Decrease Fracture Risk Research Articles

Plasma phospholipid fatty acids and fish-oil consumption in relation to osteoporotic fracture risk in older adults: the Age, Gene/Environment Susceptibility Study

Polyunsaturated fatty acids (PUFAs) may play a role in fracture, but studies have been largely confined to estimates of dietary intake. We aimed to examine associations between fatty acids measured in late life and fish-oil consumption in early life, midlife, and late life with osteoporotic fracture risk. Osteoporotic fractures were determined from medical records over 5-9 y of follow-up in men and women aged 66-96 y. Data were analyzed from 1438 participants including 898 participants who were randomly selected from the Age, Gene/Environment Susceptibility Study, which is an observational study, and 540 participants with incident fracture. Plasma phospholipid fatty acids were assessed by using gas chromatography. Fish-oil consumption was assessed by using validated questionnaires as never (referent), less than daily, or daily. HRs and 95% CIs adjusted for age, education, height, weight, diabetes, physical activity, and medications were estimated by using Cox regression. In men, the highest tertile of PUFAs, n-3 (ω-3), and eicosapentaenoic acid were associated with decreased fracture risk [HRs (95% CIs): 0.60 (95% CI: 0.41, 0.89), 0.66 (0.45, 0.95), and 0.59 (0.41, 0.86), respectively]. In women, PUFAs tended to be inversely associated with fracture risk (P-trend = 0.06), but tertiles 2 and 3 were not independently associated with risk. Tertile 2 of n-6 and arachidonic acid was associated with fracture risk in women [HRs (95% CIs): 1.43 (1.10, 1.85) and 1.42 (1.09, 1.85), respectively]. Daily fish-oil consumption in late life was associated with lower fracture risk in men (HR: 0.64; 95% CI: 0.45, 0.91). Daily fish-oil consumption in midlife was associated with lower fracture risk in women (HR: 0.75; 95% CI: 0.58, 0.98). Greater PUFA concentrations may be associated with lower osteoporotic fracture risk in older adults, particularly in men. Critical time periods for n-3 fatty acid consumption may differ by sex.

ZFN-mediated genome editing of albumin “safe harbor” in vivo results in supraphysiological levels of human IDS, IDUA and GBA in mice

Skeletal complications, particularly fracture, can be one of the most debilitating consequences of Gaucher disease (GD). Understanding the risk factors for fracture and the relationship to timing of initiation of treatment is important for successful evaluation and management of patients. The International Collaborative Gaucher Group (ICGG) Gaucher Registry is a multinational, observational study (sponsored by Genzyme, a Sanofi company, Cambridge, MA) that captures clinical outcomes in both treated and untreated GD patients. Descriptive statistics and an adjusted logistic regression model were used to evaluate demographics and risk factors in patients enrolled in the ICGG Registry with GD type 1who had experienced a fracture. A total of 4047 patients with GD type 1 in the ICGG Registry who had received imiglucerase had sufficient bone and splenectomy data for analyses. Of these, 46% were male, the median age of diagnosis was 15 years of age, and 336 patients (8%) had experienced a fracture during treatment. Splenectomized patients were nearly twice as likely to have a fracture compared to those who were not (OR 1.930; p = b0.0001). The presence of bone pain or bone crisis (acute pain requiring immobilization, narcotics, and accompanied by periosteal elevation, elevated WBC count, fever and/or debilitation of N3 days) was a predictor of fracture, even if reported considerably prior to the fracture itself. Patients with bone pain were 2.5 times more likely to have a fracture (OR 2.683; p = b0.0001); those with bone crises were nearly twice as likely (OR 1.739; p = b0.0004). Additionally, early treatment decreased fracture risk. Patients who did not begin treatment until after the age of 25 were 30% (OR 1.373; p = 0.0132) more likely to have a fracture. The 3711 patients who did not have a fracture were diagnosed (median age: 14 years) and treated (median age: 27 years) younger than the 336 with a fracture who were diagnosed (median age: 17.5 years) and treated (median age: 37 years) later. Understanding risk factors, symptoms, and treatment patterns is important to avoid potential fractures. Splenectomy, bone pain, and bone crisis substantially elevate risk of fractures in patients on therapy, and should be considered early warning signs. Younger age at treatment initiation lowers the risk of fracture, suggesting that developing bone pathologymay be interrupted when early treatment is provided.

Predictors of fracture in treated Gaucher disease patients

Skeletal complications, particularly fracture, can be one of the most debilitating consequences of Gaucher disease (GD). Understanding the risk factors for fracture and the relationship to timing of initiation of treatment is important for successful evaluation and management of patients. The International Collaborative Gaucher Group (ICGG) Gaucher Registry is a multinational, observational study (sponsored by Genzyme, a Sanofi company, Cambridge, MA) that captures clinical outcomes in both treated and untreated GD patients. Descriptive statistics and an adjusted logistic regression model were used to evaluate demographics and risk factors in patients enrolled in the ICGG Registry with GD type 1who had experienced a fracture. A total of 4047 patients with GD type 1 in the ICGG Registry who had received imiglucerase had sufficient bone and splenectomy data for analyses. Of these, 46% were male, the median age of diagnosis was 15 years of age, and 336 patients (8%) had experienced a fracture during treatment. Splenectomized patients were nearly twice as likely to have a fracture compared to those who were not (OR 1.930; p = b0.0001). The presence of bone pain or bone crisis (acute pain requiring immobilization, narcotics, and accompanied by periosteal elevation, elevated WBC count, fever and/or debilitation of N3 days) was a predictor of fracture, even if reported considerably prior to the fracture itself. Patients with bone pain were 2.5 times more likely to have a fracture (OR 2.683; p = b0.0001); those with bone crises were nearly twice as likely (OR 1.739; p = b0.0004). Additionally, early treatment decreased fracture risk. Patients who did not begin treatment until after the age of 25 were 30% (OR 1.373; p = 0.0132) more likely to have a fracture. The 3711 patients who did not have a fracture were diagnosed (median age: 14 years) and treated (median age: 27 years) younger than the 336 with a fracture who were diagnosed (median age: 17.5 years) and treated (median age: 37 years) later. Understanding risk factors, symptoms, and treatment patterns is important to avoid potential fractures. Splenectomy, bone pain, and bone crisis substantially elevate risk of fractures in patients on therapy, and should be considered early warning signs. Younger age at treatment initiation lowers the risk of fracture, suggesting that developing bone pathologymay be interrupted when early treatment is provided.

Osteoporosis after renal transplantation

Bone loss and fracture are serious sequelae of kidney transplantation, associated with morbidity, mortality and high economic costs. The pathogenesis of post-transplantation bone loss is multifactorial and complex. Pre-existing bone mineral disease is responsible for a significant part, but it is aggravated by risk factors emerging after renal transplantation with immunosuppressive agents being one of the key contributors. The decrease in bone mass is particularly prominent during the first 6-12 months after transplantation, continuing at a lower rate thereafter. Bone mineral density measurements do not predict bone histology and bone biopsy findings reveal heterogeneous lesions, which vary according to time after transplantation. Currently, vitamin D and bisphosphonates are the most extensively tested therapeutic agents against this accelerated bone loss in renal transplant recipients. Both of these agents have proven effective, but there is no evidence that they decrease fracture risk. More studies are needed to examine the complex pathophysiologic mechanisms implicated in this population, as well as the effects of different therapeutic interventions on bone disorders after kidney transplantation.

Application of self-efficacy theory in patients of diabetic osteoporosis

To investigate the impact of self-efficacy theory health education in patients of diabetic osteoporosis. We used SPSS 19.0 software to generate random numbers and 260 diabetic osteoporosis patients were randomly divided into an observation group and a control group. There was 130 patients in observation group, 130 in control group. The self-efficacy theory health education was carried out in observation group, and routine health education in control group. SF-36 questionnaire was used to assess the quality of life. Osteoporosis self-efficacy scale (OSES) was used to assess self-efficacy. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry. Blood glucose was detected by glucose oxidase method. Glycosylated hemoglobin was detected by high efficiency liquid chromatography to estimate the index change before intervention and after one year's follow up. The number of patients that had completed follow-up was 104 in control group and 107 in observation group. The self-efficacy scores, movement efficiency scores and calcium intake efficiency scores were all higher in intervention group ((82.25 ± 13.54) , (79.26 ± 15.37) , (84.39 ± 17.09) points) than which in the control group ((71.14 ± 14.19), (63.89 ± 19.87), (75.24 ± 10.70) points) after one year's follow up, there were significant differences in two groups (t values were 6.04, 7.95, 5.77, all P values<0.05). The scores of quality of life in the dimension of general health, vitality, social function, role emotional and mental health were all higher in intervention group ((75.29 ± 14.90) , (68.61 ± 17.38) , (75.74 ± 18.50) , (71.22 ± 17.93) , (73.69 ± 14.40 ) points) than in the control group ( (44.25 ± 11.01) , (47.39 ± 18.90) , (63.54 ± 15.95), (49.04 ± 19.36), (55.15 ± 19.74) points), there were significant differences in two groups (t values were 8.45, 8.83, 6.92, 8.79, 8.05, all P values<0.05) . Fasting blood-glucose 2 hour postprandial blood glucose and glycosylated hemoglobin were all lower in intervention group ((7.29 ± 1.81) mmol/L, (8.21 ± 2.37) mmol/L, (6.59 ± 0.92) %) than in the control group ((8.53 ± 1.66) mmol/L, (9.41 ± 3.30) mmol/L, (7.66 ± 1.50) %) , there were significant differences in two groups (t values were 5.33, 4.67, 5.49, all P values<0.05). There were 1 (0.93%) fracture case in observation group and 7 (6.73%) cases in control group during one year's follow up, there are significant difference in two groups (χ(2) = 4.86, P = 0.028). The self-efficacy theory health education may improve the quality of life and decreased fracture risk of diabetic osteoporosis patients.

Reduction in Proximal Femoral Strength in Patients With Acute Spinal Cord Injury

Bone loss after spinal cord injury (SCI) is associated with an increased risk of fracture resulting from minor trauma. Proximal femoral fractures account for approximately 10% to 20% of the fractures in this population and are among the most serious of injuries. Our purpose was to quantify changes to proximal femoral strength in patients with acute SCI. Thirteen subjects received dual-energy X-ray absorptiometry (DXA) and clinical computed tomography (CT) scans at serial time points during acute SCI separated by a mean of 3.5 months (range 2.6 to 4.8 months). Areal bone mineral density (aBMD) at the proximal femur was quantified from DXA, and proximal femoral strength was predicted using CT-based finite element (FE) modeling in a sideways fall configuration. During the acute period of SCI, femoral neck and total proximal femur aBMD decreased by 2.0 ± 1.1%/month (p < 0.001) and 2.2 ± 0.7%/month (p < 0.001), respectively. The observed reductions in aBMD were associated with a 6.9 ± 2.0%/month (p < 0.001) reduction in femoral strength. Thus, changes in femoral strength were some 3 times greater than the observed changes in aBMD (p < 0.001). It was interesting to note that in just 3.5 months of acute SCI, reductions in strength for some patients were on the order of that predicted for lifetime declines owing to aging. Therefore, it is important that therapeutic interventions are implemented soon after SCI in an effort to halt bone loss and decrease fracture risk. In addition, clinicians utilizing DXA to monitor bone health after SCI should be aware of the potential discrepancy between changes in aBMD and strength.

Bone cell-independent benefits of raloxifene on the skeleton: A novel mechanism for improving bone material properties

Raloxifene is an FDA approved agent used to treat bone loss and decrease fracture risk. In clinical trials and animal studies, raloxifene reduces fracture risk and improves bone mechanical properties, but the mechanisms of action remain unclear because these benefits occur largely independent of changes to bone mass. Using a novel experimental approach, machined bone beams, both from mature male canine and human male donors, were depleted of living cells and then exposed to raloxifene ex vivo. Our data show that ex vivo exposure of non-viable bone to raloxifene improves intrinsic toughness, both in canine and human cortical bone beams tested by 4-point bending. These effects are cell-independent and appear to be mediated by an increase in matrix bound water, assessed using basic gravimetric weighing and sophisticated ultrashort echo time magnetic resonance imaging. The hydroxyl groups (OH) on raloxifene were shown to be important in both the water and toughness increases. Wide and small angle X-ray scattering patterns during 4-pt bending show that raloxifene alters the transfer of load between the collagen matrix and the mineral crystals, placing lower strains on the mineral, and allowing greater overall deformation prior to failure. Collectively, these findings provide a possible mechanistic explanation for the therapeutic effect of raloxifene and more importantly identify a cell-independent mechanism that can be utilized for novel pharmacological approaches for enhancing bone strength.

Cortical bone loss at the tibia in postmenopausal women with osteoporosis is associated with incident non-vertebral fractures: Results of a randomized controlled ancillary study of HORIZON

BackgroundIn postmenopausal women, yearly intravenous zoledronate (ZOL) compared to placebo (PLB) significantly increased bone mineral density (BMD) at lumbar spine (LS), femoral neck (FN), and total hip (TH) and decreased fracture risk. The effects of ZOL on BMD at the tibial epiphysis (T-EPI) and diaphysis (T-DIA) are unknown. MethodsA randomized controlled ancillary study of the HORIZON trial was conducted at the Department of Osteoporosis of the University Hospital of Berne, Switzerland. Women with ≥1 follow-up DXA measurement who had received ≥1 dose of either ZOL (n=55) or PLB (n=55) were included. BMD was measured at LS, FN, TH, T-EPI, and T-DIA at baseline, 6, 12, 24, and 36 months. Morphometric vertebral fractures were assessed. Incident clinical fractures were recorded as adverse events. ResultsBaseline characteristics were comparable with those in HORIZON and between groups. After 36 months, BMD was significantly higher in women treated with ZOL vs. PLB at LS, FN, TH, and T-EPI (+7.6%, +3.7%, +5.6%, and +5.5%, respectively, p<0.01 for all) but not T-DIA (+1.1%). The number of patients with ≥1 incident non-vertebral or morphometric fracture did not differ between groups (9 ZOL/11 PLB). Mean changes in BMD did not differ between groups with and without incident fracture, except that women with an incident non-vertebral fracture had significantly higher bone loss at predominantly cortical T-DIA (p=0.005). ConclusionZOL was significantly superior to PLB at T-EPI but not at T-DIA. Women with an incident non-vertebral fracture experienced bone loss at T-DIA.

Images in Medicine - Bisphosphonate Induced Atypical Fracture

Bisphosphonates are the first line therapy for treating post menopausal osteoporosis. Usually,they are well tolerated and have good efficacy in decreasing fracture risk with few adverse effects. The common side effect is upper gastrointestinal tract irritation like oesophagitis especially seen with oral bisphosphonates. One of the less commonly encountered adverse effect is atypical fracture of femoral shafts. Physicians who are prescribing bisphosphonates should be aware of this rare adverse effect. We report a case who presented to us with an atypical fracture.

Osteoporosis Prevention and Management

The purpose of this review is to evaluate current evidence regarding the use of dietary and exercise interventions to prevent fractures in postmenopausal women with osteoporosis. The key lifestyle modifications that can decrease risk of fracture in postmenopausal women include regular weight-bearing exercise and a balanced diet with adequate calcium and vitamin D intake. Other modifiable lifestyle factors critical to bone health and to decrease fracture risk include the avoidance of smoking, an excessively low body weight, excessive alcohol intake, and fall risks at home. Emerging modifiable factors may include B-vitamin, omega-3 fatty acid, soy isoflavone, and dehydroepiandrosterone supplementation.

Bone Quality: The Determinants of Bone Strength and Fragility

Bone fragility is a major health concern, as the increased risk of bone fractures has devastating outcomes in terms of mortality, decreased autonomy, and healthcare costs. Efforts made to address this problem have considerably increased our knowledge about the mechanisms that regulate bone formation and resorption. In particular, we now have a much better understanding of the cellular events that are triggered when bones are mechanically stimulated and how these events can lead to improvements in bone mass. Despite these findings at the molecular level, most exercise intervention studies reveal either no effects or only minor benefits of exercise programs in improving bone mineral density (BMD) in osteoporotic patients. Nevertheless, and despite that BMD is the gold standard for diagnosing osteoporosis, this measure is only able to provide insights regarding the quantity of bone tissue. In this article, we review the complex structure of bone tissue and highlight the concept that its mechanical strength stems from the interaction of several different features. We revisited the available data showing that bone mineralization degree, hydroxyapatite crystal size and heterogeneity, collagen properties, osteocyte density, trabecular and cortical microarchitecture, as well as whole bone geometry, are determinants of bone strength and that each one of these properties may independently contribute to the increased or decreased risk of fracture, even without meaningful changes in aBMD. Based on these findings, we emphasize that while osteoporosis (almost) always causes bone fragility, bone fragility is not always caused just by osteoporosis, as other important variables also play a major role in this etiology. Furthermore, the results of several studies showing compelling data that physical exercise has the potential to improve bone quality and to decrease fracture risk by influencing each one of these determinants are also reviewed. These findings have meaningful clinical repercussions as they emphasize the fact that, even without leading to improvements in BMD, exercise interventions in patients with osteoporosis may be beneficial by improving other determinants of bone strength.

Duration of Antiresorptive Effects of Low-Dose Zoledronate in Osteopenic Postmenopausal Women: A Randomized, Placebo-Controlled Trial

Annual intravenous administration of 5 mg zoledronate decreases fracture risk, but the optimal dosing regimen for zoledronate has not been determined. We set out to evaluate the antiresorptive effects of a single administration of lower doses of zoledronate. A total of 180 postmenopausal women with osteopenia enrolled in a double-blind, randomized, placebo-controlled trial over 2 years at an academic research center. Participants were randomized to a single baseline administration of intravenous zoledronate in doses of 1 mg, 2.5 mg, or 5 mg, or placebo. The primary endpoint was change in bone mineral density(BMD) at the lumbar spine. Secondary endpoints were change in BMD at the proximal femur and total body, and changes in biochemical markers of bone turnover. After 2 years, the change in spine BMD was greater in each of the zoledronate groups than in the placebo group; values are mean (95% confidence interval [CI]) difference versus placebo: zoledronate 1 mg 4.4% [2.7% to 6.1%]; 2.5 mg 5.5% [3.9% to 7.2%]; 5 mg 5.3% [3.8% to 6.7%], p < 0.001 for each dose). Change in BMD at the total hip was greater in each of the zoledronate groups than the placebo group (mean [95% CI] difference versus placebo: zoledronate 1 mg 2.6% [1.5% to 3.7%]; 2.5 mg 4.4% [3.5% to 5.3%]; 5 mg 4.7% [3.7% to 5.7%], p < 0.001 for each dose). Each of the bone turnover markers, β-C-terminal telopeptide of type I collagen (β-CTX) and procollagen type-I N-terminal propeptide (P1NP), was lower in each of the 2.5-mg and 5-mg zoledronate groups than the placebo group throughout the trial (p < 0.001 versus placebo for each marker for each dose at each time point). For each endpoint, changes were similar in the 2.5-mg and 5-mg zoledronate groups, whereas those in the 1-mg group were smaller than those in the other zoledronate groups. These data demonstrate that single administrations of zoledronate 1 mg or 2.5 mg produce antiresorptive effects that persist for at least 2 years. Trials assessing the antifracture efficacy of intermittent low doses of zoledronate, in particular the 2.5-mg dose, are justified.

SAT0373 The role of the combination of bone and fall related risk factors on short-term subsequent fracture risk

BackgroundBone- and fall-related risk factors contribute to subsequent NVF risk and mortalityObjectivesWe analysed whether a combination of bone-related and fall-related risk factors (RFs) in patients with a recent non-vertebral fracture...

Low androstenedione/sex hormone binding globulin ratio increases fracture risk in postmenopausal women. The Women's Health in the Lund Area study

The Women's Health in the Lund Area (WHILA) project (n=6917) is a cohort study that started in 1995 and includes a postal questionnaire, physical examination, bone density measurement and blood laboratory analyses. Fracture data have been added, and in this report fracture risk and its association with sex hormones was analysed in postmenopausal women without current hormone therapy (HT).A total of 409 women (median age 56.8 years) with 489 fractures were identified from the postmenopausal women without HT during a median follow-up time of 8.4 years. Lower serum levels of androstenedione (p<0.001), testosterone (p=0.008), androstenedione/sex hormone binding globulin (SHBG) ratio (p<0.001), testosterone/SHBG ratio (p=0.003) and higher levels of SHBG (p=0.005) were observed in women with fractures compared to no fracture. No difference in oestradiol levels was observed.Androstenedione and androstenedione/SHBG ratio were further divided into percentiles. Increased fracture risk was found in postmenopausal women with androstenedione in 5th percentile compared to 11–89th percentile HR 1.51 (95% CI 1.02–2.24). The androstenedione/SHBG ratio (11–89th percentile as reference) showed increased fracture risk in women with low ratio 5th percentile HR 1.75 (95% CI 1.20–2.54) and decreased fracture risk with high ratio 95th percentile HR 0.52 (95% CI 0.28–0.98).An increased fracture risk during follow-up was encountered in postmenopausal women with low serum androstenedione and androstenedione/SHBG ratio at baseline and a decreased fracture risk with high androstenedione/SHBG ratio. This study suggests that postmenopausal osteoporosis is influenced by lower levels of androgens.

HIV: An underrecognized secondary cause of osteoporosis?

HIV: An underrecognized secondary cause of osteoporosis?

Postmenopausal women treated with combination parathyroid hormone (1–84) and ibandronate demonstrate different microstructural changes at the radius vs. tibia: the PTH and Ibandronate Combination Study (PICS)

In postmenopausal women receiving combination parathyroid hormone (PTH) (1-84) therapy and ibandronate, we evaluated bone microarchitecture and biomechanics using high-resolution peripheral quantitative computed tomography (HR-pQCT). Cortical and trabecular changes were different at the nonweight-bearing radius vs. the weight-bearing tibia, with more favorable overall changes at the tibia. PTH therapy and bisphosphonates decrease fracture risk in postmenopausal osteoporosis, but their effects on bone microstructure and strength have not been fully characterized, particularly during combination therapy. PTH increases trabecular bone mineral density (BMD) substantially but may decrease cortical BMD, possibly by stimulating intracortical remodeling. We evaluated bone microarchitecture and biomechanics with HR-pQCT at the radius (a nonweight-bearing site) and tibia (weight bearing) in women receiving combination PTH(1-84) and ibandronate. Postmenopausal women with low bone mass (n = 43) were treated with 6 months of PTH(1-84) (100 μg/day), either as one 6- or two 3-month courses, in combination with ibandronate (150 mg/month) over 2 years. HR-pQCT was performed before and after therapy. Because changes in HR-pQCT parameters did not differ between treatment arms, groups were pooled into one cohort for analysis. Trabecular BMD increased at both radius and tibia (p < 0.01 for each). Cortical thickness and BMD decreased at the radius (p < 0.01), consistent with changes in dual-energy X-ray absorptiometry, while these parameters did not change at the tibia (p ≤ 0.02 for difference between radius and tibia). In contrast, cortical porosity increased at the tibia (p < 0.01) but not radius. Stiffness and failure load decreased at the radius (p < 0.0001) but did not change at the tibia. Cortical and trabecular changes in response to the PTH/ibandronate treatment combinations utilized in this study were different at the nonweight-bearing radius vs. the weight-bearing tibia, with more favorable overall changes at the tibia. Our findings support the possibility that weight bearing may optimize the effects of osteoporosis therapy.

Diagnosis and Treatment of Osteoporosis in Older Adults

Osteoporosis in the elderly is a serious problem that is increasing as the population ages. Diagnosis is established by measurement of bone mineral density or by the presence of a fragility fracture, especially a spine or hip fracture. Bone-active agents should be prescribed for older patients with osteoporosis to decrease fracture risk. Nonskeletal risk factors for fracture and psychosocial impairment must be identified and managed, and therapy must be individualized.

The role of the combination of bone and fall related risk factors on short-term subsequent fracture risk and mortality

BackgroundWe analysed whether a combination of bone- and fall-related risk factors (RFs) in addition to a recent non-vertebral fracture (NVF) contributed to subsequent NVF risk and mortality during 2-years in patients who were offered fall and fracture prevention according to Dutch fracture- and fall-prevention guidelines.Methods834 consecutive patients aged ≥50 years with a recent NVF who were included. We compared subgroups of patients according to the presence of bone RFs and/or fall RFs (group 1: only bone RFs; group 2: combination of bone and fall RFs; group 3: only fall RFs; group 4: no additional RFs). Univariable and multivariable Cox regression analyses were performed adjusted for age, sex and baseline fracture location (major or minor).Results57 (6.8%) had a subsequent NVF and 29 (3.5%) died within 2-years. Univariable Cox regression analysis showed that patients with the combination of bone and fall RFs had a 99% higher risk in subsequent fracture risk compared to all others (Hazard Ratio (HR) 1.99; 95% Confidence Interval (CI) 1.18-3.36) Multivariable analyses this was borderline not significant (HR 1.70; 95% CI: 0.99-2.93). No significant differences in mortality were found between the groups.ConclusionEvaluation of fall RFs contributes to identifying patients with bone RFs at highest immediate risk of subsequent NVF in spite of guideline-based treatment. It should be further studied whether earlier and immediate prevention following a NVF can decrease fracture risk in patients with a combination of bone and fall RFs.

Osteoporosis in men: recent progress

As osteoporosis in men has been recognized as an important clinical problem, new information is being accumulated on its scope, pathophysiology, evaluation, and treatment. Fracture risk calculators, such as FRAX, identify a large proportion of the older male population to be at heightened risk for fracture. The classification of osteoporosis into primary and secondary forms, while still useful, is affected by the fact that many men have multiple contributing factors to their fracture risk. The role of sex steroids is being better defined as other risk factors for fracture are delineated. As longevity continues to increase in men and until osteoporotic fracture is truly recognized as a potentially fatal disorder, many men will be undiagnosed and untreated. Two recent studies provide more evidence that treatments which decrease fracture risk in women do the same in men. With the publication of guidelines and increasing strength of evidence for treatment efficacy, it is hoped that more men will be evaluated and treated for this often neglected disorder.

Vitamin B12, Folate, Homocysteine, and Bone Health in Adults and Elderly People: A Systematic Review with Meta-Analyses

Elevated homocysteine levels and low vitamin B12 and folate levels have been associated with deteriorated bone health. This systematic literature review with dose-response meta-analyses summarizes the available scientific evidence on associations of vitamin B12, folate, and homocysteine status with fractures and bone mineral density (BMD). Twenty-seven eligible cross-sectional (n = 14) and prospective (n = 13) observational studies and one RCT were identified. Meta-analysis on four prospective studies including 7475 people showed a modest decrease in fracture risk of 4% per 50 pmol/L increase in vitamin B12 levels, which was borderline significant (RR = 0.96, 95% CI = 0.92 to 1.00). Meta-analysis of eight studies including 11511 people showed an increased fracture risk of 4% per μmol/L increase in homocysteine concentration (RR = 1.04, 95% CI = 1.02 to 1.07). We could not draw a conclusion regarding folate levels and fracture risk, as too few studies investigated this association. Meta-analyses regarding vitamin B12, folate and homocysteine levels, and BMD were possible in female populations only and showed no associations. Results from studies regarding BMD that could not be included in the meta-analyses were not univocal.