Osteoporosis International最新文献

Little is known regarding osteoporosis management between Traditional Medicare (TM) and Medicare Advantage (MA). MA beneficiaries had higher rates of osteoporosis testing and higher rates of osteoporosis drug treatment initiation rates. Following an osteoporotic fragility fracture, MA beneficiaries were more likely to be prescribed osteoporosis treatment. While osteoporosis testing and treatment initiation rates are low in both TM and MA, rates tended to be higher in MA.

Purpose: Osteoporosis represents a substantial clinical challenge in the United States, particularly for older women, and requires effective care coordination. Medicare Advantage (MA) plans have financial incentives in the form of star ratings to improve osteoporosis testing and treatment. The objective of this study was to compare osteoporosis management practices between Traditional Medicare (TM) beneficiaries and MA female enrollees.

Methods: We conducted a cross-sectional study using a nationally representative 20% sample of 2017-2019 TM claims and MA encounter records. We identified 2,994,203 female TM beneficiaries and 1,924,132 MA enrollees. The exposure was enrollment in MA. The primary outcomes were the rates of guideline-recommended bone mineral density (BMD) testing and osteoporosis drug initiation following a new osteoporosis diagnosis and after a new osteoporotic fragility fracture.

Results: MA beneficiaries had higher unadjusted (22.0% vs. 19.8% in TM; P < 0.001) and adjusted rates (0.8 percentage points [p.p.] higher; P < 0.001) of BMD testing. Osteoporosis drug treatment initiation rates were higher in the MA cohort, both unadjusted (24.9% vs. 20.3% in TM; P < 0.001) and adjusted (4.0 p.p. higher; P < 0.001). Following an osteoporotic fragility fracture, MA beneficiaries were more likely to be prescribed pharmacologic treatment (28.7% vs. 21.1% in TM; P < 0.001), with an adjusted increase of 5.9 p.p (P < 0.001).

Conclusion: Overall osteoporosis testing and treatment initiation rates in both TM and MA enrollees were low, with improved rates in MA compared to TM.

Vitamin D status has long been related to falls risk. In this planned secondary analysis of a vitamin supplementation trial in postmenopausal women, standardized 25-hydroxyvitamin D concentration up to 60 ng/mL was not associated with increased falls. Women with 25(OH)D ≥ 60 ng/mL had higher odds of ≥ 2 falls.

Purpose: Falls are common and cause fractures. High circulating 25(OH)D may increase falls risk; thus, recent guidance recommends 25(OH)D not exceed 50 ng/mL. Prior falls studies have not reported standardized 25(OH)D (s25D) data. The purpose of this planned secondary analysis of a 4-year calcium/vitamin D supplementation trial was to evaluate the association of s25D with falls.

Methods: This study recruited 2,303 postmenopausal women. The analytic dataset consisted of pooled concatenated data from years 2-4 (N_Total = 5,732). Serum 25(OH)D was measured annually and subsequently retrospectively standardized using Vitamin D Standardization Program methods. Falls were recorded by diary. Incidence for ≥ 1 fall and ≥ 2 falls was assessed by s25D group (≤ 20, 20- < 30, 30- < 40, 40- < 50, 50- < 60 and ≥ 60 ng/mL) using multivariable logistic regression.

Results: Mean (SD) baseline s25D was 32.6 ng/mL (8.3) with no difference between supplement and placebo groups. s25D increased to 41.3 ng/mL at year 2 in the supplement group then remained stable. By s25D group, incidence for ≥ 1 fall varied from 22-32% (p = 0.19). For ≥ 2 falls incidence varied (p = 0.03) from 6% (< 20 ng/mL) to 17% (≥ 60 ng/mL.) There was no significant association between s25D and ≥ 1 fall. Those with s25D ≥ 60 ng/mL had a higher adjusted odds of ≥ 2 falls (OR = 1.99 ± 1.2-3.3) compared to women with s25D of 30- < 40 ng/mL.

Conclusion: s25D up to 60 ng/mL was not associated with greater risk for ≥ 1 or ≥ 2 falls. Women with a s25D ≥ 60 ng/mL were at higher odds for ≥ 2 falls, however this group included only ~ 2% of study observations; therefore, confirmation in other cohorts is necessary.

This systematic review of 18 RCTs assessed the impact of yoga on balance, fall risk, fear of falling, bone mineral density (BMD), and bone turnover markers in healthy individuals. Yoga significantly improved balance but its effects on BMD were inconclusive. Standardised protocols and longer-term studies are needed.

Background: Yoga's effects on interconnected bone health parameters viz balance, falls, fear of falling (FOF), bone mineral density (BMD), and bone turnover markers (BTMs) in healthy individuals are unclear. We critically evaluated randomized controlled trials (RCTs) that compared yoga to no intervention control (NIC) or comparators such as Tai Chi, on these parameters in healthy individuals.

Methods: We systematically searched multiple scientific data bases using a predefined protocol. We summarized data qualitatively when there was heterogeneity in reporting. A meta-analysis of those studies comparing yoga to NIC was done. Since the included studies used different scales for the same outcomes, we used standardised mean differences (SMDs) to allow pooling. We assessed the risk of bias with the Cochrane RoB2 tool for randomized trials and graded certainty of evidence using the GRADE approach.

Results: Eighteen RCTs with 1408 participants were evaluated. Fifteen explored yoga's effects on balance and/or falls or FOF, and three RCTs, its effect on BMD and BTMs. Yoga types included Hatha, Vinyasa, Ashtanga, Iyengar, Bikram, and specially designed yoga protocols. Twenty-four kinds of balance assessment tools were used in the studies. Study durations varied from 6 weeks to 14 months. Almost all the studies reported positive effects of yoga on balance compared to NIC, and non-inferiority when compared to active interventions such as Tai Chi. Meta-analysis of four RCTs comparing yoga to NIC demonstrated significant improvements in static balance with yoga (SMD = 2.36; 95% CI 1.13-3.58; P = 0.0002, I² = 93% ⊕ ⊕ ⊝ ⊝). Yoga's effects on falls and FOF were mixed. Two studies showed a positive effect of yoga on bone formation. Yoga was found to have a positive effect on BMD in only one study. Meta-analysis of two RCTs showed no significant effect on BMD for yoga compared to NIC. The studies exhibited substantial heterogeneity in terms of yoga styles, intervention durations, and assessment methods.

Conclusion: In healthy adults, low certainty evidence shows that yoga has a beneficial effect on balance. Its effect on BMD remains unclear. Standardised protocols and longer-term research are necessary to facilitate more definitive conclusions on yoga's role in enhancing skeletal health and preventing falls.

We investigated the efficacy of romosozumab in premenopausal women with low bone mass. Romosozumab substantially increased bone mineral density and trabecular bone score in these women, aligning with its proven therapeutic benefits for postmenopausal osteoporosis.

Purpose: Romosozumab, an anti-sclerostin antibody, is a promising anabolic agent that increases bone formation and decreases bone resorption. However, its efficacy in premenopausal women with low bone mass remains understudied.

Methods: We retrospectively reviewed premenopausal women with low bone mass treated with romosozumab (ROMO group) or drug-naïve patients (control group). Patients in the ROMO group were classified into the glucocorticoid-induced osteoporosis (GIOP), idiopathic osteoporosis (IOP), and pregnancy and lactation-induced osteoporosis (PLO) subgroups. Bone mineral density (BMD) and trabecular bone score (TBS) were measured before and after one year of romosozumab treatment.

Results: Twenty-five patients in the ROMO group and five in the control group were included in the study. Among patients in the ROMO group, 12 were in the GIOP, 9 in the IOP, and 4 in the PLO subgroups. The mean age was 37.0 years [32.0-42.0], and the median body mass index was 18.8 kg/m² [17.5-21.3]. After romosozumab treatment, lumbar spine (LS), femur neck (FN) BMD, and TBS increased from baseline (LSBMD, 12.8% [8.2-19.3], p < 0.001; FNBMD, 4.6% [- 0.6-10.7], p = 0.016; TBS, 4.1% ± 3.8, p < 0.001) in the ROMO group. Patients in both the GIOP and IOP subgroups showed a significant increase in LSBMD, while those in the IOP subgroup demonstrated significant increases in FNBMD.

Conclusion: We demonstrated romosozumab's efficacy in BMD increment in premenopausal women. Romosozumab may be a potential treatment option for premenopausal women with low bone mass, regardless of etiologies, although further research on fracture risk reduction is warranted.