Archives of Osteoporosis最新文献

Summary

The effect of melatonin receptor agonists on bone remains unclear. This retrospective cohort study provides the first evidence that the short- to mid-term use of ramelteon is not associated with the risk of fracture. Further research with longer follow-up is needed to clarify the effects of ramelteon on bone health.

Background

Recent studies have suggested that melatonin may have the potential to treat osteoporosis. However, few studies have examined the effects of melatonin receptor agonists on bone health. This study aimed to evaluate the association between ramelteon use and the risk of fragility fractures.

Methods

We conducted a retrospective cohort study from April 2014 to November 2022 using the DeSC database, a large healthcare claims database in Japan, employing an active comparator and new-user design. Female participants aged ≥ 50 years were included in the study. Exposure was defined as the first dispensation of ramelteon or orexin receptor antagonists. The outcome was a composite of major fragility fractures, including hip, vertebral, wrist, proximal humeral, and ankle fractures. To adjust for potential confounders, we used overlap weighting analysis with propensity scores. Cox regression analyses were performed both before and after applying overlap weighting.

Results

A total of 106,511 individuals were identified, including 23,312 new ramelteon users and 83,199 new orexin receptor antagonist users. The overall fracture incidence was 9,429 per 100,000 person-years in the ramelteon group and 7,330 per 100,000 person-years in the orexin receptor antagonist group. The adjusted hazard ratio for overall fractures associated with ramelteon use was 1.07 (95% confidence interval: 0.99–1.17). The results were consistent across fracture types, age groups, and landmark analyses.

Conclusions

In a real-world setting, short- to mid-term ramelteon use was not associated with an increased risk of fractures. Future studies should consider longer follow-up periods to further investigate the effects of ramelteon on bone health.

Summary

This study investigates the incidence and risk factors of pelvic fragility fractures in endometrial cancer survivors using a national claims database. The incidence was 0.6%, with older age as a significant risk factor. These findings emphasize the need for careful detection and management to improve outcomes.

Purpose

This study aimed to evaluate the incidence of fragility fracture of pelvis (FFP) in endometrial cancer survivors and identify associated risk factors using data from the Korean National Claims Database.

Methods

A total of 6923 endometrial cancer patients were identified between 2007 and 2016 using data from the linkage between the Korea National Health Insurance Service and Korea Central Cancer Registry. The incidence of FFP was estimated and risk factors, such as age, radiation therapy (RT) status, medical institution type, residential area, income level, insurance type, and comorbidities, were assessed using a Cox proportional hazards regression.

Results

The overall incidence of FFP was 0.6%, with a higher incidence in patients who underwent RT (0.8%) compared to those who did not (0.5%). However, the difference was not statistically significant (P = 0.355). Older age was significantly associated with an increased risk of FFPs (adjusted HR = 1.101, 95% CI 1.066–1.138; P < 0.001).

Conclusions

The incidence of FFP in endometrial cancer survivors was 0.6%, with a slightly higher rate in those who received RT. Older age was a significant risk factor of FFP. These findings emphasize the need for careful detection and management of FFP, particularly in older patients, to improve long-term outcomes in endometrial cancer survivors.

Background

Osteoporotic fractures pose a significant public health challenge, with various risk factors contributing to their incidence. Smoking, diabetes mellitus (DM), and rheumatoid arthritis (RA) are known to disrupt bone metabolism and increase fracture susceptibility. Moreover, smoking is a well-known risk factor of DM and RA, and thereby imposes a greater impact on osteoporotic fractures. This review explores the impact of these conditions on osteoporotic fractures, emphasizing the underlying mechanisms and clinical implications.

Methods

A comprehensive literature review was conducted to examine the biochemical and physiological effects of smoking, DM, and RA on bone metabolism. The review focused on key regulatory pathways, including the role of parathyroid hormone (PTH), vitamin D, receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG), and inflammatory cytokines.

Results

Smoking contributes to osteoporotic fractures by altering bone metabolism through multiple mechanisms, including dysregulation of PTH, vitamin D, and the RANKL/OPG balance. RA disrupts bone homeostasis by increasing osteoclast activity, reducing osteoblast function, and elevating pro-inflammatory cytokines such as IL-1, IL-6, and TNF-α. Additionally, RA treatment with glucocorticoids further impairs calcium balance and bone integrity. DM accelerates bone resorption by upregulating osteoclastogenic factors (e.g., TNF-α, VEGF, RANKL) and suppressing osteoblastogenic pathways (e.g., Runx2). It also reduces essential bone-forming substances, including PTH and osteocalcin, while promoting the accumulation of advanced glycation end-products and adiposity, both of which negatively impact bone health.

Conclusions

Smoking, DM, and RA significantly contribute to osteoporotic fractures by disrupting bone metabolism through direct biochemical alterations and treatment-related effects. Furthermore, smoking exacerbates both DM and RA, compounding the risk of fractures. Effective clinical management of these risk factors is essential to reducing the burden of osteoporotic fractures and improving patient outcomes.

Summary

This study analyses comorbidity, surgical management, and complications and their impact on in-hospital outcomes in centenarian hip fracture patients admitted in Spain, 2004–2020. It provides evidence on the prognostic impact of comorbidity and in-hospital complications and highlights the need for specific interventions to improve care in this vulnerable population.

Purpose

This work aims to describe the clinical characteristics, in-hospital progress, and risk factors for worse in-hospital outcomes in centenarian patients with proximal hip fracture (PHF).

Methods

A retrospective nationwide cohort study was conducted that included all centenarian patients hospitalized for PHF (2004–2020) according to the Spanish National Health System’s Minimum Basic Data Set. Demographic, clinical, and hospitalization-related variables were analyzed. Univariate and multivariate analyses were performed.

Results

This study included 4261 patients (83.3% women). The mean Charlson comorbidity index (CCI) was 0.9 ± 1.2; 11.4% had severe comorbidity. Surgery was performed in 87.2% of patients and in 44.5% after 48 h of admission. Higher CCI scores (OR 1.3, 95% CI 1.0–1.7) and admission to medical departments (OR 4.11, 95% CI 3.0–5.6) were associated with nonsurgical management. Surgical delays ≥ 48 h were associated with admissions on Saturdays (OR 1.9, 95% CI 1.3–2.8) or to medical departments (OR 2.79, 95% CI 1.34–5.83) and with the development of ≥ 3 complications (OR 1.5, 95% CI 1.1–2.0). Overall, 15% of patients died during hospitalization, with significantly higher mortality in nonsurgical patients (31.8% vs. 12.5%, p < 0.001). In surgical patients, mortality and prolonged hospital stays were primarily related to higher CCI scores and complications.

Conclusions

Centenarians with PHF have a low severe disease burden but high in-hospital mortality risk. Key predictors of mortality in surgical patients include higher CCI scores and in-hospital complications. This highlights the relevance of integrated care and early optimization of clinical status. Prospective studies with long-term follow-up are needed to better characterize prognostic factors.

Summary

Factors underlying ethnic differences in the incidence of femoral fractures are not fully understood. Reference curves of femoral neck geometric parameters (FNGPS) between Changsha-Chinese women and three United States (US) ethnic groups of women varied by ethnicity, age, and measurement parameters. Further investigations might better explain fracture-rate differences.

Purpose

Osteoporotic fractures are associated with race, and the risk of femoral neck fractures is associated with FNGPs. We compared age-related FNGPs of Changsha-Chinese women with those of three ethnic groups of women in the US.

Methods

Data on 4236 Changsha-Chinese women and non-Hispanic Whites (NHWs), non-Hispanic Blacks (NHBs) and Mexican women (aged 20–91 years) from a laboratory database and research literature, were analyzed to measure their FNGPs: outer diameter (OD), cross-sectional area (CSA), averaged cortical thickness (ACT), endocortical diameter (ED), buckling ratio (BR), section modulus (SM), and cross-sectional moment of inertia (CSMI).

Results

The overall means of the OD, ED, SM, and CSMI of the Changsha-Chinese women were significantly lower than those of the NHWs. Their CSA, ACT, SM, and CSMI were significantly lower than that of the NHBs and the age-related reference curves of their CSA, ACT, SM, and CSMI were significantly lower than those of the NHWs, NHBs, and Mexican women. Their OD and ED reference curves were significantly lower than those of the NHWs and NHBs; their OD, CSA, and ACT reference curves were lower than those of the NHWs; and their CSA, ACT, and SM were significantly lower than those of the NHBs. However, their buckling ratio (BR) reference curve was significantly higher than that of the NHWs, NHBs, and Mexican women in the US.

Conclusion

Ethnic differences in the FNGPs of Changsha-Chinese women and US ethnic groups may explain differences in hip-fracture rates among different ethnic groups.

Summary

In postmenopausal women with osteoporosis, 10-year denosumab was estimated to be cost-effective vs 5 years of oral alendronate, a 2-year drug holiday, and subsequently 3-years of alendronate with an estimated incremental cost-effectiveness ratio of $97,574 per quality-adjusted life-years gained. Cost-effectiveness was demonstrated in most of the scenario simulations.

Purpose

A previous economic analysis estimated that 5-year denosumab was cost-effective compared with 5-year alendronate in women with postmenopausal osteoporosis (PMO) in the United States (US). Emerging literature has provided data on the long-term clinical benefits of denosumab. Therefore, the cost-effectiveness analysis was updated to understand the potential implications of a longer treatment duration (10-year) with denosumab vs generic oral alendronate or no treatment from a US third-party payer perspective.

Methods

A lifetime Markov cohort model was used to compare 10-year denosumab treatment to 5 years of alendronate, followed by a 2-year drug holiday and, then an additional 3 years of alendronate. The target population consisted of PMO women in the US with a starting age of 72 years. Recent publicly available data, including epidemiology, treatment efficacy, persistence, and costs, were used to inform model inputs. Scenario analyses and a probabilistic sensitivity analysis (PSA) were conducted to account for uncertainty.

Results

Estimated mean total lifetime cost and quality-adjusted life years (QALYs), respectively, were $81,003 and 8.035 for denosumab, and $75,358 and 7.977 for alendronate, resulting in denosumab having an incremental cost-effectiveness ratio of $97,574 per QALY gained. At a threshold of $150,000 per QALY, the PSA demonstrated that denosumab was considered cost effective in 62.1% of simulations. Denosumab was dominant over no treatment.

Conclusions

Ten-year denosumab treatment would be cost-effective compared with 5 years of alendronate, followed by a 2-year drug holiday and 3 years of alendronate at the threshold of $150,000. Cost-effectiveness was demonstrated across most scenarios with robust PSA results.