Related Fragility Fractures Research Articles

Guidelines for fracture risk assessment and management of osteoporosis in postmenopausal women and men above the age of 50 in Qatar

SummaryWe present comprehensive guidelines for osteoporosis management in Qatar. Formulated by the Qatar Osteoporosis Association, the guidelines recommend the age-dependent Qatar fracture risk assessment tool for screening, emphasizing risk-based treatment strategies and discouraging routine dual-energy X-ray scans. They offer a vital resource for physicians managing osteoporosis and fragility fractures nationwide.PurposeOsteoporosis and related fragility fractures are a growing public health issue with an impact on individuals and the healthcare system. We aimed to present guidelines providing unified guidance to all healthcare professionals in Qatar regarding the management of osteoporosis.MethodsThe Qatar Osteoporosis Association formulated guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men above the age of 50. A panel of six local rheumatologists who are experts in the field of osteoporosis met together and conducted an extensive review of published articles and local and international guidelines to formulate guidance for the screening and management of postmenopausal women and men older than 50 years in Qatar.ResultsThe guidelines emphasize the use of the age-dependent hybrid model of the Qatar fracture risk assessment tool for screening osteoporosis and risk categorization. The guidelines include screening, risk stratification, investigations, treatment, and monitoring of patients with osteoporosis. The use of a dual-energy X-ray absorptiometry scan without any risk factors is discouraged. Treatment options are recommended based on risk stratification.ConclusionGuidance is provided to all physicians across the country who are involved in the care of patients with osteoporosis and fragility fractures.

Opportunistic hand radiographs to screen for low forearm bone mineral density: a prospective and retrospective cohort study

BackgroundLow bone mineral density affects 53% of women over age 65 in the US, yet many are unaware and remain untreated. Underdiagnosis of forearm osteoporosis and related fragility fractures represent missed warning signs of more deadly, future fractures. This study aimed to determine if hand radiographs could serve as early, simple screening tools for predicting low forearm bone mineral density (BMD).MethodsWe evaluated posterior-anterior (PA) hand radiographs (x-rays) and Dual-energy X-ray absorptiometry (DXA) scans of 43 participants. The ratio of the intramedullary cavity to total cortical diameter of the second metacarpal (second metacarpal cortical percentage (2MCP)) was used as a potential diagnostic marker. Mixed-effects linear regression was performed to determine correlation of 2MCP with BMD from various anatomic regions. Repeated measures ANOVAs were used to compare BMD across sites. An optimal 2MCP cutoff for predicting forearm osteopenia and osteoporosis was found using Receiver Operating Curves.Results2MCP is directly correlated with BMD in the forearm. The optimal 2MCP of 48.3% had 80% sensitivity for detecting osteoporosis of the 1/3 distal forearm. An 2MCP cutoff of 50.8% had 84% sensitivity to detect osteoporosis of the most distal forearm. Both 2MCP cutoffs were more sensitive at predicting forearm osteoporosis than femoral neck T-scores.ConclusionsThese findings support the expansion of osteoporosis screening to include low-cost hand x-rays, aiming to increase diagnosis and treatment of low forearm BMD and fractures. Proposed next steps include confirming the optimal 2MCP cutoff at scale and integrating automatic 2MCP measurements into PAC systems.

Rescuing SERCA2 pump deficiency improves bone mechano-responsiveness in type 2 diabetes by shaping osteocyte calcium dynamics

Type 2 diabetes (T2D)-related fragility fractures represent an increasingly tough medical challenge, and the current treatment options are limited. Mechanical loading is essential for maintaining bone integrity, although bone mechano-responsiveness in T2D remains poorly characterized. Herein, we report that exogenous cyclic loading-induced improvements in bone architecture and strength are compromised in both genetically spontaneous and experimentally-induced T2D mice. T2D-induced reduction in bone mechano-responsiveness is directly associated with the weakened Ca2+ oscillatory dynamics of osteocytes, although not those of osteoblasts, which is dependent on PPARα-mediated specific reduction in osteocytic SERCA2 pump expression. Treatment with the SERCA2 agonist istaroxime was demonstrated to improve T2D bone mechano-responsiveness by rescuing osteocyte Ca2+ dynamics and the associated regulation of osteoblasts and osteoclasts. Moreover, T2D-induced deterioration of bone mechano-responsiveness is blunted in mice with osteocytic SERCA2 overexpression. Collectively, our study provides mechanistic insights into T2D-mediated deterioration of bone mechano-responsiveness and identifies a promising countermeasure against T2D-associated fragility fractures.

Experiences of postmenopausal osteoporosis: a narrative review

Purpose A narrative review was conducted to identify, critically appraise, and synthesise primary research on the lived experiences of postmenopausal women with osteoporosis. Materials and methods A systematic search of qualitative studies published between January 1960 and August 2021 was conducted across seven databases. The selected qualitative studies reported the lived experiences of postmenopausal women with osteoporosis, both with and without a history of fragility fractures. Results A total of 17 publications (n = 334) were identified. These results suggest that osteoporosis and fragility fractures significantly affected postmenopausal women’s lives. They reported difficulties in carrying out daily activities due to pain and change in their routines to cope with health problems. Some women were satisfied with the information provided by healthcare professionals. Their medicine adherence was also determined by their belief in the importance of their scheduled treatment for osteoporosis. Conclusion Qualitative studies that explored the lived experiences of postmenopausal women with osteoporosis can provide important insights into the impact of the disease on women’s lives and potential pathways for improving care and management. Implications for rehabilitation Osteoporosis and fragility fractures affect the quality of life of postmenopausal women worldwide. The provision of targeted and tailored health information for postmenopausal women with osteoporosis is paramount in improving their health literacy and aiding in the long-term management of their bone health. What is already known Osteoporosis and related fragility fractures are common, affecting more than 200 million people worldwide, including three million people in the UK. Osteoporotic fractures have significant clinical and public health impacts. What this study adds Osteoporosis, particularly fragility fractures, has a significant impact on the lives of postmenopausal women, including pain and functional impairment. Women’s belief in the importance of their scheduled treatment plays a significant role in their concordance with the prescribed medications for osteoporosis. Provision of targeted health information for postmenopausal women with osteoporosis is key to their involvement in decision-making and disease management.

Cardiovascular Safety and Effectiveness of Bisphosphonates: From Intervention Trials to Real-Life Data.

Both osteoporosis with related fragility fractures and cardiovascular diseases are rapidly outspreading worldwide. Since they are often coexistent in elderly patients and may be related to possible common pathogenetic mechanisms, the possible reciprocal effects of drugs employed to treat these diseases have to be considered in clinical practice. Bisphosphonates, the agents most largely employed to decrease bone fragility, have been shown to be overall safe with respect to cardiovascular diseases and even capable of reducing cardiovascular morbidity in some settings, as mainly shown by real life studies. No randomized controlled trials with cardiovascular outcomes as primary endpoints are available. While contradictory results have emerged about a possible BSP-mediated reduction of overall mortality, it is undeniable that these drugs can be employed safely in patients with high fracture risk, since no increased mortality has ever been demonstrated. Although partial reassurance has emerged from meta-analysis assessing the risk of cardiac arrhythmias during bisphosphonates treatment, caution is warranted in administering this class of drugs to patients at risk for atrial fibrillation, possibly preferring other antiresorptives or anabolics, according to osteoporosis guidelines. This paper focuses on the complex relationship between bisphosphonates use and cardiovascular disease and possible co-management issues.

Impact of Low Energy Availability on Skeletal Health in Physically Active Adults.

For decades researchers reported that pre-menopausal women who engage in extensive endurance exercise and have menstrual dysfunction can develop low bone mineral density (BMD) or osteoporosis. More recently, low energy availability has been recognized as the initiating factor for low BMD in these women. Furthermore, the relationship between low energy availability and poor skeletal health is not exclusive to women engaging in endurance exercise. Rather, both males and females commonly experience endocrine dysfunction resulting from low energy availability and high exercise levels that degrades skeletal health. Consequences to skeletal health can range from short-term changes in bone metabolism and increased risk of bone stress injuries to long-term consequences of low BMD, such as osteoporosis and related fragility fractures. The degree to which low energy availability degrades skeletal health may be dependent on the length and extent of the energy deficit. However, the complex relationships between under-fueling, short- and long-term skeletal consequences and the factors that mediate these relationships are not well described. In this review, we discuss the consequences of low energy availability on sex hormones and skeletal health in two highly-active populations-athletes and military trainees-and provide a summary of existing knowledge gaps for future study.

Denosumab in chronic kidney disease: a narrative review of treatment efficacy and safety.

Patients with CKD are at increased risk of fragility fractures and associated consequences. We discuss the complexity of fracture prevention in CKD, summarize the efficacy and safety of denosumab, and provide an approach to denosumab-induced hypocalcemia. Using predefined terms, we searched PubMed, MEDLINE, and Google Scholar for studies on fracture prevention in CKD and the efficacy and safety of denosumab. We included observational studies, randomized controlled trials (RCTs), meta-analyses, evidence-based reviews, and clinical practice guidelines. The diagnosis of osteoporosis and prevention of related fragility fractures is complex in CKD, particularly in those with advanced and end-staged kidney disease (ESKD). Prior to initiating denosumab, it is important to assess for and optimize CKD-mineral and bone disorders (CKD-MBD). In observational studies and small RCTs, denosumab has been shown to improve bone mineral density and reduce bone turnover in CKD, but there have been no studies focused upon its fracture efficacy. Denosumab-induced hypocalcemia has also been reported, which disproportionately impacts those with ESKD. Risk factors for hypocalcemia with denosumab use in CKD include lower baseline serum calcium and 25 hydroxyvitamin D and both low and high bone turnover. Choosing the "right patient" for denosumab, supplementing with calcium and vitamin D, adjusting calcium dialysate, and close clinical monitoring are essential if considering this drug. With optimization of CKD-MBD, calcium and vitamin D supplementation, and close monitoring, denosumab can be considered in CKD. There are however opportunities to better understand its fracture efficacy and safety in an RCT setting.

P210 Tocilizumab versus prednisolone only treatment for giant cell arteritis: an observational study

Abstract Background/Aims Giant cell arteritis (GCA) is a medical emergency that requires prolonged high dose glucocorticoids (GC). Tocilizumab (TCZ) is currently approved for GCA in combination with GC tapering for those at high risk of glucocorticoid toxicity, who relapse or have refractory disease. The aim is to evaluate indications and characteristics of patients who were started on TCZ and to assess the rate of relapse and steroid tapering for patients on TCZ compared with an age matched prednisolone (PDN) only treated control group (CTRL). Methods Retrospective review of electronic patient health record data of patients who were diagnosed and treated for GCA in a single rheumatology centre from January 2017- July 2020. All patients were initially treated with high dose PDN (40-60 mg/day) with subsequent steroid tapering with or without TCZ (162 mg/week). Results We included 36 GCA patients who were treated with TCZ+PDN and 26 patients with PDN only. Mean age of patients started on TCZ was 69.3±6.8, 81% were female. There was no significant demographic difference to the CTRL group.The most common reason for starting TCZ (50%) was a GCA relapse requiring uptitration of PDN. 13 patients (36%) started TCZ as they had developed significant steroid side effects including steroid-induced diabetes, hypertension and osteoporosis related fragility fractures. Almost one fifth of patients (19.4%) who were started on TCZ had imaging evidence of large vessel involvement.The mean PDN dose of patients who started TCZ was 26.6±13.1 mg/day. Patients who started TCZ were able to approximately half the PDN dose every 3 months. The average daily PDN dose was 11.3±7.0 mg after 3 months, 6.0±4.3 mg after 6 months, and 3.3±4.7 mg after 12 months of starting TCZ. When compared with the CTRL group (4%), significantly more TCZ patients (41.7%) were able to reduce the PDN dose to a low dose (0-5 mg) after 6 months treatment (p = 0.001).During the course of treatment more CTRL patients (34.6%) relapsed than patients receiving TCZ (11.1% vs CTRL, p = 0.013). The majority of TCZ patients (88.9%) stayed in remission and 2 (5.6%) patients completed 12 months treatment and have ceased therapy. 4 (11.1%) patients stopped Tocilizumab due to side effects (diarrhoea, diverticulitis, scalp irritation) and 2 stopped due to concerns over long term risks. Conclusion Our real-world study shows that TCZ is predominantly initiated in those who relapse or develop GC related side effects. Patients who received TCZ were able to half their PDN dose every 3 months and had lower 6 and 12-month PDN requirements compared to those on PDN solely. The relapse rate was significantly higher in the PDN only treated group than in the TCZ group. TCZ is a good option as steroid sparing agent for the treatment of GCA. Disclosure H. Preston: None. O. Cronin: None. B. Kuske: None. N.D. McKay: None. B. Hauser: Honoraria; Dr Hauser has received speaker fees from Roche.

The anti-osteoporotic effect of Moringa oleifera leaves extract on glucocorticoids-induced jawbone osteoporosis in Albino rats

Objective: Glucocorticoids induced osteoporosis and its related fragility fractures represent a costly humanand socioeconomic load worldwide. All the current pharmacological therapies possess multiple adverse effectsand high cost. Thus, the pesent study aimed to evaluate the bone healing ability of Moringa oleifera (MO) onglucocorticoids induced osteoporosis in the jawbone of Albino rats. Material and Methods: Osteoporosis wasprompted by a daily intraperitoneal injection of 200 micro g/ 100 g dexamethasone for 30 days. Next,the animalswere randomly divided into 2 groups; osteoporotic and MO treated group. The treated group receivd a dailyoral dose of 200mg/kg of MO. Rats from the MO group were sacrificed after 4 weeks from the beginning oftreatment, and the same sacrifice date was used for the osteoporotic group. Bone regeneration was evaluated bydual energy x-ray absorptiometry (DEXA), real time polymerase chain reaction (RT-PCR), histopathological andhistomorphometric examination. Results: After the sacrifice, the DEXA analysis revealed a significant upregulationin the BMD in the MO treated group (p <0.001). The RT-PCR test showed a significant decline in RANKL geneexpression and a significant rise in OPG gene expression in the MO group (p < 0.001, p = 0.002, respectively).The histopathological examination of the MO group displayed a marked healing of the jawbone micro-anatomy.The histomorphometric analysis also showed that the bone area percentage increased significantly in the MOgroup (p <0.05). Conclusion: A cheap, easy to get, yet a powerful plant like MO leaves, can be cosidered aneffective treatment for osteoporosis.KEYWORDSBone regeneration; Glucocorticoids; Moringa oleifera; Osteoporosis.

The effect of Qigong Wuqinxi for osteopenia and primary osteoporosis: A protocol for systematic review and meta analysis.

Introduction:Osteoporosis (OP) and related fragility fractures are a significant public health problem which leads to pain, disability, loss function of independence, considerable complications and increased mortality. Exercise training is the only alternative strategy to improve multiple skeletal and fall risk factors simultaneously. Wuqinxi is 1 of the Chinese mind-body exercises using to improve physical and mental health and fight against diseases for thousands of years. Our study aims to systematically review the existing literature to further explore the efficacy and safety of Wuqinxi in the prevention and treatment of osteopenia and OP.Methods and analysis:The following electronic databases (PubMed, Science Citation Index, Embase (Ovid) database, the Cochrane Library, the China National Knowledge Infrastructure, the China Biology Medicine disc, the China Science and Technology Journal Database, the Wan fang Database, ClinicalTrials.gov and the Chinese Clinical Trial Registry Platform) will be searched from the beginning to 1 June 2020. Only randomized controlled trials will be enrolled, in which the intervention group must include a form of Wuqinxi, while the control group can involve other conventional treatment or no intervention. The potential outcome measures will include bone mineral density values, bone turnover markers, fragility fractures, quality of life, pain scores, and adverse events. The Cochrane risk of bias assessment tool will be used to assess the risk of bias in each study.Results:The current study is a protocol for systematic review and meta-analysis without results, and data analysis will be carried out after the protocol. We will share our findings in the third quarter of 2021.Conclusion:This review aims to evaluate up-to-date evidence of Wuqinxi for bone health in English or Chinese language studies, and explore whether Wuqinxi can be used as an adjuvant treatment for osteoporosis and osteopenia.Ethics and dissemination:Ethical approval is not required as the review is a secondary study based on published literature. The results of the study will be published in peer-reviewed publications and disseminated electronically or in print.Protocol registration number:INPLASY202040135.

The effect of different exercise programs on bone mineral density and physical function in women with osteoporosis: A randomized controlled trial

Aim: Osteoporosis is a multifactorial progressive skeletal disorder characterized by reduced bone mass. Exercise is widely recommended to reduce osteoporosis, falls and related fragility fractures. The purpose of this study was to investigate the effects of land exercise (LE) and aquatic exercise (AE) on physical function and bone mineral density (BMD). Methods: Fifty-eight postmenopausal women, aged 50-70 years, diagnosed with osteoporosis according to BMD measures, enrolled in this study. The subjects were randomly assigned to either the intervention group (LE group) or the control group (AE group). Physical function and BMD were assessed in all subjects in both groups before and after 10 months of intervention. The muscle strength, flexibility, balance, gait time and pain were measured to assess physical function. Bone mineral density at the lumbar spine was measured by dual energy X-ray absorptiometry (DEXA). Results: There were no significant differences between the two groups in the baseline anthropometric data. The two groups were similar with respect to age, weight, height, and body mass index (p>0.05). After the exercise program, muscle strength, flexibility, gait time, pain, and bone density (p<0.001) significantly improved with LE compared to AE. There was no significant difference between the two groups in balance at the 10-month follow-up. Conclusion: Significant improvements in physical function and BMD suggest that LE is a possible alternative for postmenopausal women with OP. Clinical rehabilitation impact: In the current available literature there is insufficient data regarding combined regimens, additionally, conclusions from our research can inspire further studies in order to promote land and water based exercise.

Putting the Brakes on Breaks: Osteoporosis Screening and Fracture Prevention.

Introduction:This prospective study sought to implement a screening tool to identify and risk stratify at-risk patients for osteoporosis and evaluate patient knowledge of osteoporosis and fragility fractures in an orthopedic trauma clinic affiliated with a level 1 trauma academic center.Methods:Of 297 eligible patients, 291 were screened and risk stratified. Patients completed an osteoporosis screening questionnaire and were risk stratified. Lifestyle advice was given to patients at low fracture risk. A dual-energy X-ray absorptiometry scan was ordered for patients at intermediate fracture risk. A referral was initiated for treatment to a bone health specialist in high fracture risk patients. Twenty patients completed a knowledge-based pretest/posttest.Results:A total of 291 patients were screened, which represented 97.7% of patients over the age of 50. Of those patients, 165 (56.7%) patients met criteria for further osteoporosis evaluation as they were considered either intermediate or high risk for future fractures. One hundred thirty-six (82.4%) patients were referred for bone mineral density evaluation. For the knowledge-based evaluation portion, patients had a 33% gain in knowledge (P = .0004). The largest knowledge deficit identified pertained to osteoporosis risk factors and lifestyle management.Discussion:The use of an osteoporosis screening questionnaire in the orthopedic trauma clinic produced clinically significant improvement in identification of at-risk patients. A lack of knowledge regarding osteoporosis and fragility fractures was found to exist among these patients.Conclusion:The implementation of an osteoporosis screening tool to identify, risk stratify, and treat patients with osteoporosis and related fragility fractures can be successfully integrated into a busy clinical practice.

Proteasome inhibitor bortezomib is a novel therapeutic agent for focal radiation-induced osteoporosis.

Bone atrophy and its related fragility fractures are frequent, late side effects of radiotherapy in cancer survivors and have a detrimental impact on their quality of life. In another study, we showed that parathyroid hormone 1-34 and anti-sclerostin antibody attenuates radiation-induced bone damage by accelerating DNA repair in osteoblasts. DNA damage responses are partially regulated by the ubiquitin proteasome pathway. In the current study, we examined whether proteasome inhibitors have similar bone-protective effects against radiation damage. MG132 treatment greatly reduced radiation-induced apoptosis in cultured osteoblastic cells. This survival effect was owing to accelerated DNA repair as revealed by γH2AX foci and comet assays and to the up-regulation of Ku70 and DNA-dependent protein kinase, catalytic subunit, essential DNA repair proteins in the nonhomologous end-joining pathway. Administration of bortezomib (Bzb) reversed the loss of trabecular bone structure and strength in mice at 4 wk after focal radiation. Histomorphometry revealed that Bzb significantly increased the number of osteoblasts and activity in the irradiated area and suppressed the number and activity of osteoclasts, regardless of irradiation. Two weeks of Bzb treatment accelerated DNA repair in bone-lining osteoblasts and thus promoted their survival. Meanwhile, it also inhibited bone marrow adiposity. Taken together, we demonstrate a novel role of proteasome inhibitors in treating radiation-induced osteoporosis.-Chandra, A., Wang, L., Young, T., Zhong, L., Tseng, W.-J., Levine, M. A., Cengel, K., Liu, X. S., Zhang, Y., Pignolo, R. J., Qin, L. Proteasome inhibitor bortezomib is a novel therapeutic agent for focal radiation-induced osteoporosis.

Prevalence and Incidence of Osteoporosis and Osteoporotic Vertebral Fracture in Korea: Nationwide Epidemiological Study Focusing on Differences in Socioeconomic Status.

A cross-national study. To determine the prevalence and incidence of osteoporosis (OP) and osteoporotic vertebral fracture (OVF) in Korea and to investigate if socioeconomic status has an effect. As life expectancy increases, OP and related fragility fractures are also increasing. This presents a serious challenge, not only for health authorities but also for individuals, their families, and society overall. Determining the prevalence and incidence of OP and related fragility fractures is the first step in developing strategies to reduce their increasing disease burdens. Concurrently, we need to confirm whether people with low socioeconomic status are more susceptible to these diseases. Using the Health Insurance Review and Assessment Service (HIRA) database from 2008 to 2012, we estimated the annual prevalence and incidence of OP and OVF and investigated the differences according to socioeconomic status by National Health Insurance (NHI) beneficiaries and Medical Aid (MA) recipients. In 2012, the standardized prevalence of OP in the NHI and MA groups was 3968 and 6927 per 100,000, respectively (odds ratio, 3.83). The standardized incidence of OP in the MA group was significantly higher than in the NHI group in 2011 and 2012 (odds ratios, 2.34 and 2.19, respectively). In addition, the standardized incidence of OVF in the MA group in 2011 and 2012 was 408 and 389 per 100,000, respectively, and the incidence in the MA group was significantly higher than in the NHI group (odds ratios, 4.13 and 4.12, respectively; P < 0.001). We confirmed that the prevalence and incidence of OP and OVF in the MA group were higher than those in the NHI group. It showed that low income might be a significant factor related to OP and OVF. 3.

The Effect of the Modified Eighth Section of Eight-Section Brocade on Osteoporosis in Postmenopausal Women: A Prospective Randomized Trial.

Osteoporosis and related fragility fractures represent a serious and global public health problem.To evaluate whether the modified eighth section of Eight-section Brocade (MESE) exercise could improve the symptom and indexes associated with osteoporosis in postmenopausal women.Guangzhou and Liuzhou hospital of traditional Chinese medicine in China.Women (n = 198) aged 50 to 75 years were randomized into Control, Ca, MESE, and MESE + Ca.Subjects in Ca and MESE groups were separately asked to consume thrice daily Calcium Carbonate Chewable D3 tablet and to perform thrice daily MESE exercise by 7 repetitions per time for 12 months. Subjects in MESE + Ca group performed such the combined treatment project for 12 months. Body height and Hospital for Special Surgery (HSS) scores of both knees, chronic back pain visual analogue scale scores (VAS), bone mineral density (BMD) at L2 to L4 and the left femoral neck, 3-feet Up and Go Test (3′) and one-leg Stance (OLS).In our study, the improvement in chronic back pain of the patients in Ca, MESE, and MESE + Ca group was better than that in control group. There was 1.9% and 1.7%, 2.3%, and 2.1% net profit in left femoral neck and lumbar BMD after the treatment for 12 months in MESE and MESE + Ca groups. For the balance capacity, the subjects in MESE and MESE + Ca groups secured much better performance than those in Ca and control group after the treatment for 12 months (P < 0.001, P < 0.001).The treatment of MESE exercise is the most effective for the improvement of the symptom and indexes in postmenopausal women. Importantly, the low attrition and the high exercise compliance indicate that MESE exercise is safe, feasible, and well tolerated by postmenopausal women.

A new antiresorptive approach to the treatment of fragility fractures: long-term efficacy and safety of denosumab

An imbalance of the remodeling process for bone resorption leads to a loss of tissue with consequent microarchitectural damage, evident in conditions such as osteoporosis and related fragility fractures. Currently, pharmacological therapies are able to prevent or slow down bone resorption by inhibiting osteoclast activity. An innovative and targeted anti-resorptive approach is represented by the inhibition of RANK ligand (RANK-L), essential for the proliferation and activity of osteoclastic cells. The human monoclonal antibody against RANK-L (denosumab) has been approved for the treatment of osteoporosis. In clinical trials of patients with osteoporosis, inhibition of RANK-L has reduced bone loss and damage to the microarchitecture and was associated with an increase in mass and resistance at different skeletal sites, with most significant effects than those demonstrated by any other antiresorptive drugs. In addition, after 3 years of treatment, it showed a reduction in vertebral and non-vertebral fracture risk. Denosumab treatment also has not revealed any alteration in the physiological processes of fracture repair, showing no increase in the onset of complications 3 years after the fracture. The data show that denosumab offers an effective alternative therapeutic approach for the treatment of severe osteoporosis, with positive effects on BMD and reduction of fragility fractures risk. So, promising results in terms of therapeutic efficacy and reliability make desirable the wide clinical use of denosumab for the treatment of osteoporotic fractures in the near future.

SP0122 Osteoporosis and bone disease

Osteoporosis can be divided in primary osteoporosis and secondary osteoporosis. In the field of primary osteoporosis, the new focus is the diagnostic and therapeutic follow-up of individuals 50 years and...

Epidemiologia dell’osteoporosi nelle malattie reumatologiche

To date, many studies have tried to establish the impact of osteoporosis and related fragility fractures in rheumatic diseases. Several cross-sectional studies reported that disability and reduced motility due to functional impairment are among the most important determinants of bone loss in different rheumatic diseases. At the same time longitudinal studies have confirmed the detrimental effect of uncontrolled disease activity on bone density. In this perspective the suppression of inflammation remains probably the main concern when considering treatment options. Besides these variables, pharmacologic agents commonly used in the treatment of rheumatic diseases have probably an adjunctive effect on bone loss in rheumatic patients. Large epidemiological studies have clearly demonstrated that patients with rheumatoid arthritis, systemic lupus erythematosus and ankylosing spondylitis are at increased risk for fragility fractures. Further studies are required to investigate the impact of osteoporosis and fragility fractures in other rheumatic diseases. A better appreciation of the impact and mechanisms of osteoporosis in rheumatic diseases by rheumatologists represents a clinical challenge but certainly a greater understanding of this frequent complication will improve the quality of health care and the lives of rheumatic patients.

L’approccio multidisciplinare alle fratture da fragilità

Osteoporosis and related fragility fractures are a serious medical and socio-economic problem that is frequently underestimated. Patients with fragility fractures are at high risk for further fractures, but awareness and cooperation of clinicians about this problem are still lacking. As a result, diagnostic and treatment procedures to implement the prevention of new fractures are at present inadequate.

Bone Mineral Density Changes in Patients with Recent-Onset Rheumatoid Arthritis

Background:Osteoporosis and related fragility fractures are one of the most common complications seen in patients with rheumatoid arthritis (RA) and dramatically affect quality of life.Objective:To evaluate changes in bone mineral density in patients with recent onset rheumatoid arthritis (<1 year) and its correlation if any with a modified DAS-28 score and simple erosion narrowing score (SENS).Methods:This study included 30 patients with recent-onset rheumatoid arthritis fulfilling the new American College of Rheumatology/European League Against Rheumatism diagnostic criteria for rheumatoid arthritis and 20 healthy volunteers as controls. All were subjected to a complete blood count, erythrocyte sedimentation rate, C-reactive protein, liver function tests, renal function tests, rheumatoid factor, and plain x-rays of the hands and feet. Dual-energy x-ray absorptiometry DEXA was used to measure bone mineral density (BMD) of the left proximal femur, lumbar spine (L1–L4), and lower distal radius at the time of recruitment.Results:In the RA patients, 13.3% had osteoporosis, 50% had osteopenia, and 36.7% had normal BMD. The most common site of osteoporosis was the lumbar spine (four patients, 13.3%) followed by the femur (two patients, 6.6%), and forearm (only one patient, 3.3%). There was a significantly higher percentage of osteoporosis among RA males than females and the difference was statistically significant (P = 0.009). Osteoporosis was more common in patients treated with corticosteroids and disease modifying antirheumatic drugs (DMARDs) than in patients treated with only nonsteroidal anti-inflammatory drugs (P = 0.004). Higher disease activity (DAS-28) was found in RA patients with osteoporosis compared to RA patients with normal BMD or osteopenia, but the difference was not statistically significant. Osteoporotic RA patients were found to have a higher SENS score for radiological damage than nonosteoporotic ones.Conclusion:BMD changes do occur in patients with early RA, and are not necessarily correlated with disease activity (DAS-28). However, a significant negative correlation was found between BMD and the score of radiological damage (SENS). Dual energy x-ray absorptiometry is an important investigation to assess BMD in early RA patients.