Osteoporosis International最新文献

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.

Background: The Middle East and North Africa region are traditionally known as regions with a high prevalence of vitamin D deficiency. However, serum 25-hydroxyvitamin D (25OHD) levels seem to be increasing lately. We developed guidelines on the screening and supplementation of adult Lebanese patients with vitamin D. These guidelines address community-dwelling and institutionalized individuals.

Methods: Our guideline panel consisted of clinical and methodology experts that formulated the guidelines questions. We conducted a systematic review to gather global data on fracture (CRD42019129540), regional data on vitamin D trials (CRD42014010488), and on patients' values and preferences (CRD42022320022). We also complemented the latter with results from a cross-sectional local study. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to assess the quality and certainty of evidence, and to develop recommendations.

Results: For community-dwelling and institutionalized Lebanese adult population, the panel suggests no screening for vitamin D deficiency, over screening for vitamin D deficiency (conditional recommendation, based on very low certainty evidence). For community-dwelling Lebanese adult population, the panel suggests no supplementation with calcium and vitamin D, over supplementation (conditional recommendation, based on moderate certainty evidence). For institutionalized Lebanese adult population, the panel suggests supplementation with calcium and vitamin D, over no supplementation (conditional recommendation, based on moderate certainty evidence). The guidelines also identify high-risk subgroups, more likely to benefit from screening and supplementation. In community dwelling and institutionalized Lebanese adult individuals, for whom there is a decision to supplement with calcium and vitamin D, the panel suggests supplementation with a daily vitamin D equivalent of 600-2000 IU, as compared to doses higher than 2000 IU (conditional recommendation, very low certainty evidence).

Conclusion: The Lebanese GRADE-based vitamin D guidelines recommend against population screening and vitamin D supplementation. Subgroups at high risk are identified. The guidelines take into account contextual factors, and allow their adoption or adaptation in countries in the region.

Osteoporosis significantly impacts healthcare costs in Denmark, with annual expenses exceeding €3097 per individual. The total annual burden of healthcare and productivity losses attributed to osteoporosis in Denmark surpasses €2 billion. Effective prevention, early detection, and management strategies should be considered to offset these costs and improve patient outcomes.

Purpose: As the prevalence of osteoporosis rises, driven by an ageing population, quantifying its financial impact and guiding resource allocation becomes crucial. The aim of this paper is to establish the healthcare (medical and social care) costs and productivity costs attributable to osteoporosis and osteoporosis-related fractures in Denmark.

Methods: The osteoporosis and osteoporosis fracture groups were identified from Danish healthcare registers using ICD-10 codes. The intervention group included individuals born in 1930-1950 with an osteoporosis diagnosis or an osteoporotic fracture with incidence between 2000 and 2021. A control group without osteoporosis and osteoporosis fractures was matched 1: 1 on a number of clinical and demographic variables from the general Danish population. Difference-in-difference approach was applied through generalised estimating equations with individual-level fixed effects to establish attributable costs.

Results: Osteoporosis and osteoporosis-related fractures can be attributed with more than €3097 annually in healthcare costs for individuals aged 50 to 91, with expenses increasing sharply with age. Cumulative attributable healthcare (medical and social care) cost of osteoporosis between the ages of 50 and 91 was estimated at reach €127,000 per person. For the identified population of over 667,000 people with osteoporosis, the total annual healthcare burden attributable to the disease would amount to over €2 billion. The osteoporosis group also incurred an annual productivity loss of €3883, until the age of 66.

Conclusion: Osteoporosis carries a pronounced economic burden for the health system and the individual. Resource allocative decisions should consider whether implementing strategies improving prevention, earlier detection, and better management of osteoporosis could be efficient given the high identified costs.

Osteoporosis poses a significant concern for childhood cancer survivors (CCS). While recommendations for surveillance and management of bone mineral density (BMD) exist, no systematic review and meta-analysis has been undertaken to quantify BMD Z-scores in childhood cancer patients undergoing cancer treatment and survivors who have completed treatments. Accordingly, we conducted a systematic review with a 3-level mixed-effects meta-analysis to examine the course of BMD Z-scores in childhood cancer patients and survivors and identified possible moderators using meta-regression models. A systematic search was conducted in CINAHL, Embase, PubMed, SPORTDiscus, and Web of Science databases from inception to November 2023. We included studies that involved children and adolescents diagnosed with cancer before the age of 18 who were undergoing cancer treatment or had completed treatments and reported lumbar spine, hip/femoral neck, or total body BMD Z-scores derived from dual-energy x-ray absorptiometry. Forty-nine studies (4547 participants) were included in the meta-analysis. BMD Z-scores across different sites decreased with respect to baseline in children undergoing cancer treatment (mean difference: - 0.36, 95% CI - 0.62 to - 0.11; p = .01) and remained low following treatment in child and adolescent CCS (lumbar spine: - 0.85 SD, 95% CI - 1.17 to - 0.54; p < .001; hip/femoral neck: - 1.03 SD, 95% CI - 1.38 to - 0.68; p < .001), and adult CCS (lumbar spine: - 0.46 SD, 95% CI - 0.67 to - 0.26; p < .001; hip/femoral neck: - 0.36 SD, 95% CI - 0.57 to - 0.16; p < .001). Hip/femoral neck BMD Z-scores were moderated by age at assessment (p = .006), time from diagnosis (p = .004), sex (p = .037), and height (p = .026). Lumbar spine BMD Z-scores were moderated by age at assessment (p = .018), and sex (p = .015). In conclusion, childhood cancer patients and survivors experience reductions in BMD. Future research should evaluate the implications of regular physical activity, targeted exercise medicine, and nutrition therapy as first-line countermeasures to mitigate the declines in bone health.

The FEMuR III economic evaluation presents costs and consequences of the intervention compared with usual care at 52-week follow-up. There was no evidence of clinical effectiveness in terms of improvement of quality of life, and the total health service costs were higher in the intervention group.

Purpose: To explore the costs and consequences of the new FEMuR III intervention compared to usual care after hip fractures.

Methods: This cost-consequence analysis accompanies the FEMuR III randomised controlled trial using a micro-costing approach. The main outcome measures in this economic evaluation were healthcare service use, costs, and quality of life over 12 months, from both National Health Service and wider societal perspectives. Quality of life was measured using the EuroQoL-5D-3L.

Results: The mean cost of delivering the intervention was £444 per participant. For participants with complete EQ-5D data (n = 142), both groups showed improvement in EQ-5D index score, moving scores closer to UK norms. Participants in the intervention group gained 0.02 (95% CI: - 0.036, 0.076) more quality-adjusted life years (QALYs) than the usual care group. However, this was not statistically significant (p value = 0.312). For imputed cases, participants in the intervention group gained less QALYs than the usual care by 0.01 (95% CI: - 0.056, 0.030). For participants with complete cost data (n = 115), at 52-week follow-up, mean health service use costs were higher in the intervention group from both perspectives.

Conclusions: The mean health service use costs were higher in the intervention group due to longer inpatient stays. There was no significant difference in QALYs between both groups. The trial was affected by the COVID-19 pandemic, and this goes some way to explaining the large proportion of missing data (40%).

Trial registration: ISRCTN28376407.

We conducted a randomized controlled trial to assess the preventive effect of perioperative teriparatide on proximal junctional kyphosis and proximal junctional failure (PJF) in osteoporosis patients undergoing adult spinal deformity surgery. Teriparatide (experimental group) and denosumab (active control) were administered. The teriparatide group demonstrated significantly better PJF incidence and VAS for back pain, EQ-5D than the control group.

Purpose: This randomized controlled trial is aimed at investigating and comparing the effects of perioperative teriparatide and denosumab as an active control for preventing proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in patients with osteoporosis after adult spinal deformity (ASD) surgery.

Methods: A total of 64 patients with osteoporosis, who planned to undergo ASD surgery, were randomly assigned to the teriparatide and denosumab groups. Treatment with teriparatide or denosumab in both groups was conducted from 3 months preoperatively to 3 months postoperatively based on the standard regimen for each medication. The primary outcome was PJK and PJF incidence within 1 year after ASD surgery. The secondary outcomes were patient-reported outcomes (PROs), bone mineral density (BMD), and dual-energy X-ray absorptiometry (DEXA) t-score of the hip.

Results: The teriparatide group showed a lower incidence of PJK than the denosumab group (17.2% vs. 33.3%), although this difference was not statistically significant (p = 0.165 in a modified intention-to-treat (mITT) analysis). Furthermore, the teriparatide group exhibited a significantly lower incidence of PJF than the denosumab group (3.4% vs. 22.2%; p = 0.034 in the mITT analysis). As for the secondary outcomes, no significant differences in BMD of the hip were observed between the two groups at the 1-year follow-up. The teriparatide group showed significantly improved postoperative VAS for back pain and EQ-5D score.

Conclusions: Perioperative teriparatide treatment of patients with osteoporosis after ASD surgery effectively reduced PJF incidence and postoperative back pain.

Brief rationale: To assess bone dimensions in the radius over 7 years.

Main result: Cross-sectional area did not change significantly, but endosteal circumference increased, leading to decreased cortical thickness. Significance of the paper: Bone mineral density loss is associated with a decrease in cortical thickness in the forearm.

Purpose: To assess site-specific volumetric bone and muscle differences in women with and without forearm fracture in a longitudinal study.

Methods: One hundred four postmenopausal women with a forearm fracture and 99 age-matched controls were included and underwent peripheral quantitative computed tomography (pQCT) in the forearm at a mean age of 65 (range 44-88) years and were invited for a reassessment after mean 7 (6-11) years, at which 80 and 79 women took part, respectively. Three cases had movement artifacts on pQCT; 77 cases and 79 controls were finally analysed.

Results: Twenty-two of the cases and 20 of the controls sustained a fracture during the follow-up. From baseline to follow-up, bone mineral content and bone mineral density decreased irrespective of group belonging at baseline, both at the 4% and the 66% level in the forearm. Cross-sectional area did not change significantly at the 4% and the 66% level. At the 66% level, periosteal circumference was unchanged and endosteal circumference increased, leading to decreased cortical thickness. Muscle area decreased, while muscle density was unchanged. A high cross-sectional area and low bone volumetric bone mineral density were predictive of fracture during the follow-up.

Conclusion: Over a mean follow-up of 7 years, postmenopausal women lose bone mineral density, associated with a decrease in cortical thickness in the forearm.