COPD as an independent risk factor for osteoporosis and fractures
ConclusionThese results add robust evidence to an increased odds of osteoporosis and fractures in COPD. Fractures in the COPDG occurred at higher BMD values than expected, suggesting that COPD may be an independent marker of fracture risk, reinforcing a need for regular osteoporosis screening with BMD measurement and prophylaxis of fractures in patients with this disorder. (Source: Osteoporosis International)
Source: Osteoporosis International - December 6, 2019 Category: Orthopaedics Source Type: research

Treatment of bone loss in proximal femurs of postmenopausal osteoporotic women with AGN1 local osteo-enhancement procedure (LOEP) increases hip bone mineral density and hip strength: a long-term prospective cohort study
AbstractSummaryThis first-in-human study of AGN1 LOEP demonstrated that this minimally-invasive treatment durably increased aBMD in femurs of osteoporotic postmenopausal women. AGN1 resorption was coupled with new bone formation by 12 weeks and that new bone was maintained for at least 5 –7 years resulting in substantially increased FEA-estimated femoral strength.IntroductionThis first-in-human study evaluated feasibility, safety, and in vivo response to treating proximal femurs of postmenopausal osteoporotic women with a minimally-invasive local osteo-enhancement procedure (LOEP) to inject a resorbable triphasic ost...
Source: Osteoporosis International - December 4, 2019 Category: Orthopaedics Source Type: research

Intravenous bisphosphonate therapy in children with spinal muscular atrophy
ConclusionThese findings suggest that in children with SMA, IV BP therapy appears to be safe with minimal acute side effects and effective to reduce fracture rate. Caution is still needed given the occurrence of an atypical femur fracture in SMA population. (Source: Osteoporosis International)
Source: Osteoporosis International - December 2, 2019 Category: Orthopaedics Source Type: research

Secondary prevention of fragility fractures in Asia Pacific: an educational initiative
This article puts this initiative into context with a narrative review describing the burden of fragility fractures in the region, the current secondary fracture prevention care gap and a summary of emerging best practice. The results of a survey to evaluate the impact of the APBA educational initiative is presented, in addition to commentary on recent activities intended to improve the care of individuals who sustain fragility fractures across the Asia -Pacific. A FLS Toolbox for Asia-Pacific was developed which included the following sections:1. The burden of fragility fractures in the Asia-Pacific region.2. A summary of...
Source: Osteoporosis International - December 1, 2019 Category: Orthopaedics Source Type: research

Lessons learned with Bone Health TeleECHO: making treatment decisions when guidelines conflict
We report three cases based on those presented at Bone Health TeleECHO, where, through discussion, treatment outside of commonly used guidelines was ultimately recommended. Guidelines developed by different organizations may provide “evidence-based” or “informed” recommendations which do not account for the variability of clinical circumstances encountered in the care of individual patients. This highlights the importance of Bone Health TeleECHO, where healthcare professionals can share knowledge, individualize treatmen t decisions, and improve patient care.Learning objectivesAt the end of this acti...
Source: Osteoporosis International - November 25, 2019 Category: Orthopaedics Source Type: research

A bone resorption marker as predictor of rate of change in femoral neck size and strength during the menopause transition
ConclusionsMeasuring a bone resorption marker in pre- and early perimenopause may identify women who will experience the greatest loss in bone strength during the MT. (Source: Osteoporosis International)
Source: Osteoporosis International - November 25, 2019 Category: Orthopaedics Source Type: research

Understanding patient experiences and challenges to osteoporosis care delivered virtually by telemedicine: a mixed methods study
ConclusionThe TM program bridges the access gap for those living with OP in underserviced and remote areas. However, we identified the need to improve the existing processes to better coordinate access to allied health team members and arrangements for investigations. Participants also expressed interest for a virtual osteoporosis self-management program. (Source: Osteoporosis International)
Source: Osteoporosis International - November 23, 2019 Category: Orthopaedics Source Type: research

Persistence and compliance with osteoporosis therapies among postmenopausal women in the UK Clinical Practice Research Datalink
ConclusionsOnly about one in three patients who received osteoporosis therapy continued to be on treatment after 2 years. There is a need to improve persistence with osteoporosis therapy, especially for high-risk patients (Source: Osteoporosis International)
Source: Osteoporosis International - November 22, 2019 Category: Orthopaedics Source Type: research

Kidney function and its association to imminent, short- and long-term fracture risk —a longitudinal study in older women
ConclusionOlder women with mild-moderate reduction of kidney function are at increased risk of fractures, but not those with the worst function. Our findings furthermore confirm the value of osteoporosis assessment and it is possible that in this age group, age-related decline of kidney function has limited contribution compared with BMD. (Source: Osteoporosis International)
Source: Osteoporosis International - November 21, 2019 Category: Orthopaedics Source Type: research

Predicting the intervention threshold for initiating osteoporosis treatment among postmenopausal women in China: a cost-effectiveness analysis based on real-world data
ConclusionsUsing real-world data, our model indicated that widespread use of zoledronate was of both clinical and economic benefit among Chinese postmenopausal women. Using a FRAX-based intervention threshold of 7% with zoledronate should permit cost-effective access to therapy to patients and contribute to reducing the disease burden of osteoporosis in Mainland China. (Source: Osteoporosis International)
Source: Osteoporosis International - November 21, 2019 Category: Orthopaedics Source Type: research

Determinants of trabecular bone score and prevalent vertebral fractures in women with fragility fractures: a cross-sectional sub-study of NoFRACT
ConclusionSince TBS and SQ1 –SQ3 fractures were not associated, they may act as independent risk factors, justifying the use of both in post-fracture risk assessment. (Source: Osteoporosis International)
Source: Osteoporosis International - November 21, 2019 Category: Orthopaedics Source Type: research

Proton pump inhibitors and fracture risk. The HUNT study, Norway
ConclusionsUse of PPIs was not associated with an increased risk of fractures. (Source: Osteoporosis International)
Source: Osteoporosis International - November 18, 2019 Category: Orthopaedics Source Type: research

Association between postoperative delirium and mortality in elderly patients undergoing hip fractures surgery: a meta-analysis
ConclusionsOur meta-analysis demonstrated that approximated one-fourth of patients undergoing hip fracture surgery would develop POD, and delirium increased the short-term and long-term mortality in these patients. (Source: Osteoporosis International)
Source: Osteoporosis International - November 18, 2019 Category: Orthopaedics Source Type: research

The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone
We report a high vertebral fracture prevalence and incidence in transplantation-eligible patients on dialysis, suggesting that these patients may benefit from radiographic screening for vertebral fractures. Parathyroid hormone had a U-shaped association with vertebral fracture risk.IntroductionVertebral fractures are often overlooked, but even undiagnosed vertebral fractures negatively impact physical functioning, quality of life, and mortality. The risk of vertebral fractures in end-stage renal disease (ESRD) patients is unclear, and parathyroid hormone (PTH) might play a role in the development of vertebral fractures. We...
Source: Osteoporosis International - November 14, 2019 Category: Orthopaedics Source Type: research

Impact of whole dairy matrix on musculoskeletal health and aging –current knowledge and research gaps
AbstractDairy products are included in dietary guidelines worldwide, as milk, yoghurt, and cheese are good sources of calcium and protein, vital nutrients for bones and muscle mass maintenance. Bone growth and mineralization occur during infancy and childhood, peak bone mass being attained after early adulthood. A low peak bone mass has consequences later in life, including increased risk of osteoporosis and fractures. Currently, more than 200 million people worldwide suffer from osteoporosis, with approximately 9 million fractures yearly. This poses a tremendous economic burden on health care. Between 5% and 10% of the el...
Source: Osteoporosis International - November 14, 2019 Category: Orthopaedics Source Type: research

X-ray-based quantitative osteoporosis imaging at the spine
AbstractOsteoporosis is a metabolic bone disease with a high prevalence that affects the population worldwide, particularly the elderly. It is often due to fractures associated with bone fragility that the diagnosis of osteoporosis becomes clinically evident. However, early diagnosis would be necessary to initiate therapy and to prevent occurrence of further fractures, thus reducing morbidity and mortality. X-ray-based imaging plays a key role for fracture risk assessment and monitoring of osteoporosis. Whereas over decades dual-energy X-ray absorptiometry (DXA) has been the main method used and still reflects the referenc...
Source: Osteoporosis International - November 14, 2019 Category: Orthopaedics Source Type: research

The impact of stroke on bone properties and muscle-bone relationship: a systematic review and meta-analysis
AbstractTo systematically review available evidence related to the characteristics of bone changes post-stroke and the relationship between various aspects of muscle function (e.g., strength, spasticity) and bone properties after stroke onset. An extensive online database search was undertaken (last search in January 2019). Articles that examined the bone properties in stroke patients were included. The quality of the studies was evaluated with the National Institutes of Health (NIH) Study Quality Assessment Tools. Publication bias of meta-analyses was assessed using the Egger ’s regression asymmetry test. The select...
Source: Osteoporosis International - November 13, 2019 Category: Orthopaedics Source Type: research

Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures
ConclusionsA platform is provided on which specific guidelines can be developed for national use to characterise fracture risk and direct interventions. (Source: Osteoporosis International)
Source: Osteoporosis International - November 13, 2019 Category: Orthopaedics Source Type: research

Hearing loss but not bone-regulating hormones predicts fractures in older women —a 17-year follow-up of the Gothenburg BEDA study
ConclusionHearing loss and higher S-Ca, but not bone-regulating hormones, medication or lifestyle factors predicted incident fractures, mainly caused by falling, during 17  years of follow-up in women up to 97 years of age. (Source: Osteoporosis International)
Source: Osteoporosis International - November 13, 2019 Category: Orthopaedics Source Type: research

Peripheral quantitative computed tomography (pQCT) –based finite element analysis provides enhanced diagnostic performance in identifying non-vertebral fracture patients compared with dual-energy X-ray absorptiometry
ConclusionspQCT-FE modeling can provide enhanced diagnostic performance compared with DXA and, given its moderate cost, may be useful in clinical settings. (Source: Osteoporosis International)
Source: Osteoporosis International - November 13, 2019 Category: Orthopaedics Source Type: research

Associations between physical activity and bone structure in older adults: does the use of self-reported versus objective assessments of physical activity influence the relationship?
AbstractSummaryAssociations of current and previous physical activity (PA) with bone health are unclear. In postmenopausal women with low bone mineral density (BMD), current PA was positively associated with femoral neck BMD and microarchitecture. Past PA was positively associated with tibial microarchitecture. PA appears beneficial for bone health throughout the lifespan.IntroductionTo compare associations of current and past self-reported bone-specific physical activity, and current accelerometer-determined physical activity (PA), with bone structure (bone mineral density [BMD] and microarchitecture) in postmenopausal wo...
Source: Osteoporosis International - November 13, 2019 Category: Orthopaedics Source Type: research

PTH and bone material strength in hypoparathyroidism as measured by impact microindentation
ConclusionsPTH levels might be associated with bone material strength, although other factors might be contributory. In HypoPT, resistance to microfracture is decreased and may be associated with greater supplemental calcium doses and might increase with PTH replacement. It remains to be determined whether changes in bone remodeling and microarchitecture contribute to the effects of PTH on microfracture resistance. (Source: Osteoporosis International)
Source: Osteoporosis International - November 13, 2019 Category: Orthopaedics Source Type: research

Subclinical thyroid dysfunction, bone mineral density, and osteoporosis in a middle-aged Korean population
ConclusionsNo apparent association was found between subclinical hypothyroidism or subclinical hyperthyroidism defined on single TSH measurement and BMD at the lumbar spine and femur in a large cohort of middle-aged men and women. Subclinical hypothyroidism was independently associated with a lower risk of osteoporosis in postmenopausal women. (Source: Osteoporosis International)
Source: Osteoporosis International - November 13, 2019 Category: Orthopaedics Source Type: research

Multiple simultaneous fractures are associated with higher all-cause mortality: results from a province-wide fracture liaison service
ConclusionsPresenting with multiple fractures was an indicator of higher risk of death relative to a distal radius fracture. This finding indicates the need for increased focus on this high-risk group. (Source: Osteoporosis International)
Source: Osteoporosis International - November 13, 2019 Category: Orthopaedics Source Type: research

Physiotherapy rehabilitation for osteoporotic vertebral fracture —a randomised controlled trial and economic evaluation (PROVE trial)
ConclusionsAdherence was problematic. Benefits at 4  months did not persist and at 12 months, we found no significant differences between treatments. There is inadequate evidence a short physiotherapy intervention of either manual therapy or home exercise provides long-term benefits, but arguably short-term benefits are valuable.Trial registrationISRCTN 49117867. (Source: Osteoporosis International)
Source: Osteoporosis International - November 12, 2019 Category: Orthopaedics Source Type: research

The association between chronic kidney disease, falls, and fractures: a systematic review and meta-analysis
The objective of this systematic review and meta-analysis was to assess whether, and in which degree, CKD was associated with falls and fractures in adults. A systematic search in PubMed, Embase, CINAHL, and The Cochrane Library was performed on 7 September 2018. All retrospective, cross-sectional, and longitudinal studies of adults (18 years of older) that studied the association between CKD, fractures, and falls were included. Additional studies were identified by cross-referencing. A total of 39 publications were included, of which two publications assessed three types of outcome and four publications assessed two types...
Source: Osteoporosis International - November 12, 2019 Category: Orthopaedics Source Type: research

Underestimated fracture risk in postmenopausal women —application of the hybrid intervention threshold
ConclusionsOne quarter of Taiwanese postmenopausal women with osteopenia had high fragility fracture risk evaluated by FRAX and HIT. Due to the poor sensitivity of BMD for fragility fracture, we suggest that intervention for fragility fracture for postmenopausal women should also be guided by FRAX and HIT instead of BMD alone. (Source: Osteoporosis International)
Source: Osteoporosis International - November 6, 2019 Category: Orthopaedics Source Type: research

Age-related periosteal expansion at femoral neck among elderly women may maintain bending stiffness, but not femoral strength
AbstractSummaryPeriosteal expansion and bone loss have opposite effects on femur strength. Their combined effect has not been fully understood. Our investigation using a recently developed beam model suggested that periosteal expansion may maintain femur bending stiffness among elderly women, but not help preserve femoral strength and reduce hip fracture risk.IntroductionPeriosteal expansion and bone loss are two accompanying biological phenomena in old population. Their combined effect on bone stiffness, strength, and fracture risk is still not clear, because previous studies have reported contradictory results.MethodsA r...
Source: Osteoporosis International - November 6, 2019 Category: Orthopaedics Source Type: research

Impact of risk minimisation measures on the use of strontium ranelate in Europe: a multi-national cohort study in 5 EU countries by the EU-ADR Alliance
ConclusionsOur study demonstrates a substantial impact of the regulatory action to restrict use of SR in Europe: SR utilisation overall decreased strongly. The proportion of patients fulfilling the restricted indications, without contraindications, increased after the proposed RMMs. (Source: Osteoporosis International)
Source: Osteoporosis International - November 6, 2019 Category: Orthopaedics Source Type: research

The Nottingham Spinal Health (NoSH) Study: a cohort study of patients hospitalised with vertebral fragility fractures
This study aims to justify such a service.MethodsPatients admitted with an acute vertebral fragility fracture over 12 months were prospectively recruited from a university hospital in England. Data were collected soon after their admission, at discharge from hospital and 6 months after their hospital discharge on their characteristics, pain, physical functioning, and clinical outcomes.ResultsData from 90 participants were analysed. They were mainly elderly (mean age 79.7 years), multimorbid (69% had ≥ 3 comorbid condition), frail (56% had a Clinical Frailty Scale score ≥ 5), cognitively impaired (54% had a MoCA score of
Source: Osteoporosis International - November 6, 2019 Category: Orthopaedics Source Type: research

Weaker bones and white skin as adaptions to improve anthropological “fitness” for northern environments
AbstractThe vitamin D paradox relates to the lower risk of osteoporosis in people of sub-Saharan African ancestry (Blacks) compared with people of European ancestry (Whites). The paradox implies that for bone health, Blacks require less vitamin D and calcium than Whites do. Why should populations that migrated northward out of Africa have ended up needing more vitamin D than tropical Blacks? Human skin color became lighter away from the tropics to permit greater skin penetration of the UVB light that generates vitamin D. Lack of vitamin D impairs intestinal calcium absorption and limits the amount of calcium that can depos...
Source: Osteoporosis International - November 6, 2019 Category: Orthopaedics Source Type: research

Comprehensive genetic analyses using targeted next-generation sequencing and genotype-phenotype correlations in 53 Japanese patients with osteogenesis imperfecta
ConclusionWe identified pathogenic mutations in 81% of our Japanese patients with OI. Most mutations were located onCOL1A1 andCOL1A2. This study revealed that glycine substitutions onCOL1A1 resulted in the severe phenotype among Japanese patients with OI. (Source: Osteoporosis International)
Source: Osteoporosis International - October 23, 2019 Category: Orthopaedics Source Type: research

The use of microindentation for the study of bone properties in type 1 diabetes mellitus patients
ConclusionsT1DM premenopausal patients showed bone tissue properties comparable to those shown by controls. Further larger-scale studies should be conducted to confirm these results. (Source: Osteoporosis International)
Source: Osteoporosis International - October 23, 2019 Category: Orthopaedics Source Type: research

Parathyroid hormone-dependent familial hypercalcemia with low measured PTH levels and a presumptive novel pathogenic mutation in CaSR
AbstractFamilial hypocalciuric hypercalcemia (FHH) is a benign autosomal dominant condition characterized by lifelong asymptomatic hypercalcemia. FHH is typically caused by a heterozygous inactivating mutation of the calcium-sensing receptor (CaSR) and characterized by moderate hypercalcemia, inappropriately normal or elevated serum parathyroid hormone (PTH), and relative hypocalciuria (FeCa  2%. PTH levels were repeatedly below the mean of the reference range (on two separate assays) and sometimes even below the lower reference limit. Two siblings, one niece, and her son had hypercalcemia without nephrolithiasis. C...
Source: Osteoporosis International - October 23, 2019 Category: Orthopaedics Source Type: research

Bisphosphonates and lower mortality risk: when it sounds to be good to be true …
(Source: Osteoporosis International)
Source: Osteoporosis International - October 19, 2019 Category: Orthopaedics Source Type: research

Bone mineral density gains with a second 12-month course of romosozumab therapy following placebo or denosumab
ConclusionsAfter 12  months off-treatment, a second romosozumab course again led to rapid and large BMD gains. Following denosumab, BMD gains with romosozumab were smaller than with initial treatment. No new safety findings were observed during the second course. (Source: Osteoporosis International)
Source: Osteoporosis International - October 18, 2019 Category: Orthopaedics Source Type: research

Drug holidays in osteoporosis treatment: mind the gaps!
(Source: Osteoporosis International)
Source: Osteoporosis International - October 15, 2019 Category: Orthopaedics Source Type: research

Bisphosphonate drug holidays
(Source: Osteoporosis International)
Source: Osteoporosis International - October 15, 2019 Category: Orthopaedics Source Type: research

Calcifediol or vitamin D to optimize vitamin D status: Reply to letter of M Sosas
(Source: Osteoporosis International)
Source: Osteoporosis International - October 14, 2019 Category: Orthopaedics Source Type: research

Understanding patients ’ preferences for osteoporosis treatment: the impact of patients’ characteristics on subgroups and latent classes
ConclusionsThis study revealed patterns in patients ’ preferences for osteoporosis treatment, which cannot be related to specific socio-demographic or clinical characteristics. Therefore, patients should be involved in clinical decision-making to reveal their preferences. (Source: Osteoporosis International)
Source: Osteoporosis International - October 12, 2019 Category: Orthopaedics Source Type: research

Systematic screening using FRAX ® leads to increased use of, and adherence to, anti-osteoporosis medications: an analysis of the UK SCOOP trial
AbstractSummaryIn the large community-based SCOOP trial, systematic fracture risk screening using FRAX® led to greater use of AOM and greater adherence, in women at high fracture risk, compared with usual care.IntroductionIn the SCreening of Older wOmen for Prevention of fracture (SCOOP) trial, we investigated the effect of the screening intervention on subsequent long-term self-reported adherence to anti-osteoporosis medications (AOM).MethodsSCOOP was a primary care –based UK multicentre trial of screening for fracture risk. A total of 12,483 women (70–85 years) were randomised to either usual NHS car...
Source: Osteoporosis International - October 12, 2019 Category: Orthopaedics Source Type: research

Use of short-acting and long-acting hypnotics and the risk of fracture: a critical analysis of associations in a nationwide cohort
ConclusionThe use of short-acting and long-acting hypnotics is associated with an increased risk of fracture. This risk was highest before initiation of treatment and remained after end of therapy. The results suggest that the increased risk during treatment is influenced by other factors such as underlying disease. (Source: Osteoporosis International)
Source: Osteoporosis International - October 1, 2019 Category: Orthopaedics Source Type: research

Parathyroid hormone independently predicts fracture, vascular events, and death in patients with stage 3 and 4 chronic kidney disease
ConclusionsWe found that among individuals with stage 3 and 4 CKD, PTH was an independent predictor of fractures, vascular events, and death. Additional epidemiologic studies are needed to confirm these findings. If a target PTH range can be confirmed, then randomized placebo-controlled trials will be needed to confirm that treating HPT reduces the risk of fracture, vascular events, and death. (Source: Osteoporosis International)
Source: Osteoporosis International - October 1, 2019 Category: Orthopaedics Source Type: research

Bisphosphonates and mortality: confounding in observational studies?
ConclusionBisphosphonate use was associated with lower mortality within days of treatment initiation. This finding is consistent with confounding, although an early treatment effect cannot be ruled out. (Source: Osteoporosis International)
Source: Osteoporosis International - October 1, 2019 Category: Orthopaedics Source Type: research

Practical tips for prescribing exercise for fall prevention
ConclusionDepending on the population, exercise as a single or as part of a multifactorial intervention may be beneficial in reducing falls. (Source: Osteoporosis International)
Source: Osteoporosis International - October 1, 2019 Category: Orthopaedics Source Type: research

Atypical femur fracture incidence in women increases with duration of bisphosphonate exposure
This study examines the incidence of AFF in a northern California population.MethodsWomen age 45 –89 years who initiated oral BP during 2002–2014 in Kaiser Permanente Northern California were followed for AFF outcome, defined by a primarily transverse diaphyseal femur fracture through both cortices, with focal periosteal/endosteal hypertrophy, minimal trauma, and minimal/no comminution. To tal BP exposure was determined from dispensed prescriptions. The incidence of AFF, calculated for 2-year BP categories ranging from  10 years, was age-adjusted using the 2000 US Census.ResultsAmong 94,542 wom...
Source: Osteoporosis International - September 25, 2019 Category: Orthopaedics Source Type: research

Revisit three “I” model: a novel five “I” model of fracture liaison service
(Source: Osteoporosis International)
Source: Osteoporosis International - September 11, 2019 Category: Orthopaedics Source Type: research

Fracture liaison service and mortality in elderly hip fracture patients: a prospective cohort study
AbstractSummaryOsteoporosis is a metabolic disorder that results in increased bone fragility and risk of fractures. Hip fracture is the most important fragility fracture. Fracture Liaison Service (FLS) is a secondary prevention model which identifies patients at risk for fragility fractures. The introduction of an intensive FLS model could decrease 1-year-mortality of hip fracture patients.IntroductionHip fractures are a clinical manifestation of osteoporosis, and these patients are at risk of premature death and suffering subsequent fractures. FLS is an approach for secondary facture prevention by identifying patients wit...
Source: Osteoporosis International - September 11, 2019 Category: Orthopaedics Source Type: research

Correction to: CD4 T cell count is positively associated with lumbar spine bone mass in HIV-infected men under the age of 50  years
Discussion section were incorrect. (Source: Osteoporosis International)
Source: Osteoporosis International - September 10, 2019 Category: Orthopaedics Source Type: research

The association between sarcopenia and osteoporotic vertebral compression refractures
In this study, we reported for the first time that sarcopenia was an independent risk predictor of osteoporotic vertebral compression refractures (OVCRFs). Other risk factors of OVCRFs are low bone mass density T-scores, female sex, and advanced age.IntroductionThe purpose of this study was to investigate the association between osteoporotic vertebral compression refractures (OVCRFs) and sarcopenia, and to identify other risk factors of OVCRFs.MethodsWe evaluated 237 patients with osteoporotic vertebral compression fracture who underwent percutaneous kyphoplasty (PKP) in our hospital from August 2016 to December 2017. To d...
Source: Osteoporosis International - September 3, 2019 Category: Orthopaedics Source Type: research