Archives of Osteoporosis最新文献

Evaluation of the effectiveness of bone mineral density (BMD) testing within national health screening programs should consider country-specific contexts when applied to asymptomatic populations. BMD testing at age 66 in women was associated with increased osteoporosis-related medical visit and a reduction of subsequent fracture incidence. These findings suggest potential benefits of population-based screening with BMD testing.

Purpose: Early detection of osteoporosis through bone mineral density (BMD) testing may help prevent future fractures. This study aimed to investigate the impact of incorporating BMD testing in South Korea's national health screening program on outpatient visits with an osteoporosis diagnosis and fractures.

Methods: We used data from the Korean National Health Insurance Service-Senior Cohort (2002-2019) and included only women aged 66 years, as specified by national screening policy, without prior osteoporosis who underwent national health screening between 2004 and 2009. Screening periods were categorized by the inclusion of BMD testing. Outcomes included osteoporosis-related medical visits within two years and incident osteoporotic fractures. Multivariable logistic regression and Cox proportional hazards regression were used to examine osteoporosis detection and fracture risk, respectively.

Results: Among the 24,895 women screened, 24.7% had osteoporosis-related medical visits within two years, and 21.5% experienced fractures during follow-up. Compared to the period without BMD testing, the inclusion of BMD testing was associated with a 52% increase in osteoporosis-related medical visits (odds ratio: 1.52, 95% confidence interval [CI]: 1.42-1.62), whereas the risk of subsequent fractures was reduced by 9% (hazard ratio: 0.91, 95% CI: 0.86-0.96). These associations were more pronounced among those with low body mass index and significant during the 5-10 years of follow-up for hip and vertebral fractures.

Conclusion: Nationwide implementation of BMD testing increased the medical visits for osteoporosis and was associated with a reduction in subsequent fractures. To further enhance the effectiveness of the screening program, improved post-screening management is needed.

Fragility fractures often signal untreated osteoporosis. This study shows that a digitally enhanced Fracture Liaison Service (FLS) can identify affected patients in routine hospital care and improve structured assessment and treatment. Dedicated staff remain essential to translate digital solutions into effective fracture prevention.

Purpose: Although Fracture Liaison Services (FLS) are established internationally, structured programs remain scarce in Austria. This study aimed to assess the real-world feasibility of a digitally supported, International Osteoporosis Foundation (IOF)-certified FLS implemented in routine inpatient care.

Methods: We conducted a retrospective, monocentric cohort study at a tertiary care hospital in Vienna, Austria. Hospitalized patients aged ≥ 50 years with major osteoporotic fractures were included in a digital FLS module integrated into the hospital information system between April 2023 and March 2024. Feasibility parameters included patient capture rate, implementation of standardized diagnostics, and initiation or recommendation of osteoporosis therapy.

Results: Overall, 141 patients were enrolled (78% women; mean age 75.8 ± 11.4 years). Vertebral (31.9%) and hip fractures (25.5%) were the most frequent fracture sites. A previous fragility fracture was documented in 46.1% of patients; 24.1% had a prior diagnosis of osteoporosis. In total, 38.1% of all eligible inpatients with osteoporotic fractures were included in the digital FLS. Calcium and vitamin D supplementation was initiated during hospitalization in 73.0% of patients. Specific antiosteoporotic medication was initiated during the inpatient stay in 15.6% and in the outpatient setting in 9.9% and 8.5% of patients, respectively. Treatment was recommended for post-discharge initiation in 56.0% of cases. The most commonly prescribed drugs were denosumab and zoledronic acid.

Conclusion: Implementation of a digitally integrated FLS in routine inpatient care is feasible and enables structured identification, assessment, and treatment recommendation for patients with fragility fractures. However, limited staffing resources and challenges in post-discharge therapy implementation highlight the need for dedicated personnel and improved cross-sectoral care pathways.

Osteoporotic fractures are associated with morbidity, mortality and high healthcare costs. Fracture Liaison Services (FLS) prevent subsequent osteoporotic fractures but are traditionally limited to include major osteoporotic fractures (MOF). When the FLS at Skaraborg Hospital in Skövde, Sweden included both MOF and non-MOF, treatment indication was present for 51% (Number Needed to Screen (NNS) 1.41) and 71% (NNS 1.95), respectively. High treatment indication rates and low NNS were observed both in patients with MOF and non-MOF, suggesting that all fracture patients should be included in FLSs.

Background: Fracture Liaison Services (FLS) are coordinator-based, multidisciplinary programmes that provide systematic secondary prevention of fragility fractures. Many FLS programmes have been limited to major osteoporotic fractures (MOF, i.e. vertebrae, hip, proximal humerus, wrist and pelvis), but it is unclear whether patients with other types of fractures have similar risk profiles, as defined by low bone mineral density (BMD) and present clinical risk factors (CRF).

Objective: To compare key characteristics related to fracture risk (e.g. FRAX and BMD) and eligibility for osteoporosis treatment between patients with a recent non-MOF and those with recent MOF after inclusion in an FLS at Skaraborg Hospital in Skövde, Sweden.

Methods: Patients 50 years and older with a BMD measurement between December 2023 and May 2024, with a recent fracture were included (N = 705). Data on age, sex, CRFs, FRAX score, BMD, trabecular bone score, vertebral fracture assessment (VFA), and physician-issued assessment of osteoporosis treatment indication from the FLS evaluation were collected. Differences were analyzed using t-tests, chi-square tests, and expressed as standardized mean differences. The odds ratio (OR) for osteoporosis treatment indication (yes/no) was calculated using logistic regression for non-MOF vs. MOF, with adjustment for incremental number of confounders.

Results: There were high rates of osteoporosis treatment indication in both non-MOF (51%) and MOF (71%) patients, and low numbers needed to screen (NNS) to identify one patient with osteoporosis treatment indication in both the non-MOF (1.95) and MOF groups (1.41). When comparing non-MOF and MOF within the subgroup of patients with osteoporosis treatment indication, BMD and risk profiles were similar.

Conclusion: The proportions of patients with osteoporosis treatment indications were high regardless of fracture site category, indicating that patients with both recent non-MOF and MOF should be included in FLS programmes.

Simple functional measures may help identify older women at high fracture risk. In this cross-sectional study, reduced handgrip strength, calf circumference, and lean mass were associated with higher risk of fracture by FRAX. These easily obtainable parameters may enhance fracture-risk screening in primary care.

Purpose: To examine the associations between frailty, sarcopenia-related parameters, and fracture risk in community-dwelling older women, and to evaluate whether simple functional measures may help identify individuals at elevated risk of osteoporotic fractures.

Methods: We conducted a cross-sectional study including women aged ≥ 60 years recruited from a primary care facility in Southern Brazil. Frailty was assessed using the Clinical Frailty Scale, and muscle strength and physical performance were evaluated using SARC-F, Timed Up and Go, gait speed, the Short Physical Performance Battery, calf circumference (CC), and handgrip strength (HGS). Bone mineral density and trabecular bone score (TBS) were measured by DXA. Ten-year fracture probability was estimated using the Brazilian FRAX® algorithm. Appendicular lean mass index (ALMI) and biochemical markers relevant to bone metabolism were also analyzed.

Results: Among the 119 participants, 38.5% were classified as having high or very high 10-year fracture risk. Compared with women in the low-risk group, those at high risk were older and had lower BMI, TBS, HGS, CC, and ALMI, in addition to a higher comorbidity burden. In multivariable Poisson regression adjusted for age and comorbidity, lower muscle strength, reduced muscle mass, and poorer physical performance were independently associated with higher fracture risk prevalence, whereas frailty status was not. Among the muscle parameters, ALMI showed the strongest association with high fracture risk.

Conclusion: Reduced muscle strength and lean mass were associated with higher fracture risk, even in women without established frailty or sarcopenia. HGS and CC emerge as simple, low-cost indicators that may enhance fracture-risk screening in primary care and complement conventional assessments such as DXA and FRAX.

This study investigated how walking speed affects survival in patients with clinical osteoporotic vertebral fractures. A walking speed below 0.71 m/sec was associated with increased mortality. Walking speed may serve as a simple yet powerful prognostic indicator, highlighting the importance of mobility preservation in fracture management.

Purpose: The number of patients with fractures caused by osteoporosis has increased with the increasing proportion of aging adults in recent years. Osteoporotic vertebral fractures (OVFs) are associated with poor prognosis. Although several reports on the life expectancy of patients with OVFs exist, it is unclear how walking speed affects the life expectancy of patients with clinical OVFs. This study investigated the relationship between walking speed and life expectancy after injury in patients with clinical OVFs.

Methods: A total of 104 patients with new clinical OVFs were conservatively treated with a trunk cast from 2015 to 2017. Lumbar spine and femur bone mineral density (BMD), the Geriatric Nutritional Risk Index (GNRI), walking speed, and spinopelvic parameters were measured. We compared the deceased and survival groups and examined the risk factors influencing survival.

Results: Among the 104 patients included in the study, 67 were women; the median age was 82 years, and the median observation period was 1168 days. Thirty-two patients died during the observation period. The deceased group had a lower GNRI and a slower walking speed at discharge. In addition, imaging revealed more local kyphosis and more calcification of vessels in the deceased group. The risk of death increased when the walking speed after the OVF was less than 0.71 m/sec.

Conclusion: A walking speed of 0.71 m/sec or slower was associated with poor prognosis after clinical vertebral fracture. Nutritional management, kyphotic deformity prevention, and walking speed maintenance are essential for vertebral fracture treatment.

Osteoporosis causes bone fragility and fractures, yet most patients receive no treatment. This German registry study of nearly 1500 elderly pelvic fracture patients found that two-thirds were untreated before fracture. Paradoxically, treated patients sustained more severe, displaced fractures requiring surgery more often, possibly reflecting advanced disease severity or altered bone properties from medication.

Background: Fragility fractures of the pelvis (FFP) are related to low-energy trauma and osteoporosis. Currently, data on secondary pharmacological fracture prevention and their effect on fracture morphology is rare. We aimed to determine the proportion of patients receiving specific osteoporosis medication (SOM), vitamin D supplementation only (VitD), or no treatment (NOT) before and after a FFP. Secondarily, we evaluated possible differences in fracture morphology and treatment in the study population.

Methods: This retrospective cohort study analyzed data from the German Pelvic Fracture Registry (2018-2024) of patients ≥ 60 years with an FFP. Patients were grouped hierarchically in the following groups: SOM, VitD, or NOT. Demographics, fracture morphology, treatment, and postfracture group changes regarding osteoporosis treatment were compared between groups.

Results: Of 1493 patients, mean age 82.34 ± 8.06 years, predominantly female (83.5%), 98 (6.6%) had a SOM, 386 (25.9%) VitD, and 1009 (67.6%) NOT before FFP. The SOM group was significantly older, predominantly female (p < 0.05), and demonstrated higher prefracture functional independence (71.4% SOM vs. 58.5% VitD vs. 66.4% NOT; p = 0.018). FFP Type IV fractures occurred more frequently in the SOM group (33.7% SOM vs. 23.3% VitD, 19.8% NOT; p = 0.006) and were more frequently operatively treated (45.9% SOM vs. 30.4% VitD, 29.2% NOT; p = 0.006). Following a FFP, in 527 patients (35.9%), the treatment regime was escalated; in 463 patients (31.0%), no change occurred.

Conclusions: Despite established treatment guidelines, two-thirds of patients who sustained an FFP received neither SOM nor VitD in Germany. Patients with prefracture SOM treatment sustained more unstable fractures requiring surgical intervention, possibly reflecting advanced disease severity or altered bone biomechanics. Secondary fracture prevention remains suboptimal, with one-third of patients not receiving treatment postfracture.