Osteoporotic Fractures In Postmenopausal Women Research Articles

Osteoporotic quality of life, self-efficacy, and fracture protection behaviors in postmenopausal women

SummaryIt is important for postmenopausal women to acquire bone health protective behaviors to protect them from fractures. For this reason, it is necessary to evaluate bone health during menopause and to inform women.PurposeThis study was conducted to examine osteoporotic fracture protection behaviors, quality of life, and self-efficacy in postmenopausal women.MethodsIn the study, the data were evaluated with the socio-demographic data form, Osteoporotic Fracture Protection Scale, Osteoporosis Self-Efficacy-Efficacy Scale, European Osteoporosis Foundation Quality of Life Questionnaire-41, which includes introductory information on socio-demographic characteristics.ResultsIt was determined that the postmenopausal women included in our study were between the ages of 45–92; more than half of them had chronic diseases; their average BMI was 29; and their DEXA score was − 3.00 ± 0.41. Among the people included in our study, those with a history of fractures had lower self-efficacy scores. It was determined that the fracture prevention scale scores of the participants were above the average, and the average of the osteoporosis-related quality of life score was high. In addition, it was determined that there was a strong positive correlation between self-efficacy and fracture prevention scale.ConclusionIt is important to determine behaviors to prevent osteoporotic fractures in postmenopausal women, to raise the necessary awareness and to inform patients about the precautions to be taken. It is thought that it will increase patients’ quality of life by increasing their disease-related self-efficacy. Therefore, there is a need for research on providing education to op patients and examining the results.

Comparative Study of Serum Calcium Level Between Postmenopausal and Premenopausal Women

In postmenopausal women, more significant bony consequences are associated with low blood calcium levels. A observational cross-sectional study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka from July 2014 to June 2015. Serum calcium levels were compared between postmenopausal women as cases and premenopausal women as controls. The study sample size was 100 of which 50 were postmenopausal, and 50 were premenopausal. Mean (±SD) of serum calcium level was significantly higher in the premenopausal group than in the postmenopausal group. Serum calcium level was 8.66±0.43 mg/dL in postmenopausal women and 9.12±0.59mg/dL in premenopausal women. Both the values were within the normal reference range, but the difference was statistically significant with a p-value of 0.001. By this research work, it is observed that postmenopausal women are more prone to develop osteoporosis with a decreased serum calcium concentration. Routine check-up of this biochemical parameter may provide valuable information for preventing osteoporotic fractures in postmenopausal women.
 Bangladesh J Med Biochem 2019; 12(1): 1-5

Obesity variants in the GIPR gene do not associate with risk of fracture or bone mineral density.

The objective of this study was to investigate the risk of fracture and bone mineral density (BMD) of sequence variants in GIPR that reduce the activity of the GIPR receptor and have been associated with reduced body mass index (BMI). We analysed the association of three missense variants in GIPR, a common variant, rs1800437 (p.Glu354Gln), and two rare variants, rs139215588 (p.Arg190Gln) and rs143430880 (p.Glu288Gly), as well as a burden of predicted loss of function (LoF) variants with risk of fracture and with BMD in a large meta-analysis of up to 1.2 million participants. We analysed associations with fractures at different skeletal sites in the general population; any fractures, hip fractures, vertebral fractures and forearm fractures, and specifically non-vertebral and osteoporotic fractures in postmenopausal women. We also evaluated associations with BMD at the lumbar spine, femoral neck, and total body measured with dual-energy X-ray absorptiometry (DXA), and with BMD estimated from heel ultrasound (eBMD). None of the three missense variants in GIPR associated significantly with increased risk of fractures or with lower BMD. Burden of LoF variants in GIPR were not associated with fractures or with BMD measured with clinically validated DXA, but associated with eBMD. Missense variants in GIPR, or burden of LoF variants in the gene, do not associate with risk of fractures or with lower BMD.

Height Loss Is an Independent Predictor of Fracture Incidence in Postmenopausal Women: The Results from the Gliwice Osteoporosis Study (GO Study).

The aim of a longitudinal, retrospective study was to establish variables predicting fracture incidence over a decade. The study sample comprises a group of 457 postmenopausal women aged over 55 years, recruited from the database of an outpatient osteoporotic clinic. Several variables with potential influence on bone status, including the measurement of body height and hip bone densitometry, were collected. BMD at the femoral neck (FN BMD) was established using a Prodigy device (Lunar, GE, USA). Current body height was compared with the maximal historical body height in early adulthood, as reported by the patient. Three hundred and ninety-four women did not have fractures during the follow up, and 63 subjects presented fractures. Subjects with fracture had lower FN BMD with a T-score of -1.86 ± 1.04 compared to -1.44 ± 0.89 in those without fractures (p < 0.001). Mean height loss (HL) was 3.47 ± 2.11 cm in fractured subjects and 2.50 ± 2.47 cm in unfractured ones, and differed significantly, p < 0.01. Fracture incidence was significantly related to age, rheumatoid arthritis, falls, and previous fractures. In the multivariable analysis using logistic regression, FN BMD, baseline fracture, and HL were identified as the significant predictors of fractures of follow up. Osteoporotic fractures in postmenopausal women were predicted by FN BMD, prior fracture(s), and HL easily established during physical examination.

Bone Marrow Adiposity and Fragility Fractures in Postmenopausal Women: The ADIMOS Case-Control Study.

Noninvasive assessment of proton density fat fraction (PDFF) by MRI may improve the prediction of fractures. To determine if an association exists between PDFF and fractures. A case-control study with 2 groups of postmenopausal women: one with recent osteoporotic fractures, and the other with no fractures. Lille University Hospital, Lille, France. Lumbar spine and proximal femur (femoral head, neck, and diaphysis) PDFF, determined using chemical shift-based water-fat separation MRI (WFI) and DXA scans of the lumbar spine and hip. Our primary objective was to determine the relationship between lumbar spine PDFF and osteoporotic fractures in postmenopausal women. Analysis of covariance (ANCOVA) was used to compare PDFF measurements between cases (overall and according to the type of fracture) and controls, after adjusting for age, Charlson comorbidity index (CCI) and BMD. In 199 participants, controls (n = 99) were significantly younger (p < 0.001) and had significantly higher BMD (p < 0.001 for all sites) than cases (n = 100). 52 women with clinical vertebral fractures and 48 with nonvertebral fractures were included. When PDFFs in cases and controls were compared, after adjustment on age, CCI and BMD, no significant differences between the groups were found at lumbar spine or proximal femur. When PDFFs in participants with clinical vertebral fractures (n = 52) and controls were compared, femoral neck PDFF and femoral diaphysis PDFF were detected to be lower in participants with clinical vertebral fractures than in controls (adjusted mean (standard error) 79.3% (1.2) vs 83.0% (0.8), p = 0.020, and 77.7% (1.4) vs. 81.6% (0.9), p = 0.029, respectively). No difference in lumbar spine PDFF was found between those with osteoporotic fractures and controls. However, imaging-based proximal femur PDFF may discriminate between postmenopausal women with and without clinical vertebral fractures, independently of age, CCI and BMD.

Genome-wide polygenic risk score for major osteoporotic fractures in postmenopausal women using associated single nucleotide polymorphisms

BackgroundOsteoporosis is highly polygenic and heritable, with heritability ranging from 50 to 80%; most inherited susceptibility is associated with the cumulative effect of many common genetic variants. However, existing genetic risk scores (GRS) only provide a few percent predictive power for osteoporotic fracture.MethodsWe derived and validated a novel genome-wide polygenic score (GPS) comprised of 103,155 common genetic variants to quantify this susceptibility and tested this GPS prediction ability in an independent dataset (n = 15,776).ResultsAmong postmenopausal women, we found a fivefold gradient in the risk of major osteoporotic fracture (MOF) (p < 0.001) and a 15.25-fold increased risk of severe osteoporosis (p < 0.001) across the GPS deciles. Compared with the remainder of the GPS distribution, the top GPS decile was associated with a 3.59-, 2.48-, 1.92-, and 1.58-fold increased risk of any fracture, MOF, hip fracture, and spine fracture, respectively. The top GPS decile also identified nearly twofold more high-risk osteoporotic patients than the top decile of conventional GRS based on 1103 conditionally independent genome-wide significant SNPs. Although the relative risk of severe osteoporosis for postmenopausal women at around 50 is relatively similar, the cumulative incident at 20-year follow-up is significantly different between the top GPS decile (13.7%) and the bottom decile (< 1%). In the subgroup analysis, the GPS transferability in non-Hispanic White is better than in other racial/ethnic groups.ConclusionsThis new method to quantify inherited susceptibility to osteoporosis and osteoporotic fracture affords new opportunities for clinical prevention and risk assessment.

Asia–pacific consensus on osteoporotic fracture prevention in postmenopausal women with low bone mass or osteoporosis but no fragility fractures

Postmenopausal women are at significant risk for osteoporotic fractures due to their rapid bone loss. Half of all postmenopausal women will get an osteoporosis-related fracture over their lifetime, with 25% developing a spine deformity and 15% developing a hip fracture. By 2050, more than half of all osteoporotic fractures will occur in Asia, with postmenopausal women being the most susceptible. Early management can halt or even reverse the progression of osteoporosis. Consequently, on October 31, 2020, the Taiwanese Osteoporosis Association hosted the Asia-Pacific (AP) Postmenopausal Osteoporotic Fracture Prevention (POFP) consensus meeting, which was supported by the Asian Federation of Osteoporosis Societies (AFOS) and the Asia Pacific Osteoporosis Foundation (APOF). International and domestic experts developed ten applicable statements for the prevention of osteoporotic fractures in postmenopausal women with low bone mass or osteoporosis but no fragility fractures in the AP region. The experts advocated, for example, that postmenopausal women with a high fracture risk be reimbursed for pharmaceutical therapy to prevent osteoporotic fractures. More clinical experience and data are required to modify intervention tactics.

Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women.

Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women.

RISK FACTORS FOR THE DEVELOPMENT OF OSTEOPOROSIS IN TYPE 2 DIABETES MELLITUS IN POST-MENOPAUSAL PERIOD

ABSTRACT Women with type 2 diabetes mellitus (T2DM) are at a significantly higher risk of fractures, even with normal or elevated bone mineral density (BMD). It was found that in the general population among women, the incidence of osteoporosis is more than 30% in the menopausal period and 43.3% among postmenopausal women, while among people with type 2 diabetes it reaches 75%. An aggravating risk factor in this case is the period of transition of patients with diabetes to postmenopausal age. DM, already predisposing to osteoporotic processes, is aggravated by postmenopausal osteoporosis. Comorbid exacerbation of these processes, which have different mechanisms of action on the bone structure, exacerbates changes in bone characteristics. At the same time, for DM, the most characteristic is a violation of the structure of the cortical bone, mainly the femoral neck and peripheral skeleton, and in postmenopausal osteoporosis, mainly trabecular tissue is damaged, with a predominant lesion of the vertebrae. However, the pathogenetic mechanisms of this influence remain poorly understood. Objective: to evaluate the features of changes in BMD in the lumbar spine and proximal femur in patients with type 2 DM aggravated by postmenopausal osteoporosis. Methods: A total of 96 postmenopausal women with T2DM and 32 control women without diabetes were assessed for bone mineral density (BMD, using dual energy X-ray absorptiometry), biochemical bone markers β-isomerized C-terminal telopeptides (β-CTx) and total procollagen type 1 amino-terminal propeptide (P1NP) and glucose metabolism. Results: In patients with type 2 diabetes When comparing the indicators of phosphorus-calcium metabolism and bone density, a fairly high degree of correlation was found only between the indicators of bone mineral density and ionized calcium (r = -0.321; p = 0.03), as well as between the BMD of the LI-LIV zone and beta-CTx marker (r = -0.436; p = 0.006), which indicates increased bone resorption. At the same time, starting from the state of diabetes subcompensation, bone tissue resorption significantly and significantly increased bone resorption (increased levels of beta-CTx) in 76% of patients and reduced bone mineral density. Conclusion: Our data support the ability of the beta-CTx marker to detect differences in the risk of osteoporotic fractures in postmenopausal women with T2DM compared with non-diabetic controls. The activity of total alkaline phosphatase does not reflect the essence of metabolic changes in bone tissue in diabetes mellitus. It should be noted that in patients suffering from type 2 diabetes, osteopenic syndrome depends not so much on age as on the duration of the disease, the degree of compensation of the glycemic profile. Also, the higher the HbA1c level in women with diabetes, the lower the bone density of the lumbar spine. Assessment of the state of bone mineral density and indicators of its metabolism in postmenopausal women with diabetes will allow timely detection of changes in bone remodeling and contribute to the prevention of fractures, including such a severe injury as a fracture of the femoral neck. Keywords: osteoporosis, diabetes mellitus type 2, post menopause.

Trabecular Bone Score as a Risk Factor of Major Osteoporotic Fracture in Postmenopausal Women: The First Study in Thailand.

To compare the trabecular bone score (TBS) between Thai postmenopausal women with and without major osteoporotic fracture, and to determine whether TBS is associated with fracture risk. All postmenopausal women sent for dual-energy X-ray absorptiometry (DXA) at the Police General Hospital were retrospectively recruited. The hospital's online database and radiographs were reviewed to collect information on underlying disease, medication, previous fractures, bone mineral density, and trabecular bone score. Patients with anti-osteoporotic medication use, skeletal malignancy, fracture from high-energy trauma, and uninterpretable DXA images were excluded. A total of 407 Thai postmenopausal women were enrolled. They were divided into 292 women without fractures and 115 women with major osteoporotic fractures. The fracture group was older (73.36 ± 9.95 vs. 66.00 ± 8.58, P < 0.001) and had lower serum 25-hydroxyvitamin D levels (23.28 ± 9.09 vs. 26.44 ± 9.20, P = 0.023). The mean TBS was lower in the fracture group, compared to the non-fracture group (1.244 ± 0.101 vs. 1.272 ± 0.099, P = 0.011). The subgroup analysis resulted in noticeably lower TBS in spine fracture, but not other fracture sites. The odds ratio of fracture was 1.355 (P = 0.013) for a decrease in one standard deviation of TBS. TBS was significantly lower in postmenopausal women having fractures with an odd ratio of 1.355 (P = 0.013) per SD decrease in TBS. Categorizing by fracture sites, TBS was only found to be noticeably lower in the lumbar spine despite similar lumbar spine bone mineral density.

Prevalence of osteoporosis and osteoporotic fractures in postmenopausal women with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) and osteoporosis are chronic diseases with increasing prevalence. The aim of this study was to determine the prevalence of osteoporosis and osteoporotic fracture in women with T2DM and to identify predictive factors of fracture occurrence. The prevalence of osteoporosis and fractures in postmenopausal women with T2DM was 23.1% and 16.9%, respectively. 46.2% of T2DM patients had normal bone mineral density (BMD) (P&lt;0.01) and 58.5% of control subjects had osteopenia (P&lt;0.01). Incidence of fracture in T2DM patients with osteopenia was significantly increased versus control subjects when stratified according the BMD (P=0.009). By stratifying T2DM patients according to fractures, factors that were significantly associated with occurrence included T2DM duration (P=0.038), use of insulin (P=0.017), and lower BMD (P=0.048). Our study suggests that there was a higher prevalence of fracture in T2DM patients compared to control subjects and a significant difference in BMD was found between the groups. We also showed that insulin use, low BMD, and long duration of T2DM are factors associated with an increased risk of bone fracture.

Частота і локалізація остеопоротичних переломів залежно від віку, мінеральної щільності та якості кісткової тканини в українських жінок у постменопаузальному періоді

Актуальність. Низькотравматичні переломи є важливими ускладненнями системного остеопорозу, що призводять до зниження якості життя, збільшення захворюваності, інвалідності та смертності. У наш час мінеральна щільність кісткової тканини (МЩКТ) і трабекулярний кістковий індекс (ТКI), що визначаються за допомогою двохенергетичної рентгенівської абсорбцiометрiї, є двома основними параметрами міцності кістки. Вони широко використовуються при діагностиці остеопорозу. Метою дослідження було вивчення частоти і локалізації різних остеопоротичних переломів у жінок в постменопаузальному періоді залежно від віку, МЩКТ і ТКI. Матеріали та методи. Проведено одномоментне дослідження і проаналізовані дані 1369 жінок у постменопаузальному періоді (вік 45–89 років). Пацієнтки були розділені на групи залежно від МЩКТ згідно з критеріями Всесвітньої організації охорони здоров’я: нормальний стан кісткової тканини (T-індекс &gt; –1,0 стандартного відхилення (СВ)), остеопенія (≤ –1,0 T-індекс &gt; –2,5 СВ), остео­пороз (T-індекс ≤ –2,5 СВ), і в залежності від квартилів (груп) ТКI (L1-L4): QI — найнижча квартиль (0,36–1,08); QII — нижня квартиль (1,08–1,20); QIII — верхня квартиль (1,20–1,32); QIV — найвища квартиль (1,32–1,79). МЩКТ і ТКI поперекового відділу хребта (L1-L4) вимірювали за допомогою денситометра Prodigy (GE Medical systems, Lunar, модель 8743, 2005). ТКI визначали з використанням програмного забезпечення TBS Insight (Med-Imaps, Bordeaux, France, 2006). Результати. Встановлено, що ризик усіх типів остеопоротичних переломів у жінок достовірно збільшується з віком (вертебральних переломів — у 1,97–4,26 раза, невертебральних — у 1,96–5,45, комбінованих — у 1,54—3,14 раза). Крім того, ми ви­явили, що остеопоротичні переломи присутні у всіх групах жінок iз різною МЩКТ: при остеопорозі (45,5 %), остеопенiї (26,9 %) та за нормального стану кісткової тканини (18,1 %). Найбільшою частота остеопоротичних переломів була при остеопорозі (46,5 %), переважно в жінок iз хребцевими і комбінованими переломами. Тільки в 25,5 % пацієнток iз невертебральними переломами спостерігається остеопороз. Низький ТКI відзначався в 50,8 % жінок iз вертебральними, 43,7 % — невертебральними і в 32,8 % — iз комбінованими (хребцевими і невертебральними) остеопоротичними переломами. Висновки. Остеопоротичні переломи частково пов’язані з віком, МЩКТ і ТКI. Однак існують й інші важливі чинники, що впливають на ризик переломів, і їх поєднання вимагає подальшого вивчення.

Application of the Trabecular Bone Score in Clinical Practice.

The trabecular bone score (TBS) was introduced as an indirect index of trabecular microarchitecture, complementary to bone mineral density (BMD), and is derived using the same dual energy X-ray absorptiometry images. Recently, it has been approved for clinical use in Korea. Therefore, we conducted a comprehensive review to optimize the use of TBS in clinical practice. The TBS is an independent predictor of osteoporotic fractures in postmenopausal women and men aged >50 years. The TBS is potentially useful in monitoring the skeletal effects of anabolic agents but not of antiresorptive agents. In postmenopausal women with type 2 diabetes mellitus, the TBS assesses osteoporotic fracture risk not captured by BMD. However, high body mass index and soft tissue thickness can cause underestimation of the TBS; however, this limitation has been improved in recent versions of the TBS software. However, a high precision error and low reproducibility limit the use of TBS. This review may provide information on the application of the TBS in clinical practice based on reliable evidence.

Pentosidine and carboxymethyl-lysine associate differently with prevalent osteoporotic vertebral fracture and various bone markers

Pentosidine (PEN) and carboxymethyl-lysine (CML) are well-recognized advanced glycation end products (AGEs). However, how these AGEs affect the pathophysiology of osteoporosis and osteoporotic fractures remains controversial. This cross-sectional study aimed to investigate the associations of PEN and CML with bone markers, bone mineral density (BMD), and osteoporotic fractures in postmenopausal women from the Nagano Cohort Study. A total of 444 Japanese postmenopausal outpatients (mean ± standard deviation age: 69.8 ± 10.2 years) were enrolled after the exclusion of patients with acute or severe illness or secondary osteoporosis. The relationships among urinary PEN and serum CML levels, various bone markers, lumbar and hip BMD, and prevalent vertebral and long-bone fractures were evaluated. PEN associated significantly with prevalent vertebral fracture after adjustment for other confounders (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.22–2.07; P < 0.001), but not with lumbar BMD. In contrast, a significant negative correlation was found between CML and lumbar BMD (r = − 0.180; P < 0.001), and this relationship was significant after adjustment for confounders (OR 0.84, 95% CI 0.76–0.93; P < 0.01). Although patients with prevalent vertebral fracture had significantly higher CML levels, the association between CML and prevalent vertebral fracture did not reach significance in the multivariate regression model. Both PEN and CML may play important roles in bone health for postmenopausal women, possibly via different mechanisms.

Economic implications of osteoporotic fractures in postmenopausal women.

Osteoporosis is a condition affecting millions of Americans, the majority of which are women secondary to low estrogen in the postmenopausal state. In many instances, the diagnosis is not recognized until after a fracture has occurred due to the "silent" nature of this disease. As a result, this leads to millions of fractures each year, placing a substantial economic burden of billions of dollars from Medicare alone. Prevention, early diagnosis, and treatment remain paramount in reducing this economic impact as well as improving overall incidence of mortality and morbidity. Goals of care include preventing the progression of disease and minimizing bone fractures, particularly in the hips, spine, and wrists. This article will examine the risks of osteoporosis and osteoporotic fractures in postmenopausal women, the current and emerging pharmacologic treatment options, and the role of managed care pharmacists in decreasing economic burden and improving patient care.

Low Bone Turnover Markers in Young and Middle-Aged Male Patients with Type 2 Diabetes Mellitus.

Accumulating evidence has supported an increased risk of osteoporotic fracture in postmenopausal women and elderly men diagnosed with diabetes mellitus. However, it is not uncommon for young and middle-aged male patients diagnosed with type 2 diabetes mellitus (T2DM) to suffer from osteopenia or osteoporosis. Few studies focused on this population group are available. The aim of this study is to evaluate bone metabolic status and investigate the influence of T2DM on bone metabolism in 30-50-year-old men. Anthropometric assessment and blood samples were obtained from 160 patients with T2DM and 69 nondiabetic volunteers. Serum parathyroid hormone (PTH) and bone turnover markers (BTMs), including serum procollagen type I N-terminal peptide (PINP), osteocalcin (OC), and β-cross-linked C-telopeptide of type I collagen (β-CTX), were analysed. No significant differences were observed based on age, body mass index, systolic blood pressure, serum calcium, phosphorus, creatinine, total protein, and albumin levels when comparing T2DM and control groups. Fasting blood glucose, HbA1c, triglyceride (TG), total cholesterol, and low-density lipoprotein cholesterol were significantly increased, while high-density lipoprotein cholesterol was significantly decreased in the T2DM group. Compared with controls, diabetic patients showed lower serum PINP, OC, and PTH levels, whereas serum β-CTX levels were similar between the two groups. Moreover, HbA1c levels were positively correlated with PINP and inversely associated with PTH levels. TG levels were negatively correlated with OC or β-CTX levels. Furthermore, multiple linear regression revealed a positive correlation between HbA1c and PINP levels. These results also revealed a negative association between HbA1c and PTH, and between TG and OC levels, even after adjusting for expected confounder factors. Collectively, these findings indicated that young and middle-aged male patients with T2DM showed a lower turnover state resulting from bone formation inhibition. Glucose and lipid metabolic disorders may affect bone formation through different pathways.

Relationship Between Obesity and Risk of Major Osteoporotic Fracture in Postmenopausal Women: Taking Frailty Into Consideration.

The role of obesity in fracture risk remains uncertain and inconclusive in postmenopausal women. Our study aimed to assess the relationship between obesity and risk of major osteoporotic fracture (MOF; ie, a clinical fracture of upper arm or shoulder, hip, spine, or wrist) in postmenopausal women, after taking frailty into consideration. We used the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 5-year Hamilton cohort for this study. Frailty was measured by a frailty index (FI) of deficit accumulation at baseline. We incorporated an interaction term (obesity × FI) in the Cox proportional hazards regression model. We included 3985 women (mean age 69.4 years) for analyses, among which 29% were obese (n = 1118). There were 200 (5.02%) MOF events documented during follow-up: 48 (4.29%) in obese women and 152 (5.65%) in the nonobese group. Significant relationships between obesity, frailty, and MOF risk were found: hazard ratio (HR) = 0.72 (95% confidence interval [CI] 0.67-0.78) for those with an FI of zero regarding MOF risk among obese women, and HR = 1.34 (95% CI 1.11-1.62) per SD increase in the FI among nonobese women. The interaction term was also significant: HR = 1.16 (95% CI 1.02-1.34) per SD increase in the FI among obese women. Increased HRs were found with higher FIs regarding the relationship between obesity and MOF risk, indicating increasing frailty attenuated the protective effect of obesity. For example, although the HR for obesity and MOF risk among those who were not frail (FI = 0) was 0.72 (95% CI 0.67-0.78), among those who were very frail (FI = 0.70), the HR was 0.91 (95% CI 0.85-0.98). To conclude, after taking frailty into consideration, obesity was significantly associated with decreased risk of MOF in postmenopausal women among those who were not frail; however, increasing frailty attenuated this protective effect of obesity. Evaluating frailty status may aid in understanding of the complex relationship between obesity and fracture risk. © 2020 American Society for Bone and Mineral Research (ASBMR).

Exercise Therapy For Bone Health: Translation To Clinical Practice

We previously reported that high-intensity resistance and impact training (HiRIT) is safe and improves risk factors for osteoporotic fracture in postmenopausal women and older men with low bone mass under trial conditions (LIFTMOR and LIFTMOR-M trials). We have now established a translational research Clinic implementing HiRIT in practice alongside systematic longitudinal monitoring of musculoskeletal and functional outcomes to determine effectiveness and feasibility as osteoporosis prevention and therapy in the ‘real world’. PURPOSE: The aim of the current report is to present 4 year outcomes from the Clinic. METHODS: All Clinic clients undergo testing for height, weight, spine (LS), total hip (TH) and femoral neck (FN) bone mineral density (BMD), lean and fat mass, back extensor strength (BES), and functional indices of fall risk at their baseline visit, and annually thereafter. Twice-weekly supervised HiRIT with balance training and a dietary consult is provided. Compliance and injuries are comprehensively monitored. In the absence of a control group, program effectiveness is determined from one-sample t-tests of percent change from baseline. RESULTS: We report outcomes from 275 clients (94.9% female) who have completed a minimum of 12 months HiRIT (63.6±7.1 yrs, 162.3±6.8 cm, 60.6±10.0 kg, LS T-score -2.0±1.1, FN T-score -2.0±0.7, compliance 69.1±39.6%). 70 clients were on bone medications at baseline but only 18 at follow-up. Improvement was observed in weight (0.8±3.8%, P<0.0001), LS (2.2±5.1%, P<0.0001), TH (1.0±3.7%, P<0.0001) and FN BMD (1.4±4.8%, P<0.0001), lean mass (2.3±5.5%, P<0.0001), fat percent (-4.5±10.7%, P<0.0001), functional reach (7.2±13.4%, P<0.0001), timed up and go (-9.8±12.0%, P<0.0001), tandem walk (-20.6±35.1%, P<0.0001), sit to stand (-9.9±15.9%, P<0.0001), BES (20.6±35.1%, P<0.0001), and kyphosis (5.1±54.8%, P<0.05). Clients increased daily dietary calcium (23±67%, P<0.0001) and total calcium (19±68%, P<0.0001). 20 injuries were sustained in a total of 31,483 training sessions, the majority being minor muscle strains. CONCLUSION: We show that, when supervised in clinical practice, an evidence-based, targeted, high-intensity resistance and impact training program is safe and highly effective osteoporosis therapy for older men and women with low bone mass.

Clinical efficacy and safety of drug interventions for primary and secondary prevention of osteoporotic fractures in postmenopausal women: Network meta-analysis followed by factor and cluster analysis.

We aimed to evaluate the comparative efficacy and safety of drugs respectively for primary prevention and secondary prevention of osteoporotic fractures in postmenopausal women (PMW), and to further identify the optimal intervention(s) respectively for the two groups when efficacy and safety both considered. We searched three databases. Bayesian network meta-analyses were conducted for two efficacy outcomes (vertebral fractures and nonvertebral fractures) and two safety outcomes (tolerability and acceptability) respectively in primary prevention group and secondary prevention group. We synthesized hazard ratios (HRs) and 95% confidence intervals (CIs) for nonvertebral fractures, and risk ratios (RRs) for three others. Factor and cluster analyses on surface under the cumulative ranking curve (SUCRA) values were conducted to identify the best intervention(s) with efficacy and safety both considered. The study protocol has been registered in PROSPERO. We included 57 randomized trials involving fifteen anti-osteoporotic interventions and 106320 PMW. For primary prevention, only zoledronate (once per 18 months) reduced both vertebral (RR 0.46, 95% CI 0.28-0.74) and nonvertebral (HR 0.66, 95% CI 0.51-0.85) fractures. For secondary prevention, abaloparatide, alendronate, denosumab, lasofoxifene, risedronate, romosozumab, teriparatide, and zoledronate (once per 12 months) reduced both vertebral (RRs: from 0.17 to 0.62) and nonvertebral (HRs: from 0.54 to 0.81) fractures. PTH (1-84) and abaloparatide increased withdrawal risk. Romosozumab, teriparatide, denosumab and risedronate, with the greatest composite scores, constituted the optimal cluster having both superior efficacy and superior safety. Zoledronate used at 5 mg per 18 months, with the similar safety as placebo, is the only drug intervention which has been shown to significantly reduce both vertebral and nonvertebral fractures for primary prevention of osteoporotic fractures in PMW; while romosozumab, teriparatide, denosumab, and risedronate are the optimal treatments for secondary prevention when efficacy and safety both considered. A limitation is that safety outcomes failed to consider the severity of adverse effects.

Identification of prevalent vertebral fractures using Vertebral Fracture Assessment (VFA) in asymptomatic postmenopausal women: A systematic review and meta-analysis.

Vertebral fracture (VF) is the most common osteoporotic fracture in postmenopausal women, although most VFs are subclinical. Prevalent VFs are a significant predictor of subsequent fracture and therefore, identification of VF improves the identification of those with high fracture risk. The aim of present study was to systematically review the literature that assessed the prevalence of VF in asymptomatic postmenopausal women, using Vertebral Fracture Assessment (VFA) by dual-energy X-ray absorptiometry. Medline, Web of Science and Cochrane databases were searched between Jan 1st, 2000 and Jan 31st, 2018, for publications in English that reported the prevalence of VFA-detected VF in asymptomatic postmenopausal women. We also searched for reports, conference papers and grey literature. Reviewers screened studies for eligibility and extracted data for included studies. Random effects meta-analyses were performed to calculate the prevalence of VF. The presence of publication bias was assessed using funnel plots by precision and Egger's Test of the Intercept. A total of 1777 articles were identified, 94 studies were fully reviewed and 28 studies (n=25,418) met the inclusion criteria and were analyzed. More than two thirds of the studies were cross-sectional and the sample size varied widely across the studies (from 63 to 5156). The mean age ranged from 59.5 to 86.2years old. The prevalence of osteoporosis and osteopenia varied between 6-57.0% and 25.1-58.9%, respectively. However, among women who had prevalent VFs, up to 43% had osteopenia and as many as 32% had normal bone density. The weighted pooled prevalence of VFA-detected VF in asymptomatic women was 28% (95% CI: 23%-32%). VFA is able to identify prevalent VF in asymptomatic postmenopausal women. The use of VFA identified an average of 28% of asymptomatic women with VFs, many of whom did not have a diagnosis of osteoporosis. Implementation of VFA as a routine screening tool may detect high risk women. Detection of VF might lead to pharmacological treatment in individuals who may not otherwise be treated.