Archives of Osteoporosis最新文献

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.

Summary

An electronic survey of 341 UK primary care staff identified barriers to evidence-based osteoporosis care including low confidence in clinical skills, the complex nature of decision-making, insufficient incentivisation and lack of systematic case finding. Opportunities to enhance osteoporosis care may include enhanced education and wider utilisation of the extended workforce.

Purpose

To investigate the beliefs, confidence and practices of general practice staff in the care of people with, or at increased risk of, osteoporotic fractures and the association between professional role and beliefs and confidence about osteoporosis care.

Methods

An electronic survey was designed and distributed to UK general practice staff, including healthcare professionals (HCPs) and non-healthcare professionals (non-HCPs). Content was informed by UK clinical guidelines, a scoping review and patient and clinical stakeholder input. Descriptive statistics and Fisher’s exact test were utilised for analysis, with free text responses analysed using reflexive thematic analysis.

Results

Three hundred forty-one responses were obtained (309 HCPs, 32 non-HCPs). Most responding HCPs (173, 62.2%) and non-HCPs (17, 70.8%) reported osteoporosis management of moderate priority. The majority of HCPs (228, 73.8%) agreed that they were worried about osteoporosis medicines causing unpleasant side effects. Most respondents (314, 98.7%) reported GPs as involved in osteoporosis care, followed by Pharmacists (241, 75.8%) and Practice Nurses (159, 50.0%). GPs and Pharmacists reported the highest level of agreement with confidence in osteoporosis medicine related skills. Fewer than a third of respondents reported systematic invitation of patients with risk factors (fracture, steroids or falls) for assessment. Free text responses indicated problems with communication between primary and secondary care, challenging decision-making, limited access to resources (e.g. DXA scan, dentistry) and insufficient incentivisation as barriers to delivery of recommended osteoporosis care.

Conclusion

Identified opportunities to improve osteoporosis care include improved education, incentivisation, automated case finding and involvement of the wider primary care workforce, particularly Pharmacists.

Summary

This study proposes age- and sex-specific trabecular bone score (TBS) reference curves for Mexican children and adolescents. Using the latest software version, results highlight significant pubertal changes and provide reference data for assessing pediatric bone health, paving the way for a wider use of this technology in children and adolescents.

Purpose

Trabecular Bone Score (TBS) is a grey scale texture measure that correlates with bone microarchitecture derived from dual-energy X-ray absorptiometry (DXA). While extensively studied in adults, limited data exist for pediatric populations. This study aims to develop age- and sex-specific reference curves for TBS adjusted for abdominal soft tissue thickness in healthy children and adolescents from Mexico City.

Methods

This cross-sectional study reanalyzed data from 1552 healthy participants (5–18 years) who underwent lumbar spine DXA scans using Lunar iDXA and TBS iNsight 4.0 (Core Module 19.4.0), which accounts for soft tissue thickness. Generalized Additive Models for Location, Scale, and Shape (GAMLSS) were employed to construct smoothed percentile curves. TBS values were stratified by age, sex, and Tanner stage, with descriptive statistics and outlier exclusions.

Results

TBS showed distinct age- and sex-related trajectories, with steep increases during puberty. Girls demonstrated a sharper rise in TBS starting at age 9, peaking by age 16, while boys exhibited a more gradual increase starting at age 10–11, peaking by age 18. Differences were also observed between Tanner stages, with the most significant changes occurring from stages 2 to 3.

Conclusion

This study proposes the first TBS reference curves for Mexican children and adolescents using the latest software version. This data may prove to be a valuable tool for assessing bone health in pediatric populations. Yet further research to explore TBS’s utility in predicting bone fragility in pediatric population as well as its life-course trends.

Summary

Post-stroke fracture risk necessitates investigation of bone properties and contributing factors. The decline in paretic tibia failure load post-stroke was attributed to decreased trabecular bone density and thickness at 2-year follow-up. Less decline in bone strength was associated with better leg blood flow, walking speed, strength, and activity at baseline.

Purpose

To delineate long-term changes in distal tibia bone properties after stroke and identify their associated factors.

Methods

High-resolution peripheral quantitative computed tomography (HR-pQCT) scans of the bilateral distal tibia were performed in 46 chronic stroke participants (age, 60.4 ± 7.8 years; post-stroke onset, 6.3 ± 4.2 years) and 45 controls (age, 57.7 ± 6.3 years) at baseline and 2 years later. We measured the change in the estimated failure load (indicator of bone strength), volumetric bone mineral density (vBMD), geometry, and microstructure. Blood flow volume of the popliteal artery, muscle strength, sensory function, and gait speed were also assessed.

Results

In the paretic leg of stroke participants, a significant decline in estimated failure load was observed (− 3.39%, p < 0.01), which was greater than that of the non-paretic side (− 1.93%, p < 0.01) and controls (− 1.89 to − 2.18%, p < 0.05). The deterioration in estimated failure load was accompanied by a decline in trabecular vBMD and thickness. Greater arterial blood flow, higher walking velocity, better muscle strength, and higher physical activity level at baseline at 2-year follow-up portended less decline in estimated failure load.

Conclusions

During the 2-year follow-up, there was a decline in estimated failure load of the paretic distal tibia among people with chronic stroke, attributed to a decreased trabecular density and thickness. Greater decline in estimated tibial bone strength was associated with lower arterial blood flow volume and motor function on the paretic side.

Summary

We externally validated the FRISBEE models of 2-year and 5-year fracture risk prediction in 517 women with index fractures. Both models overestimated the fracture risk. Recalibration of the FRISBEE models are needed before use in Norwegian women with recent fractures.

Purpose

We externally validated the Fracture Risk Brussels Epidemiological Enquiry (FRISBEE) groups’ 2-year and 5-year fracture risk models.

Methods

We included women above 50 years with a recent fracture from the consent-based part of the Norwegian Capture the Fracture Initiative study (NoFRACT). They had bone mineral density assessed and filled in a questionnaire including risk factors for fracture at baseline between October 2015 and December 2017. We calculated and validated the 2-year and 5-year fracture risk using the FRISBEE equation models.

Results

Of 517 women aged 65.5 ± 8.6 years with fractures, 94 (18%), 55 (11%), and 31 (6%) sustained a subsequent fracture of any type, major osteoporotic fractures (MOF), or central fracture, during 4.7 ± 1.3 years mean follow-up. The area under the receiver-operating curve (AUC) (95% confidence interval (CI)) for any type of fracture, MOF, and central fracture was 0.57 (0.51–0.63), 0.57 (0.46–0.67), and 0.65 (0.53–0.77), respectively, for the FRISBEE 2-year risk models and 0.57 (0.51–0.64), 0.58 (0.50–0.67), and 0.67 (0.57–0.76) for the FRISBEE 5-year risk models. The calibration slopes (with 95% CI) that compared observed vs. predicted probabilities for fracture across deciles of risk for any type of fracture, MOF, and central fracture were all low: 0.34 (0.02–0.64), 0.33 (− 0.09–0.74), and 0.61 (0.16–1.06), in the FRISBEE 2-year models, and 0.54 (0.13–0.95), 0.43 (0.05–0.80), and 0.69 (0.31–1.08), in the FRISBEE 5-year models.

Conclusion

Overall, the FRISBEE models overestimated both 2-year and 5-year fracture risk. Recalibration is needed before these models can be used in Norwegian women with recent fractures.

Summary

This multicentre, retrospective case series analysed bone mineral density (BMD) changes in 26 patients who switched early from romosozumab (3–10 months) to antiresorptives. BMD gains over 12 months were similar to those in patients (n = 99) completing the full 12-month course.

Background

Romosozumab is typically administered for a duration of 12 months before transitioning to antiresorptive therapies. This study analysed the bone mineral density (BMD) changes of patients who were prematurely switched to an antiresorptive regimen.

Methods

This multicentre, retrospective case series investigated the BMD response to romosozumab administered for 3 to 10 months, followed by subsequent antiresorptive therapy, across four bone centres in Switzerland. BMD measurements at the lumbar spine, total hip and femoral neck were conducted at the initiation of romosozumab and again 12 months later. The study compared the BMD changes in patients who received short-term romosozumab with those in a cohort of patients who completed the full 12-month course.

Results

Twenty-six patients (25 postmenopausal women and one man, median age 73 years [interquartile range: 65, 81]) were enrolled from February 2022 to December 2024. They received a median of six romosozumab injections (range: 3 to 10) and were prematurely switched to antiresorptives (14 to denosumab, 11 to zoledronate and one to alendronate) due to possible side effects or adverse events. Over 12 months, BMD increased by 13.5% [8.6, 16.6] at the lumbar spine, 2.9% [0.3, 7.3] at the total hip and 3.2% [0.4, 7.8] at the femoral neck, without significant differences compared with the cohort of 99 patients who received 12 months of romosozumab therapy. In both the short- and full-duration romosozumab treatment groups, significantly lower BMD responses were observed in patients who were pretreated with antiresorptives compared with those who were treatment naïve.

Conclusion

In patients who underwent an early switch from romosozumab to antiresorptive therapy, BMD responses during the first year were similar to those in patients who completed the full 12-month romosozumab treatment. However, the subsequent changes in BMD, when all patients are receiving antiresorptive therapy, remain to be determined.

Summary

The prevalence of osteoporosis, particularly among the elderly population and postmenopausal women (PMW), remains a significant public health concern. Women aged 50 to 60 years are especially vulnerable to osteoporosis-related bone loss, emphasizing the need for preventative measures and early intervention.

Purpose

This systematic review and meta-analysis aimed to evaluate the impact of aerobic, resistance, and combined training on bone mineral density (BMD) in PMW aged 50 to 60 years.

Methods

A systematic search of six databases (Web of Science, Embase, Cochrane, PubMed, Google Scholar, and Scopus) was conducted. The review was registered in PROSPERO (CRD42024569040). Risk of bias was assessed using the Cochrane RoB 2 tool. A random-effects model was used to calculate mean differences (MDs) and 95% confidence intervals (CIs).

Results

Forty studies with 2,230 participants were included. All exercise modalities significantly improved BMD at the lumbar spine (MD = 0.02 g/cm²; p < 0.001), total hip (MD = 0.01 g/cm²; p < 0.001), femoral neck (MD = 0.01 g/cm²; p < 0.001), trochanter (MD = 0.02 g/cm²; p < 0.001), and total body (MD = 0.00 g/cm²; p = 0.002).

Conclusion

Regular exercise, particularly combined aerobic and resistance training, is an effective non-pharmacological strategy to mitigate bone loss and promote skeletal health in PMW.

Summary

Vertebral fractures (VF) can occur due to childhood-onset lupus nephritis (cLN), which needs long-term use of immunosuppressants that affect bone health. This study found VF in 26.7% of cLN patients. Risk factors included low lumbar spine BMD Z-scores and high disease activity (SLEDAI-2K ≥ 20). Bone-strengthening and disease management strategies are important.

Purpose

Pediatric vertebral fracture (VF) may occur under conditions that lead to decreased bone mass. Childhood-onset lupus nephritis (cLN) requires treatment with glucocorticoids and immunosuppressants. This study aimed to determine the prevalence of and risk factors for VF in patients with cLN.

Methods

Patients with cLN who received glucocorticoids for more than 12 months underwent bone mineral density (BMD) evaluation and vertebral fracture assessment (VFA) via DXA scanning. Lupus disease activity was determined with the SLE Disease Activity Index 2000 (SLEDAI-2K), and scores ≥ 20 were classified as very high. Patients were classified based on the degree of vertebral compression using the Genant grading into two groups: VF (VFA > 20%) and no VF. Logistic regression was conducted to identify risk factors for VF.

Results

Seventy-five patients (67 females, 89%) were enrolled. The average age at diagnosis was 11.5 ± 2.2 years. The mean duration of cLN was 7.9 ± 5.8 years. Twenty patients (26.7%) had VF and 11 (55%) had multiple VFs. The median VFA was 20%, with an anterior compression predominance (84%). A logistic regression model identified two risk factors: a low lumbar spine BMD Z-score (OR 0.48, 95% CI 0.25–0.89, P = 0.02) and a very high SLEDAI-2K score (OR 20.38, 95% CI 1.60–257.89, P = 0.02).

Conclusion

Multiple VFs were prevalent in patients with cLN. The risk of VF increased by 48% with a one-unit decrease in the BMD Z-score and by 20 times with a very high SLEDAI-2K score. A strategy to maintain bone strength and control disease activity should be implemented in patients with cLN.

Summary

Studies using rodent models have demonstrated the ability for probiotics to attenuate estrogen-related bone loss, but findings in humans are limited. Postmenopausal women consuming a novel combination of bacteria strains as a probiotic supplement demonstrated no changes in bone health outcomes.

Purpose

This study determined if a probiotic supplement could attenuate the loss of femoral neck bone mineral density (BMD) and assessed its effect on fracture risk and markers of bone cell activity.

Methods

Seventy-two postmenopausal women (40–59 years) were randomized to a daily probiotic supplement or placebo for 48 weeks. Femoral neck BMD was assessed at weeks 0 and 48 using DXA along with fracture risk using the FRAX® assessment tool. Serum procollagen type 1 N-terminal propeptide (P1NP), bone-specific alkaline phosphatase (BALP), cross-linked C-telopeptide of type I collagen (CTx), and osteocalcin (OC) were analyzed at weeks 0, 12, 24, and 48.

Results

There was no significant time by treatment interaction (p > 0.05) for femoral neck BMD or fracture risk. Independent of treatment, femoral neck BMD decreased (p = 0.034), while risk of hip (p = 0.003) and major osteoporotic fracture (p = 0.044) increased. There was no mean difference in bone marker levels between groups from baseline to endpoint. These findings align with the lack of difference in BMD and fracture risk at the end of study.

Conclusion

Probiotics did not alter BMD or fracture risk, as supported by bone cellular activity that was similar to the placebo group by the end of study.