Risk Of Osteoporosis In Patients Research Articles

Sex-specific association of serum dehydroepiandrosterone and its sulfate levels with osteoporosis in type 2 diabetes.

This study is to investigate the relation between serum dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) levels and the risk of osteoporosis in patients with T2DM. This cross-sectional study involved 938 hospitalized patients with T2DM. Linear regression models were used to explore the relationship between DHEA and DHEAS and the BMD at different skeletal sites. Multinominal logistic regression models and the restricted cubic spline (RCS) were used to evaluate the associations of DHEA and DHEAS with the risks of osteopenia and/or osteoporosis. In postmenopausal women with T2DM, after adjustment for confounders including testosterone and estradiol, DHEA showed a significant positive correlation with lumbar spine BMD (P = 0.013). Moreover, DHEAS exhibited significant positive correlations with BMD at three skeletal sites: including femoral neck, total hip, and lumbar spine (all P < 0.05). Low DHEA and DHEAS levels were associated with increased risk of osteopenia and/or osteoporosis (all P < 0.05) and the risk of osteoporosis gradually decreased with increasing DHEAS levels (P overall = 0.018, P-nonlinear = 0.559). However, DHEA and DHEAS levels in men over the age of 50 with T2DM were not associated with any of above outcomes. In patients with T2DM, independent of testosterone and estradiol, higher DHEA and DHEAS levels are associated with higher BMD and lower risk of osteopenia/osteoporosis in postmenopausal women but not men over the age of 50.

Bone loss over time and risk of osteoporosis in advanced pancreatic cancer.

Pancreatic cancer has a high risk of developing osteoporosis. However, the impact of osteoporosis has not been well-studied. This study aimed to evaluate bone loss over time and risk of osteoporosis in patients with advanced pancreatic cancer. We retrospectively examined consecutive patients with unresectable pancreatic cancer who had evaluable computed tomography before treatment and at 1-year follow-up. Bone mineral density at the first lumbar vertebra was measured on computed tomography, and osteoporosis was defined as bone mineral density <135 Hounsfield units. The prevalence and risk factors for osteoporosis, changes in bone mineral density over time and incidence of bone fractures were analyzed. Three hundred eighty patients were included. Osteoporosis was associated with older age, female sex, low body mass index and poor performance status at baseline. A consistent decrease in bone mineral density was observed over time regardless of age, sex or disease status, resulting in an increase in the prevalence of osteoporosis over time (47% at baseline, 79% at 1year, 88% at 2years, 89% at 3years, 95% at 4years and 100% at 5years). Changes in bone mineral density from baseline were greater in patients with locally-advanced pancreatic cancer, in those who received modified FOLFIRINOX or S-IROX for more than 3 months, and in those who received radiation therapy. Incident fractures developed in 45 patients (12%) during follow-up. Osteoporosis and osteoporotic fractures were highly prevalent in patients with advanced pancreatic cancer. This study highlights the importance of screening for osteoporosis in such patients.

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.

Machine learning predicts the risk of osteoporosis in patients with breast cancer and healthy women

ObjectiveIn this study, we investigated the effects of endocrine therapy and related drugs on the body composition and bone metabolism of patients with breast cancer. Additionally, using body composition-related indicators in machine learning algorithms, the risks of osteoporosis in patients with breast cancer and healthy women were predicted.MethodsWe enrolled postmenopausal patients with breast cancer who were hospitalized in a tertiary hospital and postmenopausal women undergoing health checkups in our hospital between 2019 and 2021. The basic information, body composition, bone density-related indicators, and bone metabolism-related indicators of all the study subjects were recorded. Machine learning models were constructed using cross-validation.ResultsCompared with a healthy population, the body composition of patients with breast cancer was low in bone mass, protein, body fat percentage, muscle, and basal metabolism, whereas total water, intracellular fluid, extracellular fluid, and waist-to-hip ratio were high. In patients with breast cancer, the bone mineral density (BMD), Z value, and T value were low and the proportion of bone loss and osteoporosis was high. BMD in patients with breast cancer was negatively correlated with age, endocrine therapy status, duration of medication, and duration of menopause, and it was positively correlated with body mass index (BMI) and basal metabolism. The parameters including body composition, age, hormone receptor status, and medication type were used for developing the machine learning model to predict osteoporosis risk in patients with breast cancer and healthy populations. The model showed a high accuracy in predicting osteoporosis, reflecting the predictive value of the model.ConclusionsPatients with breast cancer may have changed body composition and BMD. Compared with the healthy population, the main indicators of osteoporosis in patients with breast cancer were reduced nonadipose tissue, increased risk of edema, altered fat distribution, and reduced BMD. In addition to age, duration of treatment, and duration of menopause, body composition-related indicators such as BMI and basal metabolism may be considerably associated with BMD of patients with breast cancer, suggesting that BMD status can be monitored in clinical practice by focusing on changes in the aforementioned indexes, which may provide a way to prevent preclinical osteoporosis.

Serum 14‑3‑3η levels are increased and associated with a higher risk of osteoporosis in patients with rheumatoid arthritis: A meta‑analysis.

14-3-3η can regulate the cell cycle, immunity, inflammation and the secretion of matrix metalloproteinases, while it may also be involved in the development of rheumatoid arthritis (RA) and promote bone injury. Therefore, the present meta-analysis focused on the dysregulated serum levels of 14-3-3η and its association with osteoporosis in patients with RA. Studies comparing the serum levels of 14-3-3η between patients with RA and healthy controls (HCs) or patients with RA with different bone mineral densities were retrieved from the EMBASE, Web of Science, PubMed and Cochrane databases. A total of 14 studies comprising 2,164 patients with RA and 1,136 HCs were included and analysed. Pooled analyses showed that the serum levels of 14-3-3η were enhanced in patients with RA compared with HCs [standardized mean difference (SMD): 1.34; 95% confidence interval (CI): 1.01-1.66; P<0.001]. In addition, the serum levels of 14-3-3η were also significantly higher in patients with RA with osteoporosis and osteopenia compared with those with normal bone mass (SMD: 1.96; 95% CI: 0.01-3.92; P=0.049 and SMD: 0.80; 95% CI: 0.09-1.52; P=0.028, respectively). Begg's and Egger's tests demonstrated that the publication bias for each evaluated indicator was low (all P>0.05). However, sensitivity analyses revealed that the findings were not very robust, which may be due to the omission of several individual studies. Overall, the present meta-analysis suggested that the serum levels of 14-3-3η were elevated and were associated with a higher risk of osteoporosis in patients with RA, thus supporting its potency as a circulating biomarker in the management of RA.

Increased risk of osteoporosis in patients with cognitive impairment: a systematic review and meta-analysis

BackgroundBoth osteoporosis and cognitive impairment affect overall health in elderly individuals. This study aimed to investigate the association between cognitive impairment and the risk of osteoporosis.MethodsPubMed, Web of Science, and the Cochrane Library were searched for studies on the association between osteoporosis and cognitive impairment from their inception until August 2023. The random-effects model was used to calculate the pooled risk ratio (RR) of osteoporosis in patients with cognitive impairment. Subgroup analysis was used to detect the sources of heterogeneity. Sensitivity analysis was used to test the robustness of the pooled results. Funnel plots, Egger’s test, and Begg’s test were used to test publication bias.ResultsTen studies involving 9,872 patients were included in this meta-analysis. The pooled results showed that patients with cognitive impairment had an increased risk of osteoporosis (RR = 1.56, 95% confidence interval [CI]: 1.30–1.87, p < 0.001). Subgroup analysis showed that patients with Alzheimer’s disease (AD) are at 1.7-fold risk of osteoporosis compared with the control group (RR = 1.70, 95% CI: 1.23–2.37, p = 0.001), and sex, cognitive classification, study region, study design, and study quality might be the sources of heterogeneity. Sensitivity analysis showed robustness of the pooled results. No significant publication bias was found (Begg’s test, p = 0.474; Egger’s test, p = 0.065).ConclusionCurrent evidence suggests that patients with cognitive impairment are at increased risk of osteoporosis, especially patients with AD.

Evaluation of Bone Mineral Changes in Panoramic Radiographs of Hypothyroid and Hyperthyroid Patients Using Fractal Dimension Analysis

Objective Hyperthyroidism and hypothyroidism are endocrinopathies that cause a decrease in bone mineral density. The aim of this study is to investigate possible bone changes in the mandible caused by hyperthyroidism and hypothyroidism using fractal analysis (FA) on panoramic radiographs.Material and Methods Panoramic radiographs of a total of 180 patients, including 120 patient groups (60 hyperthyroid, 60 hypothyroid) and 60 healthy control groups, were used. Five regions of interests (ROI) were determined from panoramic radiographs and FA was performed. ROI1: geometric midpoint of mandibular notch and mandibular foramen, ROI2: geometric midpoint of mandibular angle, ROI3: anterior of mental foramen, ROI4: basal cortical area from distal mental foramen to distal root of first molar, ROI5: geometric center of mandibular foramen and mandibular ramus.Results While a significant difference was observed between the patient and control groups regarding ROI1 and ROI2 (p < 0.05); there was no significant difference between the groups in relation to ROI3, ROI4, and ROI5. All FA values were lower in the hyperthyroid group than in the hypothyroid group.Conclusion Fractal analysis proves to be an effective method for early detection of bone mass changes. In the present study, it was concluded that while the mandibular cortical bone was intact, trabecular rich regions were affected by osteoporosis caused by thyroid hormones. Necessary precautions should be taken against the risk of osteoporosis in patients with thyroid hormone disorders.

Association of cholecystectomy with osteoporosis risk: a prospective study using data from the UK Biobank.

To investigate whether prior cholecystectomy is associated with incident osteoporosis. Cholecystectomy may have consequences involving abnormal metabolism. Studies investigating the association between prior cholecystectomy and osteoporosis have yielded inconsistent results. In total, 17,603 UK Biobank participants underwent cholecystectomy, and 35,206 matched controls were included in this study. They were followed up for incident osteoporosis, which was determined using ICD-10 codes (M80-82). The association between cholecystectomy and osteoporosis was assessed using Cox proportional regression modeling. The association between osteoporosis risk and cholecystectomy was further analyzed across age, sex, serum vitamin D level, and body mass index (BMI) categories. Within a median follow-up period of 13.56 years, 3,217 participants were diagnosed with osteoporosis. After adjustment for relevant confounders, prior cholecystectomy was associated with a 1.21 times higher risk of osteoporosis in women (hazard ratio (HR): 1.21 [95% CI, 1.12-1.31], p < 0.001) and a 1.45 times higher risk in men (HR: 1.45 [95% CI, 1.10-1.90], p = 0.007). In women, the association was stronger for patients who were aged 40-55 years, with BMI < 18.5 kg/m2, and vitamin D between 30 and 50 nmol/ml. No significant interactions between cholecystectomy and income level, education level, presence of hypertension, or diabetes were identified in either sex. Our findings indicated that people who underwent cholecystectomy had a higher risk of developing osteoporosis after adjustment for potential confounders. Our findings suggest that awareness of the risk of osteoporosis in patients with a history of cholecystectomy is merited.

Pokaznyky kaltsiievo-fosfornoho obminu ta remodeliuvannia kistok yak chynnyky ryzyku vynyknennia porushen mineralnoi shchilnosty kistkovoi tkanyny u khvorykh na revmatoidnyi artryt

Introduction. Osteoporosis (OP) is one of the most common causes of disability decrease in life expectancy among the elderly. The main risk factors for the occurrence of osteoporosis in patients with rheumatoid arthritis (RA) include family predisposition, female sex, age, the presence of menopause, chronic inflammatory process and its treatment. The current task remains the assessment of risk factors for the occurrence of OP in patients with RA, and there is also the need to assess risk factors for the occurrence of OP in patients with RA based on the results of laboratory parameters of calcium-phosphorus metabolism and markers of bone remodeling, which will improve the diagnosis of bone mineral density (BMD) disorders. The aim of the study. To determine the indices of calcium-phosphorus metabolism and bone remodeling as risk factors for the occurrence of bone mineral density disorders in patients with rheumatoid arthritis. Materials and methods. To the study were randomly enrolled 76 patients with RA (64 women (84.21%) in the premenopausal period and 12 men (15.78%) 38-60 years old (the average age at the time of examination of women – 48.67 ± 2.34 years, men – 45.42 ± 2.78). All patients were receiving methylprednisolone at a dose of 4.0 mg/day and a short course during an exacerbation up to 24.0 mg/day for RA treatment, but received no drugs for the treatment of BMD disorders. All patients underwent an assessment of BMD using ultrasound bone densitometry of the calcaneus, indicators of calcium-phosphorus metabolism and markers of bone remodeling were determined. Based on the obtained results, patients were stratified into three groups as follows: (1) 18 patients – 15 women and 3 men, aged 38-52, with RA without BMD disorders; (2) 34 patients – 31 women and 3 men, aged 38-54, with RA and osteopenia; (3) 24 patients – 18 women and 6 men, aged 41-53, with RA and OP. The control group consisted of 22 practically healthy individuals. Results. Patients with RA without BMD disorders significantly more often observed a decrease in the content of total calcium (p is less than 0.015) and ionized calcium (p is less than 0.000) in the blood serum, as well as a decrease in the individual osteocalcin (OK) index (р is less than 0.000). These patients were also endangered with reduced OC and/or total Ca in blood serum (p is less than 0.005). It was also revealed that in RA patients a decrease in urinary phosphorus indicates higher risk of osteopenia compared to RA patients with normal reference values of the same index (p is less than 0.000). Moreover, in patients with RA increased ionized calcium and decreased phosphorus indeces in urine correlated with significantly higher risk of osteoporosis compared to RA patients with these indeces normal levels (p is less than 0.050). According to the obtained data, an increase in the β-CrossLaps index in patients with RA is a risk factor for the occurrence both osteopenia and OP (p is less than 0.050). It was also founded that the reduced OC and increased ionized calcium levels can be treated as a risk factor for the occurrence of OP in patients with RA (p is less than 0.023). Conclusions. The risk of osteopenia in patients with rheumatoid arthritis without a violation of the mineral density of bone tissue is significantly higher in case of decreased content of blood serum total calcium or ionized calcium levels, or reduced osteocalcin index, or a simultaneous decreased content of total calcium and osteocalcin levels in blood serum. The risk of osteopenia in patients with rheumatoid arthritis is significantly higher if there is detected decreased phosphorus content in urine, or an increasede content of C-terminal telopeptide in blood serum, specific for the degradation of type I collagene. The risk of osteoporosis in patients with rheumatoid arthritis is significantly higher if there is a statistically significant increased level of ionized calcium in blood serum, or decreased content of phosphorus in the urine, or increased serum level of C-terminal telopeptidee, or an increased level of ionized calcium in the blood serum accompanied by a reduced level of osteocalcin. Keywords: calcium-phosphorus metabolism, bone remodeling markers, osteoporosis, osteocalcin, rheumatoid arthritis, bone mineral density.

Analysis of Molecular Genetic Markers of Osteoporosis in Residents of the Russian Federation

Relevance. Osteoporosis is a multifactorial disease with a high level of disability, which is a serious health problem worldwide. High prevalence and disability rates are associated not only with the peculiarities of the course of this pathology, but also with the untimely diagnosis and initiation of therapy. Therefore, it is extremely relevant to search for specific and accessible markers of osteoporosis, such as molecular genetic markers or single-nucleotide polymorphisms, analysis of which will help identify risk factors for disease development before clinical symptoms manifest during patient examinations.Aims. This study is aimed at finding risk factors for the development of HCG in patients with gastritis and the relationship of polymorphisms of various genes with the development of this pathology.Materials and methods. A search was made for the association with osteoporosis of singlenucleotide polymorphisms of the genes: COL1A1, CYP2R1, ESR1, LCT, LRP5, VDR in residents of the Russian Federation (n = 669). Polymorphic markers of candidate genes were selected for research based on the presence of associations with osteoporosis according to previously conducted studies published in the RSCI, PubMed, Web of Science, MEDLINE, Scopus databases, as well as on the results of monitoring polymorphisms included in the panels of genetic predisposition to osteoporosis of companies engaged in genetic testing in the Russian Federation. Two groups were formed for the study: the main (case) – 234 patients with an established diagnosis of Osteoporosis, the control – 435 patients selected using a random number generator from conditionally healthy individuals from the Basis Genomic Group database (Basis Genomics LLC). The groups were comparable in age and gender (p &gt; 0.05).Statistical analysis was carried out using the StatTech v. 3.1.6. program (developed by Stattech LLC, Russia). The nature of the distribution of quantitative data was checked by the Shapiro-Wilk, Kolmogorov-Smirnov criteria, the statistical significance of differences in 2 independent groups was assessed using the Mann-Whitney U-test. The ꭓ2 Pearson criterion was used to evaluate the associations of alleles of selected genes with the risk of osteoporosis.Results and discussions. Analysis of the maps of 669 patients showed that for residents of the Russian Federation, the polymorphism rs3736228 of the LRP5 gene can be used as a genetic marker of osteoporosis, since there were significant differences in the frequency of occurrence of CT and TT allele variants in the group of patients with osteoporosis and in the control group. Results of studies of single-nucleotide polymorphisms COL1A1_rs1800012_G/T, CYP2R1_rs10741657_A/G, ESR1_rs2234693_C/T, ESR1_rs9340799_A/G, LCT_rs4988235_C/T, VDR_rs1544410_A/G, VDR_rs2228570_C/T in residents of the Russian Federation The federations did not show significant differences between the groups, therefore, in the future, the results of studies of these polymorphisms to assess the risk of osteoporosis in patients should be evaluated with caution.Conclusions. According to the results of the study conducted on residents of the Russian Federation, only one of the eight alleles in candidate genes for the risk of osteoporosis showed a significant relationship in patients in the Russian Federation. It has been shown that variants of TT and CT polymorphism rs3736228 of the LRP5 gene are the risk genotype for osteoporosis.

Bone mineral density and its influential factors in Chinese patients with newly diagnosed Crohn's disease.

Bone loss is a common morbidity sign in patients with inflammatory bowel disease. Bone mineral density measurement is currently recommended for those with high risk of osteoporosis in patients with inflammatory bowel disease. However, there is lack of evidence in the need of bone mineral density measurement in patients who are young at the age of first onset. In this study, we aimed to investigate the prevalence of bone mineral density disorders in newly diagnosed Crohn's disease with young age and to determine potential risk factors. A retrospective cross-sectional study from a single center was conducted. Dual energy X-ray absorptiometry scan was collected to evaluate the prevalence of bone mineral density disorders (including osteopenia and osteoporosis) in newly diagnosed Crohn's disease with young age. Logistic regression analysis was applied to investigate risk factors for bone mineral density disorders. A total of 221 patients with Crohn's disease were included in this study. 23.1% or 39.4% of patients with osteopenia and 8.6% or 7.2% of patients with osteoporosis were diagnosed (Z-score and T-score respectively). Male and body mass index at diagnosis were identified as independent factors for bone mineral density disorders. Bone mineral density disorders are common in newly diagnosed Crohn's disease with young age. Male and malnourished patients are at high risk of bone loss. Therefore, bone mineral density measurement and early intervention are recommended in these patients. This article is protected by copyright. All rights reserved.

The risk of osteoporosis in patients with ankylosing spondylitis—A large retrospective matched cohort study

BackgroundAnkylosing spondylitis (AS) is associated with increased bone turnover and systemic inflammation. Osteoporosis is common but frequently underappreciated in AS, studies regarding the incidence of osteoporosis in AS are limited and based on small cohorts. The aim of this study is to assess the risk of osteoporosis in patients with AS compared to matched controls. MethodsA population based retrospective cohort study using data retrieved from a large electronic medical record in Israel, the Clalit health services. Included patients that were diagnosed with AS from January 2002 to December 2018 were followed for development of osteoporosis. The incidence of osteoporosis was compared between AS and controls and a logistic regression model was used to assess the interaction between AS and osteoporosis. ResultsThe study included 5476 AS patients, and 27,657 age- and sex-frequency matched controls. The incidence of osteoporosis in AS patients was significantly higher than controls (4.7% vs 2.8%, p<0.001) in the whole cohort as well as when stratified by sex. Osteoporosis developed earlier in patients with AS versus controls (4.1 vs 5.2 years, p<0.001). In multivariate analysis and after adjustment to several potential confounders, AS was found to independently associated with osteoporosis (HR 1.83, 95%CI 1.58–2.11, p<0.0001). ConclusionsOur study confirms the higher incidence and earlier development of osteoporosis in patients with AS. Such finding highlights the increased need of awareness and earlier detection of such comorbidity allowing prompt treatment to prevent undesired sequalae including increased risk of fractures.

Vitamin D receptor gene polymorphisms influence on clinical profile and bone mineral density at different skeletal sites in postmenopausal osteoporotic women.

Bone remodeling is marked by bone synthesis and absorption balance, and any altered dynamic in this process leads to osteoporosis (OP). The interaction of hormonal, environmental and genetic factors regulate bone metabolism. Since vitamin D displays a classic role in bone metabolism regulation, acting through vitamin D receptor (VDR), the genetic variants within VDR were the first ones associated with bone density and remodelling. Therefore, we investigated whether three single nucleotide polymorphisms (SNPs) within VDR were associated with OP differential susceptibility and clinical profile from postmenopausal versus healthy women from Northeast Brazil. Genetic association study enrolling 146 postmenopausal osteoporotic women as the patient group and 95 healthy age-matched women as the control group. We assessed three SNPs within VDR (rs11168268, rs1540339 and rs3890733), considering the clinical profile of all patients. Our results showed an association of rs11168268 G/G genotype with higher bone mineral density (BMD) mean for the total hip (A/A=0.828±0.09; A/G=0.081±0.13; G/G=0.876±0.12, p=.039), and the rs3890733 T/T genotype was associated with increased OP risk in patients below 60 years old (odds ratio [OR]=5.12, 95% confidence interval [CI]=1.13-23.27, p=.012). The rs1540339 T/T genotype was associated with protection for individuals with low melanin deposition when compared to the high melanin deposition group (OR=0.24, 95%CI=0.06-0.94, p=.029). Additionally, 61% of patients presented deficient vitamin D serum levels. The SNP rs11168268 G/G was associated with a significantly increased mean total hip BMD in patients OP, highlighting this SNP and its relationship with BMD.

The risk of osteoporosis in patients with ankylosing spondylitis—A large retrospective matched cohort study

BackgroundAnkylosing spondylitis (AS) is associated with increased bone turnover and systemic inflammation. Osteoporosis is common but frequently underappreciated in AS, studies regarding the incidence of osteoporosis in AS are limited and based on small cohorts. The aim of this study is to assess the risk of osteoporosis in patients with AS compared to matched controls. MethodsA population based retrospective cohort study using data retrieved from a large electronic medical record in Israel, the Clalit health services. Included patients that were diagnosed with AS from January 2002 to December 2018 were followed for development of osteoporosis. The incidence of osteoporosis was compared between AS and controls and a logistic regression model was used to assess the interaction between AS and osteoporosis. ResultsThe study included 5476 AS patients, and 27,657 age- and sex-frequency matched controls. The incidence of osteoporosis in AS patients was significantly higher than controls (4.7% vs 2.8%, p<0.001) in the whole cohort as well as when stratified by sex. Osteoporosis developed earlier in patients with AS versus controls (4.1 vs 5.2 years, p<0.001). In multivariate analysis and after adjustment to several potential confounders, AS was found to independently associated with osteoporosis (HR 1.83, 95%CI 1.58–2.11, p<0.0001). ConclusionsOur study confirms the higher incidence and earlier development of osteoporosis in patients with AS. Such finding highlights the increased need of awareness and earlier detection of such comorbidity allowing prompt treatment to prevent undesired sequalae including increased risk of fractures.

Association between sensitivity to thyroid hormone indices and osteoporosis in euthyroid patients with type 2 diabetes mellitus.

Thyroid hormones are known to regulate bone metabolism and may influence bone mineral density (BMD), as well as the risk of osteoporosis (OP) and fractures in patients with type 2 diabetes mellitus (T2DM). Recently, sensitivity to thyroid hormone indices has been linked with T2DM and OP independently. However, the relationship between thyroid hormone sensitivity and OP in euthyroid T2DM patients has yet to be investigated. The aim of this study was to determine the association between sensitivity to thyroid hormone indices and the risk of OP in euthyroid patients with T2DM. This study employed a retrospective, cross-sectional design and utilized data acquired from the Cangzhou Central Hospital in China between 2019 and 2020. We retrospectively analyzed the data of 433 patients with T2DM for anthropometric measurements, clinical laboratory test results, and BMD. The thyroid-stimulating hormone index, thyrotroph thyroxine resistance index, and thyroid feedback quantile-based index (TFQI) were calculated to determine thyroid hormone sensitivity. Finally, multivariable logistic regression, generalized additive models, and subgroup analysis were performed to detect the association between sensitivity to thyroid hormone indices and the risk of OP in these patients. We did not observe a statistically significant linear relationship between sensitivity to thyroid hormones indices and OP after covariate adjustment. However, a nonlinear relationship existed between TFQI and the prevalence of OP. The inflection point of the TFQI was at -0.29. The effect sizes (odds ratio) on the left and right of the inflection point were 0.07 [95% confidence interval (CI): 0.01-0.71; p = 0.024] and 2.78 (95% CI: 1.02-7.58; p = 0.046), respectively. This trend was consistent in older female patients with higher body mass index (BMI; 25-30 kg/m2). An approximate U-shaped relationship was observed between sensitivity to thyroid hormone indices and OP risk in euthyroid patients with T2DM with variations in sex, age, and BMI. These findings provide a new perspective to elucidate the role of thyroid hormones in OP, specifically in patients with T2DM.

Simvastatin therapy in higher dosages deteriorates bone quality: Consistent evidence from population-wide patient data and interventional mouse studies

BackgroundCombining mouse experiments with big data analysis of the Austrian population, we investigated the association between high-dose statin treatment and bone quality. MethodsThe bone microarchitecture of the femur and vertebral body L4 was measured in male and ovariectomized female mice on a high-fat diet containing simvastatin (1.2 g/kg). A sex-specific matched big data analysis of Austrian health insurance claims using multiple logistic regression models was conducted (simvastatin 60–80 mg/day vs. controls; males: n = 138,666; females: n = 155,055). ResultsHigh-dose simvastatin impaired bone quality in male and ovariectomized mice. In the trabecular femur, simvastatin reduced bone volume (µm3: ♂, 213 ± 15 vs. 131 ± 7, p < 0.0001; ♀, 66 ± 7 vs. 44 ± 5, p = 0.02) and trabecular number (1/mm: ♂, 1.88 ± 0.09 vs. 1.27 ± 0.06, p < 0.0001; ♀, 0.60 ± 0.05 vs. 0.43 ± 0.04, p = 0.01). In the cortical femur, bone volume (mm3: ♂, 1.44 ± 0.03 vs. 1.34 ± 0.03, p = 0.009; ♀, 1.33 ± 0.03 vs. 1.12 ± 0.03, p = 0.0002) and cortical thickness were impaired (µm: ♂, 211 ± 4 vs. 189 ± 4, p = 0.0004; ♀, 193 ± 3 vs. 169 ± 3, p < 0.0001). Similar impairments were found in vertebral body L4. Simvastatin-induced changes in weight or glucose metabolism were excluded as mediators of deteriorations in bone quality. Results from mice were supported by a matched cohort analysis showing an association between high-dose simvastatin and increased risk of osteoporosis in patients (♂, OR: 5.91, CI: 3.17–10.99, p < 0.001; ♀, OR: 4.16, CI: 2.92–5.92, p < 0.001). ConclusionHigh-dose simvastatin dramatically reduces bone quality in obese male and ovariectomized female mice, suggesting that direct drug action accounts for the association between high dosage and increased risk of osteoporosis as observed in comparable human cohorts. The underlying pathophysiological mechanisms behind this relationship are presently unknown and require further investigation.

Prevalence of Osteoporosis in Myelodysplastic Syndrome Patients and Association with Cytopenias

Background :Perturbations of the osteo-hematopoietic niche architecture disrupt tissue homeostasis and can promote malignant diseases such as myelodysplastic syndromes (MDS). Recently an increased risk of osteoporosis in patients with CHIP has been observed after adjusting on usual risk factors for osteoporosis and in mouse models DnmT3a mutation cause a reduction in bone mass. However, little is known on the clinical presentation of osteoporosis in MDS patients. Here we report the results of a prospective cohort study of bone mass evaluation in newly diagnosed MDS patients. Methods : All patients with newly-diagnosed MDS or CMML (proved by bone marrow aspirate) were prospectively enrolled since January 2020 after informed consent. Bone mass evaluation was performed by conventional radiography of dorsal and lumbar rachis and bone mineral density was measured by a HOLOGIC® device at the upper extremity of the femur and the rachis. Osteoporosis risk factor were collected by a rheumatologist. After analysis of osteoporosis biomarker and biological MDS evaluation, if the diagnosis of osteoporosis was established, specific treatment were proposed. Avaible bone marrow biopsies were analysed by RAMAN microspectrosopy and compared to healthy bone marrow analysis specimens. Results : At data cut off (06/06/2022)108 pts were enrolled and evaluable for bone mineral density. Median age was 77 years [55-99] and 45.4% were female. WHO classification included MDS-MLD, MDS-MLD, MDS-RS-SLD, MDS-RS-MLD, 5Q-, MDS-EB1, MDS-EB2, CMML and AML (with 20-30% blast) in 10.2%,16.7%, 10.7%, 5.6%, 10.2%, 14.8%, 5.6%, 23.2% and 2.6% respectively. IPSS-R was very low, low, intermediate, high and very high in 20.4%, 51%, 19.4%, 8.3%, 1% respectively. Prior to the bone assessment, 15 pts had already a diagnosis of osteoporosis and among them 10 had previously received bisphosphonates. At the time of the bone assessment, 57 additional pts (52.8%) were diagnosed with osteoporosis including 22 males et 35 females and 30 pts (27.8%) had a prevalent osteoporotic vertebral fracture. In our cohort, prevalence of osteoporosis seem to increase with R-IPSS score with 49.4 %, 57.1% and 70% in low, intermediate, and high-risk, pts respectively, near significativity (p=0.052). After univariate analysis neither age (p=0.46) , 25 OH -vitamine D (p=0.07), ferritine (p=0.53), EPO (p=0.45), nor R-IPSS score (p=0.2) were associated with osteoporosis. However osteoporotic pts had significantly lower hemoglobin levels (9.7 vs 10.3 g/dL, p=0.04) and platelet counts (215 vs 170 G/L, p=0.05). After multivariate analysis, only female gender remained statistically associated with osteoporosis (p=0.01). After initial evaluation among the 57 pts with ostoporosis, 53 pts (49% of the cohort) were treated with intravenous bisphosphonates (2 pts refused and 2 had a contraindication). Analysis of avaible bone marrow biopsies (n=8) by Raman microspectoscopy at the center of trabecula showed defects in the bone marrow matrix in MDS pts in comparison to healthy specimens (n=18) with an increase in the hydoxylation of proline suggesting degradation of collagen type I in MDS bone. (figure 1) Conclusion :We found a high prevalence of osteoporosis in 52.3% of prospective, newly diagnosed MDS pts with 27.8% of pts with osteoporotic vertebral fracture. More profound cytopenias seem to be associated with an increased risk of osteoporosis prevalence underlying the impact of the osteo-hematopoietic niche in the physiopathology of MDS. An update of this study will be presented Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Incidence of Osteoporosis in Primary Care Patients with Atrial Fibrillation Receiving Different Oral Anticoagulants.

Studies investigating the association between the use of oral anticoagulants (OACs) and osteoporosis are limited. We aimed to determine the risk of osteoporosis in patients with atrial fibrillation (AF) and receiving different OACs. We performed a population-based cohort study using a nationwide primary care dataset, MedicineInsight. Patients aged between 18 and 111 years with AF and newly recorded OAC prescriptions between 1 January 2013 and 31 December 2017 were included and followed until 31 December 2018. We applied propensity score matching to control for patients' baseline characteristic differences before calculating adjusted hazard ratios (aHRs) for a new diagnosis of osteoporosis, using Cox proportional hazard models. A total of 18,454 patients (1714 prescribed dabigatran, 5871 rivaroxaban, 5248 apixaban and 5621 warfarin) were included. Of these, 39.5% were females, and the overall mean age (standard deviation [SD] was 73.2(10.3) years. Over a mean follow-up of 841 days, 1627 patients (1028 receiving direct-acting oral anticoagulants (DOACs) and 599 warfarin) had a newly recorded diagnosis of osteoporosis. The weighted incidence rates (95% confidence interval; CI) per 100 person-years of treatment were 5.0 (4.7-5.2) for warfarin, 4.3 (3.8-4.8) for dabigatran, 3.6 (3.3-3.8) for rivaroxaban, and 4.4 (4.0-4.7) for apixaban. Overall, DOAC use was associated with a significantly lower risk of a new diagnosis of osteoporosis than warfarin use (aHR, 0.79, 95% confidence interval (CI) 0.74-0.85; p &lt; 0.001). Use of each individual DOAC was associated with a significantly lower risk of osteoporosis compared with warfarin (aHRs, 0.75, 95% CI 0.69-0.82 for rivaroxaban; 0.78, 95% CI 0.71-0.86 for apixaban; 0.88, 95% CI 0.77-0.99 for dabigatran). Compared with warfarin, the use of DOACs was associated with a significantly lower risk of developing osteoporosis in patients with AF. This association remained significant when individual DOACs were compared with warfarin.

Risk of osteoporosis in patients with atrial fibrillation with and without oral anticoagulant therapy

Background We aimed to compare the risk of developing osteoporosis in patients prescribed warfarin or direct-acting oral anticoagulants (DOACs) with those with no therapy. Research design and methods We included 37,632 patients aged between 18 and 111 years with a recorded diagnosis of AF between 1 Jan 2013 and 31 Dec 2017. Patients were followed until the diagnosis of osteoporosis, switch or discontinuation of the OAC, last clinical visit, or end of the study period (31 Dec 2018), whichever occurred first. The incidences of new-onset osteoporosis were calculated using the Cox proportional hazards model. Results Of total, 16,995 (45.2%) had no recorded OAC prescription, and 20,637 had a recorded prescription of warfarin (6,609) or DOAC (14,028). Compared with those not prescribed an OAC, the risk of being diagnosed with new-onset osteoporosis increased in patients prescribed warfarin (HR 2.22, 95% CI 2.00-2.47, p<0.001) and DOACs (HR 1.42, 95% CI 1.29-1.58, p<0.001). However, the effect of DOACs was not statistically significant (HR 1.07, 95% CI 0.86-1.33, p<0.535) after excluding patients with at least one recorded prescription of systemic corticosteroids, antiepileptics, or proton pump inhibitors. Conclusions Use of warfarin or DOACs was associated with a significantly increased risk of developing osteoporosis compared with no OAC treatment.

Prevalence of osteoporosis in osteoarthritis: a systematic review and meta-analysis.

Data are contradictory regarding the relationship between osteoarthritis (OA) and osteoporosis (OP) with some studies showing the increased risk of OP in OA. The study was conducted to determine whether OP prevalence is increased in patients with OA, compared to age and sex-matched population. MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library (inception-2019) were searched for studies reporting the frequency, rate, prevalence, incidence, risk, or excess risk of OP in patients with OA compared to age and sex-matched population. Estimates were combined using a random effects model. Consistency was evaluated using the I2 statistic. Articles with fewer than 200 participants were excluded. Of 2772 articles, 49 had full article screening, and 8 articles met the inclusion criteria. Other articles reporting mean BMD and not OP were excluded. In women, 998 participants with OA were compared with 1903 controls. The pooled estimate of the odds ratio for prevalence of OP vs general matched population was not statistically different. In men, 136 participants with OA were compared with 682 controls. The results did not show a statistically significant difference in the frequency of OP in OA in men. According to the site of bone mineral density measurement, a higher prevalence of OP at lumbar spine was found in both men and women. The frequency of OP overall in participants with OA was not different, except for a higher prevalence of OP in lumbar spine in both men and women compared to the matched controls.