Archives of Osteoporosis最新文献

Summary

This is the first study to report that TBS seems not only unaffected by bone artifacts, but also is superior to BMD in the discrimination of vertebral fractures in SAPHO patients, which highlights the importance of adding TBS measurement to DXA images in routine clinical evaluation.

Purpose

To investigate the impact of bone artifacts on trabecular bone score (TBS) and lumbar spine (LS) bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) and analyze the clinical utility of TBS evaluation for vertebral fracture (VF) risk assessment in SAPHO patients compared with BMD assessment.

Methods

Seventy SAPHO patients (mean age 50.1 (10.7) years, 81% women) and an equal number of age- and sex-matched controls were enrolled. TBS and BMD were assessed using DXA. Bone artifacts and VF of the spine were evaluated using whole-spine CT. Univariate logistic regression analysis was performed to identify factors associated with VF. Odds ratios (ORs) per standard deviation decrease in TBS and BMDs were estimated from logistic regression models with adjustment for age.

Results

In patients with bone artifacts, TBS, but not LS BMD, was lower than matched controls, and in those without bone artifacts, both BMDs and TBS were lower than controls. After adjustment, LS BMD was significantly lower in the SAPHO group than in controls. TBS and LS BMD (OR [95% confidence interval], 12.0 [3.6, 40.4] and 4.7 [2.0, 10.9]) showed statistically significant ORs but the others did not. For evaluating VF in SAPHO patients, TBS showed the greatest AUC in the ROC curve, with a value of 0.920 compared with 0.777, 0.690, and 0.652 for LS, FN, and TH BMD, respectively.

Conclusion

TBS seems not to be influenced by bone artifacts in opposition to LS BMD and has a better discriminatory value than BMD for VF in SAPHO patients.

Summary

In South Korea, osteoporosis incidence among the elderly was unclear. Our study revealed an incidence of 18.4 per 1000 person-years, with higher rates in females and those with lower education. The findings indicate a need for targeted prevention strategies to guide health policy for improved osteoporosis care for the elderly.

Background

Although osteoporosis significantly affects morbidity and mortality among the older population in South Korea, the incidence of osteoporosis and its associated factors within this demographic group remains unclear.

Method

We analyzed data from the Korean National Health Panel Survey, a nationally representative, population-based panel survey covering 2008 to 2018, to compute the incidence of osteoporosis among South Koreans aged 50 and older. Using the stepwise Cox Proportional Hazard model, we then identified and determined the associated factors of osteoporosis.

Result

Out of the 7304 study participants in our analysis, we identified 792 osteoporosis events, resulting in an overall cumulative incidence rate of 18.4 per 1000 person-years. The incidence of osteoporosis increased steadily with age and was higher among those with lower levels of education. We also found that female study participants were at a statistically significant 7.2-fold higher risk (aHR = 7.2, 95% CI = 5.8–8.8) of developing osteoporosis compared to males. At the same time, those with hyperlipidemia had a statistically significant 1.3-fold increased risk (aHR = 1.3, 95% CI = 1.1–1.4) of developing osteoporosis.

Conclusion

Our study highlights a significant proportion of the older South Korean population developed osteoporosis, especially among those who are older, females, and who have hyperlipidemia. This indicates the pressing need for the government’s and healthcare systems’ consideration of osteoporosis diagnosis and prevention strategies to ensure the health and well-being of the older South Korean population.

Summary

Epidemiologic and economic data regarding osteoporotic fractures in Mexico is scarce and mostly outdated. Through a model, we estimated the incidence and costs of osteoporotic fractures in adults ≥ 50 years old in Mexico during the year 2023. Results showed that these events are both frequent and costly, leading to a considerable economic impact.

Purpose

Osteoporosis and its fractures impose a high clinical and economic burden. The objective of this analysis was to estimate the frequency and costs owing to incident fragility fractures (FFs) during the year 2023 in Mexico.

Methods

This is an incidence-based cost-of-illness study. The target population is adults ≥ 50 years old sustaining a fracture related to osteoporosis (caused by a fall on the same level). The model estimates the costs and productivity losses associated with their treatment within 1 year post-fracture. National epidemiologic databases supplemented with information, derived from literature when appropriate, were used to estimate the frequency of new FFs during 2023 in the study population. Resource use included surgical and non-surgical inpatient or ambulatory care the patients received immediately after fracture plus the outpatient physiotherapy post-discharge and the eventual follow-up with a specialist who may prescribe pharmacotherapy. Sick days taken in employed patients were estimated from the literature. Local unitary costs of services and drugs for both public and private settings as well as average income in those occupied were applied. All costs are reported in Mexican pesos (MXN) from 2023.

Results

The model estimated a total of 229,239 FFs, among which 63% were classified as a major osteoporotic fracture, including 53,842 and 41,459 fractures located at the hip and vertebral, respectively. The total costs were estimated at 15,593 million MXN; most of them (75.2%) were attributable to acute-phase care.

Conclusions

Fragility fractures represent a serious health problem for Mexico. Better preventive/therapeutic strategies may help to mitigate their significant financial toll.

Summary

Hip structural analysis parameters are associated with risk of fracture in women across a long follow-up period, with buckling ratio persisting independent of total hip BMD.

Purpose

Hip structural analysis (HSA) uses dual X-ray absorptiometry (DXA) hip scans to calculate geometries of narrow neck (NN), intertrochanter (IT), and shaft (S), which may complement bone mineral density (BMD) for assessing fracture risk. We aimed to determine whether HSA parameters were associated with fracture.

Methods

Participants were women (n = 986, ages 40–94 year) from the Geelong Osteoporosis Study. HSA was calculated from Lunar DPX-L scans. Low-trauma incident fractures were identified radiologically. Participants were followed from baseline to first fracture, death, or end of follow-up period (31/12/16) (13,487 person-years follow-up). Time-updating Cox-proportional hazards modelling investigated associations between HSA parameters and fracture.

Results

Three hundred thirty-five participants reported fractures (rate: 24.99/1000 person-years [95% CI 22.46–27.80]). Higher NN BMD (HR:0.12, 95% CI:0.05–0.29), cross-sectional area (CSA) (0.37, 0.26–0.52), cross-sectional moment of inertia (CSMI) (0.66, 0.50–0.89), section modulus (SM) (0.40, 0.24–0.68) and cortical thickness (CT) (0.00, 0.00–0.01 due to rounding) were associated with decreased risk. IT BMD (0.08, 0.04–0.20), CSA (0.58, 0.49–0.69), CSMI (0.90, 0.85–0.94), and SM (0.69, 0.59–0.81) were similarly associated. Decreased risk was observed at increased values of S BMD (0.20, 0.10-0.38), CSA (0.60, 0.47–0.76), SM (0.60, 0.43–0.83), and CT (0.03, 0.01–0.14). Higher S endocortical diameter (1.81, 1.29–2.53), and buckling ratio (BR) at all sites (NN: 1.07, 1.04-1.11; IT: 1.08, 1.05–1.11, S: 1.31, 1.19–1.46) were associated with increased risk. After adjustment for total hip BMD, the associations with BR at the shaft (1.14, 1.00–1.30) were sustained. Other associations were attenuated.

Conclusion

A greater shaft buckling ratio was associated with an increased risk for fracture, independent of total hip BMD.

Summary

The prognostic nutritional index (PNI) is a useful tool for assessing nutritional status using serum albumin and lymphocyte count. This study indicates that a higher preoperative PNI correlates with improved mobility and health-related quality of life during the initial postoperative period in elderly patients with hip fractures.

Purpose

To investigate the prognostic value of the prognostic nutritional index (PNI) in predicting mobility and health-related quality of life (HRQoL) in elderly hip fracture patients after surgery.

Methods

We prospectively involved patients aged 65 and above, who could walk freely before injury and underwent surgery between 2018 and 2019. Admission PNI was calculated as serum albumin (g/L) + 5 × total lymphocyte count (× 10⁹/L). Patients were classified into two groups based on PNI median value. All patients were followed up by telephone for four times (30-day, 120-day, 1-year, and 3-year after surgery). The Fracture Mobility Score (FMS) and EuroQol 5-Dimension 5-Level (EQ-5D 5L) were used to evaluate mobility and HRQoL, respectively.

Results

Of 705 eligible patients, 487 completed all assessments. Patients in the higher PNI group had a significantly increased possibility of achieving unrestricted mobility at the 120-day follow-up (OR 1.69, 95% CI 1.10–2.61, P.adj = 0.017), while no significant differences were observed at other follow-ups. Additionally, patients in the higher PNI group had a significantly higher EQ-5D utility value at the 30-day follow-up (P.adj = 0.015). A linear regression model with adjusting for all confounders showed that admission PNI value was positively associated with EQ-5D utility values at 30-day, 120-day, and 1-year follow-up assessments (P.adj = 0.011, P.adj = 0.001, and P.adj = 0.030, respectively). However, this correlation was not observed at the 3-year time point (P.adj = 0.079).

Conclusion

The PNI is a valuable predictor of functional outcomes in elderly patients with hip fractures following surgery.

Summary

Osteoporosis affects over half of older women, whether urban compared to rural residents have different risk of osteoporosis is unclear. This 23-year longitudinal study of Australian women found lower risk of osteoporosis and fractures among women living in rural compared with urban areas, which may relate to distribution of risk factors and/or screening opportunities.

Purpose

To determine whether the prevalence of osteoporosis, fractures, and dual-X-ray absorptiometry (DXA) differs between Australian women living in rural compared with urban areas.

Methods

The Australian Longitudinal Study on Women’s Health, a prospective longitudinal study of Australian women, includes a cohort of women born 1946–1951, surveyed nine times from 1996–2019. Data from administrative health records were linked to survey data. Geographic area was classified as major city, inner regional, outer regional, or remote. Generalised estimating equations (GEE) explored outcomes of osteoporosis, fracture, and DXA rates. Univariable and multivariable regression were performed and bootstrapping with 100 repetitions at 95% sampling of the original dataset to ensure robust results.

Results

A total of 13,712 women were included: 5000 (36.5%) living in major cities, 5214 (38.0%) inner regional, 2798 (20.41%) outer regional, and 700 (5.1%) remote areas. Baseline age, 47.6 (1.46) years (mean (SD)), was similar; but education, marital status, country of birth, smoking, BMI, and comorbidities varied between areas. Over 23 years, 2956 (21.6%) were diagnosed with osteoporosis, 3185 (23.2%) had an incident fracture, and 8151 (59.4%) had a DXA. On univariable analysis, women living outside major cities had lower risk of osteoporosis (inner regional OR 0.92; 95% CI 0.84, 0.99; outer regional 0.70; 0.63, 0.79; remote 0.43; 0.34, 0.53), and lower risk of fractures (inner regional area OR 0.92, 95% CI 0.84, 0.99; outer regional 0.81; 0.73, 0.90; remote 0.54; 0.42, 0.67), than women living in major cities. These differences were no longer significant on multivariable analysis, suggesting differences might be related to the distribution of risk factors. Women living in inner regional and outer regional areas were significantly less likely to have a DXA, than those living in a major city (OR 0.75, 95% CI 0.70, 0.81; OR 0.72; 95% CI 0.64, 0.77, respectively), and this remained significant on multivariable analysis.

Conclusion(s)

Osteoporosis or fracture affected one-third of older Australian women, and women living outside major cities had lower rates of osteoporosis, fractures, and DXA completion.

Summary

A retrospective analysis was performed to evaluate the frequency of vitamin D blood testing in individuals from the Padua province, Veneto, Italy from 2005 to 2016. A significant increase in the frequency of vitamin D blood tests, particularly in females was observed and in individuals with severe vitamin D deficiency (Class I).

Purpose

Vitamin D deficiency has been linked to negative health outcomes that extend beyond bone-related conditions. The frequency of vitamin D blood testing in residents from the Padua province, (Veneto, Italy) from 2005 to 2016 was evaluated.

Methods

Data were retrospectively retrieved from blood test databases (Laboratory Medicine Unit, Padua University Hospital) and information on number of vitamin D blood tests performed on residents from 2005 to 2016 was collected. Data were stratified by sex and ten birth cohorts from 1901 to 2016. Blood tests were classified into five vitamin D classes: I < 50 nmol/L, II 50–74.9 nmol/L, III 75–149 nmol/L, IV 150–250 nmol/L, and V > 250–1000 nmol/L. Blood test trends were analyzed as blood test rate and vitamin D class rate/resident population. Population analysis was analyzed by incidence rates and stratified by vitamin D class.

Results

293,013 vitamin D blood tests were conducted between 2005 and 2016 across 10 birth cohorts. Females accounted for 75% of tests and fewer were conducted in the youngest and oldest birth cohorts. Sex differences in vitamin D blood test frequency were observed; adjusted rates ranging from 1.7 to 35.6% for males and 8 to 81% for females from 2005 to 2016. Crude incidence rates (per 1000 from 2005 to 2016) varied from 1.5 to 10.8‰ for males and 7 to 19.4‰ for females. Crude blood test rates for vitamin D deficiency (Class I) increased from 1.1 to 9.9‰ in 2016 for males and 5 to 17.3‰ for females. Crude incidence rates (from 2005 to 2016) for Class I were 9.7–57.1‰ in males and 43.6–92.4‰ in females.

Conclusions

These findings highlight sex-related differences in vitamin D testing, providing valuable insight for healthcare planning.

Background

Bilateral pedicle fractures of the lumbar spine are uncommon and are typically associated with strenuous activities, traumatic events, or previous spinal surgery. This study reported a case of bilateral pedicle fracture in a patient with a long history of osteoporosis treatment with bisphosphonate and included a histological evaluation of the bone.

Case presentation

An 82-year-old woman with no history of trauma presented to our hospital with back pain that had worsened over the previous month. Computed tomography and magnetic resonance imaging revealed bilateral pedicle fractures of the third lumbar vertebra. She had osteoporosis and had been taking bisphosphonates for 9 years. The patient underwent posterior lumbar fusion, and her symptoms improved. Bone biopsy results from the spinous process revealed few osteoblasts and an absence of osteoclasts, indicating low bone turnover.

Conclusions

Long-term use of bisphosphonates may contribute to the development of atypical bilateral pedicle fractures in patients with osteoporosis.