Osteoporotic Fractures In Women Research Articles

Pathogenetic Role of Osteoprotegerin and Osteopontin in the Development of Cardiovascular Complications in Comorbid Pathology

This study investigated the pathogenetic role of osteoprotegerin (OPG) and osteopontin (OPN) in the development of cardiovascular complications and osteoporotic fractures in women with chronic heart failure (CHF), osteoporosis, and type 2 diabetes mellitus (T2DM). A total of 150 postmenopausal women participated in the study. The serum levels of OPG and OPN were assessed, along with their relationship with the frequency of adverse cardiovascular events (CVE) and osteoporotic fractures. It was found that patients with elevated OPG levels (>50 mmol/L) had a significantly higher rate of CVE (65%) compared to those with lower levels. Increased OPN levels (>250 ng/mL) were associated with a rise in osteoporotic fractures, reaching up to 60%. Patients with high levels of both biomarkers showed the highest risk for both cardiovascular events and fractures. Statistical analysis revealed a strong correlation between OPG levels and CVE frequency (r=0.62, p<0.001), as well as between OPN levels and fracture frequency (r=0.58, p<0.001). These results highlight the critical role of OPG and OPN in the pathogenesis of comorbid conditions and their potential clinical significance as markers for predicting complication risks. The identified relationships could be used to develop new diagnostic and preventive strategies for cardiovascular and osteoporotic complications in patients with comorbid pathologies.

Is denosumab an efficient and safe drug for osteoporosis in dialysis patients? Considerations and state of the art about its use in this setting.

In patients with chronic kidney disease (CKD), renal osteodystrophy may be associated with a progressive bone mass loss that increases fracture risk. Denosumab, a monoclonal antibody inhibiting osteoclast activity, is an antiresorptive medication used for the treatment osteoporosis. Its efficacy and safety were initially established in the FREEDOM study, showing a significant reduction in incident fractures in osteoporotic women treated with denosumab. Subsequent post hoc analyses showed its efficacy in patients stratified by kidney function, but these analyses did not include patients with advanced stages of CKD. The capability of denosumab in improving bone mineral density in uremic patients was evaluated in 12 studies including 461 dialysis patients with low bone mineral density. The improvement of bone mineral density was the final end point in these studies assessed during a follow-up of 6-60months. Nine of these studies did not have hyperparathyroidism among criteria for patient inclusion and their participants may have low-turnover bone disease. Despite current recommendations, no patients underwent bone biopsy before denosumab therapy. Overall, findings in these studies suggest that denosumab is a viable option for promoting bone mass recovery in patients with advanced stages of CKD having either high or low serum levels of PTH. However, the increase of bone mineral density was lower in patients with low serum markers of bone turnover at baseline. These studies also highlighted the need for calcium and vitamin D supplementation to prevent hypocalcemia that remains a serious concern. Denosumab emerges as a potentially safe and effective option for enhancing bone health in CKD patients.

Application of Machine Learning Algorithms to Predict Osteoporotic Fractures in Women.

Predicting the risk of osteoporotic fractures is vital for prevention. Traditional methods such as the Fracture Risk Assessment Tool (FRAX) model use clinical factors. This study examined the predictive power of the FRAX score and machine-learning algorithms trained on FRAX parameters. We analyzed the data of 2,147 female participants from the Ansan cohort study. The FRAX parameters employed in this study included age, sex (female), height and weight, current smoking status, excessive alcohol consumption (>3 units/d of alcohol), and diagnosis of rheumatoid arthritis. Osteoporotic fracture was defined as one or more fractures of the hip, spine, or wrist during a 10-year observation period. Machine-learning algorithms, such as gradient boosting, random forest, decision tree, and logistic regression, were employed to predict osteoporotic fractures with a 70:30 training-to-test set ratio. We evaluated the area under the receiver operating characteristic curve (AUROC) scores to assess and compare the performance of these algorithms with the FRAX score. Of the 2,147 participants, 3.5% experienced osteoporotic fractures. Those with fractures were older, shorter in height, and had a higher prevalence of rheumatoid arthritis, as well as higher FRAX scores. The AUROC for the FRAX was 0.617. The machine-learning algorithms showed AUROC values of 0.662, 0.652, 0.648, and 0.637 for gradient boosting, logistic regression, decision tree, and random forest, respectively. This study highlighted the immense potential of machine-learning algorithms to improve osteoporotic fracture risk prediction in women when complete FRAX parameter information is unavailable.

Knowledge of Osteoporosis among women of 40 years and above in Nepalgunj sub-Metropolitan City

Background: Osteoporosis is a global problem with a lifetime risk of osteoporotic fractures in women. It is the condition that reduces bone mass per unit volume of normally mineralized bone resulting in fractures, even minor trauma which increases as an increase in age. Objectives: The study aimed to assess the osteoporosis knowledge among women of 40 years and above residing in Muktipur-12, Nepalgunj, Banke. Methods: A quantitative cross-sectional study was carried out in Muktipur-12, Nepalgunj Sub Metropolitan city among 150 women of 40 years and above. Face to face interview was conducted during July-August, 2018. Statistical Package for the Social Sciences (SPSS) version-16 was used for descriptive and inferential statistics. Results: Study showed 61.3% women of 40 years and above had fair knowledge of osteoporosis. Personal presence of osteoporosis was reported by 26% of respondents. Diet low in calcium (79.3%), lack of exercise (57.3%) and personal history of fracture as an adult (44.7%) were the major reported causes of osteoporosis. Regarding knowledge on symptoms, lower back pain (78%), stooped position (64.7%) and bone fracture (42.7%) were reported. More than three fourth (84%) answered adequate calcium intake as preventive measures for osteoporosis. Knowledge of osteoporosis was found to be significantly associated with age (p<0.001), literacy (p=0.028) and occupation (p=0.019) of the participants. Conclusion: Study concluded fair level of knowledge regarding osteoporosis. Osteoporosis awareness program need to be continued and expanded covering young age women which could minimize the future risk of osteoporosis.

Estimation of bone mineral density and algorithms of 10-year risk of osteoporotic fractures in women

Osteoporosis is the fourth most common after cardiovascular, cancer and endocrine diseases. With an increase in life expectancy, it becomes one of the main causes of deterioration in health and an increase in mortality.
 Aim of the study. Assess bone mineral density using ultrasonic densitometry and the risk of osteoporotic fractures among women in Cherkasy region.
 Materials and methods. The study was based on a survey of 43 women in the Odessa region, the average age of the subjects was 56,4±9,9 years, the average body weight was 73,5±11,6 kg, height 164,9±5,9 cm, the average BMI was 27,1±4,3. All women were divided into groups by age with a ten-year interval and by densitometry indices.
 Results. Decreased bone density was found in 58,1 % of subjects, osteoporosis - 2 (4,8%). Women with osteopenia and osteoporosis have an increased risk of fractures and significantly reduced ultrasound densitometry compared to respondents with normal BMD. The structure of concomitant pathology was dominated by diseases of the circulatory system (22 cases;51,2 %) and digestive organs (12; 27,9 %). More than half of women (26; 60,5 %) had a total of 50 comorbidities, with an average of 1.2 cases of comorbidity.
 Conclusions. Most women had osteopenic manifestations. Age significantly correlates with BMD parameters. The number of women with changes in the structure of bone tissue increases with age. Algorithms for assessing the 10-year risk of FRAX and Q-Fracture fractures are significantly correlated with densitometry. The combination of ultrasonic densitometry with algorithms for assessing the risk of osteoporotic fractures increases the diagnosis of osteoporosis.

Protocolo diagnóstico de las fracturas vertebrales

Vertebral fracture are the most prevalent osteoporotic fractures in women and men, yet they are currently underdiagnosed because their manifestations are nonspecific. In addition, vertebral fractures evident on radiological images requested for other diseases are occasionally not reported. A conventional radiological study with anteroposterior and lateral X-rays of the dorsal and lumbar spine is standard practice. On these X-rays, a vertebral morphometry is performed using the Genant scale. Other diagnostic procedures include morphometry based on densitometric images (vertebral fracture assessment), computed tomography, and magnetic resonance imaging. The main differential diagnosis is made between an acute or subacute osteoporotic fracture and a neoplastic fracture. A set of radiological signs is useful for differentiating both diseases.

Информативность различных моделей FRAX в оценке риска остеопоротических переломов у женщин Украины

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Risk of osteoporotic fracture in women using the FRAX tool with and without bone mineral density score in patients followed at a tertiary outpatient clinic ‒ An observational study

ObjectivesFragility fractures increase morbidity and mortality. Adding assessment of clinical risk factors independently or as a previous step to Bone Densitometry (BD) should provide better accuracy in fracture risk prediction. FRAX tool might be used to stratify patients in order to rationalize the need for BD and risk classification. The primary objective of this study is to describe and perform comparisons between the estimated risk of fractures in 10 years using the FRAX calculator based on clinical factors with and without BD results for women aged 40 or more with clinical diseases monitored in tertiary care service in internal medicine. MethodsCross-sectional. Women over 40 years with BD in the previous year. After medical chart review, identification of risk factors and risk estimations using FRAX-BRAZIL with (FRAX BDI) and without (FRAX BDNI) the inclusion of T-score. Results239 women. Age 65 ± 10.35 years. BMI 29.68 ± 6.27kg/m2. Risk factors: 32(13.4%) previous fractures; 23 (9.6%) current smoking; 78 (32.6%) corticosteroids use; 44 (18.4%) rheumatoid arthritis; 38 (15.9%) secondary causes; FRAX scores were higher when BD was not included. Spearman correlation coefficients between FRAX BDNI and FRAX BDI for major fractures r = 0.793 (95% CI 0.7388‒0.836). For hip fractures r = 0.6922 (95% CI 0.6174‒0.75446) ConclusionUsing FRAX to estimate 10-year fracture risk without BD data might be a reliable tool for screening, even for patients with a high prevalence of risk factors, improving accessibility and equity in health systems. The present study's data suggest an overestimation of fracture risk with FRAX BDNI, suggesting that it is safe to be widely used as a screening tool.

Influence of physical activity in childhood on bone state, physical capabilities of postmenopausal women with osteoporosis and vertebral fractures

Background. To date, the results of scientific research continue to discuss the long-term effect of regular sports in childhood on the prevention of bone quality loss in postmenopausal women, as well as the positive effect of a sufficient level of physical activity in the prevention of osteoporotic fractures in women older age. The purpose was to assess the effect of physical activity (PA) in childhood on the state of BT, physical capabilities of postmenopausal women with osteoporosis and vertebral fractures. Materials and methods. As part of a single-stage study, 115 postmenopausal women aged 50–89 years were examined. For the analysis, the selected individuals were divided into groups: I (control) group— women without any history of osteoporotic fractures (n=84), II (main) group — patients with vertebral fractures at the level of the thoracic and lumbar spine (n = 31). With the help of the author’s questionnaire, the peculiarities of the PA of women were assessed at different age periods of life and at the time of the survey. Results. We did not find significant differences in the frequency and types of sports in childhood between the groups depending on vertebral fractures. Most of the women with vertebral fractures (85.7 %) maintained regular physical activity, sports in childhood up to 10 years (41.7 % in the control group, p = 0.04), moreover, in 57.1% of the surveyed, these activities lasted 1–4 years and did not differ from the indicator of the control group. The type, frequency and duration of FU training and PH procedures, as well as the level of physical activity, did not significantly differ in patients depending on the presence of vertebral fractures, but the group of women regularly exercising in sports sections was significantly higher among patients with vertebral fractures (41.9 %) compared with women without vertebral fractures (10.7 %, p = 0.0002). In addition, the part of women in the control group who regularly maintained a sufficient level of PA (6 or more hours a day) was significantly higher (14.3 %) compared with the corresponding result of the main group (3.2 %, p = 0.04). Conclusions. Women with vertebral body fractures are more likely to engage in PE in sports sections and have a lower level of total PA compared to patients without vertebral fractures. The regularity, duration of PE, and the age at which sports start in childhood may influence the risk of osteoporotic fractures of the vertebral bodies in postmenopausal women, which requires further study.

Description of Major Osteoporotic Fractures in Women with Invasive Breast Cancer Who Received Endocrine Therapy

Description of Major Osteoporotic Fractures in Women with Invasive Breast Cancer Who Received Endocrine Therapy

10-летний риск основных остеопоротических переломов у женщин с ревматоидным артритом согласно украинской модели FRAX

Актуальность. Своевременная оценка риска остео-поротических переломов у больных ревматоидным артритом (РА) является чрезвычайно актуальной и возможна благодаря использованию опросника Fracture Risk Assessment Tool (FRAX®) и показателей рентгеновской денситометрии (ДРА). В Украине есть собственная модель FRAX, определены и предельные значения для начала антиостеопоротического лечения, однако ее информативность у больных с РА изучена недостаточно. Цель: изучение показателей 10-летнего риска основных остеопоротических переломов (ОПП) и переломов бедренной кости (ПБК) у женщин с РА с использованием украинской модели FRAX. Материалы и методы. Обследованы 230 женщин в возрасте 43–73 года, среди которых было 110 больных с РА. Пациентки достоверно не отличались по показателям возраста, массы тела, срока менопаузы и ее продолжительности. Риск переломов рассчитывали без показателей ДРА, также определяли процент лиц, нуждающихся в дообследовании или лечении согласно рекомендованным пределам вмешательства для украинской модели FRAX. Анализ результатов проводили в различных возрастных подгруппах в зависимости от наличия ранней менопаузы и продолжительности постменопаузы. Результаты. У больных с РА установлены достоверно более высокие показатели ОПП и ПБК по сравнению с показателями контроля (7,6 [5,7–11,0] и 4,3 [3,0–7,7] %, р = 0,0000001, и 1,4 [0,8–2,5] и 0,7 [0,3–1,7] %, р = 0,0000001 соответственно). 24,5 % женщин с РА и 6,7 % лиц контрольной группы имели низкоэнергетические переломы (р < 0,001), частота приема глюкокортикоидов в группах составила, соответственно, 62,7 и 1,7 % (р < 0,0001). 33,6 % лиц с РА и 5 % лиц контрольной группы нуждались в лечении без проведения дообследования, тогда как 24,2 % лиц контрольной группы не нуждались в проведении ДРА в связи с низкими показателями FRAX. Выводы. Женщины с РА имеют достоверно более высокие показатели FRAX по сравнению со здоровыми лицами, около трети из них нуждаются в антиостеопоротическом лечении без дополнительного обследования, что должно быть учтено при их ведении для снижения риска остеопоротических переломов.

Bone Strain Index predicts fragility fracture in osteoporotic women: an artificial intelligence-based study

BackgroundWe applied an artificial intelligence-based model to predict fragility fractures in postmenopausal women, using different dual-energy x-ray absorptiometry (DXA) parameters.MethodsOne hundred seventy-four postmenopausal women without vertebral fractures (VFs) at baseline (mean age 66.3 ± 9.8) were retrospectively evaluated. Data has been collected from September 2010 to August 2018. All subjects performed a spine x-ray to assess VFs, together with lumbar and femoral DXA for bone mineral density (BMD) and the bone strain index (BSI) evaluation. Follow-up exams were performed after 3.34 ± 1.91 years. Considering the occurrence of new VFs at follow-up, two groups were created: fractured versus not-fractured. We applied an artificial neural network (ANN) analysis with a predictive tool (TWIST system) to select relevant input data from a list of 13 variables including BMD and BSI. A semantic connectivity map was built to analyse the connections among variables within the groups. For group comparisons, an independent-samples t-test was used; variables were expressed as mean ± standard deviation.ResultsFor each patient, we evaluated a total of n = 6 exams. At follow-up, n = 69 (39.6%) women developed a VF. ANNs reached a predictive accuracy of 79.56% within the training testing procedure, with a sensitivity of 80.93% and a specificity of 78.18%. The semantic connectivity map showed that a low BSI at the total femur is connected to the absence of VFs.ConclusionWe found a high performance of ANN analysis in predicting the occurrence of VFs. Femoral BSI appears as a useful DXA index to identify patients at lower risk for lumbar VFs.

Hearing and Balance Exceed Initial Bone Mineral Density in Predicting Incident Fractures: A 25-Year Prospective Observational Study in Menopausal Women With Osteoporosis.

ABSTRACTHearing and balance deteriorate, and fracture incidence increases with age, especially in women. The aim of the present study was to investigate whether impaired hearing and body balance are stronger predictors of fractures than bone mass. Between 1995 and 1997, 80 women, aged 50 to 70 years, with primary osteoporosis, taking menopausal hormone therapy, mainly for menopausal symptoms, participated in a double‐blind, randomized, placebo‐controlled study of treatment with growth hormone versus placebo. All women received calcium 750 mg and vitamin D 400 U daily. They were then examined yearly until 2007 and followed up by registers until 2020. Hearing was assessed by audiometry. Body balance and fine motor function were tested according to the Bruininks‐Oseretsky test. Bone properties were measured with DXA. Data on fractures were derived from the Gothenburg Hospital register. Over the 25‐year follow‐up, 50 women (63%) sustained 104 fractures, most often related to accidental falls. Thoracic and lumbar spine fractures were most common (36%). Other fractures occurred in the pelvis (14%), humerus (14%), hip (11%), and wrist (10%). Hearing impairment at baseline, measured as pure tone average‐high (p = 0.007), pure tone average‐mid (p = 0.003), and speech‐recognition score (p = 0.025), was associated with a subsequent first fracture, as were worse body balance (p = 0.004), upper limb coordination (p = 0.044), and higher running‐speed agility (p = 0.012). After adjustment for age and BMD, pure tone average‐high (p = 0.036), pure tone average‐mid (p = 0.028), and body balance (p = 0.039) were still significantly associated with incident fractures. Bone mineral content, BMD, and treatment at baseline were not associated with subsequent fracture. In conclusion, hearing and body balance at baseline exceeded initial BMD in predicting incident fractures in osteoporotic women regardless of treatment during 25‐year follow‐up. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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<0.01) and 58.5% of control subjects had osteopenia (P<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.

Estimation of bone mineral density and algorithms of 10-year risk of osteoporotic fractures in women

Osteoporosis is the fourth most common after cardiovascular, cancer and endocrine diseases. With an increase in life expectancy, it becomes one of the main causes of deterioration in health and an increase in mortality.
 Aim of the study. Assess bone mineral density using ultrasonic densitometry and the risk of osteoporotic fractures among women in Cherkasy region.
 Materials and methods. The study was based on a survey of 43 women in the Odessa region, the average age of the subjects was 56,4±9,9 years, the average body weight was 73,5±11,6 kg, height 164,9±5,9 cm, the average BMI was 27,1±4,3. All women were divided into groups by age with a ten-year interval and by densitometry indices.
 Results. Decreased bone density was found in 58,1 % of subjects, osteoporosis - 2 (4,8%). Women with osteopenia and osteoporosis have an increased risk of fractures and significantly reduced ultrasound densitometry compared to respondents with normal BMD. The structure of concomitant pathology was dominated by diseases of the circulatory system (22 cases;51,2 %) and digestive organs (12; 27,9 %). More than half of women (26; 60,5 %) had a total of 50 comorbidities, with an average of 1.2 cases of comorbidity.
 Conclusions. Most women had osteopenic manifestations. Age significantly correlates with BMD parameters. The number of women with changes in the structure of bone tissue increases with age. Algorithms for assessing the 10-year risk of FRAX and Q-Fracture fractures are significantly correlated with densitometry. The combination of ultrasonic densitometry with algorithms for assessing the risk of osteoporotic fractures increases the diagnosis of osteoporosis.

Assessment of the use of different risk algorithms for osteoporotic fractures in women in the practice of a family doctor

Object of research: Women in whom the risk of osteoporotic fractures was assessed using the FRAX, Q-Fracture algorithms, and the risk factors for osteoporosis and their role in the development of osteoporotic fractures were studied.
 Investigated problem: the use of various algorithms in the practice of a family doctor to assess the 10-year risk of osteoporotic fractures.
 Main scientific results: A decrease in bone mineral density was found in 51.4 % of the surveyed women, of whom osteopenia was in 48.7 %, osteoporosis in 2.9 % of women. The risk of fractures according to all algorithms was higher in women of the age group 70–79 years: FRAX Total – 8.87±3.2, FRAX Hip – 4.03±3.1, Q fracture total – 12.87±1.5, Q fracture Hip – 7.97±2.7, FRAX Total without BMD – 11.9±5.5, FRAX Hip without BMD – 6.3±4.8. Age correlates negatively with the T score (r=–0.47, p=0.007) and positively with the FRAX Total algorithms without BMD (r=–0.47, p=0.003), FRAX Hip without BMD (r=0.78, p=0.006), Q fracture total (r=0.86, p=0.007), Q fracture Hip (r=0.92, p=0.008), FRAX Hip with BMD (r=0.55, p=0.009). No statistically significant difference was found with FRAX Total with BMD (r=0.21, p=0.345).
 Risk factors: 14.3 % of women had fractures of various localization; fractures in parents were noted by 37.1 % of respondents; a decrease in height by 3 cm during life occurred in 13.3 %. Early menopause (up to 45 years old) occurred in 11.4 % of women. Physical activity less than 30 minutes a day was noted by 68.6 %.
 The area of practical use of the research results: the primary level of medical care.
 Innovative technological product: early identification of risk factors for osteoporosis and calculation of the risk of fractures will reduce the medical and social consequences of complications in osteoporosis.
 Scope of application of the innovative technological product: in the clinical practice of general practitioners.

A prospective study of lifestyle factors and bone health in breast cancer patients who received aromatase inhibitors in an integrated healthcare setting.

Fracture and osteoporosis are known side effects of aromatase inhibitors (AIs) for postmenopausal hormone receptor positive (HR+) breast cancer (BC) patients. How modifiable lifestyle factors impact fracture risk in these patients is relatively unknown. We conducted a prospective cohort study to examine the association of lifestyle factors, focusing on physical activity, with risk of incident major osteoporotic fracture and osteoporosis in 2152 HR+ BC patients diagnosed from 2006 to 2013 at Kaiser Permanente Northern California and who received AIs. Patients self-reported lifestyle factors at study entry and at 6-month follow-up. Fracture and osteoporosis outcomes were prospectively ascertained by physician-adjudication and bone mineral density (BMD) values, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated from multivariable proportional hazards regression. Models were adjusted for age, menopausal status, race/ethnicity, body mass index (BMI), AJCC stage, breast cancer treatment, prior osteoporosis, and prior major fracture. Over a median 6.1 years of follow-up after AI initiation, 165 women experienced an incident osteoporotic fracture and 243 women had osteoporosis. No associations were found between overall moderate-vigorous physical activity and fracture risk, although < 150 min/week of aerobic exercise in the 6 months after BC diagnosis was associated with increased fracture risk (HR=2.42; 95% CI: 1.34, 4.37) compared with ≥ 150 min/week (meeting physical activity guidelines). Risk was also higher for never or infrequently engaging in aerobic exercise (HR=1.90; 95% CI: 1.05, 3.44). None or infrequent overall moderate-vigorous physical activity in the 6 months before BC diagnosis was associated with increased risk of osteoporosis (HR=1.94; 95% CI: 1.11; 3.37). Moderate-vigorous physical activity during the immediate period after BC diagnosis, particularly aerobic exercise, was associated with lower risk of major osteoporotic fractures in women on AI therapy. Findings may inform fracture prevention in women on AI therapy through non-pharmacologic lifestyle-based strategies.

Bone strain index as a predictor of further vertebral fracture in osteoporotic women: An artificial intelligence-based analysis.

BackgroundOsteoporosis is an asymptomatic disease of high prevalence and incidence, leading to bone fractures burdened by high mortality and disability, mainly when several subsequent fractures occur. A fragility fracture predictive model, Artificial Intelligence-based, to identify dual X-ray absorptiometry (DXA) variables able to characterise those patients who are prone to further fractures called Bone Strain Index, was evaluated in this study.MethodsIn a prospective, longitudinal, multicentric study 172 female outpatients with at least one vertebral fracture at the first observation were enrolled. They performed a spine X-ray to calculate spine deformity index (SDI) and a lumbar and femoral DXA scan to assess bone mineral density (BMD) and bone strain index (BSI) at baseline and after a follow-up period of 3 years in average. At the end of the follow-up, 93 women developed a further vertebral fracture. The further vertebral fracture was considered as one unit increase of SDI. We assessed the predictive capacity of supervised Artificial Neural Networks (ANNs) to distinguish women who developed a further fracture from those without it, and to detect those variables providing the maximal amount of relevant information to discriminate the two groups. ANNs choose appropriate input data automatically (TWIST-system, Training With Input Selection and Testing). Moreover, we built a semantic connectivity map usingthe Auto Contractive Map to provide further insights about the convoluted connections between the osteoporotic variables under consideration and the two scenarios (further fracture vs no further fracture).ResultsTWIST system selected 5 out of 13 available variables: age, menopause age, BMI, FTot BMC, FTot BSI. With training testing procedure, ANNs reached predictive accuracy of 79.36%, with a sensitivity of 75% and a specificity of 83.72%.The semantic connectivity map highlighted the role of BSI in predicting the risk of a further fracture.ConclusionsArtificial Intelligence is a useful method to analyse a complex system like that regarding osteoporosis, able to identify patients prone to a further fragility fracture. BSI appears to be a useful DXA index in identifying those patients who are at risk of further vertebral fractures.

Association between Irritable Bowel Syndrome and Risk of Osteoporosis in Korean Premenopausal Women

Objective: The objective of this study is to evaluate irritable bowel syndrome (IBS) as a risk factor for osteoporosis and osteoporotic fracture in Korean women after controlling for basic confounding factors and considering detailed demographic and clinical information. Subjects and Methods: We performed a nationwide population-based retrospective cohort analysis and matched every IBS case with a non-IBS case at a 1:4 frequency ratio based on age. The population consisted of female patients with data in the Health Insurance Review and Assessment (HIRA) database from 2002 to 2010. To determine the risk of osteoporosis and osteoporotic fracture in IBS and non-IBS patients, hazard ratios (HRs) with 95% confidence intervals (CI) were estimated using Cox proportional hazards regression models, adjusting for confounding variables, such as the area of residence, health insurance type, and economic status. Results: We identified 1,017,468 patients in the HIRA database with data from 2002 to 2010 who could potentially be included in the cohort. Among these, we identified 1,545 (11.4%) women (age >19 years) with newly diagnosed IBS (IBS group). Additionally, 6,180 patients without IBS and age-matched to the IBS group were selected. Cox modeling revealed that the crude HRs for osteoporosis and osteoporotic fractures in patients with IBS were 1.476 (95% CI, 1.241–1.754) and 1.427 (95% CI, 1.086–1.876), respectively. Conclusion: Our data showed an increased incidence of osteoporosis and osteoporotic fractures in women with IBS compared with age-matched controls.

Dietary calcium and vitamin K are associated with osteoporotic fracture risk in middle-aged and elderly Japanese women, but not men: the Murakami Cohort Study.

Although dietary Ca, vitamin D and vitamin K are nutritional factors associated with osteoporosis, little is known about their effects on incident osteoporotic fractures in East Asian populations. This study aimed to determine whether intakes of these nutrients predict incident osteoporotic fractures. We adopted a cohort study design with a 5-year follow-up. Subjects were 12 794 community-dwelling individuals (6301 men and 6493 women) aged 40-74 years. Dietary intakes of Ca, vitamin D and vitamin K were assessed with a validated FFQ. Covariates were demographic and lifestyle factors. All incident cases of major osteoporotic limb fractures, including those of the distal forearm, neck of humerus, neck or trochanter of femur and lumbar or thoracic spine were collected. Hazard ratios (HR) for energy-adjusted Ca, vitamin D and vitamin K were calculated with the residual method. Mean age was 58·8 (sd 9·3) years. Lower energy-adjusted intakes of Ca and vitamin K in women were associated with higher adjusted HR of total fractures (Pfor trend = 0·005 and 0·08, respectively). When vertebral fracture was the outcome, Pfor trend values for Ca and vitamin K were 0·03 and 0·006, respectively, and HR of the lowest and highest (reference) intake groups were 2·03 (95 % CI 1·08, 3·82) and 2·26 (95 % CI 1·19, 4·26), respectively. In men, there were null associations between incident fractures and each of the three nutrient intakes. Lower intakes of dietary Ca and vitamin K were independent lifestyle-related risk factors for osteoporotic fracture in women but not men. These associations were robust for vertebral fractures, but not for limb fractures.