Archives of Osteoporosis最新文献

We conducted a review of 10 national guidelines from five EU countries to identify similarities or differences in recommendations for the management of patients with osteoporosis. We found general alignment of key recommendations; however, there are notable differences, largely attributed to country-specific approaches to risk assessment and reimbursement conditions.

Introduction: The classification of fracture risk is critical for informing treatment decisions for post-menopausal osteoporosis. The aim of this review was to summarise 10 national guidelines from five European countries, with a focus on identifying similarities or differences in recommendations for the management of patients with osteoporosis.

Methods: We summarised the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Disease-International Osteoporosis Foundation guidelines and reviewed guidelines from France, Germany, Italy, Spain and the UK.

Results: The approach to risk assessment differed across the guidelines. In France, and Spain, risk assessment was based on DXA scans and presence of prior fractures, whereas UK, German and Italian guidelines recommended use of a validated risk tool. These differences led to distinct definitions of very high and high-risk patients. Guidelines aligned in recommending antiresorptive and anabolic agents as pharmacologic options for the management of osteoporosis, with sequential treatment recommended. There was agreement that patients at high or very high risk of fracture or with severe osteoporosis should receive anabolic agents first, followed by antiresorptive drugs. Variations were identified in recommendations for follow up of patients on anti-osteoporosis therapies. Reimbursement conditions in each country were a key difference identified.

Conclusions: Criteria for risk assessment of fractures differ across European guidelines which may impact treatment and access to anabolic agents. Harmonisation across EU guidelines may help identify patients eligible for treatment and impact treatment uptake. However, country-specific reimbursement and prescribing processes may present a challenge to achieving a consistent approach across Europe.

This study investigated osteoporosis risk factors among older Asian men with type-2 diabetes mellitus, hypertension, or hyperlipidaemia in primary care. Advanced age, dementia, depression, and polypharmacy were associated with higher risks for osteoporosis. Screening strategies targeting these factors are crucial for improving bone health as part of comprehensive preventive care.

Purpose: Asian patients with type-2 diabetes mellitus (T2DM), hypertension, or hyperlipidaemia (DHL) are predominantly managed in primary care. They are also at risk of osteoporosis, but men are often under-screened and under-treated for this preventable bone disorder. This study aimed to identify the clinical characteristics and risk factors of osteoporosis among older men with DHL in primary care for early intervention.

Methods: This retrospective study included men aged 65 years and older managed in public primary care clinics for their DHL between 1st July 2017 and 30th June 2018. Demographic, clinical, laboratory, and imaging data were extracted from their electronic medical records based on their International Classification of Diseases-10 (ICD-10) diagnosis codes. Descriptive statistical analyses, with statistical significance set at p < 0.05, were conducted, followed by generalized estimating equation (GEE) modelling.

Results: Medical records of 17,644 men (83.1% Chinese, 16.9% minority ethnic groups, median age 71 years) were analysed. 2.3% of them had diagnosis of osteoporosis, 0.15% had fragility fracture, and 26.0% of those diagnosed with osteoporosis were treated with bisphosphonates. Their mean HbA1c was 6.9%; mean systolic and diastolic blood pressure were 133 and 69 mmHg. The GEE model showed that age (OR = 1.07, 95%CI = 1.05-1.09, p < 0.001), dementia (OR = 2.24, 95%CI = 1.33-3.77, p = 0.002), depression (OR = 2.38, 95%CI = 1.03-5.50, p = 0.043), and polypharmacy (OR = 6.85, 95%CI = 3.07-15.26, p < 0.001) were significantly associated with higher risks for osteoporosis.

Conclusion: Age, dementia, depression, and polypharmacy are associated with osteoporosis risks in men with DHL. Strategies to incorporate osteoporosis screening among older men with these risk factors are needed to improve their bone health.

The population has aged; there is a greater risk of osteoporosis and hip fracture. We describe the standards of care for hip fractures in various hospitals of Mexico. A total of 1042 subjects participated. The acute mortality was 4.3%.

Significance: Hip fracture registries provide a means to compare care and establish improvement processes.

Background: The Mexican population has aged; thus, there is a greater risk of osteoporosis, and its main consequence is hip fracture due to fragility. Its incidence is high, and it is expected to increase due to aging in our country. International guidelines provide standardized recommendations for the care of people with hip fractures, while hip fracture registries provide a means to compare care with local, national, and international clinical standards and establish improvement processes.

Objective: Describe the standards of care for hip fractures in various hospital centers of the Mexican Social Security Institute.

Methods: This was an observational, multicenter, longitudinal, and descriptive study. It included 24 hospital centers in Mexico. Informed consent was obtained. Data were recorded during the hospital stay, epidemiological data, and management, and follow-up was carried out 30 and 120 days after discharge. The information was analyzed using SPSS version 22.0.

Results: A total of 1042 subjects aged 79.5 ± 7.6 years participated, mostly women (n = 739; 70.9%) from the community (n = 1,021; 98.0%) and with functional independence (Barthel 80.9 ± 22.2). The transfer time to the emergency room was 4.6 ± 14.6 days. Pertrochanteric hip fracture was the most common (n = 570, 54.7%). The most common type of procedure was dynamic hip screw (DHS) (n = 399; 40.1%). Documented thromboprophylaxis was granted in 91.5% (n = 953) and antibiotic prophylaxis in 53.0% (n = 552) of the patients. The goal of 36 h for the surgical procedure was achieved in 7.6% of the subjects (n = 76), with the most frequent cause being a delay in scheduling (n = 673, 67.6%). The mean time from emergency room to surgery was 7.8 ± 7.0 days. The acute mortality rate was 4.3%. Secondary pharmacologic prevention upon discharge occurred in 64.2% of patients. At 30 days, 370 subjects (37.1%) were lost to follow-up, with a mortality of 3%, while at 120 days, 166 subjects (27.8%) were lost, with a mortality of 2.8%.

Conclusion: In the hospital centers where the study was carried out, there are still no standards of care for hip fractures, which makes it necessary to rethink the care for this population group through a strategy focused on meeting those standards.

This cross-sectional study investigated osteosarcopenia prevalence and its correlates among 2142 adults aged 55 and older in Finland. Findings show 3.9% had osteosarcopenia, while 13.8% and 11.1% had probable sarcopenia only or osteoporosis only, respectively. Osteosarcopenia was associated with low BMI, impaired mobility, ADL limitations and depression. Sarcopenia appeared to drive these associations more than osteoporosis. Osteosarcopenia may be a risk factor for functional decline, hospitalization, and institutionalization, warranting further research.

Purpose: Osteosarcopenia is a disorder consisting of concurrent osteoporosis and sarcopenia. This cross-sectional study using nationally representative data from Finland in 2000 aimed to determine the prevalence of osteosarcopenia in Finland. In addition, associations of sociodemographic, lifestyle, anthropometric, physical and mental function indicators, chronic conditions and various biomarkers with osteosarcopenia were examined.

Methods: The study included 2142 subjects aged 55 and over (mean age 68.0 years, SD 9.0). Probable sarcopenia was defined as grip strength < 27 kg for men and < 16 kg for women. Osteoporosis was defined as either ultrasound-based bone density measurement of T < -2.5, or self-reported, pre-existing diagnosis of osteoporosis. Participants were categorized into 4 groups: no sarcopenia and no osteoporosis, probable sarcopenia only, osteoporosis only, and osteosarcopenia. Information on sociodemographic, lifestyle, anthropometric, physical and mental function indicators, chronic conditions and various biomarkers were collected via structured interview, questionnaires, clinical examination, and blood and urine samples.

Results: The prevalence of probable sarcopenia, osteoporosis and osteosarcopenia was 13.8%, 11.1%, and 3.9%, respectively. Osteosarcopenia was associated with low BMI, slow gait speed, impaired mobility, impaired ability in the activities of daily living and depression. Of the two components, probable sarcopenia appeared to contribute to these associations more than osteoporosis.

Conclusion: According to representative population-based study, about every fifth person with probable sarcopenia also has osteoporosis. Mobility and ADL limitations were more common among people with osteosarcopenia than those with osteoporosis or probable sarcopenia alone. Future studies are needed to examine osteosarcopenia as an independent risk factor for functional decline, hospitalization, and institutionalization.

This population-based retrospective cohort study aimed to estimate the association between antibiotic exposure and osteoporotic fracture risk. Long-term antibiotic use was associated with the risk of osteoporotic fracture. An increase in the number of antibiotic classes prescribed may also be associated with an increased osteoporotic fracture risk.

Purpose: This study aims to examine the association between antibiotic usage and osteoporotic fractures in a large cohort of Korean adults, with a specific focus on the duration of antibiotic exposure and the number of antibiotic classes used.

Methods: This retrospective cohort study from the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) database from January 1, 2002, to December 31, 2019, included 167,370 Korean adults aged 50 years or older (mean [SD] age, 59.3 [7.82] years; 65,425 [39.09%] women). The cumulative antibiotic prescription days and the classes of antibiotics prescribed between 2004 and 2008 were exposure variables, respectively. The main outcome was a newly diagnosed osteoporotic fracture during follow-up. Cox proportional hazard regression was used to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the incident osteoporotic fractures associated with antibiotic exposure.

Results: The antibiotic user group with 91 days had a higher risk of osteoporotic fracture in comparison to the antibiotic non-user group (aHR, 1.12; 95% CI, 1.03-1.21). Additionally, those who used more than four different antibiotic classes had an elevated risk of osteoporotic fracture compared to the non-user group (aHR, 1.10; 95% CI, 1.02-1.18).

Conclusion: This extensive population-based cohort study conducted on a large population has identified an association between the utilization of antibiotics and an elevated risk of osteoporotic fractures. The cumulative days exposed to antibiotics and osteoporotic fractures may be positively associated.

Clinical relevance: Awareness of the causes of hypercalcemia is essential for timely diagnosis of calcium disorders and optimal treatment. Citrate is commonly used as an anticoagulant during continuous renal replacement therapy (CRRT). Accumulation of citrate in the systemic circulation during CRRT may induce several metabolic disturbances, including total hypercalcemia and ionized hypocalcemia. The aim of the present study is to increase awareness of citrate accumulation and toxicity as a cause of hypercalcemia by relating three cases and reviewing the pathophysiology and clinical implications.

Observations: We utilized electronic health records to examine the clinical cases and outlined key studies to review the consequences of citrate toxicity and general approaches to management.

Conclusions: Citrate toxicity is associated with high mortality. A safe threshold for tolerating hypercalcemia during citrate anticoagulation is not clearly defined, and whether citrate toxicity independently increases mortality has not been resolved. Greater attention to citrate toxicity as a cause of hypercalcemia may lead to earlier detection, help to optimize the management of systemic calcium levels, and foster interest in future clinical studies.

Bone and muscle impairment, named osteoporosis and sarcopenia, may co-occur with age, and patients with both disorders might exhibit physical frailty. One-hundred sixty-three patients were included. 14.2% had both disorders and presented more frequent with previous fall, reduced daily activity level, walk/balance challenges, and need of walking aid, indicating overall frailty.

Purpose: In older adults, sarcopenia (muscle impairment) and physical frailty may accompany osteoporosis (bone brittleness), yet osteoporosis is typically assessed without evaluating these conditions, even though coexistence may contribute to exacerbated negative health outcomes. We aimed at evaluating the prevalence of sarcopenia and impaired muscle domains in osteoporotic patients and explore the risk of osteosarcopenia from markers of physical frailty.

Methods: In Copenhagen, Denmark, osteoporotic patients aged 65 + were assessed cross-sectionally in 2018-2019. Evaluations included muscle mass, strength, and function; bone mineral density; and self-reported physical activity, fall, balance challenges, dizziness, and the need of walking aid. Low bone mass, low-energy fracture, or treatment with anti-osteoporotic medication defined patient with osteoporosis, and sarcopenia was defined by low muscle strength and mass. Osteosarcopenia was defined from the coexistence of both conditions.

Results: One-hundred sixty-three patients with osteoporosis were included. Of those, 23 (14.2%) exhibited sarcopenia, hence osteosarcopenia. Hand-grip-strength, 30-s-chair-stand-test, relative-appendicular-lean-muscle-mass, and gait-speed were below cut-off levels in 21.0%, 30.9%, 28.8%, and 23.6% of the patients, respectively. Previous fall, activity level, walk and balance challenges, and need of walking aid were statistically (or borderline) significantly more often affected in the osteosarcopenic group compared with the solely osteoporotic. Logistic regression analysis, however, revealed that only the need for walking aid significantly increased the risk of an osteosarcopenia diagnosis (odds ratio 5.54, 95% CI (1.95-15.76), p < 0.01).

Conclusions: Sarcopenia and impaired muscle domains were frequent in osteoporotic patients, as were markers of physical frailty, indicating the need of thorough examination of osteoporotic patients.

This study aimed to assess the association between composite indices of femoral neck strength and the odds of hip fracture in Chinese adults.After adjusting for confounders, higher values of CSI and ISI were associated with a lower risk of fracture. They may provide useful information for improving hip fracture risk assessment.

Purpose: With the increased incidence of hip fractures worldwide, numerous studies have reported that composite indices of femoral neck strength can improve hip fracture risk assessment. This study aimed to assess the association between composite indices of femoral neck strength and the odds of hip fracture in Chinese adults.

Methods: This retrospective cross-sectional study conducted at Changzhou Second People's Hospital included 937 Chinese adults (248 with hip fractures). After overnight fasting for ≥ 8 h, blood samples were collected from all participants within 24 h of admission. Composite indices of femoral neck strength were derived by combining bone mineral density, weight, and height with femoral axis length and width, which were measured by dual-energy X-ray absorptiometry.

Results: In total, 937 participants (293 men and 644 women) were enrolled. The mean age was 68.3 years (SD 10.5). After adjusting for confounders, higher values of CSI and ISI were associated with a lower odd of hip fracture. Increase in CSI (per 1 g/m·kg) was associated with a 46% decrease in the odd of hip fracture (OR = 0.54; 95% CI, 0.39-0.74), and increase in ISI (per 0.1 g/m·kg) was associated with an 82% decrease (OR, 0.18; 95% CI, 0.11-0.30). Effect sizes of CSI and ISI on the odds of hip fracture remained robust and reliable in subgroup analyses.

Conclusions: Increased CSI and ISI were associated with a lower odd of hip fracture, especially in women, suggesting that composite indices of femoral neck strength may provide useful information for improving hip fracture risk assessment.