1 and 2 years from index fracture. RESULTS In total, 32,926 patients were eligible with a median follow-up duration of 12.3 months. The percentage of patients experiencing subsequent fractures was 14.1% across the study duration, and 10.8% and 18.6% in patients with 1 and 2 years of follow-up, respectively. In the Cox proportional hazards model, patients with vertebral or NHNV index fractures had a higher subsequent fracture risk than patients with a hip index fracture (adjusted hazard ratio [aHR] 1.11 and 1.26, respectively); subsequent fracture risk was lower in males than females (aHR 0.89). Patients with baseline claims for tranquilizers and glucocorticoids had a higher subsequent fracture risk than those without (aHR 1.14 and 1.08, respectively). Additionally, baseline claims for anti-Parkinson's medications, alcoholism, and stage 4/5 chronic kidney disease were significantly associated with higher odds of subsequent fracture in the logistic regression models. CONCLUSION Several clinical and demographic factors were associated with a higher risk and odds of subsequent fracture. This may help to identify patients who should be prioritized for osteoporosis treatment.
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Affiliation(s)
| | | | - Alvin Ng
- Costello Medical, Singapore, Singapore
| | | | | | - Hong Li
- Amgen Asia Holding Limited, Hong Kong, China
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Sato Y, Yamamoto N, Inagaki N, Iesaki Y, Asamoto T, Suzuki T, Takahara S. Deep Learning for Bone Mineral Density and T-Score Prediction from Chest X-rays: A Multicenter Study. Biomedicines 2022; 10:2323. [PMID: 36140424 PMCID: PMC9496220 DOI: 10.3390/biomedicines10092323] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 12/23/2022] Open
Abstract
Although the number of patients with osteoporosis is increasing worldwide, diagnosis and treatment are presently inadequate. In this study, we developed a deep learning model to predict bone mineral density (BMD) and T-score from chest X-rays, which are one of the most common, easily accessible, and low-cost medical imaging examination methods. The dataset used in this study contained patients who underwent dual-energy X-ray absorptiometry (DXA) and chest radiography at six hospitals between 2010 and 2021. We trained the deep learning model through ensemble learning of chest X-rays, age, and sex to predict BMD using regression and T-score for multiclass classification. We assessed the following two metrics to evaluate the performance of the deep learning model: (1) correlation between the predicted and true BMDs and (2) consistency in the T-score between the predicted class and true class. The correlation coefficients for BMD prediction were hip = 0.75 and lumbar spine = 0.63. The areas under the curves for the T-score predictions of normal, osteopenia, and osteoporosis diagnoses were 0.89, 0.70, and 0.84, respectively. These results suggest that the proposed deep learning model may be suitable for screening patients with osteoporosis by predicting BMD and T-score from chest X-rays.
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Kawabata R, Takahashi T, Saito Y, Nakatsuka R, Imamura H, Motoori M, Makari Y, Takeno A, Kishi K, Adachi S, Miyagaki H, Kurokawa Y, Yamasaki M, Eguchi H, Doki Y. Analysis of the risk factors for osteoporosis and its prevalence after gastrectomy for gastric cancer in older patients: a prospective study. Surg Today 2022. [PMID: 36066746 DOI: 10.1007/s00595-022-02581-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/01/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Osteoporosis leads to fragility fractures and is a major public health problem. We conducted this study to analyze the prevalence of and risk factors for osteoporosis after gastrectomy in older patients. METHODS This multicenter prospective trial comprised older patients without recurrence of gastric cancer for > 3 years after curative surgery. The prevalence of osteoporosis was identified using the World Health Organization bone mineral density (BMD)-based definition. Univariate and multivariate analyses were performed to identify the risk factors for osteoporosis. RESULTS BMD values were measured in 267 of the 271 enrolled patients. The prevalence of osteoporosis was 38.2% (men 24.0%; women 60%). Analysis using FRAX® revealed that 51.7% of patients were candidates for pharmacologic therapy. Female sex (odds ratio [OR] 5.16, 95% confidence interval [CI] 2.61-10.2), age (OR 1.06, 95% CI 1.00-1.12), low body mass index (< 19.0 kg/m2) after gastrectomy (OR 5.31, 95% CI 2.79-10.13), and history of fracture (OR 2.06, 95% CI 1.06-4.02) were independently associated with osteoporosis. CONCLUSIONS The prevalence of osteoporosis in older patients after gastrectomy was 38.2%. Moreover, female sex, age, low body mass index after gastrectomy, and a history of fracture were risk factors significantly associated with osteoporosis. Thus, older patients undergoing gastrectomy should have proactive surveillance and receive treatment for osteoporosis.
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Yamada SM. Changes in bone mineral density in unconscious immobile stroke patients from the acute to chronic phases of brain diseases. Osteoporos Sarcopenia 2022; 8:106-111. [PMID: 36268498 PMCID: PMC9577216 DOI: 10.1016/j.afos.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/31/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Decreased bone mineral density (BMD) is observed in immobile stroke patients. But it is not clarified yet how rapidly BMD reduction occurs or what the most influencing factor to BMD loss is. Methods BMDs in the lumbar vertebrae and the proximal femur of the paralyzed side were measured in 100 immobile stroke patients at 1 week (0 month), 1 month, and 2 months after admission. The levels of serum calcium, phosphorous, 25-hydroxyvitamin D, and urine cross-linked N-telopeptide of type I collagen (NTx) were also measured. Results The average age of patients was 75.0 ± 11.4 years (31–94 years). No BMD reduction was identified in the lumbar vertebrae in 2 months; however, BMD in the femur significantly decreased in 2 months in female patients (P < 0.05). Serum calcium and phosphorous levels remained within the normal range during hospitalization, and 25-hydroxyvitamin D value rose in 2 months. Urine NTx significantly increased in both males and females in 2 months (male: P < 0.05, female: P < 0.01). Conclusions While there was no significant change in lumbar spine BMD in the 2 month period of immobilization after stroke, BMD in the proximal femur showed a significant reduction, particularly in women. The differential loss of BMD in the 2 regions of interest could possibly be due to the physical forces acting on different body parts during mobilization and nutritional factors. More studies are needed with larger study samples and prolonged follow-up to check the accuracy of these observations.
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Nakamoto T, Taguchi A, Kakimoto N. Osteoporosis screening support system from panoramic radiographs using deep learning by convolutional neural network. Dentomaxillofac Radiol 2022; 51:20220135. [PMID: 35816516 PMCID: PMC10043624 DOI: 10.1259/dmfr.20220135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study was performed to develop computer-aided screening systems that could predict osteoporosis. The systems were constructed using panoramic radiographs of women aged ≥ 50 years through three types of deep convolutional neural networks (CNNs): Alexnet, VGG-16, and GoogLeNet; the performances of the constructed systems were evaluated. METHODS One oral radiologist classified 1500 panoramic radiographs into three types. In C1, the endosteal margin of the cortex was smooth and sharp, whereas porosities were observed in C2 and C3. The risks of osteoporosis were higher in C2 and C3 than in C1; C3 had the highest risk. This information was included with the images as training data; three CNNs were transfer trained. Using each trained CNN, the diagnostic accuracy was assessed using panoramic radiographs and bone mineral density inspection findings in the lumbar spine and femoral neck of 100 additional patients. RESULTS All CNNs exhibited relatively good agreement with the oral radiologist's judgement (86.0%-90.7%). The predictive results of the three systems for osteoporosis of the lumbar spine showed sensitivities of 78.3%-82.6%, specificities of 71.4%-79.2%, and accuracies of 74.0%-79.0%. The predictive results for osteoporosis of the femoral neck showed sensitivities of 80.0%-86.7%, specificities of 67.1%-74.1%, and accuracies of 70.0%-75.0%. CONCLUSIONS The constructed systems were generally more accurate than the previously developed conventional system. The new systems may facilitate osteoporosis prediction and prevent subsequent fractures by encouraging patients with suspected osteoporosis to undergo further inspections (e.g., dual-energy X-ray absorptiometry) and treatment.
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Affiliation(s)
- Takashi Nakamoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Akira Taguchi
- Department of Oral and Maxillofacial Radiology, Matsumoto Dental University, Nagano, Japan
| | - Naoya Kakimoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
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Lundberg HE, Glasø M, Chhura R, Shukla AA, Austlid T, Sarwar Z, Hovland K, Iqbal S, Fagertun HE, Holo H, Larsen SE. Effect on bone anabolic markers of daily cheese intake with and without vitamin K 2: a randomised clinical trial. BMJ Nutr Prev Health 2022; 5:182-190. [PMID: 36619332 PMCID: PMC9813627 DOI: 10.1136/bmjnph-2022-000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/26/2022] [Indexed: 02/01/2023] Open
Abstract
Background Daily intake of 57 g Jarlsberg cheese has been shown to increase the total serum osteocalcin (tOC). Is this a general cheese effect or specific for Jarlsberg containing vitamin K2 and 1,4-dihydroxy-2naphtoic acid (DHNA)? Methods 66 healthy female volunteers (HV) were recruited. By skewed randomisation (3:2), 41 HV were allocated to daily intake of 57 g Jarlsberg (J-group) and 25-50 g Camembert (C-group) in 6 weeks. After 6 weeks the C-group was switched to Jarlsberg. The study duration was 12 weeks with clinical investigations every 6 weeks. The main variables were procollagen type 1 N-terminal propeptide (PINP), tOC, carboxylated osteocalcin (cOC) and the osteocalcin ratio (RO) defined as the ratio between cOC and undercarboxylated osteocalcin (ucOC). Serum cross-linked C-telopeptide type I collagen (CTX), vitamin K2, lipids and clinical chemistry were used as secondary variables. Results PINP, tOC, cOC, RO and vitamin K2 increased significantly (p<0.01) after 6 weeks in the J-group. PINP remained unchanged in the C-group. The other variables decreased slightly in the C-group but increased significantly (p≤0.05) after switching to Jarlsberg. No CTX-changes detected in neither of the groups.Serum lipids increased slightly in both groups. Switching to Jarlsberg, total cholesterol and low-density lipoprotein-cholesterol were significantly reduced (p≤0.05). Glycated haemoglobin (HbA1c), Ca++ and Mg++ were significantly reduced in the J-group, but unchanged in the C-group. Switching to Jarlsberg, HbA1c and Ca++ decreased significantly. Conclusion The effect of daily Jarlsberg intake on increased s-osteocalcin level is not a general cheese effect. Jarlsberg contain vitamin K2 and DHNA which increases PINP, tOC, cOC and RO and decreases Ca++, Mg++ and HbA1c. These effects reflect increased bone anabolism and a possible reduced risk of adverse metabolic outcomes. Trial registration number NCT04189796.
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Affiliation(s)
| | | | | | | | | | | | | | - Sapna Iqbal
- Stallbakken Medical Center, Rælingen, Norway
| | | | - Helge Holo
- Norwegian University of Life Sciences, As, Norway
| | - Stig Einride Larsen
- Clinical Department, Meddoc Research, Lillestrøm, Skjetten, Norway,Veterinary Medicine, Norwegian University of Life Sciences, As, Oslo, Norway
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Ebina K, Etani Y, Tsuboi H, Nagayama Y, Kashii M, Miyama A, Kunugiza Y, Hirao M, Okamura G, Noguchi T, Takami K, Goshima A, Miura T, Fukuda Y, Kurihara T, Okada S, Nakata K. Effects of prior osteoporosis treatment on the treatment response of romosozumab followed by denosumab in patients with postmenopausal osteoporosis. Osteoporos Int 2022; 33:1807-1813. [PMID: 35362725 DOI: 10.1007/s00198-022-06386-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/25/2022] [Indexed: 01/28/2023]
Abstract
UNLABELLED In patients with postmenopausal osteoporosis, prior osteoporosis treatment affected the bone mineral density increase of following treatment with 12 months of romosozumab, although it did not affect that of following treatment with 12 months of denosumab after romosozumab. PURPOSE To investigate the effects of prior osteoporosis treatment on the response to treatment with romosozumab (ROMO) followed by denosumab (DMAb) in patients with postmenopausal osteoporosis. METHODS In this prospective, observational, multicenter study, treatment-naïve patients (Naïve; n = 55) or patients previously treated with bisphosphonates (BP; n = 37), DMAb (DMAb; n = 45) or teriparatide (TPTD; n = 17) (mean age, 74.6 years; T-scores of the lumbar spine [LS] - 3.2 and total hip [TH] - 2.6) were switched to ROMO for 12 months, followed by DMAb for 12 months. Bone mineral density (BMD) and serum bone turnover markers were evaluated for 24 months. RESULTS A BMD increase was observed at 12 and 24 months in the following patients: Naïve (18.2% and 22.0%), BP (10.2% and 12.1%), DMAb (6.6% and 9.7%), and TPTD (10.8% and 15.0%) (P < 0.001 between the groups at both 12 and 24 months) in LS and Naïve (5.5% and 8.3%), BP (2.9% and 4.1%), DMAb (0.6% and 2.2%), and TPTD (4.3% and 5.4%) (P < 0.01 between the groups at 12 months and P < 0.001 at 24 months) in TH, respectively. The BMD increase in LS from 12 to 24 months was negatively associated with the levels of bone resorption marker at 24 months. Incidences of major fragility fractures for the respective groups were as follows: Naïve (5.5%), BP (16.2%), DMAb (11.1%), and TPTD (5.9%). CONCLUSIONS Previous treatment affected the BMD increase of following treatment with ROMO, although it did not affect that of following treatment with DMAb after ROMO.
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Affiliation(s)
- K Ebina
- Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Y Etani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - H Tsuboi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025, Japan
| | - Y Nagayama
- Nagayama Rheumatology and Orthopaedic Clinic, 4-3-25 Hiokisounishi-machi, Higashi-ku, Sakai, 599-8114, Japan
| | - M Kashii
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - A Miyama
- Department of Orthopaedic Surgery, Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Y Kunugiza
- Department of Orthopaedic Surgery, Japan Community Health Care Organization, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, 573-8511, Japan
| | - M Hirao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - G Okamura
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025, Japan
| | - T Noguchi
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - K Takami
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - A Goshima
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - T Miura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Y Fukuda
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - T Kurihara
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - S Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - K Nakata
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
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Hattori K, Takahashi N, Kojima T, Imagama S. Risk Factors for Denosumab Discontinuation in Patients with Postmenopausal Osteoporosis. Mod Rheumatol 2022:6631070. [PMID: 35788363 DOI: 10.1093/mr/roac070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Persistence with treatment is key to achieving successful treatment outcomes in patients with osteoporosis. We investigated risk factors for denosumab discontinuation in patients with postmenopausal osteoporosis (PMO). METHODS A total of 333 patients with PMO who had never received osteoporosis treatment were included in this study. Baseline demographics and retention rate of denosumab were evaluated in all patients. Univariate analysis was performed in patients divided into two groups according to whether they had continued or discontinued denosumab. A Cox proportional hazards model was used to determine risk factors for denosumab discontinuation. RESULTS Mean age was 80.7 years, body mass index (BMI) was 21.5 kg/m2, and T-scores for the lumbar spine and femoral neck were -2.7 and -2.8, respectively. The retention rate of denosumab at 36 months was 50.3%. Patients who continued denosumab were younger and had higher BMI, serum albumin (Alb) levels, and lumbar spine bone mineral density, and fewer vertebral fractures (VFs), compared with those who discontinued denosumab. The Cox proportional hazards model revealed that a low BMI, low serum Alb levels, and a high number of VFs are independent risk factors for denosumab discontinuation. CONCLUSIONS A low BMI, low serum Alb levels, and a high number of VFs were associated with denosumab discontinuation in patients with PMO.
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Affiliation(s)
- Kyosuke Hattori
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Nobunori Takahashi
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Toshihisa Kojima
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shiro Imagama
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Park H, Yang H, Heo J, Jang HW, Chung JH, Kim TH, Min YK, Kim SW. Bone Mineral Density Screening Interval and Transition to Osteoporosis in Asian Women. Endocrinol Metab (Seoul) 2022; 37:506-512. [PMID: 35678100 PMCID: PMC9262692 DOI: 10.3803/enm.2022.1429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/03/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGRUOUND Bone mineral density (BMD) testing is indicated for women aged 65 years, but screening strategies for osteoporosis are controversial. Currently, there is no study focusing on the BMD testing interval in Asian populations. The current study aimed to evaluate the estimated time interval for screening osteoporosis. METHODS We conducted a study of 6,385 subjects aged 50 years and older who underwent dual-energy X-ray absorptiometry screening more than twice at Samsung Medical Center as participants in a routine health checkup. Subjects were divided based on baseline T-score into mild osteopenia (T-score, <-1.0 to >-1.5), moderate osteopenia (T-score, ≤-1.5 to >-2.0), and severe osteopenia (T-score, ≤-2.0 to >-2.5). Information about personal medical and social history was collected by a structured questionnaire. RESULTS The adjusted estimated BMD testing interval for 10% of the subjects to develop osteoporosis was 13.2 years in mild osteopenia, 5.0 years in moderate osteopenia, and 1.5 years in severe osteopenia. CONCLUSION Our study provides extended information about BMD screening intervals in Asian female population. Baseline T-score was important for predicting BMD screening interval, and repeat BMD testing within 5 years might not be necessary in mild osteopenia subjects.
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Affiliation(s)
- Hyunju Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heera Yang
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Heo
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Won Jang
- Department of Medical Education, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Ki Min
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Corresponding author: Sun Wook Kim Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-1653, Fax: +82-2-6918-4653, E-mail:
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Hori M, Yasuda K, Takahashi H, Kondo C, Shirasawa Y, Ishimaru Y, Sekiya Y, Morozumi K, Maruyama S. Effects of bone turnover status on the efficacy and safety of denosumab among haemodialysis patients. Sci Rep 2022; 12:7781. [PMID: 35546172 DOI: 10.1038/s41598-022-12029-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/04/2022] [Indexed: 11/08/2022] Open
Abstract
Denosumab is reported to increase bone mineral density (BMD) among haemodialysis patients; however, hypocalcaemia is a serious adverse effect among chronic kidney disease (CKD) patients. Identifying which patients will show greater improvement in BMD is important. We enrolled 84 haemodialysis patients with osteoporosis in our study. 28 patients initiated denosumab treatment between October 2019 and October 2020. We assessed BMD changes and investigated the association between baseline bone turnover marker (BTM) levels and 6-month changes in BMD after denosumab treatment. BMD was increased at 6 months in denosumab-treated patients compared with patients not treated with denosumab (lumbar spine: 5.34% vs. - 0.49%; total hip: 2.43% vs. - 0.47%). Bone-specific alkaline phosphatase (BAP) and tartrate-resistant acid phosphatase-5b (TRACP-5b) at baseline were independently associated with increased BMD in the total hip (BAP: β = 0.472, p value = 0.004; TRACP-5b: β = 0.433, p value = 0.008) and lumbar spine (BAP: β = 0.591, p value = 0.001; TRACP-5b: β = 0.613, p value = 0.0008). BAP and TRACP-5b were also independent predictors of hypocalcaemic events (OR [95% CI] 1.747 [1.084-4.604] and 1.006 [1.000-1.015], respectively). BTMs may be associated with increased BMD and hypocalcaemic events after denosumab treatment. BTM measurement may be useful for assessing the effect of denosumab on BMD; however, careful monitoring of serum calcium levels is needed.
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Iki M, Fujimori K, Nakatoh S, Tamaki J, Ishii S, Okimoto N, Kamiya K, Ogawa S. Guideline adherence by physicians for management of glucocorticoid-induced osteoporosis in Japan: a nationwide health insurance claims database study. Osteoporos Int 2022; 33:1097-1108. [PMID: 35022812 DOI: 10.1007/s00198-021-06265-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/06/2021] [Indexed: 12/12/2022]
Abstract
UNLABELLED Risk of fracture due to glucocorticoid-induced osteoporosis (GIO) can be reduced by anti-osteoporosis (OP) medications. The proportion of patients on long-term glucocorticoid therapy who received anti-OP medications according to the GIO management guidelines has increased in recent years, but is still suboptimal. INTRODUCTION Adherence of physicians to guidelines for glucocorticoid (GC)-induced osteoporosis (GIO) management is currently unclear. This study aimed to clarify the state of guideline adherence by physicians in Japan and identify factors associated with guideline adherence using a nationwide health insurance claims database (NDBJ). METHODS Patients aged ≥ 50 years who were prescribed GC for ≥ 90 days after 180 days without a GC prescription and who were followed up for osteoporosis (OP) management for the subsequent 360 days during the period spanning 2012-2018 were selected from the NDBJ. Guideline adherence was evaluated with the proportion of patients who received OP management as recommended by the Japanese guidelines. Information on previous vertebral and hip fractures, dementia, and polypharmacy was obtained. Factors associated with OP management were evaluated by logistic regression analysis. RESULTS A total of 512,296 patients were considered to be at high risk of fracture according to the guidelines. Proportions of patients receiving OP management (BMD testing or anti-OP medications) have increased in recent years. In 2017, 33.7% of men and 55.3% of women received OP management in the initial 90 days of GC therapy. Female sex, previous anti-OP medications, polypharmacy, and higher GC dose were significantly associated with receiving OP management, while dementia showed an inverse association. A prior history of hip fracture, a strong risk factor for future fracture, was not significantly associated with receiving OP management. CONCLUSIONS Although guideline adherence by physicians has increased in recent years, it remains suboptimal. Further efforts to improve guideline adherence are necessary. TRIAL REGISTRATION NUMBER The present study is not registered.
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Affiliation(s)
- M Iki
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan.
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan.
| | - K Fujimori
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan
- Department of Health Administration and Policy, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - S Nakatoh
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan
- Department of Orthopedic Surgery, Asahi General Hospital, 477 Tomari, Asaimachi, Shimo-Nikawa-gun, Toyama, 939-0798, Japan
| | - J Tamaki
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan
- Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - S Ishii
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan
- Department of Regulatory Science, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachiouji, Tokyo, 193-0392, Japan
| | - N Okimoto
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan
- Okimoto Clinic, 185-4 Kubi, Yutaka-machi, Kure, Hiroshima, 734-0304, Japan
| | - K Kamiya
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan
- Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - S Ogawa
- National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka, 589-8511, Osaka-Sayama, Japan
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8511, Japan
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Liu G, Yang MH, Zhu SW, Zhang P, Wang G, Wang MY, Wu XB. Effect of Orthogeriatric Co-Management on Geriatric Hip Fractures in China. Orthop Surg 2022; 14:671-677. [PMID: 35174660 PMCID: PMC9002067 DOI: 10.1111/os.13233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Although geriatric hip fracture is a serious public health problem in China, the result of orthogeriatric co‐management (OGC) is rarely reported. This study aimed to evaluate the effect of OGC in Chinese patients aged ≥65 years. Methods In this single‐centre, pre‐post intervention, retrospective study, traditional orthopaedic care (TOC) was used until OGC was implemented in May 2015, a multidisciplinary team was organized, and clinical protocol was designed. Consecutive hip fracture patients who were ≥65 years and injured within 3 weeks were included in this study. Demographic characteristics, comorbidities, fracture patterns, surgical procedure, time to surgery, length of hospital stay, inpatient complications, and in‐hospital mortality were extracted and examined. At 1‐year after surgery, data on patients' mobility and mortality were collected. The time to surgery, incidence of inpatient complications, mortality and functional outcomes were compared between the groups. Results There were no significant differences in sex, fracture type, and surgical pattern between OGC (n = 434) and TOC (n = 452) groups. Patients in OGC group were significantly older (P < 0.001) and had a higher age‐adjusted Charlson comorbidity index (P < 0.001). However, waiting time between admission and operation was significantly lower in OGC group (P < 0.001). There was no significant difference in the mortality rate at the time of the patient being in‐hospital and at 1, 3, and 6 months after surgery. Although 1‐year mortality was higher in OGC group (P = 0.036), Cox regression analysis showed no significant correlation of OGC with 1‐year mortality. There was no significant difference in pre‐injury mobility and 1‐year follow‐up mobility assessed by Parker score. Only approximately half of the patients in both groups completely returned to their pre‐injury mobility level. Conclusion OGC significantly shortens time to surgery for geriatric hip fractures compared with TOC. However, there is no significant effect on mortality rate within 1 year and functional status at 1 year of follow‐up.
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Affiliation(s)
- Gang Liu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Ming-Hui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Shi-Wen Zhu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Ping Zhang
- Department of Geriatric Medicine, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Geng Wang
- Department of Anesthesiology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Man-Yi Wang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Xin-Bao Wu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
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McCloskey EV, Harvey NC, Johansson H, Lorentzon M, Liu E, Vandenput L, Leslie WD, Kanis JA. Fracture risk assessment by the FRAX model. Climacteric 2022; 25:22-28. [PMID: 34319212 DOI: 10.1080/13697137.2021.1945027] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
The introduction of the FRAX algorithms has facilitated the assessment of fracture risk on the basis of fracture probability. FRAX integrates the influence of several well-validated risk factors for fracture with or without the use of bone mineral density. Since age-specific rates of fracture and death differ across the world, FRAX models are calibrated with regard to the epidemiology of hip fracture (preferably from national sources) and mortality (usually United Nations sources). Models are currently available for 73 nations or territories covering more than 80% of the world population. FRAX has been incorporated into more than 80 guidelines worldwide, although the nature of this application has been heterogeneous. The limitations of FRAX have been extensively reviewed. Arithmetic procedures have been proposed in order to address some of these limitations, which can be applied to conventional FRAX estimates to accommodate knowledge of dose exposure to glucocorticoids, concurrent data on lumbar spine bone mineral density, information on trabecular bone score, hip axis length, falls history, type 2 diabetes, immigration status and recency of prior fracture.
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Affiliation(s)
- E V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - H Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, VIC, Australia
| | - M Lorentzon
- Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Sweden
| | - E Liu
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, VIC, Australia
| | - L Vandenput
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, VIC, Australia
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Sweden
| | - W D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, VIC, Australia
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Liu IT, Liang FW, Li CC, Chang YF, Sun ZJ, Lu TH, Chang CS, Wu CH. Validation of the Taiwan FRAX® calculator for the prediction of fracture risk. Arch Osteoporos 2022; 17:27. [PMID: 35094177 DOI: 10.1007/s11657-022-01068-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/20/2022] [Indexed: 02/03/2023]
Abstract
The Taiwan FRAX® calculator was validated to predict incident fractures preliminarily. Cutoffs of FRAX probability for predicting major osteoporotic fracture and hip fracture were proposed as 9.5% and 4% in Taiwanese individuals. PURPOSE FRAX® is an algorithm used to calculate fracture probabilities based on clinical risk factors (CRFs) and bone mineral density (BMD). The country-specific Taiwan FRAX calculator has not been validated since its establishment in 2010. The aim of the present study is to evaluate the predictive performance of the Taiwan FRAX calculator using longitudinal fracture data. METHODS A total of 1975 subjects, aged ≧ 40 years old, from Yunlin and Tianliao cohorts in Taiwan during the period 2009-2010, were identified and completely connected with the 2008-2016 National Health Insurance Research Database. RESULTS During the average 6.8 ± 1.1 years of follow-up, 160 incident major osteoporotic fractures (MOFs) were identified. The predictive ability assessing based on the observed to expected fractures (O/E) ratio calculated with the FRAX probability adjusted for 6.8 years were 1.19 (95%CI 1.02-1.39) for MOF, and 1.07 (95%CI 0.82-1.39) for hip fractures. In the discriminative statistics, the AUC for prediction of major osteoporotic fractures using FRAX was 0.75 without and 0.77 with BMD (AUC for hip fracture was 0.75 without and 0.77 with BMD). The optimal cutoff value was 9.5% of the FRAX score with BMD for all major osteoporotic fractures, with good sensitivity (76.9%) and specificity (65.3%). For hip fractures, the optimal cutoff point for the FRAX probability with BMD was 4.0%, and the sensitivity and specificity were 74.4% and 68.3%, respectively. CONCLUSION The Taiwan FRAX® calculator was validated to predict incident fractures preliminarily. Cutoffs are proposed for predicting fracture risk in Taiwanese individuals.
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Tada M, Yamada Y, Mandai K, Matsumoto Y, Hidaka N. Osteosarcopenia synergistically increases the risk of falls in patients with rheumatoid arthritis. Osteoporos Sarcopenia 2022; 7:140-145. [PMID: 35005250 PMCID: PMC8714468 DOI: 10.1016/j.afos.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/07/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives Osteosarcopenia is defined as osteoporosis with sarcopenia. The impacts of osteosarcopenia on falls and fractures in rheumatoid arthritis (RA) patients were investigated using 4 years of data from a longitudinal study (CHIKARA study). Methods The patients were divided into 4 groups by their baseline status: no sarcopenia and no osteoporosis (SP-OP-); only sarcopenia (SP + OP-); only osteoporosis (SP-OP+); and both sarcopenia and osteoporosis (SP + OP+). Survival rates and Cox hazard ratios were analyzed using falls and fractures as endpoints, adjusted by age, sex, and body mass index. Results A total of 100 RA patients (SP-OP-: 44%, SP + OP-: 17%, SP-OP+: 28%, and SP + OP+: 11%) were enrolled; 37 patients had falls, and 19 patients had fractures. The fall-free and fracture-free survival rates were significantly lower in SP + OP+ (36.4%, 54.5%) than in SP-OP- (75.0%, 86.4%). The hazard ratio of falls was significantly increased in SP + OP+, by 3.32-fold (95%CI: 1.01-10.9), whereas in SP + OP- and SP-OP+, there were no differences compared to SP-OP-. Conclusions The survival rates with the endpoints of falls and fractures in RA patients with osteosarcopenia were lower during 4-year follow-up. The risk of falls increased with the synergistic effect of osteoporosis and sarcopenia.
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Affiliation(s)
- Masahiro Tada
- Department of Orthopaedic Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Yutaro Yamada
- Department of Orthopaedic Surgery, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Koji Mandai
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Kita-ku, Osaka, 530-0012, Japan
| | - Yoshinari Matsumoto
- Search Institute for Bone and Arthritis Disease (SINBAD), Shirahama Foundation for Health and Welfare, 1447 Shirahama-cho, Nishimuro-gun, Wakayama, 649-2211, Japan.,Department of Medical Nutrition, Osaka City University Graduate School of Human Life Science, 3-3-138 Sugimoto-cho, Sumiyoshi-ku, Osaka, 558-8585, Japan
| | - Noriaki Hidaka
- Department of Orthopaedic Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
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Azurin ES, Yamamoto N, Hayashi K, Takeuchi A, Miwa S, Igarashi K, Higuchi T, Yonezawa H, Morinaga S, Asano Y, Saito S, Tsuchiya H. Monostotic Fibrous Dysplasia in the Femur Strongly Expressing RANKL With Concomitant Osteoporotic Vertebral Compression Fracture: A Case Report. Cancer Diagn Progn 2022; 2:93-100. [PMID: 35400000 PMCID: PMC8962839 DOI: 10.21873/cdp.10082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM This study aimed to present a rare case of fibrous dysplasia (FD) in a healthy young adult man with a concomitant osteoporotic vertebral compression fracture. FD is a benign lesion of the bone characterized by replacement of the medullary component with fibro-osseous tissue that contains abnormally arranged trabeculae of immature woven bone. Recently it has been reported that several bone tumors including FD express the receptor activator of nuclear factor-kappa B (RANK) and its ligand (RANKL). Therefore, we hypothesized that FD contributed to osteoporosis, linked by the RANK-RANKL pathway of osteoclastogenesis. CASE REPORT We report the case of a healthy man with monostotic femoral fibrous dysplasia (FD) with concomitant 7 th thoracic vertebra compression fracture due to osteoporosis [young adult mean (YAM) was 79% in bone mineral density (BMD)]. After curettage of the FD, artificial bone grafting in the cavity, and administration of alendronate sodium, BMD improved considerably within 9 months. FD is a benign bone condition in which abnormal fibrous tissue replaces normal bone. The axis of the receptor activator of nuclear factor-kappa B (RANK) and its ligand (RANKL) has been implicated in osteoporosis pathogenesis. RANKL immunohistochemical staining was performed, and strong staining of stromal cells was observed compared to other FD cases that showed weak to moderate staining. CONCLUSION The presence of FD might have contributed to the low BMD due to the RANK-RANKL axis acting as osteoclastogenesis stimulator.
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Affiliation(s)
- Edelyn S Azurin
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
- Department of Orthopaedics, Jose B. Lingad Memorial General Hospital, Pampanga, the Philippines
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Shinji Miwa
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kentaro Igarashi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Takashi Higuchi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hirotaka Yonezawa
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Sei Morinaga
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Yohei Asano
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Shiro Saito
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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Martínez AV, Merino V, Ganem-Rondero A. Transdermal formulations and strategies for the treatment of osteoporosis. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Taguchi A, Uemura Y, Tanaka S, Ohta H, Mori S, Hagino H, Shiraki M, Nakamura T, Soen S; Adequate Treatment of Osteoporosis (A-TOP) research group. Influence of symptomatic periodontal disease on changes in skeletal bone density during medication therapy for osteoporosis in postmenopausal women: the Japanese Osteoporosis Intervention Trial (JOINT)-04 and JOINT-05. Arch Osteoporos 2021; 17:7. [PMID: 34958402 DOI: 10.1007/s11657-021-01054-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/20/2021] [Indexed: 02/03/2023]
Abstract
Japanese postmenopausal women with symptomatic periodontal disease had a significantly smaller increase in the T-score for total hip bone density than those without periodontal disease during medication therapy for osteoporosis. Intervention to treat symptomatic periodontal disease before and/or during osteoporosis therapy could maintain the effect of osteoporosis medications. PURPOSE Women with periodontal disease may be more likely to develop osteoporosis. We evaluated whether the presence of symptomatic periodontal disease can influence changes in skeletal bone mineral density (BMD) during medication therapy for osteoporosis in Japanese postmenopausal women. METHODS A total of 4,258 postmenopausal women participated in the Japanese Osteoporosis Intervention Trial protocol number 4 (JOINT-04 trial) and number 5 (JOINT-05 trial), which were multi-center, open-label, randomized controlled trials in Japan. Of these, 3,670 non-edentulous subjects participated in the study. Subjects who had self-reported symptoms of periodontal disease at baseline were defined as having periodontal disease. The study outcome was the difference in BMD changes during the study between subjects with and without periodontal disease. Mixed models for repeated measures after adjusting for covariates were used to investigate the difference in the BMD changes during the study between subjects with and without periodontal disease. RESULTS Subjects with periodontal disease had significantly lower T-scores for total hip (p = 0.035) and metacarpal (p = 0.048) BMD than those without periodontal disease at baseline. During medication therapy for osteoporosis, subjects with periodontal disease had a significantly smaller increase in T-score for total hip BMD than those without periodontal disease (p = 0.021), although no significant differences were observed in the changes in T-scores for other skeletal BMD measurements between subjects with and without periodontal disease. CONCLUSIONS The presence of self-reported symptoms of periodontal disease may be associated with a decrease in the effect of osteoporosis medications in Japanese postmenopausal women.
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