History Of Low-energy Fractures Research Articles

Predictors of repeated and first-time low-energy fractures in patients with rheumatoid arthritis

Introduction. Low-energy fractures in patients with rheumatoid arthritis (RA) occur more often than in the general population, reduce the quality and life expectancy of patients. Establishment of predictors of fractures will allow to personalize treatment and preventive measures.Aim. To study the frequency, structure, predictors of new and repeated low-energy fractures that occurred in patients with RA during long-term prospective follow-up.Materials and methods. 123 women with RA, aged 63.7 ± 8.3 years, were included in an open, prospective, non-interventional study, the follow-up period was 9.4 ± 1.8 years. Initially and in dynamics, laboratory and X-ray examinations were performed (X-ray morphometry of the spine, X-ray densitometry of the lumbar spine (L1-4) and femoral neck (SB)).Results. During the follow-up period, 101 low-energy fractures occurred in 63 (51%) patients: in 33 (52%) people – for the first time, in 25 (48%) – again. Two or more fractures occurred in 25 (39%) patients. There were 32 (32%) peripheral fractures, 69 (68%) vertebral fractures. A direct relationship was established between fractures and a longer duration of RA course (r = 0.231, p < 0.05), with X-ray stage of RA at baseline (r = 0.280, p < 0.05) and over time (r = 0.819, p < 0.05), intake of glucocorticoids (GC) initially (r = 0.202, p < 0.05) and over time (r = 0.308, p < 0.05), cumulative dose of GC initially (r = 0.239, p < 0.05) and over time (r = 0.268, p < 0.05), duration of GC use (r = 0.270, p < 0.05), history of low-energy fractures (r = 0.291, p < 0.05), and feedback with OP in SB (r = -0.190, p < 0.05).Conclusions. А high frequency of repeated and first-time low-energy fractures was established in patients with RA, among which fractures of the vertebrae, distal forearm, humerus and lower leg bones predominated. Fracture predictors: GC intake, history of low-energy fractures, baseline radiological stage of RA. A mathematical model for assessing the risk of fractures with good predictive ability has been developed.

Endocrine disorders after heart transplantation: national cohort study

BackgroundEndocrine disorders in patients after heart transplantation (HT) remain understudied. We aimed to assess endocrine profiles and management of HT recipients in the early post- transplant period.MethodsWe conducted a retrospective cohort study on 123 consecutive HT recipients in the Advanced Heart Failure and Transplantation Programme between 2009 and 2018. All recipients had per-protocol endocrine follow-up within the first postoperative year. The median time to first post-transplant endocrine follow-up was 3 months (IQR 2–4). We assessed the incidence of vitamin D deficiency, bone mineral density, history of low energy fractures, hypogonadism in male recipients, posttransplant diabetes mellitus, and thyroid and parathyroid function.ResultsWe enrolled 22 women and 101 men of median age 57 years (IQR 50–63). Post-transplant diabetes mellitus developed in 14 patients (11.4%). 18 of 25 patients (14.6%) with preexisting type 2 diabetes mellitus required intensification of antidiabetic therapy. 38 male patients (40.4%) had hypogonadism. 5 patients (4.6%) were hypothyroid and 10 (9.3%) latent hyperthyroid. Secondary hyperparathyroidism was present in 19 (17.3%), 25-hydroxyvitamin D deficiency in 64 (54.7%) of patients. Osteoporosis was present in 26 (21.1%), osteopenia in 59 (48.0%) patients. 47 vertebral fractures, 3 hip and 1 humerus fractures occurred in 21 patients. Most of the patients had coincidence of two or three disorders, while less than 5% did not have any endocrine irregularities. All patients received calcium and vitamin D supplements. Forty-six patients (37.4%) were treated with zoledronic acid, 12 (9.8%) with oral bisphosphonates. Two patients were treated with teriparatide.ConclusionsThe prevalence of multiple endocrine disorders early after heart transplantation is high. Assessment and management of increased fracture risk and all other potentially affected endocrine axes should be considered as a standard of care in this early period.

RISK FACTORS OF BONE MINERAL DENSITY DEFICIT AND LOW-ENERGY FRACTURES IN PRIMARY OSTEOPOROSIS IN MEN

Purpose:to evaluate the role of well-known factors on the formation of bone mineral density (BMD) and risk of fractures in primary osteoporosis in men.Patients and methods.The influence of well-known osteoporosis risk factors such as age, smoking, alcohol consumption, obesity, genetic disorders in genes encoding COL1A1, COL1A2 and VDR-receptor products, history of low-energy fractures in first-line relatives upon the BMD value and risk of fractures was evaluated in 231 patients with primary osteoporosis. All patients were divided into three age groups according to the following forms of osteoporosis: 17-20 years (n=26) – juvenile form, 21-50 (n=103) – idiopathic form, patients over 51 years (n=102). To assess the influence of study factors on the risk of fractures the patients were subdivided into 5 groups according to fracture localization.Results.The relationship between BMD deficit and mutations in homozygous form of gene rs2412298 (encodes collagen), and the tendency to a reliable increase of BMD deficit in L1 – L4 vertebrae under polymorphism in homozygous form of 1800012 gene was noted that might be evidence of their contribution to the development of primary osteoporosis in men. At the same time, smoking, alcohol consumption, age, mutations in homozygous form of gene rs2412298 and a history of low-energy fractures in first-line relatives increased the risk of low-energy fractures of the vertebral bodies and proximal femur.

Risk factors of bone mineral density deficit and low-energy fractures in primary osteoporosis in men

Purpose: to evaluate the role of well-known factors on the formation of bone mineral density (BMD) and risk of fractures in primary osteoporosis in men. Patients and methods. The influence of well-known osteoporosis risk factors such as age, smoking, alcohol consumption, obesity, genetic disorders in genes encoding COL1A1, COL1A2 and VDR-receptor products, history of low-energy fractures in first-line relatives upon the BMD value and risk of fractures was evaluated in 231 patients with primary osteoporosis. All patients were divided into three age groups according to the following forms of osteoporosis: 17-20 years (n=26) - juvenile form, 21-50 (n=103) - idiopathic form, patients over 51 years (n=102). To assess the influence of study factors on the risk of fractures the patients were subdivided into 5 groups according to fracture localization. Results. The relationship between BMD deficit and mutations in homozygous form of gene rs2412298 (encodes collagen), and the tendency to a reliable increase of BMD deficit in L1 - L4 vertebrae under polymorphism in homozygous form of 1800012 gene was noted that might be evidence of their contribution to the development of primary osteoporosis in men. At the same time, smoking, alcohol consumption, age, mutations in homozygous form of gene rs2412298 and a history of low-energy fractures in first-line relatives increased the risk of low-energy fractures of the vertebral bodies and proximal femur.

Evaluation of trabecular microarchitecture in nonosteoporotic postmenopausal women with and without fracture

This study compared microscopic magnetic resonance imaging (µMRI) parameters of trabecular microarchitecture between postmenopausal women with and without fracture who have normal or osteopenic bone mineral density (BMD) on dual-energy X-ray absorptiometry (DXA). It included 36 postmenopausal white women 50 years of age and older with normal or osteopenic BMD (T-scores better than -2.5 at the lumbar spine, proximal femur, and one-third radius on DXA). Eighteen women had a history of low-energy fracture, whereas 18 women had no history of fracture and served as an age, race, and ultradistal radius BMD-matched control group. A three-dimensional fast large-angle spin-echo (FLASE) sequence with 137 µm × 137 µm × 400 µm resolution was performed through the nondominant wrist of all 36 women using the same 1.5T scanner. The high-resolution images were used to measure trabecular bone volume fraction, trabecular thickness, surface-to-curve ratio, and erosion index. Wilcoxon signed-rank tests were used to compare differences in BMD and µMRI parameters between postmenopausal women with and without fracture. Post-menopausal women with fracture had significantly lower (p < 0.05) trabecular bone volume fraction and surface-to-curve ratio and significantly higher (p < 0.05) erosion index than postmenopausal women without fracture. There was no significant difference between postmenopausal women with and without fracture in trabecular thickness (p = 0.80) and BMD of the spine (p = 0.21), proximal femur (p = 0.19), one-third radius (p = 0.47), and ultradistal radius (p = 0.90). Postmenopausal women with normal or osteopenic BMD who had a history of low-energy fracture had significantly different (p < 0.05) µMRI parameters than an age, race, and ultradistal radius BMD-matched control group of postmenopausal women with no history of fracture. Our study suggests that µMRI can be used to identify individuals without a DXA-based diagnosis of osteoporosis who have impaired trabecular microarchitecture and thus a heretofore-unappreciated elevated fracture risk.

Evaluation of bone tissue remodeling and mineral metabolism in elderly patients who have not been previously examined and have received no antiosteoporotic therapy

Objective: to evaluate bone tissue remodeling and mineral metabolism in elderly women who have not been previously examined and have received no antiosteoporotic therapy. Patients and methods. A total of 3152 women aged 65—75 years were examined using questionnaires and tests according to international validated scales and tests. The investigators measured bone density by dual-energy X-ray absorptiometry and mineral and bone mineral parameters. Results. Most patients were ascertained to have motor and physical impairments and cognitive dysfunction; 100% of cases had risk factors for osteoporosis (OP); 32.4% had a history of atraumatic fractures; 56.4% were diagnosed as having OP during standard examinations; 72.7% needed treatment in accordance with the FRAX procedure. The sensitivity of FRAX in patients (with OP without pathological fractures, OP with a history of low-energy fractures, or osteopenia with pathological fractures) requiring treatment according to these standard methods was 70.3, 71.5, and 24.3%, respectively. Conclusion. The majority of elderly (65—75-year-old) women who had not been previously examined and had received no antiosteoporotic therapy were found to have bone metabolic disturbances, a history of fractures in the presence of cognitive dysfunction, impaired motor activity, lowered quality of life, and inadequate calcium intake. At the same time, FRAX is not always the method of choice.

Clinical benefit of gluten-free diet in screen-detected older celiac disease patients

BackgroundThe utility of serologic screening for celiac disease is still debatable. Evidence suggests that the disorder remains undetected even in the older population. It remains obscure whether screening makes good or harm in subjects with long-standing gluten ingestion. We evaluated whether older subjects benefit from active detection and subsequent gluten free dietary treatment of celiac disease.MethodsThirty-five biopsy-proven patients aged over 50 years had been detected by serologic mass screening. We examined the disease history, dietary compliance, symptoms, quality of life and bone mineral density at baseline and 1-2 years after the commencement of a gluten-free diet. Symptoms were evaluated by gastrointestinal symptom rating scale and quality of life by psychological general well-being questionnaires. Small bowel biopsy, serology, laboratory parameters assessing malabsorption, and bone mineral density were investigated.ResultsDietary compliance was good. The patients had initially low mean serum ferritin values indicating subclinical iron deficiency, which was restored by a gluten-free diet. Vitamin B12, vitamin D and erythrocyte folic acid levels increased significantly on diet. Celiac patients had a history of low-energy fractures more often than the background population, and the diet had a beneficial effect on bone mineral density. Alleviation in gastrointestinal symptoms was observed, even though the patients reported no or only subtle symptoms at diagnosis. Quality of life remained unchanged. Of all the cases, two thirds would have been diagnosed even without screening if the family history, fractures or concomitant autoimmune diseases had been taken carefully into account.ConclusionsScreen-detected patients benefited from a gluten-free diet. We encourage a high index of suspicion and active case-finding in celiac disease as an alternative to mass screening in older patients.

Sex hormone-binding globulin, estradiol, and bone turnover markers in male osteoporosis

The role of estrogen deficiency in male osteoporosis is still under discussion. One hundred five subjects, 65 of them suffering from osteoporosis (mean age, 53.9 years) and 40 age-matched controls were studied. Osteoporosis was defined by a T score < −2.5 in the lumbar spine or at the femoral neck. Forty-one (63.1%) of the subjects had a history of low-energy fractures, involving vertebrae in 33 cases (50.8%). Osteoporosis was considered to be idiopathic in 33 subjects (50.8%) for whom no etiology could be found. We measured levels of total estradiol (pg/ml, with a detection threshold of 4 pg/ml), total testosterone (ng/ml), and their carrier protein, that is, sex hormone-binding globulin (SHBG, pmol/ml). Various markers of bone remodeling were also measured. Two of them provide an estimate of bone formation—osteocalcin (OC) and bone alkaline phosphatase (BAP). Two others evaluate bone resorption—procollagen type I C-terminal telopeptide (ICTP) and serum C-telopeptide of type I collagen (sCTX). There was no significant difference in estradiol levels between controls and osteroporosis patients. We did not find any significant correlation between estradiol levels and spinal bone mineral density (BMD) ( r = 0.15, P > 0.05), and the relationship between estradiol levels and BMD at the femoral neck was weak ( r = 0.25, P < 0.05). On the other hand, SHBG was significantly higher in the osteoporotic patients than in controls ( P < 0.01). This difference persisted after adjustment for body mass index (BMI) and after exclusion of patients with a condition known to increase SHBG levels. Moreover, this carrier protein was negatively correlated with BMD at the femoral neck ( r = −0.37, P < 0.01) and at the lumbar spine ( r = −0.27, P < 0.05). SHBG also correlates strongly with sCTX ( r = 0.37, P < 0.01). Finally, logistic regression analysis showed that serum SHBG concentration was significantly associated with the presence of fractures; the odds ratio of having a fracture was 2.04 [95% confidence interval (CI) 1.2–3.4, P < 0.01] for each increase of 1 standard deviation (SD) in the patient's SHBG level. The stronger relationship was nearly the same for the whole group and for patients with idiopathic osteoporosis. This study therefore suggests that SHBG may play a key role in male patients with idiopathic or secondary osteoporosis. It shows that serum SHBG concentration is increased in middle-aged men with osteoporosis and is correlated with hip, spine BMD, and sCTX levels. Finally, our findings are in agreement with previous studies which suggest that serum SHBG is a new biological marker of fracture risk in men.