Osteoporosis Initiation Research Articles

Frequent apheresis donation is not associated with adverse bone health in donors aged 45 years and over-Results from a cohort study in Australia.

We investigated whether frequent apheresis donors have altered risk of bone fractures, and prescription of osteoporosis medicine//s due to their repeated exposure to citrate anticoagulant. We used the Sax Institute's 45 and Up Study data linked with blood donation and other health-related datasets. We used a "5-year qualification period" method to identify active donors who donated at least one (any type) donation in the first and fifth year of the "qualification period." We categorized donors into 0, 1-29, and 30+ donation groups based on the number of apheresis donations made during the qualification period. We then compared the risk of bone fractures, and initiation of osteoporosis medicine/s in the years following the "qualification period" between the groups, using Cox proportional-hazards models including several potential confounders. A total of 7369 donors met the qualification criteria, of which 2033 (27.6%) made at least one apheresis donation. Of those donating by apheresis, 381 (18.7%) also made platelet as well as plasma donation, and rest donated plasma only. The median follow-up time for overall bone fractures was 5.49 years/per-donor (Q1-Q3, 5.27-5.95). In the fully adjusted models, compared to donors not making any apheresis donation, the hazard ratio for all-cause bone fractures, osteoporotic bone fractures, and initiation of osteoporosis medicine/sin donors donating 30+ apheresis donations was 0.96 (95% CI: 0.58-1.60), 0.73 (95% CI: 0.29-1.82), and 1.09 (95% CI: 0.66-1.81), respectively. We did not observe a statistically significant change in risk of bone fractures, and initiation of osteoporosis medicine/sin frequent apheresis donors predominantly consisting of plasmapheresis donors.

The miRNA-15b/USP7/KDM6B axis engages in the initiation of osteoporosis by modulating osteoblast differentiation and autophagy.

Osteoporosis is a metabolic disease that results from oxidative stress or inflammation in renal disorders. microRNAs (miRNAs) are recently implicated to participate in osteoporosis, but the mechanism remains largely unexplored. Herein, we aimed to explore the potential role of miR‐15b in osteoblast differentiation and autophagy in osteoporosis. We established osteoporosis models through ovariectomy and determined that miR‐15b was highly expressed whereas USP7 and KDM6B were poorly expressed in tissue of osteoporosis mice. Treatment of silenced miR‐15b resulted in the elevation of decreased bone mineral density (BMD), the maximum elastic stress and the maximum load of osteoporosis mice. In osteoblasts, miR‐15 overexpression decreased proliferation but suppressed the cell differentiation and autophagy, accompanied with decreased expression of USP7. Mechanistically, miR‐15 bound and inhibited USP7 expression, while overexpression of USP7 promoted autophagy of osteoblasts. USP7, importantly, strengthened the stability of KDM6B and promoted KDM6B expression. MG132 protease inhibitor increased KDM6B and USP7 expression in osteoblasts. Silencing of KDM6B reversed the promoting effect on autophagy and proliferation induced by overexpression of USP7. Taken altogether, miR‐15b inhibits osteoblast differentiation and autophagy to aggravate osteoporosis by targeting USP7 to regulate KDM6B expression.

The impact of a musculoskeletal training program on residents\u2019 recognition and treatment of osteoporosis

BackgroundOsteoporosis is inadequately treated in primary care settings. Under-recognition of the condition among male Veterans may contribute to this problem. In order to improve understanding of bone health in older male patients, we developed the “Musculoskeletal (MSK) Education Week”, a multidisciplinary clinical training initiative within a primary care ambulatory rotation for internal medicine (IM) residents at the Salt Lake City VA Medical Center. The objective of this study was to evaluate the impact of this program on trainees’ recognition of osteoporosis or treatment of this condition following the training experience.MethodsWe examined several clinical behaviors of post-graduate year 1 (PGY-1) IM trainees following their participation in the MSK Education Week between July 1–April 30, 2014. To determine the prevalence of these clinical behaviors, we conducted an observational study of patients age 50 and older enrolled at the Salt Lake City VA Healthcare System from July 1, 2013 to May 31, 2014. We used time-dependent multivariable Cox proportional hazard models to evaluate the impact of the training program on 4 osteoporosis-related outcomes: (1) completion of dual energy X-ray absorptiometry (DXA) scan, (2) diagnosis of osteopenia, (3) diagnosis of osteoporosis, and (4) initiation of osteoporosis medications.ResultsTwenty-six PGY-1 IM residents participated in the MSK Education Week, and 43,678 Veterans were identified over these periods of observation. In the Veterans cohort, 1154 had an encounter with a provider who had completed the training (and were therefore “exposed” to the training) and 42,524 Veterans did not. After adjusting for confounders, the effect of the provider training program was significant for DXA (HR = 1.78, 95% CI: 1.11, 2.87), osteoporosis diagnosis (HR = 3.90, 95% CI: 2.09, 7.29), and initiation of medications (HR = 2.87, 95% CI: 2.02, 4.09) outcomes.ConclusionsWe have shown that IM residents’ participation in the MSK Education Week was associated with significantly improvements in their completion of DXA scans, diagnosis of osteoporosis, and initiation of fracture-reducing medications in a population of US Veterans. Long-term follow up is needed to determine whether these initial results are followed by actual reductions in osteoporotic fractures.

Pharmacist Screening for Risk of Osteoporosis in Elderly Veterans.

To assess the effect of pharmacist screening for osteoporosis risk with increased bone mineral density (BMD) testing. Prospective, quasi-experiment. Veterans Affairs medical center Community Living Centers (CLC), home-based primary care, and outpatient geriatric clinic. Patients with a routine pharmacist interaction were included. Exclusion criteria included hospice, dialysis, and respite care. Risk assessment with recommendations communicated by progress notes to consider BMD testing or interventions in the settings described. A second phase of the project was conducted in CLC patients to evaluate the effect of an interdisciplinary team with the inclusion of a physician to assess clinical appropriateness of interventions. Proportion of patients meeting guidelines for BMD testing and change in proportion of patients with BMD testing ordered after intervention. Secondary measures included response to recommendations and initiation of osteoporosis pharmacotherapies. A total of 219 patients were included in the first phase of the project, with 120 (54.8%) identified as candidates for BMD testing with recommendations documented. Of this population, 5 patients without previous dual-energy absorptiometry results had BMD testing ordered (P = 0.6). In the second phase, 22 high-risk patients in the CLC met criteria for BMD testing, with 14 determined to have reasons for not pursuing BMD testing. Most patients in the settings described met guidelines for BMD testing. Pharmacist recommendations to consider BMD testing did not increase the rate of testing. Including a physician on an interdisciplinary team appeared to help determine appropriateness and improve the rate of testing, though the increase in testing was not statistically significant.

Effect of medication on biomechanical properties of rabbit bones: Heparin induced osteoporosis

The aim of this controlled study is to investigate the effect of heparin on osteoporosis initiation and of calcitonin and tamoxifen on the progress of osteoporosis induced by heparin through biomechanical means and, thus, to assist in clinical usage of these drugs. 32 four-month-old female New Zealand white rabbits were divided into four different experimental groups. The animals in group A were administered heparin (Liquemine) intraperitoneally at the dosage of 1000 IU/kg/day. The animals in group B were injected the same amount of heparin as those of group A, and in addition, were given calcitonin at the dosage of 100 IU/kg/day. The animals in group C were medicated the same way as group B but 2 mg/kg/day tamoxifen (Nolvadex) was orally added into their intestine via cannula, one side connected to the injector. The animals in group D were the control. The experiment lasted 8 weeks. The animals in all experimental groups showed the same growth pattern as that of the control group. Whole-bone femur, humerus and tibia specimens were subjected to 3-point bending tests while sections from the proximal ends of the same specimens were subjected to compression tests. The data, recorded as load vs deflection, were converted into stress vs strain using the strength of materials formulae. The data obtained from the bending and the compression experiments were treated separately. The stiffness of the bones of the medicated groups were compared with those of the control groups. Our data indicated that the tamoxifen treated humera, femora and tibiae attained the largest bending stiffness in all cases investigated. However, this was not the case for compression. None of the drug administered groups attained the stiffness of the control group except for the case of tamoxifen treated femora which attained stiffness close to that of the controls. The results show that heparin altered the mechanical properties of bones indicating osteoporosis, tamoxifen was effective in reducing the effect of heparin while calcitonin yielded no conclusive result.