Journal of Bone and Mineral Metabolism最新文献

Introduction: Fracture Liaison Service (FLS) programs are beneficial for reducing the frequency of subsequent fractures and mortality in post-hip fracture patients. The aim of this study was to investigate recent changes in the rate of pharmaceutical treatment for osteoporosis in post-hip fracture surgery patients in the absence of FLS programs compared to the previous 10 and 20 years, and whether introduction of a new reimbursement scheme in hip fracture care, launched in 2022 by the Japanese government, improved the pharmaceutical treatment rate after surgical intervention.

Materials and methods: Study 1 included 1490 post-hip fracture patients in seven hospitals without an FLS program. Study 2 included 396 osteoporosis patients who were covered by the new reimbursement scheme at five of the seven hospitals. Treatment-related variables and the number of patients who received the different pharmaceutical treatments at 0, 3, 6 and 12 months after discharge from the hospital were examined.

Results: Two hundred and thirty-two of 1474 patients received anti-osteoporotic medication at hospital discharge, which was not a significant improvement in the rate of pharmaceutical treatment in comparison with that in our previous studies over 20 years. On the other hand, introduction of the new reimbursement scheme at hospitals significantly improved the rate of pharmaceutical treatment, with 263 of the 391 patients receiving anti-osteoporotic medication at discharge, as well as a significant improvement.

Conclusion: We demonstrated a significant improvement in the pharmaceutical treatment rate for osteoporosis in post-hip fracture surgery patients after introduction of the new reimbursement scheme launched by the Japanese government.

Background: There are no established guidelines for antibiotic administration to prevent the development of medication related-osteonecrosis of the jaw (MRONJ) after tooth extraction in patients receiving antiresorptive agents (ARAs). Since 2022, the duration of antibiotic administration during extractions in such patients has been intentionally shortened to prevent antimicrobial resistance at our hospitals.

Methods: This retrospective study involved 160 patients on low-dose bisphosphonates (BPs) requiring tooth extractions between 2019 and 2024 at four Japanese institutions. In 2019-2021, patients received amoxicillin (AMPC) 500 mg 1 h before and 750 mg per day for 2 days post-extraction. In 2022-2024, a single 500 mg dose of AMPC was administered 1 h pre-extraction. Patients were managed with tension-free wound suturing and regular follow-up. The rates of MRONJ development were compared between the two periods.

Results: MRONJ developed in 3 out of 170 teeth (1.76%) in 2019-2021, and in 2 out of 147 teeth (1.36%) in 2022-2024, with no significant difference (P = 1.000). All MRONJ cases were low-stage (Stage 1) and healed completely within 12-16 weeks. Four out of five MRONJ cases (80%) exhibited radiopaque changes around the root. When all teeth in both groups were surveyed, MRONJ development was significantly higher in teeth with such changes compared to those without (4/58 vs. 1/259; P = 0.004).

Conclusion: A single preoperative dose of AMPC may be sufficient for tooth extractions in patients on low-dose BPs. However, teeth with radiopaque changes around the root require careful monitoring postextraction.

Introduction: Fragility hip fracture (FHF) has been frequently seen in trauma of older people, resulted in decreased mobility and a loss of independence.

Materials and methods: This study retrospectively assessed the long-term health-related quality of life (HRQOL) and living arrangement in older patients following FHF, and evaluated the factors associating with long-term EuroQol 5D (EQ5D) for 5 years or more. This study included 203 Japanese patients (male 26, female 177) with FHF over the age of 60 years. We examined the long-term EQ5D and life style at final follow-up, and identified the factors affecting with EQ5D.

Results: The mean age at baseline of 79 years, the mean observation duration was 6 years, and the average value of EQ5D at final follow-up was 0.65. Multivariate analysis presented that EQ5D at final follow-up was significantly predicted by serum albumin, trochanteric fracture, comorbidity stroke, higher BI at post-admission, less length of stay hospital, and living at home at final follow-up. The people living at home at final follow-up (148/203 [72.9%]) was less than the people at baseline (190/203 [93.6%]). In multivariate analysis, the people living at home at final follow-up were younger age at baseline, and higher BI at post-admission.

Discussion: In conclusion the long-term EQ5D after FHF was decreased in patients with lower serum albumin at baseline, with trochanteric fracture, with stroke comorbidity, and with lower BI at post-admission. The people living at home after FHF were young age at baseline and high BI at post-admission.

Introduction: Hyperglycemia increases the risk of bone fragility by promoting reactive oxygen species and advanced glycation end products, which disrupt osteoblast activity. Mechanical stress, including osmotic stress from elevated glucose levels, affects bone homeostasis; however, the specific impact of osmotic stress on osteoblast function is not fully understood. The transient receptor potential vanilloid 4 (TRPV4) channel, known to mediate calcium influx in response to mechanical stress, plays a key role in osteoblast differentiation. This study investigated the effects of osmotic stress on osteoblast differentiation and mineralization, as well as the role of TRPV4-mediated calcium influx.

Materials and methods: We investigated the effects of osmotic stress on osteoblast differentiation and mineralization using MC3T3-E1 cells. Mannitol and sorbitol treatments were adjusted to match the osmolality of glucose to assess osmotic stress effects. TRPV4 involvement was examined using the TRPV4 antagonist, HC-067047.

Results: Mineralization was inhibited not only by glucose, but also by treatment with mannitol and sorbitol, which were adjusted to match the osmolality of glucose. Both glucose and mannitol treatments inhibited the nuclear translocation of Runx2 while decreasing the mRNA expression of osteogenic markers such as osteocalcin, ALP, and collagen I. Notably, osmotic stress suppressed calcium influx through TRPV4 channels, which is linked to differentiation induction. Furthermore, HC-067047 inhibited mineralization and osteogenic marker expression.

Conclusion: These findings indicate that osmotic stress impairs osteoblast mineralization by inhibiting TRPV4-mediated calcium influx. TRPV4 may represent a therapeutic target for mitigating bone loss in diabetes, suggesting a novel approach for treating diabetic bone disease.

Introduction: The effects of teriparatide (TPTD) and alendronate (ALN) on health-related quality of life (HRQOL) were evaluated in osteoporotic patients with high fracture risk using data from the JOINT-05 trial.

Materials and methods: JOINT-05 was a randomized, controlled trial comparing the fracture prevention effects of sequential therapy with TPTD for 72 weeks followed by ALN for 48 weeks with those of ALN monotherapy for 120 weeks. This sub-analysis evaluated the effects of TPTD and ALN on HRQOL using data from baseline to 72 weeks. HRQOL was assessed at baseline, 4, 12, 24, 48, and 72 weeks using the EuroQoL-5Dimension (EQ-5D) questionnaire containing five domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Scores were also transformed using utility weights derived from the general Japanese population.

Results: This sub-analysis included 476 patients in the TPTD group and 492 patients in the ALN group. No significant differences in utility scores were observed between groups at all times. Utility scores improved significantly after 12 weeks in the TPTD group and after 24 weeks in the ALN group. Mobility and self-care scores improved significantly in the TPTD group. Significant improvements in usual activity, pain/discomfort, and anxiety/depression scores occurred earlier in the TPTD group.

Conclusion: Although there were no significant differences in utility scores between the TPTD and ALN groups, significant improvements in the utility score and 5 domain scores were observed earlier in the TPTD group. When treating osteoporosis patients with a high risk of fracture, the selecting treatment drugs may be decided with primary consideration of its effect on fracture prevention, followed by its effect on improving HRQOL.

Introduction: The prevalence of osteoporosis (OP) is steadily rising, leading to a higher risk of mortality. This study assessed the impact of the Weight-Adjusted Waist Index (WWI) on osteoporosis-related mortality.

Materials and methods: Data from NHANES 2005-2010, 2013-2014, and 2017-2018 were analyzed to evaluate the relationship between WWI and mortality in osteoporotic patients using weighted proportional hazards model and Kaplan-Meier survival analysis. A subgroup analysis was performed to ensure the stability of the findings.

Results: The study included 1324 participants. The findings indicated a positive correlation between WWI and OP (OR 1.65, 95% CI 1.45-1.89). Among patients with OP, WWI showed a positive association with all-cause mortality (HR 1.28, 95% CI 1.10-1.48). There was no observed correlation between varying WWI levels and mortality due to cardiovascular disease or cancer.

Conclusions: Maintaining a lower WWI is associated with a reduced risk of all-cause mortality among individuals with OP.