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1.
M. A. Amiche J. M. Albaum M. Tadrous P. Pechlivanoglou L. E. Lévesque J. D. Adachi S. M. Cadarette 《Osteoporosis international》2016,27(6):1989-1998
Summary
Efficacy of osteoporosis medication is not well-established among patients taking oral glucocorticoids. We assessed the efficacy of approved osteoporosis pharmacotherapies in preventing fracture by combining data from randomized controlled trials. Teriparatide, risedronate, and etidronate were associated with decreased vertebral fracture risk.Introduction
Several osteoporosis drugs are approved for the prevention and treatment of glucocorticoid (GC)-induced osteoporosis. However, the efficacy of these treatments among oral GC users is still limited. We aimed to examine the comparative efficacy of osteoporosis treatments among oral GC users.Methods
We updated a systematic review through to March 2015 to identify all double-blinded randomized controlled trials (RCTs) that examined osteoporosis treatment among oral GC users. We used a network meta-analysis with informative priors to derive comparative risk ratios (RRs) and 95 % credible intervals (95 % CrI) for vertebral and non-vertebral fracture and mean differences in lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD). Treatment ranking was estimated using the surface under the cumulative ranking curve (SUCRA) statistic. A meta-regression was completed to assess a subgroup effect between patients with prior GC exposures and GC initiators.Results
We identified 27 eligible RCTs examining nine active comparators. Etidronate (RR, 0.41; 95%CrI?=?0.17–0.90), risedronate (RR?=?0.30, 95%CrI?=?0.14–0.61), and teriparatide (RR?=?0.07, 95%CrI?=?0.001–0.48) showed greater efficacy than placebo in preventing vertebral fractures; yet, no treatment effects were statistically significant in reducing non-vertebral fractures. Alendronate, risedronate, and etidronate increased LS BMD while alendronate and raloxifene increased FN BMD. In preventing vertebral fractures, teriparatide was ranked as the best treatment (SUCRA: 77 %), followed by risedronate (77 %) and zoledronic acid (76 %). For non-vertebral fractures, teriparatide also had the highest SUCRA (69 %), followed by risedronate (64 %). No subgroup effect was identified with regards to prior GC exposure.Conclusions
Despite weak trial evidence available for fracture prevention among GC users, we identified several drugs that are likely to prevent osteoporotic fracture. Teriparatide, risedronate, and etidronate were associated with decreased vertebral fracture risk.2.
3.
Yaqi Zong Yanming Tang Yuan Xue Huairong Ding Zhiyang Li Dong He Ying Zhao Pei Wang 《European spine journal》2016,25(11):3418-3423
Propose
To determine whether depression in postmenopausal women with osteoporosis is associated with an increased risk of thoracolumbar fragility fracture.Methods
Postmenopausal women with osteoporosis and without prior vertebral fracture history who were seen at our institution from January 2006 to January 2010 (n = 1397) were divided into depression group (n = 494) and depression-free group (n = 903). After at least 4 years the incidence of thoracolumbar osteoporotic vertebral fracture was compared between the groups. For those who developed vertebral fracture, quality of life over the subsequent 2 months and fracture pain in the subsequent 2 weeks were compared. Depression was assessed with the 21-item Beck Depression Inventory, pain intensity with the visual analogue scale and quality of life with the Medical Outcomes Study 36-item Short-Form Survey.Results
The incidence of thoracolumbar fractures among women with continuous depression was higher than the group without depression (35.43 vs. 25.14 %, respectively; (P < 0.05). Osteoporotic thoracolumbar fractures were associated with significantly lower quality of life scores in women with depression than in those without depression (P < 0.05). Fracture pain was experienced by a higher percentage of patients with continuous depression than by those without depression (44.00 vs. 27.31 %; P < 0.05).Conclusion
Depression is associated with a higher risk of thoracolumbar fracture, with more fracture pain and with lower quality of life in the 2 months following fracture.4.
Background
Osteoporosis-associated fractures represent a risk factor for developing further fragility fractures. Therefore, guideline-oriented osteoporosis intervention is of utmost importance during inpatient fracture treatment.Patients and methods
Women >50 years and men >60 years with fractures of the lumbar or thoracic spine, proximal femur, proximal humerus and distal radius were included in a prospective study. We analyzed the initiation of diagnosis and treatment of osteoporosis during the inpatient stay.Results
A total of 455 patients were included and bone mineral density measurement (DXA) was carried out in 65.9 %. Women underwent DXA in 69.5 % and men significantly less frequently in 52.1 %. Osteoporosis was diagnosed in 56.6 %, where women were affected in 56.2 % and men in 59 % of cases. In 83.8 % osteoporosis had been previously unknown. Treatment according to the guidelines of the Organisation of German Scientific Osteology-related Societies (DVO) was initiated in 86.7 % and 77.1 % of women >70 years and men >80 years required anti-resorptive treatment after DXA.Conclusions
The majority of elderly patients with fractures also suffer from osteoporosis, independent of gender. Even nowadays, osteoporosis is predominantly not diagnosed until the incidence of a fracture. Therefore, the trauma surgeon is in a key position to initiate diagnosis and treatment of osteoporosis.5.
Summary
Gastroesophageal reflux disease (GERD) with proton pump inhibitor (PPI) use is associated with an increased risk of osteoporosis. The risk of hip fracture is not increased in GERD patients with PPI use.Introduction
The relationship between GERD with PPI treatment and the risk of osteoporosis is unclear. We aimed to determine the risk of developing osteoporosis in patients diagnosed with GERD.Methods
Patients diagnosed with GERD and received PPI treatment between 2000 and 2010 were identified from the Longitudinal Health Insurance Database as the study cohort (n?=?10,620), which was frequency matched with the comparison cohort (n?=?20,738) sampled from the general population according to age, sex, index year, and comorbidities. Both cohorts were followed until the end of 2011. The risk of osteoporosis was evaluated in both groups by using Cox proportional hazards regression models.Results
The GERD patients with PPI treatment had a greater incidence (31.4 vs 20.7 per 1000 person-year; crude hazard ratio [cHR] 1.51; 95 % confidence interval [CI] 1.40–1.63) and a higher risk (adjusted HR [aHR] 1.50; 95 % CI 1.39–1.62) of osteoporosis than that of the comparison cohort. However, the overall incidence of hip fracture was not different between the GERD with PPI use and the control cohorts (aHR 0.79; 95 % CI 0.53–1.18).Conclusion
GERD with PPI use is associated with an increased risk of osteoporosis. The findings of our study do not support an increased risk of hip fracture in GERD patients treated with a PPI.6.
Purpose
The purpose of this study was to investigate if a 2-year intervention with a minimal resource fracture liaison service (FLS) was associated with increased investigation and medical treatment and if treatment was related to reduced re-fracture risk.Methods
The FLS started in 2013 using existing secretaries (without an FLS coordinator) at the emergency department and orthopaedic wards to identify risk patients. All patients older than 50 years of age with a fractured hip, vertebra, shoulder, wrist or pelvis were followed during 2013–2014 (n?=?2713) and compared with their historic counterparts in 2011–2012 (n?=?2616) at the same hospital. Re-fractures were X-ray verified. A time-dependent adjusted (for age, sex, previous fracture, index fracture type, prevalent treatment, comorbidity and secondary osteoporosis) Cox model was used.Results
The minimal resource FLS increased the proportion of DXA-investigated patients after fracture from 7.6 to 39.6 % (p?<?0.001) and the treatment rate after fracture from 12.6 to 31.8 %, which is well in line with FLS types using the conventional coordinator model. Treated patients had a 51 % lower risk of any re-fracture than untreated patients (HR 0.49, 95 % CI 0.37–0.65 p?<?0.001).Conclusions
We found that our minimal resource FLS was effective in increasing investigation and treatment, in line with conventional coordinator-based services, and that treated patients had a 51 % reduced risk of new fractures, indicating that also non-coordinator based fracture liaison services can improve secondary prevention of fractures.7.
M. A. Amiche J. M. Albaum M. Tadrous P. Pechlivanoglou L. E. Lévesque J. D. Adachi S. M. Cadarette 《Osteoporosis international》2016,27(5):1709-1718
Summary
Little data exist on the frequency of fracture among oral glucocorticoid users. We examined the effect of oral glucocorticoids on fracture incidence using data from randomized controlled trials. Patients starting glucocorticoids had a higher probability of fracture and decline in bone mineral density compared to chronic glucocorticoid users.Introduction
Oral glucocorticoids (GCs) are the leading cause of secondary osteoporosis. However, there have been few studies that quantify the rate of fracture among GC users. We sought to provide a pooled estimate of fracture risk from randomized controlled trials (RCTs) of GC-treated patients.Methods
We updated a MEDLINE search published by the American College of Rheumatology through to March 2015 and identified RCTs of osteoporosis therapies that reported fracture and bone mineral density (BMD) among oral GC users. We restricted the analysis to placebo or control arms. RCT arms were stratified by GC exposure at enrolment to GC initiators (≤6 months) and chronic GC users (>6 months). Bayesian meta-regression was used to estimate the annual probability of vertebral fracture (primary), non-vertebral fracture and percentage change in lumbar spine and femoral neck BMD.Results
The annual incidence of vertebral and non-vertebral fracture was 5.1 % (95 % CrI?=?2.8–8.2) and 2.5 % (95 % CrI?=?1.2–-4.2) among GC initiators, and 3.2 % (95 % CrI?=?1.8–5.0) and 3.0 % (95 % CrI?=?0.8–5.9) among chronic GC users. Our meta-regression identified a non-significant effect of group-level variables (mean age, mean BMD, mean GC daily dose, patients with previous vertebral fractures, proportion of women and adjuvant used) on vertebral fracture rate.Conclusion
Our study found higher vertebral fracture incidence among GC initiators, yet a relative decline in fracture incidence with longer exposure. Our findings suggest that fracture incidence among oral GC users may be more common than previously estimated. Optimizing GC-induced osteoporosis management during early exposure to GC is essential to prevent fractures.8.
S. J. Bae S. H. Lee S. H. Ahn H.-M. Kim B.-J. Kim J.-M. Koh 《Osteoporosis international》2016,27(8):2533-2541
Summary
A high level of circulating sphingosine-1-phosphate (S1P) is associated with a high incidence of osteoporotic fracture and a high rate of an insufficient response to bisphosphonate therapy.Introduction
Sphingosine-1-phosphate (S1P) is a significant regulator of bone metabolism. Recently, we found that a high plasma S1P level is associated with low bone mineral density (BMD), high levels of bone resorption markers (BRMs), and a high risk of prevalent vertebral fracture in postmenopausal women. We investigated the possibility that S1P is a predictor of incident fracture.Methods
A total of 248 postmenopausal women participated in this longitudinal study and were followed up for a mean duration of 3.5 years (untreated [n?=?76] or treated with bisphosphonate or hormone replacement therapy [n?=?172]). The baseline plasma S1P level and prevalent and incident fracture occurrence were assessed.Results
A high S1P level was significantly associated with a higher rate of prevalent fracture after adjusting for femoral neck (FN) BMD, BRM, and potential confounders (odds ratio?=?2.05; 95 % confidence interval [CI]?=?1.03–4.00). Incident fractures occurred more frequently in the highest S1P tertile (T3) than in the lower two tertiles (T1–2) after adjusting for confounders, including baseline FN BMD, prevalent fracture, antiosteoporotic medication, annualized changes in FN BMD, BRM, and potential confounders (hazard ratio?=?5.52; 95 % CI?=?1.04–56.54). Insufficient response to bisphosphonate therapy occurred more frequently in T3 than T1–2 (odds ratio?=?4.43; 95 % CI?=?1.02–21.25).Conclusions
The plasma S1P level may be a potential predictor of fracture occurrence and an insufficient response to bisphosphonate therapy in postmenopausal women.9.
R. Wiklund A. Toots M. Conradsson B. Olofsson H. Holmberg E. Rosendahl Y. Gustafson H. Littbrand 《Osteoporosis international》2016,27(3):923-931
Summary
Knowledge of risk factors for hip fracture among very old people is limited. Walking indoors with help from ≤1 person, Parkinson’s disease, currently smoking, delirium in the previous month, underweight, and age were associated with increased risk of hip fracture and could be important for preventive strategy development.Introduction
The purpose of this study is to investigate risk factors for hip fracture among a representative sample of very old people.Methods
In total, 953 participants from the Umeå 85+/Gerontological Regional Database population-based cohort study were interviewed and assessed during home visits. Associations of baseline characteristics with hip fracture during the maximum 5-year follow-up period were analyzed using Cox proportional hazards regression.Results
Participants had a mean age of 89.3?±?4.7 years; 65.8 % were women, 36.8 % lived in residential care facilities, 33.6 % had dementia, and 20.4 % had histories of hip fracture. During a mean follow-up period of 2.7 years, 96 (10.1 %) individuals sustained hip fracture. Walking indoors with help from no more than one person (hazard ratio [HR]?=?8.57; 95 % confidence interval [CI], 1.90–38.71), Parkinson’s disease (HR?=?5.12; 95 % CI, 1.82–14.44), currently smoking (HR?=?4.38; 95 % CI 2.06–9.33), delirium in the previous month (HR?=?2.01; 95 % CI, 1.15–3.49), underweight (body mass index <22; HR?=?1.74, 95 % CI, 1.09–2.77), and age (HR?=?1.09; 95 % CI, 1.04–1.14) were associated independently with an increased risk of hip fracture. Hip prosthesis at baseline decreased the risk of hip fracture (HR?=?0.37; 95 % CI, 0.15–0.91), but only for those with bilateral hip prostheses.Conclusions
Seven factors were associated independently with incident hip fracture during follow-up in this sample of very old people. These factors could have important clinical implications in identifying persons at high risk of hip fracture, as well as in the development of effective preventive strategies.10.
M. Shiraki S. Ueda T. Sugimoto T. Kuroda T. Nakamura 《Osteoporosis international》2016,27(10):3057-3062
Summary
Monitoring bone mineral density is useful to assess treatment response for osteoporosis, but it does not always reflect fracture prevention. Two types of bone mineral density thresholds were used to analyze data from a once-weekly teriparatide trial, and they appear to be useful indicators of treatment success for osteoporosis.Introduction
This study aimed to clarify whether the criteria of treatment response could be used to evaluate treatment success with once-weekly teriparatide.Methods
The data of subjects whose lumbar or femoral neck bone mineral density (BMD) was measured in the TOWER study were included. The least significant change (LSC) and the absolute change were used as the criteria for judgment of treatment success. The correlation between the incidence of fractures and the treatment response was also assessed.Results
There was no significant difference in baseline characteristics between the placebo and teriparatide groups. Once-weekly teriparatide therapy for 72 weeks showed treatment success in 79.2 % of the subjects for lumbar BMD and 44.1 % for femoral neck BMD by LSC and in 50.5 and 39.6 % by absolute change, respectively. A lower incidence of vertebral fracture was observed in patients who achieved treatment success for lumbar BMD. With the LSC, some treatment success was observed in the early phase of treatment, and it increased with treatment duration.Conclusions
It appears that the LSC could be used as a surrogate efficacy indicator at an earlier stage of treatment, and the absolute criterion of ?2.5SD was confirmed as a useful marker of long-term treatment success.11.
Summary
This study compared the effects sarcopenic osteoarthritis on metabolic syndrome, insulin resistance, osteoporosis, and bone fracture. By using national survey data, we suggest that the relationship between sarcopenia and metabolic syndrome or insulin resistance is potentiated by the severity of osteoarthritis and is independent of body weight.Introduction
Sarcopenia and osteoarthritis are known risk factors for metabolic syndrome. However, their combined effects on metabolic syndrome, insulin resistance and osteoporosis remain uncertain.Methods
We used data from the fifth Korean National Health and Nutrition Examination Survey using a total of 3158 adults (age >50 years). Sarcopenia was defined as a skeletal muscle index score (appendicular skeletal muscle mass/body weight) within the fifth percentile of sex-matched younger reference participants. Radiographic knee osteoarthritis was defined as a Kellgren-Lawrence (K-L) grade of 2 or greater. Metabolic syndrome was diagnosed using the National Cholesterol Education Program criteria. Insulin resistance was evaluated using the homeostasis model assessment-estimated insulin resistance index (HOMA-IR). Osteoporosis was defined using the World Health Organization T-score criteria.Results
In multivariable logistic regression analysis, the sarcopenic osteoarthritis group had a higher odds ratio (OR) for metabolic syndrome (OR?=?11.00, 95 % confidential interval (CI)?=?2.12–56.99, p?=?0.013) than the non-sarcopenic osteoarthritis (OR?=?1.02, 95 % CI?=?0.65–1.62, p?=?0.972) and sarcopenic non-osteoarthritis groups (OR?=?7.15, 95 % CI?=?1.57–32.53, p?=?0.027). Similarly, sarcopenic osteoarthritis had a greater OR of highest HOMA-IR quartiles (OR?=?8.19, 95 % CI?=?2.03–33.05, p?=?0.003) than the other groups. Overall, the association between the K-L grade and body mass index was significant; however, this significance was lower in individuals with sarcopenia and was lost in those with sarcopenic osteoarthritis. Additionally, osteoporosis and bone fracture were not associated to sarcopenic osteoarthritis (p?>?0.05).Conclusions
These results suggest that the relationship between sarcopenia and metabolic syndrome or insulin resistance is potentiated by the severity of osteoarthritis and is independent of body weight.12.
A. B. Pedersen D. Cronin Fenton M. Nørgaard N. R. Kristensen B. Kuno Møller C. Erikstrup 《Osteoporosis international》2016,27(9):2765-2775
Summary
Despite improvements in preoperative and postoperative treatment, hip fracture surgery may lead to blood transfusion. Little is known about the impact of body mass index on transfusion risk and subsequent mortality. Opposite overweight and obese patients, underweight patients had increased risk of transfusion and death within 1 year of surgery.Introduction
Despite improvements in preoperative and postoperative treatment of hip fracture patients, hip fracture surgery may lead to blood loss. We examined the risk of red blood cell transfusion (as an indirect measure of blood loss) and subsequent mortality by body mass index level in patients aged 65 and over undergoing hip fracture surgery.Methods
This is a population-based cohort study using medical databases. We included all patients who underwent surgery for hip fracture during 2005–2013. We calculated the cumulative risk of red blood cell transfusion within 7 days of surgery treating death as a competing risk and, among transfused patients, short- (8–30 days postsurgery) and long-term mortality (31–365 days postsurgery).Results
Among 56,420 patients, 47.7 % received at least one red blood cell transfusion within 7 days of surgery. In patients with normal weight, the risk was 48.8 % compared with 57.0 % in underweight patients (adjusted RR?=?1.11; CI 1.08–1.15), 42.1 % in overweight patients (adjusted RR?=?0.89; CI 0.86–0.91), and 42.2 % in obese patients (adjusted RR?=?0.87; CI 0.84–0.91). Among transfused patients, adjusted HRs for short-term mortality were 1.52 (CI 1.34–1.71), 0.70 (CI 0.61–0.80), and 0.58 (CI 0.43–0.77) for underweight, overweight, and obese patients, respectively, compared with normal-weight patients. The corresponding adjusted HRs for long-term mortality were 1.45 (CI 1.33–1.57), 0.80 (CI 0.74–0.86), and 0.58 (CI 0.50–0.69). Similar association between BMI and mortality was observed also among non-transfused patients.Conclusions
Underweight patients had a higher risk of red blood cell transfusion and death in the first year of surgery than normal-weight patients, even when controlling for age and comorbidity. Opposite findings were seen for overweight and obese patients.13.
J. I.-H. Chiang T.-C. Li C.-I. Li C.-S. Liu N.-H. Meng W.-Y. Lin S.-Y. Yang H.-J. Chen C.-C. Lin 《Osteoporosis international》2016,27(12):3587-3597
Summary
We investigated the association between fasting plasma glucose variability (FPG-CV) and the risk of hip fracture in elderly diabetic patients. Our finding showed a temporal association between FPG-CV and hip fracture as patients categorized as FPG-CV greater than 25.4 % showed an increased risk in hip fractures.Introduction
Hip fracture is a major health burden in the population and is associated with high rates of mortality and morbidity especially in elderly. It is evident that diabetes mellitus is a risk factor of osteoporosis which is a significant risk factor of hip fracture. However, epidemiological studies exploring the risks of hip fracture among type 2 diabetic patients are limited.Methods
A retrospective study of 26,501 ethnic Chinese older persons enrolled in the National Diabetes Care Management program in Taiwan was conducted; related factors were analyzed with extended Cox proportional hazards regression models to competing risk data on hip fracture incidence.Results
The results show a temporal association between FPG-CV and hip fracture as patients categorized as FPG-CV greater than 25.4 % showed an increased risk in hip fractures, confirming a linear relationship between the two. After multivariate adjustment, the risk of hip fracture increased among patients with FPG-CV of 25.4–42.3 % and >42.3 % compared with patients with FPG-CV of ≦ 14.3 % (hazard ratio, 1.35; 95 % confidence interval 1.14–1.60 and 1.27; 1.07–1.52, respectively). Significant linear trends among various FPG-CV were observed.Conclusions
Thus, the present study demonstrated the importance of glucose stability for fracture prevention in older persons with type 2 diabetes. Future studies should be conducted to explore whether reduction in glucose oscillation in older adults with diabetes mellitus can reduce the risk of hip fracture.14.
P. Y. Chang F. S. Saechao J. Lee S. G. Haskell S. M. Frayne J. S. Lee 《Osteoporosis international》2016,27(11):3177-3186
Summary
In a national sample of women veterans, the rate of lower limb fracture diagnosis was the highest across ages 18–74 years; rates of fracture diagnosis of other skeletal sites peaked in women aged 75+. Women with two or more primary care visits or mental healthcare visits had elevated odds of fracture diagnosis.Introduction
We assessed the prevalence and healthcare utilization characteristics associated with a diagnosis of any fracture in women of all adult ages within the Veterans Health Administration.Methods
In 344,488 women during fiscal year 2012, logistic regression models for fracture diagnosis included age, race/ethnicity, residence, number of primary care visits, number of mental healthcare visits, and degree of service-connected disability.Results
Lower limb fracture diagnosis was most prevalent across ages 18–74 years and peaked in women aged 55–64 years. In women aged 75+, the prevalence rates of fracture diagnosis at the hip (102, 95 % CI?=?88–115 per 10,000 women), upper limb (100, 95 % CI?=?87–114 per 10,000 women), and lower limb (84, 95 % CI?=?72–97 per 10,000 women) were the highest. Fractures at other skeletal sites peaked in those aged 75+?years. Black women had the lowest odds of a fracture diagnosis, followed by Asian/Pacific Islander and Hispanic women compared to non-Hispanic White (by 25–51 %, P?<?0.05). Having two or more primary care visits or any mental health visit was each associated with an increased risk. Women with five or more primary care visits had a 3.36-fold (95 % CI?=?3.02–3.75) greater odds than those with no such visit, and separately, women with five or more mental health visits had a 1.51-fold (95 % CI?=?1.43–1.60) greater odds. Women with a fracture diagnosis had higher overall healthcare costs than those without (P?<?0.001).Conclusions
Prevalence of fracture diagnosis differed by age, race/ethnicity, and skeletal site of fracture. Fracture diagnosis may identify women veterans with greater overall healthcare needs.15.
C. Beaudoin S. Jean L. Bessette L.-G. Ste-Marie L. Moore J. P. Brown 《Osteoporosis international》2016,27(9):2835-2844
Summary
The aim of this review is to compare the efficacy and safety of denosumab over other treatments for osteoporosis. The results of this study suggest that the safety of denosumab and its efficacy in reducing fractures is not significantly different from bisphosphonates. Denosumab was, however, more effective in increasing bone mineral density.Introduction
This study was conducted to compare the efficacy and safety of denosumab over other pharmacological treatments for osteoporosis in individuals at risk of fracture.Methods
Randomised controlled trials comparing denosumab with another pharmacological treatment for osteoporosis were searched in MEDLINE, EMBASE and CENTRAL. Identified articles were screened by two independent reviewers and assessed for inclusion. Data from included studies were extracted and meta-analyses were conducted using random effects models.Results
Nine studies including a total of 4890 postmenopausal women were identified. The follow-up period varied from 12 to 24 months. In all studies except one, the comparator treatment was a bisphosphonate. There was no statistically significant difference between patients receiving denosumab and those receiving a bisphosphonate in terms of fracture risk (RR[95 % CI]?=?1.15 [0.84–1.58]), adverse events (RR[95 % CI]?=?0.99 [0.96–1.02]) or deaths (OR[95 % CI]?=?0.58 [0.12–2.71]). Withdrawals due to adverse events were less frequent in denosumab than in other treatment groups but the difference did not reach statistical significance (OR[95 % CI]?=?0.68 [0.45–1.04]). The percent change in bone mineral density at the total hip, lumbar spine, femoral neck and one-third radius was significantly higher in participants who received denosumab (e.g. mean difference [95 % CI] at the total hip: 1.06 [0.86–1.25]).Conclusions
These results suggest that, after 12 to 24 months, the safety and efficacy of denosumab for reducing fracture risk is not significantly different from bisphosphonates despite higher gains in bone mineral density. In a clinical setting, denosumab may demonstrate greater effectiveness.16.
Summary
The incidence of hip fractures in Turkey increased markedly from that reported in 1988/1989 so that FRAX® models for Turkey should be revised.Introduction
The MEDOS study in 1988/1989 reported that men and women from Turkey had exceptionally low rates of hip fracture. The aim of the FRACTURK study was to estimate current and future hip fracture risks and the prevalence of osteoporosis in Turkey.Methods
Hip fracture cases in 2009 were identified from interviews of a population-based sample of 26,424 residents aged 50 years or more in 12 different regions of Turkey and in two hospital surveys. Bone mineral density was evaluated by DXA in an age-stratified sample of 1,965 men and women.Results
Hip fracture incidence in the community-based survey was similar to that in the hospital survey. The age-specific incidence in men and women was substantially higher than that reported for 1988/1989. At the age of 50 years, the remaining lifetime probability of a hip fracture was 3.5% in men and 14.6% in women. In 2009, there were approximately 24,000 hip fractures estimated in Turkey, 73% of which were found in women. Assuming no change in the age- and sex-specific incidence, the number of hip fractures was expected to increase to nearly 64,000 in 2035. The prevalence of osteoporosis at the femoral neck was 7.5% and 33.3% in men and women, respectively, aged 50 years or more.Conclusion
Although Turkey is still among the countries with low hip fracture rates in Europe, the incidence has increased markedly in the last 20 years. This finding can be used to recalibrate fracture risk assessment models for Turkey.17.
L. H. R. Xu B. Adams-Huet J. R. Poindexter N. M. Maalouf 《Osteoporosis international》2016,27(5):1701-1708
Summary
In a retrospective analysis of 208 osteoporotic patients followed during a bisphosphonate holiday, lower body weight and risedronate use were associated with a more rapid decline in bone mineral density during the bisphosphonate holiday, while bone mineral density (BMD) trends were similar in patients who sustained vs. did not sustain a fracture.Introduction
A drug holiday has been suggested for some bisphosphonate-treated patients with osteoporosis to minimize potential side effects from prolonged use. However, there is limited information on the evolution of BMD during a bisphosphonate holiday. Our study analyzed the longitudinal course of BMD following bisphosphonate discontinuation and assessed its determinants.Methods
Retrospective single-center cohort study of osteoporosis patients treated with alendronate or risedronate for at least 2 years and then discontinued their bisphosphonate for a drug holiday. Patients were stratified by bisphosphonate type and by fracture occurrence during drug holiday.Results
A total of 208 patients were included in this analysis (87.5 % female). At the time of bisphosphonate cessation, mean?±?SD age was 66.9?±?8.9 years and BMI 24.5?±?4.4 kg/m2. Duration of bisphosphonate treatment was 5.2?±?2.3 years, and follow-up during holiday was 3.3?±?1.7 years. During the first 2 years of the holiday, BMD remained stable at the lumbar spine and femoral neck, but declined significantly at the total hip. BMD declined significantly at all sites thereafter. Significant predictors of BMD decline during bisphosphonate holiday included lower BMI at the start of the holiday and change in body weight during the holiday. BMD decline was more pronounced in former risedronate compared to former alendronate users. BMD trends were similar in patients who sustained vs. did not sustain a fracture during the holiday.Conclusions
BMD at the total hip declines significantly within 1 year of bisphosphonate discontinuation, particularly in lean patients. Additional studies are needed to identify predictors of fracture incidence during a bisphosphonate holiday.18.
19.
I. Kuo C. Ong L. Simmons D. Bliuc J. Eisman J. Center 《Osteoporosis international》2007,18(12):1633-1639
Summary
In this study, we offered osteoporosis investigation and treatment directly to patients at out-patient fracture clinics shortly after they sustained minimal trauma fractures. We achieved long-term compliance to the recommended investigation and treatment in 80% of patients. This approach is much more successful than previous interventions.Introduction
Osteoporosis remains under-treated in minimal-trauma fracture subjects. The aim of this study was to determine if direct intervention at orthopaedic fracture clinics would improve post-fracture management in these subjects.Methods
From March 2004 to March 2006, 155 consecutive minimal-trauma fracture subjects (mean age 64.0?±?17.6) attending fracture clinics at St. Vincent’s Hospital, Sydney, had a specific medical assessment, following which they were recommended BMD and laboratory testing. Treatment recommendations were given after review of investigations with further follow-up at a median of 8.6 months following therapy. Comparison of outcomes was made with a similar group of patients given written information 2 years prior.Results
At baseline, 47% of patients had prior fractures, but only 26% had had BMD screening. Twenty-one percent were on anti-resorptive therapy, and 15% were on calcium/vitamin D. Following intervention, 83% had a BMD and of these, 68% had a T-score < ?1.0. Of treatment naïve patients, 44% were recommended anti-resorptive therapy and 56% were recommended calcium/vitamin D. Compliance was 80% for anti-resorptive and 76% for calcium/vitamin D. Female gender and lower BMD were predictors of compliance.Conclusion
Compared with information-based intervention, direct intervention improved management two to fivefold, maintaining long-term treatment in 90% of osteoporotic and 73% of osteopenic subjects requiring therapy.20.