Risk Factors For Osteoporosis Research Articles

Osteoporosis in Chronic Obstructive Pulmonary Disease

The common risk factors for Chronic Obstructive Pulmonary Disease (COPD) and Osteoporosis are age, smoking and inactivity

Bone Mineral Density and Fracture Risk Assessment in Patients of Systemic Sclerosis

Background: Systemic sclerosis (SSc) is a chronic disease presenting in the age group of 20-50yrs and females are more affected than males. Osteoporosis is common in many rheumatological diseases and an association has been well established in Rheumatoid Arthritis and Systemic Lupus Erythematosus. However, there is no such robust data in patients affected with SSc. Our study aimed to measure Bone Mineral Density and assess the risk of fracture in patients of systemic sclerosis using the Fracture Risk Assessment using (FRAX) algorithm. Methodology: The case control study conducted in a tertiary care hospital included 24 patients of age 18-45years with systemic sclerosis and 24 age and sex matched healthy controls. 62.5% cases were antiScl-70 antibody positive, 62.5% had interstitial lung disease and 37.5% had pulmonary arterial hypertension. The BMD of Scl-70 antibody positive patients was 0.64± 0.08 gm/sq.cm at neck of femur, 0.70± 0.08 gm/sq cm at lumbar spine and 0.37± 0.06 gm/sq. cm at forearm. A significant lower T score at neck of femur was noted in cases as compared to controls (-1.91± 10 vs -0.32± 1.06, p=0.001). The mean FRAX score value for major osteoporotic fracture in cases, was 1.46± 0.61% with maximum value of 3% and minimum value of 0.9%. Whereas, for the hip fracture mean FRAX was 0.83± 0.07% with range of 0.7% to 1.9%. A significant difference was noted in risk of major osteoporotic fractures between cases and controls (p=0.017). On multivariate regression models computed to analyse the covariates of BMD for neck of femur, lumbar spine and forearm, it was observed that serum vitamin D levels, presence of pulmonary hypertension and/or ILD were significant covariates of BMD neck of femur. Conclusion: Systemic sclerosis is associated with significantly low bone mineral density compared to controls. The bone mass was negatively correlated with involvement of internal organs and serum iPTH levels. SSc may be considered as an independent risk factor for osteoporosis and patients of SSc should be evaluated for BMD with DEXA scan to prevent osteoporotic fractures.

The Monocyte-to-High-Density Lipoprotein Cholesterol Ratio as a Novel Predictor of the Prevalence of Senile Osteoporosis.

The prevalence of osteoporosis in elderly individuals is high, and osteoporosis is strongly associated with chronic inflammation. The monocyte-to-high-density lipoprotein ratio (MHR) is acknowledged as a marker for assessing systemic inflammation and oxidative stress, and changes in the MHR are associated with many chronic disease prevalent among the elderly population. This study investigated the relationships between the MHR and the incidence of osteoporosis in older adults, along with its predictive value. Data from 563 participants aged ≥70 years were retrospectively analysed. The haematological parameters were evaluated via established methodologies, utilizing fasting blood samples collected from the participants. The absolute monocyte count was used to calculate the MHR (MHR=monocyte/HDL-C). BMD was measured by dual-energy X-ray absorptiometry. The results were evaluated via comparative statistical analyses, Spearman correlation, logistic regression analyses, and receiver operating characteristic (ROC) curve analysis. The differences in the MHR were statistically significant among the osteoporosis groups (p < 0.001). Spearman correlation analysis revealed a positive correlation between the MHR and BMD. Furthermore, stratifying the sample into four groups on the basis of quartiles of MHR (M1, M2, M3, and M4) revealed a decreased risk of osteoporosis in the highest quartile compared with the lowest quartile (p <0.001). Multiple logistic regression analysis revealed that BMI and the MHR were independent risk factors for osteoporosis. The area under the ROC curve and the cut-off value of the MHR were 0.710 and 0.308(109/mmol), with specificity and sensitivity of 0.599 and 0.735, respectively (95% CI: 0.668~0.752, p < 0.0001). A low MHR was associated with a greater risk of senile osteoporosis. In clinical practice, the MHR has shown predictive value for senile osteoporosis, contributing to early intervention and treatment of this disease.

Денситометрическая оценка минеральной плотности костной ткани у пациентов молодого возраста с лимфомой Ходжкина

Hodgkin’s lymphoma is more often diagnosed in young patients. One of the late complications of pathogenetic therapy of Hodgkin’s lymphoma is osteopenia/osteoporosis and the increased risk of low-energy fractures. Conducting densitometry in young patients in order to assess the bone tissue condition is advisable, but its clinical assessment remains difficult. At the same time, early diagnosis and prevention of bone mineral density decrease in patients with Hodgkin’s lymphoma who received antitumor therapy are very relevant. The purpose — to study the features of densitometric indicators for the verification of osteopenia / osteoporosis in young patients with Hodgkin’s lymphoma. Material and methods. 63 people were included in the study, 33 of them were patients with Hodgkin’s lymphoma who received pathogenetic therapy, and 30 people the control group — healthy volunteers. Bone mineral density was measured in all patients using the HOLOGIC (Hologic Inc., Bedford) in the lumbar spine (L1–L4) and in the hip area (the total area of the hip and hip neck). Criteria such as minimum bone mineral density, T-criteria and Z-criteria for young patients with Hodgkin’s lymphoma were determined. Results. In the group of patients with Hodgkin’s lymphoma, a decrease in bone mineral density is significantly more often recorded in all measurement areas, as well as the Z-criterion in the lumbar spine. Regretfully, in young patients the T-criterion can only be used given a more intensive mineralization of bone tissue than in older people and the presence of additional risk factors for osteoporosis (PCTs, glucocorticosteroids, decreased androgenic and fertile function). In patients with HL who received pathogenetic therapy, a decrease in the T-criterion to osteopenia is more often observed in the proximal femur. Conclusion. In many cases, modern capabilities for osteoporosis diagnostic allow correcting mineral metabolism in bone tissue and preventing the development of complications in young patients with Hodgkin’s lymphoma.

Investigating β Thalassemia Patients and Their Growth: A Brief Review and Our Clinical Experience

Background: The prevalence of short stature was reported high in thalassemia major patients. It causes mental and social problems for them. As different cut-off points for growth retardation are suggested in these patients, it is desirable to find a careful cut-off age using statistical analysis to help patients before it is too late. Methods: Data from 803 thalassemia major patients was extracted from questionnaires completed in person by the operator. They contained demographic data, family, medical, and drug history. Height and weight measurements were conducted by only one device. The mean age was 20±7 years and there were 420 females in the sample. Children (&lt;20 years of age) constituted 47% of the participants. Patients who reported a major risk factor for osteoporosis were omitted from this study. The SPSS software, version 16 was used for the statistical analysis Results: Short stature was found in 32% of patients. Being 10 to 11 years old or above increased the risk of short stature, 28.5 and 21.4 times, respectively compared to younger patients (P&lt;0.001). On the other hand, after 7 years of age up to 18 years of age, similar to 10 years of age and 11 years of age, increases the risk of short stature. Also being 27 years old and 30 years old and above increases the risk of short stature 1.4 and 1.7 times, respectively, compared to younger patients (P=0.042 and &lt;0.018, respectively). Conclusions: Awareness of short stature and monitoring it in thalassemic patients should be done in their childhood. Accordingly, being 7 years old or above increases the risk of short stature; therefore, we suggest the start of monitoring as early as 5 years of age.

The Level of Knowledge, Awareness, and Practice Regarding Osteoporosis among Female Adults in Hail city, Saudi Arabia

This is a cross-sectional study conducted on the adult female population of Hail city. Informed consent was obtained from the participants through the electronic survey. The sample size needed to enroll was 384, estimated from the total female population of Hail city 267,113 by Raosoft sample size calculator, with a 95% confidence interval and 5% margin of error (General Authority for statistics). All Saudi females in Hail city constituted the study population. However, all non-Saudi females and males, Saudi or otherwise, were excluded from the study population. We used the Osteoporosis Knowledge Assessment Tool (OKAT) which was pre-validated, translated to Arabic, and self-answered questionnaire. The OKAT survey is a valid measurement of knowledge of risk factors for osteoporosis, (Tania M Winzenberg et al, 2003). It consists of 20 statements; the first 12 assess the knowledge of osteoporosis, 4 questions assess the attitude towards osteoporosis and the last 4 questions assess the preventive factors of osteoporosis. Each statement has three choices, true, false, and I do not know. The OKAT survey was translated into Arabic language which is found to be reliable and acceptable according to Sayed-Hassan et al. The questionnaire was distributed randomly through social media platforms during the period from March to May 2020. Keywords: Knowledge, awareness, practice, osteoporosis, Saudi Arabia

Оптимизация восстановления костной ткани у больных ревматоидным артритом и остеопорозом, осложненным переломами

The article provides a brief summary of bone remodeling, including its stages, disorders, and correction. Osteoporosis (OP) is a systemic skeletal disease in which bone resorption predominates over bone formation. OP is characterized by a decrease in bone mass and density, as well as a disturbance of bone microarchitecture. This leads to a decrease in bone strength and an increased risk of fractures. This paper describes a case of a woman with rheumatoid arthritis (RA) and OP complicated by low-trauma fractures. The authors emphasize that OP is a multifactorial disease and one of the most common bone diseases, particularly among the elderly. OP in RA is an immune- mediated secondary osteopathy and is considered both a comorbidity and complication of the underlying disease. Patients with RA have a higher bone mineral density (BMD) and a higher rate of fractures than the general population. Fractures can occur in individuals with osteopenia or normal BMD values. Therefore, it is important to carefully analyze the risk factors for OP and fractures when planning RA therapy. The ‘treat to target' strategy aims to achieve RA remission or reduce disease activity while also preventing complications, such as osteoporotic fractures. To manage bone metabolism disorders in patients with RA who also have osteoporosis and fractures, it is necessary to control RA activity and prescribe basic therapy for osteoporosis, such as ossein-hydroxyapatite complex and alfacalcidol, as well as pathogenic drugs that prevent bone resorption. Additionally, patients with osteoporosis and fractures require pain-reducing measures, restorative treatment, and rehabilitation. Effective management requires a multidisciplinary approach involving physicians from various specialties. KEYWORDS: bone tissue structure, resorption, rheumatoid arthritis, osteoporosis, fractures, pharmacotherapy of bone metabolism disorders, ossein-hydroxyapatite complex. FOR CITATION: Dydykina I.S., Kovalenko P.S., Kudinskiy D.M., Kovalenko A.A., Ivanova M.E. Optimizing bone repair in patients with rheumatoid arthritis and osteoporosis complicated by fractures. Russian Medical Inquiry. 2024;8(2):94–101 (in Russ.). DOI: 10.32364/2587- 6821-2024-8-2-7.

Association of bone mineral density and potential risk factors for osteoporosis in patients with severe haemophilia A.

In people with haemophilia (PWH), recurrent episodes of bleeding lead to joint deterioration and bone resorption. To date, the effects of various other factors on bone mineral density (BMD) reduction have found conflicting results. The aim of this study was to analyse the relationships between BMD, bone mineral content (BMC), and trabecular bone score (TBS) parameters based on the dual X-ray absorptiometry method (DXA) and potential risk factors for osteoporosis in patients with severe haemophilia A. Fifty-five men with severe haemophilia A, aged 18-68 years, and 59 healthy volunteer men were enrolled in this study. Densitometric-derived lumbar spine and femoral neck BMD, BMC, and TBS were measured. Blood analyses were performed for morphology parameters, liver and kidney function parameters, and viral status. Serum levels of oestradiol (E2 ), testosterone (T), dehydroepiandrosterone sulphate (DHEA-S), parathormone, and vitamin D were measured. Patients showed significantly lower BMD compared to controls (p<.003). The result below the expected range for age was nearly double (6.82%vs. 3.92%) in PWH under 50 years old compared to controls. Haemophilic patients also exhibited significantly higher vitamin D3 deficiency (p<.0001), which was strongly associated with low TBS. Additionally, low body mass index and high neutrophil/lymphocyte ratio were correlated with low BMC and BMD. This study confirms the prevalence of low BMD and BMC in patients with haemophilia in Poland. Factors that contribute to low BMD are primarily vitamin D deficiency, low BMI, high neutrophil/lymphocyte ratio, and low testosterone/oestradiol ratio.

Prevalence of vitamin D level disorders in therapeutic patients and features of their correction

Objective: to study the prevalence of vitamin D level disorders in therapeutic patients and the features of their correction.&#x0D; Materials and methods: 322 patients who applied for medical help in the field of therapy (rheumatology and cardiology) were examined. Methods: clinical, laboratory (study of the level of vitamin D in the blood), statistical.&#x0D; Results: it was found that among patients with a therapeutic profile, vitamin D concentration disorders (deficiency and insufficiency) occur in 72,7 % of the surveyed. There is a high prevalence of risk factors for osteoporosis in the examined patients: female sex prevails (81 %), age average age was (53,6 14,3) years, drug use (50 % take proton pump inhibitors, 21,4 % take glucocorticoids). When comparing the proportion of people with impaired vitamin D levels in comparison with the data of previous years, there was a decrease in the proportion of people with vitamin D deficiency and an increase in the proportion of people with vitamin D deficiency. Among people with a vitamin D level of 30100 ng/ml, daily use of vitamin D preparations in dosages exceeding the recommended consumption levels was noted.&#x0D; Conclusion: based on the data obtained, the prevalence of vitamin D deficiency and insufficiency remains high. However, recently there has been a trend towards a decrease in the proportion of people with vitamin D deficiency and an increase in the proportion of people with vitamin D deficiency. In this connection, it is necessary to inform the population about the recommended adequate levels of vitamin D in blood serum and safe dosages of vitamin D preparations for daily intake.

Prediction of osteoporosis in patients with rheumatoid arthritis using machine learning

Osteoporosis is a serious health concern in patients with rheumatoid arthritis (RA). Machine learning (ML) models have been increasingly incorporated into various clinical practices, including disease classification, risk prediction, and treatment response. However, only a few studies have focused on predicting osteoporosis using ML in patients with RA. We aimed to develop an ML model to predict osteoporosis using a representative Korean RA cohort database. The KORean Observational study Network for Arthritis (KORONA) database, established by the Clinical Research Center for RA in Korea, was used in this study. Among the 5077 patients registered in KORONA, 2374 patients were included in this study. Four representative ML algorithms were used for the prediction: logistic regression (LR), random forest, XGBoost (XGB), and LightGBM. The accuracy, F1 score, and area under the curve (AUC) of each model were measured. The LR model achieved the highest AUC value at 0.750, while the XGB model achieved the highest accuracy at 0.682. Body mass index, age, menopause, waist and hip circumferences, RA surgery, and monthly income were risk factors of osteoporosis. In conclusion, ML algorithms are a useful option for screening for osteoporosis in patients with RA.

Dehydrocostus lactone (DHC) promotes osteoblastic differentiation and mineralization through p38/RUNX-2 signaling.

Dysregulation of osteoblastic differentiation is an important risk factor of osteoporosis, the therapy of which is challenging. Dehydrocostus lactone (DHC), a sesquiterpene isolated from medicinal plants, has displayed anti-inflammatory and antitumor properties. In this study, we investigated the effects of DHC on osteoblastic differentiation and mineralization of MC3T3-E1 cells. Interestingly, we found that DHC increased the expression of marker genes of osteoblastic differentiation, such as alkaline phosphatase (ALP), osteocalcin (OCN), and osteopontin (OPN). Additionally, DHC increased the expressions of collagen type I alpha 1 (Col1a1) and collagen type I alpha 2 (Col1a2). We also demonstrate that DHC increased ALP activity. Importantly, the Alizarin Red S staining assay revealed that DHC enhanced osteoblastic differentiation of MC3T3-E1 cells. Mechanistically, it is shown that DHC increased the expression of Runx-2, a central regulator of osteoblastic differentiation. Treatment with DHC also increased the levels of phosphorylated p38, and its blockage using its specific inhibitor SB203580 abolished the effects of DHC on runt-related transcription factor 2 (Runx-2) expression and osteoblastic differentiation, suggesting the involvement of p38. Based on these findings, we concluded that DHC might possess a capacity for the treatment of osteoporosis by promoting osteoblastic differentiation.

Low screening rates and high prevalence of osteoporosis in cirrhosis: A real-world retrospective analysis.

Patients with cirrhosis are at increased risk for osteoporosis, and those who suffer a fracture are at high risk for mortality. Despite this, osteoporosis is often overlooked and undertreated. This study aimed to evaluate osteoporosis screening, management, and adverse osteoporosis medication events in patients with cirrhosis. We performed a retrospective chart review of adult outpatients with compensated and decompensated cirrhosis seen in single health system over a 6-year period. Patient demographics, liver and bone health comorbidities, DEXA scan results, and medications were abstracted. In total, 5398 patients met criteria. The cohort was predominately white (79.1%) and older (age 59). 44.4% were female. 64.6% had decompensated cirrhosis. Median MELD-Na score was 12.8. 23.5% had a DEXA scan ordered, approximately 50% completed this test. Patients who were older, female, white, with more severe liver disease, and other osteoporosis risk factors were more likely to have a DEXA scan ordered. 48.5% of patients had osteopenia and 30.2% had osteoporosis on DEXA scan. Only 22.6% of patients with osteoporosis received treatment, most commonly oral bisphosphonates. Oral bisphosphonate prescription was not associated with variceal bleeding (8.4% without vs. 4.8% with, p = 0.487). A minority of patients with cirrhosis were screened for osteoporosis. The majority screened had osteopenia or osteoporosis on DEXA scan. Less than a quarter of patients with osteoporosis were started on treatment. Real-world experience of oral bisphosphonate use did not reveal higher rates of gastrointestinal bleeding. There is room for improvement in all aspects of bone health care in cirrhosis.

Links between three chronic and age-related diseases, osteoarthritis, periodontitis, and osteoporosis, in a wild mammal (moose) population

ObjectiveOsteoarthritis, periodontitis and osteoporosis are chronic, age-related diseases which adversely impact millions of people worldwide. Because these diseases pose a major global public health challenge, there is an urgent need to better understand how these diseases are interrelated. Our objective was to document the age and sex-specific prevalence of each disease and assess interrelationships among the three diseases in a wild mammal (moose, Alces alces) population. MethodsWe examined the bones of moose dying from natural causes and recorded the severity of osteoarthritis (typically observed on the hip and lowest vertebrae), osteoporosis (osteoporotic lesions observed on the skull) and periodontitis (observed on maxilla and mandibles). ResultsPeriodontitis was associated with a greater prevalence of both severe osteoarthritis and osteoporotic lesions in moose. We found no evidence to suggest that moose with osteoporotic lesions were more or less likely to exhibit signs of osteoarthritis or severe osteoarthritis. The prevalence of osteoarthritis, periodontitis and osteoporotic lesions was greater among males than for females. ConclusionsOur results were consistent with the hypothesis that bacterial pathogens causing periodontitis are a risk factor for osteoarthritis and osteoporosis. They are also consistent with the hypothesis that the inverse association between osteoarthritis and osteoporosis sometimes observed in humans may be influenced by shared risk factors, such as obesity, smoking or alcohol consumption, which are absent in moose. Together these results provide insights about three diseases which are expected to become more prevalent in the future and that cause substantial socio-economic burdens.

Prevalence and associated risk factors of osteoporosis among residents living in a nursing home: A pilot study

Prevalence and associated risk factors of osteoporosis among residents living in a nursing home: A pilot study

Osteoporosis in Renal Disease.

Osteoporosis is a disorder characterized by decreased bone mass and skeletal fragility with increased fracture risk. Chronic kidney disease presents with wide range of bone metabolic disorders, including osteoporosis. Osteoporosis prevalence is high in early stages of CKD; whereas in late stages, it coexists with renal osteodystrophy. Risk factors for osteoporosis include advancing age, low bone mineral density (BMD), glucocorticoid therapy, smoking, alcohol intake, etc. The diagnosis of osteoporosis in renal disease is made after assessment of BMD, in addition to exclusion of chronic kidney disease-mineral bone disorder (CKD-MBD), eliciting history of prior fragility fractures and relevant laboratory investigations. The treatment of osteoporosis varies with the different stages of CKD, with management in stages 1-3 being similar to the general population. Special emphasis must be laid on prevention of fractures as well.

Evaluation of cortical and trabecular bone structure of the mandible in patients using L-Thyroxine

BackgroundLong-term use of L-Thyroxine (LT4), the synthetic thyroxine hormone used for thyroid hormone replacement therapy, is an important risk factor for osteoporosis. The aim of this study was to investigate the differences between mandibular cortical index (MCI) and trabecular bone fractal dimension (FD) values on panoramic radiographs of patients using LT4 and control subjects.MethodsA total of 142 female patients, 71 cases and 71 controls, were analyzed in the study. Ages were matched in case and control groups and the mean age was 36.6 ± 8.2 (18 to 50) years. MCI consisting of C1 (Normal Mandibular Cortex), C2 (Moderately Resorbed Mandibular Cortex) and, C3 (Severely Resorbed Cortex) scores was determined for case and control groups. Fractal analysis was performed using ImageJ on selected regions of interest from the gonial and interdental regions. The box-count method was used to calculate FD values. Wilcoxon signed-rank test, Mann-Whitney U test, and Spearman correlation analysis were applied to compare the measurements. Statistical significance of differences was established at P < 0.05 level.ResultsFD values did not show statistically significant differences between case and control groups (p > 0.05). The mean FD in the right gonial region was 1.38 ± 0.07 in the case group and 1.38 ± 0.08 in the control group (p = 0.715). The mean FD in the right interdental region was 1.37 ± 0.06 in the cases and 1.36 ± 0.06 in the control group (p = 0.373). The mean FD in the left gonial region was 1.39 ± 0.07 in the cases and 1.39 ± 0.07 in the control group (p = 0.865). The mean FD in the left interdental region is 1.37 ± 0.06 in the cases and 1.38 ± 0.05 in the control group (p = 0.369). The most common MCI score was C1, with 62% in the cases and 83.1% in the control group. MCI scores showed a statistically significant difference between cases and controls (p = 0.016, p < 0.05). While the C2 score was higher in the cases, the C1 score was higher in the controls.ConclusionsLT4 use was not associated with the FD of mandibular trabecular bone, but was associated with MCI values of cortical bone. Further studies on larger samples with different imaging modalities and image processing methods are needed.

Epidemiology of Osteoporosis.

India has a population capacity of 1.2 billion people. With a worldwide aging population, the prevention and management of osteoporosis has become a significant healthcare challenge. It is crucial to recognize the factors impacting poor bone health and appreciate the many hurdles to treat the disease to provide a better quality of life and decrease the financial burden on healthcare. In this review article, we discuss the epidemiology of osteoporosis and address the definition, incidence, and prevalence, geographical variation in the occurrence of osteoporosis, and the risk factors for osteoporosis. Search terms using various combinations of the keywords 'osteoporosis,' 'epidemiology,' 'incidence,' 'prevalence,' 'fracture,' 'India,' 'world,' 'screening,' and 'FRAX' was done to review all relevant literature till June 2023. India has a recent estimate of population capacity of 1.2 billion people. Various studies have revealed an osteoporosis prevalence in Indian women ranging from 8% to 62%. Poor dietary calcium intake, low vitamin D, and lifestyle changes contribute to osteoporosis.

An Investigation of the Risk Factors of Osteoporosis and the Correlation between Drug Consumption and Osteoporosis: Results of the Fasa PERSIAN Cohort Stud

Background: Osteoporosis, as the most common bone-related disease, causes massive irrecoverable consequences for the health level and life quality of people, especially at advanced ages. The present research aimed to evaluate the prevalence and risk factors of osteoporosis and the correlation between drug consumption and osteoporosis. The present study is a cross-sectional study and is the first stage in the longitudinal Fasa branch of the PERSIAN cohort study. Materials and Methods: The subjects of the present cross-sectional-descriptive study consisted of all cohort populations of Fasa University of Medical Sciences (n=10123) who were chosen through census sampling. The data were collected through a demographic data form and medication checklist, and SPSS-22 was used to analyze the data. Results: Among a total population of 10133, 994 had osteoporosis, of which 880 were women and 114 were men, which was statistically significant (P&lt;0.05). The overall prevalence rate of osteoporosis was estimated to be 9.8%, and the mean age of people with osteoporosis was 56 years. The results demonstrated significant positive correlations among osteoporosis and age, gender, marital status, education, smoking, physical activity, alcohol use, hypertension, diabetes mellitus, fatty liver, and glucocorticoid steroid drugs (P&lt;0.05). Conclusion: Identifying factors related to osteoporosis can be effective in adopting health promotion programs at all healthcare and prevention levels. Thus, the use of some drugs, such as corticosteroids, as an alarm and risk factor should be taken into consideration by specialists when adopting healthcare plans.

Assessing the knowledge, attitude and practice of osteoporosis among Pakistani women: A national social-media based survey.

There are numerous risk factors for osteoporosis and understanding and recognizing these risk factors is critical when deciding whether to take preventive measures. It is critical to reduce the healthcare expenditure burden of the Pakistani population by raising awareness and implementing osteoporosis-preventable measures. This survey aims to assess the knowledge, attitudes, and practices (KAP) of Pakistani women as well as their misconceptions about osteoporosis. A cross-sectional survey was conducted from August 2021 to January 2022 by the Bone & Mineral Disease research group at Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, with exemption from the ethical review committee. Using snowball sampling, a validated Osteoporosis Prevention and Awareness Tool (OPAAT) was disseminated online via social media. With informed consent, 400 Pakistani women aged ≥ 18 years were included in the study. SPSS Statistics version 25.0 was used for data analysis. Chi-square test for association and Fisher-exact test were applied, and significance level was α<0.05. Based on the OPAAT scores of all (n = 400) participants, 22% (n = 88) had low knowledge, 44% (n = 176) had average knowledge, while 34% (n = 136) had good knowledge of osteoporosis. The most common misconceptions were about age-related risk, presentation of symptoms, radiation risk, associated risk factors like tooth loss, osteoarthritis, and knowledge about predictors of bone health. Adult Pakistani women have a fair understanding of osteoporosis, but the OPAAT tool clarifies some common misconceptions. There is a need to develop educational strategies to increase the knowledge of osteoporosis among Pakistani adults and to promote a bone-healthy lifestyle.

Risk of fracture in women with glucocorticoid requiring diseases is independent from glucocorticoid use: An analysis on a nation-wide database

ObjectiveGlucocorticoid-induced osteoporosis (GIOP) is a common cause of secondary osteoporosis. However, glucocorticoid requiring diseases pose a risk themselves for fracture. The aim of the present study was to determine the risk of fracture associated with variety of glucocorticoid requiring diseases independently from glucocorticoid use and other risk factors for osteoporosis. MethodsWe conducted a retrospective cross-sectional analysis of a nation-wide cohort (DeFRACalc79 database). We used multivariable regression analysis adjusting for several risk factors for fracture and glucocorticoid intake to estimate the independent role of glucocorticoid requiring illnesses on fracture risk. ResultsWe found that patients with rheumatoid arthritis, connective tissue diseases, chronic obstructive pulmonary disease (COPD) and neurological diseases were at greater risk of vertebral or hip fracture (crude ORs 1.31, 1.20, 1.92 and 2.97 respectively). After adjusting for potential confounders COPD and neurological diseases remained significantly associated with an increased risk of vertebral or hip fractures (aORs 1.33, 95 % CI 1.18–1.49 and 2.43, 95 % CI 2.17–2.74). Rheumatoid arthritis, COPD, IBD and neurological diseases also significantly increased the risk of non-vertebral, non-hip fractures (aORs 1.23, 1.42, 1.52 and 1.94 respectively). ConclusionSome glucocorticoid requiring diseases were independently associated with an increased risk of fractures. COPD and neurological diseases with both vertebral and non-vertebral fracture risk while RA and IBD were independently associated only with non-vertebral, non-hip fractures.