Journal of Bone and Mineral Metabolism最新文献

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.

Introduction: Facial skin aging (FSA) is a very easily observable indicator of aging, but whether FSA is associated with osteoporosis is still unknown.

Materials and methods: Based on the individual-level datasets from UK Biobank, this study calculated the PhenoAge (an accurate aging parameter), genetic risk score (GRS) and PhenoAge_advance, and performed multiple linear correlation analyses and Cox regression analyses. Based on the summary data from genome-wide association Studies (GWAS), linkage disequilibrium regression (LDSC), pleiotropic analysis under composite null hypothesis (PLACO) and Mendelian randomization (MR) analysis were performed to reveal shared genetic components and infer causal effects, respectively.

Results: Higher degrees of FSA were associated with lower eBMD (p < 0.001), and FSA was positively associated with the risks of osteoporosis (HR = 1.852, p < 0.001) and fracture (HR = 1.501, p < 0.001). However, FSA was not genetically associated as well as causally associated with all studied osteoporosis-related traits. In addition, we found significant phenotypic and genetic correlations between FSA and PhenoAge (rp = -0.137, p < 0.05) as well as between PhenoAge and fractures (rg = 0.092, p < 0.05).

Conclusion: FSA, PhenoAge and osteoporosis are three aging-related parameters that coexist with aging, and the aging process is accompanied by FSA and osteoporosis. FSA may serve as a marker for the onset of osteoporosis. These findings provide clues for early detection of bone loss in at-risk populations and for OP diagnosis using accurate clinical tools.

Introduction: Osteoporosis is highly prevalent in China and imposes a substantial economic burden. Early community-level management is pivotal and community health centers play an important role in prevention and management. As shared decision-making in medication expands, understanding public preferences can help improve community health services. This study investigated public preferences of osteoporosis community-level management in China, considering access to screening information, screening duration, service supplier, mode of administration, management approach and out-of-pocket costs.

Materials and methods: A discrete choice experiment (DCE) was conducted in Shanghai among community-dwelling adults. We constructed a mixed logit model with a total of 14 levels of the above 6 attributes. Willingness-to-pay (WTP) and scenario predictions were performed. Exploratory subgroup analyses assessed heterogeneity by age, income, geographic location and self-reported osteoporosis.

Results: A total of 170 valid questionnaires were collected from 6 communities in Shanghai. OOP costs had the largest impact on utility, followed by screening duration, service supplier and access to screening information. Subgroup analyses revealed that shorter screening duration and specialist-provided screening services had greater positive impact on utility among suburban residents than among urban sample. Scenario predictions suggested that the combination of shorter screening duration, service supplied by tertiary-hospital specialists and management supplied by general practitioners meaningfully increased predicted participants' utility.

Conclusion: Public preferences favored lower costs, convenient screening, clear information and specialist-led screening with general-practitioner-delivered management. Understanding the impact of attributes in community-level management strategies on residents' utility and willingness to pay is important for optimizing community-level management strategies.

Introduction: Hip fractures in older adults lead to high mortality and reduced quality of life, requiring effective outcome prediction tools. The Geriatric Nutritional Risk Index (GNRI) evaluates nutritional status, while inflammatory markers such as the Systemic Immune-Inflammation Index (SII), pan-immune-inflammation value (PIV), and c-reactive protein-to-lymphocyte ratio (CLR) serve as potential predictors. This study assesses the combined effectiveness of GNRI and these markers in forecasting post-hip fracture surgery outcomes.

Materials and methods: This retrospective cohort study included geriatric hip fracture patients treated from 2020 to 2022. Biomarkers including GNRI, SII, PIV, and CLR were calculated from pre-operative laboratory data. GNRI was based on serum albumin and body weight, while inflammatory indices were derived from neutrophil, lymphocyte, platelet, monocyte counts, and CRP levels measured via hospital analyzers. Time-dependent ROC curves were used to identify optimal cutoff values, and Cox regression was applied to examine associations with overall survival.

Results: A total of 159 patients aged ≥ 60 years were included. In single-index analyses, a high GNRI (HR 0.95, 95% CI 0.91-0.98) was significantly associated with improved overall survival (OS), while a high SII (HR 1.002, 95% CI 1.0006-1.0034) was associated with reduced OS. Combination analyses revealed that low GNRI and elevated CLR significantly associated with risk of postoperative mortality (HR 4.92, 95% CI 2.25-10.92). Combining GNRI with CLR predicted mortality within 3 months post-hip surgery with 90% accuracy.

Conclusion: Combining GNRI and CLR effectively predicts mortality risk in elderly hip fracture patients, particularly during the high-risk first 3 months after surgery.

Background: A significant proportion of bone loss per year occurs starting around 1-3 years before menopause. A number of fractures occur in the osteopenic range of bone mineral density (BMD). There are no recommendations for the treatment of osteopenic peri-menopausal women. We conducted this study to explore the utility of zoledronic acid in preserving bone health in this population.

Materials and methods: This is a prospective single-blinded randomized controlled trial. A total of 60 peri-menopausal women and 30 postmenopausal women with osteopenia were enrolled. The peri-menopausal women were randomized to receive either zoledronic acid or placebo in a 1:1 ratio. All postmenopausal osteopenic women received zoledronic acid. Participants were followed up for 12 months. BMD and bone turnover markers (BTM) were assessed.

Results: At the end of 12 months, there was a significant increase in lumbar spine BMD in the peri-menopausal and postmenopausal groups which received zoledronic acid. On further subcategorizing the T-score, the improvement in BMD was statistically significant in the group with a T-score of - 1.75 to - 2.5. In peri-menopausal women with osteopenia with a T-score of - 1.75 to - 2.5, a single infusion of zoledronic acid increased lumbar spine and femoral neck BMD and suppressed the high bone turnover. Zoledronic acid thus could be used for preserving bone density and preventing the risk of osteoporosis and fragility fractures in the future.