Osteoporosis International最新文献

Both osteoporosis and idiopathic normal pressure hydrocephalus may increase the risk of falls and fractures. This study showed that osteoporosis is more common in older patients with iNPH. It is important to raise awareness of osteoporosis in older patients with iNPH to prevent adverse health consequences.

Purpose: Idiopathic normal pressure hydrocephalus (iNPH), a potentially reversible condition with timely intervention, may cause cognitive impairment, balance and gait disturbance, and urinary incontinence in advanced age. Osteoporosis is a progressive metabolic bone disease that increases bone fragility in older adults. Both conditions may lead to falls and fractures. Therefore, this study aims to investigate osteoporosis in older adults with iNPH.

Methods: A total of 64 patients diagnosed with iNPH and 458 participants in the control group were included in the study. Demographic and clinical characteristics, including age, sex, comorbidities, laboratory findings, and comprehensive geriatric assessment parameters, were recorded. Osteoporosis was defined according to the WHO classification. The relationship between osteoporosis and iNPH was assessed with regression analysis.

Results: The mean age was higher in the iNPH group than in the control group (79.91 ± 6.36 vs 75.86 ± 6.51 years, p < 0.001). The frequency of female patients was higher in the control group than in the iNPH group (81% vs 70.3%, p = 0.046). The osteoporosis frequency was higher in the iNPH group than in the controls (51.6% vs 32.1%, p = 0.002). Adjusted for age and gender, iNPH was associated with osteoporosis (odds ratio (OR), 1.750; confidence interval (CI) 95%, 1.002-3.054; p = 0.049).

Conclusions: This study showed that osteoporosis is more common in older patients with iNPH. Therefore, screening and treatment of osteoporosis in these individuals is crucial to avoid adverse health outcomes such as fractures.

Rheumatoid arthritis (RA) is a potentially devastating disorder associated with increased risk of fractures, but current studies do not completely evaluate the RA fracture risk profile. This study estimates fracture incidence by site of fracture and makes comparisons between RA and controls using the key variables gender, age, and comorbidities.

Background: Rheumatoid arthritis RA is a potentially devastating osteoimmunological disorder, predisposing to osteoporosis (OP), fragility fracture (FF), and major osteoporotic fractures (MOF). As few studies incorporate statistical matching, comorbidity and non-MOF sites, we compared the incidence of first FF, MOF, and non-MOF in RA patients with a matched control cohort adjusting for comorbidities.

Methods: This longitudinal cohort study uses routinely collected administrative data from the West Australian Rheumatic Disease Epidemiological Registry (WARDER) between 1980 and 2015. RA patients, as defined using International Classification of Disease (ICD) codes, were compared to hospitalised patients free of rheumatic disease. Case-control matching adjusted for age, gender, and comorbidities (Charlson Comorbidity Index). Incidence rates (IR) per 1000 person years (PY) with 95% confidence intervals (CI) were compared by incidence rate ratios (IRR).

Findings: In RA patients from 2000 to 2010, the first fracture IR was 18.3 (15.7-21.2) for an IRR of 1.32 (1.10-1.60). Upper limb, lower limb, and axial IR were 5.56 (95% CI 4.18-7.26), 10.60 (95% CI 8.66-12.87), and 2.47 (95% CI 2.58-3.68) with IRR of 1.18 (95% CI 0.84-1.65), 1.44 (95% CI 1.19-1.86), and 1.01 (95% CI 0.61-1.63) respectively. The first fracture IR increased 6 years before first RA hospital record (RR 1.58, CI 1.05-2.39).

Conclusions: After age, gender, and comorbidity adjustment, RA is associated with a 32% higher incidence of first fracture, increased MOF, and a fracture incidence that is already increased before a first recorded RA diagnosis. This suggests a need for early attention to prevention of all fractures in RA patients.

The prevalence of AAC in patients attending a Fracture Liaison Service is 27.6%. Prevalent vertebral fractures were associated with AAC, but not with severe AAC in patients without CVD. Fracture location and BMD were not related to AAC or severe AAC.

Purpose: Abdominal aortic calcification (AAC) is associated with an increased risk of cardiovascular disease (CVD), osteoporosis and fractures. We aimed to analyze the prevalence and severity of AAC and to assess whether index fracture location, bone mineral density (BMD) and prevalent VFs are associated with AAC in patients with a recent fracture.

Methods: Cross-sectional cohort study of patients with a recent clinical fracture (aged 50-90 years) attending the FLS. Patients received a BMD measurement and lateral spine imaging using Dual-energy X-ray absorptiometry. AAC prevalence was assessed using the AAC-24 score and categorized as none, moderate (AAC-24 1-4) and severe (AAC-24 ≥ 5). Multivariate logistic regression analyses were performed to study the association between risk factors and AAC presence/ severity.

Results: AAC was present in 478 (27.6%) of 1731 patients of whom 207 (43.3%) had moderate and 271 (56.7%) severe AAC. The presence of AAC was associated with age, BMI, smoking, history of CVD and prevalent grade 2 or 3 VFs, but index fracture location and BMD were not associated with AAC or severe AAC. In patients with AAC (n =  318) without a history of CVD, there was no association between index fracture location and BMD. In that subgroup, severe AAC was not associated with prevalent VFs.

Conclusions: In FLS patients, the prevalence of AAC and severe AAC was 27.6% and 15.7%. Index fracture location and BMD were not associated with AAC or severe AAC. Prevalent VFs were associated with AAC, but not with severe AAC in the subgroup of patients without CVD.

The importance of osteoporosis assessment before lumbar surgery is well recognized. The MRI-based Vertebral Bone Quality (VBQ) score is introduced to evaluate bone quality; however, its diagnostic value has not been well documented. The purpose of this meta-analysis was to summarize the diagnostic value of the VBQ score for osteoporosis or osteopenia in patients undergoing lumbar surgery. We comprehensively searched electronic databases for studies exploring the diagnostic accuracy of the VBQ score for osteoporosis/osteopenia in patients with lumbar disease following the PRISMA guidelines. The quality of the included studies was assessed. The VBQ scores were compared between the groups, and the pooled sensitivity, specificity, and summary receiver operating characteristic (ROC) were calculated. Publication bias was assessed, and meta-regression was conducted. We included 17 studies with a total of 2815 patients, with a mean age of 66.4 years and a percentage of females of 72.5%. According to the QUADAS-2 tool, the quality of the included studies was relatively high. The results showed a significantly higher VBQ score in the osteoporosis/osteopenia group compared with the control group. According to the mean VBQ cutoff value of 3.02 ± 0.38 for the diagnosis of osteoporosis, the pooled sensitivity and specificity were 0.76 and 0.74, respectively, and the AUC was 0.81. According to the mean VBQ cutoff value of 2.31 ± 0.18 for the diagnosis of osteopenia, the pooled sensitivity and specificity were 0.78 and 0.58, respectively, and the AUC was 0.76. The MRI-based VBQ score could provide useful information for identifying patients with low bone mass who need further evaluation. Future prospective studies are still needed to evaluate the complementary role of the VBQ score.

While US Asian and Pacific Islander adults have lower 25-hydroxyvitamin D (25(OH)D) levels than White adults, ethnic subgroup data remain limited. In a large California population, the adjusted prevalence of 25(OH)D < 20 ng/mL (50 nmol/L) was 1.5- to 2.7-fold higher for Asian/Pacific Islander compared to White adults, with substantial variation by ethnicity.

Purpose: US Asian and Pacific Islander (PI) adults generally have lower 25-hydroxyvitamin D [25(OH)D] levels than non-Hispanic White (NHW) adults, but subgroup data remain limited. We compared sex- and ethnicity-specific prevalence of low 25(OH)D among older Asian/PI and NHW adults.

Methods: Data from 102,556 Asian/PI and 381,724 NHW adults aged 50-89 years with measured 25(OH)D in 2012-2019 and body mass index (BMI, within ± 1 year) were examined in a California healthcare system. Low 25(OH)D < 20 ng/mL (50 nmol/L) was examined by race and ethnicity. Covariates included age, smoking, BMI, and season of measurement. Modified Poisson regression was used to estimate prevalence ratios (aPR), adjusting for covariates.

Results: Among 31,287 Asian/PI men and 71,269 Asian/PI women, the prevalence of low 25(OH)D was 22.6% and 14.7%, respectively, significantly higher than observed for 122,162 NHW men (12.3%) and 259,562 NHW women (9.9%). Within Asian/PI subgroups, low 25(OH)D prevalence ranged from 17 to 18% (Korean, Japanese, Filipino), 22 to 24% (Chinese, Vietnamese), 28% (South Asian), and 35% (Native Hawaiian/PI) among men and 11 to 14% (Japanese, Filipina, Chinese, Korean), 17 to 18% (South Asian, Vietnamese), and 26% (Native Hawaiian/PI) among women. The corresponding aPRs (NHW reference) for men and women were as follows: Native Hawaiian/PI, 2.70 and 2.34; South Asian, 2.56 and 2.07; Vietnamese, 2.17 and 2.31; Chinese, 2.04 and 1.89; Korean, 1.60 and 1.85; Filipino, 1.58 and 1.52; and Japanese, 1.58 and 1.49 (p < 0.001).

Conclusion: In a large US healthcare population of older Asian/PI adults, low 25(OH)D prevalence was 1.5- to 2.7-fold higher for Asian/PI compared to NHW adults, with substantial variation by sex and ethnicity.

Purpose: To identify the optimal statistical approach for predicting the risk of fragility fractures in the presence of competing event of death.

Methods: We used real-world data from the Dubbo Osteoporosis Epidemiology Study that has monitored 3035 elderly participants for bone health and mortality. Fragility fractures were ascertained radiologically. Mortality was confirmed by the State Registry. We considered four statistical models for predicting fracture risk: (i) conventional Cox's proportional hazard model, (ii) cause-specific model, (iii) Fine-Gray sub-distribution model, and (iv) multistate model. These models were fitted and validated in the development (60% of the original sample) and validation (40%) subsets, respectively. The model performance was assessed by discrimination and calibration analyses.

Results: During a median follow-up of 11.3 years (IQR: 7.2, 16.2), 628 individuals (34.5%) in the development cohort fractured, and 630 (34.6%) died without a fracture. Neither the discrimination nor the 5-year prediction performance was significantly different among the models, though the conventional model tended to overestimate fracture risk (calibration-in-the-large index =  - 0.24; 95% CI: - 0.43, - 0.06). For 10-year risk prediction, the multistate model (calibration-in-the-large index =  - 0.05; 95% CI: - 0.20, 0.10) outperformed the cause-specific (- 0.23; - 0.30, - 0.08), Fine-Gray (- 0.31; - 0.46, - 0.16), and conventional model (- 0.54; - 0.70, - 0.39) which significantly overestimated fracture risk.

Conclusion: Adjustment for competing risk of death has minimum impact on the short-term prediction of fracture. However, the multistate model yields the most accurate prediction of long-term fracture risk and should be considered for predictive research in the elderly, who are also at high mortality risk. Fracture risk assessment might be compromised by the competing event of death. This study, using real-world data found a multistate model was superior to the current competing risk methods in fracture risk assessment. A multistate model is considered an optimal statistical method for predictive research in the elderly.