Previous Osteoporotic Fracture Research Articles

Total knee arthroplasty and periprosthetic distal femoral fracture: looking beyond the osteoporosis to previous osteoporotic fracture.

Osteoporosis is a risk factor for fractures, including those of the hip, vertebrae, and distal radius; however, the association between osteoporosis and periprosthetic fractures after total knee arthroplasty (TKA) has not been much investigated. Therefore, we aimed to investigate the association of the presence of systemic osteoporosis with periprosthetic fractures after TKA. This study included 34 patients with periprosthetic fractures following primary TKA and 106 controls matched for age and sex. Bone mineral density was evaluated at the femoral neck, total hip, and lumbar spine using dual X-ray absorptiometry. Medical records were reviewed for age; sex; body mass index; smoking; rheumatoid arthritis, endocrine diseases, and cardiovascular diseases; history of glucocorticoid use; medication for osteoporosis; and history of previous osteoporotic fracture. In addition, anterior femoral notching after TKA was evaluated. Univariable and multivariable logistic regression analysis were used to determine factors associated with periprosthetic fracture. The prevalence of osteoporosis in the fracture group was higher than that in the control group (61.8% vs. 40.6%, p=0.045). The rate of medication for osteoporosis was significantly low in the fracture group (47.6 % vs 76.7%, p=0.026). History of previous osteoporotic fracture (odds ratio [OR], 9.1; p=0.015) and osteoporosis (OR, 3.6; p=0.013) were significant risk factors for periprosthetic fractures after TKA. Medication for osteoporosis could decrease the risk of periprosthetic fracture (OR 0.3; p=0.020). Osteoporosis is a major risk factor for periprosthetic distal femoral fractures after TKA. Therefore, careful assessment and proper treatment of osteoporosis need and the importance of taking osteoporotic medication needs to be recognized to the patients following primary TKA, especially in patients with a history of osteoporotic fracture. Prognostic study, level III.

New point-of-care calcaneal ultrasound densitometer (Osteosys BeeTLE) compared to standard dual-energy X-ray absorptiometry (DXA)

Dual-energy X-ray absorptiometry (DXA) represents the gold standard for measuring bone mineral density (BMD). However, its size and bulkiness limit its use in mass screening. Portable and easily accessible instruments are more suitable for this purpose. We conducted a study to assess the repeatability, sensitivity, accuracy, and validation of a new ultrasound densitometer for the calcaneus (OsteoSys BeeTLe) compared to standard DXA. BMD (g/cm2) was measured at the femoral and lumbar spine levels using DXA (Discovery Acclaim (Hologic, Waltham, MA, USA) or Lunar Prodigy (GE Healthcare, Madison, WI, USA) devices). Bone Quality Index (BQI, a dimensionless measure of bone quality derived from measures of SOS [Speed Of Sound] and BUA [broadband ultrasound attenuation]) was measured with OsteoSys BeeTLe. The Bland–Altman test and simple linear regression were used to evaluate the association between values measured with the two instruments. Additionally, the ability of the T-score calculated with BeeTLe to identify patients with previous osteoporotic fractures was tested using ROC curves. A total of 201 patients (94.5% females) with a mean age of 62.1 ± 10.2 were included in the study. The BeeTLe instrument showed a coefficient of variation (CV, in 75 repeated measurements) of 1.21%, which was not statistically different from the CV of DXA (1.20%). We found a significant association between BQI and BMD at the femoral neck (r2 = 0.500, p < 0.0001), total femur (r2 = 0.545, p < 0.0001), and lumbar spine (r2 = 0.455, p < 0.0001). T-scores bias were 0.215 (SD 0.876), 0.021 (SD 0.889) and 0.523 (SD 0.092), for femoral neck, total hip and lumbar spine respectively. AUC for discriminating fracture and non-fractured patients were not significantly different with OsteoSys BeeTLe and standard DXA. In this preliminary study, BeeTLe, a new point-of-care ultrasound densitometer, demonstrated good repeatability and performance similar to DXA. Therefore, its use can be proposed in screening for osteoporosis.

Osteoporosis is associated with anti-topoisomerase I positivity and glucocorticoids use in patients with systemic sclerosis.

Patients with systemic sclerosis (SSc) are at increased risk for osteoporosis (OP) and associated fragility fractures. This study aimed to identify underlying risk factors for these conditions in patients with SSc. This cross-sectional study was based on a large prospective cohort of patients with SSc using retrospectively collected bone health data. OP was defined as the presence of a T-score below -2.5 at the femoral neck or lumbar spine, a previous major osteoporotic fracture, or the prescription of anti-osteoporotic therapy. A total of 485 patients fulfilling the ACR/EULAR 2013 diagnostic criteria for SSc, followed in the Lille University Hospital, were included in the study. The prevalence of OP was 23%; fragility fractures occurred in 18% of patients. OP was associated with higher age, diffuse cutaneous subset, interstitial lung disease (ILD), anti-topoisomerase I positivity, treatment with glucocorticoids (GC) and DMARDs in univariable analysis. Multivariable analysis indicated that higher age (OR 1.06 [95%CI 1.04-1.08]), anti-topoisomerase I antibody positivity (OR 2.22 [1.18-4.16]) and treatment with GC (OR 4.48 [2.42-8.26]) were significantly and independently associated with OP. Our study shows that OP risk in patients with SSc is determined by age, disease-related factors such as diffuse cutaneous subset, ILD and anti-topoisomerase I antibody positivity, but also treatment with GC independently of other factors.

Association between osteoporotic fractures and statin use – A review of literature and results of a preliminary case control study done at National Hospital of Sri Lanka

A case control study was conducted among elderly patients presenting to NHSL accident service. A hundred patients aged more than 60 years who presented with newly diagnosed neck of femur, distal radial and vertebral body wedge fractures following minor trauma were recruited from April 2021 to July 2021. Patients who had previous osteoporotic fractures and previous hip, distal radius and spine surgery were excluded from the study. An additional group of 100 patients who were matched for age and sex presenting to the same unit following minor trauma without osteoporotic fractures were selected as the control group with the same exclusion criteria. Use of statins for more than 4 months and other sociodemographic and lifestyle factors were compared among the two groups.&#x0D; As no other independent variable was found to be significantly related to osteoporotic fracturs between the two groups, univariable analysis was done. The odds of current statin use in cases with osteoporotic fracture (45.2%) were lower than the odds of current statin use (54.8%) in subjects without osteoporotic fractures adjusted OR 0.74, 95% CI 0.42, 1.32) (p=0.304).&#x0D; According to our results there might be a protective effect in statin use against osteoporotic fractures although a statistical significance was not demonstrated. However further studies using larger sample size and randomized control studies are suggested to ascertain a statistically significant result.

Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study.

ABSTRACTSevere osteoporotic fractures (hip, proximal humerus, pelvic, vertebral and multiple rib fractures) carry an increased risk of mortality. This retrospective cohort study in the French national healthcare database aimed to estimate refracture and mortality rates after severe osteoporotic fractures at different sites, and to identify mortality‐related variables. A total of 356,895 patients hospitalized for severe osteoporotic fracture between 2009 and 2014 inclusive were analyzed. The cohort was followed for 2 to 8 years up to the study end or until the patient died. Data were extracted on subsequent hospitalizations, refracture events, treatments, comorbidities of interest and survival. Time to refracture and survival were described using Kaplan‐Meier analysis by site of fracture and overall. Mortality risk factors were identified using a Cox model. Hip fractures accounted for 60.4% of the sample (N = 215,672). In the 12 months following fracture, 58,220 patients (16.7%) received a specific osteoporosis treatment, of whom 21,228 were previously treatment‐naïve. The 12‐month refracture rate was 6.3% (95% confidence interval [CI], 6.2%–6.3%), ranging from 4.0% (95% CI, 3.7%–4.3%) for multiple rib fractures to 7.8% (95% CI, 7.5%–8.1%) for pelvic fractures. Twelve‐month all‐cause mortality was 12.8% (95% CI, 12.7%–12.9%), ranging from 5.0% (95% CI, 4.7%–5.2%) for vertebral fractures to 16.6% (95% CI, 16.4%–16.7%) for hip fractures. Osteoporosis‐related mortality risk factors included fracture site, previous osteoporotic fracture (hazard ratio 1.21; 95% CI, 1.18–1.23), hip refracture (1.74; 95% CI, 1.71–1.77), and no prior osteoporosis treatment (1.24; 95% CI, 1.22–1.26). Comorbid cancer (3.15; 95% CI, 3.09–3.21) and liver disease (2.54; 95% CI, 2.40–2.68) were also strongly associated with mortality. In conclusion, severe osteoporotic fractures, including certain non‐hip nonvertebral fractures, carry a high burden in terms of mortality and refracture risk. However, most patients received no anti‐osteoporotic treatment. The findings emphasize the importance of better management of patients with severe fractures, and of developing effective strategies to reduce fracture risk in patients with osteoporosis. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Effect of Statin Use on the Risk of Osteoporotic Fracture in Patients With Metabolic Syndrome: A Nested Case-Control Study

Statins may have advantageous pleiotropic effects on bone metabolism, however, the clinical evidence about the association is still unclear. Although many studies have already evaluated this association, they have performed mostly in a general population with limitation of between-study heterogeneity. Statin may not be equally effective for bone metabolism to every patient, but it can give some benefits for some patients especially with metabolic syndrome (MetS). However, no recent study assessing this relationship, to best our knowledge, has evaluated specifically on patients with MetS. It is also unclear whether the association between statin and osteoporotic fracture differ by statin intensity, dose (cumulative defined daily dose), and duration. This study aimed to investigate the association of statin use with the risk of major osteoporotic fracture in MetS patients from a population-based cohort (NHIS-HEALS, 2002–2015). A nested case-control study was performed in patients with MetS (≥50 years) who had no history of previous osteoporotic fracture. This study included 17,041 cases diagnosed as new-onset osteoporotic fractures and controls matched in a 1:1 ratio by age, sex, body mass index, cohort entry date, and follow-up duration. Conditional logistic regression analysis was used to evaluate covariate-adjusted odds ratio (OR) and 95% confidence interval (CI). During the 4-year follow up period, statin users had a significantly lower risk of major osteoporotic fractures by 9% (OR, 0.91; 95% CI, 0.85 to 0.97) compared with non-users. Among subtypes of major osteoporotic fracture, a risk reduction of vertebral fracture was significant (OR, 0.86; 95% CI, 0.79 to 0.94), but not non-vertebral fracture (OR, 0.97; 95% CI, 0.88 to 1.06) with statin use. Longer duration (OR, 0.97 per 1 year) and cumulative dose (OR, 0.97 per 365 defined daily dose) of statin was negatively associated with the risk of major osteoporotic fracture. There was no difference in risk of major osteoporotic fractures among groups according to statin intensity. In conclusion, this study supports the hypothesis that statin treatment has a beneficial effect on major osteoporotic fracture, especially for vertebral fracture, in patients with MetS with a possibly dose-effect relationship.

Radiofrequency Echographic Multi Spectrometry (REMS) for the diagnosis of osteoporosis in a European multicenter clinical context.

Radiofrequency Echographic Multi Spectrometry (REMS) is a non-ionizing technology for the densitometric assessment of osteoporosis. It has already been validated in Italian women with respect to the current clinical reference technology, Dual-energy X-ray Absorptiometry (DXA). Aim of the current study was to assess the diagnostic accuracy of REMS technology with respect to DXA in a wider European clinical context. A total of 4307 female Caucasian patients aged between 30 and 90years underwent DXA and REMS scans at femoral neck and/or lumbar spine (the site depending on the medical prescription). The acquired data underwent a rigorous quality check in order to exclude the erroneous DXA and REMS reports. The diagnostic agreement between the two technologies was assessed, also stratifying for patients' age groups. The ability to recognise previously fractured patients was also investigated. Overall, 4245 lumbar spine scans and 4271 femoral neck scans were performed. The ability to discriminate patients with and without osteoporosis by femoral neck investigation resulted in sensitivity and specificity of 90.4% and 95.5%, respectively. For lumbar spine scans, a sensitivity of 90.9% and a specificity of 95.1% were obtained. The areas under the curve (AUCs) of the Receiver Operating Characteristic (ROC) curve evaluating the ability to discriminate groups of patients with previous osteoporotic fracture using DXA and REMS T-score values were 0.631 and 0.683 (p<0.0001), respectively, for femoral neck scans, whereas 0.603 and 0.640 (p=0.0002), respectively, for lumbar spine scans. The diagnostic effectiveness of REMS technology at reference anatomical sites for the assessment of osteoporosis has been confirmed in a large series of female patients, spanning from younger and pre-menopausal to elderly women up to 90years, in a multicenter European clinical context.

The Use of FRAX in Identifying Women Less Than 65 Years Needing Bone Mineral Density Testing

The purpose of this study is to determine if the United States Preventive Services Task Force (USPSTF) screening guideline for osteoporosis identifies women under the age of 65 with osteoporosis needing bone mineral density (BMD) testing. If the Fracture Risk Assessment Tool (FRAX) tool fails to identify women under the age of 65 with undiagnosed osteoporosis, then diagnosis and treatment are delayed, potentially leading to increased fractures and morbidity. Another aim of this study is to characterize women under the age of 65 with osteoporosis that FRAX fails to identify and provide descriptive data on our study population. A retrospective chart review was completed between 2012 and 2018. We extracted data for 113 women ≤ 65-years with osteoporosis confirmed by BMD or fractures. Major osteoporotic fracture (MOF) risk calculation without BMD by FRAX of 9.3% or greater (high risk group) was found in 51 (45.1%) of patients. Osteoporosis by T-score < 2.5 was evident in 102 (90%) of patients. Previous osteoporotic fractures were noted in 29 (25.7%) of patients. The average age of women in the high-risk group was 58 years and 55 years in the low-risk group. The sensitivity of FRAX for identifying women with a T-score <−2.5 was 40%. The sensitivity of FRAX for identifying women with a history of fracture was 32%. The sensitivity of FRAX for identifying women with a T-score <−2.5 or identifying women with a history of fracture was 32%. These results demonstrate that the FRAX tool alone (USPSTF recommendation) fails to identify many women under the age of 65 with osteoporosis in need of BMD testing. Over half of women would not have had a BMD performed based on guidelines for screening BMD in women <65. Further study is needed to characterize women under the age of 65 with osteoporosis with a FRAX MOF risk less than 9.3%.

2965 Utilizing Fracture Risk Assessment Tool (FRAX) in Patients With Osteopenia Listed for Liver Transplant to Guide Treatment for Fracture Prophylaxis

INTRODUCTION: Low bone mineral density (BMD) is common in chronic liver disease and predisposes to fracture. FRAX score is a widely used web-based algorithm used to estimate fracture risk with or without dual-emission x-ray absorptiometry (DEXA). FRAX score has not been studied in patients listed for liver transplant. Aim of this study was to determine if FRAX score with DEXA is effective in patients with osteopenia listed for liver transplant to guide treatment for fracture prophylaxis. METHODS: 104 consecutive patients who were actively listed for liver transplant at Baylor St. Luke's medical center were included. Clinical and demographic patient information was collected retrospectively. FRAX scores calculated with BMD data. RESULTS: 104 patients (29 ALD, 26 HCV, 22 NASH, 27 others) were studied (mean age 56 ± 10, 59% male, 41% female, mean BMI 28 ± 5, mean MELD 17+8). All patients had bone mineral density assessed (13 [12%] were osteoporotic and 42 [40%] were osteopenic at the spine and/or hip. 4 [3.8%] had a previous osteoporotic fracture. Mean FRAX score for a 10-year probability of a hip fracture was 1.7% and a 10-year probability of a major osteoporosis-related fracture was 6.2% based on the US-adapted WHO algorithm. Among 40% osteopenic and 13% osteoporotic patients, only 3% and 8% of patients had significantly high FRAX score respectively. CONCLUSION: BMD FRAX score underestimated fracture risk in actively listed liver transplant patients. We believe this could be related to small sample size of the study and strict selection criteria for liver transplant listing. Majority of our study population was non-smoker, non-drinker and with a higher BMI. Therefore, future studies with bigger sample size would be helpful to utilize FRAX score to guide treatment in osteopenic patients for fracture prophylaxis.

Patients' knowledge and opinions regarding osteoporosis, osteoporosis treatment, and oral health care

BackgroundIn this study, the authors assessed the knowledge and opinions of patients regarding osteoporosis and the associations among osteoporosis, osteoporosis treatments, and oral health care use. MethodsOutpatients with osteopenia or osteoporosis completed a questionnaire, including sociodemographic data, internet use, osteoporosis status, oral health care use status, and knowledge regarding the effect of osteoporosis pharmacotherapy on dental procedures. ResultsAmong 258 patients (mean [standard deviation] age, 68.5 [9.3] years; 93% female), 83.9% had osteoporosis, one-third had previous osteoporotic fracture, and 74.4% took osteoporosis medication, mostly antiresorptive agents. In addition, 66.3% had more than 12 years of education, and 53.9% used the internet daily. A total of 79.9% visited a dentist during the past year, and 29.0% had undergone an invasive procedure. Yet 46.5% estimated that their dentist did not know that they had osteoporosis. Approximately one-half of the participants responded that they did not know the answers to knowledge questions regarding associations between osteoporosis, its pharmacotherapy, and oral health care. Of the patients who answered questions about associations between osteoporosis and oral health care, 70% incorrectly believed osteoporosis increased gingival disease, and 30% incorrectly thought medications should be discontinued before caries restoration. ConclusionsOutpatients with osteoporosis or osteopenia who responded to a questionnaire had limited knowledge about associations among osteoporosis, osteoporotic treatment, and oral health care. Practice ImplicationsDentists should review previous and current medical treatments with their patients, including osteoporosis diagnoses. The medical community should make more efforts to provide balanced, accurate information to help patients prioritize health care treatment and avoid unnecessary interruptions in osteoporosis treatment.

Ten-year fracture risk by FRAX and osteoporotic fractures in patients with systemic autoimmune diseases.

The Fracture Risk Assessment Tool (FRAX) has been used universally for the purpose of fracture risk assessment. However, the predictive capacity of FRAX for autoimmune diseases remains inconclusive. This study aimed to compare the applicability of FRAX for autoimmune disease patients. This retrospective study recruited rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and primary Sjögren syndrome (pSS) patients with bone mineral density (BMD) tests. Patients with any osteoporotic fractures were identified. Taiwan-specific FRAX with and without BMD were then calculated. In total, 802 patients (451 RA, 233 SLE and 118 pSS) were enrolled in this study. The cumulative incidences of osteoporotic fractures in the RA, SLE and pSS patients were 43.0%, 29.2% and 33.1%, respectively. For those with a previous osteoporotic fracture, T-scores were classified as low bone mass. Overall, the patients' 10-year probability of major fracture risk by FRAX without BMD was 15.8%, which then increased to 20.3% after incorporation of BMD measurement. When analyzed by disease group, the fracture risk in RA patients was accurately predicted by FRAX. In contrast, current FRAX, either with or without BMD measurement, underestimated the fracture risk both in SLE and pSS patients, even after stratification by age and glucocorticoid treatment. For pSS patients with major osteoporotic fractures, FRAX risks imputed by RA were comparable to major osteoporotic fracture risks of RA patients. Current FRAX accurately predicted fracture probability in RA patients, but not in SLE and pSS patients. RA-imputed FRAX risk scores could be used as a temporary substitute for SLE and pSS patients.

SAT-523 The Use of FRAX in Identifying Women Less Than 65 Years Needing Bone Mineral Density Testing

The United States Preventive Service Task Force (USPSTF) recommends bone mineral density (BMD) screening for osteoporosis in women under the age of 65 by dual-energy x-ray absorptiometry (DXA) if their risk of a major osteoporotic fracture (MOF) is greater or equal to that of an average 65-year-old woman without risk factors for osteoporosis.(1) The absolute risk of a MOF is calculated using the FRAX ®, a tool that incorporates various risk factors to calculate risk with or without the addition of BMD of the femoral neck as a variable. Those, without the BMD variable, having a calculated 10-year risk of a MOF of 9.3% or greater are recommended for BMD testing. A retrospective chart review was completed for patients between 2012 to 2018. We identified 128 charts and analyzed the extracted data for 113 women < 65-years with osteoporosis confirmed by BMD or fractures. MOF fracture risk calculation without BMD by FRAX of 9.3% or greater were found in 51 (45.1%) patients. Osteoporosis by T-score <-2.5 at the spine, total hip, femoral neck or distal radius was evident in 102 (90%) patients. Previous osteoporotic fractures were noted in 29 (25.7%) patients. Demographics were stratified in terms of high-risk (FRAX >= 9.3%) and low-risk (FRAX< 9.3%). The average age of women in the high-risk group was 58 years and 55 years in the low-risk group. In the high-risk group, 88.2% were Caucasian, 11.8% Hispanic, 0% African American, 0% Asian. In the low risk group, 59.7% were Caucasian, 32.3% Hispanic, 3.2% African American, 4.8% Asian. Women with MOF >9.3% were older, had more years post menopause, and had more risk factors (average 2.18 factors vs 0.61) than women with MOF <9.3%. Total hip T-score was lower in the high-risk group. The sensitivity of FRAX for identifying women with a T-score < -2.5 was 40%. The sensitivity of FRAX for identifying women with a history of fracture was 32%. The sensitivity of FRAX for identifying women with a T-score < -2.5 or identifying women with a history of fracture was 32%. These results demonstrate that the FRAX tool alone, according to USPSTF recommendation, fails to identify many women under the age of 65 with osteoporosis in need of BMD testing. Over half of women would not have had a BMD performed based on guidelines for screening BMD in women < 65. Further study is needed to characterize women under the age of 65 with osteoporosis with FRAX MOF less than 9.3%. Reference: 1. U.S. Preventive Services Task Force (2011). Screening for osteoporosis: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2011;154:356-64. Research Support: Grant to support statistical analysis from the University of Texas Health San Antonio School of Medicine Office of the Dean.

A Case Series Study of Odontoid Fracture in the Elderly: A Severe Fracture Occurring Most Frequently in Osteoporotic Subjects.

ABSTRACTThe WHO definition of osteoporosis excludes cervical fractures. Recent studies suggest that atraumatic odontoid fractures (OF) may be favored by osteoporosis but global bone status for osteoporosis diagnosis has not been described. We present a case series of patients >65 years old hospitalized for low‐energy OF who had an evaluation of their bone status within 3 months after fracture, including clinical risk factors of osteoporosis, bone mineral density (BMD), vertebral fracture assessment (VFA) by dual X‐ray absorptiometry, and laboratory tests. Osteoporosis was defined as a T‐score ≤ −2.5 on at least one site, or a bone fragility fracture associated with a T‐score ≤ −1 at one site. Thirty‐three patients were hospitalized for OF, 30 of them as a consequence of a low‐energy impact: 20 women and 10 men (mean age: 85 years). Eight patients died before bone evaluation, four refused, and six were lost to follow‐up. Twelve patients were included: 11 women and one man (mean age: 83.8 years). Ten out of twelve patients fulfilled diagnostic criteria of osteoporosis, including eight with previous osteoporotic fractures (six severe fractures). Eight fulfilled specific treatment of osteoporosis criteria, but only two were treated. The mean follow‐up period was 12.2 ± 4.1 months. Prior to OF occurrence, all lived at home and were independent; at the time of discharge, six went to a nursing home. At 3 months of follow‐up (n = 10), one was dead and nine lived at home. At 12 months (n = 9), two were dead and seven lived at home. This study provides for the first time a classical evaluation of osteoporotic status for low‐energy OF in the elderly and shows that it occurs in osteoporotic subjects. These preliminary results require larger‐scale studies to determine whether OF could be considered as a severe osteoporotic fracture. © 2018 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

Real-world Management of Women with Postmenopausal Osteoporosis Treated with Denosumab: A Prospective Observational Study in the Czech Republic and Slovakia.

IntroductionOsteoporosis is characterized by low bone mineral density (BMD) and an increased risk of fracture. In randomized controlled trials, denosumab has been shown to significantly reduce the fracture risk in women with osteoporosis. However, little is known about the real-world management of women who are prescribed denosumab.MethodsThis multicenter, prospective, observational real-world study in the Czech Republic and Slovakia evaluated the baseline characteristics and clinical management of women with postmenopausal osteoporosis prescribed denosumab for 24 months.ResultsA total of 600 women were included (300 in each country). In the Czech Republic and Slovakia, respectively, mean age at enrollment was 69.0 and 64.3 years, 67.7% and 30.0% of patients had a previous osteoporotic fracture, and 85.0% and 48.7% had previously received osteoporosis medication. In both countries, ‘low BMD T score’ and ‘a history of osteoporotic fracture’ were the main reasons for prescribing denosumab. Most patients received all four post-baseline denosumab injections (Czech Republic, 82.0%; Slovakia, 81.0%), and more than 98% of patients in both countries received all injections at the prescribing center. At 24 months, most patients experienced an increase in BMD T score for the lumbar spine, total hip, or femoral neck (Czech Republic, 69.7–91.7%; Slovakia, 67.1–92.9%). Adverse drug reactions were consistent with the known safety profile of denosumab.ConclusionBaseline characteristics of patients receiving denosumab in the Czech Republic and Slovakia reflect the reimbursement criteria for this agent in each country. The findings of our study in patients who are at high risk for fracture are consistent with the growing body of evidence demonstrating the effectiveness of denosumab in real-world clinical practice.Trial RegistrationClinicalTrials.gov identifier, NCT01652690.FundingAmgen Inc.Electronic supplementary materialThe online version of this article (10.1007/s12325-018-0779-9) contains supplementary material, which is available to authorized users.

Prevalencia de osteoporosis, estimación de la probabilidad de fractura y estudio del metabolismo óseo en pacientes con reciente diagnóstico de cáncer de próstata en el área sanitaria de Lugo

ObjectiveTo study the prevalence of osteoporosis and fracture probability in patients diagnosed with prostate cancer. DesignObservational descriptive transversal study. SiteStudy performed from Primary Care of Lugo in collaboration with Rheumatology and Urology Services of our referral hospital. ParticipantsPatients diagnosed with prostate cancer without bone metastatic disease from January to December 2012. Main measurementsEpidemiologic, clinical, laboratory and densitometric variables involved in osteoporosis were collected. The likelihood of fracture was estimated by FRAX® Tool. ResultsEighty-three patients met the inclusion criteria. None was excluded. The average age was 67 years. The Body Mass Index was 28.28. Twenty-five patients (30.1%) had previous osteoporotic fractures. Other prevalent risk factors were alcohol (26.5%) and smoking (22.9%). Eighty-two subjects had vitamin D below normal level (98.80%). Femoral Neck densitometry showed that 8.9% had osteoporosis and 54% osteopenia.The average fracture risk in this population, estimated by FRAX®, was 2.63% for hip fracture and 5.28% for major fracture.Cut level for FRAX® major fracture value without DXA >5% and ≥7.5% proposed by Azagra et al. showed 24 patients (28.92%) and 8 patients (9.64%) respectively. ConclusionsThe prevalence of osteoporosis in this population was very high.The more frequent risk factors associated with osteoporosis were: previous osteoporotic fracture, alcohol consumption, smoking and family history of previous fracture.The probability of fracture using femoral neck FRAX® tool was low.Vitamin D deficiency was very common (98.8%).

Concomitant and previous osteoporotic vertebral fractures

Background and purpose — Patients with osteoporosis who present with an acute onset of back pain often have multiple fractures on plain radiographs. Differentiation of an acute osteoporotic vertebral fracture (AOVF) from previous fractures is difficult. The aim of this study was to investigate the incidence of concomitant AOVFs and previous OVFs in patients with symptomatic AOVFs, and to identify risk factors for concomitant AOVFs.Patients and methods — This was a prospective epidemiological study based on the Registry of Pathological Osteoporotic Vertebral Fractures (REPAPORA) with 1,005 patients and 2,874 osteoporotic vertebral fractures, which has been running since February 1, 2006. Concomitant fractures are defined as at least 2 acute short-tau inversion recovery (STIR-) positive vertebral fractures that happen concomitantly. A previous fracture is a STIR-negative fracture at the time of initial diagnostics. Logistic regression was used to examine the influence of various variables on the incidence of concomitant fractures.Results — More than 99% of osteoporotic vertebral fractures occurred in the thoracic and lumbar spine. The incidence of concomitant fractures at the time of first patient contact was 26% and that of previous fractures was 60%. The odds ratio (OR) for concomitant fractures decreased with a higher number of previous fractures (OR =0.86; p = 0.03) and higher dual-energy X-ray absorptiometry T-score (OR =0.72; p = 0.003).Interpretation — Concomitant and previous osteoporotic vertebral fractures are common. Risk factors for concomitant fractures are a low T-score and a low number of previous vertebral fractures in cases of osteoporotic vertebral fracture. An MRI scan of the the complete thoracic and lumbar spine with STIR sequence reduces the risk of under-diagnosis and under-treatment.

Baseline Characteristics and Changes in Bone Mineral Density T-Scores of Bulgarian Women with Postmenopausal Osteoporosis Receiving Denosumab in Routine Clinical Practice.

BackgroundPostmenopausal osteoporosis (PMO) is common among women over 50 years of age and is associated with an increased risk of fracture. Bone-targeted agents, such as denosumab, can reduce fracture risk in patients with PMO.ObjectiveThe aim was to describe baseline characteristics and changes in bone mineral density (BMD) T-scores among women with PMO receiving denosumab in Bulgaria.MethodsThis multicenter chart review included women with PMO receiving denosumab for ≥1 year in Bulgaria (October 2011–August 2013). Participants were required to have a baseline BMD T-score of ≤−2.5 standard deviations (SDs) at one or more skeletal sites.ResultsOverall, 222 women were included. The mean (SD) age at denosumab initiation was 64.2 (8.5) years; 26.6% reported a previous osteoporotic fracture and 6.8% a previous hip fracture. Only half of those reporting a previous fracture (49.2%) had received prior osteoporosis therapy. At baseline, mean (SD) BMD T-scores were lumbar spine −3.2 SD (0.6 SD), total hip −2.3 SD (0.8 SD), and femoral neck −2.7 SD (0.7 SD). After 1 year of denosumab treatment, scores increased significantly at all three sites, reaching −2.7 SD (0.6 SD), −2.1 SD (0.9 SD), and −2.4 SD (0.7 SD), respectively (all p < 0.0001 vs. baseline). No serious adverse drug reactions were identified.ConclusionDenosumab is usually prescribed in women with PMO at high fracture risk. In the patients who were persistent with treatment at 1 year, denosumab was well tolerated and effective at increasing BMD T-scores at several skeletal sites.

Time trends in osteoporosis risk factor profiles: a comparative analysis of risk factors, comorbidities, and medications over twelve years.

The aim of this article was to identify prevalent osteoporosis risk factors, medications and comorbidities associated with bone mineral density (BMD). Furthermore to evaluate changes in risk factor profiles over 12years. 6285 women consecutively referred to an osteoporosis specialist clinic were included. Information of potential risk factors was obtained by questionnaire and clinical examination. Additional information on medication use, comorbidities and fractures were obtained from national registries. An association (<0.05) between well-known risk factors negatively influencing bone health was established in a real-life setting. The prevalence of osteoporosis and proportion of patient's having comorbidity's associated with osteoporosis were increasing during the inclusion period (start 23.8%, end 29.7%). Increasing age (OR=1.05), current smoking (OR=1.18), estrogen deficiency (OR=1.7), hyperthyroidism (OR=1.5), previous major osteoporotic fracture (OR=1.7), former osteoporosis treatment (OR=3.5), higher BMI (OR=0.87), use of calcium supplementation (OR=1.2), high exercise level (OR=0.7), and use of thiazide diuretics (OR=0.7) were identified as predictors of osteoporosis by DXA. Rheumatoid arthritis (OR=2.4) and chronic pulmonary disease (OR=1.5) was associated with site-specific osteoporosis by DXA at the total hip. Current use of loop diuretics (OR=1.7) and glucocorticoid use (OR=1.04-1.06) were associated with both total hip and femoral neck T-score <-2.5. Our data confirms an independent negative association with BMD of many established risk factors, certain comorbidities, and medications. Exercise level, use of loop diuretics, and prevalent chronic pulmonary disease, risk factors not included in fracture risk calculators were associated with osteoporosis by DXA. Time trends indicate risk profile is dynamic, with increasing focus on secondary osteoporosis.

Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research.

Bisphosphonates (BPs) are the most commonly used medications for osteoporosis. This ASBMR report provides guidance on BP therapy duration with a risk-benefit perspective. Two trials provided evidence for long-term BP use. In the Fracture Intervention Trial Long-term Extension (FLEX), postmenopausal women receiving alendronate for 10 years had fewer clinical vertebral fractures than those switched to placebo after 5 years. In the HORIZON extension, women who received 6 annual infusions of zoledronic acid had fewer morphometric vertebral fractures compared with those switched to placebo after 3 years. Low hip T-score, between -2 and -2.5 in FLEX and below -2.5 in HORIZON extension, predicted a beneficial response to continued therapy. Hence, the Task Force suggests that after 5 years of oral BP or 3 years of intravenous BP, reassessment of risk should be considered. In women at high risk, for example, older women, those with a low hip T-score or high fracture risk score, those with previous major osteoporotic fracture, or who fracture on therapy, continuation of treatment for up to 10 years (oral) or 6 years (intravenous), with periodic evaluation, should be considered. The risk of atypical femoral fracture, but not osteonecrosis of the jaw, clearly increases with BP therapy duration, but such rare events are outweighed by vertebral fracture risk reduction in high-risk patients. For women not at high fracture risk after 3 to 5 years of BP treatment, a drug holiday of 2 to 3 years can be considered. The suggested approach for long-term BP use is based on limited evidence, only for vertebral fracture reduction, in mostly white postmenopausal women, and does not replace the need for clinical judgment. It may be applicable to men and patients with glucocorticoid-induced osteoporosis, with some adaptations. It is unlikely that future trials will provide data for formulating definitive recommendations. © 2015 American Society for Bone and Mineral Research.

On "2015 Guidelines for Prevention and Treatment of Osteoporosis". Diagnostic criteria of primary osteoporosis and the criteria for pharmacological treatment

Diagnosis of osteoporosis is based on the bone mineral density (BMD) measurement and differential diagnosis. The most important clinical determinant of bone strength is BMD in the conditions without previous fractures. It is indispensable to measure BMD to prevent first fractures. On the other hand, previous osteoporotic fractures are known to be the risk factors for other fractures. Particularly, osteoporotic vertebral fractures and hip fractures increase the risk of fractures even after the adjustment with BMD. These are the reasons why the information about previous osteoporotic fracures are important in the diagnosis of osteoporosis. In the current guideline, the patients who are given the diagnosis of primary osteoporosis are the candidates of pharmacological treatment. In addition, the patients of osteopenia one of whose parents has the history of hip fractures or those with the 10-year risk of major osteoporotic fractures of FRAX® are also considered to be the candidates of pharmacological treatment.