Osteoporosis International最新文献

Disability overcomes mortality burden in older adults with hip fracture, expanding unhealthy lifespan. Building comprehensive assessment, pre-fracture functional status and 30-day post-surgical recovery are the most powerful predictors of 5-years survival. A tool supporting estimation of long-term survival may optimize the appropriate delivery of targeted interventions.

Background: Older people with hip fractures are highly heterogeneous patients, impacting health and economic systems. The availability of tools to estimate survival may help optimize patients' outcomes and treatment management decisions.

Methods: A prospective observational study was conducted on older patients with hip fractures who received baseline and 30-day comprehensive assessment from discharge, focusing on functional status based on Basic Activity of Daily Living (BADL). The primary outcome was to identify predictors of 5-year survival and develop nomograms to be adopted at admission or 30 days after discharge.

Result: Among 231 hip fracture patients, 5-year survival was 38.3% in men and 61.9% in women; women experienced a 1.8 higher likelihood of survival than men. Pre-fracture functional status predicted mortality as a function of age. At hospital admission, pre-fracture BADL level was a protective factor (HR 0.742; 95% CI 0.668-0.825), while male gender (HR 1.840; 95% CI 1.192-2.841), age (HR 1.070; 95% CI 1.037-1.105), and multimorbidity (HR 1.096; 95% CI 1.007-1.193) were independent mortality risk factors. At the 30-day follow-up visit, the BADL recovery gap was an independent predictor of 5-year survival (HR 1.439; 95% CI 1.158-1.789), in addition to male gender (HR 1.773; 95% CI 1.146-2.744), age (HR 1.046; 95% CI 1.010-1.083), and pre-fracture BADL (HR 0.621; 95% CI 0.528-0.730), while comorbidity disappeared (HR 1.083; 95% CI 0.994-1.179).

Conclusion: More than half of hip fracture patients are still alive 5 years after surgical repair. Pre-fracture functional status and a 30-day functional recovery gap are the main predictors of survival. Nomograms may help to define prognosis and suitable interventions.

The goal of the work was to determine the effects of altering muscle quality (peak torque and muscle CSA) via NMES-RT on bone mineral density (BMD) following application of FES-lower extremity cycling. Components of muscle quality were altered and attenuated the decline in BMD after SCI.

Introduction: Spinal cord injury (SCI) negatively impacts muscle quality and bone health. Neuromuscular electrical stimulation-resistance training (NMES-RT) has been shown to enhance muscle quality. It is unclear whether adding NMES-RT to functional electrical stimulation (FES)-lower extremity cycling may further augment muscle quality and subsequently enhance bone mineral density (BMD).

Methods: Thirty-two participants were randomized into either 12 weeks of NMES-RT followed by 12 weeks of FES- lower extremity cycling (NMES-RT + FES; n = 16) or 12 weeks of passive movement training (PMT) followed by 12 weeks of FES-lower extremity cycling (PMT + FES; n = 16). Measurements were conducted at baseline (BL), post-interventions 1 and 2 (P1 and P2) separated evenly by 12 weeks. Left thigh muscle isometric and isokinetic torques were measured using an isokinetic dynamometer. Magnetic resonance imaging measured whole thigh and knee extensor (KE) muscle CSAs. Dual energy X-ray absorptiometry measured total and regional BMD.

Results: NMES-RT elicited a trend towards greater isometric torque at 80 Hz (P = 0.057) and isokinetic torque (60 deg/s; P = 0.009 and 180 deg/s; P = 0.003) compared to PMT. Muscle CSA was greater in left whole thigh (F (2,20) = 9.1; P = 0.007) and KE (F (2,20) = 15.5; P = 0.001) by 11.0 and 8.0 cm² respectively at P1 in the NMES-RT + FES compared to PMT + FES. In the NMES-RT + FES, ankle weights were positively associated with muscle CSA, isometric and isokinetic torques as well as muscle quality following P1. Compared to PMT + FES, NMES-RT + FES maintained BMD at the distal femur.

Conclusion: NMES-RT + FES enhanced muscle quality as measured by torque production and muscle CSA as result of increasing ankle weights. The addition of FES- lower extremity cycling to NMES-RT maintained but did not further augment muscle quality. Furthermore, NMES-RT + FES may help maintain BMD after SCI.

Clinical trial registration: Registered with clinicaltrials.gov: NCT02660073.

Background: Studies have shown that beta-antagonists, an antihypertensive drug, may be associated with fracture risk in adult users. However, this conclusion remains controversial. This meta-analysis was used to explore the association between beta-receptor antagonist use and fracture risk in adult patients.

Methods: We searched Embase, Medline, PubMed, and Web of Science; finally, 16 articles were identified, and the extracted odds ratio (OR), hazard ratio (HR), and 95% confidence interval (95% CI) were used to estimate the association between beta-blockers and the risk of fracture in adult patients. All the results are adjusted. Sensitivity analysis and Egger's test were employed to assess the stability of the results and potential publication bias.

Results: We included eight cohort studies, one of which was only used for subgroup analysis because it only discussed the male and female groups separately and did not discuss the combined population. Thus, we included seven studies in which cohort studies did not find an association between beta-receptor antagonists and fracture risk, the HR is 0.96 (95% CI: 0.88-1.05; P = 0.41). Nine case-control studies included 156,437 beta-blockers users and 432,288 non-users for analysis showed that beta-receptor antagonists would reduce the risk of fracture in middle-aged and elderly users, the OR is 0.86 (95% CI: 0.77-0.95; P < 0.0001). In the subgroup analysis by the sites of fracture, no association was found between beta-receptor antagonists and fracture risk. However, in analyzing groups stratified by gender, beta-receptor antagonists reduce the fracture risk.

Conclusion: In cohort studies, no association was found between beta-receptor antagonists and fracture risk. However, beta-receptor antagonists have been shown to reduce the risk of fractures in adult users in case-control studies. The results of this study need careful interpretation for the reason that case-control studies are inferior to cohort studies in determining cause and effect and the lack of enough randomized controlled trials (RCTs).

Osteoporosis, defined by reduced bone mineral density and macro- and micro-architectural degradation, leads to increased fracture risk, particularly in aging populations. While randomized controlled trials (RCTs) demonstrate that PTH1 receptor agonists, teriparatide and abaloparatide, are effective at reducing fracture risk, real-world evidence (RWE) remains sparse. This study reviews and compares the anti-fracture efficacy of these agents, against each other and against other osteoporosis treatments using both RCTs and RWE. We systematically searched Medline, Embase, and Cochrane up to May 2024, focusing on RCTs and RWE studies reporting reduction in vertebral, non-vertebral, hip, or all fractures as primary endpoint. A network meta-analysis (NMA) was conducted, first through pairwise meta-analyses of teriparatide versus abaloparatide, then a Bayesian NMA comparing each to other treatments. Safety assessments included adverse events classified by MedDRA, with a particular attention to hypercalcemia and cardiac events. Seventeen studies (11 RCTs, 6 RWE) met inclusion criteria. Teriparatide and abaloparatide were effective in reducing vertebral and non-vertebral fractures in all pairwise meta-analyses versus placebo. Abaloparatide showed an advantage over teriparatide for non-vertebral fractures (OR: 0.87, 95% CI: 0.80-0.95) and hip fractures (OR: 0.81, 95% CI: 0.71-0.93). In the NMA model, teriparatide and abaloparatide were superior to placebo, raloxifene, and calcitonin in reducing vertebral fracture while teriparatide was further superior to denosumab and risedronate. For non-vertebral fracture, abaloparatide was better than any other treatment while teriparatide was only superior to alendronate or placebo. PTH1 analogs were better than placebo at reducing all fractures while no difference was observed for the risk of hip fracture. Both abaloparatide and teriparatide demonstrate comparable safety to other osteoporosis treatments, with no increased cardiovascular risk. This review highlights that PTH1 receptor agonists effectively reduce fracture risk, with abaloparatide offering enhanced benefits for non-vertebral and hip fractures compared to teriparatide. Both agents exhibit acceptable safety profiles, suggesting their valuable role in managing osteoporosis, particularly for high-risk patients.

To determine the potential economic, morbidity and mortality impact of improvements in reporting of vertebral fragility fractures (VFFs) following a complete audit cycle. Six percent interval increase in reporting of moderate/severe VFFs results in an additional 890 hip fractures predicted in year one and a potential cost saving of £13,207,000.

Purpose: To determine the potential economic, morbidity and mortality impact of improvements in reporting of vertebral fragility fractures (VFFs) following an initial UK-wide audit initiated by the Royal College of Radiologists (RCR), collaborating with the Royal Osteoporosis Society (ROS) and Royal College of Physicians (RCP) and subsequent re-audit in 2022.

Methods: Patient-specific and organisational questionnaires in 2019 and 2022 involved retrospective analysis of between 50 and 100 consecutive, non-traumatic CT studies which included the thoracolumbar spine where the spine was not the area of clinical interest in patients > 70 years. VFFs were recorded and the severity graded using the Genant reporting system. A series of UK-wide interventions were initiated between the audits. Results of the re-audit were evaluated using a bespoke ROS calculator to identify potential patient related and economic benefits from any improvements demonstrated.

Results: Widespread improvements were evident between the two audits across all audit parameters, both patient-related and organisational. Notably, there was a 6% interval increase in reporting of moderate/severe VFFs (26 to 32%). Extrapolating from NHS England data, approximately 1.8 million non-trauma CT studies including the thoracolumbar spine for patients > 70 years were performed in the UK in 2022. The incidence of VFFs in the 2022 audit was found to be 21.7%. Using these figures and the 6% increase, the number of additional patients potentially diagnosed with a VFF equates to 23,420. Applying the ROS Benefits Calculator, in this cohort of 23,420 patients with no treatment, 890 hip fractures can be predicted in year one. With initiation of treatment, this figure falls to 328 patients (562 hip fractures prevented in year one), a potential cost saving of £13,207,000.

Conclusion: The 2022 national re-audit confirmed improvements in radiology diagnostic performance and practice in VFF reporting. Ongoing work is required to build on this improvement and to further embed best practice. To realise this potential, there will need to be significant and maintained investment in onward referral and treatment systems (fracture liaison services or equivalent). Increasing availability of artificial intelligence will significantly increase the diagnoses of these fractures.

Over 12 years in the US and 26 years in Ontario, Canada, we found major differences in osteoporosis medications used. In both countries, osteoporosis medication initiation has not returned to pre-2008 levels; however, denosumab use is increasing. Future work should determine whether targeted screening or undertreatment drives these trends.

Purpose: Concerns about adverse events caused a rapid decline in osteoporosis medication use globally between 2008 and 2012. Trends in use in recent years have not been described. We aimed to describe and compare trends over time in the initiation and overall use of osteoporosis medications among older adults in the US and Ontario, Canada.

Methods: We conducted a serial cross-sectional study leveraging two data sources: healthcare administrative data for all older adult residents of Ontario, Canada (ON) and Medicare claims and enrollment data for a 20% random sample of beneficiaries (US). We included community-dwelling older adults aged ≥ 66 years at their first dispensing of an osteoporosis medication between 05/01/1996-12/31/2022 in ON and 01/01/2008-12/31/2020 in the US. We described and compared the number of incident and prevalent users of osteoporosis medications annually.

Results: We identified 771,025 (average age = 75.2 years; 78% female) individuals in ON and 424,995 (average age = 75.3 years; 85% female) in the US initiating osteoporosis medications. In the US, alendronate and denosumab were the most common therapies, while in ON, risedronate and denosumab were most common. New use of osteoporosis medications dropped more between 2008 and 2011 in the US versus ON (58% vs. 29% relative decrease). Initiation of osteoporosis medications did not rebound to pre-2008 levels.

Conclusion: New use of osteoporosis medications remains below pre-2008 levels, and differs between the US and Canada. Future research should aim to understand drivers of decreased use, like changes in the screening strategy used for initial treatment or persisting concerns about adverse effects.

This study focused on individuals aged ≥ 50 years with periprosthetic femoral fractures (PFF). When compared to those with native hip fractures, patients with PFF were older, had a higher BMI, and demonstrated a greater number of comorbidities. Given the high frequency of osteoporosis risk factors and the BMD results, PFF should be classified as osteoporotic fractures.

Introduction: To compare patients presenting with periprosthetic femoral fractures (PFF) to patients with native hip fractures with a special focus on bone mineral density (BMD) measurements, in order to reinforce the hypothesis that PFF are osteoporotic fractures.

Methods: A retrospective, single-centre, observational study of all patients aged ≥ 50 years with low-energy PFF identified at the Lille University Hospital from January 1, 2016, to December 31, 2022, was conducted. The PFF group was compared to a group of patients with native hip fractures hospitalized during the same period. To compare the T-score data, we used a linear mixed model that considered a predefined adjustment for age, sex, and BMI. Adjusted means ± standard error of the mean (SEM) are derived from the mixed model.

Results: Among 71 patients with PFF (78.9% female, median (IQR) age 81 (72-88) years), osteoarthritis (57.8%) was the primary indication for hip surgery. Compared with the native hip fracture group (n = 117), patients in the PFF group were significantly older (p = 0.002), had a significantly greater BMI (p = 0.043), and had a higher history of multiple falls (54.3% vs. 26.1%, p < 0.001). A greater frequency of previous low-energy fractures (69.0% vs. 44.0%, p < 0.001) and an increased prescription of anti-osteoporosis medications (26.8% vs. 11.1%, p = 0.006) in patients with PFF were found. Adjusted T-scores differed between the two groups at the lumbar spine (mean adjusted ± SEM, - 0.5 ± 0.2 (PFF group) vs. - 1.2 ± 0.2 (comparator group), p = 0.008) but not at the femoral neck or at the total hip.

Conclusion: Low-energy PFF should be considered as an osteoporotic fracture and treated accordingly.

We examined vertebral fracture (VF) prevalence, incidence, and treatment among 1488 older adults. VF prevalence and incidence were higher in women, older participants, and those with low bone density. In addition to VFs being underdiagnosed (only 20.7% of VFs clinically recognized), treatment rates were low, underscoring the need for improved screening and management.

Purpose: To estimate prevalence and incidence of osteoporotic VFs and VF progressions overall and by sex, age, and bone status and to describe the proportion of participants with VFs in reporting osteoporosis (OP) medication use.

Methods: This observational analysis of the DO-HEALTH trial, a three-year, randomized, controlled trial among community-dwelling adults age ≥ 70 years, includes a subsample of participants recruited at four study sites equipped with DXA machines. Prevalence and incidence rates (IR) of VFs and VF progressions were described overall and by subgroups of sex, age, and bone status. Incidence of VFs which were clinically recognized was also estimated. Further, we estimated the proportion of participants on OP medication.

Results: A total of 1488 participants were included (mean age 74.9 years, 63.1% women, 77.0% had osteopenia or osteoporosis). One hundred forty-four (9.7%) participants had at least one radiographic VF at baseline and of those 19.4% participants reported OP medication use. Over the three-year follow-up, 50 participants sustained 58 new radiographic VFs (IR 1.4, 95% CI 1.1, 1.9). Of the 58 radiographic VFs, only 12 (20.7%) were clinically recognized. Furthermore, 31 participants sustained 35 VF progressions (N = 157; IR 7.7, 95% CI 5.5, 10.7). Prevalence and incidence were significantly higher in women, in older participants and those with osteopenia or osteoporosis compared to those with normal bone density.

Conclusions: This study suggests a high prevalence and incidence of VFs in community-dwelling European older adults. Underdiagnosis may be even more prevalent than previously observed, and treatment rates were low.

Identifying patients at risk of low bone mineral density (BMD) from X-rays presents an attractive approach to increase case finding. This paper showed the diagnostic accuracy, reproducibility, and robustness of a new technology: OsteoSight™. OsteoSight could increase diagnosis and preventive treatment rates for patients with low BMD.

Purpose: This study aimed to evaluate the diagnostic accuracy, reproducibility, and robustness of OsteoSight™, an automated image analysis tool designed to identify low bone mineral density (BMD) from routine hip and pelvic X-rays. Given the global rise in osteoporosis-related fractures and the limitations of current diagnostic paradigms, OsteoSight offers a scalable solution that integrates into existing clinical workflows.

Methods: Performance of the technology was tested across three key areas: (1) diagnostic accuracy in identifying low BMD as compared to dual-energy X-ray absorptiometry (DXA), the clinical gold standard; (2) reproducibility, through analysis of two images from the same patient; and (3) robustness, by evaluating the tool's performance across different patient demographics and X-ray scanner hardware.

Results: The diagnostic accuracy of OsteoSight for identifying patients at risk of low BMD was area under the receiver operating characteristic curve (AUROC) 0.834 [0.789-0.880], with consistent results across subgroups of clinical confounders and X-ray scanner hardware. Specificity 0.852 [0.783-0.930] and sensitivity 0.628 [0.538-0.743] met pre-specified acceptance criteria. The pre-processing pipeline successfully excluded unsuitable cases including incorrect body parts, metalwork, and unacceptable femur positioning.

Conclusion: The results demonstrate that OsteoSight is accurate in identifying patients with low BMD. This suggests its utility as an opportunistic assessment tool, especially in settings where DXA accessibility is limited or not recently performed. The tool's reproducibility and robust performance across various clinical confounders further supports its integration into routine orthopedic and medical practices, potentially broadening the reach of osteoporosis assessment and enabling earlier intervention for at-risk patients.

A systematic review and meta-analysis of the presentation, risk factors and treatment response of pregnancy-associated osteoporosis was conducted involving 35 studies and 943 patients. Vertebral fractures, back pain and family history of osteoporosis were common features. Analysis of treatment response was inconclusive due to limited availability of data.

Introduction: Pregnancy-associated osteoporosis (PAO) is a rare disorder most often presenting with vertebral fractures during pregnancy or postpartum.

Aims: This meta-analysis aimed to evaluate the presenting features of PAO, its risk factors and the effectiveness of various treatments at improving bone mineral density (BMD) and preventing further fractures.

Methods: A systematic search of PubMed, EMBASE and Web of Science identified 35 studies comprising 943 cases of PAO. A meta-analysis was conducted to evaluate the effect of treatment on change in BMD at the lumbar spine, femoral neck and total hip.

Results: Vertebral fractures and back pain occurred in 89.2% and 90.2% of cases, respectively. The diagnosis was predominantly made postpartum. The most common risk factor was a family history of osteoporosis (40.5%). Calcium and vitamin D supplements (31.8%) and teriparatide (30.8%) were the most commonly used treatments. The meta-analysis of BMD response was inconclusive due to limited availability of data. The BMD change at the lumbar spine was greater with teriparatide compared with calcium/vitamin D and bisphosphonates but this was based on only two studies. There was no difference in BMD response at the femoral neck. Recurrent fractures were reported in 12.9% with no difference between treatment groups.

Conclusion: While this review can assist clinicians with the diagnosis and management of PAO, it highlights some key knowledge gaps that may inform conduct of a Delphi process on the diagnosis and management of this disorder, pending conduct of randomised controlled trials.