Additional Risk Factors For Osteoporosis Research Articles

Денситометрическая оценка минеральной плотности костной ткани у пациентов молодого возраста с лимфомой Ходжкина

Hodgkin’s lymphoma is more often diagnosed in young patients. One of the late complications of pathogenetic therapy of Hodgkin’s lymphoma is osteopenia/osteoporosis and the increased risk of low-energy fractures. Conducting densitometry in young patients in order to assess the bone tissue condition is advisable, but its clinical assessment remains difficult. At the same time, early diagnosis and prevention of bone mineral density decrease in patients with Hodgkin’s lymphoma who received antitumor therapy are very relevant. The purpose — to study the features of densitometric indicators for the verification of osteopenia / osteoporosis in young patients with Hodgkin’s lymphoma. Material and methods. 63 people were included in the study, 33 of them were patients with Hodgkin’s lymphoma who received pathogenetic therapy, and 30 people the control group — healthy volunteers. Bone mineral density was measured in all patients using the HOLOGIC (Hologic Inc., Bedford) in the lumbar spine (L1–L4) and in the hip area (the total area of the hip and hip neck). Criteria such as minimum bone mineral density, T-criteria and Z-criteria for young patients with Hodgkin’s lymphoma were determined. Results. In the group of patients with Hodgkin’s lymphoma, a decrease in bone mineral density is significantly more often recorded in all measurement areas, as well as the Z-criterion in the lumbar spine. Regretfully, in young patients the T-criterion can only be used given a more intensive mineralization of bone tissue than in older people and the presence of additional risk factors for osteoporosis (PCTs, glucocorticosteroids, decreased androgenic and fertile function). In patients with HL who received pathogenetic therapy, a decrease in the T-criterion to osteopenia is more often observed in the proximal femur. Conclusion. In many cases, modern capabilities for osteoporosis diagnostic allow correcting mineral metabolism in bone tissue and preventing the development of complications in young patients with Hodgkin’s lymphoma.

Review of the Long-Term Effect of the Atypical Antipsychotic Medication on the Bone Mineral Density of the Pediatric Patient with Consideration of Autism Spectrum Disorder

Objectives: To shed some light on the understudied complication of chronic prolonged exposure to antipsychotics (AP) in children with consideration to with autism spectrum disorder (ASD). Methods: We electronically searched PubMed, Google Scholar, clinical trial.gov, and Medline Database of clinical studies up to June 2021. We used the following keywords: “bone mineral density, osteoporosis, osteopenia, bone loss, bone changes” AND “antipsychotics, SGAs, atypical antipsychotics” AND “pediatric, adolescent, young, youth, children.” We used [Mesh] Term for “antipsychotics agent” and “bone mineral density” and “autism spectrum disorder” and “child.” We retrieved relevant observational studies, reviews, case series, and randomized clinical trials. Results: Yvette Roke et al., in 2012, reported in a retrospective observational study that lumbar spine bone mineral density (BMD) and the biochemical bone marker were lower in the AP-treated boy with hyperprolactinemia in comparison to the non-AP-treated group, while a retrospective observational study of institutional adolescents with a psychiatric condition, carried out by Bonnot et al. in 2011, found significant vitamin D deficiency in psychiatric inpatient adolescents that is unrelated to the specific APs. Third, Calarge et al. in a 2010 retrospective observational study have reported a significant reduction in BMD in adolescents with risperidone-induced hyperprolactinemia and selective serotonin reuptake inhibitor (SSRI) compared to another group with risperidone-induced hyperprolactinemia without SSRI. On the other hand, Nivin A. Nagiub et al. (2019) in the cross-sectional study found no correlation between BMD and AP use in children with ASD. Houghton et al., in 2021, found a high fracture prevalence of 38% with aripiprazole compared to risperidone in children with ASD. Conclusion: Clinicians should be aware of the potential negative effects of APs on BMD, considerably in children with ASD that has additional risk factors for osteoporosis and bone disease. A provider needs to utilize more sensitive screening and diagnostic tools; the pediatric physician should evaluate other risk factors to prevent early osteopenia and bone fracture in children with ASD who are on chronic psychotropic medication, before adjusting to the AP medication.

Chronic urticaria and osteoporosis

Osteoporosis is a condition in which the bones are thinner and more liable to fracture. It is commoner in women and in people over 50. It cannot be cured so the focus is on prevention, which means identifying and addressing risk factors such as obesity, low vitamin D, chronic inflammation and prolonged steroid medication. Chronic urticaria (hives, CU) is an inflammatory condition, so one might expect it to be linked with osteoporosis, but that has never been investigated. If people with CU are indeed more likely to develop osteoporosis, they could be advised about preventative measures. To study this, doctors from Israel identified 11,944 patients diagnosed with CU in a large medical database covering 4.5 million people. A potential difficulty was that people with CU are more likely to be female, obese and to have been treated with systemic steroids, all of which also increase the risk of osteoporosis. Therefore for each CU patient they studied 5 age‐ and sex‐matched control patients (people of the same age and sex but without CU) and their analyses took into account other known risk factors for osteoporosis. During a 16 year period 8.7% of the patients with CU were diagnosed with osteoporosis compared with 6.8% of the controls. They concluded that CU is a small but significant additional risk factor for osteoporosis. An accompanying editorial cautions against basing conclusions on routine health records which may not have all the information required. Nonetheless, doctors treating chronic urticaria might bear in mind the risk of osteoporosis in their patients, and counsel accordingly.

Hyponatremia Is Associated With Increased Osteoporosis and Bone Fractures in Patients With Diabetes With Matched Glycemic Control.

ContextPatients with diabetes mellitus are at increased risk for bone fragility fracture secondary to multiple mechanisms. Hyperglycemia can induce true dilutional hyponatremia. Hyponatremia is associated with gait instability, osteoporosis, and increased falls and bone fractures, and studies suggest that compromised bone quality with hyponatremia may be independent of plasma osmolality. We performed a case-control study of patients with diabetes mellitus matched by median glycated hemoglobin (HbA1c) to assess whether hyponatremia was associated with increased risk of osteoporosis and/or fragility fracture.DesignOsteoporosis (n = 823) and fragility fracture (n = 840) cases from the MedStar Health database were matched on age of first HbA1c ≥6.5%, sex, race, median HbA1c over an interval from first HbA1c ≥6.5% to the end of the encounter window, diabetic encounter window length, and type 1 vs type 2 diabetes mellitus with controls without osteoporosis (n = 823) and without fragility fractures (n = 840), respectively. Clinical variables, including coefficient of glucose variation and hyponatremia (defined as serum [Na+] <135 mmol/dL within 30 days of the end of the diabetic window), were included in a multivariate analysis.ResultsMultivariate conditional logistic regression models demonstrated that hyponatremia within 30 days of the outcome measure was independently associated with osteoporosis and fragility fractures (osteoporosis OR 3.09; 95% CI, 1.37 to 6.98; fracture OR, 6.41; 95% CI, 2.44 to 16.82).ConclusionsOur analyses support the hypothesis that hyponatremia is an additional risk factor for osteoporosis and fragility fracture among patients with diabetes mellitus.

Osteoporosis, bone mineral density and CKD-MBD: treatment considerations.

Osteoporosis and chronic kidney disease (CKD) have both independently important potential impact on bone health. A significant number of patients with CKD stages 3a-5D have been shown to have low bone mineral density (BMD), leading to a strikingly elevated risk of fractures (mainly hip fractures) and higher associated morbidity and mortality. Mechanical properties of bone beyond age and menopausal status are additionally affected by intrinsic uremic factors. Therefore, we review in this article not only general concepts of osteoporosis and related consequences, but also the diagnostic and therapeutic implications of low BMD and bone fractures in CKD, beyond increased vascular calcification. Antiresorptive agents (mainly bisphosphonates) were not previously recommended when the estimated glomerular filtration rate (GFR) was lower than 30ml/min/1.73m2. However, post-hoc analysis of large randomized clinical trials found that these drugs (i.e. alendronate, ribandronate, denosumab) had comparable efficacy in improving BMD and reducing fracture risk in individuals (mainly women) with moderate reductions of GFR (mostly CKD stages 3-4). Therefore, at least in the absence of clear abnormalities of CKD-related mineral metabolism disturbances, bone antiresorptive agents (and maybe anabolic agents) that are or will be approved for general osteoporosis may be appropriate for CKD. Nephrologists should probably not ignore any longer fracture risk assessment, especially in patients with additional risk factors for osteoporosis if results will impact treatment decisions. However, although different therapeutic agents have been shown to reduce the risk of fracture in CKD patients with low BMD, specific prospective studies, with or without bone biopsies, in CKD are urgently needed.

PTU-155 Investigation of the relationship between age, gender, body mass index (BMI) and bone mineral density (BMD) as assessed by dual-energy x-ray absorptiometry (DXA) of the spine and left femur in newly diagnosed patients with coeliac disease (CD)

Introduction CD is a risk factor for osteoporosis and low BMD (osteopenia). Present national guidelines (BSG 2007) do not identify young patients with CD as being at risk of low BMD. Few studies have investigated BMD in coeliac patients below 40 years of age. This audit analysed the DXA results of newly diagnosed coeliac patients attending a coeliac clinic. Method BMD (age matched Z-scores) as assessed by DXA in consecutive patients with CD between 2013 and 2014 were compared for age, gender and BMI (majority ≤12 months of diagnosis). Low BMD was defined locally as: Z-score -1.5. This compares to WHO criteria for osteopenia: T-score of -2.5 and osteoporosis: T-score of ≤-2.5. Results Conclusion Current UK guidelines (BSG 2007) recommend that BMD should be measured in coeliac patients after 1 year of a gluten-free diet (GFD) in patients who have additional risk factors for osteoporosis or if over 55 years. We found 28% of patients Disclosure of interest None Declared. Reference British Society of Gastroenterology (BSG). Guidelines for osteoporosis in inflammatory bowel disease and coeliac disease, 2007

AB0812-PC Clinical and epidemiological characteristics of women with breast cancer and aromatase inhibitors treatment who presented hip fracture between 2008-2010

BackgroundThe main source of estrogen is produced in peripheral tissues in post-menopausal women. Due to this, lowering estrogen production at peripheral tissues with aromatase inhibitors might be an additional risk...

Vitamin D insufficiency together with high serum levels of vitamin A increases the risk for osteoporosis in postmenopausal women

Postmenopausal women who were vitamin D deficient and had high serum levels of retinol had an eight times higher risk of having osteoporosis. A high retinol level together with vitamin D deficiency/insufficiency is an additional risk factor for osteoporosis. The aim of this study was to evaluate the association between vitamin D deficiency/insufficiency and excess of vitamin A intake as an osteoporosis risk factor in healthy postmenopausal women The design is a cross-sectional study of 232 healthy postmenopausal women. Bone mass was evaluated by dual energy X-ray absorptiometry. Serum calcium, albumin phosphorus, creatinine, total high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, and triglycerides analyzed by standard methods and retinol and 25-hydroxyvitamin D [25(OH)D] measured by an online solid-phase extraction coupled with high-pressure liquid chromatography-ultraviolet detection. Prevalence of vitamin D deficiency [25(OH)D < 20ng/mL] was 70.1%; 14.3% had a 25(OH)D < 10ng/mL, and 23.6% had insufficiency [25(OH)D 21-29ng/mL]. Prevalence of high serum levels of retinol (>80μg/dL) was 36.4%. Among subjects with 25(OH)D <20ng/mL (n = 152), 60.4% (n = 92) had serum levels of retinol > 80μg/dL. Bone density measurements revealed that the risk of osteoporosis was ~8 times higher in women with the highest retinol levels, as compared with women with the lowest retinol levels. In women with 25(OH)D < 20ng/mL, the risk for osteoporosis increased substantially in women who had the highest blood levels of retinol compared to the women with lowest retinol levels. Higher retinol levels together with vitamin D deficiency could be a significant additional risk factor for osteoporosis, underscoring the need for improved physician and public education regarding optimization of vitamin D status in postmenopausal women and developing policies to avoid high serum levels of vitamin A.

Canadian Association of Gastroenterology Position Statement: Hip Fracture and Proton Pump Inhibitor Therapy – a 2013 Update

Health Canada recently provided an information update on proton pump inhibitor (PPI) therapy and risk of fracture in April 2013 (1) stating “Several scientific studies suggest that PPI therapy may be associated with a small increased risk for fractures of the hip, wrist, or spine related to osteoporosis, a disease resulting in the weakening of bones. The risk of fracture was higher in patients who received multiple daily doses of PPIs and therapy for a year or longer. Additional risk factors for osteoporosis, such as age, gender and the presence of other health conditions, may also contribute to the increased risk of fractures. At Health Canada’s request, manufacturers of all PPIs marketed in Canada have updated the drug labels for their products to include information on this risk.” The Canadian Association of Gastroenterology (CAG) provided a position statement on PPI therapy and risk of hip fracture in 2008 (2) and we have updated this in light of the recent Health Canada statement. Large administrative databases are a useful tool to assess possible benefit or harms of health care interventions; however, given that billions of associations can be measured with these databases, highly statistically significant findings will inevitably occur by chance. Added to this problem is that any association may simply be due to confounding factors and not due to the health care intervention causing the disease (eg, a database study may find that steroid inhaler therapy increases the risk of lung cancer but this may simply be due to smokers being more likely to have lung disease [and be given steroid inhalers] and smoking causes lung cancer). Associations between health care interventions and risk of harm are, therefore, being reported almost every week and it is, therefore, very difficult for the clinician to know what associations are likely to be causal and what are likely to be spurious. There is no simple answer to this problem because epidemiological data can never prove or disprove a hypothesis. Hill (3) described nine factors that make an association more likely to be causal. We have previously evaluated the evidence for PPI therapy and risk of fracture according to the most important of these factors, namely, strength of the association, biological plausibility, specificity, consistency of the association and evidence of a dose response relationship (4). We have conducted an updated systematic review evaluating PPI therapy and risk of fracture that will be submitted to a peer reviewed journal and have used these data to assess the CAG’s position on the use of PPI therapy and risk of fracture.

Is antipsychotic treatment linked to low bone mineral density and osteoporosis? A review of the evidence and the clinical implications

Osteoporosis is increasingly common worldwide and there is a growing concern that the long-term use of antipsychotic medications increases the risk of this disorder. In this review, we consider whether antipsychotics may contribute to the development of osteoporosis through reductions in bone mineral density, discuss the possible mechanisms involved and consider the clinical implications of such a relationship. We searched the literature for studies in this area published between 1966 and 2010 using the Medline and PubMed databases, supplemented by hand searches of retrieved reports. The available data indicate that statistically significant reductions in bone mineral density are frequently seen in patients prescribed with antipsychotic medications and suggest that there is a higher incidence of clinically significant reductions compared with the normal population. Clinicians should be aware for the potential negative effects of antipsychotic medications on bone mineral density, particularly in patients with additional risk factors for osteoporosis. Recommendations regarding routine monitoring of bone mineral density for patients prescribed antipsychotic medications cannot be made on the basis of existing evidence, and more research is required.

Hyperhomocysteinemia Due to Levodopa Treatment as a Risk Factor for Osteoporosis in Patients with Parkinson’s Disease

Parkinson's disease (PD) patients have been reported to have lower bone mineral density (BMD) and higher fracture risk than individuals without PD. We assessed the association between hyperhomocysteinemia due to levodopa intake and BMD in PD patients. We measured serum homocysteine (Hcy) concentrations and BMD in the proximal femur and lumbar spine of PD patients aged 55 years or older (n = 95) and three age-/gender-matched control subjects (n = 285). The prevalence of osteoporosis was higher in both men (2.5-fold) and women (1.7-fold) with PD than in controls, and adjusted odds ratios for osteoporosis were 3.57 (95% confidence interval [CI], 1.25-10.20) for men and 2.54 for women (95% CI, 1.31-4.93) with PD. Serum Hcy concentrations were significantly higher in PD patients (median = 13.0 micromol/l) than controls (median = 11.5 micromol/l) (P = 0.005). Serum Hcy concentrations were independently associated with BMD values at all proximal femur sites in all subjects (P = 0.005 to 0.012). In PD patients, higher serum Hcy concentrations were independently associated with higher fracture risk (P = 0.029). PD patients taking higher doses of levodopa had significantly higher serum Hcy concentrations (P = 0.013), and greater levodopa intake was associated with lower BMD values in some areas (P = 0.008 to 0.029). In conclusion, these findings indicate that hyperhomocysteinemia due to levodopa intake may be one additional risk factor for osteoporosis and fracture in PD patients. Reducing Hcy may be a therapeutic modality for treating osteoporosis in PD patients taking levodopa.

NCCN Task Force Report: Bone Health and Cancer Care

Higher incidences of osteoporosis and osteopenia are found in cancer patients, particularly in women receiving aromatase inhibitors or with chemotherapy-induced ovarian failure, or in men with prostate cancer and androgen deprivation therapy. Therefore, management of long-term bone health is emerging as an important aspect of comprehensive cancer care. Patients with cancer typically have a number of additional risk factors for osteoporosis that should prompt screening, regardless of patient age or sex. Maintaining bone health requires a broad knowledge base, including understanding underlying bone metabolism and how it is affected by both cancer itself and the drugs used to treat cancer, the effect of chemotherapy-induced menopause on bone health, bone markers and imaging techniques used to assess bone health, therapeutic strategies to maintain bone health, and treatment of bone metastases, including surgery for pathologic fractures. Multiple members of the healthcare team may need to be involved in education and care of the patient. This report summarizes discussion of these and other issues regarding bone health and cancer care from the NCCN Bone Health and Cancer Care Task Force meeting in early 2006. (JNCCN 2006;4(Suppl 2):S1-S24)

Smokeless tobacco use accelerates age-related loss of bone mineral density among older women in a multi-ethnic rural community

Cigarette smoking is a recognized risk factor for low bone mineral density (BMD) and osteoporosis. Despite the prevalence of smokeless tobacco (ST) use by women in some areas of the United States, minority groups in the United Kingdom, and populations in South Asia and Africa, no data exist to evaluate its effect on bone health. The objective of the study is to identify risk factors for low BMD among older women in a multi-ethnic population, with particular attention to smoking and ST use. Data were collected in Robeson County, North Carolina. ST use from childhood is common among women in this community. Two hundred-forty women aged 60 years and older (approximately equal numbers of African Americans, Native Americans and whites) were recruited at a variety of community events to obtain a cross-section of the demographic composition of the county. The main outcome was BMD measured in the heel using a portable dual energy x-ray absorptiometry. Twenty-nine percent of women were current or former smokers, and 26% current or former ST users. Increased BMD was predicted by greater body mass index, estrogen use in the past year, and African American and Native American ethnicity. There was a significant interaction between ST use and age, and between smoking and nutritional supplement use. BMD declined with age; the decline with age was greater for women who were current or former ST users than for those who never used ST. Women who formerly smoked and did not use supplements had a decreased BMD. ST should be considered as an additional risk factor for osteoporosis in populations where its use is prevalent.

Osteoporosis Screening and Education in Community Pharmacies Using a Team Approach

To develop a model for osteoporosis screening and education in community pharmacies using a team approach, compare bone mineral density T-scores between quantitative ultrasound (QUS) and dual-energy x-ray absorptiometry (DXA), and determine patient satisfaction with this pharmacist-provided osteoporosis screening and education program. Prospective, cross-sectional study. Community pharmacies and outpatient family medicine, internal medicine, and obstetrics and gynecology clinics in Amarillo, Texas. Women aged 55 years or older with no previous diagnosis of osteoporosis or osteopenia who had at least one additional risk factor for osteoporosis and had not been screened in the previous 3 years. Patients were referred from family medicine, internal medicine, and obstetrics and gynecology clinics to a community pharmacy. Osteoporosis screening using heel QUS and education regarding disease prevention and treatment were provided by pharmacists. Screening results, recommendations for confirmatory DXA, and potential treatments options were provided to the referring physicians. A total of 100 patients (mean age 66.2+/-7.9 yrs) were enrolled in the study; three were subsequently excluded. Of the 97 study patients who were screened using QUS, 45 (46%) patients were at moderate risk (T-score<-1 to>-2.5) and nine (9%) were at high risk (T-score<or=-2.5). Of 54 patients recommended for DXA referral, 20 (37%) completed the scan. All 20 were diagnosed with either osteopenia (9 patients [45%]) or osteoporosis (11 patients [55%]). Correlation was moderate between T-scores obtained by QUS and DXA of lumbar vertebrae 1-4 (r=0.45, p=0.026). Counseling regarding risk factors, screening results, smoking cessation, calcium intake, exercise, and caffeine intake was perceived by patients as valuable or highly valuable (medians for all items ranged from 4-5 on a 5-point Likert scale). Of 84 patients assessed (13 were lost to follow-up), 81 (96%) said they would recommend this service to others. Osteoporosis screening and education in community pharmacies are effective in detecting undiagnosed disease and are perceived by patients as highly useful.

Osteoporosis Screening and Education in Community Pharmacies Using a Team Approach

Study Objectives. To develop a model for osteoporosis screening and education in community pharmacies using a team approach, compare bone mineral density T-scores between quantitative ultrasound (QUS) and dual-energy x-ray absorptiometry (DXA), and determine patient satisfaction with this pharmacist-provided osteoporosis screening and education program. Design. Prospective, cross-sectional study. Setting. Community pharmacies and outpatient family medicine, internal medicine, and obstetrics and gynecology clinics in Amarillo, Texas. Patients. Women aged 55 years or older with no previous diagnosis of osteoporosis or osteopenia who had at least one additional risk factor for osteoporosis and had not been screened in the previous 3 years. Intervention. Patients were referred from family medicine, internal medicine, and obstetrics and gynecology clinics to a community pharmacy. Osteoporosis screening using heel QUS and education regarding disease prevention and treatment were provided by pharmacists. Screening results, recommendations for confirmatory DXA, and potential treatments options were provided to the referring physicians. Measurements and Main Results. A total of 100 patients (mean age 66.2 + 7.9 yrs) were enrolled in the study; three were subsequently excluded. Of the 97 study patients who were screened using QUS, 45 (46%) patients were at moderate risk (T-score < −1 to > −2.5) and nine (9%) were at high risk (T-score ≤ −2.5). Of 54 patients recommended for DXA referral, 20 (37%) completed the scan. All 20 were diagnosed with either osteopenia (9 patients [45%]) or osteoporosis (11 patients [55%]). Correlation was moderate between T-scores obtained by QUS and DXA of lumbar vertebrae 1–4 (r=0.45, p=0.026). Counseling regarding risk factors, screening results, smoking cessation, calcium intake, exercise, and caffeine intake was perceived by patients as valuable or highly valuable (medians for all items ranged from 4–5 on a 5-point Likert scale). Of 84 patients assessed (13 were lost to follow-up), 81 (96%) said they would recommend this service to others. Conclusion. Osteoporosis screening and education in community pharmacies are effective in detecting undiagnosed disease and are perceived by patients as highly useful.

Osteoporosis in systemic lupus erythematosus: prevention and treatment.

The patient with systemic lupus erythematosus (SLE) is at risk of osteoporosis through several factors: the inflammatory disease itself, disease-related co-morbidity, and its treatment. Bone loss is apparent early in the disease and this may be confounded primarily by treatment with corticosteroids. Patients should be assessed for additional risk factors for osteoporosis and general lifestyle measures adopted. Bone mineral density measurement should be considered in SLE patients at high risk of osteoporosis, particularly those starting corticosteroids and in postmenopausal women. Calcium and vitamin D supplementation provide general prophylaxis and are a suitable first-line option. Hormone replacement should be used in hypogondal subjects unless contra-indicated. In subjects at high fracture risk, particularly in postmenopausal women, bisphosphonate therapy should be considered as these agents have been shown to significantly reduce vertebral fracture risk. These measures should reduce the burden of osteoporosis and fracture in patients with lupus.