Archives of Osteoporosis最新文献

Summary

The study assesses the performance of AI models in evaluating postmenopausal osteoporosis. We found that ChatGPT-4o produced the most appropriate responses, highlighting the potential of AI to enhance clinical decision-making and improve patient care in osteoporosis management.

Purpose

The rise of artificial intelligence (AI) offers the potential for assisting clinical decisions. This study aims to assess the accuracy of various artificial intelligence models in providing recommendations for the diagnosis and treatment of postmenopausal osteoporosis.

Methods

Using questions from the 2020 American Association of Clinical Endocrinologists (AACE) guidelines for osteoporosis, AI models including ChatGPT-3.5, ChatGPT-4.0, ChatGPT-4o, Gemini, Gemini Advanced, and Copilot were prompted. Responses were classified as accurate if they did not contradict the clinical guidelines. Two additional categories, over-conclusive and insufficient, were created to further evaluate responses. Over-conclusive was designated if AI models provided recommendations not specified in the guidelines, while insufficient indicated a failure to provide relevant information included in the guidelines. Chi-square tests were employed to compare categorical outcomes among different AI models.

Results

A total of 42 clinical questions were evaluated. ChatGPT-4o achieved an accuracy of 88%, ChatGPT-3.5 57.1%, ChatGPT-4.0 64.3%, Gemini 45.2%, Gemini Advanced 57.1%, and Copilot 47.6% (p < 0.001).

Conclusions

The study reveals significant response accuracy variations across each AI model, with ChatGPT-4o demonstrating the highest accuracy. Further research is necessary to explore the broader applicability of AI in the medical domains.

Summary

The National Osteoporosis Guideline Group (NOGG) has updated the revised UK guideline for the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women, and men age 50 years and older. This guideline is relevant for all healthcare professionals involved in osteoporosis management.

Introduction

The UK National Osteoporosis Guideline Group (NOGG) first produced a guideline on the prevention and treatment of osteoporosis in 2008, with updates in 2013, 2017 and 2021. This paper presents a minor update of the 2021 guideline, the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women and men aged 50 years and older.

Methods

Where available, systematic reviews, meta-analyses and randomised controlled trials have been used to provide the evidence base. Conclusions and recommendations have been systematically graded according to the strength of the available evidence.

Results

Review of the evidence and recommendations are provided for the diagnosis of osteoporosis, fracture-risk assessment and intervention thresholds, management of vertebral fractures, non-pharmacological and pharmacological treatments, including duration and monitoring of anti-resorptive therapy, glucocorticoid-induced osteoporosis, as well as models of care for fracture prevention. Recommendations are made for training, service leads and commissioners of healthcare, and for review criteria for audit and quality improvement. Specific 2024 updates include guidance on fracture risk assessment by ethnicity, Parkinson’s disease, Down’s syndrome and lower-limb amputation; furthermore, the definition of very high fracture risk has been clarified. Hormone replacement therapy (HRT) is now recommended as a first-line treatment option in younger postmenopausal women with high fracture risk and low baseline risk for adverse events; recommendations regarding abaloparatide are included; additional training resources have been added.

Conclusion

The guideline provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals involved in its management. This position paper has been endorsed by the International Osteoporosis Foundation and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).

Summary

This retrospective cohort study analysed a total of 344 patients from the OSTEOMED registry with matched baseline and follow-up DXA data, finding that comorbidities such as nephrolithiasis, hypertension or coronary heart disease may influence the response to prescribed anti-osteoporotic treatment.

Purpose

To determine: 1) comorbidities associated with reduced bone mineral density (BMD), T-score and Z-score at the lumbar spine (L1 to L4 vertebrae), femoral neck and total hip; and 2) the role of multimorbidity (≥ 2 comorbidities) in reduced BMD, T-score and Z-score at the lumbar spine, femoral neck and total hip.

Methods

Retrospective cohort study analyzing patients [319 females (92.73%), 25 males (7.27%), age 62.13 ± 10.46 years] from the OSTEOMED registry with matched baseline and follow-up dual-energy X-ray absorptiometry (DXA) data. Patients' sex, age, body mass index (BMI), comorbidities and treatments were collected from their medical records after they had given written informed consent.

Results

Considering a least significant change (LSC) of 4.2%, neither comorbidity nor multimorbidity was statistically significantly associated with a reduction in BMD in any of the bone regions studied. However, binary logistic regression analyses adjusted for sex, age, BMI and treatments showed that nephrolithiasis (p = 0.044) and coronary heart disease (p = 0.026) were statistically significantly associated with a reduction in total hip T-score and that hypertension (p = 0.049) and coronary heart disease (p = 0.01) were statistically significantly associated with a reduction in total hip Z-score.

Conclusion

Despite comorbidity and multimorbidity, patients with osteoporosis are mostly well protected by anti-osteoporotic treatment in daily clinical practice. However, nephrolithiasis, hypertension, and coronary heart disease can influence the response to prescribed anti-osteoporotic treatment, especially at the total hip level.

Summary

In middle-aged adults, we evaluated the associations between multimorbidity count and patterns with fall- and fracture-related hospitalisations. Falls risk increased linearly with multimorbidity count, and certain multimorbidity patterns were associated with increased risks of falls and fractures. Multimorbidity count and pattern should therefore be considered when risk stratifying patients.

Purpose

Although multimorbidity is recognised as a risk factor for falls and fractures, most studies are retrospective, and few have explored these relationships through statistically derived multimorbidity patterns. Our prospective cohort study with 4991 participants of the Busselton Healthy Ageing Study aged 45–69 years evaluated the associations of multimorbidity count and classes with incident fall- and fracture-related hospitalisations.

Methods

Twenty-one morbidities were assessed at baseline, and four multimorbidity classes were identified using latent class analysis. Fall- and fracture-related hospitalisations were captured through the Western Australian Data Linkage System over a median follow-up of 7.9 years. Associations were examined using Cox regression models adjusting for sex, baseline age, lifestyle factors, and prior falls/fractures.

Results

During follow-up, incident fall- and fracture-related hospitalisations were recorded for 177 (3.5%) and 197 (3.9%) participants, respectively. Each one-unit increase in multimorbidity count was associated with a 16% (95% CI, 7.8–25%) increased risk of fall-related hospitalisations. Multimorbidity scores of 9 and above (HR 2.32 [1.22–4.42]) showed an increased risk of fractures. Compared with the relatively healthy class, the cardiometabolic or mental health and musculoskeletal classes were associated with an increased risk of fall-related hospitalisations (HR 2.84 [1.76–4.59] and 1.78 [1.23–2.59], respectively). The cardiometabolic class was associated with an increased risk of fracture-related hospitalisations (HR 1.79 [1.04–3.07]).

Conclusion

In middle-aged adults, we showed that multimorbidity count and certain multimorbidity patterns were associated with increased risk for fall- and fracture-related hospitalisations. Multimorbidity should therefore be considered when assessing a patient’s risk of falls and fractures.

Summary

We examined the trends in vitamin D insufficiency and deficiency over a 10-year period in the general population. The prevalence of deficiency significantly decreased (29.5% vs. 21.6%), whereas mean serum levels increased (23.3 ng/mL vs. 25.1 ng/mL). These trends may reduce the incidence of osteoporosis and osteoporotic fractures.

Purpose

We aimed to clarify the trends in the prevalence of vitamin D insufficiency and deficiency in the general population using population-based cohort data from a baseline survey and a follow-up survey conducted 10 years later.

Methods

A baseline survey of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study was conducted from 2005 to 2007. Blood samples were collected to measure serum 25-hydroxyvitamin D (25D) and intact parathyroid hormone levels from 1,683 participants (595 men, 1,088 women). Participants also completed an interviewer-administered questionnaire, and underwent bone mineral density measurements and radiographic examinations. The fourth survey was conducted from 2015 to 2016 with 1,906 individuals (637 men, 1,269 women), including both follow-up participants from the baseline survey and newly recruited individuals to increase the sample size for future longitudinal analyses. All participants completed assessments identical to those in the baseline survey. Vitamin D deficiency and insufficiency were defined as serum 25D levels of < 20 ng/mL and ≥ 20 ng/mL but < 30 ng/mL, respectively.

Results

The mean serum vitamin D levels were 23.3 ng/mL at baseline and 25.1 ng/mL at the fourth survey, indicating a significant increase (p < 0.001). The prevalences of vitamin D insufficiency and deficiency were 52.9% and 29.5%, respectively, at baseline, and 54.8% and 21.6%, respectively, in the fourth survey, indicating a significant decrease in vitamin D deficiency (p < 0.001).

Conclusions

In this population-based survey with a 10-year interval, the prevalence of hypovitaminosis D significantly decreased. This favourable trend may contribute to future reductions in the incidence of osteoporosis and osteoporotic fractures.

Summary

In diabetes- and age-related osteopenia/osteoporosis, a pathogenetic role of advanced glycation end-products and their soluble receptors (RAGE) is implicated. We studied how these compounds relate to bone health in girls with anorexia nervosa. We found that higher levels of endogenous secretory RAGE were associated with poorer bone quality, warranting further research.

Purpose

We explored the association of plasma protein–bound advanced glycation end-products (AGEs) and their soluble receptors with bone mineralization and turnover markers in girls with a restrictive type of anorexia nervosa.

Methods

A total of 102 girls with anorexia nervosa aged 14.0 ± 2.7 years and 29 age-matched healthy controls were included. Plasma levels of chemically defined AGEs (N^ε-(carboxymethyl)-lysine, methylglyoxal-derived hydroimidazolone-1, and their soluble receptors were determined using the ELISA methods; parathormone, osteocalcin, amino-terminal propeptide of human procollagen type I, carboxy-terminal telopeptide of type I collagen (CTX), and estradiol using the electrochemiluminescence. Girls with AN underwent dual-energy X-ray absorptiometry to assess bone mineral density (BMD) and trabecular bone score (TBS). Multivariate regression was performed using the orthogonal projection to latent structures model.

Results

Girls with anorexia nervosa displayed higher plasma levels of N^ε-(carboxymethyl)-lysine (by 52%) and methylglyoxal-derived hydroimidazolone-1 (by 34%) than controls, while soluble RAGE levels were similar in both groups. In girls with anorexia nervosa, low levels of nutritional markers, high endogenous secretory RAGE, and high CTX predicted low hip and femoral neck BMD. Low levels of nutritional markers and high bone turnover markers predicted TBS.

Conclusions

To clarify the role of the AGEs/RAGE axis in anorexia nervosa-associated low bone mass, longitudinal studies assessing the dynamic changes of these markers during re-alimentation-induced weight restoration and bone health recovery are needed. In clinical practice, monitoring of the AGEs/sRAGE axis could offer a novel approach for assessing disease status and guiding personalized interventions to mitigate long-term health consequences in patients with AN.

Summary

This study evaluated the quality of osteoporosis videos on TikTok, finding that while most are by doctors, the information quality is low. Longer videos tend to have better quality but receive less engagement, highlighting concerns about the suitability of TikTok for medical education.

Background

TikTok has become a significant channel for the general public to access and adopt health information. However, the quality of health content about osteoporosis on TikTok remains underexplored.

Objective

This study aimed to investigate the information quality of osteoporosis videos on TikTok.

Methods

We analyzed the first 200 videos related to osteoporosis on TikTok, focusing on 128 videos that met our criteria. The quality of these videos was evaluated using quantitative scoring tools such as the DISCERN instrument and Content Integrity Assessment. Additionally, the correlation between video quality and characteristics, including duration, likes, comments, and shares, was investigated.

Results

Of the videos analyzed, 93.0% were posted by doctors. Content integrity scores were as follows: definition 0.61 ± 0.77, symptoms 0.34 ± 0.71, evaluation 0.39 ± 0.71, risk factors 0.55 ± 0.65, management 0.82 ± 0.56, and outcomes 1.17 ± 0.75. The average DISCERN score was 36.51 ± 6.87, the majority of videos were rated as poor (71.1%) or fair (22.7%) in quality. DISCERN scores of videos published by doctors were lower than those created by non-professionals (Z = -2.062, P = 0.039). DISCERN scores were significantly correlated with video duration (r = 0.581, P < 0.001). Engagement metrics such as likes, comments, favorites, and shares were highly interrelated (r = 0.855 to 0.901, P < 0.001), but did not correlate with video quality (P > 0.05).

Conclusion

Although the videos about osteoporosis on TikTok are mainly provided by doctors, their quality is low. We found a positive correlation between video duration and video quality. High-quality videos received low attention, while popular videos were of low quality. The medical information on TikTok is currently not rigorous enough to guide patients to make accurate judgments. Due to the low quality and reliability of the information, TikTok is not an appropriate source of knowledge to educate patients.

Introduction

Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by the excessive secretion of parathyroid hormone (PTH), resulting in significant hypercalcemia and skeletal complications. In the context of chronic kidney disease (CKD), neglected PHPT can progress to a biochemical profile resembling tertiary hyperparathyroidism (THPT), further complicating diagnosis, especially when concomitant genetic skeletal disorders (GSD) exist.

Case report

We present a rare and complex case of a 63-year-old woman with stage 3 CKD who presented with recurrent pathological fractures, severe hypercalcemia, and extensive osteolytic bone lesions in both femurs. The patient’s clinical picture was complicated by notable skeletal anomalies, including short stature, brachydactyly, and hypoplastic metatarsals. Elevated serum calcium, markedly increased PTH levels, hypercalciuria, hyperphosphaturia, and parathyroid imaging, confirmed previously untreated PHPT resulting in a THPT-like biochemical profile in the setting of CKD. The patient ultimately underwent surgical fixation for bilateral lower limb fractures, followed by a simple parathyroidectomy, achieving symptomatic relief and metabolic stabilization. A genetic investigation, prompted by distinctive skeletal features, uncovered a frameshift mutation in the growth differentiation factor 5 (GDF5) gene indicative of brachydactyly type C, a rare form of GSD.

Conclusion

This case highlights the complexity in differentiating PHPT from other causes of hyperparathyroidism in the setting of CKD, particularly when concurrent skeletal dysplasia is present. The thorough clinical, biochemical, imaging, and genetic assessments were pivotal in reaching an accurate diagnosis and guiding appropriate surgical management.

Summary

We studied the associations between the state of the vascular wall in the coronary and carotid arteries with bone mineral density (BMD) and the bone turnover marker.

Purpose

To examine the associations of arterial stiffness, atherosclerotic plaque (ASP) and coronary artery calcification (CAC) parameters with BMD and bone resorption marker CTX.

Methods

Our cross-sectional study included 357 outpatient—women 45 to 82 years of age. Intima-media thickness (IMT), presence, and number of ASP in the carotid arteries were studied using duplex ultrasound imaging. Pulse wave velocity (PWV) and augmentation index (AI) were assessed via applanation tonometry method. Coronary artery calcification (CAC) on multislice computed tomography was scored using the Agatston calcium index (ACI). BMD was measured using by dual-energy X-ray absorptiometry (DXA). The C-terminal telopeptide of type 1 collagen (CTX) was investigated by enzyme-linked immunosorbent assay.

Results

Women with osteoporosis had higher IMT values (p = 0.045), more ASP (p < 0.001), and higher ACI (p < 0.001) than those with normal BMD values. In a multivariate linear regression analysis adjusted for age, duration of postmenopause, BMI, and levels of CTX and ALP in blood serum, we confirmed that ACI makes an independent contribution to the reduction in BMD of all measured parts of the skeleton, while IMT and the presence of ASP contribute to the reduction in BMD of femoral neck.

Conclusion

The results of our study demonstrated an association between vascular calcification, the presence of ASP in the carotid arteries and low bone mass in women without clinical manifestations of atherosclerosis, which is of clinical significance and important for the prevention of both osteoporotic fractures and cardiovascular incidents.

Summary

Femoral artery calcification (FAC) is a significant predictor of hip fractures in hemodialysis patients. A higher FAC score is associated with increased fracture risk and poor survival outcomes. Identifying FAC through radiographic assessment may improve fracture risk stratification and clinical management in this high-risk population.

Purpose

Patients with end-stage renal disease (ESRD) on hemodialysis (HD) are at increased risk for vascular calcification (VC) and bone fractures. While previous studies have linked aortic calcification with hip fractures, the relationship between medium-caliber artery-femoral artery calcification (FAC) and fall-related hip fractures in HD patients remains unclear.

Methods

We retrospectively analyzed 170 HD patients who experienced falls and sought treatment in the emergency department (ED) between 2007 and 2014. The FAC score, representing the severity of femoral artery calcification, was calculated as the ratio of the total length of calcification plaques to the length of the femoral vessel visible on plain radiographs of the hip and femur. A logistic regression model assessed the association between FAC score and hip fracture risk, and receiver operating characteristic curve analysis evaluated its predictive power.

Results

Among the 130 patients meeting inclusion criteria, 55 had fall-related hip fractures. The incidence rate of hip fractures among dialysis patients was 6.18 cases per 1000 person-years by dividing the total number of hip fracture events by the cumulative dialysis duration (in years) of all enrolled patients. Fracture patients were older and had lower serum creatinine, sodium, and albumin levels but higher aspartate aminotransferase levels. The fracture group also had a higher FAC score (0.47 [IQR, 0.28 – 0.76] vs. 0.00 [IQR, 0.00 – 0.40], p < 0.001). Multivariable analysis identified old age, heart failure with reduced ejection fraction (EF), and higher FAC scores as independent risk factors for hip fractures. Survival curves showed increased mortality among patients with higher FAC scores and hip fractures (p < 0.01). Conclusion.

High FAC scores were associated with an increased risk of hip fractures in HD patients, independent of traditional risk factors, and were linked to poor survival outcomes.