Journal of Bone and Mineral Metabolism最新文献

Introduction: Glucocorticoid-induced osteoporosis (GIOP) is the most common form of secondary osteoporosis, and bisphosphonates (BPs) are widely used for treatment. Localized cortical thickening (LCT, "beaking" or "flaring") is a characteristic radiographic finding and a potential precursor of atypical femoral fracture, a known complication of long-term BP use. The incidence of LCT and its association with BP duration in GIOP remain unclear.

Materials and methods: In this cross-sectional study, 86 outpatients with GIOP (mean age, 60.6 years; 62.8% women) were included. Femoral radiographs were evaluated for LCT, cortical thickness index (CTI; diaphyseal/subtrochanteric), and lateral bowing angle (LBA). Patients were stratified by BP duration (≥2 or ≥4 years), and 1:1 propensity score matching was used to evaluate the association with LCT. Associations of BP duration with CTI and LBA were analyzed using linear mixed-effects models; correlations with bone turnover markers (BTMs) and bone mineral density (BMD) were also examined.

Results: LCT was observed in 11 (12.8%) patients, including 10 undergoing BP therapy. Patients with LCT had a significantly longer duration of BP use (median: 8.0 years vs. 1.2 years, p <0.01). After matching, BP use for ≥4 years was significantly associated with LCT (odds ratio=11.29, p=0.01), whereas that for ≥2 years was not. Diaphyseal CTI significantly increased with BP duration; no associations were found with subtrochanteric CTI, LBA, BTMs, or BMD.

Conclusion: In GIOP, prolonged BP use, especially for ≥4 years, was associated with LCT and greater diaphyseal cortical thickness. Radiographic assessment is essential in patients with GIOP and long-term BP use.

Introduction: Accurate prediction of fracture risk is important for treatment decisions, yet evaluations of commonly used thresholds are limited, and the added value of volumetric bone mineral density (vBMD) remains uncertain. We conducted the first head-to-head comparison of the SHAFRE and FRAX algorithms using identical predictor information.

Materials and methods: We included 3525 community-dwelling Swedish men and women (mean age 71.4 years) who underwent a health examination with femoral neck areal BMD (aBMD) and radial vBMD. Incident fractures were retrieved from the National Patient Register. Model performance was evaluated using threshold-specific sensitivity and specificity.

Results: Over a mean follow-up of 8.7 years, 559 participants sustained a fracture. SHAFRE predicted a mean 10-year fracture risk of 21.9% in those who fractured versus 15.6% in the remaining cohort (ROC-area: 68%, 95% CI: 66-71%). Corresponding FRAX values were 16.7% and 12.6% (ROC-area: 66%, 95% CI: 63-68%), and FRAX slightly underestimated fracture risk in this cohort. Adding radial vBMD on top of aBMD did not materially improve discrimination for SHAFRE (70%, 95% CI: 67-72%) or FRAX (68%, 95% CI: 65-70%). Threshold-specific analysis identified an optimal predicted risk threshold of 13-17%, consistently below the commonly recommended 20%.

Conclusions: Predictive ability for major fractures remained modest for both algorithms and was not improved by adding vBMD. The estimated optimal threshold for treatment initiation was lower than the commonly recommended 20%. These findings reinforce that discrimination is substantially stronger for hip fracture than for major osteoporotic fractures.

Introduction: To determine the incidence and risk factors of fragility fractures and atypical femoral fracture (AFF)-related events in patients with systemic lupus erythematosus (SLE) receiving long-term glucocorticoid (GC) therapy.

Materials and methods: A retrospective analysis was conducted of 170 SLE patients followed from 2016 to 2023. Data on GC use, bisphosphonate (BP) therapy, bone-related events, and clinical characteristics were collected. Risk factors for fragility fractures and AFF-related events, including localized periosteal thickening (LPT), were analyzed using multivariate logistic regression.

Results: Although the median daily dose of prednisolone decreased over time, 82.9% of patients still met the criteria for pharmacologic intervention for GC-induced osteoporosis in 2023, and most continued to receive > 5 mg/day of GC. The median duration of BP therapy was 10.4 years, with 69 patients maintaining BP treatment throughout the observation period (median, 12.5 years). Fragility fractures and AFF-related events occurred in 7.6% and 5.8% of patients, respectively. Fragility fractures were independently associated with SLE flares and infection-related hospitalizations, whereas AFF-related events were significantly associated with prolonged BP use.

Conclusion: Despite a gradual reduction in GC dosage, many patients with longstanding SLE remain at elevated risk for fractures. The comparable frequencies of fragility fractures and AFF-related events highlight the clinical relevance of both complications. The prevention of SLE flares and infections may contribute to lowering the risk of fragility fractures. In addition, careful monitoring for AFF/LPT is warranted in patients receiving long-term BP and GC therapy.

Introduction: To compare 12-month real-world treatment persistence and compliance in postmenopausal women prescribed denosumab or alendronate for osteoporosis in Asia-Pacific.

Materials and methods: This prospective cohort study enrolled women aged ≥ 50 years from Australia, Taiwan, South Korea, Hong Kong and Singapore between 2019-2021. Study participants were prescribed bi-annual denosumab injection or weekly alendronate, based on physicians' decision. Medication persistence and compliance were estimated over 12 months of follow-up. Multivariable logistic regression was used to determine if treatment type (denosumab or alendronate) was significantly associated with persistence and compliance, while adjusting for age, fracture history, baseline BMD, prior osteoporosis treatment, and prior treatment with oral glucocorticoids. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.

Results: Among 686 enrolled women, 580 completed their 12-month visit (301 in denosumab and 279 in alendronate group). At baseline, those in the denosumab group were older and more likely to have received prior osteoporosis treatment. Overall treatment persistence and compliance were 72.4% and 70.7%, respectively. Patients receiving denosumab exhibited higher persistence (82.7% vs. 61.3%, P < 0.001) and compliance (86.0% vs. 54.1%, P < 0.001), versus those on alendronate. Regression results also showed that patients on denosumab were more likely to be persistent (aOR = 3.08; 95% CI 2.04-4.63) and compliant (aOR = 5.32; 95% CI 3.45-8.21) with treatment. Gastrointestinal disorders were more frequently reported in the alendronate group, while bone and joint injuries were more common in the denosumab group.

Conclusion: Postmenopausal women with osteoporosis were more likely to be persistent and compliant with denosumab, compared with weekly oral alendronate.

Introduction: There are many risk factors for fractures in chronic obstructive pulmonary disease patients, and investigating the effects of any particular factor on bones is extremely difficult. We hypothesized that the presence of pulmonary emphysema would delay the recovery of bone mass by reloading after unloading, and our study aimed to assess changes in bone metabolism dynamics in response to mechanical stress under pulmonary emphysema in model mice.

Materials and methods: We used C57BL/6J mice, with or without emphysema, via intratracheal administration of elastase or vehicle. Half of these mice underwent 1 week of hindlimb unloading followed by reloading, with bone assessed by μCT and histomorphometry.

Results: Mice without emphysema exhibited transient bone loss, with bone mass fully recovering by week 3 after unloading, driven by a robust rebound in bone formation. Conversely, mice with emphysema showed a delay in the response of bone metabolism dynamics to mechanical stress; bone loss due to unloading were delayed by week 3 after unloading and bone recovery due to reloading by week 6.

Conclusions: Slow changes in bone metabolism dynamics were observed during both unloading and reloading in mice with elastase-induced emphysema. The mechanism underlying these phenomena is unclear and requires further investigation.

Introduction: Hip fractures are common in elderly individuals and contribute to significant morbidity and mortality. Low body mass index (BMI) is associated with osteoporosis and frailty, yet its impact on postoperative outcomes after hip fracture surgery remains unclear.

Materials and methods: We conducted a retrospective cohort study using Japan's Diagnosis Procedure Combination (DPC) database. Patients aged ≥ 65 years undergoing surgery for hip fractures from April 2016 to March 2022 were included. Low BMI was defined as < 17.0 kg/m², and < 18.5 kg/m² was used for sensitivity analyses. Patients < 65 years or treated non-operatively were excluded. Primary outcomes included venous thromboembolism (VTE), pneumonia, urinary tract infection, cognitive dysfunction, in-hospital mortality, transfusion volume, and length of stay. Propensity score matching (1:1) was performed, followed by logistic regression.

Results: Of 474,293 patients identified, 63,761 matched pairs were analyzed. Compared to the non-low BMI group, the low BMI group had higher rates of urinary tract infection (3.6% vs. 3.0%; OR 1.203, 95% CI 1.131-1.280), pneumonia (5.3% vs. 3.0%; OR 1.850, 95% CI 1.746-1.961), and in-hospital mortality (3.4% vs. 1.6%; OR 2.233, 95% CI 2.068-2.411). Perioperative transfusion volume was higher in the low BMI group, while VTE was less frequent. Sensitivity analyses using < 18.5 kg/m² confirmed these findings.

Conclusion: Low BMI is associated with increased complications and mortality following hip fracture surgery in the elderly. These findings emphasize the prognostic relevance of BMI in perioperative risk assessment.