Archives of Osteoporosis最新文献

Summary

Discontinuation risk for osteoporosis therapy rises in older adults. In a study of 8,677 Japanese patients aged ≥ 75 years, 365-day discontinuation was 41.4% with romosozumab and 70.9% with teriparatide. This suggests that the less frequent, once-a-month dosing schedule of romosozumab may improve treatment adherence in this population.

Purpose

To compare one-year treatment persistence between romosozumab and teriparatide in Japanese patients aged 75–99 years with osteoporosis.

Methods

We performed an active comparator new-user cohort study using a Japanese health insurance claims database (April 2018–March 2023). Eligible patients initiated romosozumab or any teriparatide formulation between March 2019 and March 2022. We used inverse probability weighting to balance measured baseline covariates. The study outcome was treatment discontinuation within 365 days. Cumulative incidence functions accounted for the competing risk of death. Subgroup analyses were performed by teriparatide formulation (daily, weekly, twice-weekly), by sex, and by age group (75–84 vs. 85–99 years).

Results

Among 8,677 eligible patients (romosozumab, n = 1,869; teriparatide, n = 6,808; mean age 86.1 years; 12.6% men), baseline covariates were well-balanced after weighting. At 365 days, the weighted cumulative incidence (risk) of discontinuation was 41.4% (95% CI, 38.4 to 44.4) for romosozumab versus 70.9% (95% CI, 69.8 to 72.0) for teriparatide (risk ratio, 0.58; 95% CI, 0.54 to 0.63). Twice-weekly teriparatide showed the highest persistence among teriparatide formulations but remained inferior to romosozumab. Across both treatment arms, women had lower discontinuation risk than men, and patients aged 75–84 years had lower risk than those aged 85–99 years.

Conclusions

Romosozumab demonstrated higher one-year persistence than any teriparatide formulation in Japanese patients aged ≥ 75 years. Its monthly administration may lessen the adherence barriers posed by more frequent teriparatide injections. This finding may aid treatment decision-making for older patients with osteoporosis.

Summary

Incident vertebral fractures are a major issue in elderly women with severe osteoporosis. Beyond well-established risk factors, osteoporosis treatment given, low serum triglyceride levels, and intensity of low back pain were identified as predictors of new fractures in high-risk elderly women. Clinical strategies need to take these findings into account.

Purpose

Vertebral fractures (VFs) are a major cause of morbidity and economic burden in aging populations. Despite effective osteoporosis treatments, VF incidence continues to increase. This study aimed to identify predictors for incident VFs in elderly women with severe osteoporosis.

Methods

This was a post hoc analysis of data of 778 women aged ≥ 75 years with severe osteoporosis from the JOINT-05 trial. We investigated potential predictors for incident VFs, including the burden of prevalent vertebral fractures (number and Genant grade), prior osteoporosis treatment, lipid profile (e.g., triglycerides), low back pain VAS, physical function (timed-up-and-go, one-leg standing), and nutritional indices (e.g., albumin, selected nutrients from the Food Frequency Questionnaire). Multivariate Poisson regression analysis was used to identify independent predictors.

Results

During the study, 138 participants (17.7%) developed incident VFs. The allocated osteoporosis treatment, the number and grade of pre-existing VFs, prior history of osteoporosis treatment, lower serum triglyceride levels, and the low back pain score were significant predictors of incident VFs. VF incidence was significantly higher in patients with pre-existing VFs, although risk did not increase with the severity of existing VFs.

Conclusion

Beyond established risk factors such as pre-existing fractures, this study identified the allocation of osteoporosis treatment, low serum triglyceride levels, and the intensity of low back pain as independent predictors of new VFs in high-risk elderly women. Thus, clinical strategies to prevent subsequent fractures should include optimizing pharmacological treatment (e.g., sequential therapy with teriparatide), considering lipid status, and implementing effective, multimodal pain management.

Summary

This was a cross-section study of postmenopausal women with osteoporosis/fractures. In multivariate analysis, P1NP was independently and negatively correlated with appendicular skeletal muscle index (ASMI). ASMI was positively correlated with body mass index and bone mineral density and negatively associated with smoking. ASMI assessment is crucial for postmenopausal osteoporotic women.

Purpose

To evaluate the relationship between appendicular skeletal muscle index (ASMI) and bone turnover markers and bone mineral density (BMD) in postmenopausal women with osteoporosis.

Methods

This cross-sectional study recruited 313 postmenopausal osteoporosis/fracture women from the Osteoporosis Prevention and Treatment Center of Keeling Chang Gung Memorial Hospital. Assessment included anthropometric data, medical history, lifestyle factors, 25-hydroxyvitamin D, parathyroid hormone, procollagen type 1 amino-terminal propeptide (P1NP), carboxy-terminal collagen crosslinks (CTX), lateral thoracolumbar spine x-rays, BMD, and ASMI.

Results

The prevalence of low ASMI in postmenopausal women with osteoporosis was 30.0%. The mean value of P1NP (66.2 ± 38.7 ng/mL) and CTX (0.45 ± 0.25 ng/mL) were both higher than the cutoff values proposed as treatment targets. Univariate linear regression analysis showed that ASMI was positively correlated with age, body mass index (BMI), and total hip, femoral neck, and lumbar spine BMD. Smoking and P1NP levels were negatively associated with ASMI. In all multivariable models adjusted for potential confounders, P1NP was consistently and significantly inversely associated with ASMI. Smoking was also negatively associated with ASMI. ASMI showed significant positive correlations with total hip and femoral neck BMD, but not with lumbar spine BMD. BMI and ASMI showed a consistently strong positive correlation.

Conclusion

ASMI not only showed a significant positive correlation with BMD, but also had similar risk factors as BMD. The significant negative correlation between ASMI and P1NP further confirmed the connection between muscle and bone.

Summary

In a rural cohort of older adults, osteoporosis was associated with moderate-to-severe white matter hyperintensities of presumed vascular origin in men but not women. This association was influenced by age and diet. Study results underscore potential sex-specific cerebrovascular implications of low bone mineral density.

Objectives

This study aimed to assess the association between bone mineral density (BMD) and white matter hyperintensities (WMH) of presumed vascular origin in men and women aged ≥ 60 years living in rural settings.

Methods

Following a population-based cross-sectional design, participants received dual-energy x-ray absorptiometry to estimate bone health, and a brain MRI to grade WMH severity. Logistic regression models, adjusted for relevant confounders, were fitted to assess the association between categories of BMD (normal, osteopenia and osteoporosis), as well as the continuous BMD value, and the presence of moderate-to-severe WMH.

Results

The study included 399 participants (mean age 68.8 ± 6.8 years; 42% men). A total of 94 (24%) individuals had normal BMD T-scores, 149 (37%) had osteopenia, and 156 (39%) had osteoporosis. Moderate-to-severe WMH were detected in 88 (22%) cases. Logistic regression models, adjusted for the above-mentioned covariates, showed no significant association between categories of BMD and WMH severity in the total population. When men and women were modeled separately, the association between osteoporosis and moderate-to-severe WMH became significant for men (OR: 7.15; 95% C.I.: 1.13 – 45.3), but not for women. Parsimonious models showed that covariates driving this association significant were the combination of age and diet (OR: 6.41; 95% C.I.: 1.04 – 39.7). Similar findings were noted when BMD was treated as a continuous variable.

Conclusion

Osteoporosis is associated with a higher prevalence of moderate-to-severe WMH in older men living in a population of frequent fish consumers. Increasing age and an unhealthy diet contributed significantly to this association.

Summary

We analyzed vertebral changes in spinal fusion patients treated with teriparatide or romosozumab. Both therapies improved bone quality, but romosozumab showed a significantly greater HU increase. These findings suggest that romosozumab demonstrated a more pronounced effect than TPD in patients undergoing spinal fusion surgery.

Purpose

Osteoporosis negatively impacts spinal fusion surgery outcomes. Although teriparatide (TPD) has been used perioperatively, romosozumab (ROMO) has recently gained attention. This study aimed to evaluate changes in vertebral bone density using computed tomography (CT)-derived Hounsfield units (HU) before and after spinal fusion surgery and to examine the impact of concomitant bone anabolic therapy.

Methods

This is retrospective cohort study included 115 patients who underwent spinal fusion surgery between 2021 and 2023. Patients were categorized into three groups: non-osteoporosis, teriparatide-treated, and romosozumab-treated (n = 27, each). Osteoporosis therapy was initiated 59.5 days preoperatively and continued postoperatively. HU values were assessed at the levels of one and two vertebrae above the uppermost instrumented level (HU + 1, HU + 2) at two time points: preoperatively and 12 months postoperatively. The primary outcome measure was the percent change of HU values over time.

Results

The non-osteoporosis group exhibited no significant changes in HU values 12 months postoperatively. Both the TPD and ROMO groups demonstrated significant increases in the percent change of HU values from baseline to 12 months postoperatively. Moreover, the ROMO group exhibited a significantly greater increase in the percent change of HU values than the non-osteoporosis and TPD groups at HU + 1. (p < 0.001 and p < 0.009, respectively).

Conclusion

Perioperative administration of TPD and ROMO significantly improved vertebral bone density, as determined by HU values. ROMO demonstrated a more pronounced effect than TPD, suggesting that it may be the preferred option for optimizing bone density in patients undergoing spinal fusion surgery.

Summary

Lower estimated glomerular filtration rate (eGFR) independently predicted greater increases in lumbar spine and total hip bone mineral density after romosozumab readministration following denosumab. An eGFR cutoff of 54 mL/min/1.73 m² may guide patient selection for romosozumab readministration. However, further studies are needed to validate our results.

Purpose

This study investigated whether renal function is an independent predictor of bone mineral density (BMD) increase during romosozumab readministration after denosumab in women with osteoporosis.

Methods

A multicenter study was conducted involving 31 Japanese women with osteoporosis who received romosozumab readministration between March 2019 and July 2024 following initial 12-month romosozumab treatment and sequential denosumab therapy. The estimated glomerular filtration rate (eGFR) at baseline and percent changes in lumbar spine (LS) and total hip (TH) BMD from baseline to 12 months were investigated. Multivariate regression analyses were performed to assess the association between renal function and BMD, adjusting for all previously reported potential confounders, including secondary osteoporosis, age, denosumab duration, BMD, and bone turnover makers. Receiver operating characteristic (ROC) curves were used to determine eGFR cutoff values predicting ≥ 3% BMD increase (i.e., treatment response).

Results

Approximately 38.7% and 19.4% of patients achieved ≥ 3% increase in LS and TH BMD at 12 months, respectively. Lower eGFR was significantly associated with greater LS (adjusted β =  − 0.14, 95% confidence interval [CI] − 0.27 to − 0.01) and TH BMD increases (adjusted β =  − 0.10, 95% CI − 0.18 to − 0.01). The optimal eGFR cutoff value predicting LS or TH response was 54.1 mL/min/1.73 m², with 64.3% sensitivity and 94.1% specificity (area under the ROC curve 0.77).

Conclusion

Lower baseline eGFR was an independent predictor of greater LS or TH BMD response to romosozumab readministration after denosumab, with an optimal cutoff value of 54 mL/min/1.73 m². Larger studies are needed to validate these findings.

Summary

Context: DXA densitometry is the current gold standard for the diagnosis of osteoporosis, but alternatives have been proposed.

Main result: REMS densitometry shows high correlation with DXA in the identification of osteoporosis, especially in the lumbar spine.

Relevance: REMS can be a useful tool for the identification of osteoporosis.

Introduction

Osteoporosis is characterized by reduced bone mineral density (BMD). The gold standard for diagnosis is bone densitometry using dual-energy X-ray absorptiometry (DXA). However, a non-ionizing technique based on quantitative ultrasound—radiofrequency echographic multispectrometry (REMS)—has recently emerged as a potential alternative.

Objective

To evaluate the diagnostic concordance between REMS and DXA in identifying osteoporosis among postmenopausal women attending the endocrinology clinic at Hospital de San José in Bogotá, Colombia, between June and December 2024.

Materials and methods

This descriptive cross-sectional study included 50 women with clinical indications for densitometry, for whom BMD was assessed using both DXA and REMS. Diagnostic agreement was evaluated based on the proportion of patients classified into the same diagnostic category by both methods and the corresponding concordance correlation coefficient (CCC).

Results

The mean age of participants was 67 ± 12.4 years. According to DXA, 56% were diagnosed with osteoporosis and 38% with osteopenia. Among those diagnosed with osteoporosis by DXA, 92.9% were similarly classified by REMS. The CCC between methods was 0.53 (95% CI 0.32–0.68; p < 0.01) for the lumbar spine and 0.38 (95% CI 0.13–0.58; p < 0.01) for the femoral neck.

Conclusions

REMS demonstrates substantial concordance with DXA in diagnosing osteoporosis, particularly in the lumbar spine. However, agreement varies by anatomical site, and influencing factors should be considered. This is the first study in Colombia to assess diagnostic agreement between these two techniques, and further research is recommended to validate and expand upon these findings.

Summary

Osteoporosis is a growing health burden requiring early risk assessment. In Saudi adults ≥ 60 years, FRAX scores with and without BMD showed minimal reclassification, with most shifts toward higher risk in younger groups. FRAX without BMD offers reliable stratification, supporting its use as a first-line screening tool.

Methods

A retrospective cross-sectional study included patients aged ≥ 60 years attending family medicine clinics at King Faisal Specialist Hospital & Research Centre, Riyadh, undergoing DXA screening between January 1, 2016, and December 31, 2022. Baseline variables were age, sex, and BMI. FRAX variables assessed were family history of hip fracture (HF), prior fracture, smoking, glucocorticoid use, rheumatoid arthritis, and alcohol intake. Fracture risk was categorized using fixed and age-specific thresholds; differences in FRAX scores and reclassification patterns were evaluated.

Results

Among 1,429 patients (mean age 68.07 ± 6.62 years), FRAX scores for major osteoporotic fracture (MOF) and HF) differed significantly with and without BMD. Subgroup analysis revealed no significant differences within specific age ranges (70–75 years for MOF and 60–75 years for HF) or among men across all age groups. Reclassification occurred in a small subset of patients, predominantly shifting toward higher-risk categories, particularly in younger age groups.

Conclusion

FRAX without BMD provides robust risk stratification, with minimal impact on reclassification across age categories. These results highlight its utility as a primary screening strategy, whereas BMD assessment may be reserved for cases requiring further refinement.

Purpose

Osteoporosis is a skeletal disorder defined by reduced bone mineral density (BMD), commonly assessed by dual-energy X-ray absorptiometry (DXA). The Fracture Risk Assessment Tool (FRAX) estimates 10-year fracture risk. Saudi Arabia was recently included in FRAX, enabling population-specific risk estimation. Notably, FRAX can be applied with or without BMD, but limited Saudi data exist comparing both methods.

Summary

Hip fractures in elderly pose signifcant healthcare challenges. Understanding the burden of disease associated with fall-related hip fractures will enable the implementation of measures for prevention and treatment in this vulnerable group.

Purpose

This study aimed to assess the disease burden of fall-related HFs and the national trend in Ecuador from 1990 to 2021.

Materials and methods

Using data from GBD 2021, the present study demonstrated trends in the incidence, prevalence, and years lived with disability (YLDs) of fall-related HFs in Ecuador with their corresponding 95% uncertainty intervals. A joinpoint regression analysis was conducted to assess trends in the calculated annual percentage changes (APC) and the average annual percentage change (AAPC) with their corresponding 95% confidence interval.

Results

In 2021, among all incident cases of fall-related HFs in the population aged 55 years and older in Ecuador, 42% and 58% were men and women, respectively, whereas 47% and 53% were men and women in the population aged 70 years and older, respectively. An estimated number of 8836 new cases of fall-related hip HFs occurred in Ecuador in 2021 (3557.05 in men and 5278.90 in women), resulting in 2287.89 YLDs (1362.22 in women and 925.67 in in women and men, with AAPCs of 1.3% and 1.0%, respectively (p < 0.001). YLDs of fall-related HFs decreased in both men and women, with, AAPCs of − 0.1% and − 0.1%, respectively (p < 0.001).

Conclusions

Fall-related HFs represents an important health problem in Ecuador. Incidence and prevalence increased, whereas YLDs decreased in the last three decades. This could reflect improvements in medical care, rehabilitation, and complication prevention after HFs. However, future studies are warranted to better assess and understand the reasons for the changing trends.

Summary

This study examines the association between multimorbidity, fragility fractures, and the subsequent financial burden among older adults in India using nationwide data of 66,066 individuals. Seventy-one percent reported multimorbidity with fractures, higher costs in private care, and infirm integrated health strategies that target fall prevention, multimorbidity, and equal access to healthcare.

Background

Fragility fractures are a major public health concern, particularly among older adults. While osteoporosis is widely recognized as a risk factor, the cumulative impact of multiple chronic conditions on fracture risk and post-fracture outcomes remains underexplored. This study examines the multimorbidity, fragility fractures, and financial burden in older Indian adults. The current study examines the association between multimorbidity, fragility fractures, and the subsequent financial burden among older adults in India.

Methods

We conducted a secondary analysis of 66,066 older adults (≥ 45 years) from the Longitudinal Aging Study in India (Wave 1). Fracture multimorbidity was defined as the presence of two or more chronic conditions, along with fracture, and fragility fractures were identified based on the self-reported history of fractures. The percentage of mediation was also recorded to assess the degree of mediation effect. We reported the direct, indirect, and total effects of mediation analyses.

Results

The prevalence of fracture was 4.2%. Of these, 43% underwent surgery, 71% reported fracture with multimorbidity, and falls accounted for 87% of fractures. Hospitalization burden was significantly higher among fracture multimorbid individuals. Out-of-pocket expenditure was found to be more than twice in private hospitals as compared to public hospitals, which considerably vary by age, sex, place of residence, living status, education level, and wealth quintile.

Conclusion

Major predictors of fragility fractures in those with multimorbidity include age, sex, place of residence, living status, education level, and wealth quintile. In addition, ADL disability, cognitive impairment, and depression were also found to be significantly associated with bone or joint fractures. These findings highlight the urgent need for policy interventions, including integrating multimorbidity screening into fracture prevention programs, expanding insurance coverage for pre- and post-fracture treatment, and access to mobility assistive devices.

Interpretation

A shift towards multimorbidity-inclusive fracture prevention and management policies is essential to mitigate the health and economic burden of fragility fractures. Future interventions should focus on comprehensive assessment, fall prevention strategies, and equitable healthcare financing mechanisms.