Archives of Osteoporosis最新文献

Summary

Dietary acid load could be associated with bone mass, but there are limited and conflicting results. This secondary cross-sectional analysis evaluated these associations among 123 children/adolescents, mostly Hispanics. Dietary acid load seems to be associated with bone mass in boys, but these results should be confirmed through long-term studies.

Background

Childhood/adolescence is key for developing strong bones. With the continuing rise in osteoporosis rates in Western societies, attention has turned to the possible impact of diets that create high levels of acid in the body. Some studies have shown an association between dietary acid load and bone mass, but there are limited studies in children/adolescents and none in Hispanics.

Objective

This study aimed to evaluate the associations between dietary acid load (assessed as dietary potential renal acid load, PRAL, and protein to potassium ratio) and whole-body bone mineral content (BMC) and density (BMD) in a sample of 123 children and adolescents of predominantly Hispanic ethnicity.

Design

This study is a secondary cross-sectional analysis.

Results

Dietary PRAL was positively associated with BMC and BMD overall (p < 0.05) and with BMC in boys (p < 0.05) when adjusted for energy misreporting only. The vegetable protein to potassium ratio was inversely associated with BMC (p = 0.004) in boys only, after adjusting for important factors.

Conclusions

Dietary acid load seems to be associated with BMC in boys in this sample of primarily Hispanic children. Long-term studies are needed to confirm these results and to understand the importance of protein intake in relation to other key nutrients in bone mass acquisition among Hispanic boys.

Summary

Osteoporosis, fragility fractures, and bone health optimization share the same pathophysiology, diagnostic tools, risk assessment, and treatments. Grouping them into “Lee’s TRIAD” allows surgeons and physicians to collaborate more efficiently, using unified principles and strategies for managing these conditions.

Purpose

The primary goal of osteoporosis management is to prevent fragility fractures, which occur from falls from standing height or less in individuals over fifty. However, the management of bone health optimization is often neglected in patients undergoing elective surgeries, such as arthroplasty and spinal surgeries. The objective of this article is to link all these three conditions into a TRIAD so that surgeons and physicians can collaborate more effectively, utilizing similar principles and strategies for better management.

Methodology

Clinical approaches based on country-specific guidelines are commonly used to manage osteoporosis. However, skeletal assessments are rarely conducted before or after elective procedures, leading to overlooked conditions such as osteoporosis, osteopenia, and fragility fracture risk factors. These three conditions are illustrated from the patient case study shown, to highlight the importance of not neglecting bone health optimization in high risk individuals undergoing elective surgery, with underlying osteopenia and multiple risk factors who sustained fragility fracture intraoperatively.

Result

Patients undergoing elective surgeries often have their bone health neglected, leading to a higher incidence of complications such as aseptic loosening and peri-prosthetic fractures due to poor bone quality and density. Bone health assessment and optimization therefore is essential in patients with osteoporosis, osteopenia with clinical risk factors, and patients with history of fragility fracture, to ensure implants sit on bone with good density and quality to minimize the complications.

Conclusion

By combining osteoporosis, fragility fractures, and bone health optimization into a TRIAD, “Lee’s TRIAD,” surgeons and physicians can collaborate more effectively, utilizing similar principles and strategies for better management.

Summary

Grip strength measurement, as a surrogate of sarcopenia diagnosis, effectively predicts secondary fracture risk in distal radius fracture patients. This simple tool enhances clinical practice by identifying high-risk patients for targeted interventions, potentially preventing or reversing functional decline and recurrent fractures.

Purpose

To evaluate grip strength and hand muscle cross-sectional area as predictors of secondary fracture risk in patients with a history of distal radius fracture (DRF), serving as surrogates of the diagnosis of sarcopenia.

Methods

A retrospective cohort study of 745 DRF patients was analyzed with their grip strength data using Cox proportional hazards regression, receiver operating characteristic analysis, and Kaplan–Meier analysis to predict secondary fracture risk over an average of 12 years. Hand muscle cross-sectional area was similarly analyzed.

Results

Patients with a history of DRF were predicted to have a 4.1% higher likelihood of experiencing a secondary fracture per kilogram reduction in their grip strength (p < 0.008), independent of age and sex. Patients were categorized as high-risk (≤ 16 kg), moderate-risk (17–24 kg), or low–risk (≥ 25 kg) (p < 0.001). High-risk patients showed a 2.2-fold (95% CI = 1.55–3.17) higher recurrent fracture risk compared to low-risk patients. Cumulative secondary fracture probabilities of the high-risk group patients at 5, 10, and 15 years were estimated to be 16%, 30%, and 54%, respectively.

Conclusions

Grip strength measurement, as a surrogate of sarcopenia diagnosis, effectively predicts secondary fracture risk in patients with DRF. This simple tool could improve clinical practice by identifying high-risk patients for targeted interventions to prevent recurrent fractures or even reverse functional decline.

Summary

The management of osteoporosis even after a fracture is declining. Our pilot study in patients with osteoporosis confirms a large ignorance of the disease and major fears and uncertainties about the treatments. Complete and sustained medical information seems essential to counteract the contradictory information, which are exclusively negative.

Purpose

The management of osteoporosis (OP) even after a fracture has declined over recent years despite the actions of the medical societies concerned with this disease. The objective of this pilot study was to investigate patients’ perceptions of OP, their treatment pathways, and how information is obtained.

Methods

The Association Française de Lutte Anti-Rhumatismale (AFLAR) constituted an advisory group of 7 French patients (mean age 63.7 years [54–74 years]), with various stages of OP and duration of disease. A qualitative, anonymized study was conducted with an open-ended semi-structured questionnaire, with a contribution of the International Osteoporosis Foundation (IOF) and the “Groupe de Recherche et Informations sur les Ostéoporoses” (GRIO).

Results

The onset of OP was often sudden, with the fracture occurring in a context of deep misunderstanding of OP by both the public and physicians. The patients have confidence in the physician, mostly a rheumatologist, who informs about OP and initiates the treatment. The main cause of non-adherence being major fears and uncertainties about efficacy and safety of treatments. Medical information is considered as insufficient, or poorly understood. Negative information has the highest impact, even if the sources seem unreliable, such as media. There is no trust in pharmaceutical companies and the ethics of physicians are in question.

Conclusion

This IOF/GRIO/AFLAR Patient Advisory Group pilot study illustrates the numerous barriers to effective OP management. Complete and sustained medical information, especially at the time of diagnosis and initiation of treatment, seems essential to counteract the contradictory information, which are exclusively negative.

Summary

The fracture liaison service in the study hospital developed and successfully implemented a digital platform to support the identification of patients while concurrently optimizing participation in the National Fracture Liaison Database. This initiative provides additional evidence of the capacity of digital health to support fracture liaison services.

Purpose

Resourced fracture liaison services (FLSs) are accepted internationally as the preeminent means of reducing the risk of future fragility fractures. The FLS in the study hospital sought to develop and implement a digital platform to support the identification of patients and concurrently effectively participate in the National Fracture Liaison Service Database (FLS-DB) established to monitor key performance indicators (KPIs).

Method

Through linkage with the already established hospital’s eTrauma digital system and Inpatient Management System, a bespoke fracture liaison digital platform was developed and introduced. Platform functionality supports automated patient identification and interoperability with the National Fracture Liaison Service Database enabling the anonymized safe transfer of key performance indicator data.

Results

Through automated identification of patients who require fracture liaison services, rates of identification have improved from 10% in 2021 to 87%. Time previously spent manually identifying patients is now available for clinical care. Key performance indicator data are recorded as part of the assessment and treatment process and successfully anonymized and transferred to the national database.

Conclusion

This initiative provides additional evidence of the capacity of digital health to support fracture liaison services. In comparable settings nationally and internationally where there are coexisting digital systems to support patient management and a national digital database for FLS key performance indicators, there is potential for the successful introduction of similar FLS digital platforms.

Summary

Our study investigated trends in osteoporosis management in Xiamen from 2012 to 2021, revealing improvements in screening and treatment, although medication use remained low. Additionally, we identified factors that may influence medication use and emphasized the importance of effective osteoporosis management strategies.

Purpose

The goal of the current study is to explore trends in assessment, diagnosis after fragility fractures, and osteoporosis treatment among hospitalized patients in Xiamen, China, between 2012 and 2021.

Methods

We conducted a retrospective cross-sectional study, using the Cochran-Armitage trend test to describe trends. Logistic regression was performed to identify the influencing factors of anti-osteoporosis medication (AOM) treatment. We performed a sensitivity analysis to verify the robustness of our findings.

Results

From 2012 to 2021, the rates of dual-energy X-ray absorptiometry (DXA) scans and bone turnover marker (BTM) examinations increased from 0 to 37% and 36.5%, respectively. 29.3% of patients with fragility fractures were diagnosed with osteoporosis. The use rate of AOM was only 22.7%. There was an upward trend in the prescription of bisphosphonates, increasing from 1% in 2012 to 16.8% in 2021. The use of calcitonin ranged from 4.1% (2014) to 32.7% (2021). Calcium and vitamin D supplementation prescribing increased significantly from 5.6% in 2012 to 78.7% in 2021. Logistic regression analysis showed that old age, female sex, history of fractures, DXA scans, and osteoporosis diagnosis were significantly associated with increased AOM use. Tobacco use, hypertension, diabetes, congestive heart failure, cerebral vascular accidents, and severe liver diseases were associated with a reduced likelihood of AOM treatment.

Conclusions

Although assessment, diagnosis after fragility fractures, and osteoporosis treatment have increased over the past decade, there are still deficiencies in the management of osteoporosis. In the future, it will be necessary to further strengthen management of osteoporosis.

Summary

The FRAX® algorithm showed good accuracy in women living with DM followed in primary care. There were no differences between the ROC curve with and without adjustments for major and hip fractures. The FRAX® 10-year and FRAX® AR were better calibrated in this population.

Purpose

An increased risk of fractures in people living with diabetes has been described. Screening instruments to calculate this risk have been proposed, including the FRAX® algorithm. Some studies suggest that minor modifications to this instrument can improve its performance. These modifications work well in other countries, but we do not know if they work in Brazil. The objective of our study was to evaluate the performance of the FRAX® algorithm with and without adjustments for women living with DM (WLDM) in primary care in Brazil.

Methods

A cohort study that included post-menopausal women attending primary care in Santa Maria, Brazil, was conducted from 2013 to 2018. The risk for major and hip fractures was calculated using the FRAX® tool. The FRAX® risk was calculated: (1) without adjustments (unadjusted FRAX®); (2) increasing the entered age by 10 years in individuals with DM (FRAX® 10 years); and (3) inserting the diagnosis of DM as rheumatoid arthritis (FRAX® AR).

Results

The accuracy for major fracture was 0.948 (unadjusted FRAX®), 0.947 (FRAX® 10 years), and 0.946 (FRAX® AR). For hip fractures, the accuracies were 0.989 (unadjusted FRAX®), 0.988 (FRAX® 10 years), and 0.988 (FRAX® AR). Furthermore, there were no differences between the area under the ROC curve with and without adjustments for major and hip fractures. Conversely, the FRAX® 10 years and the FRAX® AR were better calibrated, presenting a lower Chi-square.

Conclusion

The FRAX® algorithm showed good accuracy in WLDM followed in primary care. The FRAX® 10 years and FRAX® AR were better calibrated in this population.

Paget’s disease is a condition marked by abnormal bone remodeling, involving both excessive bone formation and destruction, predominantly in the elderly. Pagetic vertebral ankylosis is a rare manifestation, often associated with Paget’s disease, ankylosing spondylitis, or diffuse idiopathic skeletal hyperostosis. This form of acquired vertebral ankylosis is uncommon and occurs in cases with bone-bridging syndesmophytes or osteophytes. Here, we present a case of delayed diagnosis of Paget’s disease in the lower vertebral column, progressing to cervicothoracic vertebral ankylosis secondary to ankylosing spondylitis.

Summary

Brief rationale: The use of L1–L4 vertebrae, without exclusions, has been recommended for trabecular bone score (TBS) measurements.

Main result: Excluding abnormal and fractured vertebrae affected the TBS.

Significance of the paper: Fracture or degenerative abnormality may not affect TBS. The preferred action may involve including all levels without exclusions.

Purpose

The use of L1–L4 vertebrae, without exclusions, has been recommended for trabecular bone score (TBS) measurements. We aimed to investigate the effect of excluding fractured or abnormal vertebrae from TBS.

Methods

Dual-energy X-ray absorptiometry images of 2767 participants, including 1080 without excluded vertebrae, 556 with fractured vertebrae, and 1131 with abnormal vertebrae showing a 1.0 T-score difference compared to the adjacent vertebrae, were retrospectively reviewed. Differences between TBS measurements with and without fractured or abnormal vertebrae were evaluated.

Results

Among 1080 participants without excluded vertebrae, TBS was 1.234 at L1, 1.296 at L2, 1.308 at L3, and 1.301 at L4. A significantly higher mean TBS was seen after excluding L1, whereas a significantly lower mean TBS was seen after excluding L2–L4. In the 556 participants with fractured vertebrae, excluding the involved level from the TBS calculation led to a significant difference in the total sample, women, ≥ 70 years old, and overweight subgroups. A significantly higher mean TBS was seen after excluding the fractured L1, whereas a significantly lower mean TBS was seen after excluding fractures at L2–L4. Among the 1131 participants with abnormal vertebrae, excluding the involved level from the TBS led to a significant difference in age, sex, and body mass index subgroups. Excluding abnormal L1 and L4 vertebrae led to a significantly higher and lower mean TBS, respectively.

Conclusion

Excluding fractured or abnormal vertebrae led to differences in TBS across various subgroups. Regarding the effect of vertebral level exclusion, the observed differences may be attributed to the systematic intervertebral variation, which is unrelated to any effect from fractures or degenerative abnormalities.

Summary

This study examines how power training affects estimated bone strength, revealing that females benefit more than males, especially in the upper limbs (radius). These findings highlight the importance of designing sex-specific exercise programs to enhance bone health. Further research is needed to optimize training duration and address site-specific differences.

Purpose

This study aimed to compare the effects of 12-week of power training (PWT), an explosive form of strength training, on bone microarchitecture, estimated bone strength, and markers in mobility-limited (gait speed < 0.9 m/s) older adults.

Methods

Fifty-seven older adults (83 ± 5 years) were randomly assigned to either a training group (TRAIN, n = 28, 15 females, 13 males) performing high-intensity PWT or a control group (CTRL, n = 29, 22 females, 7 males) maintaining their usual lifestyle. High-resolution peripheral quantitative computed tomography (HR-pQCT) assessed bone geometry, densities, microarchitecture (e.g. trabecular number (Tb.N) and thickness (Tb.Th)), and estimated bone strength (stiffness and failure load) at the tibia and radius. Blood markers for bone metabolism (PINP and CTX-1) and muscle strength (handgrip and leg press) were also measured.

Results

Baseline sex differences showed females having lower stiffness (− 37.5%) and failure load (− 38%) at the radius compared with males. After PWT, females in the TRAIN group exhibited declines in Tb.N (− 4.4%) and improvements in Tb.Th (+ 6.0%), stiffness (+ 2.7%), and failure load (+ 2.4%) at the radius (p < 0.05). A time x group interaction indicated increases in leg press strength for the whole TRAIN group (+ 23%), and within females (+ 29%) and males (+ 19%) (p < 0.001). Baseline handgrip strength correlated with stiffness (r = 0.577) and failure load (r = 0.612) at the radius (p < 0.001). Females in the TRAIN group showed a reduction in PINP (− 25%), while males showed an increase in CTX-1 (+ 18%).

Conclusion

A 12-week PWT may enhance estimated bone strength in mobility-limited older adults, especially at sites less accustomed to daily loading (i.e. radius).

Clinical trial registration

NCT02051725.