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Tokashiki T, Igarashi T, Shiraishi M, Kano R, Ojiri H. Evaluation of the association between osteoporotic vertebral compression fractures and psoas major/paraspinal muscle mass and ADC measured on MRI. Skeletal Radiol 2024; 53:675-682. [PMID: 37831148 DOI: 10.1007/s00256-023-04461-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Evaluate magnetic resonance imaging factors associated with osteoporotic vertebral compression fractures. MATERIALS AND METHODS We retrospectively reviewed 457 patients' records. Age, sex, and body mass index were recorded. Two blinded readers measured psoas major and paraspinal muscle areas at the L3 vertebral body level on transverse T2-weighted magnetic resonance images and the mean apparent diffusion coefficient values of the non-fractured vertebrae from Th12 to L5. Inter-reader reliability for continuous variables was assessed by intraclass correlation coefficients. RESULTS We evaluated 210 patients (103 [49.0%] men). The osteoporotic vertebral compression fractures group was older and had lower BMI and smaller psoas major and paraspinal muscle areas than the group without vertebral compression fractures (p < 0.001). The mean apparent diffusion coefficient was weakly correlated with paraspinal muscle area in the osteoporotic vertebral compression fractures group. The intraclass correlation coefficient value was 0.83, and the intraclass correlation coefficients of the psoas major and paraspinal muscles were 0.94 and 0.97, respectively. Multivariate analysis revealed that decreased psoas major and paraspinal muscle areas and increased mean apparent diffusion coefficient values were significantly associated with the presence of osteoporotic vertebral compression fractures (all p < 0.05). Psoas major and paraspinal muscle areas showed relatively high predictive accuracy (57%, 61%). CONCLUSION Psoas major and paraspinal muscle areas at the L3 level and the mean apparent diffusion coefficient value of non-fractured vertebrae from the Th12 to L5 level were associated with osteoporotic vertebral compression fractures. This may contribute to detecting the potential risk of healthy individuals developing osteoporotic vertebral compression fractures.
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Affiliation(s)
- Tadashi Tokashiki
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan.
| | - Takao Igarashi
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Megumi Shiraishi
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Rui Kano
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Hiroya Ojiri
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
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Saeki C, Kanai T, Ueda K, Nakano M, Oikawa T, Torisu Y, Saruta M, Tsubota A. Osteosarcopenia predicts poor survival in patients with cirrhosis: a retrospective study. BMC Gastroenterol 2023; 23:196. [PMID: 37277731 DOI: 10.1186/s12876-023-02835-y] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Osteosarcopenia, defined as the coexistence of sarcopenia and osteoporosis, is associated with adverse clinical outcomes. The present study investigated the prognostic significance of osteosarcopenia in patients with cirrhosis. METHODS This retrospective study evaluated 126 patients with cirrhosis. Participants were classified into three groups based on the presence or absence of (1) sarcopenia and/or osteoporosis; and (2) Child-Pugh (CP) class B/C cirrhosis and/or osteosarcopenia, and the cumulative survival rates were compared between the groups. Cox proportional hazards model was used to identify independent factors associated with mortality. Sarcopenia and osteoporosis were diagnosed according to the Japan Society of Hepatology and the World Health Organization criteria, respectively. RESULTS Among the 126 patients, 24 (19.0%) had osteosarcopenia. Multivariate analysis identified osteosarcopenia as a significant and independent prognostic factor. The cumulative survival rates were significantly lower in patients with osteosarcopenia than in those without (1/3/5-year survival rates = 95.8%/73.7%/68.0% vs. 100%/93.6%/86.5%, respectively; p = 0.020). Patients with osteosarcopenia, but not sarcopenia or osteoporosis alone, had significantly lower cumulative survival rates than those without both conditions (p = 0.019). Furthermore, patients with both CP class B/C and osteosarcopenia had significantly lower cumulative survival rates than those without both (p < 0.001) and with either condition (p < 0.001). CONCLUSIONS Osteosarcopenia was significantly associated with mortality in patients with cirrhosis. The cumulative survival rates were lower in patients with osteosarcopenia than in those without both conditions. Additionally, comorbid osteosarcopenia worsened the prognosis of patients with CP class B/C. Therefore, simultaneous evaluation of both sarcopenia and osteoporosis is crucial to better predict the prognosis.
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Affiliation(s)
- Chisato Saeki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
- Division of Gastroenterology, Department of Internal Medicine, Fuji City General Hospital, Fuji-Shi, Shizuoka, Japan.
| | - Tomoya Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
- Division of Gastroenterology, Department of Internal Medicine, Fuji City General Hospital, Fuji-Shi, Shizuoka, Japan
| | - Kaoru Ueda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Masanori Nakano
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
- Division of Gastroenterology, Department of Internal Medicine, Fuji City General Hospital, Fuji-Shi, Shizuoka, Japan
| | - Tsunekazu Oikawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Yuichi Torisu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
- Division of Gastroenterology, Department of Internal Medicine, Fuji City General Hospital, Fuji-Shi, Shizuoka, Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Akihito Tsubota
- Project Research Units, Research Center for Medical Science, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
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Cai S, Fan J, Zhu L, Ye J, Rao X, Fan C, Zhong Y, Li Y. Bone mineral density and osteoporosis in relation to all-cause and cause-specific mortality in NHANES: A population-based cohort study. Bone 2020; 141:115597. [PMID: 32814125 DOI: 10.1016/j.bone.2020.115597] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 04/15/2020] [Revised: 07/01/2020] [Accepted: 08/12/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The majority of the published studies ascertaining the relationships between low bone mineral density (BMD) and mortality highlighted the elderly population with limited sample size. Our study aimed to ascertain the relationships in general population. METHODS This study ascertained the relationships between BMD levels in femur and lumbar spine with all-cause and cause-specific mortality in the National Health and Nutrition Examination Survey (NHANES) (n = 15,076, mean age 48.6 years). Cox proportional hazards models were adopted to calculate the hazard ratios (HR) and the corresponding 95% confidence intervals (CIs) for mortality. RESULTS During a 6.8-year median follow-up, 1216 men and women in the cohort died. There was a higher risk of all-cause mortality among participants with osteoporosis compared with normal in the regions of total femur (HR = 1.36, 95% CI = 1.07-1.73), femur neck (HR = 1.41, 95% CI = 1.11-1.78), intertrochanter (HR = 1.34, 95% CI = 1.05-1.72), as well as overall (HR = 1.36, 95% CI = 1.09-1.69). Non-linear dose-response analyses showed a statistically significant L-shaped association for all-cause mortality with BMD increment in the regions of total femur, femur neck, trochanter, and intertrochanter. The protective role of higher BMD level in femur for decreased risk of cancer mortality and heart diseases mortality was more evident in male participants and female participants, respectively. CONCLUSIONS In summary, our results revealed that maintaining normal BMD is critical to lower the risk of mortality. The association between higher BMD level in femur and decreased risk of cancer as well as heart diseases mortality varies by gender.
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Affiliation(s)
- Shaofang Cai
- Department of Science and Education, The Second Affiliated Hospital of Xiamen Medical College, Xiamen 361021, China
| | - Jiayao Fan
- School of Public Health, Hangzhou Medical College, Hangzhou 310053, China
| | - Lina Zhu
- School of Public Health, Hangzhou Medical College, Hangzhou 310053, China
| | - Jianhong Ye
- Department of Science and Education, The Second Affiliated Hospital of Xiamen Medical College, Xiamen 361021, China
| | - Xianming Rao
- Department of Science and Education, The Second Affiliated Hospital of Xiamen Medical College, Xiamen 361021, China
| | - Chunhong Fan
- School of Public Health, Hangzhou Medical College, Hangzhou 310053, China
| | - Yaohong Zhong
- School of Public Health, Hangzhou Medical College, Hangzhou 310053, China
| | - Yingjun Li
- School of Public Health, Hangzhou Medical College, Hangzhou 310053, China.
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Wu GJ, Chen JT, Lin PI, Cherng YG, Yang ST, Chen RM. Inhibition of the estrogen receptor alpha signaling delays bone regeneration and alters osteoblast maturation, energy metabolism, and angiogenesis. Life Sci 2020; 258:118195. [PMID: 32781073 DOI: 10.1016/j.lfs.2020.118195] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/17/2020] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 01/03/2023]
Abstract
AIMS The estrogen-ERα axis participates in osteoblast maturation. This study was designed to further evaluated the roles of the estrogen-ERα axis in bone healing and the possible mechanisms. MAIN METHODS Female ICR mice were created a metaphyseal bone defect in the left femurs and administered with methylpiperidinopyrazole (MPP), an inhibitor of ERα. Bone healing was evaluated using micro-computed tomography. Colocalization of ERα with alkaline phosphatase (ALP) and ERα translocation to mitochondria were determined. Levels of ERα, ERβ, PECAM-1, VEGF, and β-actin were immunodetected. Expression of chromosomal Runx2, ALP, and osteocalcin mRNAs and mitochondrial cytochrome c oxidase (COX) I and COXII mRNAs were quantified. Angiogenesis was measured with immunohistochemistry. KEY FINDINGS Following surgery, the bone mass was time-dependently augmented in the bone-defect area. Simultaneously, levels of ERα were specifically upregulated and positively correlated with bone healing. Administration of MPP to mice consistently decreased levels of ERα and bone healing. As to the mechanisms, osteogenesis was enhanced in bone healing, but MPP attenuated osteoblast maturation. In parallel, expressions of osteogenesis-related ALP, Runx2, and osteocalcin mRNAs were induced in the injured zone. Treatment with MPP led to significant inhibition of the alp, runx2, and osteocalcin gene expressions. Remarkably, administration of MPP lessened translocation of ERα to mitochondria and expressions of mitochondrial energy production-related coxI and coxII genes. Furthermore, exposure to MPP decreased levels of PECAM-1 and VEGF in the bone-defect area. SIGNIFICANCE The present study showed the contributions of the estrogen-ERα axis to bone healing through stimulation of energy production, osteoblast maturation, and angiogenesis.
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Affiliation(s)
- Gong-Jhe Wu
- Department of Anesthesiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jui-Tai Chen
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Pei-I Lin
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shun-Tai Yang
- Department of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ruei-Ming Chen
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; TMU Research Center of Cancer Translational Medicine, Taipei, Taiwan.
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Lenchik L, Register TC, Hsu FC, Xu J, Smith SC, Carr JJ, Freedman BI, Bowden DW. Bone Mineral Density of the Radius Predicts All-Cause Mortality in Patients With Type 2 Diabetes: Diabetes Heart Study. J Clin Densitom 2018; 21:347-354. [PMID: 29284565 PMCID: PMC5984132 DOI: 10.1016/j.jocd.2017.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 07/21/2017] [Revised: 11/09/2017] [Accepted: 11/16/2017] [Indexed: 12/21/2022]
Abstract
This study aimed to determine the association between areal and volumetric bone mineral density (BMD) with all-cause mortality in patients with type 2 diabetes (T2D). Associations between BMD and all-cause mortality were examined in 576 women and 517 men with T2D in the Diabetes Heart Study. Volumetric BMD in the thoracic and lumbar spine was measured with quantitative computed tomography. Areal BMD (aBMD) in the lumbar spine, total hip, femoral neck, ultradistal radius, mid radius, and whole body was measured using dual X-ray absorptiometry. Association of BMD with all-cause mortality was determined using sequential models, stratified by sex: (1) unadjusted; (2) adjusted for age, race, smoking, alcohol, estrogen use; (3) model 2 plus history of cardiovascular disease, hypertension, and coronary artery calcification; (4) model 3 plus lean mass; and (5) model 3 plus fat mass. At baseline, mean age was 61.2 years for women and 62.7 years for men. At mean 11.0 ± 3.7 years' follow-up, 221 (36.4%) women and 238 (43.6%) men were deceased. In women, BMD at all skeletal sites (except spine aBMD and whole body aBMD) was inversely associated with all-cause mortality in the unadjusted model. These associations remained significant in the mid radius (hazard ratio per standard deviation = 0.79; p = 0.0057) and distal radius (hazard ratio per standard deviation = 0.76; p = 0.0056) after adjusting for all covariates, including lean mass. In men, volumetric BMD measurements but not aBMD were inversely associated with mortality and only in the unadjusted model. In this longitudinal study, lower baseline aBMD in the radius was associated with increased all-cause mortality in women with T2D, but not men, independent of other risk factors for death.
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Affiliation(s)
- Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Thomas C Register
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jianzhao Xu
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - S Carrie Smith
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - J Jeffrey Carr
- Department of Radiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Donald W Bowden
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Chen YC, Lin WC. Risk of long-term infection-related death in clinical osteoporotic vertebral fractures: A hospital-based analysis. PLoS One 2017; 12:e0182614. [PMID: 28793342 DOI: 10.1371/journal.pone.0182614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/16/2017] [Indexed: 01/22/2023] Open
Abstract
Background Osteoporotic vertebral fractures adversely impact quality of life and also increase the risk of infection and mortality. Alendronate treatment increases bone mass and reduces the risk of fractures in patients with osteoporosis by suppressing bone resorption. We investigated the relationship between alendronate treatment and infection-related death in patients with osteoporotic vertebral fractures. Methods We retrospectively reviewed patients with osteoporosis and vertebral fractures from January 2001 to December 2007. The use of alendronate, glucocorticoid and medical factors including smoking, alcohol consumption, diabetes, hypertension, stroke, liver disease, heart disease, and pulmonary disease were analyzed. Cox regression was used to analyze the factors associated with life-threatening infections. Results A total of 210 patients (161 females and 49 males) were included with a mean age of 74.06±7.43 years. Among them, 87 had life-threatening infections and 123 did not. In Cox regression analysis, the patients who used alendronate had a significantly lower risk of life-threatening infections (p = 0.006, HR = 0.845, 95% CI 0.750–0.954), while glucocorticoid users had higher risk of death (p = 0.010, HR = 2.037, 95% CI 1.187–3.498). Conclusions Osteoporosis was associated with a high rate of life-threatening infections, and the use of alendronate had a lower rate of infection-related death. Therefore, we suggest that alendronate be used after vertebral fractures in these patients.
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Chen YC, Lin WC. Poor 1st-year adherence to anti-osteoporotic therapy increases the risk of mortality in patients with magnetic resonance imaging-proven acute osteoporotic vertebral fractures. Patient Prefer Adherence 2017; 11:839-843. [PMID: 28490865 PMCID: PMC5414717 DOI: 10.2147/ppa.s131564] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Indexed: 12/12/2022] Open
Abstract
AIM Anti-osteoporotic therapy requires years of proper compliance to reduce the risk of fractures. This study investigated the effects of 1st-year adherence to anti-osteoporotic treatment on the risk of mortality in patients with magnetic resonance imaging-proven acute osteoporotic vertebral fractures after vertebroplasty. PATIENTS AND METHODS This retrospective study included 294 patients (252 females; mean age, 73.93±7.18 years) with osteoporosis and acute vertebral fractures treated with vertebroplasty between January 2001 and December 2007. Sex, age, body mass index, comorbidities, previous hip fracture, number of vertebral fractures, 5-year re-fracture rate, and use of anti-osteoporotic therapy were recorded for each patient. Adherence was determined according to compliance and persistence for 1 year. Compliance was calculated as the medication possession ratio (MPR), and persistence as the time from treatment initiation to discontinuation. Poor adherence was defined as either non-compliance or non-persistence. RESULTS The MPR of the patients at 1 year was 55.1%, with a persistence rate of 69.4% and a poor adherence rate of 62.6%. Cox regression analysis revealed that poor adherence to medications was associated with a significantly higher risk of mortality after adjustment for potential confounders (hazard ratio [HR]: 1.75; 95% CI: 1.13-2.71). Poor adherence to medications was significantly associated with an increase in the rate of infection (HR: 4.56; 95% CI: 1.12-18.52), which was the most common cause of death. CONCLUSION Poor adherence to anti-osteoporotic therapy significantly increases the risk of morality, possibly due to an increased risk of infection. Efforts should be made to improve adherence.
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Affiliation(s)
- Ying-Chou Chen
- Department of Rheumatology
- Correspondence: Ying-Chou Chen, Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan, Republic of China, Tel +886 7 731 7123, Fax +886 7 735 1843, Email
| | - Wei-Che Lin
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
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Zhou R, Liu D, Li R, Zhou S, Cui M, Chen L, Zhou H. Low Bone Mass is Associated with Stroke in Chinese Postmenopausal Women: The Chongqing Osteoporosis Study. Cell Biochem Biophys 2016; 71:1695-701. [PMID: 25481304 DOI: 10.1007/s12013-014-0392-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The objective of the present study was to investigate the association of low bone mass with the risk of stroke and death in community residents of China. This study was based on the follow-up data acquired from 5,136 postmenopausal women aged 50 years or older between July 2006 and June 2011. Baseline and the follow-up bone mineral density (BMD) in these patients were measured by dual energy X-ray absorptiometry scanning. The association of BMD and risk of stroke and death was further evaluated by Cox proportional hazard analysis. During the follow-up, 148 subjects (2.9%) sustained prospective stroke, and 261 subjects (5.1%) died. After adjustments for age and BMI, our results indicated that neck BMD and osteoporosis were independent predictors of stroke (HR for neck BMD = 1.35, 95% CI = 1.21-1.62; HR for osteoporosis = 2.24, 95% CI = 1.47-3.58) and were also associated with increased risk of death (HR for neck BMD = 1.39, 95% CI = 1.24-1.71; HR for osteoporosis = 1.97, 95% CI = 1.21-2.97). Our results also suggest that low neck BMD and osteoporosis are associated with significantly elevated risk of stroke and death in Chinese postmenopausal women.
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Affiliation(s)
- Rui Zhou
- Department of Orthopedics, The Orthopedic Surgery Center of Chinese PLA, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Dong Liu
- Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Rui Li
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Shiming Zhou
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Min Cui
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Lin Chen
- Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Huadong Zhou
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China.
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Cheung EY, Tan KC, Cheung CL, Kung AW. Osteoporosis in East Asia: Current issues in assessment and management. Osteoporos Sarcopenia 2016; 2:118-133. [PMID: 30775478 PMCID: PMC6372753 DOI: 10.1016/j.afos.2016.07.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 06/27/2016] [Accepted: 07/01/2016] [Indexed: 12/31/2022] Open
Abstract
The greatest burden of hip fractures around the world is expected to occur in East Asia, especially China. However, there is a relative paucity of information on the epidemiology and burden of fractures in East Asia. Osteoporosis is greatly under-diagnosed and under-treated, even among the highest-risk subjects who have already suffered fractures. The accessibility to bone densitometry, the awareness of the disease by professionals and the public, and the use and reimbursement of drugs are some of the areas which need improvement especially. Cost-effective analysis on screening strategy and intervention thresholds based on local epidemiology data and economic status are available only in Japan. In addition, clinical risk factor models for the assessment of fracture probability may be ethnic specific. Further research is needed to develop a cost-effective risk assessment strategy to identify high-risk individuals for screening and treatment based on local data. Moreover, inadequate calcium and vitamin D intake is still an issue faced by this region.
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Affiliation(s)
- Elaine Y.N. Cheung
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kathryn C.B. Tan
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ching-Lung Cheung
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
- Centre for Genomic Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Annie W.C. Kung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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Yoshii I, Satake Y, Kitaoka K, Komatsu M, Hashimoto K. Relationship between dementia degree and gait ability after surgery of proximal femoral fracture: Review from Clinical Pathway with Regional Alliance data of rural region in Japan. J Orthop Sci 2016; 21:481-486. [PMID: 27075586 DOI: 10.1016/j.jos.2016.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/17/2015] [Revised: 02/12/2016] [Accepted: 03/11/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Proximal femoral fracture (PFF) is one of the most serious injury-related problems in developed countries. Functional prognosis after operation for PFF is unsatisfactory, as a considerable number of patients cannot perform similar gait function before fracture. Postoperative gait function is a key in performing activities of daily living (ADL). It is well known that PFF patients with dementia result in worse prognosis compared to without dementia. It is believed that dementia affects gait function after operation. However, it is still unclear whether lost function recovers after dementia level improves. METHODS Relationship between ADL and dementia of PFF patients after surgery was investigated using data of Clinical Pathway with Regional Alliance system. Functional Independence Measurement (FIM), revised version of Hasegawa's Dementia Scale (HDS-R), motivation for rehabilitation (MR), and gait status (GS) measured in acute and recovery institute (A-I and R-I) of 266 patients were analyzed with linear regression analysis. Degrees of patients' dementia were classified into three groups with HDS-R for ten points increment partition, and their average FIM and GS in R-I for groups were compared statistically with ANOVA. FIM gain and GS gain from A-I to R-I were compared statistically with chi-square test. RESULTS FIM and HDS-R demonstrated significant regression with each of all other parameters (p < 0.01) for both A-I and R-I. The group with lowest HDS-R score demonstrated significant lower FIM gain and lower GS gain than groups with higher scores (p < 0.01). However, patients who demonstrated improvement in HDS-R at R-I demonstrated significant better GS gain (p < 0.05) even in the group with lowest HDS-R at A-I. CONCLUSIONS These results show that there is a very close correlation between patients' gait function and dementia and that it is necessary to control a patient's status not only for physical condition but also for mental status after PFF operation.
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Affiliation(s)
- Ichiro Yoshii
- In Yoshii Hospital from Medical Corporation Genyu, 6-7-5 Nakamura-Ohashidori, Shimanto-City, 787-0033 Kochi Prefecture, Japan.
| | - Yoshinori Satake
- Department of Orthopaedic Surgery, Kochi Prefectural Aki General Hospital, 3-33Hoheicho, Aki, 784-0027 Kochi Prefecture, Japan
| | - Kenichi Kitaoka
- Department of Orthopaedic Surgery, Kochi Prefectural Hata Kenmin Hospital, 3-1 Yoshina, Yamada-cho, 788-0785 Kochi Prefecture, Japan
| | - Makoto Komatsu
- Department of Orthopaedic Surgery, Kochi Prefectural Hata Kenmin Hospital, 3-1 Yoshina, Yamada-cho, 788-0785 Kochi Prefecture, Japan
| | - Kyuichi Hashimoto
- Department of Orthopaedic Surgery, Otsuki Hospital, 603 Hokotsuti, Otsuki, 788-0311 Kochi Prefecture, Japan
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Chen YC, Su FM, Cheng TT, Lin WC, Lui CC. Can antiosteoporotic therapy reduce mortality in MRI-proved acute osteoporotic vertebral fractures? J Bone Miner Metab 2016; 34:325-30. [PMID: 26040410 DOI: 10.1007/s00774-015-0672-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/02/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
Abstract
Patients with MRI-proved acute painful vertebral fractures in whom conservative pain management fails are frequently referred for vertebroplasty. This study investigated the effects of treating osteoporosis on the mortality rate of patients with MRI-proved acute osteoporosis-related vertebral fractures who had undergone vertebroplasty. We retrospectively reviewed the cases of osteoporosis patients with MRI-proved acute vertebral fractures who had been treated with vertebroplasty from January 2001 to December 2007. The long-term outcomes of the patients who received antiosteoporotic therapy were compared with those of patients who received no therapy. A total of 304 patients (247 female patients and 57 male patients; mean age, 74.1 ± 7.7 years) were enrolled in the study. The patients who received antiosteoporotic therapy had a significantly lower mortality rate than did patients who did not receive antiosteoporotic therapy (P = 0.001; hazard ratio, 0.396, 95 % confidence interval, 0.273-0.575). At the end of the study, 183 patients were alive, and 121 had died. Effective treatment for osteoporosis may improve survival in patients with osteoporosis-related vertebral fractures after vertebroplasty.
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Affiliation(s)
- Ying-Chou Chen
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833, Taiwan.
| | - Fu-Mei Su
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833, Taiwan
| | - Tien-Tsai Cheng
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833, Taiwan
| | - Wei-Che Lin
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833, Taiwan
| | - Chun-Chung Lui
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833, Taiwan
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Avramovski P, Avramovska M, Sikole A. Bone Strength and Arterial Stiffness Impact on Cardiovascular Mortality in a General Population. J Osteoporos 2016; 2016:7030272. [PMID: 27047700 DOI: 10.1155/2016/7030272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/31/2015] [Revised: 02/06/2016] [Accepted: 02/14/2016] [Indexed: 11/29/2022] Open
Abstract
Osteoporosis and increased arterial stiffness independently have been found to be associated with higher cardiovascular events rates in the general population (GP). We examined 558 patients from GP by dual-energy X-ray absorptiometry (DXA) and pulse wave velocity (PWV) measurements at baseline, with 36-month follow-up period. DXA assessed bone mineral density of femoral neck (BMD FN) and lumbar spine (BMD LS). Carotid-femoral PWV was assessed by pulsed-Doppler. The aim of our study is to find correlation between bone strength and arterial stiffness and their impact on cardiovascular mortality in GP. The mean ± SD of BMD FN, BMD LS, and PWV was 0.852 ± 0.1432 g/cm(2), 0.934 ± 0.1546 g/cm(2), and 9.209 ± 1.9815 m/s. In multiple regression analysis we found BMD FN (βst = -6.0094, p < 0.0001), hypertension (βst = 1.7340, p < 0.0091), and diabetes (βst = 0.4595, p < 0.0046). With Cox-regression analysis, after 17 cardiovascular events, the significant covariates retained by the backward model were BMD FN (b = -2.4129, p = 0.015) and PWV (b = 0.2606, p = 0.0318). The cut-off values were PWV = 9.4 m/s, BMD FN = 0.783 g/cm(2), and BMD LS = 0.992 g/cm(2). The results for BMD FN and PWV hazard ratio risk were 1.116 and 1.297, respectively. BMD FN as a measure of bone strength and PWV as a measure of arterial stiffness are strong independent predictors of cardiovascular mortality in GP.
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Su FM, Chen YC, Cheng TT, Lin WC, Lui CC. Is raloxifene associated with lower risk of mortality in postmenopausal women with vertebral fractures after vertebroplasty?: a hospital-based analysis. BMC Musculoskelet Disord 2015; 16:209. [PMID: 26286481 DOI: 10.1186/s12891-015-0670-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 02/19/2015] [Accepted: 08/10/2015] [Indexed: 12/02/2022] Open
Abstract
Background Osteoporotic fractures are associated with mortality in postmenopausal woman. Whether raloxifen treatment after vertebroplasty can reduce mortality is unclear in this group. To compare the effect of raloxifene and no osteoporosis treatment on the risk of mortality after vertebroplasty, we designed this study. Methods This was a retrospective study (January 2001 to December 2007). Follow-up for each participant was calculated as the time from inclusion in the study to the time of death, or to December 31st, 2013, whichever occurred first. All of the patients underwent baseline bone density studies, and age and body mass index (kg/m2) were recorded. All associated medical diseases such as diabetes, hypertension, and liver and renal disease were recorded. Results One hundred and forty-nine patients with vertebral fractures were enrolled, of whom 51 used raloxifene and 98 patients did not receive any anti-osteoporotic therapy. At the end of the follow-up period, 62 patients had died and 87 were still alive. The treated patients had a lower mortality rate than those who did not receive treatment (P = 0.001, HR = 3.845, 95 % CI 1.884-7.845). The most common cause of mortality was sepsis, and those who received raloxifene had a lower rate of sepsis compared to those who did not receive treatment (P < 0.001). Conclusions Effective treatment with raloxifene may had a lower mortality rate in patients with postmenopausal osteoporosis-related vertebral fractures after vertebroplasty.
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Hita-Contreras F, Martínez-López E, González-Matarín P, Mendoza N, Cruz-Díaz D, Ruiz-Ariza A, Martínez-Amat A. Association of bone mineral density with postural stability and the fear of falling in Spanish postmenopausal women. Maturitas 2014; 79:322-8. [DOI: 10.1016/j.maturitas.2014.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 07/15/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
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15
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Ma D, Wu L, He Z. Effects of walking on the preservation of bone mineral density in perimenopausal and postmenopausal women: a systematic review and meta-analysis. Menopause 2013; 20:1216-26. [PMID: 24149921 DOI: 10.1097/GME.0000000000000100] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to critically evaluate the effects of a walking intervention on bone mineral density (BMD) in perimenopausal and postmenopausal women and to identify the optimal duration of this walking exercise intervention. METHODS Two independent reviewers assessed for eligibility randomized and nonrandomized controlled trials evaluating the effects of walking on BMD in perimenopausal and postmenopausal women. Heterogeneity, potential publication bias, and the quality of the included trials were assessed. RESULTS Ten trials were eligible for inclusion. A meta-analysis of trials assessing lumbar spine BMD showed no significant effects (weighted mean difference [WMD] [fixed effects], 0.01 g/cm(2); 95% CI, -0.00 to 0.02; P = 0.05) regardless of the length of the intervention duration. BMD at the femoral neck increased after long intervention durations (6 mo to 1-2 y), although no significant effect could be seen when all trials assessing femoral neck BMD were taken into account (WMD [fixed effects], 0.01 g/cm(2); 95% CI, -0.00 to 0.01; P = 0.07). The effects of walking on the radius and whole body were not significant (WMD [random effects], -0.01 g/cm; 95% CI, -0.06 to 0.04; P = 0.71; and WMD [fixed effects], 0.04 g/cm(2); 95% CI, -0.00 to 0.08; P = 0.06, respectively). CONCLUSIONS Walking as a singular exercise therapy has no significant effects on BMD at the lumbar spine, at the radius, or for the whole body in perimenopausal and postmenopausal women, although significant and positive effects on femoral neck BMD in this population are evident with interventions more than 6 months in duration.
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Sato M, Vietri J, Flynn JA, Fujiwara S. Treatment for Osteoporosis among Women in Japan: Associations with Patient Characteristics and Patient-Reported Outcomes in the 2008-2011 Japan National Health and Wellness Surveys. J Osteoporos 2014; 2014:909153. [PMID: 25587485 DOI: 10.1155/2014/909153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/26/2014] [Accepted: 11/27/2014] [Indexed: 11/28/2022] Open
Abstract
This study was conducted to identify characteristics associated with treatment for osteoporosis among women aged 50 years and older in Japan and to explore differences among patients according to treatment regimen. Data were provided by a large annual survey representative of Japanese aged 18 and older; all measures were by self-report. Women aged 50 and older who reported diagnosed osteoporosis (N = 900) were compared based on current treatment status using bivariate statistics and logistic regression. Approximately 1 in 3 women in this study reporting diagnosed osteoporosis were currently untreated. Factors associated with current treatment for osteoporosis included having ≥1 physician visit in the prior 6 months (OR = 5.4, P < 0.001), self-rated moderate or severe osteoporosis (OR = 2.8, P < 0.001), completion of menopause (OR = 1.6, P < 0.05), and family history of osteoporosis (OR = 1.5, P < 0.05), while longer duration of osteoporosis diagnosis (OR = 0.9, P < 0.05) and arthritis (OR = 0.7, P < 0.05) were associated with lower odds of treatment. These findings suggest that diagnosed patients are not being actively managed in the longer term, and efforts need to be made to ensure that patients stay engaged with their healthcare providers.
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Nojiri S, Burge RT, Flynn JA, Foster SA, Sowa H. Osteoporosis and treatments in Japan: management for preventing subsequent fractures. J Bone Miner Metab 2013; 31:367-80. [PMID: 23536192 DOI: 10.1007/s00774-013-0444-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 02/14/2013] [Indexed: 11/28/2022]
Abstract
Prevalent fractures are major contributors to an increased risk of subsequent fractures, particularly in people with osteoporosis. While many studies have been conducted to assess the incidence of fracture in Japanese people with osteoporosis, far fewer have been conducted to assess the risk of subsequent fractures. This article reviews the morbidity, mortality, and risk of fracture in patients who are at high risk of subsequent fracture in Japan and the current treatment options available for these patients. Osteoporotic fractures in Japan are associated with high morbidity and mortality that result in significant financial and social costs. The rise in the proportion of elderly women in the Japanese population is contributing to a greater proportion of people with osteoporotic fractures and the high cost of osteoporosis. Although hip fractures have a significant effect on costs, a greater proportion of the Japanese population experience vertebral fractures. An increase in the incidence of vertebral fractures is concerning because preexisting vertebral fractures in older patients are associated with an increased risk of subsequent fractures. Hence, there is a clear rationale for pharmacological treatment of patients with prevalent vertebral fractures, or for those who are hospitalized or undergo surgery for osteoporotic fractures. Several pharmacological therapies are now available in Japan for the treatment of patients with osteoporosis. Understanding the consequences of subsequent fractures and the treatment options available for patients at high risk of subsequent fractures may contribute to clinical decision-making and improved outcomes for patients with osteoporosis.
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Affiliation(s)
- Shuko Nojiri
- Japan Health Technology Assessment, Eli Lilly Japan K.K., Sannomiya Plaza Building, 7-1-5, Isogamidori, Chuo-ku, Kobe, 651-0086, Japan.
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Tanaka I, Sato M, Sugihara T, Faries DE, Nojiri S, Graham-Clarke P, Flynn JA, Burge RT. Adherence and persistence with once-daily teriparatide in Japan: a retrospective, prescription database, cohort study. J Osteoporos 2013; 2013:654218. [PMID: 24455412 DOI: 10.1155/2013/654218] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 08/05/2013] [Accepted: 10/25/2013] [Indexed: 11/17/2022] Open
Abstract
Adherence and persistence with osteoporosis treatments are essential for reducing fracture risk. Once-daily teriparatide is available in Japan for treating osteoporosis in patients with a high risk of fracture. The study objective was to describe real-world adherence and persistence with once-daily teriparatide 20 μg during the first year of treatment for patients who started treatment during the first eight months of availability in Japan. This prescription database study involved patients with an index date (first claim) between October 2010 and May 2011, a preindex period ≥6 months, and a postindex period ≥12 months and who were aged >45 years. Adherence (medication possession ratio (MPR)) and persistence (time from the start of treatment to discontinuation; a 60-day gap in supply) were calculated. A total of 287 patients started treatment during the specified time period; 123 (42.9%) were eligible for inclusion. Overall mean (standard deviation) adherence was 0.702 (0.366), with 61.0% of patients having high adherence (MPR > 0.8). The percentage of patients remaining on treatment was 65.9% at 180 days and 61.0% at 365 days. Our findings suggest that real-world adherence and persistence with once-daily teriparatide in Japan are similar to that with once-daily teriparatide in other countries and with other osteoporosis medications.
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