Prevention Of Osteoporosis In Patients Research Articles

P001 An audit to assess whether patients who had a delayed or missed denosumab dose during the covid-19 pandemic came to any harm or suffered a subsequent fracture

Abstract Background/Aims Denosumab is licensed by NICE for the secondary prevention of osteoporosis in patients who are unable to comply, have an intolerance, or contraindication to bisphosphonates. With the outbreak of Covid-19, denosumab appointments were delayed. A delay of denosumab doses by more than 16 weeks is associated with an increased risk of vertebral fractures. This audit was carried out to see if the Pandemic caused a delayed (>1 month) or missed (>6 months) dose in patients receiving their denosumab injection and whether this delay/missed dose resulted in patients coming to any harm such as a subsequent fracture. Methods We included 166 patients of which 95% were female. We stratified data utilising the Oberoi consulting clinical audit services which provided a database of patients who were on six monthly repeat prescriptions for Denosumab. Retrospective data was collected including indications for denosumab, start date, duration, missed or delayed doses, reasons for delayed doses and whether a fracture of a pathological nature was sustained. We later reviewed if the missed or delayed doses occurred during the covid pandemic (2020-22) and subsequently, if the fracture occurred as a result of the pandemic. Results 34/166(21%) patients did not receive their Denosumab dose on time during Covid-19. 21/166(12.6%) patients had a delayed dose (6 pre-Covid and 15 post-Covid) and 13/166 (7.8%) patients missed a dose entirely (3 pre-Covid and 10 post-Covid) showing more delays/missed doses occurred during the pandemic. Reasons as to why patients did not receive timely doses include, clinical reasons (7/34 20.6%), patient safety decisions made by clinicians in patients’ best interest 12/34(35.3%) and patient choice related factors 15/34 (44.1%). Reasons for delays include not wanting repeat bloods, being on holiday, chest infection low Vitamin D levels, pre dose bloods delayed, patient had covid, and isolating. Whilst on Denosumab, 8/166(4.8%) patients sustained a fracture of which 6/8(75%) also experienced a delayed/missed dose during Covid-19. Conclusion Of the 34/166 patients that had a delayed/missed dose, eight suffered a fracture bringing the fracture risk to 23.5% which is an increase from baseline (6.6%) confirming that a missed Denosumab dose does increase fracture risk. We can conclude a greater proportion of patients endured a missed or delayed dose as a consequence of the Covid-19 pandemic. 8/166(4.8%) patients sustained a fracture of which six had a missed/delayed dose as a result of the pandemic. The conclusions drawn are in keeping with the MHRA4 alert, a missed dose of Denosumab does increase the risk of pathological treatment discontinuation fractures. This highlights to clinicians the significance of timely doses and uninterrupted treatment. Disclosure S. Rehman: None. S. Sultan: None.

Comparison of the prevalence of osteoporosis in people with spinal cord injury according to bone mineral density reference values for the diagnosis of osteoporosis: a retrospective, cross-sectional study

BackgroundSpinal cord injury (SCI) is a complex cause of rapid low bone mass that easily predisposes the affected individuals to osteoporosis-induced fractures. Several studies have investigated osteoporosis pathophysiology in SCI; however, those associated with its diagnosis in SCI are limited. Additionally, errors in osteoporosis diagnosis and its prevalence vary based on the bone mineral density (BMD) reference values (BMDRV), and no studies have reported BMDRV application for osteoporosis diagnosis in individuals with SCI. Therefore, this study aimed to compare the prevalence of osteoporosis among Korean adults aged ≥ 50 years with SCI according to BMDRV for diagnosing osteoporosis.MethodsOverall, 855 patients with SCI who underwent BMD tests of the lumbar spine, femoral neck, and total hip at the National Rehabilitation Center (NRC) in Korea between 2010 and 2020 were included in this retrospective cross-sectional study. Osteoporosis was diagnosed in patients with SCI by comparing the differences in prevalence, diagnostic consistency, and risk factors according to the region-based BMDRV of the dual-energy x-ray absorptiometry (DXA) manufacturer and international BMDRV based on the Third National Health and Nutrition Examination Survey (NHANES III) data of females aged 20–29 years.ResultsThe prevalence of osteoporosis according to the T-score provided by a single reference population of the NHANES III (TNHA) (PONHA) (males: 26.69%; females: 69.35%) was significantly higher in females and males than that according to the T-scores provided by the DXA manufacturer (TDXA) (PODXA) (males: 15.32%; females: 43.15%). The lumbar spine and femoral neck were major osteoporosis diagnosis sites for the PODXA and PONHA, respectively. Risk factors for osteoporosis differed based on the probability of osteoporosis (also known as the OZ ratio) according to the BMD criteria; however, the risk factors were similar according to old age, female sex, low body mass index (BMI), and long SCI period. No significant relationship was noted between the different SCI-related clinical factors (p > 0.05).ConclusionsThe osteoporosis diagnostic site and prevalence in SCI differed according to the regional-based TDXA and international standards of the TNHA. Therefore, further studies on BMDRV are warranted to establish accurate diagnostic criteria for osteoporosis prevention in patients with SCI.

Problems of osteoporosis in patients with ankylosing spondylitis (literature review)

The article presents literature data on the incidence and risk factors of osteoporosis in ankylosing spondylitis (Bekhterev's disease), the features of the course of the underlying disease in their combination. Separately, the issues of the relationship of inflammation, calcium metabolism, kidney stone formation and osteoporosis are considered. The directions of further research for predicting the development and prevention of osteoporosis in patients with ankylosing spondylitis are determined. This review expands doctors' understanding of comorbidity in inflammatory diseases of the joints and spine, in particular, in ankylosing spondylitis.

Prevention of Osteoporosis in Patients With Breast Cancer Treated With Aromatase Inhibitor Combined With Calcium/Vitamin D Supplements

Purpose: Tamoxifen and aromatase inhibitor (AI) are used for hormone therapy for hormone-positive breast cancer, and AI is well known to decrease bone mineral density (BMD). The authors compared the serial BMD of patients with hormone-positive breast cancer to evaluate the preventive effect of AI combined with calcium and vitamin D (Ca/Vit D) supplements.Methods: A total of 249 women with hormone-positive breast cancer who underwent serial BMD assessments between 2011 and 2015 were included. The patients were classified as the tamoxifen alone group (n=23), AI with Ca/Vit D group (n=139), and extended regimen from tamoxifen to AI with Ca/Vit D group (n=87). Moreover, osteoporosis was diagnosed based on the World Health Organization guideline.Results: The incidence of osteoporosis was highest in the AI with Ca/Vit D group (n=50, 36.0%) and lowest in the tamoxifen only group (n=4, 17.4%). Furthermore, it showed statistical difference between the three groups (p=0.003). However, considering the baseline of initial BMD in each patient, the mean change value did not show any statistical difference between the three groups (p=0.498). Moreover, the lumbar T-scores were lower than that of the total hip T-scores in each patient.Conclusion: Although it has been reported that osteoporosis is common in patients treated with AI, the decreased BMD was not significantly severe compared to that in the tamoxifen alone group if Ca/Vit D was administrated with AI. Therefore, Ca/Vit D has some preventive effect for osteoporosis in patients treated with AI.

Vitamin D Supplementation in Sarcoidosis: A Double-Edged Sword

AbstractSarcoidosis is complicated by disordered vitamin D and calcium metabolism, which has important implications on disease activity and bone health. Although the majority of the patients with sarcoidosis are typically deficient in 25-hydroxyvitamin D, repletion of vitamin D is controversial in light of the hypercalcemia risk. Presently, there are no clear guidelines regarding vitamin D supplementation as a part of osteoporosis prevention in patients with vitamin D deficiency and sarcoidosis. We report a patient with sarcoidosis who presented with severe hypercalcemia following vitamin D supplementation and review the debated role of vitamin D supplementation in vitamin D-deficient sarcoid patients.

To Evaluate the Awareness and Prevention of Osteoporosis in Patients Attending Orthopaedics Outdoor Clinics in a Tertiary Level Hospital

To Evaluate the Awareness and Prevention of Osteoporosis in Patients Attending Orthopaedics Outdoor Clinics in a Tertiary Level Hospital

Nutrients in the Prevention of Osteoporosis in Patients with Inflammatory Bowel Diseases.

The chronic character of inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, results in various complications. One of them is osteoporosis, manifested by low bone mineral density, which leads to an increased risk of fractures. The aetiology of low bone mineral density is multifactorial and includes both diet and nutritional status. Calcium and vitamin D are the most often discussed nutrients with regard to bone mineral density. Moreover, vitamins A, K, C, B12; folic acid; calcium; phosphorus; magnesium; sodium; zinc; copper; and selenium are also involved in the formation of bone mass. Patients suffering from inflammatory bowel diseases frequently consume inadequate amounts of the aforementioned minerals and vitamins or their absorption is disturbed, resulting innutritional deficiency and an increased risk of osteoporosis. Thus, nutritional guidelines for inflammatory bowel disease patients should comprise information concerning the prevention of osteoporosis.

Role of calcium and vitamin d in prevention of postmenopausal osteoporosis in patients with endometriosis

The study to assess the effectiveness of the use of the drug Calcium-D3 Nycomed for the prevention and correction of disorders of calcium-phosphorus metabolism, bone metabolism in 67 patients with endometriosis on the background of climacteric syndrome and calcium deficiency was performed. 35 patients (main group) against the symptomatic treatment of climacteric syndrome were prescribed Calcium-D3 Nycomed. 32 patients, who did not receive calcium supplements, entered the control group. The period of observation in the course of treatment was 3 months.The most important result of the treatment was slowing or stopping bone loss resulting from the use of Calcium-Dз Nycomed. It is possible to recommend the use of this drug in patients with endometriosis and symptoms of hypocalcemia on the background of climacteric syndrome for the prevention and treatment of osteopenic syndrome

AB0620 Effects of zoledronic acid for glucocorticoid-induced osteoporosis in patients with inflammatory joints disease

BackgroundAs known, glucocorticoid-induced osteoporosis is the most common form of osteoporosis. The most pressing issue remains the prevention of osteoporosis in patients with prolonged therapy by glucocorticosteroid. The role of...

Early rehabilitation exercises in the prevention of osteoporosis in patients after spinal cord injury

Objective To investigate the function of early rehabilitation exercise in the prevention of osteoporosis in patients after spinal cord injury. Methods 26 paraplegia patients caused by traumatic spinal cord injury were randomly divided into test group and control group (13 cases for each group). Cases in test group received early rehabilitation exercises and cases in control group were treated with routine nursing about traumatic spinal cord injury. Patient's serum concentrations of ionized calcium, ALP,and urine concentrations of calcium, creatinine were performed at before and after exercise (into the group and 4 months later) and bone mineral density in lumbar vertebrae and proximal femur were measured with regularly X-ray plain radiograph at the same vertebral body. Results Compared with the period before exercise, the lumbar spine and proximal femur trabecular bone mineral density measured showed decreases in both groups but had not significant difference (P ＞ 0. 05) after exercise (4 months). Differences between the two groups had not significant difference either (P ＞ 0. 05). Compared with the period before exercise, serum alkaline phosphatase had not significant difference (P ＞ 0. 05) after exercise, while serum calcium, urinary Ca/Cr and urinary hydroxyproline had significant difference (P ＜ 0. 05); In control group, serum alkaline phosphatase, serum calcium, urinary Ca/Cr and urinary hydroxyproline had not significant difference (P ＞0. 05). Serum calcium, urinary Ca/Cr and urinary hydroxyproline had significant difference (P ＜ 0. 05) after exercise (4 months) between the two groups except serum alkaline phosphatase (P ＞ 0. 05). Conclusions The results demonstrate that early positive rehabilitation exercise can prevent ostcoporosis after spinal cord injury. Key words: Spinal cord injury; Osteoporosis; Rehabilitation

Physical activity for prevention of osteoporosis in patients with severe haemophilia on long‐term prophylaxis

Physical activity has been considered as an important factor for bone density and as a factor facilitating prevention of osteoporosis. Bone density has been reported to be reduced in haemophilia. To examine the relation between different aspects of physical activity and bone mineral density (BMD) in patients with severe haemophilia on long-term prophylaxis. The study group consisted of 38 patients with severe haemophilia (mean age 30.5 years). All patients received long-term prophylaxis to prevent bleeding. The bone density (BMD g cm(-2)) of the total body, lumbar spine, total hip, femoral neck and trochanter was measured by dual energy X-ray absorptiometry. Physical activity was assessed using the self-report Modifiable Activity Questionnaire, an instrument which collects information about leisure and occupational activities for the prior 12 months. There was only significant correlation between duration and intensity of vigorous physical activity and bone density at lumber spine L1-L4; for duration (r = 0.429 and P = 0.020) and for intensity (r = 0.430 and P = 0.019); whereas no significant correlation between all aspects of physical activity and bone density at any other measured sites. With adequate long-term prophylaxis, adult patients with haemophilia are maintaining bone mass, whereas the level of physical activity in terms of intensity and duration play a minor role. These results may support the proposition that the responsiveness to mechanical strain is probably more important for bone mass development in children and during adolescence than in adults and underscores the importance of early onset prophylaxis.

Practice patterns in osteoporosis prevention in patients on glucocorticoids

Dear Editor, We have read the recent results from the study on osteoporosis prevention in chronic (>90 days) glucocorticoid users by Feldstein et al. [1] and have three comments. 1. We believe that any apparent under-treatment may be partly due to the fact that the data analysed were collected from January 2000–December 2001. The American College of Rheumatology (ACR) guidelines for prevention of glucocorticoid-induced osteoporosis were published in July 2001 and recommended that osteoporosis prevention should be considered in those patients treated on ≥5 mg of prednisolone per day [3]. The guidelines available before this suggested that patients should be considered for osteoporosis prevention if the dose was greater than 7.5 mg per day, and the patients were treated for >6 months with the glucocorticoid [4]. We believe to be fair to the prescribers and other primary-care clinicians it should be noted that at the time that these data were collected most would only be aware that patients treated with ≥7.5 mg prednisolone should be considered for osteoporosis prevention. 2. There was no information on calcium or vitamin D (activated or non-activated) use. Were these medications/ supplements excluded/not considered or unavailable? We believe these are important to mention because they were listed in the 1996 and 2001 ACR guidelines. In addition, clinical trials with bisphosphonates have included calcium/ vitamin D in their protocol. 3. The authors note that their population had a high mean prednisone dose of 20mg/day. We believe that this unusually high dose of corticosteroid is due partly to their methods in calculating the “average” dose. The mean dose was obtained by using supplied quantities and not the actual dose. The authors included all medications dispensed including those during hospitalisation, which probably accounts for the high mean dose. For example, asthmatic/COPD patients (or other patients with sliding scales) with frequent admissions to hospital are likely to receive short courses of high-dose corticosteroid therapy in hospital, which will undoubtedly increase the mean dose. It would be interesting to know if these doses were excluded, and what the median (and range) dose of corticosteroid therapy was, i.e. what is the usual maintenance dose of corticosteroid? This may be an important consideration for prescribers when considering osteoporosis prevention because the correlation between daily dose and fracture is stronger than for cumulative dose [2]. Having said that, we don’t expect the overall results from this study (i.e., underuse of osteoporosis prevention) would change significantly. M. Naunton (*) Department of Pharmacotherapy and Pharmaceutical Care, State University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands e-mail: M.Naunton@rug.nl Tel.: +31-503-637576 Fax: +31-503-632772

Practice patterns in osteoporosis prevention in patients at risk for glucocorticoid-induced osteoporosis - a reply

Practice patterns in osteoporosis prevention in patients at risk for glucocorticoid-induced osteoporosis - a reply

Raloxifene: A Selective Estrogen Receptor Modulator for the Prevention of Osteoporosis

Objective:To review the efficacy and safety of the selective estrogen receptor modulator raloxifene hydrochloride in the prevention of osteoporosis.Data Sources:A MEDLINE search (January 1966–May 1998) and unpublished data obtained from the manufacturer were used to identify relevant studies and review articles. Additionally, bibliographies of selected articles were reviewed. Only English-language articles on human studies were obtained.Study Selection:Literature was reviewed to evaluate the pharmacology, pharmacokinetics, therapeutic use, adverse effects, and drug interactions of raloxifene. Additional relevant citations were used in the introduction material and clinical controversy section.Data Extraction:Clinical trials reviewing raloxifene for the prevention of osteoporosis were evaluated.Data Synthesis:Raloxifene hydrochloride is a partial estrogen agonist that displays both estrogenic and antiestrogenic effects. As a result of binding to estrogen receptors, raloxifene therapy, like estrogen treatment, causes positive changes in biochemical markers of bone turnover such as serum osteocalcin, serum alkaline phosphatase, urinary pyridinoline cross-links, and urinary calcium excretion. In addition, raloxifene increases bone mineral density. Furthermore, raloxifene reduces total serum cholesterol and serum low-density lipoprotein cholesterol. Raloxifene has no effect on serum high-density lipoprotein cholesterol. As a selective estrogen receptor modulator, raloxifene does not display the deleterious effects of estrogen in endometrial or breast tissue. The most common adverse effects are hot flashes and leg cramping.Conclusions:Clinical trials have found that raloxifene is effective in the prevention of osteoporosis, making the drug an alternative choice for the prevention of osteoporosis in patients who are concerned about the proliferative effects of estrogen replacement therapy on the endometrium or breast tissue. Raloxifene may not be a good alternative in women experiencing troublesome hot flushes during menopause. The use of raloxifene in the treatment of osteoporosis and in the prevention of breast cancer is currently being evaluated.