Journal of Osteoporosis最新文献

Objective: To assess the effectiveness of intercostal nerve block (INB) for treating osteoporotic vertebral compression fractures (OVCFs) with associated costal pain.

Methods: We reviewed clinical data from patients with thoracic OVCF and costal pain admitted to our hospital between January 2021 and January 2024. Patients were divided into an observation group, receiving percutaneous vertebroplasty (PVP) and INB, and a control group, receiving PVP alone. Baseline data, intraoperative parameters, deformity improvement (anterior vertebral body height [AVH] and local Cobb angle), and clinical symptom improvement (visual analog scale [VAS] scores for back and costal pain) were compared between the groups. Risk factors for residual costal pain within the control group were analyzed using multivariable logistic regression, and receiver operating characteristic (ROC) curves were constructed to determine threshold values for the identified risk factors.

Results: The study included 305 patients, 150 in the observation group and 155 in the control group. The groups were statistically comparable in baseline data. Compared with the control group, the observation group had a longer operative time (40.7 ± 5.5 vs. 32.4 ± 3.8 min, p < 0.001) and required more intraoperative C-arm fluoroscopies (30.4 ± 6.3 vs. 21.5 ± 3.9, p = 0.034). Intraoperative bleeding was similar between groups. Both groups showed similarly significant improvements in AVH, local Cobb angle, and thoracic back pain VAS scores one day postoperatively and at the final follow-up. The respective costal pain VAS scores in the control and observation groups were as follows: preoperatively, 7 (6, 8) and 7 (6, 7); one day postoperatively, 4 (2, 5) and 2 (1, 2); and at the final follow-up, 1 (1, 2) and 1 (0, 2). Univariate analysis within the control group identified disease duration, fractured vertebral body width, reduced intervertebral foramen area, and cortical breakdown of the vertebral body's posterior wall as risk factors for residual costal pain. Multivariable analysis confirmed disease duration as an independent risk factor for residual costal pain, with an area under the curve of 0.863. The threshold for self-resolution of costal pain was established at 15.5 days, with a sensitivity of 93.9% and a specificity of 70.0%. Costal pain relief was strongly correlated with disease duration (r = 0.518, p < 0.001).

Conclusions: OVCF-related costal pain can be effectively alleviated by PVP combined with INB; however, INB lengthens operative time and increases radiation exposure. PVP alone can relieve costal pain in patients with a disease duration of ≤ 15.5 days; otherwise, concomitant INB is recommended.

Bone disorders can have a devastating impact on an individual's quality of life. The main objective of our study was to analyze various demographic disparities between various bone disorders in the demographically unique Rio Grande Valley region. We hypothesized that osteoporosis would be the most prevalent condition and that the demographics between the various conditions would vary depending on age, sex, BMI, and ethnicity but not on marital status. This was a retrospective chart review using the University of Texas Rio Grande Valley UTHealth electronic database from January 1, 2017, to January 1, 2024. Any relevant individuals seen at a UTRGV affiliated institution were included. We analyzed medical charts, via ICD-10 codes, of individuals who were diagnosed with osteoporosis, osteomalacia, rickets, Paget bone disease, and osteonecrosis. Bivariate and binary logistic regression analyses were performed to analyze the data. Hispanic ethnicity showed a decreased risk of bone disorder (estimate = -0.2814), bordering on significance (p=0.053). Female participants had significantly higher odds of bone disorder (estimate = 0.7861, p < 0.001). Obese individuals (estimate = -0.7837, p < 0.001) and overweight individuals had lower odds (estimate = -0.3328, p=0.047) of bone disorder. Underweight individuals showed higher odds of bone disorder (estimate = 0.9605, p=0.002). The odds of bone disorder increased with age (estimate = 0.0581, p < 0.001). Our results increase the knowledge of orthopedics in this region, and specifically, the bone disorders are discussed. The results may also allow physicians to better identify at-risk individuals in this community and others alike to improve the management of bone disorders. This study warrants further research on at-risk demographics to further improve the orthopedic knowledge and care of medically underserved individuals.

Introduction: This study assessed patient demographic factors associated with nonattendance for osteoporosis evaluation after being referred to our Bone Health Clinic (BHC), a hospital-based outpatient Fracture Liaison Service (FLS), for a fragility fracture. Methods: 507 patients sustaining a fragility fracture were referred to the BHC over a 39-month period. Retrospective chart review was conducted to capture osteoporosis evaluation attendance rates and demographic factors (age, gender, race, area deprivation index, insurance type, and fracture type). A post-fracture follow-up visit with either the BHC or another provider in which osteoporosis was noted in the assessment was considered attendance for osteoporosis evaluation. Nonattendance was determined at a cutoff of one year after the fracture date. Results: Of the 507 patients referred to the BHC following a fragility fracture, 177 patients attended osteoporosis evaluation with either the BHC or a primary care provider. Nonattendance was associated with older age (p=0.0075), having private health insurance (p=0.0434), and recent hip fracture (p < 0.0001). Attendance was associated with having government health insurance (p=0.0103). Conclusion: Inpatient evaluation and treatment for osteoporosis should be considered in patients who are older or have sustained a hip fracture as they may have more difficulty attending post-fracture appointments.

Purpose: This pilot study aimed to explore the feasibility of scanning the human distal radius bone marrow in vivo to detect osteoporosis-related changes using magnetic resonance and evaluate whether the radius may serve as an accessible probing site for osteoporosis. This may lead in the future to the use of affordable means such as low-field MRI scanners for the monitoring of disease progression.

Methods: A clinical trial was performed using a 3T MR scanner, including 26 women assigned into three study groups: healthy-premenopausal (n = 7; mean age 48.6 ± 3.5 years), healthy-postmenopausal (n = 10; mean age 54.5 ± 5.6 years), and osteoporotic-postmenopausal (n = 9; mean age 61.3 ± 5.6 years). Marrow fat composition was evaluated using T2 maps, a two-compartment model of T1, and a Dixon pulse sequence.

Results: The osteoporotic group exhibited higher fat content than the other two groups and lower T2 values than the healthy-premenopausal group.

Conclusions: Osteoporosis-related changes in the composition of the distal radius bone marrow may be detected in vivo using MRI protocols. The scanning protocols chosen here can later be repeated using low-field MRI scanners, thus offering the potential for early detection and treatment monitoring, using an accessible, affordable means that may be applied in small clinics. This trial is registered with MOH_2018-05-23_002247, NCT03742362.

Background: Osteoporosis is a preventable disease that is simple and cost-effective to screen based on clinical practice guidelines, yet many patients go undiagnosed and untreated leading to increased burden of the disease. Specifically, racial and ethnic minorities have lower rates of dual energy absorptiometry (DXA) screening. Inadequate screening may lead to an increased risk of fracture, higher health care costs, and increased morbidity and mortality disproportionately experienced by racial-ethnic minority populations.

Purpose: This systematic review assessed and summarized the racial and ethnic disparities that exist for osteoporosis screening by DXA.

Methods: Using terms related to osteoporosis, racial and ethnic minorities, and DXA, an electronic search of databases was performed in SCOPUS, CINAHL, and PubMed. Articles were screened using predefined inclusion and exclusion criteria which dictated the final articles used in the review. Full text articles that were selected for inclusion underwent quality appraisal and data extraction. Once extracted, data from the articles were combined at an aggregate level.

Results: The search identified 412 articles. After screening, a total of 16 studies were included in the final review. The overall quality of the studies included was high. Of the 16 articles reviewed, 14 identified significant disparities between racial minority and majority groups and determined that the eligible patients in racial minority groups were less likely to be referred to DXA screening.

Conclusion: There is a significant disparity in osteoporosis screening among racial and ethnic minorities. Future efforts should focus on addressing these inconsistencies in screening and removing bias from the healthcare system. Additional research is required to determine the consequence of this discrepancy in screening and methods of equitizing osteoporosis care.

Exercise is a recognized component in the prevention and therapy of osteoporosis. The present systematic review and meta-analysis aimed to determine the effect of Vitamin D (Vit-D) added to exercise versus exercise alone on bone mineral density (BMD) at the lumbar spine (LS) or hip in older adults. A systematic review based on six literature databases according to PRISMA included (a) exercise trials, with an exercise (EX) and a combined exercise + Vit-D group (EX + Vit-D), (b) intervention ≥ 6 months, and (c) BMD assessments at LS or hip. Effects sizes (MD) and 95%-confidence intervals (95%-CI) were calculated using a random-effect model that includes the inverse heterogeneity model (IVhet). Five studies with 281 participants in the EX and 279 participants in the EX + Vit-D were included. No significant differences between EX versus EX + Vit-D were observed for BMD-LS (MD: 0.002, 95%-CI: -0.033 to 0.036) or BMD-hip (MD: 0.003, 95%-CI: -0.035 to 0.042). Heterogeneity between the trial results was moderate-substantial for LS (I² = 0%) and moderate for hip-BMD (I² = 35%). The funnel plot analysis suggests evidence for a publication/small study bias for BMD-LS and hip results. In summary, this present systematic review and meta-analysis were unable to determine significant positive interaction of exercise and Vit-D on LS- or hip-BMD. We predominately attribute this finding to (1) the less bone-specific exercise protocols of at least two of the five studies and (2) the inclusion criteria of the studies that did not consequently focus on Vit-D deficiency. This issue should be addressed in more detail by adequately powered exercise trials with promising exercise protocols and participants with Vit-D deficiency. This trial is registered with the International Prospective Register of Systematic Reviews (PROSPERO) ID: CRD42022309813.

Background: Type 4 osteoporotic fracture (OF4), according to the classification system of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU), is unstable and requires fixation as per the guidelines of the same group. We evaluated the use of stand-alone vertebral body augmentation (VBA) in pain control of OF4.

Methods: This is a single-centre, in two hospitals, comparative study to evaluate the effectiveness of percutaneous vertebroplasty (PVP) and kyphoplasty (KP) in pain control of OF4. OF4 patients treated with VBA were compared to a conservatively treated control group. The two groups of OF4 were then compared to similar cohort of OF2 and OF3 patients who were treated by either VBA or expectantly.

Results: A total of 78 cases were studied. VBA of OF4 showed a statistically significant better pain control than conservative treatment. The response of this group of fractures to VBA was similar to that of OF2 and 3.

Conclusion: VBA can provide satisfactory pain control for OF4 patients.

In previous study, we showed that nucleolar protein 66 (NO66) is a chromatin modifier and negatively regulates Osterix activity as well as mesenchymal progenitor differentiation. Genetic ablation of the NO66 (RIOX1) gene in cells of the Prx1-expressing mesenchymal lineage leads to acceleration of osteochondrogenic differentiation and a larger skeleton in adult mice, whereas mesenchyme-specific overexpression of NO66 inhibits osteochondrogenesis resulting in dwarfism and osteopenia. However, the impact of NO66 overexpression in cells of the osteoblast lineage in vivo remains largely undefined. Here, we generated osteoblast-specific transgenic mice overexpressing a FLAG-tagged NO66 transgene driven by the 2.3 kB alpha-1type I collagen (Col1a1) promoter. We found that overexpression of NO66 in cells of the osteoblast lineage did not cause overt defects in developmental bones but led to osteoporosis in the long bones of adult mice. This includes decreased bone volume (BV), bone volume density (bone volume/total volume, BV/TV), and bone mineral density (BMD) in cancellous compartment of long bones, along with the accumulation of fatty droplets in bone marrow. Ex vivo culture of the bone marrow mesenchymal stem/stromal cells (BMSCs) from adult Col1a1-NO66 transgenic mice showed an increase in adipogenesis and a decrease in osteogenesis. Taken together, these data demonstrate a crucial role for NO66 in adult bone formation and homeostasis. Our Col1a1-NO66 transgenic mice provide a novel animal model for the mechanistic and therapeutic study of NO66 in osteoporosis.