Osteoporotic Fractures In Women Research Articles

Bone Mineral Density and Risk of Osteoporotic Fractures in Women with Parkinson's Disease.

Osteoporosis and Parkinson's disease (PD) are two important age-related diseases, which have an influence on pain, physical activity, disability, and mortality. The aim of this research was to study the parameters of bone mineral density (BMD), frequency, and 10-year probability of osteoporotic fractures (OFs) in females with Parkinson's disease (PD). We have examined 113 postmenopausal women aged 50–74 years old which were divided into 2 groups (I, control group (CG), n = 53 and II, subjects with PD, n = 60). Bone mineral density of lumbar spine, femoral neck, distal radius, and total body were measured, and quantity and localization of vertebral deformities were performed by the vertebral fracture assessment (VFA). Ten-year probability of OFs was assessed by Ukrainian version of FRAX®. It was established that BMD of lumbar spine, femoral neck, distal radius, and total body in PD women was reliably lower compared to CG. The frequency of OFs in PD subjects was higher compared to CG (51.7 and 11.3%, respectively) with prevalence of vertebral fractures (VFs) in women with PD (52.6% among all fractures). 47.4% of the females had combined VFs: 74.2% of VFs were in thoracic part of the spine and 73.7% were wedge ones. Ten-year probability of major OFs and hip fracture were higher in PD women compared to CG with and without BMD measurements. Inclusion of PD in the FRAX calculation increased the requirement of antiosteoporotic treatment from 5 to 28% (without additional examination) and increased the need of additional BMD measurement from 50 to 68%. Anterior/posterior vertebral height ratios (Th8-Th11) measured by VFA in PD females without confirmed vertebral deformities were lower compared to indices of CG. In conclusion, women with PD have lower BMD indices, higher rate of osteoporosis, and risk of future low-energy fractures that should be taken into account in the assessment of their osteoporosis risk and clinical management.

Incidence and Mortality of Osteoporotic Fracture in Rheumatoid Arthritis in South Korea Using Nationwide Claims Data.

BackgroundTo investigate incidence and mortaltiy of osteoporotic fractures (including hip, spine, distal radius, and proximal humerus) in rheumatoid arthritis (RA) patients and compare them with those in the genearal population.MethodsData provided by National Health Insurance Service were used to identify osteoporotic fractures in patients aged >50 years between 2010 and 2012. Patients with RA were identified by the diagnostic code for seropositive RA. Standardized mortality ratios (SMRs; observed/expected deaths) of osteoporotic fractures were calculated based on age and gender-specific rates in the entire Korean population. Incidence, mortality, and SMR of osteoporotic fractures in RA patients and the general population were calculated and compared.ResultsOsteopororic fractures in the general population and RA patients were increased by 11.6% and 17.4% over 3 years (195,271 and 1,356 in 2010; 217,985 and 1,592 in 2012), respectively. Mean age-specific incidence of osteoporotic fracture in women and men with RA increased from 932.1/100,000 and 306.1/100,000 for aged 50 to 59 year to 9,377.0/100,000 and 3,700.9/100,000 for aged ≥80 years, respectively. Cumulative mortality rate in the first year after osteoporotic fracture in patients with RA was higher than that in the general population (7.8% in RA and 6.6% in the general population). SMR of osteoporotic fracture in RA patients was 1.4 times higher in men and 1.3 times higher in women than that for the general population.ConclusionsThis study demonstated that incidence, 1-year mortality, and SMR of osteoporotic fracture in RA patients aged 50 years and older were higher than those in the general papulation.

The Association between Polypharmacy and Hip Fracture in Osteoporotic Women: A Nested Case-Control Study in South Korea.

Polypharmacy, regarded as an indicator of potentially inappropriate medications (PIMs), may lead to a higher risk of serious health consequences in elderly patients with osteoporosis. Thus, this study aimed to analyze the association between polypharmacy and hip fracture in patients with osteoporosis because only a limited number of studies have reported on this association, with inconsistent results to date. In this nested case-control study using a population-based sample cohort, the target cases were female patients with hip fracture diagnosed with osteoporosis and aged ≥ 50years. Polypharmacy (prescription of an average of five or more daily drugs), PIMs for hip fracture (such as benzodiazepines and glucocorticoids), Charlson Comorbidity Index (CCI) score, and other comorbidities were analyzed during the year preceding the diagnosis of hip fracture. Adjusted odds ratios (ORs) for hip fracture for the variables were also analyzed. The cases (n = 1003) showed higher exposure rates to polypharmacy, glucocorticoids, and benzodiazepines, and had more severe comorbidity statuses compared with the controls. The ORs for hip fracture adjusted for confounders increased with polypharmacy level, with persistent statistical significance in most analyses. The ORs (95% confidence intervals), with reference to the 0 to < 1 drug group, were 1.65 (1.31-2.08) and 2.11 (1.12-3.96) for the 5 to < 10 and 10 + drug groups, respectively, with adjustment for PIMs, and 1.34 (1.04-1.72) and 1.45 (0.76-2.80) for the 5 to < 10 and 10 + drug groups, respectively, with adjustment for PIMs and CCI score. The results suggest that polypharmacy is associated with an increased risk of hip fracture after adjustment for confounders in patients with osteoporosis. These results highlight the importance of polypharmacy management in preventing hip fractures in patients with osteoporosis.

Alendronate improves bone density and type I collagen accumulation but increases the amount of pentosidine in the healing dental alveolus of ovariectomized rabbits.

It has been shown that the oral aminobisphosphonate sodium alendronate (ALN) therapy reduces the risk of main fractures in osteoporotic women, but its effect on the jaw bones is poorly known. Here, we hypothesized that ALN affects the newly formed alveolar bone, particularly the quality of the type I collagen cross-linking. Osteoporosis was induced by ovariectomy (OVX) in 6-month old rabbits. Six weeks following surgery, eight animals were treated by oral gavage with ALN (OVX + ALN) and ten received placebo (OVX + Pbo). Another six rabbits which were sham operated also received placebo (SHAM + Pbo). One month following the beginning of treatment, the upper and lower left first premolars were removed. Six weeks later, the upper and the lower right first premolars were also extracted. One month after the second extraction, biopsies were collected from the maxillary extraction sites and collagen crosslinks were analyzed in the newly formed bone tissue by HPLC. Also, at this time, mandibular bone segments were subjected to μCT. Animals treated with ALN achieved a roughly 2-time greater bone volume fraction value at a late healing period than animals in the other groups (p < 0.05). Collagen mean results were 2- to 4-times superior in the OVX + ALN group than in the control groups (p < 0.05). ALN-treated animals presented higher amounts of the non-enzymatic collagen cross-link pentosidine (PEN) than the sham-operated rabbits (p < 0.05), whereas the OVX + Pbo group presented the highest amount of PEN (p < 0.05). Alendronate increases bone volume and collagen accumulation, but does not fully rescue the non-osteoporotic alveolar tissue quality as is evident from the increased quantity of pentosidine.

Opportunistic Bone Density Measurement on Abdomen and Pelvis Computed Tomography to Predict Fracture Risk in Women Aged 50 to 64 Years Without Osteoporosis Risk Factors.

The aim of this study is to evaluate opportunistic vertebral bone density measurement in abdominal and pelvic computed tomography (CT) to predict future osteoporotic fracture in women aged 50 to 64 years without known osteoporosis risk factors. Consecutive female patients 50 to 64 years old without osteoporosis risk factors with 2 CT examinations more than 10 years apart were included. Vertebral height and bone density in each vertebra from T10 to L5 were measured. Vertebral fractures were diagnosed on CT preformed 10 years after the original CT and through online medical records. Thirty (15%) of 199 patients developed osteoporotic fracture. Bone density was lower in patients who developed fractures compared with those who did not (P < 0.05). Development of osteoporotic fracture of any grade was predicted for patients having bone density less than 180 HU at L4 with sensitivity of 90% (95% confidence interval, 74%-97%) and specificity of 43% (95% confidence interval, 34%-50%). Opportunistic bone density screening can identify women at elevated risk of developing fractures within 10 years.

Association of gout with osteoporotic fractures.

Previous studies have shown that serum uric acid levels and inflammation are associated with bone mineral density. Gout, a disease characterized by hyperuricemia and inflammation, contributes to the risk of osteoporotic fractures. However, this association is controversial. Therefore, this study investigated whether gout in older people (age > 55years) is associated with osteoporotic fracture risk. This population-based, cross-sectional study included 2674 participants (147 cases of gout and 388 fractures). Standardized and self-administered questionnaires were employed and physical examinations, blood tests, and bone mineral density examinations were performed; multivariate-adjusted logistic regression models were used to evaluate associations between gout and osteoporotic fracture risk. The data were adjusted for age; smoking status; alcohol status; physical activity; body mass index; waist circumference; hypertension; cardiovascular events; diabetes mellitus; rheumatoid arthritis; serum levels of total cholesterol (TC), triglycerides, and high- and low-density lipids; and T-scores. We found a significant association between gout and osteoporotic fracture risk in women (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.12-3.56; P= 0.019), but no such association in men (OR, 1.30; 95% CI, 0.58-2.88; P= 0.525). Further stratified analyses showed a significant association between gout and osteoporotic fracture risk in women without rheumatic arthritis and in those with high TC levels or with osteoporosis (all, P< 0.05). In older Chinese adults, gout is significantly associated with the risk of osteoporotic fractures in women, especially those without rheumatic arthritis and in those with high TC levels or with osteoporosis.

Thoracolumbar Intervertebral Disc Area Morphometry in Elderly Chinese Men and Women: Radiographic Quantifications at Baseline and Changes at Year-4 Follow-up.

A population-based radiographic study with longitudinal follow-up. To develop a quantitative index for lumbar disc space narrowing (DSN) evaluation in elderly subjects; to determine how DSN in the elderly is influenced by osteoporosis and sex. There is paucity of research on quantitative classification of lumbar DSN based on disc areal morphometry. With the database of Osteoporotic Fractures in Men (Hong Kong) and Osteoporotic Fractures in Women (Hong Kong) Studies and those who attended the year-4 follow-up (n = 1519 for men and n = 1546 for women), data of 491 women and 592 men were randomly selected. The anterior, middle, and posterior heights; anteroposterior diameter; and area of intervertebral discs (T4T5 to L4L5) were measured on lateral radiographs. Disc area index for lumbar spine (DAIL, disc area divided by the mean of the sum of square of the adjacent upper and lower vertebrae mid-height anterior-posterior diameter) was developed and compared with semiquantitative DSN expert grading. DAIL correlated with semiquantitative grading, with sensitivity and specificity varying from 87.3% to 96.8% for grade 1 DSN (<30% reduction in disc height), and 92.9% to 100% for grade 3 DSN (>60% reduction in disc height). The thoracolumbar disc area loss among men and women during 4-years' follow-up period varied between 1.32% and 3.56%, and it was greater for women (mean: 2.44%) than for men (mean: 1.90%, P = 0.044). Majority of lumbar DSN progressions during 72 to 76 years old were progression from normal disc space to grade 1 DSN. Osteoporosis was associated with greater disc area decrease, both for thoracic and lumbar discs. Lumbar DSN can be quantified using DAIL. In elderly Chinese, intervertebral disc narrowing over a 4-year period was greater in women than men, and associated with the presence of osteoporosis. 3.

The trabecular effect: A population-based longitudinal study on age and sex differences in bone mineral density and vertebral load bearing capacity

BackgroundApproximately 16–24% of postmenopausal women are affected by vertebral fractures, negatively affecting their quality of life. Trabecular and cortical bones in vertebrae decline differently with age, thus having a distinct impact on vertebral failure loads. The purpose of this study was to investigate the effect of trabecular and cortical volumetric bone mineral density loss over time on estimated failure loads; and to evaluate the effect of sex and age. MethodFracture properties from a cohort of 82 patients were evaluated for L1–L3 vertebrae at baseline and 6th year using an image-based method that implements axial rigidity analysis. Cortical and trabecular volumetric bone mineral density were obtained, as well as their individual contribution to total failure load. Regression analyses were performed to determine the effect of age and sex on volumetric bone mineral density and failure loads. FindingsDecline in trabecular and cortical volumetric bone mineral density, and failure load was sex-dependent (p ≤ 0.0095). Cortical and trabecular volumetric bone mineral density reduced 2.08 (g/cm3)/year and 2.02 (g/cm3)/year, respectively. A 1012 N difference in failure load, ~70% attributed to trabecular bone, was found between men and women of similar age. Over 6 years, this difference increased by 287 N. Areal bone mineral density measured by dual X-ray absorptiometry explained ~60% of the vertebral failure load. InterpretationTrabecular bone has a significantly greater effect than cortical bone on the structural integrity and load bearing capacity of vertebrae. This might lead to a higher incidence of fragility fractures in osteoporotic women. Our non-invasive, quantitative computed tomography image-based approach may improve prevention, monitoring, and management of fractures.

Association between Serum Cholesterol Level and Osteoporotic Fractures.

Previous epidemiological studies have found an association between serum cholesterol level and bone mineral density. However, epidemiological studies evaluating the association between serum cholesterol level and the incidence of osteoporotic fracture are scant. Therefore, the objective of this study was to investigate whether serum cholesterol levels in Chinese participants aged 55 years or older was associated with an increased risk of osteoporotic fracture. We performed a cross-sectional study, including 1,791 participants (62.1% postmenopausal women and 213 fractures). Standardized self-administered questionnaires, physical examination, laboratory tests, and dual-energy X-ray absorptiometry examination were performed. Multivariate-adjusted logistic regression models were used to evaluate associations between serum cholesterol [total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C)] levels and the osteoporotic fracture risk. After adjusting for potential confounding factors, there were no associations between per SD increase in TC and LDL level and an increased risk of osteoporotic fracture in total participants, and in men and women as individual groups. There was a significant association between per SD increase in HDL-C level and an increased risk of osteoporotic fracture in total participants [odds ratios (OR) 1.20, 95% confidence interval (CI) 1.03, 1.40, P = 0.023] and in women (OR 1.37, 95% CI 1.12, 1.68, P = 0.003), whereas no association was observed in men (OR 1.01, 95% CI 0.73, 1.40, P = 0.951). Additionally, we found a significant association between per SD increase in TG level and an increased risk of osteoporotic fracture in total participants (OR 1.20, 95% CI 1.04, 1.38, P = 0.015). In women, a nonlinear relationship was observed between per SD increase in TG level and an increased risk of osteoporotic fracture. The risk of osteoporotic fracture in women increased with TG level >1.64 mmol/L (OR 1.93, 95% CI 1.24, 3.00, P = 0.004). Among Chinese older adults, serum HDL-C level is significantly associated with a risk of osteoporotic fractures in women, and serum TG level is significantly associated with a risk of osteoporotic fractures in total participants and in women with TG >1.64 mmol/L.

FRAX- vs. T-score-based intervention thresholds for osteoporosis.

A FRAX® model been recently calibrated for Kuwait, but guidance is needed on how to utilise fracture probabilities in the assessment and treatment of patients. We compared age-specific fracture probabilities, equivalent to women with no clinical risk factors and a prior fragility fracture (without BMD), with the age-specific fracture probabilities associated with femoral neck T-scores of -2.5 and -1.5 SD, in line with current guidelines in Kuwait. Upper and lower assessment thresholds for BMD testing were additionally explored using FRAX. When a BMD T-score of -2.5 SD was used as an intervention threshold, FRAX probabilities of a major osteoporotic fracture in women aged 50years were approximately twofold higher than those in women of the same age but with an average BMD. The increase in risk associated with the BMD threshold decreased progressively with age such that, at the age of 83years or more, a T-score of -2.5 SD was associated with a lower probability of fracture than that of the age-matched general population with no clinical risk factors. The same phenomenon was observed from the age of 66years at a T-score of -1.5 SD. A FRAX-based intervention threshold, defined as the 10-year probability of a major osteoporotic fracture in a woman of average BMI with a previous fracture, rose with age from 4.3% at the age of 50years to 23%, at the age of 90years, and identified women at increased risk at all ages. Qualitatively comparable findings were observed in the case of hip fracture probability and in men. Intervention thresholds based on BMD alone do not optimally target women at higher fracture risk than those on age-matched individuals without clinical risk factors, particularly in the elderly. In contrast, intervention thresholds based on fracture probabilities equivalent to a 'fracture threshold' consistently target women at higher fracture risk, irrespective of age.

Frailty Assesment and Risk of Osteoporotic Fracture in Women from a Case

Frailty Assesment and Risk of Osteoporotic Fracture in Women from a Case

What is the best treatment for vertebral body compression fractures in osteoporotic women?

Evidence-Based Answer The best treatment for osteoporotic vertebral compression fractures (VCFs) remains unclear. When vertebroplasty (VP) is compared with sham treatment, no differences are noted in pain or function. Balloon kyphoplasty (BK) is better than usual care for pain relief, but has not been tested against sham intervention. Evidence-based guidelines recommend against VP and still mention BK as an option for VCFs (SOR: B, based on meta-analysis of RCTs and evidence-based guidelines).

Public health impact and cost-effectiveness of dairy products supplemented with vitamin D in prevention of osteoporotic fractures.

BackgroundDietary sources of calcium and vitamin D are recommended as a first-line strategy in prevention of osteoporosis-related fractures but their public health and economic impact has never been studied.MethodsWe designed a population-based model to forecast the potential health outcomes and medical effectiveness of the daily administration of dairy supplements containing 800 IU of vitamin D and 1 g of calcium in cohorts of subjects, from both genders, aged 50, 60, 70 and 80 years. Annual costs of dairy products were tested at €150, €250 and €350.ResultsIn total, the daily intake of vitamin-D rich dairy products reduces by 30,376 and 16,105 events the number of osteoporotic fractures in women and men respectively and permits to gain 6605 and 6144 life-years, in women and men respectively. This intervention is cost-effective from 70 years on in the general population and from 60 years on in patients at increased risk of osteoporotic fractures.ConclusionThe recommendation to use dairy products as the preferred source of calcium and vitamin D in aging males and females is supported by public health and health economic analyses.Electronic supplementary materialThe online version of this article (doi:10.1186/s13690-015-0099-3) contains supplementary material, which is available to authorized users.

Breast cancer survivors are at an increased risk for osteoporotic fractures not explained by lower BMD: a retrospective analysis.

Background:An association between higher bone mineral density (BMD) and the diagnosis of breast cancer (BC) has been reported. Data on the risk of osteoporotic fractures in women with BC are conflicting.Aims:The objective of this study was to assess fracture risk adjusted for BMD in women with and without BC, and to assess whether fracture risk in BC patients is attributed to BMD or BC characteristics.Methods:Using electronic medical records of patients who underwent dual energy X-ray absorptiometry BMD studies at Soroka University Medical Center between February 2003 and March 2011, we identified women with subsequent diagnosis of osteoporotic fractures. BC status, demographic, health characteristics, BMD, and other laboratory findings were assessed. In BC patients data on grade, stage, and treatment were collected. Primary outcome was osteoporotic fracture, analyzed by Cox proportional hazards regression models.Results:During a median follow-up of 4.9 years in 17,110 women with BMD testing (658 BC patients), 1,193 women experienced an osteoporotic fracture (62 in BC and 1,131 in no-BC groups). In multivariate analysis adjusted for age, body mass index (BMI) and BMD, hazard ratio (HR) for any osteoporotic fracture in women with BC was 1.34 (P=0.026). BMD was similar among women with and without BC who fractured. BC patients who experienced an osteoporotic fracture had a trend for less-advanced BC, lower rates of chemotherapy treatment, and higher rates of tamoxifen treatment.Conclusions:BC survivors are at increased risk of an osteoporotic fracture, which is not explained by worse BMD. Chemotherapy or aromatase inhibitors did not contribute substantially to fracture risk among our BC survivors.

Tamoxifen use reduces the risk of osteoporotic fractures in women with breast cancer in Asia: a nationwide population-based cohort study.

PurposeBone mineral density changes with tamoxifen treatment have been reported in pre- and post-menopausal women with breast cancer. However, there remains controversy as to whether tamoxifen significantly reduces fracture rates in different age groups. Breast cancer occurs at 10-20 years younger in Asian women compared with Western women. Therefore we conducted this population-based case-control study to determine whether or not tamoxifen use is associated with osteoporotic fractures.Patients and methodsWe selected 75488 women with breast cancer with no prior history of fractures from the Longitudinal Health Insurance Database for Catastrophic Illness Patients in 2000-2011. They were followed from the date of the diagnosis of breast cancer to the date a hip, vertebral or wrist fracture occurred. Because the use of tamoxifen was a time-dependent variable, we used a Cox proportional hazard model with time-dependent exposure covariates to estimate the risk of a fracture.ResultsThere were 50257 and 25231 women with breast cancer who did and did not receive tamoxifen treatment, respectively. The tamoxifen users had lower risks for overall fractures with hazard ratios (HRs) of 0.52 and 0.59 in the crude and adjusted models (95 % CI = 0.45-0.61 and 0.51-0.69), respectively. They also had lower risks for hip (HR = 0.55, 95 % CI = 0.45-0.67) and vertebral (HR = 0.64, 95 % CI = 0.50-0.82) fractures in the adjusted model. The risk of fractures decreased with an increasing dosage of tamoxifen. Regardless of the age group, the tamoxifen users had a lower risk of fractures than the non-users.ConclusionIn this Asian population-based case-control study, tamoxifen use was associated with a reduction in osteoporotic fractures, especially in hip fractures.

Spine bone texture assessed by trabecular bone score (TBS) predicts osteoporotic fractures in men: The Manitoba Bone Density Program

IntroductionOne quarter of osteoporotic fractures occur in men. TBS, a gray-level measurement derived from lumbar spine DXA image texture, is related to microarchitecture and fracture risk independently of BMD. Previous studies reported the ability of spine TBS to predict osteoporotic fractures in women. Our aim was to evaluate the ability of TBS to predict clinical osteoporotic fractures in men. Methods3620 men aged ≥50 (mean 67.6years) at the time of baseline DXA (femoral neck, spine) were identified from a database (Province of Manitoba, Canada). Health service records were assessed for the presence of non-traumatic osteoporotic fracture after BMD testing. Lumbar spine TBS was derived from spine DXA blinded to clinical parameters and outcomes. We used Cox proportional hazard regression to analyze time to first fracture adjusted for clinical risk factors (FRAX without BMD), osteoporosis treatment and BMD (hip or spine). ResultsMean followup was 4.5years. 183 (5.1%) men sustain major osteoporotic fractures (MOF), 91 (2.5%) clinical vertebral fractures (CVF), and 46 (1.3%) hip fractures (HF). Correlation between spine BMD and spine TBS was modest (r=0.31), less than correlation between spine and hip BMD (r=0.63). Significantly lower spine TBS were found in fracture versus non-fracture men for MOF (p<0.001), HF (p<0.001) and CVF (p=0.003). Area under the receiver operating characteristic curve (AUC) for incident fracture discrimination with TBS was significantly better than chance (MOF AUC=0.59, p<0.001; HF AUC=0.67, p<0.001; CVF AUC=0.57, p=0.032). TBS predicted MOF and HF (but not CVF) in models adjusted for FRAX without BMD and osteoporosis treatment. TBS remained a predictor of HF (but not MOF) after further adjustment for hip BMD or spine BMD. ConclusionWe observed that spine TBS predicted MOF and HF independently of the clinical FRAX score, HF independently of FRAX and BMD in men. Studies with more incident fractures are needed to confirm these findings.

E17. The prevention of breast cancer

A highly effective and increasingly common approach to reducing the incidence of and mortality from heart disease and stroke is the use of preventive therapy in highrisk individuals. The use of statins in people with high cholesterol levels and anti-hypertensives in those with high blood pressure has helped to reduce the death rate from heart disease by more than half and that from strokes by more than two thirds [1]. Breast cancer is by far the commonest cancer in women, with an estimated 1.4 million new cases every year, and it is an ideal candidate in which to begin to utilise this strategy for cancer prevention. Two drugs, tamoxifen and raloxifene, are licensed for preventive therapy in the United States. Both have been shown to reduce incidence by approximately 40%, but in a head-to-head comparison tamoxifen was about 25% more effective [2]. However, as these drugs are now off patent there seems to be no direct way for them to be licensed for prevention in Europe, although the National Institute for Health and Care Excellence (NICE) has now recommended their use for high-risk women in the UK, and they can be prescribed off-label. More recently two other selective oestrogen receptor (ER) modifiers (SERMs), lasofoxifene and arzoxifene, have been investigated in large prevention trials in which the primary outcome was the prevention of fractures in osteoporotic women. Both appear to be at least as effective as tamoxifen in breast cancer risk reduction, but lasofoxifene also showed large reductions in heart disease and fracture rates [3], making it an ideal candidate for preventive therapy. All of these drugs have recently been evaluated with extended follow-up in an individual patient overview [4]. The result shows a 55% reduction in ERpositive cancer in the 5 years of active treatment, but also a 42% reduction in the next 5 years, as a result of “carryover” benefits after treatment cessation (Figures 1 and 2). An important unanswered question is the duration of the carryover effect, as this enhances the benefits; however, side effects largely do not show a carryover, leading to a larger benefit/harm ratio. On the other hand, no reduction in ER-negative tumours has occurred, and in fact a marginally increased (14%, P = 0.09) incidence was seen (Figure 3). This may reflect tumours which would have appeared earlier as ER-positive tumours in the absence of treat

Hormone replacement therapy in prevention and treatment of postmenopausal osteoporosis

Menopause refers to the cessation of menstruation. Menopause brings about a deficiency of estrogen and a period of bone loss that extends till the end of life and is responsible for development of osteoporotic fractures in women. Prevention of vertebral fractures, non-vertebral fractures and hip fractures in post-menopausal women can be effectively done by Hormone Replacement Therapy (HRT) as it prevents bone loss following menopause and can delay development of osteoporosis as seen on DEXA scan. HRT use however is associated with the risk of cardiovascular disease, dementia, genito-urinary problems, breast, endometrial and ovarian cancer and the risk of venous thromboembolism. However in selected postmenopausal women with early menopause or with postmenopausal symptoms short-term use of HRT/Raloxifene/Tibolone is currently permitted to alleviate symptoms.

FRAX®: Prediction of Major Osteoporotic Fractures in Women from the General Population: The OPUS Study

PurposesThe aim of this study was to analyse how well FRAX® predicts the risk of major osteoporotic and vertebral fractures over 6 years in postmenopausal women from general population.Patients and methodsThe OPUS study was conducted in European women aged above 55 years, recruited in 5 centers from random population samples and followed over 6 years. The population for this study consisted of 1748 women (mean age 74.2 years) with information on incident fractures. 742 (43.1%) had a prevalent fracture; 769 (44%) and 155 (8.9%) of them received an antiosteoporotic treatment before and during the study respectively. We compared FRAX® performance with and without bone mineral density (BMD) using receiver operator characteristic (ROC) c-statistical analysis with ORs and areas under receiver operating characteristics curves (AUCs) and net reclassification improvement (NRI).Results85 (4.9%) patients had incident major fractures over 6 years. FRAX® with and without BMD predicted these fractures with an AUC of 0.66 and 0.62 respectively. The AUC were 0.60, 0.66, 0.69 for history of low trauma fracture alone, age and femoral neck (FN) BMD and combination of the 3 clinical risk factors, respectively. FRAX® with and without BMD predicted incident radiographic vertebral fracture (n = 65) with an AUC of 0.67 and 0.65 respectively. NRI analysis showed a significant improvement in risk assignment when BMD is added to FRAX®.ConclusionsThis study shows that FRAX® with BMD and to a lesser extent also without FN BMD predict major osteoporotic and vertebral fractures in the general population.

Vertebral microarchitecture and fragility fracture in men: A TBS study

IntroductionAlthough osteoporosis is considered a disease of women, 25% of the individuals with osteoporosis are men. BMD measurement by DXA is the gold standard used to diagnose osteoporosis and assess fracture risk. Nevertheless, BMD does not take into account alterations of microarchitecture. TBS is an index of bone microarchitecture extracted from the spine DXA. Previous studies have reported the ability of the spine TBS to predict osteoporotic fractures in women. This is the first case-controlled study in men to evaluate the potential diagnostic value of TBS as a complement to bone mineral density (BMD), by comparing men with and without fractures. MethodsTo be eligible for this study, subjects had to be non-Hispanic US white men aged 40 and older. Furthermore, subjects were excluded if they have or have had previously any treatment or illness that may influence bone metabolism. Fractured subjects were included if the presence of at least one fracture was confirmed. Cases were matched for age (±3years) and BMD (±0.04g/cm2) with three controls. BMD and TBS were first retrospectively evaluated at AP spine (L1–L4) with a Prodigy densitometer (GE-Lunar, Madison, USA) and TBS iNsight® (Med-Imaps, France) in Lausanne University Hospital blinded from clinical outcome. Inter-group comparisons were undertaken using Student's t-tests or Wilcoxon signed rank tests. Odds ratios were calculated per one standard deviation decrease as well as areas under the receiver operating curve (AUC). ResultsAfter applying inclusion/exclusion criteria, a group of 180 male subjects was obtained. This group consists of 45 fractured subjects (age=63.3±12.6years, BMI=27.1±4.2kg/m2) and 135 control subjects (age=62.9±11.9years, BMI=26.7±3.9kg/m2) matched for age (p=0.86) and BMD (p=0.20). A weak correlation was obtained between TBS and BMD and between TBS and BMI (r=0.27 and r=−0.28, respectively, p<0.01). Subjects with fracture have a significant lower TBS compared to control subjects (p=0.013), whereas no differences were obtained for BMI, height and weight (p>0.10). TBS OR per standard deviation is 1.55 [1.09–2.20] for all fracture type. When considering vertebral fracture only TBS OR reached 2.07 [1.14–3.74]. ConclusionThis study showed the potential use of TBS in men. TBS revealed a significant difference between fractured and age- and spine BMD-matched nonfractured subjects. These results are consistent with those previously reported on for men of other nationalities.