Archives of Osteoporosis最新文献

Summary

Osteoporosis affects patients emotionally, yet this aspect is often overlooked. This study found that fear, identity changes, and communication issues shape daily life and self-care. Trust in healthcare providers fosters positive engagement. Addressing emotional experiences can enhance patient-centred osteoporosis care and support treatment adherence.

Purpose

To explore the emotional experiences of individuals living with osteoporosis, with the aim of improving understanding of how these emotions influence self-care behaviours and treatment adherence.

Methods

In this qualitative descriptive study, we conducted in-depth semi-structured interviews with 20 participants diagnosed with osteoporosis, recruited through convenience sampling from an outpatient osteoporosis clinic in central Italy. We coded the interviews deductively and analyzed data using Mayring’s qualitative content analysis framework. We used a priori thematic saturation as the criterion for stopping sampling. We reported data in accordance with the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist.

Results

Participants (1 male, 19 females; age range 55–78 years) expressed a wide emotional spectrum associated with living with osteoporosis. Four overarching themes were identified: (1) emotional and psychological impact of the disease, (2) relationship with one’s identity and body, (3) interaction with healthcare professionals, and (4) managing the disease in daily life. Negative emotions, including fear, anxiety, and frustration, were frequently linked to uncertainty about treatment, insufficient communication with healthcare providers, and concerns about the disease progression. Conversely, positive emotions such as trust, hope, and satisfaction emerged when participants felt supported and engaged in their care. These emotions were associated with a stronger motivation for self-management and treatment adherence.

Conclusion

Living with osteoporosis involves a complex interplay of emotional responses that significantly affect patient engagement and disease management. Promoting effective communication and fostering trust between patients and healthcare providers are essential to supporting emotional well-being and enhancing adherence to osteoporosis care plans.

Summary

This study evaluated the cost-effectiveness of a care coordination program for hip fracture patients in Korea. The results show the program improves outcomes at a reasonable cost. These findings provide strong evidence to support national adoption of preventive care models for aging populations.

Background

Femur fractures in elderly patients are associated with high mortality rates and significant healthcare costs. Fracture Liaison Services (FLS) have emerged as a systematic approach to prevent secondary fractures, but their economic evaluation in the Korean healthcare context remains limited.

Objective

This study aimed to evaluate the cost-utility of implementing FLS coordinator services for patients with femur fractures in Korea.

Methods

A Markov model-based cost-utility analysis was conducted using National Health Insurance Service claims data (2013–2021) and patient survey data from Eulji University Hospital. The target population included patients aged 50 years and older with femur fractures. The analysis adopted a Limited societal perspective with a Lifetime horizon, 6-month cycle length, meaning that both direct medical costs and selected non-medical costs (e.g., caregiver and transportation expenses) were considered over the patients’ remaining Lifetime, with health states updated every 6 months in the model. A 4.5% annual discount rate was applied to both costs and quality-adjusted life years (QALYs).

Results

The incremental cost-effectiveness ratio (ICER) of FLS implementation was 12,057,427 KRW per QALY gained, which is below Korea’s willingness-to-pay threshold of 40 million KRW per QALY. Probabilistic sensitivity analysis showed a 92.2% probability of cost-effectiveness at the 40 million KRW threshold. The FLS program demonstrated a 41% reduction in refracture risk and a 20% reduction in mortality risk.

Conclusions

FLS coordinator services for femur fracture patients are cost-effective in the Korean healthcare system and should be considered for implementation to improve patient outcomes while managing healthcare expenditures efficiently.

Summary

We evaluated the long-term impact of a Fracture Liaison Service (FLS) in elderly hip fracture patients. FLS implementation improved one-year survival and significantly reduced the risk of secondary fractures in adherent patients. However, no significant differences in five-year mortality were observed. Structured care improves short-term outcomes and treatment adherence.

Purpose

Hip fractures are the most serious type of fragility fractures, as they are associated with increased short- and long-term all-cause mortality. The implementation of Fracture Liaison Service (FLS) programs has improved the management of osteoporosis-related fractures and demonstrated clinical effectiveness. This study aimed to evaluate the impact of an FLS model on survival rates, mortality reduction, and secondary fracture prevention over a five-year period.

Methods

We conducted a prospective cohort study on patients aged 60 years and older who sustained a hip fracture before and after FLS implementation at our centre (January 2016–December 2019). Patients were followed for five years. Mortality, complications, and secondary fractures were analysed using a multivariate Cox proportional hazards model.

Results

A total of 1,401 patients were included (355 pre-FLS and 1,046 post-FLS). The prescription of anti-osteoporotic drugs significantly increased after FLS implementation (77.5% vs. 12.1%; p < 0.01), as did adherence to treatment (48.9% vs. 30.2%; p = 0.02). One-year mortality was lower in the post-FLS group [18.3% vs. 22.0%; adjusted HR 0.77 (0.60–0.99); p = 0.045]. However, five-year mortality rates showed no significant differences between groups (59.1% vs. 54.6%; p = 0.14). Patients adherent to osteoporosis treatment had a significantly lower risk of secondary fractures (10.8% vs. 19.1%; p < 0.01).

Conclusion

Implementing an FLS protocol was associated with a significant reduction in one-year mortality and improved adherence to osteoporosis treatment, leading to a lower risk of secondary fractures. However, no significant difference was observed in overall five-year mortality.

Background

Osteoporosis is a major public health issue characterized by reduced bone mass and increased fracture risk particularly affecting the older population.

Objective

This scoping review aims to summarize the existing literature focusing on the impact of vitamin D-fortified foods in reducing the risk of osteoporosis-related outcomes and improving the overall bone health.

Methods

Considering the study objectives, two databases, i.e., PubMed and Scopus, were selected to search for literature. A search term “vitamin D” OR “vitamin D2” OR “vitamin D3” OR “cholecalciferol” OR “ergocalciferol” AND “fortified food” OR “fortification” OR “oil fortification” OR “ghee fortification” OR “cereal fortification” OR “margarine fortification” OR “milk fortification” OR “egg fortification” AND “osteoporosis” OR “bone mineral density” OR “bone health” was applied to retrieve the available literature. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed for the methodology and results compilation.

Results

A total of 14 papers were included after applying the inclusion/exclusion criteria. Evidence from most of the studies (n = 9) indicates that regular consumption of vitamin D-fortified foods improves serum 25(OH)D levels, enhances bone mineral density, and lowers the risk of fractures. However, different factors such as age, fortification dosage, and food vehicle (type of food) appear to affect the result outcomes.

Conclusion

The integration of vitamin D-fortified foods into daily diets appears to be a promising nutritional intervention strategy to support bone health and prevent osteoporosis. Further research is needed for standardization of recommendations for different age groups. Moreover, for countries like the UAE, where vitamin D deficiency remains prevalent and fortification is not yet standardized, adopting an evidence-based policy could be a decisive step toward mitigating future public health and economic burdens related to osteoporosis.

Summary

The epidemiology of metatarsal fractures remains poorly understood. We identified retrospectively all adults with ≥ 1 radiologically confirmed metatarsal fracture, over 3 years. Young men and women had similar fracture rates, but overall risks were significantly higher for women (RR 1.99, 95% CI 1.76–2.26), driven by age-related falls in male fracture incidence.

Purpose

Metatarsal fractures are clinically and economically important and may reflect trauma, insufficiency or fatigue. However, their epidemiology remains poorly understood. We evaluated radiologically confirmed metatarsal fractures identified within Shropshire over a 3-year period.

Methods

Radiology reports were searched for all patients aged ≥ 18 years between 2020 and 2023, using the terms ‘metatarsal’ AND ‘fracture’, to identify patients with ≥ 1 confirmed metatarsal fracture. Age at fracture, sex, fracture description and mechanism were recorded, and population fracture rates estimated, using local census data.

Results

A total of 1121 (758 female) individual patients aged 50.7 (18.9) years, fractured 1370 metatarsals, usually the fifth in isolation, with fewer individuals fracturing two, three or four metatarsals. Fractures were located at the metatarsal base (59%), shaft (26%), neck (12%) or head (3%); were mostly oblique, transverse or comminuted; and were usually caused by low-energy inversion injuries or falls. Fracture rates per 100,000 were 105 for women aged 18–29 years, rising to 153 and 142 in the sixth and ninth decades, with comparative male rates of 102, 40 and 31. Overall, women had more metatarsal fractures than men (RR 1.99, 95% CI 1.76–2.26), the sex difference being highest for metatarsal head fractures (RR 2.98 95% CI 1.34–6.60) and lowest for shaft fractures (RR 1.67, 95% CI 1.32–2.12).

Conclusion

Most metatarsal fractures are isolated low-energy injuries of the fifth metatarsal. Overall, women suffer twice as many fractures as men, driven by sustained high fracture rates in older women and a steep age-related decline among men. The underlying reasons for this pronounced sex difference are unclear and require further study.

Summary

This cross-sectional study evaluated knowledge, attitude, and practice regarding osteoporosis among postmenopausal Iranian women with confirmed diagnosis. Despite moderate knowledge and attitudes, participants exhibited poor preventive behaviors. Educational attainment positively correlated with knowledge and attitude, while insurance coverage significantly influenced practice. These findings underscore the necessity for structured educational interventions and policy-level support.

Background

Given the high prevalence of osteoporosis among Iranian women, this study evaluates the knowledge, attitudes, and practices of postmenopausal women with the condition to identify gaps that may hinder effective management.

Material and Methods

A cross-sectional study in Tehran province in 2023 assessed the knowledge, attitude, and practices of women aged 50 and older with osteoporosis. Participants were recruited from various osteoporosis centers, and data were collected through a standardized questionnaire, confirmed for reliability and validity. Linear regression analysis was performed using SPSS version 25 to identify factors influencing their knowledge, attitude, and practice.

Results

The study included 186 participants with an average age of 66.4 (SD 8.13). Cronbach’s alpha scores were 0.756 overall, with specific scores of 0.766 for knowledge, 0.455 for attitude, and 0.641 for practice. Cohen’s Kappa was 0.52, and CVR Ranged from 0.4 to 0.8, while CVI was 0.93 to 1, Leading to revisions for items with a CVR of 0.4. Mean scores were 74 (SD 8.01) for attitude, 12 (SD 3.70) for knowledge, and 16 (SD 3.78) for practice. Knowledge Levels showed 24.1% with good knowledge, 55% moderate, and 20.9% poor. In terms of attitudes, 29.4% had a positive attitude, while 70.6% had moderate attitude. No participants showed good practice, with 25.2% at a moderate Level and 74.8% inadequate. Multivariate analyses highlighted that the years of education influenced osteoporosis attitudes (β: 0.43, P<0.001) and knowledge (β: 0.27, P<0.001), while having health insurance affected osteoporosis practice (β: 2.34, P<0.001).

Conclusion

The study found that participants lacked sufficient knowledge about osteoporosis, despite having a somewhat positive attitude. Their performance in managing the condition was poor. This highlights the need for improved dissemination of information on osteoporosis management.

Summary

We investigated annual trends in acute care costs for hip fracture treatment in Japan from 2011 to 2021. While gross medical costs and costs per hospitalization initially declined, both increased after 2013 and 2014, respectively. In contrast, daily medical costs per person rose steadily throughout the study period.

Purpose

Hip fractures impose a substantial financial burden on healthcare systems, primarily due to acute-care hospitalization costs. Despite efforts over the past decade to improve hospital efficiency, trends in acute care costs for hip fracture treatment remain unclear. This study aimed to evaluate annual trends in these costs in Japan.

Methods

We conducted a nationwide retrospective cohort study using the Diagnosis Procedure Combination database in Japan. Patients aged ≥ 60 years who underwent hip fracture surgery between 2011 and 2021 were included. Primary outcomes were gross medical costs, costs per hospitalization, and daily medical costs per person. Secondary outcomes were length of hospital stay and waiting times for surgery.

Results

A total of 839,179 hip fracture cases were identified. Gross medical costs decreased from $890 million in 2011 to $830 million in 2013 but increased to $989 million in 2021. Medical costs per hospitalization declined from $11,587 in 2011 to $11,337 in 2014 and rose to $12,019 in 2021. In contrast, daily medical costs per person increased steadily from $378 to $442 over the study period. Both the mean hospital stay (37.1 to 33.1 days) and waiting times for surgery (3.5 to 3.0 days) decreased from 2011 to 2021.

Conclusion

Although hospital efficiency improved, initial decreases in gross costs and costs per hospitalization were followed by gradual increases after 2013 and 2014, respectively. Meanwhile, daily medical costs per person consistently increased, underscoring the sustained economic burden of acute hip fracture care.

Summary

This retrospective cohort found that osteoporosis (defined by T-score) or FRAX score is linked to a higher risk of non-fatal stroke. Additionally, a high FRAX score combined with T-score increases the risk of both major adverse cardiovascular events (MACE) and non-fatal stroke.

Purpose

This study examined the relationship between osteoporosis and major adverse cardiovascular events (MACE) in Thai older adults and evaluated the predictive capacity of the FRAX score for cardiovascular risk.

Methods

A retrospective cohort study followed 348 individuals aged 60–75 Years for over 13 years (2005–2021) after their initial bone mineral density (BMD) assessment. Osteoporosis was defined by BMD T-scores ≤ −2.5 at the lumbar spine or femoral neck, or fragility fracture. High hip fracture risk was defined as a FRAX score ≥ 3%. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke (3P-MACE). Cox proportional hazards models were used to calculate hazard ratios (HR). Statistical significance was set at p < 0.05.

Results

While overall MACE was not significantly higher in the osteoporosis group, the stroke findings were increased (adjusted HR 2.46, 95% CI 1.12–5.39, p = 0.024). Utilizing FRAX score in conjunction with T-scores (FRAX-T ≥ 3%) was independently associated with an elevated risk of 3P-MACE (adjusted HR 1.88, 95% CI 1.05–3.38, p = 0.034) as well as non-fatal stroke risk (adjusted HR 3.04, 95% CI 1.38–6.69, p = 0.006).

Conclusions

Osteoporosis demonstrates a significant association with increased stroke risk in Thai older adults. Utilizing FRAX-T may improve cardiovascular risk stratification. Further large-scale prospective studies are needed to elucidate the underlying mechanisms and establish a definitive link between osteoporosis and broader cardiovascular outcomes in this population.

Summary

Clinicians should consider baseline BMD, age, and sex when assessing osteoporosis risk. Women over 65 with severe osteopenia need close monitoring. Transition rates reached 10.7% at 2 years and 25.9% at 5 years. Routine retesting in low-risk individuals is unnecessary; rescreening should focus on older adults with moderate to severe osteopenia.

Purpose

The transition rate to osteoporosis based on baseline dual-energy X-ray absorptiometry (DXA) derived bone mineral density (BMD) status in older Asians has not been previously determined. This study was designed to evaluate the rate of transition to osteoporosis in participants aged 50 years and older.

Methods

We reviewed 1781 consecutive participants (1211 postmenopausal women and 570 men; mean age, 61.17 ± 9.10 years), who underwent repeat BMD testing with a mean follow-up duration of 2.41 ± 1.20 years. Participants were stratified into four groups according to lowest T-score (proximal femora or lumbar spine): normal BMD (T-score of >  − 1.00), mild osteopenia (− 1.01 to − 1.49), moderate osteopenia (− 1.50 to − 1.99), and severe osteopenia (− 2.00 to − 2.49). The transition rate to osteoporosis was assessed for follow-up interval periods of < 2 years and 2—5 years.

Results

A total of 581 patients (32.62%) transitioned to osteoporosis during follow-up. The transition rate to osteoporosis was higher in women than men (23.5% vs. 11.1%, p < 0.001). Transition rates to osteoporosis from baseline normal BMD and the three osteopenia subgroups (mild, moderate, severe) over 2 to 5 years were 1.2%, 7.8%, 29.9%, and 45.9% for women and 0.8%, 5.4%, 14.8%, and 39.6% for men. Transition rates from baseline normal BMD and the three osteopenia subgroups up to 2 years were 0.0%, 3.7%, 7.7%, and 30.2%, respectively. Transition rates in each category were higher in women than men, except in the severe osteopenia group (p = 0.064). Overall transition rate to osteoporosis was 10.7% for participants up to 2 years and 25.9% for between 2 and 5 years.

Conclusion

This study highlights a significant correlation between osteopenia severity and an increased risk of developing osteoporosis, particularly in older women. Women aged over 65 with severe osteopenia require close monitoring.