Incidence Of Fractures In Patients Research Articles

Romosozumab Followed by Denosumab Versus Denosumab Only: A Post Hoc Analysis of FRAME and FRAME Extension.

Osteoanabolic-first treatment sequences are superior to oral bisphosphonates for fracture reduction and BMD gain. However, data comparing osteoanabolic medications with the more potent antiresorptive, denosumab (DMAb), are limited. We analyzed FRAME and FRAME Extension data to assess BMD and fracture incidence in patients treated with romosozumab (Romo) followed by DMAb (Romo/DMAb) versus DMAb (DMAb/DMAb) for 24months. In FRAME, women aged ≥55years (total hip [TH] or femoral neck [FN] T-score: -2.5 to. -3.5) were randomized to Romo or placebo for 12months followed by DMAb for 12months. In FRAME Extension, both cohorts received DMAb for another 12months. This post-hoc analysis compared BMD change and fracture incidence in patients on Romo/DMAb (months 0-24) versus DMAb/DMAb (months 12-36). Patient characteristics were balanced by propensity score weighting (PSW) and sensitivity analyses were conducted using PSW with multiple imputation (PSW-MI) and propensity score matching (PSM). Unmeasured confounding was addressed using E-values. After PSW, over 24months, compared with DMAb/DMAb, treatment with Romo/DMAb produced significantly greater BMD increases at the lumbar spine [LS], TH, and FN (mean differences: 9.3%, 4.4%, and 4.1%, respectively; all p < 0.001). At month 24, in women with a baseline T-score of -3.0, the probability of achieving a T-score > -2.5 was higher with Romo/DMAb versus DMAb/DMAb (LS:92% versus 47%; TH:50% versus 5%). In the Romo/DMAb versus DMAb/DMAb cohorts, new vertebral fractures were significantly reduced (0.62% versus 1.26% [odds ratio = 0.45; p = 0.003]) and rates of clinical, nonvertebral, and hip fractures were lower (differences not significant). Similar BMD and fracture outcomes were observed with PSW-MI and PSM sensitivity analyses. The sequence of Romo/DMAb resulted in greater BMD gains and higher probability of achieving T-scores > -2.5, significantly reduced new vertebral fracture incidence, and numerically lowered the incidence (not significant) of clinical, nonvertebral, and hip fractures versus DMAb only through 24months.

Efficacy and safety of zoledronic acid in the treatment of osteoporosis: A meta-analysis of randomized controlled trials

PurposeZoledronic acid can inhibit the activity of osteoclasts, and thus, may slow or inhibit bone loss. The purpose of this study was to systematically evaluate the efficacy and safety of zoledronic acid in the treatment of osteoporosis. MethodsFour databases, PubMed, Embase, Cochrane Library, and Web of Science, were systematically searched up to December 26, 2022. The primary outcomes included bone mineral density (BMD), carboxy-terminal cross-linked telopeptide of type 1 collagen (CTX), bone-specific alkaline phosphatase (BSAP), procollagen type 1 N-terminal prope-ptide (P1NP), adverse events, and fracture. Secondary outcomes included serum sclerostin level, Visual Analogue Scale (VAS) score, and Oswestry Disability Index (ODI). ResultsA total of 22 randomized controlled trials were included in this meta-analysis. Meta-analysis results showed that zoledronic acid was effective in increasing BMD of the lumbar spine, femoral neck, trochanter and serum sclerostin level; and reduced CTX, BSAP, P1NP, VAS score, and ODI in patients with osteoporosis. Regarding safety, zoledronic acid could reduce the incidence of fractures but had relatively more adverse events. ConclusionZoledronic acid can significantly improve BMD of the lumbar spine, femoral neck and trochanter, and effectively reduce incidence of fracture in patients with osteoporosis, thereby significantly improving patients' quality of life. However, the incidence of adverse events was higher than that of patients treated with placebo.

#1648 Chronic kidney disease-mineral bone disorder and fractures in predialysis patients

Abstract Background and Aims Chronic Kidney Disease (CKD) patients have a complex physiopathology of bone fragility given the development of mineral bone disorder (CKD-MBD) and are at increased fracture risk [1]. Bone turnover, mineralization, and volume (TMV) classification, as proposed by Kidney Disease Improving Global Outcomes (KDIGO), defines different subtypes of renal osteodystrophy (ROD), and is evaluated through bone biopsies and respective histomorphometric analysis. The impact of these parameters and of different ROD subtypes in fracture occurrence has not been evaluated. We aim to evaluate the incidence of fractures in patients with predialysis CKD and the relationship of ROD subtypes and the impact of bone volume with the occurrence of fractures. Method We conducted a retrospective study that enrolled 54 patients (40-89 years old) followed in a predialysis clinic between 2014-2023. Blood tests, bone biopsies and histomorphometric analysis were performed at the beginning of follow-up. Data from dual x-ray absorptiometry (DXA) scan were collected if available. Information regarding clinical evident fractures was recorded from analysis of clinical registries. Radiographies of the thoracic and/or lumbar spine were evaluated to detect asymptomatic vertebral fractures. Results Median follow-up time was 7.5 ± 3 years. Mean age at the time of bone biopsy was 65.4 ± 9.8 years old and most patients were male (n = 43, 79.6%). The majority had CKD stage 4 (53.7%). During follow-up, 20 (37%) patients progressed to kidney replacement therapy and 5 (9.3%) died. DXA scan was performed in 19 patients (35.2%). Of these, 5 had osteoporosis (T-score ≤-2,5). The histomorphometric analysis showed that 40.7% (n = 22) patients had normal bone histology, 37% (n = 20) low bone turnover with normal mineralization (adynamic bone disease) and 22.3% (n = 12) high bone turnover with normal mineralization (hyperparathyroid bone disease). Two patients sustained clinical evident fractures. Radiographies of 51 patients were reviewed and asymptomatic vertebral fractures were identified in 3 (5.9%). The group that suffered fractures had higher phosphorus levels and these differences were statistically significant (4.1 mg/dL vs 3.5 mg/dL, p = 0.047). None of the patients with osteoporosis diagnosed by DXA scan fractured and bone mineral density (BMD) by DXA was similar between the groups (−1.05 vs −1.04, p = 0.530). The different histomorphometric subtypes and circulating biomarkers did not correlate with the incidence of fractures. Patients with fractures had more frequently low bone volume (40%) than patients who do not sustained fractures (25.5%) but this difference was not significant (p = 0.579). BV/TV was lower in the group that sustained fractures during follow-up (16.1 (11.9-17.2) vs 19.0 (16.2-23.6)) and this achieved borderline significance (p = 0.052). Femoral neck BMD measures in the patients who had an available DXA scan did not show any correlation with BV/TV (r = 0.039, p = 0.874). Conclusion No relationship was found between different ROD subtypes and the incidence of fractures. However, when considering bone volume isolated (but not BMD assessed by DXA), a marginally significant association was found between a low BV/TV value and the occurrence of fractures. High phosphorus levels also associated with fractures and have been previously described as a possible risk factor for fractures not only in CKD patients but also general population [2, 3]. Further studies with a larger population are needed to validate these conclusions with statistical power.

Prevalence and Incidence of Fractures in Patients With Nonfunctional Adrenal Tumors

It is unclear whether nonfunctional adrenal tumors (NFATs) are associated with fractures. To analyze fracture frequencies in individuals with NFATs. A national retrospective cohort study was conducted in patients with NFATs diagnosed in Sweden between January 1, 2005, and December 31, 2019, and control participants without adrenal tumors followed up until death or the end of 2019. Individuals with a diagnosis of adrenal hormonal excess or previous malignant tumors were excluded. Sensitivity analyses were performed in subgroups of individuals with a combination of gallbladder, biliary tract, and pancreas diseases (for whom it was assumed that controls would also have undergone computed tomography) and 3- and 12-month survival free of malignant tumors after the NFAT diagnosis. The data were analyzed from September to November 2023. Diagnosis of NFATs. Main study outcomes were prevalence and incidence of fractures after adjustment for sex, age, and comorbidities. Secondary outcomes were fragility fractures, fractures with fall on the same level, and fracture locations (distal arm and vertebral and hip fractures). Fracture incidence after adrenalectomy was also studied. Among 20 390 patients, 12 120 (59.4%) were women, and the median (IQR) age was 66 (57-73) years; among 125 392 controls, 69 994 (55.8%) were women, and the median (IQR) age was 66 (57-73) years. Previous fractures were more common in patients diagnosed with NFATs compared with controls (4310 of 20 390 [21.1%] vs 20 323 of 125 392 [16.2%]; odds ratio [OR], 1.39; 95% CI, 1.34-1.45; adjusted OR [AOR], 1.27; 95% CI, 1.23-1.33). During the follow-up period (median [IQR], 4.9 [2.2-8.2] years), incident fractures were more common in patients with NFATs (3127 of 20 390 [15.3%] vs 16 086 of 125 392 [12.8%]; hazard ratio [HR], 1.40; 95% CI, 1.34-1.45; adjusted HR [AHR], 1.27; 95% CI, 1.22-1.33). An association between NFATs and vertebral fractures was found (AOR, 1.51; 95% CI, 1.33-1.72; AHR, 1.83; 95% CI, 1.60-2.09). In men younger than 50 years, NFATs were associated with fractures (AOR, 1.45; 95% CI, 1.21-1.74; AHR, 1.48; 95% CI, 1.20-1.82). There was no association among individuals who had undergone adrenalectomy (AHR, 1.12; 95% CI, 0.90-1.38). The association between NFATs and fractures remained significant and of similar magnitude in all sensitivity analyses. In this cohort study, NFATs were associated with fractures, particularly among younger men; thus, patients with NFATs should have bone health evaluation with appropriate treatment and monitoring, especially in younger men.

The risk of bone fractures in dementia patients receiving acetylcholinesterase inhibitors: a meta-analysis.

The authors aimed to conduct a meta-analysis to determine if acetylcholinesterase inhibitors may pose a direct threat, increasing the incidence of fractures in dementia patients. PubMed, Scopus, and Cochrane Library were searched. Inclusion criteria were any original studies that demonstrated the link between acetylcholinesterase inhibitors and the incidence of fracture in patients with dementia. RevMan(5.4) was used. Seven observational studies were included. The total number of patients included in the acetylcholinesterase inhibitors group is 274332 and 290347 in the control group. The pooled analysis showed that the risk of bone fracture was not statistically different between dementia patients who received acetylcholinesterase inhibitors and those who did not receive them (odds ratio=1.44, CI 0.95, 2.19, P=0.09). Subgroup analysis showed no statistically significant difference between dementia patients who took acetylcholinesterase inhibitors, and those who didn't take acetylcholinesterase inhibitors in those more than or equal to 80 years old and those less than 80 years old (P=0.44) and (P=0.34) respectively. However, our results showed a statistically significant association between dementia patients who received acetylcholinesterase inhibitors and decreased fracture risk in those receiving the treatment for more than or less than 2 years (risk ratio=0.48, CI= 0.45, 0.51, P<0.00001) and (risk ratio=0.84, CI 0.70, 0.99, P=0.04), respectively. Our study revealed no role for acetylcholinesterase inhibitors in increasing the risk of fracture compared with controls. Hence, based on our analysis, they might have a protective role against fracture when used for long periods considering their positive action on bone growth and development. Therefore, Acetylcholinesterase inhibitors could be considered a safe option for improving cognitive functions in elderly demented patients without carrying any additional risks.

Diabetes-induced osteoporosis. Review

The literature review highlights the impact of osteoporosis on the health of the population. The attention is focused on one of the secondary osteoporosis types, diabetes‑induced osteoporosis (DIO). The mechanisms of bone mass loss are highlighted, description is given to the interaction between osteoblasts and osteoclasts, the role of immune cells in the process of osteoporosis under conditions of hyperglycemia. The risk factors of DIO in type 1 and type 2 diabetes mellitus (DM) and the causes of bone mineral density reduction are described. Special attention is focused on the phenomenon of immunoporosis, which can lead to the creation and further development of new approaches to the targeted treatment of osteoporosis.&#x0D; High incidence of fractures in patients with type 1 diabetes (DM1) is caused by both negative hyperglycemia effects on the bone architectonics, and effects of hypoglycemia that raises the risk of falls. Along with hyperglycemic‑mediated processes in bone, the state of the microcirculatory bed, muscle tissue, and peripheral nervous system is important in DIO pathogenesis. In‑depth study of immunoporosis will contribute to the creation of new and development of existing approaches to the targeted osteoporosis treatment. Literature data show that incidence of any fractures’ is increased in three times in DM1 patients. The correlation between hyperglycemia, insulin, insulin‑like growth factor, anabolic hormones and C‑peptide with the development of diabetes‑induced osteoporosis has been revealed. Despite the lower date of fractures in DM2, comparing to the DM1, the main reasons for fractures include the high risk of falls, accumulation of advanced glycosylation end‑products, the low level of bone tissue metabolism, as well as obesity and insulin resistance. The effects of hypoglycemic drugs on fracture risk and bone mineral density have been characterized. Metformin and glucagon‑like peptide‑1 receptor agonists have the most favorable fracture safety profile. It has been suggested that bisphosphonates, androgens, and receptor activator of nuclear factor‑kappa B ligand (RANKL) inhibitor may be the most effective drugs against osteoporosis in patients with DM.

Predicting Fractures Using Vertebral 18F-NaF Uptake in Prostate Cancer Patients

Background: Patients with prostate cancer tend to be at heightened risk for fracture due to bone metastases and treatment with androgen-deprivation therapy. Bone mineral density (BMD) derived from dual energy X-ray absorptiometry (DXA) is the standard for determining fracture risk in this population. However, BMD often fails to predict many osteoporotic fractures. Patients with prostate cancer also undergo 18F-sodium fluoride (&lt;sup&gt;18&lt;/sup&gt;F-NaF)-positron emission tomography/computed tomography (PET/CT) to monitor metastases. The purpose of this study was to assess whether bone deposition, assessed by &lt;sup&gt;18&lt;/sup&gt;F-NaF uptake in &lt;sup&gt;18&lt;/sup&gt;F-NaF PET/CT, could predict incident fractures better than DXA- or CT-derived BMD in patients with prostate cancer.Methods: This study included 105 males with prostate cancer who had undergone full body &lt;sup&gt;18&lt;/sup&gt;F-NaF PET/CT. Standardized uptake value (SUVmean and SUVmax) and CT-derived Hounsfield units (HU), a correlate of BMD, were recorded for each vertebral body. The average SUVmean, SUVmax, and HU were calculated for cervical, thoracic, lumbar, and sacral areas. The t-test was used to assess significant differences between fracture and no-fracture groups.Results: The SUVmean and SUVmax values for the thoracic area were lower in the fracture group than in the no-fracture group. There was no significant difference in cervical, thoracic, lumbar or sacral HU between the 2 groups.Conclusions: Our study reports that lower PET-derived non-metastatic bone deposition in the thoracic spine is correlated with incidence of fractures in patients with prostate cancer. CT-derived HU, a correlate of DXA-derived BMD, was not predictive of fracture risk. &lt;sup&gt;18&lt;/sup&gt;F-NaF PET/CT may provide important insight into bone quality and fracture risk.

Lumbar radiculopathy and fracture risk: A Korean nationwide population-based cohort study

IntroductionLumbar radiculopathy is a common disease with a high economic burden, and fractures in adults are a significant public health problem. However, studies of the relationship between lumbar radiculopathy and fractures are scarce. We investigated the fracture risk in patients with lumbar radiculopathy. MethodsThis nationwide retrospective cohort study identified 815,101 patients with lumbar radiculopathy and randomly matched individuals without lumbar radiculopathy (1:1) who were included in the Korean National Health Insurance System in 2012. Cox proportional hazards regression analyses were performed to calculate the hazard ratio (HR) for fracture risk in patients with lumbar radiculopathy. ResultsThe study included 301,347 patients with lumbar radiculopathy and matched 289,618 individuals without lumbar radiculopathy. Compared to individuals without lumbar radiculopathy, patients with lumbar radiculopathy had a 27 % increased fracture risk (adjusted HR = 1.27, 95 % confidence interval = 1.24–1.31). The Kaplan-Meier plot showed a significantly higher fracture incidence in patients with lumbar radiculopathy than in individuals without lumbar radiculopathy at all times. ConclusionLumbar radiculopathy is significantly associated with fracture risk.

Fracture Risk Following Lumbosacral Spine SBRT in Patients Having Received Previous Whole Pelvis Radiation Therapy

Stereotactic body radiation therapy (SBRT) for metastatic spinal disease provides local control with palliative effects1. Previous studies have demonstrated a posttreatment fracture rate range of roughly 5.7-39%2, with 14-17% the most commonly cited fracture risk range. However, the rate of spine fracture after lumbosacral SBRT in patients having received prior pelvic radiation therapy (RT) is unclear. The purpose of this study is to investigate the incidence of fracture in patients receiving lumbosacral spine SBRT following previous whole pelvic RT. This study was a single institution retrospective chart review. All lumbar and sacral spine SBRT cases over a 5-year period (from January 2018 through September 2022) with at least three months of post-treatment follow-up were identified. Patients having previously received pelvic RT were assessed; the development of a vertebral fracture was recorded as was the time to fracture and potential intervention (if any). A total of 35 lumbosacral spine SBRT cases were identified. Of those eight (23%) previously received whole pelvic RT, ranging from 20-70 Gy/5-35 fractions. Of the lumbosacral spine SBRT patients having received prior pelvic RT, two (25%) developed a fracture post-treatment. The average time to fracture was 7.5 months. Both fractures were treated with conservative management; neither required vertebroplasty/kyphoplasty or operative stabilization. The mean dose per SBRT fraction for patients who suffered a fracture (8.5 Gy) did not significantly differ from that for patients who did not suffer a fracture (9 Gy). In the first examination of lumbosacral fracture risk following SBRT to patients having received previous pelvic RT, the fracture rate in this patient population was 25%. Noteworthy is that the SBRT dose per fraction did not differ between patients having suffered a fracture versus those without fracture. These findings indicate that patients having received previous whole pelvis RT should be counseled on the potential increased risk of fracture; however, there is no evidence that decreasing SBRT dose per fraction reduces the likelihood of fracture in this patient population. This increased fracture rate is of concern, and further investigation in larger studies to identify potential risk factors for vertebral fracture such as systemic therapy, age and gender is warranted.

Real-world effectiveness of anti-osteoporosis medications for the prevention of incident hip and clinical vertebral fractures in patients on long-term glucocorticoid therapy: A nationwide health insurance claims database study in Japan.

Early initiation of anti-osteoporosis medications (AOMs) is recommended for patients on long-term glucocorticoid (GC) therapy. This study aimed to clarify the real-world effectiveness of AOMs against incident hip and vertebral fractures in patients undergoing GC therapy using the nationwide health insurance claims database of Japan (NDBJ). Patients aged ≥50years who were prescribed GC (≥5mg/day prednisolone or equivalent) for ≥90days and who were followed up regarding AOM prescription and hip and clinical vertebral fracture incidences for the subsequent 1080days between 2012 and 2018 were selected from NDBJ. Associations of AOMs prescribed within 90days since GC therapy initiation with hip or vertebral fracture risk were evaluated by Cox proportional hazards regression using propensity score inverse probability weighting (IPW) for receiving any AOM or individual AOMs. In total, 96,475 women and 98,385 men were included in the analysis; 38.0% of women and 27.6% of men received AOMs. Patients who received any AOM and those who received bisphosphonates or denosumab had a significantly lower risk of hip and clinical vertebral fractures than those who received no AOM in both sexes after propensity score IPW. Teriparatide was associated with an increased risk of both fractures in women and an increased risk of clinical vertebral fractures in men. Selection biases such as confounding by indication might have caused an underestimation of AOMs' protective effects. Bisphosphonates and denosumab were associated with a lower fracture incidence in patients on long-term GC therapy in real-world settings.

Risk of Fractures, Repeated Fractures and Osteoporotic Fractures among Patients with Hemophilia in Taiwan: A 14-Year Population-Based Cohort Study

The world is aging, and hemophilia patients are as well. The association between patients with hemophilia (PWH) and low bone mineral density is clear. However, the incidence of fractures in patients with hemophilia is inconclusive, and no research has yet explored repeated fractures among PWH. In this study, we investigated the incidence of all-site fractures, repeated fractures and osteoporotic fractures amongst PWH. The study compared the incidence of all-site fractures, repeated fractures and osteoporotic fractures occurring in all PWH who were enrolled in Taiwan's National Health Insurance Research Database between 1997 and 2013 with an age- and gender-matched group from the general population. Eight-hundred thirty-two PWH, along with 8320 members of the general population, were included in the final analysis. After multivariate COX regression analysis with an adjustment for confounding factors, it was found that PWH experienced a higher risk of osteoporotic fracture (HR: 1.25 with 95% CI of 1.03-2.52) but only saw a neutral effect with regards to both all-sites of fracture (HR: 1.00 with 95% CI of 0.92-1.09) and repeated fractures (HR: 1.01 with 95% CI of 0.92-1.10), when compared with the general population. This 14-year population-based cohort study showed that PWH had a higher risk of osteoporotic fracture, but that hemophilia only had a neutral effect in all-sites of fracture and repeated fractures. Screening, prevention and treatment for osteoporosis and further osteoporotic fractures among PWH, in order to improve quality of life and achieve healthy aging in this particular population, remain essential.

The incidence of fractures at various sites in newly treated patients with type 2 diabetes mellitus

PurposeIn this descriptive study, we examined the incidence of fractures in patients with newly treated type 2 diabetes mellitus (T2D) compared to matched reference population. MethodsParticipants from the UK Clinical Practice research datalink (CPRD) GOLD (1987–2017), aged ≥30 years, with a T2D diagnosis code and a first prescription for a non-insulin anti-diabetic drug (n = 124,328) were included. Cases with T2D were matched by year of birth, sex and practice to a reference population (n = 124,328), the mean follow-up was 7.7 years. Crude fracture incidence rates (IRs) and incidence rate ratios (IRRs) were calculated. Analyses were stratified by fracture site and sex and additionally adjusted for BMI, smoking status, alcohol use and history of any fracture at index date. ResultsThe IR of all fractures and major osteoporotic fractures was lower in T2D compared to the reference population (IRR 0.97; 95%CI 0.94–0.99). The IRs were lower for clavicle (IRR 0.67; 0.56–0.80), radius/ulna (IRR 0.81; 0.75–0.86) and vertebral fractures (0.83; 0.75–0.92) and higher for ankle (IRR 1.16; 95%CI 1.06–1.28), foot (1.11; 1.01–1.22), tibia/fibula (1.17; 1.03–1.32) and humerus fractures (1.11; 1.03–1.20). Differences in IRs at various fracture sites between T2D and the reference population were more pronounced in women than in men. In contrast, BMI adjusted IRs for all fractures (IRR 1.07; 1.04–1.10) and most individual fracture sites were significantly higher in T2D, especially in women. ConclusionThe crude incidence of all fractures was marginally lower in patients with newly treated T2D compared to the matched reference population but differed according to fracture site, especially in women. BMI adjusted analyses resulted in higher incidence rates in T2D at almost all fracture sites compared to crude incidence rates and this was more pronounced in women than in men. This implies that BMI may have a protective impact on the crude incidence of fractures, especially in women with newly treated T2D.

Serum Insulin-Like Growth Factor 1 Levels, Facture Risk Assessment Tool Scores and Bone Disorders in Patients with Primary Biliary Cholangitis.

Insulin-like growth factor 1 (IGF-1) plays an important role in bone growth and maintenance, and its decreased levels are associated with bone disorders. This study aimed to evaluate the association of serum IGF-1 levels with osteoporosis, prevalent fractures and fracture risk based on the Fracture Risk Assessment Tool (FRAX) in patients with primary biliary cholangitis (PBC). This study included 127 consecutive patients with PBC. Based on the baseline serum IGF-1 levels, the participants were classified into the low (L)-, intermediate (I)- and high (H)-IGF-1 groups. According to the FRAX score, high fracture risk was defined as a 10-year major osteoporotic fracture probability (FRAX-MOF) ≥ 20% or a 10-year hip fracture probability (FRAX-HF) ≥ 3%. The serum IGF-1 levels were positively correlated with bone mineral density, and were negatively correlated with the FRAX-MOF/FRAX-HF. The L-IGF-1 group had the highest prevalence of osteoporosis (58.1%), prevalent fracture (48.4%) and high fracture risk (71.0%). Meanwhile, the H-IGF-1 group had the lowest prevalence of osteoporosis (9.7%), prevalent fracture (12.9%) and high fracture risk (9.7%). The prevalence of these events increased stepwise with decreasing serum IGF-1 levels. The cutoff values of IGF-1 for predicting osteoporosis, prevalent fracture and high fracture risk were 61.5 ng/mL (sensitivity/specificity, 0.545/0.894), 69.5 ng/mL (0.633/0.784) and 61.5 ng/mL (0.512/0.929), respectively. Serum IGF-1 levels were associated with bone disorders and the FRAX-derived fracture risk, and may be a useful indicator for initiating therapeutic intervention to prevent the incidence of fracture in patients with PBC.

Association between biologic therapy and fracture incidence in patients with selected rheumatic and autoimmune diseases: A systematic review and meta-analysis of randomized controlled trials

ObjectivesTo investigate the effect of biologic therapy on risk of fracture in selected rheumatic and autoimmune diseases. MethodsThe PubMed, Cochrane library, and EMBASE databases were systematically searched from the inception dates to June 4, 2021. Randomized clinical trials (RCTs) comparing biological disease-modifying antirheumatic drugs (bDMARDs) with non-bDMARDs or placebo in patients with five selected rheumatic and autoimmune diseases were included. Meta-analyses were conducted to calculate the odds ratio (OR) with 95 % confidence intervals (CIs) for major osteoporotic fracture, hip fracture, osteoporotic non-vertebral fracture, and total fracture. ResultsA total of 100 RCTs involving 51,413 participants fulfilled the inclusion criteria. In patients with psoriasis (Ps), and psoriatic arthritis (PsA), compared with placebo or non-bDMARDs therapy, the risk of major osteoporotic fracture (OR, 0.34 [95 %Cl, 0.15–0.76], p = 0.009), hip fracture (OR, 0.22 [95 %Cl, 0.05–0.89], p = 0.03), and osteoporotic non-vertebral fracture (OR, 0.26 [95 %Cl, 0.10–0.62], p = 0.003) were significantly decreased with the use of bDMARDs. In patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), systemic lupus erythematosus (SLE), and inflammatory bowel diseases (IBD), the risk of fracture were not changed with biologic treatment. ConclusionsThe existing evidence from RCTs indicated the use of bDMARDs was associated with a low risk of major osteoporotic fracture, hip fracture, and osteoporotic non-vertebral fracture in patients with Ps and PsA. There are still urgent needs for studies regarding the actions of biologic therapies on the risk of bone fractures in systemic inflammatory diseases.

Fracture risk associated with glucocorticoid-induced osteoporosis in Japan.

Glucocorticoid-induced osteoporosis (GIOP) is associated with elevated fracture risk. Practice guidelines have been published to reduce this risk but are insufficiently followed in everyday practice. The objectives of this study were to estimate fracture incidence in patients exposed to oral glucocorticoids and to analyse the impact of glucocorticoid use on fracture incidence. This retrospective cohort study was performed using the Medical Data Vision (MDV) claims database from Japan. All patients aged ≥ 18years initiating oral glucocorticoids and fulfilling Japanese guideline criteria for starting prophylactic osteoporosis treatment between 2009 and 2019 were identified. These were matched to a cohort of unexposed controls using propensity score matching. Fracture incidence in the two cohorts were compared using a Fine-Gray proportional sub-distribution hazard model. 13,090 glucocorticoid-exposed cases were compared to 13,090 unexposed controls. The 1-year fracture rate (all sites) was 9.3[95% CI 8.8-9.8] in cases and 5.8 [5.4-6.2] in controls. One-year vertebral fracture rates were 4.3[4.0-4.7] and 2.3[2.1-2.6] respectively. In the multivariate analysis, the use of glucocorticoids was associated with an increase in the incidence of osteoporotic fractures (hazard ratio: 1.63 [1.51-1.76]). The glucocorticoid-associated risk tended to be higher in subgroups of patients with rheumatoid arthritis, asthma, COPD and in those aged < 65years. Oral glucocorticoid use is associated with an increase in fracture incidence. It is necessary to raise awareness of GIOP and to take public health measures to change the perceptions and behaviour of doctors prescribing glucocorticoids.

Reduced fracture incidence in patients having surgery for primary hyperparathyroidism.

ObjectiveThe indication of surgery in primary hyperparathyroidism has been controversial, as many patients experience mild disease. The primary aim was to evaluate fracture incidence in a contemporary population‐based cohort of patients having surgery for primary hyperparathyroidism. The secondary aim was to investigate whether preoperative serum calcium, adenoma weight or multiglandular disease influence fracture incidence.DesignA retrospective cohort study with population controls. Primary outcomes, defined by discharge diagnoses and prescriptions, were any fracture and fragility fracture, secondary outcomes were multiple fractures anytime and osteoporosis. Subjects were followed 10 years pre‐ and up to 10 years postoperatively (or 31 December 2015). Multiple events per subject were allowed. Fracture incidence rate ratios (IRRs) for patients pre‐ and postoperatively were tabulated and evaluated with mixed‐effects Poisson regression. Secondary outcomes were evaluated using conditional logistic regression.PatientsA Swedish nationwide cohort of patients having surgery for primary hyperparathyroidism (n = 5009) from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery between 2003 and 2013 was matched with population controls (n = 14,983). Data were cross‐linked with Statistics Sweden and the National Board of Health and Welfare.MeasurementsPreoperative serum calcium and adenoma weight at pathological examination.ResultsPatients had an increased incidence rate of any fracture preoperatively, IRR 1.27 (95% confidence interval: 1.11–1.46), highest in the last year before surgery. Fracture incidence was not increased postoperatively. Serum calcium, adenoma weight and multiglandular disease were not associated with fracture incidence.ConclusionsFracture incidence is higher in patients with primary hyperparathyroidism but is normalized after surgery.

Characteristics of fracture in patients who firstly starts kidney replacement therapy in Korea: a retrospective population-based study

The incidence of fractures in patients with end-stage kidney disease (ESKD) is high which is associated with high morbidity and mortality. Since fractures are preventable diseases to some extent, epidemiologic studies are needed a lot. The aim of this study is to explore the epidemiology of fractures by modality of kidney replacement therapy (KRT). We performed a retrospective analysis of 52,777 patients dependent on KRT from 2008 to 2017 using the National Health Insurance System of Republic Korea. Fractures were occurred in 8995 (17.04%) of 52,777 patients with ESKD. Hemodialysis and kidney transplant patients had the highest (57.4 per 1000 person-year) and the lowest (25.2 per 1000 person-year) incidence rate, respectively. The two most common fracture sites were the lower limb and upper limb, regardless of KRT modality. The first fractures were about 2.55 ± 2.07 years after KRT initiation, the earliest in Hemodialysis patients. Diabetes mellitus, cerebrovascular disease, chronic lung and liver disease were risk factors of fractures. The use of steroids, anti-osteoporosis medications, and some classes of psychotropics and opioids was associated with an elevated risk. The results of this study inform the understanding of fractures in KRT patients.

Association Between Biologic Therapy and Fracture Incidence in Patients with Selected Rheumatic and Autoimmune Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Association Between Biologic Therapy and Fracture Incidence in Patients with Selected Rheumatic and Autoimmune Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Association between Biologic Therapy and Fracture Incidence in Patients with Selected Rheumatic and Autoimmune Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Association between Biologic Therapy and Fracture Incidence in Patients with Selected Rheumatic and Autoimmune Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Do sandwich vertebral bodies increase the risk of post-augmentation fractures? A retrospective cohort study.

Sandwich vertebral bodies (SVBs) are intact unaugmented vertebral bodies between two previously augmented vertebrae. Until recently, only a few studies have reported the outcomes and strategies for SVBs. This retrospective cohort study aimed to describe the clinical features and incidence of new fractures in patients with SVBs. The clinical data were collected from 179 patients with 237 symptomatic osteoporotic vertebral compression fractures who underwent vertebral augmentation (VA). Among them, 23 patients with 24 levels of SVBs were included. Spinal radiographs (X-ray and CT) of all patients were evaluated prior to surgery 1 day after primary VA and during follow-up. All patients successfully underwent PKP with an average follow-up period of 21.48 months. Asymptomatic cement leakage occurred in four patients (17.4%), and eight patients (34.8%) developed new fractures following primary PKP, including four sandwich, six adjacent, four remote vertebral fractures, and one re-collapse of cemented vertebrae. The incidence of new fractures in the SVB and control groups was 16.7% (4/24) and 13.0% (6/46), respectively, but there was no significant difference. Although patients with SVBs had a relatively high risk of developing new fractures after VA, the incidence rate of new fractures was not significantly different from that of the control group. However, the statistical power of this study was very limited. Therefore, and because the refracture rate in these patients is substantial, routine long-term monitoring of patients after VA for osteoporosis is strongly recommended.