Presence Of Risk Factors For Osteoporosis Research Articles

Primary Osteoporosis Management by the Marche Region Health Care System

Osteoporosis is an illness that affects the skeleton and is characterized by progressive loss of bone mass as well asby micro architectural deterioration of bone tissue of the same. This condition exposes the person to fracture risk, aparticularly feared event not only in terms of individual health but even in terms of economic burden. The fractures,in fact, are accompanied by autonomy loss, institutionalization risk, comorbidity and mortality. On an economic level,the reduction of the same absorbs many more resources than anti-osteoporosis drug therapies even in the event thatall patients are reached with ascertained osteoporosis and with 100% adherence to medication. In the elderly, in addition to incurring in loss of bone density risk there is an increase of fall risk. Both of these factors add up causing anincrease of fracture risk. Due to the demographic increase and life expectancy, osteoporosis and fracturing events willtend to increase, causing an increase in costs. Today, the data collected in Italy regarding osteoporosis prevalenceand fragility fractures incidences are not entirely exhaustive. Concerning fractures, data is reliably collected usingthe “Diagnosis Related Group Classification” and refers to those of the femur.Detect and describe the pathway that the patient with primary osteoporosis follows in the Marche Region.Through the regional Single Booking Center (CUP) and the websites of the Italian League of Osteoporosis (LIOS)and the Italian Society of Osteoporosis, Mineral Metabolism and Skeleton Diseases (SIOMMMS), eleven serviceshave been identified, belonging to the four health care companies of the Marche Region (Asur, Inrca-Irccs, AO Ospedali Riuniti Marche Nord, AOU Ospedali Riuniti Ancona), which can be contacted for an osteoporosis checkup. Aquestionnaire was therefore prepared based on the recommendations contained in the SIOMMMS (2012), SIMFERand SIGN (2015) guidelines and sent to the above-mentioned services. The questionnaires are seven, duly completedand used for processing data.In the Marche Region, the medical specialties that deal with osteoporosis are various, demonstrating the fact that thisis a “border illness”. Concerning the interception of the patient, his sending to a specialized service, the diagnosticapproach and the use of risk-scoring tools, there is a substantial homogeneity throughout the regional territory. Thepatient is sent to the specialized center by the general practitioner (GP) or other specialist, based on the presence ofrisk factors for osteoporosis alone or on the basis of their presence in association with BMD measurement (body massdensity measurement) already known. For the purposes of diagnosis, the investigations required are the dual-energyx-ray absorptiometry (DXA) and the blood test while the use of risk-scoring tools are mainly dictated by the need todefine the threshold of pharmacological intervention and give the patient perception of its own fracture risk. The mostused algorithm is DeFRA. During the evaluation of the patient, all services detect pain and fall risk.The approach to osteoporosis and fall risk is purely pharmacological. From a non-pharmacological point of view,attention is paid in informing the patient about the modifiable risk factors for osteoporosis and falls. Only some services carry out interventions aimed at promoting adherence to treatment, resorting to different actions. In conclusion,the main critical issues relating to taking care of a fracture risk patient are: accessibility to information, early andexhaustive interception of the population at risk, detection of the fracture risk in relation to bone demineralizationand fall risk, adherence to therapy

Influence of osteoporosis risk faktors on bone mass loss in postmenopausal women

Introduction: Estrogen deficiency plays a critical role in the development of osteoporosis. However, some other factors may contribute to bone loss as well. Aim: To show presence of osteoporosis risk factors and to examine its influence on bone mass loss in women with normal menstrual history.Methods: The study included 30 postmenopausal women, ages from 50 to 65 with osteoporosis who entered into menopause before the age of 45, and 30 postmenopausal women, ages from 50 to 65 with osteoporosis who had normal menstrual history. Presence of risk factors has been calculated for both groups and statistical significance of differences between two groups presented.Results: In the group with normal menstrual history 33.33% women had low level of physical activities, 56.66% suffered from insuficient intake of calcium, 63.33% of women were active smokers. Body mass index bellow 19 had 6.66% women, insuficient exposure to the sun was registered in 60%, and 23.33% women were either taking medicaments or had diseases that could cause osteoporosis. Statistical significance of differencies in presence of certain risk factors between two groups was registered for : insuficient daily intake of calcium (p <0.001), insuficient exposure to the sun (p<0.001), and smoking (p <0.001).Conclusion: Results of the study indicate high presence of osteoporosis risk factors in women with normal menstrual history and indicate influence of certain factors (calcium, sun exposure, smoking) on occurence ofosteoporosis in this group.

Risk for Osteoporosis and Antiresorptive Therapies in Patients with Crohn's Disease

Background: The risk of osteoporosis is greater in patients with inflammatory bowel disease (IBD) because of several related risk factors such as the prolonged use of corticosteroids, the malabsorption of calcium and vitamin D following small-bowel disease or small-bowel resections, and the inflammatory process resulting from the illness. A reduction in bone mineral density (BMD) has been reported in 30–75% of patients with IBD (Crohn's disease or ulcerative colitis). An evaluation of the risk factors of osteoporosis should be performed to identify those in need of antiresorptive drug therapies (ART) and/or calcium and vitamin D supplements. Objective: To determine whether patients with Crohn's disease at risk for osteoporosis or already having decreased BMD were identified as such and treated with appropriate therapy. Methods: A cross-sectional study was performed among 54 white patients with Crohn's disease who attended a gastroenterology specialized clinic between January and March 2002. All patients with Crohn's disease having an outpatient medical visit were asked to participate in the study. Patients who agreed to the study were questioned for Crohn's disease activity index (CDAI) and osteoporosis risk factors such as nutrition, lifestyle, and corticosteroid therapy. Serum bone-specific markers and nutritional status were assessed. BMD test of the lumbar vertebrae (L2–L4) and the nondominant hip were assessed with dual-energy X-ray absorptiometry if the participants did not have a BMD test in the year prior to the study. ART and calcium/vitamin D use were assessed through a questionnaire and on community pharmaceutical drug services in the 2 year period prior to the evaluation. Results: Mean age and CDAI severity score were 41.5 years and 145, respectively. None of the patients was evaluated for BMD in the year prior to the study. Osteopenia at the nondominant hip and/or lumbar vertebrae was seen in 29 patients. Eighty-two percent of patients with a T score under −2 SD had not been exposed to ART; 84% of patients with more than 4 risk factors for osteoporosis and a T score less than −1.5 SD had not received ART. Moreover, 88% of patients with a T score less than −1.5 SD and receiving corticosteroid therapy had not been treated with ART. Conclusions: The presence of osteoporosis risk factors and osteopenia had not been recognized and treated in our population. Adequate osteoporosis management should be implemented in patients with Crohn's disease to reduce the occurrence of osteoporotic fractures.

Osteoporosis risk and low bone mineral density in women with physical disabilities

Smeltzer SC, Zimmerman V, Capriotti T. Osteoporosis risk and low bone mineral density in women with physical disabilities. ObjectivesTo describe the results of bone mineral density (BMD) screening in women with different physical disabilities and to identify their risk factors for osteoporosis and use of strategies to prevent osteoporosis. DesignA cross-sectional descriptive study. SettingCommunity. ParticipantsConvenience sample of 429 community-residing women with different disabilities. InterventionsNot applicable. Main outcome measuresPeripheral BMD screening of the os calcis, using dual-energy x-ray absorptiometry. A self-administered survey addressed osteoporosis risk factors, use of osteoporosis prevention strategies, and previous recommendations for BMD screening or testing. ResultsBased on World Health Organization criteria, 30.5% and 22.6% of the total sample had BMD values indicative of osteopenia and osteoporosis, respectively. The number of self-reported osteoporosis risk factors ranged from 0 to 10 (mean, 4.5±1.7). Subjects reported using few strategies to reduce their osteoporosis risks. One quarter of the women reported previous BMD screening or testing; about one third reported receiving recommendations for testing or screening by a health care provider. ConclusionsMore than half of the sample had low BMD, and it was present in premenopausal as well as menopausal women. Despite low BMD and the presence of osteoporosis risk factors, less than a third of the women previously had BMD testing or screening or recommendations for such testing. Because low BMD is common in women with disabilities, greater attention must be directed toward their risk for osteoporosis and osteoporotic fractures. Prevention strategies to reduce osteoporosis risk should be considered, although their efficacy is not yet known in populations with disabilities.