History Of Osteoporotic Fracture Research Articles

Evaluation of trabecular bone score in patients with a distal radius fracture.

The purpose of this study was to determine whether trabecular bone score (TBS) has additive value for discriminating distal radius fracture (DRF) independent of BMD. We compared BMD and TBS in 258 postmenopausal women with a DRF older than 50years of age with age- and body mass index (BMI)-matched controls who had no history of osteoporotic fracture. BMD was measured at the lumbar spine and hip using dual energy X-ray absorptiometry scans (GE Lunar Prodigy). TBS was calculated on the same spine image. A multivariate logistic regression analysis was used to analyze the odds ratio (OR) for the occurrence of DRF using age, BMI, lumbar spine BMD, total hip BMD, and TBS. Patients with a DRF had significantly lower BMDs at hip (neck, trochanter and total) than those of controls: 0.752±0.097, 0.622±0.089, and 0.801±0.099 in patients and 0.779±0.092, 0.648±0.089, 0.826±0.101 in controls. However, lumbar spine BMD and TBS were not significantly different between the groups (p=0.400 and 0.864, respectively). The multivariate analysis indicated that only total hip BMD was significantly associated with the occurrence of DRF (OR, 10.231; 95% confidence interval, 1.724-60.702; p=0.010). TBS was not different between women with a DRF and those without a history of osteoporotic fracture, suggesting that TBS measured at the lumbar spine does not reflect early microarchitectural changes of the distal radius. Only total hip BMD is associated with the risk of DRF in Korean women.

Metabolic syndrome and osteoporotic fracture: a population-based study in China.

BackgroundAssociations between metabolic syndrome (MetS) and osteoporotic fracture have been reported. However, the epidemiological studies are not conclusive. The objective of the study was to determine whether metabolic syndrome associates with osteoporotic fracture.MethodsThis was a cross-sectional study of 9930 Chinese adults aged 40 year or older in the Chongming District, Shanghai, China. A questionnaire, anthropometric measurements and laboratory tests were conducted. MetS was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian-Americans. A history of fractures was collected with an interviewer-assisted questionnaire. Osteoporotic fractures were defined as fractures that occurred due to low-trauma in 2 years prior to the study.ResultsAmong women, the prevalence of osteoporotic fractures was significantly higher in those with MetS (3.5 vs. 2.6 %, P =0.028). However, the difference was not found in men (2.6 vs. 2.4 %, P =0.737). The presence of Mets was significantly associated with increased odds of osteoporotic fracture among women (odds ratio 1.22; 95 % confidence interval 1.12–1.54; P = 0.039) after controlling for potential confounders. The significant associations were not detected in men.ConclusionsThe presence of MetS was significantly associated with a recent history of osteoporotic fracture in middle-aged and elderly Chinese women.Electronic supplementary materialThe online version of this article (doi:10.1186/s12902-016-0106-x) contains supplementary material, which is available to authorized users.

How the knowledge of fracture risk might influence adherence to oral therapy of osteoporosis in Italy: the ADEOST study.

The patients' adherence to osteoporosis treatments is low. In our study population a history of osteoporotic fractures was associated to better compliance and persistence; however, a 12-month randomized study carried out on 816 osteoporotic women showed that providing the patients with their individual fracture risk information did not prove effective. Several drugs are currently available for the treatment of osteoporosis, but the patients' compliance and persistence with these treatments are low. This study aimed to both analyze the adherence to oral osteoporosis medications among Italian osteoporotic patients (cross-sectional study) and evaluate if providing patients with their individual fracture risk information may improve compliance and persistence (prospective study). A total of 3379 osteoporotic patients referred as outpatients for a visit 1year after receiving a prescription of oral osteoporosis medications for the first time, were enrolled for the retrospective study. Moreover, 816 postmenopausal women receiving an oral prescription for osteoporosis for the first time, were randomized into two groups: group 1 (managed according to standard clinical practice) and group 2 (managed with greater patient involvement and information on the individual risk of major osteoporotic fractures calculated by DeFRA algorithm). In the retrospective study, a history of osteoporotic fractures, the frequency of drug administration and a condition of being overweight/obese had a significant influence on both compliance and persistence. Of the 816 patients enrolled in the longitudinal study, 731 (374 of group 1 and 357 of group 2) attended the 1year follow-up visit. The percentage of women with high compliance or persistence was greater in group 2 (64.2 vs. 58.1% and 66.8 vs. 62.6%, respectively), but without reaching any statistical significance. Although providing the patients with their individual fracture risk information was not statistically effective, further studies on additional interventions able to improve the patients' perceived risk of fracture are warranted.

Association between Glucocorticoid-Induced Osteoporosis and Myasthenia Gravis: A Cross-Sectional Study

PurposeTo investigate the association between glucocorticoid-induced osteoporosis and myasthenia gravis (MG) using a cross-sectional survey in Japan.MethodsWe studied 363 patients with MG (female 68%; mean age, 57 ± 16 years) who were followed at six Japanese centers between April and July 2012. We evaluated the clinical information of MG and fractures, bone markers, and radiological assessment. Quality of life was measured using an MG-specific battery, MG-QOL15.ResultsGlucocorticoids were administered in 283 (78%) of 363 MG patients. Eighteen (6%) of 283 MG patients treated with prednisolone had a history of osteoporotic fractures. The duration of glucocorticoid therapy, but not the dose of prednisolone, was associated with the osteoporotic fractures in MG patients. Bone mineral density was significantly decreased in the MG patients with fractures. The multivariate analyses showed that the total quantitative MG score was the only independent factor associated with osteoporotic fractures (OR = 1.30, 95% CI 1.02–1.67, p = 0.03). MG patients who had experienced fractures reported more severe difficulties in activities of daily living.ConclusionGlucocorticoid-induced osteoporosis aggravates quality of life in patients with MG.

Prevalence of osteoporotic vertebral fracture in Spanish women over age 45

The aim of this work is to study the prevalence of osteoporotic vertebral fractures in Spanish women over 45 years of age, based on the selection of a nationwide sample. An observational, cross-sectional, multicenter study was conducted during 2006, in all of Spain's regions. The sample analyzed was of 5000 individuals, representative of the female population over age 45 in Spain.A questionnaire was used to determine which factors are most often associated with vertebral fractures. We also assessed whether the Prevalent Vertebral Fracture Index, proposed by Vogt, is useful in indicating a possible osteoporotic vertebral fracture. Five hundred orthopedic surgeons, from various Spanish regions, were trained in different aspects of the study: inclusion and exclusion criteria, management of the risk factor questionnaire, and implementation of the Vogt questionnaire.The number of fracture cases was 1549 (31.79%). 528 Women (34.08%) had a single vertebral fracture, and 1021 (65.92%) had multiple vertebral fractures. The following factors were statistically significantly associated with vertebral fracture: age, late menarche, early menopause, diabetes mellitus, hyperparathyroidism, rheumatoid arthritis, height loss, daily physical activity, corticosteroid therapy, personal history of osteoporotic fracture and previous diagnosis of osteoporosis. The differences in Vogt score according to age and fracture status were statistically significant.The conclusion of the study is that vertebral osteoporotic fracture in the female Spanish population is frequent. The high prevalence in the Spanish population older than 60 years is probably related to malnutrition in the period from 1936 to 1952.

Higher plasma platelet-activating factor levels are associated with increased risk of vertebral fracture and lower bone mineral density in postmenopausal women.

Despite experimental and animal evidence showing the detrimental effects of platelet-activating factor (PAF) on bone metabolism, there are no clinical studies relating PAF to osteoporosis-related phenotypes. This case-control study investigates the association between plasma PAF, osteoporotic vertebral fracture (VF), and bone mineral density (BMD) in postmenopausal Korean women. Among 474 eligible women not taking any drug or having any disease that could affect bone metabolism, we identified 73 cases defined as subjects with radiological VF. The controls were randomly selected from the remaining 401 subjects and matched 1:1 to cases in terms of both age and body mass index (BMI). Lateral thoracolumbar radiographs, BMD, and plasma PAF levels were determined for all subjects. Postmenopausal women with VF demonstrated 34.6 % higher plasma PAF levels than subjects without VF after adjusting for age, BMI, smoking habits, alcohol intake, regular exercise, and parental history of osteoporotic fractures (P = 0.021). Multiple logistic regression analyses revealed that the odds ratio for VF linearly increased across increasing PAF quartiles (P for trend = 0.040) and the odds for VF were 2.88-fold higher in subjects in the highest quartile in comparison with those in the lowest quartile (95 % CI 1.04-8.01). Plasma PAF levels were inversely correlated with BMD at various sites (γ = -0.253 to -0.176, P = 0.003-0.041). These findings suggest that plasma PAF may be a potential biomarker for predicting poor bone health in postmenopausal women.

Serum Sema3A is in a weak positive association with bone formation marker osteocalcin but not related to bone mineral densities in postmenopausal women.

The chemorepellent semaphorin-3A (Sema3A) was shown to favor bone metabolism in mice, but its bone effects in humans are not described. The aim of the study was to investigate the associations between serum Sema3A, bone biochemical markers, and bone mineral densities (BMDs) in women. This was a cross-sectional study involving 1012 pre- and postmenopausal women. Fasting serum Sema3A, osteocalcin (Ocn), and cross-linked C-telopeptide of type 1 collagen were measured. Dual-energy X-ray absorptiometry was performed to determine the BMDs at the lumbar spine and femoral neck. History of osteoporotic fractures was reported by the participants. In postmenopausal women (n = 860), a significant positive association between Sema3A and Ocn levels was demonstrated (r = 0.077, P = 0.025) when age was adjusted. The serum Ocn level was significantly higher in the fourth quartile of serum Sema3A as compared with the first quartile (21.09 ± 0.56 ng/mL vs 19.45 ± 0.44 ng/mL, P = .018). Serum Sema3A concentrations were similar in subjects with normal BMD, osteopenia or osteoporosis, and those with and without osteoporotic fractures. Multivariate stepwise regression analysis revealed that cross-linked C-telopeptide of type 1 collagen, body mass index, creatinine, Sema3A, L1-4 BMDs, and age were determinants of Ocn (adjusted R(2) for the model = 0.532, P < .001) . The positive correlation between Sema3A and bone formation marker Ocn revealed in this human study partly supports the recently findings in mice studies. However, the general effects of Sema3A on bone metabolism are weak and not clear as evidenced by lack of association between this parameter and BMDs and osteoporotic fractures.

DXA-based variables and osteoporotic fractures in Lebanese postmenopausal women

IntroductionThe aim of this study was to assess DXA-based variables (bone mineral density, bone mineral apparent density, compressive strength index of the femoral neck and trabecular bone score) in Lebanese postmenopausal women having presented a previous fracture. Materials and methodsOne thousand Lebanese postmenopausal women between 45 and 89 years participated in this study. The women were recruited by advertisements offering bone mineral density measurements at a reduced cost. Subjects with previous history of radiotherapy or chemotherapy were excluded. Informed written consent was obtained from all the participants. ResultsFemoral neck compressive strength index (FN CSI) was significantly (P<0.001) associated with the presence of fracture using a simple logistic regression (odds ratio=0.51 [0.385–0.653]). When a multivariate logistic regression analysis was performed with the presence of fracture as a dependent variable and each of age, FN BMD and FN CSI as independent variables, only FN BMD (P=0.005) and FN CSI (P=0.004) were found to be associated with the presence of fracture. ConclusionThis study suggests that FN CSI is associated with history of osteoporotic fractures in postmenopausal women. The use of FN CSI in clinical practice may help to identify patients with high risk of fracture. Level of evidenceEpidemiological study, level IV.

Association between metabolic syndrome and osteoporotic fracture in middle-aged and elderly Chinese peoples.

Associations between metabolic syndrome (MetS) and osteoporotic fracture have been reported. However, the epidemiological studies are not conclusive. The objective of the study was to determine whether MetS associates with osteoporotic fracture. This was a cross-sectional study of 9,930 Chinese adults aged 40 years or older in the Chongming District, Shanghai, China. A questionnaire, anthropometric measurements and laboratory tests were conducted. Metabolic syndrome was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian Americans. A history of fractures was collected with an interviewer-assisted questionnaire. Osteoporotic fractures were defined as fractures that occurred due to low trauma in 2 years prior to the study. Among women, the prevalence of osteoporotic fractures was significantly higher in those with MetS (3.5 vs. 2.6 %, = 0.028). However, the difference was not found in men (2.6 vs. 2.4 %, P = 0.737). The presence of MetS was significantly associated with increased odds of osteoporotic fracture among women (odds ratio 1.22; 95 % confidence interval 1.12-1.54; P = 0.039) after controlling for potential confounders. The significant associations were not detected in men. The presence of MetS was significantly associated with a recent history of osteoporotic fracture in middle-aged and elderly Chinese women.

Analysis of elderly outpatients in relation to nutritional status, sarcopenia, renal function, and bone density

To evaluate relationships between nutritional status, sarcopenia and osteoporosis in older women. We studied 44 women, 67-94 years, by mini-nutritional assessment (MAN), glomerular filtration corr. 1.73 m(2), body mass index (BMI), arm circumference and calf (CP and CB), bone mineral density and body composition, DXA (fat mass MG; lean MM). We gauge sarcopenia: IMM MM = MSS + MIS/height(2). We used the Pearson correlation coefficient, p < 0.05 as significant. MNA and IMM were positively correlated with BMI, CP, CB and MG. Age influenced negatively FG corr., BMI, FM, IMM and CP. Fourteen had a history of osteoporotic fractures. The lowest T-score was directly related to MAN and MG. CONCLUSIONS The aging caused the decline of FG, fat mass and muscle; the calf circumference, and brachial reflected nutritional status and body composition; and major influences on BMD were nutritional status and fat mass.

Alterations in bone mineral density and bone turnover markers in newly diagnosed adults with lymphoma receiving chemotherapy: a 1-year prospective pilot study

Bone mineral density (BMD) loss is poorly defined in lymphoma patients. The aim of this study was to measure the extent of BMD loss in newly diagnosed lymphoma patients receiving chemotherapy. This was a prospective, single-center study conducted in patients aged≥18 years with previously confirmed lymphoma treated by chemotherapy. Patients with low baseline BMD defined as Z/T-score less than or equal to -2.5 and/or history of osteoporotic fractures were excluded. BMD was measured at baseline before initiating chemotherapy and 1 year later. Predictive factors of BMD loss were investigated. Forty-one lymphoma patients (31 males and 10 females) receiving chemotherapy were enrolled. The median age at diagnosis was 59 (range: 19-86) years. Histological subtypes were predominantly diffuse large B-cell lymphoma (58%), mostly stage III-IV (54%). All patients received chemotherapy and 22% of patients received second-line treatment due to relapse or progressive disease. Thirty-two patients were evaluable at 1 year. The mean BMD changes were: -2.7%±3.9% for lumbar spine (P<0.001), -2.2%±7.6% for femoral neck (P<0.01) and -2.6%±4.5% for total hip (P<0.0001). In multivariate analysis, predictive factors of BMD loss at baseline were (i) at lumbar spine: female gender (P=0.01), higher lactate dehydrogenase level (P=0.04) and lower creatinine clearance (P=0.01); (ii) at total hip: lower albumin (P=0.01), higher corrected serum calcium (P<0.01), lower alkaline phosphatase (AP) (P<0.01) and autologous stem cell transplant (P=0.03); and (iii) at femoral neck: higher corrected serum calcium (P=0.02) and lower bone AP (P=0.01). Adult patients with known lymphoma receiving chemotherapy experienced significant BMD loss at 1 year.

Diagnosis of osteoporosis by extraction of trabecular features from hip radiographs using support vector machine: An investigation panorama with DXA

BackgroundLifespan and its quality can be improved by early diagnosis of osteoporosis. Analysis of trabecular boundness on digital hip radiographs could be useful for identifying subjects with low bone mineral density (BMD) or osteoporosis. The main aim of our study was to evaluate the ability of a kernel-based support vector machine (SVM) with respect to diagnosis and add to knowledge about the trabecular features of digital hip radiographs for identifying subjects with low BMD. MethodIn this paper we present an SVM kernel classifier-based computer-aided diagnosis (CAD) system for osteoporotic risk detection using digital hip radiographs. Initially, the original radiograph was intensified, then trabecular features such as boundness, orientation, solidity of spur and delta were evaluated and radial bias function (RBF) based discrimination was manifested. The next step was the evaluation of the diagnostic capability of the proposed method in order to spot subjects with low BMD at the femoral neck in 50 (50.7±14.3 years) South Indian women with no previous history of osteoporotic fracture. Out of 50 subjects, 28 were used to train the classifier and the other 22 were used for testing. ResultsThe proposed system has achieved the highest classification accuracy documented so far by means of a fivefold cross-validation analysis with mean accuracy of 90% (95% confidence interval (CI): 82 to 98%); sensitivity and positive predictive value (PPV) were 90% (95% CI: 82 to 98%) and 89% (95% CI: 81 to 97%), respectively. Pearson's correlation was observed at the level of p<0.001, between extracted image trabecular features with age and BMDs measured by dual energy x-ray absorptiometry (DXA). Extracted image features also demonstrated significant differences between high and low BMD groups at the level of p<0.001. ConclusionOur findings suggest that the proposed CAD system with SVM would be useful for spotting women vulnerable to osteoporotic risk.

OP0246 Incidence of and Risk Factors for Clinical Fractures in Patients with Systemic Lupus Erythematosus and Matched Controls: A Population-Based Study in the United Kingdom

BackgroundSystemic lupus erythematosus (SLE) has been associated with an increased risk of low bone mineral density and fractures. However, data on absolute fracture risk and risk factors associated with clinical...

65 BONE DENSITY RESULTS OF VITAMIN-D INADEQUATE PATIENTS PRESENTING WITH UROLITHIASIS TO A TERTIARY STONE CENTER

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-Based Medicine & Outcomes (II)1 Apr 201365 BONE DENSITY RESULTS OF VITAMIN-D INADEQUATE PATIENTS PRESENTING WITH UROLITHIASIS TO A TERTIARY STONE CENTER Mohamed Elkoushy, Terence Lee, and Sero Andonian Mohamed ElkoushyMohamed Elkoushy Montreal, Canada More articles by this author , Terence LeeTerence Lee Montreal, Canada More articles by this author , and Sero AndonianSero Andonian Montreal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1443AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Vitamin-D Inadequacy (VDI) and its associated metabolic abnormalities are prevalent in patients presenting with urolithiasis. Vitamin D plays a vital role in bone health and stone-formers are at risk of premature bone loss that may be exaggerated by VDI. Therefore, the aim of the present study was to assess abnormalities in bone density studies for patients with VDI presenting with urolithiasis to a tertiary stone clinic. METHODS A retrospective review of prospectively collected data was performed for patients presenting to stone clinic from November, 2009 to August, 2012. Demographic and clinical data were collected together with metabolic stone work-up and bone density studies. VDI was defined as VD levels < 30 ng/ml. A Dual-energy X-ray Absorptiometry (DXA) scan was used to evaluate the Bone Mineral Density (BMD) at the femoral neck and lumbar spine. The World Health Organization (WHO) criteria were used to define patients with abnormal BMD; normal (within ±1 SD), osteopenia (−1 to −2.5 SD), and osteoporosis (<−2.5 SD). Patients with primary hyperparathyroidism or hypercalcemia were excluded. RESULTS A total of 49 patients with VDI with DXA studies were included; 26 (53.1%) were males. Mean age (95%CI) was 51.5 (42.5-58.3) years, mean BMI (95%CI) was 27.9 (21.6- 31.2) kg/m2 and mean serum VD (95%CI) was 18.4 (16.4-26.2) ng/ml. Twenty-nine patients (59.2%) had abnormal DXA studies where 23 (46.9%) had osteopenia and 6(12.3%) had osteoporosis in the femoral neck and/or lumbar spine. Femoral neck was affected in 42.8% of patients (36.7% osteopenia and 6.1% osteoporosis) while lumbar spine was affected in 40.8% of patients (32.6% osteopenia and 8.2% osteoporosis; one patient had severe osteoporosis with history of osteoporotic fractures). Median serum VD (95%CI) was not significantly different between patients with normal and abnormal DXA scans [19.2 (8-29) vs. 17.2 (6-28) ng/ml, p=0.10). Similarly, median serum VD (95%CI) did not significantly differ between osteopenics and osteoporotics [17.6 (6-28) vs. 15.6 (6.8-23.6) ng/ml, p=0.64]. Of interest, 61.3% of those with abnormal DXA scans were males. CONCLUSIONS A high prevalence of abnormal DXA scans was found in patients presenting with urolithiasis and vitamin D inadequacy. These findings need to be taken into account during evaluation and replacement of vitamin D in this population. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e27 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Elkoushy Montreal, Canada More articles by this author Terence Lee Montreal, Canada More articles by this author Sero Andonian Montreal, Canada More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

A large prospective European cohort study of patients treated with strontium ranelate and followed up over 3 years

Strontium ranelate has been available as an osteoporosis treatment in Europe since 2004. This article describes a large European observational survey of the use of strontium ranelate in clinical daily practice. A retrospective observational registry included 32,446 women consulting for postmenopausal osteoporosis in seven countries. Within the registry, 12,046 women were receiving strontium ranelate and were followed up over 3 years. The baseline characteristics of the follow-up cohort were similar to those of the whole registry cohort (age, 68.9 ± 10.3 years; body mass index, 25.6 ± 4.3 kg/m(2); lumbar spine T-score, -2.57 ± 0.85 SD; femoral neck T-score, -2.11 ± 0.86 SD). At baseline, 77 % of patients had at least one risk factor for osteoporosis, and 46 % had a previous history of osteoporotic fracture. Mean duration of follow-up was 32.0 ± 9.7 months, and treatment duration was 25.2 ± 13.7 months (24,956 patient-years of treatment). Persistence with strontium ranelate was 80 % at 1 year, 68 % at 2 years, and 64 % at 32 months; most patients (about 80 %) reported rarely omitting a dose. At least one emergent adverse event was reported in 2,674 (22 %) patients, most frequently gastrointestinal side effects. The crude incidence of venous thromboembolic events was 2.1/1,000 patient-years. No cases of hypersensitivity reactions, such as drug rash with eosinophilia and systemic symptoms (DRESS), Steven-Johnson syndrome, or toxic epidermal necrolysis, were reported. During follow-up, a fracture occurred in 890 patients (7 %); 429 of the fractures were nonvertebral fractures. Our observational survey over 32 months indicated good rates of adherence with strontium ranelate and confirmed its good safety profile in the management of postmenopausal osteoporosis.

Awareness of osteoporosis and its relationship with calcaneus quantitative ultrasound in a large Chinese community population

BackgroundThe People’s Republic of China has the largest population affected by osteoporosis in the world. However, no population-based survey of osteoporosis awareness in People’s Republic of China has been reported. This study investigated the level of basic awareness of osteoporosis in a large community in People’s Republic of China. The relationship between level of awareness and quantitative ultrasound (US) measurements at the calcaneus was also assessed.MethodsA questionnaire was completed by 9983 men and women aged 40 years or older in Nanjing, People’s Republic of China, between June and December 2011. During this time, the study participants underwent quantitative US measurement. Data from 9049 of the subjects were included in the final analysis.ResultsThe proportion of subjects who were aware of osteoporosis was very low. Only 30.7% had heard of osteoporosis, and only 18.5% had heard of osteoporotic fracture. In total, 52.9% of the subjects drank milk, 16.0% took calcium, 7.1% took vitamin D, and 47.2% were performing regular physical activity. Logistic regression showed that more highly educated older women had significantly better awareness of osteoporosis (P < 0.05). Subjects with a history of a previous osteoporotic fracture also had better awareness (P < 0.05) than subjects without such a history, except for those who drank milk. Similar to previous reports, female sex, old age, a low education level, and a personal history of osteoporotic fracture were significantly associated with a low quantitative US measurement (P < 0.001). Further, drinking milk and having not heard of osteoporosis were significantly associated with a higher quantitative US measurement (P < 0.05), while other indicators of osteoporosis awareness were not associated with quantitative US values (P > 0.05).ConclusionAwareness of osteoporosis in People’s Republic of China is very low. National awareness strategies should be implemented, especially for poorly educated young men.

Response: The Association between Serum Endogenous Secretory Receptor for Advanced Glycation End Products and Vertebral Fractures in Type 2 Diabetes (Endocrinol Metab 2012;27:289-94, Cheol Ho Lee et al.)

The authors would like to thank the reviewers for their time and constructive comments concerning our manuscript. This study analyzed the relationship between vertebral fracture and endogenous secretory receptor for advanced glycation end products (esRAGE) in type 2 diabetes. We verified that patients in the lowest tertile of esRAGE had a higher risk of moderate or severe vertebral fractures than patients in the highest tertile. It is well known that type 2 diabetes patients had a higher risk of hip or vertebral fractures although they had a similar or slightly higher bone mineral density (BMD) compared to healthy individuals [1,2]. This suggests that reduced bone quality is more profoundly associated with the increase in fracture risk, rather than decreased BMD in type 2 diabetes patients. Previous studies have indicated an increase in advanced glycation end products (AGEs) due to elevated blood glucose, and a decrease in esRAGE interrupting signal transmission within the cells of AGEs, as potential causal factors for deteriorating BMD [3,4]. As we mentioned, this study has statistical limitations. Some risk factors including previous fracture history, family history of osteoporotic fracture, and BMD were not included in multiple regression analysis of the relationship between esRAGE and vertebral fractures. Previous history of fracture was excluded from the analysis since it was known in only 50% to 60% of the subjects. The major limitation of our study is the lack of BMD measurements, which is an important risk factor for vertebral fractures. In addition, small sample size makes it difficult to draw conclusions. We feel that a prospective study is needed to further investigate the effects of low esRAGE levels on the increased risk of fractures in type 2 diabetes. Thanks again for your interest and comprehensive comments in our paper.

Reality and Recommendation: Comparison between Current Practice Patterns in a Single Center in Taiwan and the ACR 2010 Recommendations for Glucocorticoid-induced Osteoporosis Treatment among Elderly Patients with Systemic lupus Erythematosus, Polymyositis, and Dermatomyositis

Objectives: To compare current practice patterns with the American College of Rheumatology (ACR) 2010 recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) for patients over 65 with systemic lupus erythematosus (SLE), polymyositis (PM), or dermatomyositis (DM). Methods: Thirty-eight patients aged above 65 as of October 2009 were included in our study. We retrospectively collected clinical data from electronic medical records and stratified patients into high-, medium-, and low-risk groups based on Fracture Risk Assessment (FRAX) score, history of prior fragility fracture, and bone mineral density, according to the new ACR recommendations. Using the Taiwan version of the FRAX tool, we created a diagram that can serve as a quick reference for corresponding risk stratification in patients in Taiwan receiving corticosteroids. We then identified corresponding treatment choices according to the ACR recommendation and recorded the dose and duration of corticosteroid administration from October 2009 to September 2010. We compared actual prescribing practice to the recommended practice. Multiple variable logistic regression was performed to identify factors that affected adherence to recommendations. Results: Out of 38 patients who fulfilled the inclusion criteria, 31.6% were classified as low risk, 26.3% as medium risk, and 42.1% as high risk. Although pharmacologic interventions for the prevention and treatment of GIOP were recommended for 89.5% overall, and for 66.7%, 100%, and 100% in the low-, medium-, and high-risk groups, respectively, only 14 of the 38 patients (36.8%) in our study received any kind of bisphosphonate or teriparatide to treat or prevent osteoporosis. Specifically, among the 34 patients in our study who met the ACR recommendations to receive pharmacologic interventions, only 13 (38.2%) received antiresorptive medications or teriparatide according to the recommendations, including 1 patient out of 8 (12.5%) in the low-risk group, 3 patients out of 10 (30.0%) in the medium-risk group, and 9 patients out of 16 (56.3%) in the high-risk group. The multivariate logistic regression model showed that past history of osteoporotic fracture was associated with prescription of bisphosphonates or teriparatide (odds ratio = 47.00; 95% confidence interval =1.07 - 2063.68; p=0.046). Conclusion: Much discrepancy exists between the ACR 2010 recommendations and current practices for prevention and treatment of GIOP in patients over 65 who are diagnosed with SLE, PM, or DM. More efforts against GIOP should be made.

Inappropriate Prescribing and Related Hospital Admissions in Frail Older Persons According to the STOPP and START Criteria

Over the last few years, the Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria have been increasingly used to evaluate the prevalence of inappropriate prescribing. However, very few studies have evaluated the link between these criteria and clinical outcomes. The objectives of this study were to evaluate the prevalence of inappropriate prescribing according to STOPP and START in a population of frail elderly persons admitted acutely to hospital; to evaluate whether these inappropriate prescribing events contributed to hospital admissions; and to identify determinants of hospital admissions potentially related to inappropriate prescribing. This was a cross-sectional study including all frail older patients admitted to a 975-bed teaching hospital over a 12-month period. A pharmacist and a geriatrician independently detected events of prescribing of potentially inappropriate medication (PIM) and potential prescribing omission (PPO), using the STOPP and START criteria, respectively, in all patients included in the study. They determined whether the inappropriate prescribing event was the main cause or a contributory cause of hospital admission. Demographic, clinical and geriatric clinical syndromes (i.e. cognitive impairment, falls) were evaluated as potential determinants of hospital admissions related to inappropriate prescribing, using multivariate methods (i.e. logistic regression and a classification tree). 302 frail older persons (median age 84 years) were included in the study. PIMs (prevalence 48%) mainly involved overuse and/or misuse of benzodiazepines, aspirin and opiates. PPOs (prevalence 63%) were mainly related to underuse of calcium and vitamin D supplementation, aspirin and statins. Overall, inappropriate prescribing according to STOPP (54 PIMs) and/or START (38 PPOs) led or contributed to hospital admission in 82 persons (27%). The multivariate analyses indicated a relation between PIM-related admissions and a history of previous falls (p < 0.001), while the PPO-related admissions were associated with a history of osteoporotic fracture (p < 0.001) and atrial fibrillation (p = 0.004). Using the STOPP and START criteria, it was found that inappropriate prescribing events (both PIMs and PPOs) were frequent and were associated with a substantial number of acute hospital admissions in frail older persons. Fall-induced osteoporotic fracture was the most important cause of hospital admission related to inappropriate prescribing and should be a priority for pharmacological optimization approaches.

Association between Nonalcoholic Fatty Liver Disease (NAFLD) and Osteoporotic Fracture in Middle-Aged and Elderly Chinese

Nonalcoholic fatty liver disease (NAFLD) has been considered as a hepatic manifestation of the metabolic syndrome and is associated with various metabolic abnormalities, which may link to an increased risk of osteoporotic fracture. However, epidemiological studies investigating the association between NAFLD and osteoporotic fracture were not available. The objective of the study was to determine whether NAFLD associates with osteoporotic fracture. This was a cross-sectional study of 7797 Chinese adults aged 40 yr or older in the Jiading District, Shanghai, China. A questionnaire, anthropometric measurements, laboratory tests, and a hepatic ultrasonic examination were conducted. NAFLD was diagnosed by hepatic ultrasound after the exclusion of alcohol abuse and other liver diseases. A history of fractures was collected with an interviewer-assisted questionnaire. Osteoporotic fractures were defined as fractures that occurred due to low-trauma in 2 yr prior to the study. Among men, the prevalence of osteoporotic fractures was significantly higher in those with NAFLD (3.6 vs. 1.7%, P = 0.003); however, no difference was found in women (3.4 vs. 2.6%, P = 0.14). The presence of NAFLD was significantly associated with increased odds of osteoporotic fracture among men (odds ratio 2.53; 95% confidence interval 1.26-5.07; P = 0.009) after controlling for potential confounders. The significant associations were not detected in women. The presence of NAFLD was significantly associated with a recent history of osteoporotic fracture in middle-aged and elderly Chinese men.