Prevention Of Fragility Fractures Research Articles

Low physical performance determined by chair rising test muscle mechanography is associated with prevalent fragility fractures.

Although the interaction between muscle and bone has been demonstrated in various aspects, the clinical focus in the diagnosis of musculoskeletal disorders mainly lies on the skeletal assessments. Accordingly, the association between muscle function, bone mineral density (BMD), and fragility fractures remains to be further elucidated with a feasible muscle assessment in a clinical setting. Patient data (2076 patients, 1538 women, 538 men) were evaluated retrospectively from a large dual energy X-ray absorptiometry (DXA) database as well as from chair rising test (CRT) that was performed on a muscle mechanograph. To determine potential predictors of the CRT time and maximum force, a multivariate regression analysis was performed including age, DXA T-score, and body composition indices. Furthermore, CRT results were compared between non-fracture and fracture cases. We determined independent predictors for CRT time such as age, femoral DXA T-score, and total fat mass, whereas CRT force was only influenced by total lean mass. Both women and men with previous fragility fractures displayed a longer CRT time (women p = 0.009, men p = 0.001) and lower CRT force (women p < 0.001, men p < 0.001) than those with no fractures, while no clear differences in CRT results could be detected between normal BMD, osteopenia, and osteoporosis based on DXA T-scores. Our study demonstrates that in addition to the associations between chair rising time and femoral T-score assessed by DXA, low muscle strength is associated with previous fragility fractures.

The Influence of Protein on the Prevention of Fragility Fractures Among Senior Adults

The Influence of Protein on the Prevention of Fragility Fractures Among Senior Adults Abstract. The aim of this review article is to discuss protein intake in senior adults at risk for fragility fractures as a modifiable factor for fracture prevention. Proteins are building blocks of the bone matrix and the muscles. This dual function fits in with the concept of prevention of fragility fractures in senior adults aimed at reducing both bone loss and falls. In older adults, a protein-rich diet could be another simple and effective way to promote bone and muscle health, in addition to the established recommendations for adequate vitamin D and calcium intake.

Prevention of Secondary Fragility Fracture

Prevention of Secondary Fragility Fracture

Performance of Osteoporosis Self-Assessment Tool (OST) in Predicting Osteoporosis-A Review.

Bone health screening plays a vital role in the early diagnosis and treatment of osteoporosis to prevent fragility fractures among the elderly and high-risk individuals. Dual-energy X-ray absorptiometry (DXA), which detects bone mineral density, is the gold standard in diagnosing osteoporosis but is not suitable for screening. Therefore, many screening tools have been developed to identify individuals at risk for osteoporosis and prioritize them for DXA scanning. The Osteoporosis Self-assessment Tool (OST) is among the first tools established to predict osteoporosis in postmenopausal women. It can identify the population at risk for osteoporosis, but its performance varies according to ethnicity, gender, and age. Thus, these factors should be considered to ensure the optimal use of OST worldwide. Overall, OST is a simple and economical screening tool to predict osteoporosis and it can help to optimize the use of DXA.

Clinical research in fragility fractures

The Fragility Fracture Network is coordinating international initiatives to promote collaborative research, multidisciplinary care, and the secondary prevention of fragility fractures. This review discusses the use of national audit processes and the collection of common outcomes to facilitate research, as well as the key role played by patient and public involvement, and strategies to overcome research barriers.

How to prevent the next fracture

During the last decade, policymakers, learned societies, non-governmental organisations (NGOs) and some national alliances of all three of these groups have advocated, developed and implemented systematic approaches to fragility fracture care and prevention in a growing number of countries. This chapter reviews the impact of Orthogeriatric Services (OGS) and Fracture Liaison Services (FLS) on delivery of best practice in secondary fracture prevention. An overview of national and international strategies intended to promote widespread implementation of these service models is also provided.

Guidelines for the management of osteoporosis and fragility fractures

The purpose of this document, a result of the harmonisation and revision of Guidelines published separately by the SIMFER, SIOMMMS/SIR, and SIOT associations, is to provide practical indications based on specific levels of evidence and various grades of recommendations, drawn from available literature, for the management of osteoporosis and for the diagnosis, prevention, and treatment of fragility fractures. These indications were discussed and formally approved by the delegates of the Italian Scientific Associations involved in the project (SIE, SIGG, SIMFER, SIMG, SIMI, SIOMMMS, SIR, and SIOT).

The American Orthopaedic Association's Own the Bone® database: a national quality improvement project for the treatment of bone health in fragility fracture patients.

The American Orthopedic Association initiated the Own the Bone (OTB) quality improvement program in 2009 to improve secondary prevention of fragility fractures. In this study, we present a summary of the data collected by the OTB program and compare it to data from other large fragility fracture registries with an aim to externally validate the OTB registry. The OTB registry contained 35,038 unique cases of fragility fracture as of September, 2016. We report the demographics, presenting fracture characteristics, past fracture history, and bone mineral density (BMD) data and compare these to data from large fragility fracture studies across the world. Seventy-three percent of the patients in the OTB registry were female, Caucasian, and post-menopausal. In 54.4% of cases, patients had a hip fracture; spine fractures were the second most common fracture type occurring in 11.1% of patients. Thirty-four percent of the patients had a past history of fragility fracture, and the most common sites were the spine and hip. The average femoral neck T-score was - 2.06. When compared to other studies, the OTB database showed similar findings with regard to patient age, gender, race, BMI, BMD profile, prior fracture history, and family history of fragility fractures. OTB is the first and largest multi-center voluntary fragility fracture registry in the USA. The data collected through the OTB program is comparable to that collected in international studies. Thus, the OTB registry functions as an externally valid cohort for further studies assessing the clinical characteristics, interventions, and outcomes achieved in patients who present with a fragility fracture in the USA.

Adult Premenopausal Bone Health Related to Reproductive Characteristics-Population-Based Data from the Canadian Multicentre Osteoporosis Study (CaMos).

Amenorrhea is important for women’s bone health. However, few have reported reproductive, anthropometric (body mass index [BMI], height) and bone health (areal bone mineral density [BMD], prevalent fractures) in a population-based study. The purposes of this cross-sectional study of women in the randomly-selected Canadian Multicentre Osteoporosis Study (CaMos) population were: (1) to describe reproductive, demographic, anthropometric and lifestyle variables; and (2) in menstruating women, to relate reproductive and other variables to BMD at the lumbar spine (L1-4, LS), femoral neck (FN) and total hip (TH) sites and to prevalent fragility fractures. This study describes the reproductive characteristics of 1532 women aged 30–60 years. BMD relationships with reproductive and other variables were described in the 499 menstruating women. Mean menarche age was 12.8 years, 96% of women were parous and 95% had used combined hormonal contraceptives (CHC). Infertility was reported by 9%, androgen excess by 13%, amenorrhea by 8% and nulliparity by 4%. LS BMD was negatively associated with amenorrhea and androgen excess and positively related to current BMI and height. A later age at menarche negatively related to FN BMD. BMI and height were strongly related to BMD at all sites. Prevalent fragility fractures were significantly associated with quartiles of both LS and TH BMD.

STAT-3 regulation of CXCR4 is necessary for the prenylflavonoid Icaritin to enhance mesenchymal stem cell proliferation, migration and osteogenic differentiation

Mesenchymal stem cell (MSC) dysfunction has been implicated in the pathogenesis of osteoporosis. MSCs derived from osteoporotic subjects demonstrate significant impairment in proliferation, adhesion and chemotaxis, and osteogenic differentiation, leading to reduced functional bone-forming osteoblasts and ultimately nett bone loss and osteoporosis. Epimedium herbs and its active compound Icaritin (ICT) have been used in Chinese ethnopharmacology for the treatment of metabolic bone diseases. Using an in-vitro cell culture model, we investigated the benefits of ICT treatment in enhancing MSC proliferation, migration and osteogenic differentiation, and provide novel data to describe its mechanism of action. ICT enhances MSC proliferation, chemotaxis to stromal cell-derived factor-1 (SDF-1) and osteogenic differentiation through the activation of signal transduction activator transcription factor 3 (STAT-3), with a consequential up-regulation in the expression and activity of cysteine (C)-X-C motif chemokine receptor 4 (CXCR4). These findings provide a strong basis for future clinical studies to confirm the therapeutic potential of ICT for the prevention and treatment of osteoporosis and fragility fractures.

Commonality in the microarchitecture of trabecular bone: A preliminary study.

Understanding the relationship between the microstructure and mechanical function of trabecular bone is critical for prediction and prevention of bone fragility fractures. However, a detailed understanding of the structural design of trabecular microarchitecture is still missing. This study hypothesized that there exists a commonality in the underlying probabilistic distributions of microstructural features of trabecular bones, whereas the microstructural differences among individuals are primarily describe by a set of scalar parameters. To test the hypothesis, twenty-three trabecular bone specimens were obtained from two anatomic locations (i.e., femoral neck and vertebral body) and a diverse group of seventeen donors of different age and sex. The number, size, spatial location, and orientation of individual plates and rods in the trabecular bone specimens were determined via volumetric decomposition of 3D μCT images using the Individual Trabecula Segmentation (ITS) technique. Then, m/n bootstrap Kolmogorov-Smirnov tests were performed to compare the normalized distributions of size, orientation, and spatial arrangement of trabecular plates and rods in the specimens. The results showed that 100% of the twenty-three normalized distributions of each microstructural feature were statistically equivalent irrespective of individual differences among the bone specimens, except the distributions of rod spatial arrangement (<100%). On the other hand, nonparametric Mann-Whitney U tests showed that a set of scalar parameters (i.e., the number, average size, and average nearest neighbor distance of trabecular plates and rods) were statistically different among the individual specimens (p<0.05). Due to the commonality of the underlying distributions, the individual differences in the trabecular microstructure among the specimens seemed to be reflected primarily by changes in the scalar parameters. The above results strongly support the hypothesis of this study and may shed more light on understanding the natural design of trabecular bone microstructures.

The burden and undertreatment of fragility fractures among senior women.

The purpose of the study is to estimate prevalence of fragility fractures (FF), risk factors, and treatment rates in senior women and to assess impact of FF on physical function and quality of life. Women aged 65years and older from the EpiReumaPt study (2011-2013) were evaluated. Rheumatologists collected data regarding FF, clinical risk factors for fractures, and osteoporosis (OP) treatment. Health-related quality of life (EQ5D) and physical function (HAQ) were analyzed. Peripheral dual-energy X-ray absorptiometry was performed. FF was defined as any self-reported low-impact fracture that occurred after 40years of age. Prevalence estimates of FF were calculated. Among 3877 subjects evaluated in EpiReumaPt, 884 were senior women. The estimated prevalence of FF was 20.7%. Lower leg was the most frequent fracture site reported (37.8%) followed by wrist (18.6%). Only 7.1% of the senior women reporting a prevalent FF were under treatment for OP, and 13.9% never had treatment. OP treatment was not prescribed in 47.7% of FF women, and 23.4% refused treatment. Age (OR = 2.46, 95% CI 1.11-5.47), obesity (OR = 2.05, 95% CI 1.14-3.70), and low wrist BMD (OR = 2.29; 95% CI 1.20, 4.35; p = 0.012) were positively associated with prevalent FF. A significantly higher proportion of women in the lowest quintile of wrist bone mineral density reported FF (OR = 2.29, 95% CI 1.20-4.35). FF were associated with greater physical disability (β = 0.33, 95% CI 0.13-0.51) independent of other comorbidities. FF was frequently reported among senior women as an important cause of physical disability. However, the prevalence of OP treatment was low, which constitutes a public health problem in this vulnerable group.

Prevalence of fragility fractures according to quality and outcomes framework (qof) of the general medical services (gms) contract and quality initiatives to improve osteoporosis care in the general practice within caerphilly county borough, wales, UK: a feasibility study

Prevalence of fragility fractures according to quality and outcomes framework (qof) of the general medical services (gms) contract and quality initiatives to improve osteoporosis care in the general practice within caerphilly county borough, wales, UK: a feasibility study

Corrigendum: A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures.

Abstract During the course of providing additional analyses for the National Institute for Health and Care Excellence Technology Appraisal Committee, two errors were identified in the data entered in the network meta-analysis that informed the cost-effectiveness analysis described in the original report. This corrigendum notice describes the errors identified and the impact of correcting these errors on the main analyses presented in the original report.

Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis

Screening using the Fracture Risk Assessment Tool (FRAX) is recommended in all postmenopausal woman and mеn over 50 (A1) in order to identify individuals with high probability of fractures. It is recommended to diagnose osteoporosis and start treatment in patients with fragility fracture of large bones of the skeleton and/or high individual probability of major fragility fractures (FRAX) and/or detected decrease in bone mineral density (BMD) up to –2.5 T-score as assessed by DXA in the femoral neck and/or lumbar vertebrae (A1). Patients with back pain, lifetime height loss of 4 cm or height loss of 2 cm since a previous medical examination, those who receive glucocorticoids, patients with long lasting decompensated type 2 diabetes mellitus, or those receiving insulin therapy, as well as patients who were previously diagnosed with fragility fractures at the other sites are advised to underwent standard lateral X-ray imaging of the spine (Th4—L5) in order to verify the presence of compression vertebral fractures (B1).&#x0D; Dual-energy X-ray absorptiometry (DXA) is recommended for individuals whose 10-year probability of major osteoporotic fracture (FRAX) falls within the medium risk group (B1). It is recommended to include the trabecular bone score (TBS) the FRAX algorithm in order to improve the sensitivity of this method (B1).&#x0D; Laboratory testing is recommended for the differential diagnosis with other causes of increased skeletal fragility in all patients with newly diagnosed osteoporosis and when previously prescribed antiosteoporostic treatment was ineffective (B1).&#x0D; Bisphosphonates (BPs), antibodies to receptor activator of nuclear factor kappa-beta ligand (RANKL) (denosumab), or parathyroid hormone analogue (teriparatide) are equally recommended to prevent fragility fractures and increase BMD in patients with osteoporosis (A1). Denosumab is also recommended to prevent BMD loss and fractures in females receiving aromatase inhibitors therapy for breast cancer and males with prostate cancer receiving hormone-deprivation therapy and having no bone metastases (A1). Since teriparatide has the anabolic effect, it is recommended as the first line treatment in patients with severe osteoporosis having history of vertebral fractures, in the individuals with very high risk of fragility fractures, or in the cases when antiresorptive treatment was ineffective (B1). All medications for treatment of osteoporosis are recommended in combination with calcium and vitamin D supplements (A1).

Bone and calcium metabolism associated with malignancy. Bone management of prostate cancer in the novel anti-androgen era.

Androgen deprivation therapy(ADT)is a standard systemic therapy for prostate cancer. ADT induces bone loss(ADTIBL)and muscle loss(sarcopenia)leading to falls and farctures. There are 2 aims in bone management of prostate cancer:one is to prevent fragility fractures in patients without bone metastasis and the other is to prevent symptomatic skeletal events(SSE)which are pathologic fractures, spinal compression, radiation to bones and surgery to bones. Bone fractures and SSE are both correlated with worse overall survival(OS). Concomitant use of novel anti-androgens further increases the risk of falls and fractures. The earlier and appropiriate intervention with vitamin D and bone modifying agents(BMA)is necessary to prevent treatment related bone fractures and SSE. Bone management algorithm aids to decide the timing and doses of BMA. As for sarcopenia physical exercise and life style advices are important. Because abiraterone with glucocorticoid therapy induces stronger bone resorption, it is recommended to start denosumab simultaneously. Ra-223, bone seeking radiopharmaceuticals should not be used with abiraterone and predonisone because of high incidence of fracture and death.

Fatigue as the missing link between bone fragility and fracture.

The prevention of fragility fractures in bone-pathologic fractures resulting from daily activity and mostly occurring in the elderly population-has been a long-term clinical quest. Recent research indicating that falls in the elderly might be the consequence of fracture rather than its cause has raised fundamental questions about the origin of fragility fractures. Is day-to-day cyclic loading, instead of a single-load event such as a fall, the main cause of progressively growing fractures? Are fragility fractures predominantly affected by bone quality rather than bone mass, which is the clinical indicator of fracture risk? Do osteocytes actively participate in the bone repair process? In this Perspective, we discuss the central role of cyclic fatigue in bone fragility fracture.

The role of carboxy-terminal cross-linking telopeptide of type I collagen, dual x-ray absorptiometry bone strain and Romberg test in a new osteoporotic fracture risk evaluation: A proposal from an observational study.

The consolidated way of diagnosing and treating osteoporosis in order to prevent fragility fractures has recently been questioned by some papers, which complained of overdiagnosis and consequent overtreatment of this pathology with underestimating other causes of the fragility fractures, like falls. A new clinical approach is proposed for identifying the subgroup of patients prone to fragility fractures.This retrospective observational study was conducted from January to June 2015 at the Nuclear Medicine-Bone Metabolic Unit of the of the Fondazione IRCCS Ca' Granda, Milan, Italy. An Italian population of 125 consecutive postmenopausal women was investigated for bone quantity and bone quality. Patients with neurological diseases regarding balance and vestibular dysfunction, sarcopenia, past or current history of diseases and use of drugs known to affect bone metabolism were excluded. Dual X-ray absorptiometry was used to assess bone quantity (bone mineral density) and bone quality (trabecular bone score and bone strain). Biochemical markers of bone turnover (type I collagen carboxy-terminal telopeptide, alkaline phosphatase, vitamin D) have been measured. Morphometric fractures have been searched by spine radiography. Balance was evaluated by the Romberg test. The data were evaluated with the neural network analysis using the Auto Contractive Map algorithm. The resulting semantic map shows the Minimal Spanning Tree and the Maximally Regular Graph of the interrelations between bone status parameters, balance conditions and fractures of the studied population. A low fracture risk seems to be related to a low carboxy-terminal cross-linking telopeptide of type I collagen level, whereas a positive Romberg test, together with compromised bone trabecular microarchitecture DXA parameters, appears to be strictly connected with fragility fractures. A simple assessment of the risk of fragility fracture is proposed in order to identify those frail patients at risk for osteoporotic fractures, who may have the best benefit from a pharmacological and physiotherapeutic approach.

Case finding for the primary prevention of fragility fractures with FRAX (without BMD) in those over 70 years: Reducing the reliance on BMD as the primary tool

Objective(s): To develop and evaluate age-stratified fracture risk score thresholds without dual X-ray absorptiometry (DXA) to manage osteoporosis. Methods: A multi-centered cohort study of persons over 70 years recruited from metropolitan General Practices. Participants had osteoporosis risk assessment, DXA, health questionnaire, and FRAX Hip (HF) and Major Osteoporotic fracture (MOF) risk scores without DXA T-scores. Age-stratified fracture risk score thresholds (low, moderate and high risk of osteoporosis) were compared with measured BMD based guidelines for osteoporosis management. Results: 130/531 (24.5%) participants had osteoporosis. Our thresholds achieved a correct clinical decision compared to BMD in 83-84% of cases; avoided 249 (56%) of unnecessary DXAs; and, missed osteoporosis in 5-6% of cases. The FRAX HF and MOF were +30% and +7% more accurate than recommended guidelines in detecting osteoporosis. Conclusions: For those over 70 years of age, our proposed fracture risk score thresholds can reasonably guide osteoporosis management and reduce unnecessary DXA.

Therapeutic Approaches to Secondary Fracture Prevention in High Risk Populations: Current Recommendations and Advances

Background: Osteoporotic fragility fracture is a burgeoning health epidemic that is associated with high rates of disability, morbidity, and mortality. Based on NHANES data, approximately 10 million Americans are affected by this disease. Areas of Uncertainty: Successful secondary fracture prevention measures are often limited by the under-diagnosis of osteoporosis after fragility fractures because of lack of patient and physician awareness of the disease, lack of follow-up, and medical nonadherence. Therapeutic Advances: Current guidelines recommend the use of Bisphosphonate as the first-line therapy for secondary fracture prevention. Compared with placebo, randomized controlled trials have demonstrated a significant reduction in vertebral and nonvertebral fractures using Alendronate, Risedronate, Ibandronate, and Zoledronic acid. All but Ibandronate showed a significant reduction in hip fractures as well (all trials with P &lt; 0.05). Denosumab is an option in patients with impaired renal function or who are unresponsive to other therapies. It significantly decreases the risk of new vertebral fracture [hazard ratio (HR) = 0.32, 95% confidence interval (CI), 0.26–0.41], hip fracture (HR = 0.60, 95% CI, 0.37–0.97) and nonvertebral fracture (HR = 0.80; 95% CI, 0.67–0.95) without an increased in adverse events. Hormonal therapy has been shown to be effective but should be used in the lowest effective dose to minimize the risk of coronary heart disease, stroke, and venous thromboembolism. Selective estrogen replacement modulators, calcitonin, and parathyroid hormone analog are other alternatives described in this article. In addition to current therapies, emerging therapies under investigation such as Abaloparatide, a parathyroid receptor ligand, and Romosozumab, a monoclonal anti-sclerotin antibody both showed a reduction in new morphometric vertebral fractures compared with placebo (0.58% vs. 4.22%, relative risk = 0.14, 95% CI, 0.05–0.39 and 0.5 vs. 1.8%, relative risk = 0.27, 95% CI, 0.16–0.47, respectively). In this article, we summarize advances in current therapeutic agents used for secondary fracture prevention and provide insight into potential therapies that hold promise in the future of osteoporosis. Conclusion: Secondary prevention of fragility fractures through care coordination and initiation of various pharmacologic agents is crucial in the elderly population. Careful risk assessment and stratification should be performed before the initiation of pharmacologic treatment to optimize disease management.