Archives of Osteoporosis最新文献

Summary

This study examined how isoflavone interventions impact bone health in postmenopausal women. Analyzing 73 trials found that isoflavones reduce bone resorption markers, enhance bone minerals, and increase hormones regulating bone metabolism. This suggests that isoflavones could help address bone health issues in postmenopausal women.

Purpose

This study aimed to assess the impact of isoflavone interventions on bone turnover markers and various biochemical markers of bone metabolism through systematic review and meta-analysis.

Methods

Four electronic databases, including PubMed, Embase, Scopus, and Cochrane Library, were searched in September 2023 for investigating the effects of isoflavones on bone turnover markers as well as signaling molecules regulating osteoclast differentiation, bone minerals, and hormones regulating bone metabolism in postmenopausal women. The main effect estimates, obtained using a random-effects model, were summarized using the mean difference (MD) or standardized mean difference (SMD), as appropriate.

Results

A total of 73 randomized controlled trials were included, comparing an isoflavone intervention to a placebo. Our findings demonstrated that isoflavone interventions significantly reduced bone resorption markers, that is, β cross-linked C-telopeptide of type 1 collagen (β-CrossLaps) (MD = − 0.0943 ng/mL; P = 0.0071) and pyridinoline (PYD) (SMD = − 0.9111; P = 0.0247). Moreover, isoflavone interventions positively affected bone mineral parameters by increasing serum calcium levels (MD = 0.3430 mg/dL; P = 0.0267) and decreasing serum phosphorus levels (MD = − 0.0648 mg/dL; P = 0.0435). Hormones involved in regulating bone metabolism, particularly insulin-like growth factor type 1 (IGF-1), exhibited significant increases following isoflavone interventions (MD = 9.8163 ng/mL; P < 0.0001). Subgroup analysis suggested that the effects of isoflavones on bone turnover markers are influenced by factors such as the duration since menopause and the intervention duration.

Conclusion

This systematic review and meta-analysis highlight the potential of isoflavone interventions to rectify imbalances in bone remodeling, enhance bone mineral homeostasis, and optimize hormones regulating bone metabolism in postmenopausal women.

Summary

This study compared liquid and tablet forms of alendronate for osteoporosis treatment. After 12 months, both forms increased bone density to a similar degree with no significant differences in side effects. New low-volume liquid alendronate is as effective as tablets, offering an alternative treatment option for postmenopausal women with osteoporosis.

Purpose/Introduction

Alendronate, despite its significant efficacy, poses challenges due to complex administration protocols and patient compliance issues, underscoring the need for various formulations. This study compared the efficacy and safety of once-weekly low-volume liquid alendronate sodium trihydrate (ALN-S), an oral solution, to once-weekly alendronate sodium (ALN-T), an oral tablet, in Korean postmenopausal women with osteoporosis.

Methods

In a 12-month, multi-center, prospective, randomized, open-labeled, parallel trial conducted at two hospitals in Korea, 170 patients were randomized to alendronate solution (ALN-S) (N = 85) or alendronate tablet (ALN-T) (N = 85) groups. The bone mineral density (BMD) of the lumbar spine (LS), femoral neck (FN), and total hip (TH) was measured at baseline and after 12 months. Bone turnover markers (BTMs) were assessed at baseline, 6, and 12 months. The primary outcome was the percentage change in BMD of the LS, evaluated for non-inferiority.

Results

After 12 months, both ALN-S and ALN-T groups exhibited a significant increase in LS, FN, and TH BMD, with no significant intergroup differences (ALN-S: LS 5.0 ± 0.6%, FN 1.8 ± 0.6%, TH 2.2 ± 0.5%; ALN-T: LS 5.2 ± 0.6%, FN 1.6 ± 0.6%, TH 1.8 ± 0.5%). ALN-S was found to be non-inferior to ALN-T for BMD change at LS (treatment difference: − 0.22%, 95% CI: − 1.84 to 1.40%), excluding the predefined non-inferiority margin of − 2.29%. Changes in BTMs did not differ significantly between groups. The frequency of adverse events was similar between groups.

Conclusion

Liquid alendronate was non-inferior to tablet alendronate in increasing BMD in Korean postmenopausal women with osteoporosis, presenting a viable alternative when the tablet form is limited in various clinical scenarios.

Clinical trial registration

The trial was registered with ClinicalTrials.gov (NCT05387200).

Background

Acquired hypophosphatemic osteomalacia (AHO) is a rare metabolic bone disorder characterized by hypophosphatemia and impaired bone mineralization. Tumor-induced osteomalacia (TIO) is the most common cause of AHO, caused by phosphaturic tumors that overproduce fibroblast growth factor 23 (FGF-23).

Objective

To present the clinical characteristics, diagnostic challenges, and outcomes of seven cases of AHO in Peruvian patients between 1999 and 2023.

Methods

A retrospective review of seven patients diagnosed with AHO was conducted. Clinical data, including diagnostic procedures, treatments, and outcomes, were collected.

Results

Seven cases of AHO were reviewed. In case one, osteomalacia did not improve despite supraphysiological doses of vitamin D (ergocalciferol/cholecalciferol), and no tumor was detected with available tests, resulting in the patient’s death. Cases two and three involved tumors located in the right leg and right hemithorax, respectively, with symptom resolution following total resection. In cases four, five, and seven, exhaustive exams failed to locate tumors. Cases four, six, and seven showed elevated FGF-23 levels, while case five had inappropriately normal FGF-23 levels. Case seven was the first patient in Peru to receive burosumab treatment. In case six, a tumor in the head of the femur was identified, but the patient opted for nonsurgical management.

Conclusion

The diagnosis of AHO is challenging, requiring a high index of clinical suspicion and biochemical confirmation. TIO is the most common cause of AHO, emphasizing the importance of locating the phosphaturic tumor. However, in some cases, the tumor remains elusive despite exhaustive diagnostic workups. This is particularly challenging in developing countries like Peru, where resources are limited.

Summary

The Vfrac clinical screening tool was developed to help primary care healthcare practitioners decide if an older woman with back pain is at high risk of a vertebral fragility fracture (VFF) and requires a spinal radiograph to confirm diagnosis. The Vfrac tool developmental work was carried out in women because of the higher background prevalence of VFF. We now wish to assess Vfrac in men.

Purpose

To understand and characterise pain symptoms of men with VFF, to evaluate the wording of the Vfrac tool from men’s perspective, and to establish if a gender-specific version of the Vfrac tool was needed.

Methods

Individual interviews were conducted with 15 men using an interview topic guide based on the original Vfrac topic guide with the addition of a ‘think aloud’ section to discuss the wording of the current questions within the Vfrac tool. Thematic analysis was conducted by two researchers.

Results

Seven themes highlight that physical measurements can be potentially upsetting for those being measured (‘Weighed, measured and found wanting’), that closed questions cannot capture the complexity of experience (there is no room on the paper; pain is dynamic, not static; walking can make it better or worse; well, it depends on which chair), and that gendered roles are varied and dynamic (I try to do my share of domestic work; no more do-it-yourself).

Conclusions

This research has allowed the male perspective of osteoporosis to be heard and importantly identified that the Vfrac tool had no gender-specific barriers.

Summary

A surrogate FRAX® model for Nepal has been constructed using age- and sex-specific hip fracture rates for Indians living in Singapore and age- and sex-specific mortality rates from Nepal.

Introduction

FRAX models are frequently requested for countries with little or no data on the incidence of hip fractures. In such circumstances, the development of a surrogate FRAX model is recommended based on country-specific mortality data but using fracture data from a country, usually within the region, where fracture rates are considered to be representative of the index country.

Objective

This report describes the development and characteristics of a surrogate FRAX model for Nepal.

Methods

The FRAX model used the ethnic-specific incidence of hip fracture in the Indian community of Singapore, combined with the death risk for Nepal in 2015–2019. The number of hip fractures in 2015 and 2050 was estimated based on the United Nations’ predicted changes in population demography.

Results

The surrogate model gave similar hip fracture probabilities to estimates from Sri Lanka, India and Pakistan but lower 10-year fracture probabilities for men and women at older ages compared to the model for Singapore, reflecting a higher mortality risk in Nepal compared with Singapore. There were very close correlations in fracture probabilities between the Nepalese and the Singapore models (r > 0.995) so that the use of the Nepalese model had little impact on the rank order of risk, i.e. a person at the xth percentile of risk with one model will be at the xth percentile of risk with the other. It was estimated that 6897 hip fractures arose in 2015 in individuals aged 50 years and older in Nepal, with a predicted 3-fold increase expected by 2050, when 23,409 hip fractures are expected nationally.

Conclusion

The surrogate FRAX model for Nepal provides an opportunity to determine fracture probability within the Nepalese population and help guide decisions about treatment.

Summary

Calcium intake is widely recommended, but its association with mortality remains unclear. This study indicated higher levels of calcium intake were associated with lower mortality in American adults. However, a nonlinear association between calcium intake and mortality suggested that excessive calcium intake beyond a certain threshold may increase mortality risk.

Purpose

The study aimed to investigate the association of total, dietary, or supplemental calcium intake with all-cause, cardiovascular, and cancer mortality in American adults.

Methods

This prospective cohort study used the National Health and Nutrition Examination Survey from 2005 to 2018. Participants were categorized into tertiles based on calcium intake. Risks of all-cause, cancer, or cardiovascular mortality and the dose–response relationship were estimated using weighted Cox proportional hazard regression and restricted cubic splines, with adjustments for demographic characteristics, comorbidities, laboratory parameters, and dietary data.

Results

In total, 6172 participants were included (median age: 61 years), and 869 had died (CVD:217, cancer:224) during a median follow-up of 81 months. After adjusting for confounders, higher total calcium(≥ 1660mg/d) [HR, 95%CI: 0.867 (0.865–0.869)], dietary calcium(≥ 1075mg/d) [HR, 95%CI: 0.711 (0.709–0.713)], and supplemental calcium (≥ 600mg/d) [HR, 95%CI: 0.786 (0.784–0.787)] intake groups were associated with lower all-cause mortality risk compared to the lowest intake group. Similar beneficial associations were found for cardiovascular, cancer mortality, and across subgroups of various ages, genders, races and body mass indexes. In the dose–response analysis, a 'J-shaped' nonlinear relationship was observed between calcium intake and the risk of all-cause, cardiovascular, and cancer mortality.

Conclusions

Higher levels of total, dietary, or supplemental calcium were associated with lower all-cause, cardiovascular, or cancer mortality. However, a nonlinear association between calcium intake and mortality suggested that excessive calcium intake beyond a certain threshold may increase mortality risk.

Objective

The objective of this study was to develop the first Moroccan recommendations concerning nutrition in patients with osteosarcopenia.

Material and methods

A steering committee consisting of rheumatologists and nutritionists drafted the initial version of the recommendations in light of the literature review and the recommendations of international societies. The draft was reviewed by a reading committee of 13 experts to approve the final version.

Results

Four overarching principles and ten recommendations were established. The overarching principles emphasize that nutritional advice is not a substitute for the pharmacological treatment of osteosarcopenia. Instead, it should be based on scientific evidence and take into account the specific characteristics of Moroccan society. The recommendations emphasize the significance of adequate calcium and vitamin D intake while evaluating the benefit-risk ratio in instances where calcium supplementation is indicated. A balanced intake of trace elements, vitamins, proteins, and dairy products should be maintained. The Mediterranean diet is recommended, while vegetarian diets and restrictive diets in individuals who are not overweight are not advised. It is recommended that individuals who fast during Ramadan consume a varied and balanced diet. It is recommended that the consumption of soft drinks and alcohol be limited. The consumption of phytoestrogens from food in moderation is considered beneficial as part of a balanced diet. Nevertheless, the use of supplements is not advised.

Conclusion

The purpose of this work is to provide Moroccan rheumatologists with a practical tool to improve the nutritional aspect in patients with osteosarcopenia.