Archives of Osteoporosis最新文献

Summary

Adherence to guidelines for geriatric patients with a hip fracture is challenging. With this study, adherence to important quality indicators in geriatric hip fracture care was improved. A quality improvement collaborative including benchmarking and knowledge sharing showed to be effective in improving quality of care.

Background

Adherence to guidelines for geriatric patients with an osteoporotic hip fracture is challenging. Therefore, the aim of this study was to improve the adherence to quality indicators (QIs) for these patients using benchmarking and knowledge sharing.

Method

A prospective multicenter study was initiated throughout 19 hospitals in Flanders, Belgium. Adherence to 23 QIs was measured. Two retrospective audits (based on patient record analyses) were conducted in 2018–2019 (measurement period (MP) 1) and 2021 (MP 2). Between both audits, anonymous benchmarking was provided to the participating centers and three educative sessions on specific topics were performed.

Results

A total of 1044 patients were included in the study. At MP 1, QIs showing the lowest adherence rates were the administration of nerve blocks, steroids, and tranexamic acid, applied in only 8.0%, 9.7% and 22.2% of the patients, respectively. At MP 2, these adherence rates significantly improved up to 25.4%, 26.4% and 30.7%, respectively (p < 0.001). The indication of the start of discharge planning also significantly improved between both periods (89.3% in MP 1 vs. 93.7% in MP 2, p = 0.043), while the avoidance of intra-operative hypotension was less well realized (56.2% in MP 1 vs. 52% in MP2, p = 0.026). Overall adherence significantly increased from 61.7 to 64.5% (p < 0.001). Delirium was significantly reduced (from 22.1% in MP 1 to 17.4% in MP 2, p = 0.030).

Conclusion

Benchmarking in combination with a peer-reviewed and knowledge sharing intervention increases the adherence to quality indicators for patients with a geriatric hip fracture.

Summary

Obtaining accurate self-reports on clinical risk factors, such as parental hip fracture or alcohol and tobacco use, limits the utility of conventional risk scores for fracture risk. We demonstrate that fracture-risk prediction based on administrative health data alone performs equally to prediction based on self-reported clinical risk factors.

Background

Accurate assessment of fracture risk is crucial. Unlike established risk prediction tools that rely on patient recall, the Fracture Risk Evaluation Model (FREM) utilises register data to estimate the risk of major osteoporotic fracture (MOF). We investigated whether adding self-reported clinical risk factors for osteoporosis to the FREM algorithm improved the prediction of 1-year fracture risk by comparing three approaches: the FREM algorithm (FREM^orig), clinical risk factors (CRF^only), and FREM combined with clinical risk factors (FREM-CRF).

Method

Clinical risk factor information was obtained through questionnaires sent to women aged 65–80 years living in the Region of Southern Denmark in 2010, who participated in the Risk-stratified Osteoporosis Strategy Evaluation study. Register data was obtained through national health registers and linked to the survey data. Positive and negative predictive values and concordance statistics were calculated for the performance of each approach using logistic regression and Cox proportional hazards models.

Results

Of the 18,605 women included, 280 sustained a MOF within 1 year. All three approaches performed similarly in 1-year fracture risk prediction for low- and high-risk individuals. However, the FREM^orig and FREM-CRF approach slightly overestimated fracture risk for medium-risk individuals.

Conclusion

Adding self-reported clinical data to FREM did not increase precision in predicting 1-year MOF risk. The discrimination of FREM^orig was similar to that of CRF^only, suggesting it may be possible to estimate fracture risk with the same precision by using register data instead of self-reported risk information. Register-based prediction models may be applicable in individualised risk monitoring or large-scale osteoporosis screening programmes.

Objective

The impact of tea on bone health in postmenopausal women has generated conflicting opinions. The current study pooled previous research to evaluate the relationship between tea consumption and bone health in postmenopausal women.

Methods

Relevant papers published before October 2024 were included by conducting a comprehensive literature search in the Embase, PubMed, Scopus, and The Cochrane Library databases. Observational studies reporting the association between tea consumption and bone mineral density (BMD) or the risk of osteoporosis and fractures in women after menopause were deemed eligible. The weighted mean difference (WMD) for BMD and the pooled odds ratio (OR) for osteoporosis and fractures were calculated, together with their corresponding 95% confidence intervals (CIs).

Results

The meta-analysis examined 18 studies with a total of 48,615 individuals. The combined results indicated that postmenopausal women who consumed tea had higher BMD at several skeletal sites, including the lumbar spine (WMD, 0.02; 95% CI, 0.01–0.04; P < 0.001), greater trochanter (WMD, 0.02; 95% CI, 0.02–0.03; P < 0.001), femoral neck (WMD, 0.01; 95% CI, 0.00–0.02; P = 0.049), and ward’s triangle (WMD, 0.02; 95% CI, 0.01–0.03; P = 0.002). Additionally, these women had a lower risk of osteoporosis (OR, 0.41; 95% CI, 0.26–0.67; P < 0.001) and fracture (OR, 0.81; 95% CI, 0.67–0.98; P = 0.031).

Conclusions

The findings of this meta-analysis suggest that postmenopausal women who regularly consumed tea saw an increase in BMD and a decreased likelihood of developing osteoporosis and experiencing fractures. Future research should give priority to conducting prospective cohort studies with a more stringent methodology to verify the dose–response connection between tea consumption and the risk of osteoporosis or fracture in postmenopausal women.

Systematic review registration: PROSPERO registration number CRD42019112196.

Summary

Osteoporosis and fragility fractures are frequent complications of lung transplantation patients. Among 131 patients included, 35 (26.5%) patients had a diagnosis of fractures after transplantation. Low bone mineral density was associated with fractures. Fractures post transplantation were identified as an independent risk factor for overall mortality.

Introduction

The prevalence of osteoporosis among lung transplant candidates has been estimated at 31% to 46%, and significant bone loss occurs after lung transplantation, predominantly in the first year, with increased risk of incident fractures. This study aimed to evaluate the prevalence of fragility fractures in a population of lung transplant recipients and the associated risk factors as well as mortality after a fragility fracture.

Patients and methods

This was a cross-sectional monocentric study that included patients with lung transplantation occurring < 10 years and > 1 year who were undergoing lung transplantation monitoring. All patients underwent bone mineral density evaluation by dual-energy X-ray absorptiometry and radiography to establish the presence of vertebral fractures. Mortality was assessed 2 years after the last inclusion.

Results

We included 131 patients (82 men, 62.6%), with mean age 56.8 ± 10.8 years. The mean time from lung transplantation to inclusion was 3.5 ± 3.5 years. Overall, 35 (26.5%) patients had a diagnosis of fractures after transplantation; 67 fractures were confirmed (average of 2 per patient), including 48 (71.6%) vertebral fractures. Odds of low bone mineral density at the femoral neck, total hip and spine was associated with fracture: odds ratio 0.007 [0.0002–0.3], 0.001 [0.0002–0.05], and 0.03 [0.001–0.6], respectively. Fracture post transplantation was significantly associated with death (hazard ratio 2.32 [1.01–5.33]).

Conclusion

This study confirmed a high prevalence of vertebral fracture in lung transplant patients. Fracture after lung transplant was associated with mortality. Bone fragility needs more attention to reduce the fracture risk.

Summary

The associations between serum hemoglobin (Hb) levels and bone mineral density (BMD) were investigated in population of the 4th Iranian Multicenter Osteoporosis Study (IMOS). A positive relationship between Hb levels and BMD at hip and femoral neck were detected only in men.

Purpose

Previous studies have investigated the relationship between hemoglobin (Hb) levels and bone mineral density (BMD) with controversial findings. This study aimed to evaluate this association using data from the 4th Iranian Multicenter Osteoporosis Study (IMOS), a population-based national survey, including a population sample aged 50 years and older.

Methods

The present study was conducted as a cross-sectional data analysis derived from the fourth round of the IMOS. Demographic information, Hb levels, and BMD measurements were collected. BMD was measured with dual-energy X-ray absorptiometry (DXA). Low BMD (osteopenia/osteoporosis) and osteoporosis were defined as a T-score less than -1 and less than -2.5 at each site including hip, femoral neck, or lumbar spine, respectively. Multiple linear regression analysis was used to assess the relationship between Hb levels and BMD.

Results

This study included 1,426 participants (54.2% female) with the mean age of 62.6 ± 8.0 years. The mean Hb levels among patients with or without osteoporosis were 12.9 ± 2.0 mg/dl and 13.1 ± 1.9 mg/dl, respectively (p-value = 0.08). It was demonstrated a positive relationship between Hb levels and BMD at hip (β = 0.0079, 95% CI: 0.002- 0.0135, p-value = 0.006) and femoral neck (β = 0.0064, 95% CI: 0.0015- 0.0113, p-value = 0.01) in only men. However, there was no significant correlation between Hb levels with low BMD and osteoporosis in either gender.

Conclusion

Our findings showed a favorable relationship between Hb levels and BMD at the hip and femoral neck, particularly in men. This highlights gender and site-specific distinctions between hematological and skeletal health..Future studies should unravel these possible associations and investigate the underlying mechanisms.

Summary

This study compared denosumab and zoledronic acid for treating osteoporosis in drug-naïve postmenopausal Korean women. Over 3 years, both drugs significantly increased bone mineral density. However, denosumab also improved fat-free mass, suggesting it may be a better initial treatment for osteoporosis with low muscle mass, assuming all other conditions remain constant.

Background

Denosumab (DMAB) and zoledronic acid (ZOL), which are strong antiresorptive agents, are used to treat osteoporosis in postmenopause. Nonetheless, the data on their comparative efficacy in drug-naïve patients remain limited. Our research compared the therapeutic efficacy of DMAB and ZOL in drug-naïve postmenopausal Korean women with osteoporosis.

Methods

In total, 120 women were enrolled and equally divided to the DMAB and ZOL groups. The bone density and biochemical parameters of the patients were monitored over 3 years. Furthermore, the changes in fat-free mass (FFM), which comprises muscle mass, were assessed by bioelectric impedance analysis. Baseline characteristics, including age, BMI, and the prevalence of fractures, were similar between the groups at the onset of the study. Serum 25(OH), calcium and, phosphorus levels and baseline bone mineral density (BMD) were also comparable between the groups.

Results

Following 3 years of treatment, both groups exhibited a significant increase in BMD versus the baseline value. In particular, BMD increased by 9.7% and 5.1% at the lumber spine and total hip, respectively, in the DMAB group, versus increases of 7.1% and 4.4%, respectively, in the ZOL group. The increase in FFM was greater in the DMAB group. BMI-adjusted FFM decreased by 1.3% in the ZOL group, versus an increase of 3.6% in the DMAB group.

Conclusions

Conclusively, both DMAB and ZOL are effective antiresorptive agents that improved BMD over 3 years in drug-naïve individuals. Moreover, DMAB might represent a more reliable initial option for patients with osteoporosis accompanied by low muscle mass.

Summary

Rural communities face healthcare challenges. This study assessed a multicomponent intervention to improve hospital visits and anti-osteoporosis medication (AOM) treatment rates. A total of 567 patients were randomized into three groups. Results showed significant improvements in hospital attendance and AOM treatment in intervention groups compared to usual care group.

Purpose

Rural communities face limited healthcare access, financial constraints, and transportation barriers leading to health disparities. This study examined interventions that reduced health disparities in increasing the outpatient attendance and treatment rate of anti-osteoporosis medication (AOM), while identifying factors contributing to therapy refusal in rural communities.

Methods

A total of 567 patients were randomized at the community level into three groups: multicomponent integrated care (MIC), osteoporosis care only (OC), and usual care (UC). Fracture Risk Assessment Tool and dual-energy X-ray absorptiometry scans were used to evaluate the osteoporosis and osteoporotic fracture risk. High- and moderate-risk patients were advised to pursue further hospital-based assessments and treatment. Both the MIC and OC groups received five interventions to address rural barriers, including specialist access, disease education, overcoming transportation barriers, peer support, and dedicated case managers. However, UC excluded transportation assistance, peer support, and case management. Outcomes measured included outpatient attendance, AOM treatment rates, and factors affecting hospital assessment refusal, analyzed via multivariable logistic modeling.

Results

In the MIC group, 73.3% of patients attended the outpatient clinic and 58.6% received AOM. In the OC group, 81% patients attended and 69.3% received AOM. Conversely, in the UC group, only 4.1% attended and received AOM. Significant differences in attendance and AOM rates were found between the MIC and UC groups and between the OC and UC groups (p < .001 for both). Common barriers included beliefs that treatment was unnecessary and lack of hospital access. Risk factors hindering outpatient attendance include male sex, low education, low budget, multiple disabilities, and osteopenia diagnosis.

Conclusion

Addressing transportation barriers and implementing dedicated case management are crucial for improving healthcare access among rural patients.

Trial registration

ClinicalTrials.gov NCT05104034.

Summary

Using the UK Clinical Practice Research Datalink, our cohort study matched 237,297 individuals with hearing loss (HL) to 829,431 without HL. The study found an 8–10% higher risk of major osteoporotic fracture in individuals with HL compared to those without. Additionally, within the HL cohort, we identified risk factors for potential inclusion in fracture risk models.

Purpose

Assess association between hearing loss (HL) and major osteoporotic fracture (MOF; spine, wrist/forearm, shoulder/proximal humerus, hip) in individuals aged ≥ 60 years, and risk factors for MOF in individuals with HL.

Methods

From the UK Clinical Practice Research Datalink, our cohort study matched individuals aged ≥ 60 years diagnosed with HL (READ/ICD-10 codes; 01January2001–31December2021; index event), without secondary osteoporosis causes, with up to five individuals without HL (birth, index year, sex, general practice). Incidence rates and Cox proportional hazard ratios (HL vs. no HL; stratified by low/high fracture risk) were calculated for MOF and hip fracture; multivariate logistic regression assessed risk factors for MOF and hip fracture (HL cohort).

Results

A total of 237,297 individuals with HL matched to 829,431 without HL, with a median age of 74 and 72 years, respectively. Compared with those without HL, individuals with HL had greater frailty (severe electronic frailty index, 5.9% vs. 2.7%), higher incidence of prior falls (14.1% vs. 10.6%), longer mean follow-up with higher incidence of MOF and hip fractures (5.1 vs. 4.4 years, 20.1 and 5.32 vs. 16.58 and 4.54 per 1000 person-years, respectively) and higher risk of MOF and hip fracture (adjusted HR, 1.10 and 1.08, respectively). Significant risk factors for MOF and hip fracture included age ≥ 70 years, fracture history, falls, osteoporosis diagnosis, chronic obstructive pulmonary disorder and cardiovascular disease (HL cohort).

Conclusion

In individuals with HL, we observed an 8–10% higher risk of MOF and hip fracture versus individuals without HL and identified risk factors for potential inclusion in fracture risk models.

Mini abstract

Low-sodium salt has a protective effect on BMD and also reduces the risk of osteopenia due to elevated blood glucose. This provides a direct and effective way to improve bone health in patients with hyperglycemia.

Objective

There is no consensus on the relationship between salt type and bone mineral density (BMD). This study examined the factors affecting osteoporosis and the relationship between low-sodium salt consumption with osteoporosis based on the Substitute Salt and Stroke Study (SSaSS).

Methods

This study was a cross-sectional study and compares the prevalence and characteristics of osteoporosis and osteopenia. Multiple linear regression and restricted spline models were used to analyze the factors affecting BMD and its dose–response relationship with osteoporosis and to compare the effects of different salts.

Results

The rates of osteoporosis and osteopenia were lower in those consuming low-sodium salt (31.11% and 38.52%) than in those consuming normal salt (38.65% and 41.10%). BMD was higher in the population consuming low-sodium salt than in that using normal salt (= 0.64, 95%CI: 0.25, 0.97). Age, gender, and blood glucose level interacted with low-sodium salt and together affected BMD. Analysis of the dose–response relationship revealed a positive linear association between elevated blood glucose and the risk of osteopenia (P for overall < 0.05, P for nonlinear = 0.77), but intake of low-sodium salt significantly reduced this risk. The risk of OP increased with age (P for overall < 0.05, P for nonlinear = 0.72); low-sodium salt intake reduced this risk, with the effect being more pronounced among individuals < 70 years old.

Conclusion

Low-sodium salt has a positive effect on maintaining BMD. Elevated blood glucose and age < 70 years increase the risk of osteoporosis, but use of low-sodium salt mitigates this risk.