Fracture Risk In Persons Research Articles

The Association between Bone Turnover Markers and Fracture in People with Diabetes: A Systematic Review and Meta-Analysis

Background: The increased fracture risk in persons with diabetes is underestimated by conventional fracture predictors. The aims of this study were to conduct a systematic review and a meta-analysis to compare the levels of bone turnover markers (BTM) in persons with diabetes with and without fractures. Methods: We conducted a systematic literature search. Eligibility criteria were studies investigating BTMs in persons with diabetes with/without fractures. For the meta-analysis, we used the standardised mean difference (SMD) of the markers investigated. Results: We included eight observational studies. Levels of osteocalcin, procollagen type 1 amino terminal propeptide (P1NP), and Insulin-like growth factor-1 (IGF-1) were significantly lower in persons with fracture than in persons without fracture (-0.36 (-0.46, -0.26)) (SMD (95% confidence interval), (-0.57 (-0.75, -0.40)), and (-0.50 (-0.61, -0.39)) respectively. Levels of N-terminal cross-linked telopeptide of type 1 collagen (NTX), sclerostin, and bone-specific alkaline phosphatase (BAP) were significantly higher in persons with fracture (0.24 (0.13, 0.35), (0.47 (0.29, 0.65)), and (0.14 (0.01, 0.27)), respectively, whereas C-terminal cross-linked telopeptide (CTX) showed no difference between the groups. In sensitivity analysis removing one larger study, results were insignificant for osteocalcin, P1NP, NTX, and sclerostin. Conclusions: The results suggest that BTMs may be associated with fracture status in persons with diabetes. Persons with diabetes and fracture have lower levels of formative BTMs and IGF-1, and higher levels of NTX, sclerostin, and BAP compared with no fracture, however, some results were dependent on one larger study.

Evaluation of the relationship between bone mineral density, the risk of fractures and bone metabolism in persons residing permanently in the industrial region

The aim of the study. Determination of the relationship between the level of deoxypyridinoline urine, ultrasound densitometry and fracture risk in persons of working age residing permanently in the industrial region.Material and methods. The study included 48 people aged 50 to 65 living in Zaporizhzhia (industrial region), including 15 women and 33 men. All patients underwent ultrasonic densitometry on the Omnisense 7000 ultrasonic densitometer (BeamMedLtd, Israel). The criteria for WHO has been determined by the state of bone tissue. The fracture risk was estimated using online FRAX and Q‑Fracture calculators. In all patients the level of deoxypyridinoline was measured in morning urine samples.Results. Bone mineral density reduction was found in 73% of the examined patients, and an increase in the level of deoxypyridinoline in urine was recorded in 92%, including those with normal bone mineral density, that is, urinary deoxypyridinoline is a preclinical marker of bone marrow defect. The increased urinary deoxypyridinoline level is associated with a decrease in bone mineral density (r = –0.42) and an increased risk of fractures of FRAX Ukr Total (r = 0.41) and Q‑fracture Total (r = 0.42) (p <0. 05). The risk offractures of FRAX and Q‑fracture has reliably interconnected with densitometry data.Conclusions. The study of deoxypyridinoline in urine samples may be used to diagnose early bone changes since it is an early marker of bone resorption. Therefore, online calculators could reasonably be used in estimating the risk of fractures, along with the impossibility of densitometry performance.

The Effect of Intentional Weight Loss on Fracture Risk in Persons With Diabetes: Results From the Look AHEAD Randomized Clinical Trial.

Intentional weight loss is an important treatment option for overweight persons with type 2 diabetes mellitus (DM), but the effects on long-term fracture risk are not known. The purpose of this Look AHEAD analysis was to evaluate whether long-term intentional weight loss would increase fracture risk in overweight or obese persons with DM. Look AHEAD is a multicenter, randomized clinical trial. Recruitment began in August 2001 and follow-up continued for a median of 11.3 years at 16 academic centers. A total of 5145 persons aged 45 to 76 years with DM were randomized to either an intensive lifestyle intervention (ILI) with reduced calorie consumption and increased physical activity designed to achieve and maintain ≥7% weight loss or to diabetes support and education intervention (DSE). Incident fractures were ascertained every 6 months by self-report and confirmed with central adjudication of medical records. The baseline mean age of participants was 59 years, 60% were women, 63% were white, and the mean BMI was 36 kg/m2 . Weight loss over the intervention period (median 9.6 years) was 6.0% in ILI and 3.5% in DSE. A total of 731 participants had a confirmed incident fracture (358 in DSE versus 373 in ILI). There were no statistically significant differences in incident total or hip fracture rates between the ILI and DSE groups. However, compared to the DSE group, the ILI group had a statistically significant 39% increased risk of a frailty fracture (HR 1.39; 95% CI, 1.02 to 1.89). An intensive lifestyle intervention resulting in long-term weight loss in overweight/obese adults with DM was not associated with an overall increased risk of incident fracture but may be associated with an increased risk of frailty fracture. When intentional weight loss is planned, consideration of bone preservation and fracture prevention is warranted. © 2017 American Society for Bone and Mineral Research.

Screening approach for identifying candidate drugs and drug-drug interactions related to hip fracture risk in persons with Alzheimer disease.

To assess whether a "drugome-wide" screen with case-crossover design is a feasible approach for identifying candidate drugs and drug-drug interactions. All community-dwelling residents of Finland who received a clinically verified Alzheimer disease diagnosis in 2005 to 2011 and experienced incident hip fracture (HF) afterwards (N=4851). Three scenarios were used to test the sensitivity of this approach (1) hazard period 0 to 30 and control period 31 to 61days before HF, (2) hazard period 0 to 30 and control period 336 to 366days before HF, and (3) hazard period 0 to 14 and control period 16 to 30days before HF. Nine, 44, and 5 drugs were associated with increased HF risk and 8, 23, and 4 with decreased risk in scenarios 1, 2, and 3, respectively. Six drugs were identified with scenario 1 only and 54 and 1 with scenarios 2 and 3, respectively. Only six drugs (metoprolol, simvastatin, trimethoprim, codeine combinations, fentanyl, and paracetamol) were associated with HF in all scenarios, four with 1 and 2 (cefalexin, buprenorphine, olanzapine, and memantine), and one with 1 and 3 (enalapril) or 2 and 3 (ciprofloxacin). The direction of associations was the same in all/both scenarios. The interaction results were equally versatile, with hydroxocobalamin*oxazepam being the only interaction observed in all scenarios. Case-crossover analysis is a potential approach for identifying candidate drugs and drug-drug interactions associated with adverse events as it implicitly controls for fixed confounders. The results are highly dependent on applied hazard and control periods, but the choice of periods can help in targeting the analyses to different phases of drug use.

Dual-energy X-ray absorptiometry and fracture prediction in patients with spinal cord injuries and disorders.

Persons with a spinal cord injury (SCI) have substantial morbidity and mortality following osteoporotic fractures. The objective of this study was to determine whether dual-energy X-ray absorptiometry (DXA) measurements predict osteoporotic fractures in this population. A retrospective historical analysis that includes patients (n = 552) with a SCI of at least 2years duration who had a DXA performed and were in the VA Spinal Cord Disorders Registry from fiscal year (FY) 2002-2012 was performed. The majority of persons (n = 455, 82%) had a diagnosis of osteoporosis or osteopenia, with almost half having osteoporosis. BMD and T-scores at the lumbar spine were not significantly associated with osteoporotic fractures (p > 0.48) for both. In multivariable analyses, osteopenia (OR = 4.75 95% CI 1.23-17.64) or osteoporosis (OR = 4.31, 95% CI 1.15-16.23) compared with normal BMD was significantly associated with fractures and higher T-scores at the hip were inversely associated with fractures (OR 0.73 (95% CI 0.57-0.92)). There was no significant association of T-scores or World Health Organization (WHO) classification with incident fractures in those with complete SCI (p > 0.15 for both). The majority (over 80%) of individuals with a SCI have osteopenia or osteoporosis. DXA-derived measurements at the hip, but not the lumbar spine, predict fracture risk in persons with a SCI. WHO-derived bone density categories may be useful in classifying fracture risk in persons with a SCI.

Risk factors for osteoporotic fractures in persons with spinal cord injuries and disorders.

Clinical risk factors for fracture were explored among Veterans with a spinal cord injury. At the end of 11years of follow-up, the absolute risk of fracture was approximately 20%. Among the clinical and SCI-related factors explored, a prior history of fracture was strongly associated with incident fracture. Few studies to date have comprehensively addressed clinical risk factors for fracture in persons with spinal cord injury (SCI). The purpose of this study was to identify risk factors for incident osteoporotic fractures in persons with a SCI that can be easily determined at the point of care. The Veteran's Affairs Spinal Cord Dysfunction Registry, a national database of persons with a SCI, was used to examine clinical and SCI-related risk factors for fracture. Incident fractures were identified in a cohort of persons with chronic SCI, defined as SCI present for at least 2years. Cox regression models were used to estimate the risk of incident fractures. There were 22,516 persons with chronic SCI included in the cohort with 3365 incident fractures. The mean observational follow-up time for the overall sample was 6.2years (median 6.0, IQR 2.9-11.0). The mean observational follow-up time for the fracture group was 3.9years (median 3.3, IQR 1.4-6.1) and 6.7years (median 6.7, IQR 3.1-11.0) for the nonfracture group. By the end of the study, which included predominantly older Veterans with a SCI observed for a relatively short period of time, the absolute (i.e., cumulative hazard) for incident fractures was 0.17 (95%CI 0.14-0.21). In multivariable analysis, factors associated with an increased risk of fracture included White race, traumatic etiology of SCI, paraplegia, complete extent of SCI, longer duration of SCI, use of anticonvulsants and opioids, prevalent fractures, and higher Charlson Comorbidity Indices. Women aged 50 and older were also at higher risk of sustaining an incident fracture at any time during the 11-year follow-up period. There are multiple clinical and SCI-related risk factors which can be used to predict fracture in persons with a SCI. Clinicians should be particularly concerned about incident fracture risk in persons with a SCI who have had a previous fracture.

Incidence of low and high-energy fractures in persons with and without HIV infection

To compare fracture risk in persons with and without HIV infection and to examine the influence of highly active antiretroviral therapy (HAART) initiation on risk of fracture. Population-based nationwide cohort study using Danish registries. Outcome measures were time to first fracture at any site, time to first low-energy and high-energy fracture in HIV-infected patients (n = 5306) compared with a general population control cohort (n = 26 530) matched by sex and age during the study period 1995-2009. Cox regression analyses were used to estimate incidence rate ratios (IRRs). HIV-infected patients had increased risk of fracture [IRR 1.5, 95% confidence interval (CI) 1.4-1.7] compared with population controls. The relative risk was lower in HIV-monoinfected patients (IRR 1.3, 95% CI 1.2-1.4) than in HIV/hepatitis C virus (HCV)-coinfected patients (IRR 2.9, 95% CI 2.5-3.4).Both HIV-monoinfected and HIV/HCV-coinfected patients had increased risk of low-energy fracture, IRR of 1.6 (95% CI 1.4-1.8) and 3.8 (95% CI 3.0-4.9). However, only HIV/HCV-coinfected patients had increased risk of high-energy fracture, IRR of 2.4 (95% CI 2.0-2.9). Among HIV-monoinfected patients the risk of low-energy fracture was only significantly increased after HAART exposure, IRR of 1.8 (95% CI 1.5-2.1). The increased risk in HAART-exposed patients was not associated with CD4 cell count, prior AIDS, tenofovir or efavirenz exposure, but with comorbidity and smoking. HIV-infected patients had increased risk of fracture compared with population controls. Among HIV-monoinfected patients the increased risk was observed for low-energy but not for high-energy fractures, and the increased risk of low-energy fracture was only observed in HAART-exposed patients.

Fractures Rise With Prolonged PPIs Plus Risk

Fractures Rise With Prolonged PPIs Plus Risk

Could martial arts fall training be safe for persons with osteoporosis?: a feasibility study

BackgroundOsteoporosis is a well-established risk factor for fall-related hip fractures. Training fall arrest strategies, such as martial arts (MA) fall techniques, might be useful to prevent hip fractures in persons with osteoporosis, provided that the training itself is safe. This study was conducted to determine whether MA fall training would be safe for persons with osteoporosis extrapolated from the data of young adults and using stringent safety criteria.MethodsYoung adults performed sideways and forward MA falls from a kneeling position on both a judo mat and a mattress as well as from a standing position on a mattress. Hip impact forces and kinematic data were collected. For each condition, the highest hip impact force was compared with two safety criteria based on the femoral fracture load and the use of a hip protector.ResultsThe highest hip impact force during the various fall conditions ranged between 1426 N and 3132 N. Sideways falls from a kneeling and standing position met the safety criteria if performed on the mattress (max 1426 N and 2012 N, respectively) but not if the falls from a kneeling position were performed on the judo mat (max 2219 N). Forward falls only met the safety criteria if performed from a kneeling position on the mattress (max 2006 N). Hence, forward falls from kneeling position on a judo mat (max 2474 N) and forward falls from standing position on the mattress (max 3132 N) did not meet both safety criteria.ConclusionsBased on the data of young adults and safety criteria, the MA fall training was expected to be safe for persons with osteoporosis if appropriate safety measures are taken: during the training persons with osteoporosis should wear hip protectors that could attenuate the maximum hip impact force by at least 65%, perform the fall exercises on a thick mattress, and avoid forward fall exercises from a standing position. Hence, a modified MA fall training might be useful to reduce hip fracture risk in persons with osteoporosis.

Proton Pump Inhibitors and Histamine-2 Receptor Antagonists Are Associated With Hip Fractures Among At-Risk Patients

Drugs that inhibit gastric acid might increase the risk of hip fracture. However, little long-term exposure data exist and no large studies have been conducted in the United States. We conducted a case-control study using data from an integrated health services organization. We evaluated 33,752 patients with incident diagnoses of hip/femur fractures (cases), 130,471 matched members without fractures (controls), prescription data for use of proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) (up to 10 years' cumulative duration), and confounders. Patients with hip fractures were more likely than controls to have previously received a > or =2-year supply of PPIs (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.21-1.39) or H2RAs (OR, 1.18; 95% CI, 1.08-1.29). The risk was reduced after discontinuation of medication (OR of 1.30 [95% CI, 1.21-1.41] for current PPI users vs OR of 1.09 [95% CI, 0.64-1.85] for patients who received their last prescription 2-2.9 years ago). Higher dosages (but not increasing cumulative durations) were associated with increased risk (eg, > or =1.5 pills/day: OR, 1.41 [95% CI, 1.21-1.64]; <0.74 pills/day: OR, 1.12 [95% CI, 0.94-1.33]). Excess fracture risk for PPI use was only present among persons with at least one other fracture risk factor. Use of drugs that inhibit gastric acid is associated with an increased risk of hip fracture; however, this association was only found among persons with at least one other risk factor for hip fracture. Acid inhibition might therefore be associated with fracture risk in persons already at risk for osteoporosis, although other confounding cannot be excluded.