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PubMed2001

How reliable is the ultrasound densitometer for community screening to diagnose osteoporosis in spine, femur, and forearm?

Dual X-ray absorptiometry (DXA) is the most widely used noninvasive, quantitative diagnostic method of measuring bone density, but it exhibits several limitations for the purpose of general screening and community-based study. Thus, we evaluated the feasibility of the ultrasound densitometer SoundScan Compact for screening the osteoporosis community. We compared the reliability of the SoundScan Compact's measurement to predict both osteopenia and osteoporosis at the spine, femur, and forearm measured by the XR-36. World Health Organisation criteria and Korean reference were used for the diagnosis of osteopenia and osteoporosis. Of the 1827 subjects screened in the community, we randomly selected and invited 106 subjects to our university hospital center for clinical epidemiology for further evaluation of their bone health using DXA. The site-specific relationships among speed of sound and bone mineral density at L2-L4 spine, femoral neck, trochanter, Ward's triangle, distal radius + ulna, proximal radius + ulna, and proximal radius were highly correlated with r values of 0.633, 0.632, 0.674, 0.632, 0.668, 0.78, and 0.777 respectively (all p < 0.0001). Of the 42 subjects defined as normal in the spine by SoundScan Compact's, 27 (64.3%) were also in agreement as the normal by the XR-36. However, an agreement of 43.5% (10/23) in osteopenia and 53.7% (22/41) in osteoporosis was less sensitive. Reliability tested by kappa statistics (kappa = 0.35; t = 5.3; p < 0.0001) revealed that the degree of agreement was not coincidental. On the femur, 54.8% (23/42) agreed as normal, 73.9% (17/23) as osteopenia, and 39% (16/41) as osteoporosis (kappa = 0.33; t = 5.5; p < 0.0001). Higher reliability was found in the forearm, with a kappa value of 0.48, t = 7.2, and p < 0.0001. A magnitude of agreement was also greater in the forearm, with 83.3% (35/42) agreement in normal, 52.2% (12/23) in osteopenia, and 64% (16/25) in osteoporosis. Although the SoundScan Compact's measures different bone properties and measurements are taken at different sites, it is a very useful instrument with a high correlation and high degree of variation and reliability to predict bone health at other sites such as the spine, femur, and forearm. The ultrasound densitometer such as SoundScan Compact's merits its use for community screening and in the primary care setting to detect osteopenia and osteoporosis for the purpose of early detection and prevention.

Absorptiometry, Photon↗

PubMed2002

What are the standards by which bone mass measurement at peripheral skeletal sites should be used in the diagnosis of osteoporosis?

Measurement of bone mineral density (BMD) at central skeletal sites with dual X-ray absorptiometry is the "gold standard" both for the diagnosis of osteoporosis using the criteria of the World Health Organization (WHO) and for monitoring individuals receiving antiresorptive treatment for osteoporosis. Measurement of BMD at peripheral sites (peripheral BMD) can be used to assess fracture risk, but application of the WHO criteria gives different prevalence values for "osteoporosis" with peripheral devices, and different risks for fracture at the same cut points. The International Society for Clinical Densitometry Position Development Conference panelists reached the following conclusions about peripheral BMD testing: First, WHO T-score criteria should not be used with peripheral devices. Second, for the identification of a level for peripheral BMD measurements above which osteoporosis is unlikely, device-specific cut points for peripheral BMD should be identified that have 90% sensitivity for identifying patients who have osteoporosis (T-score of -2.5 or below) based on measurements of the spine and hip. If central BMD testing is available, patients who have peripheral BMD below the 90% sensitivity level should have a central BMD measurement. If central BMD testing is not available, peripheral BMD might be used for identification of patients who are likely to have osteoporosis. Risk-based cut points were preferred to prevalence based cut points, and, again, device-specific cut points are needed. For patients tested only with a peripheral BMD device whose result is intermediate, clinical judgment would be needed. Third, peripheral BMD testing should not be used for monitoring patients who are taking antiresorptive therapy for osteoporosis. Fourth, peripheral BMD testing performs best when used for postmenopausal women. Further research on all these issues is needed.

Absorptiometry, Photon↗

PubMed2003

Comparison between T-score-based diagnosis of osteoporosis and specific skeletal site measurements: prognostic value for predicting fracture risk.

T-score-based diagnosis of osteoporosis might lead to diagnostic misclassification when using multiple-site bone mineral density (BMD) measurements. To compare the diagnostic concordance of T-score-based diagnosis of osteoporosis among different skeletal sites and its correlation to osteoporotic fracture, we studied 1200 postmenopausal women with (441) and without (759) fragility fracture after measuring BMD at the femoral neck, Ward's triangle, trochanter, and spine. Agreement rates of T-score-based diagnosis of osteoporosis were statistically different between pairs of measurements taken at different skeletal sites (McNemar test, p < 0.001). Fragility fractures poorly matched T-score-based diagnosis of osteoporosis (Cohen and Younden indexes <0.4). Technique inaccuracies support these discrepancies as also shown by the large range of T-score values (from -2 to -3) with similar abilities to predict fractures by ROC curve area comparison. Concordance rates between T-score and fragility fracture diagnosis of osteoporosis (marginal homogeneity test, p < 0.001) were also different across the various measurement sites. Our data show that the T-score leads to diagnostic inconsistencies among different skeletal sites and low concordance with fragility fracture based diagnosis of osteoporosis. Integration of the T-score with multiple risk assessment from clinical sources should be tested to better diagnose osteoporosis and related fracture risk.

Aged↗

PubMed2004

Height loss and osteoporosis of the hip.

Osteoporosis of the hip is associated with hip fracture, a devastating outcome on both an individual and aggregate basis. Height loss is a frequent manifestation of vertebral osteoporosis and is simple to evaluate in the clinical setting. The goal of this study was to determine whether height loss is significantly associated with low bone mineral density at the femur, using a retrospective review of cross-sectional data from 2108 women referred for a bone density scan. Collected data included self-reported maximum adult height, current height, and total hip bone mineral density, along with other demographic and risk factor information. We then investigated the relationship between height loss and osteoporosis using multinomial logistic regression modeling. We found that height loss of 2 in. or more is a highly significant predictor of osteoporosis at the hip. In particular, the odds women had osteoporosis at the hip, as determined by total hip bone mineral density, increased 4.4 times (95% confidence interval, 2.6-7.4) if the women had lost > or = 2 but < 3 in. of height. In addition, women with at least 3 in. of height loss had odds of osteoporosis of the hip that were 9.6 times greater (95% confidence interval, 4.8-19.2) than women with less than an inch of height loss. These odds ratios were adjusted for the confounding variables of age, weight, and maximum adult height. Our findings suggest loss of height may be an important clue in detecting osteoporosis of the hip, implying that evaluation of height loss should be routine in the outpatient setting.

Absorptiometry, Photon↗

PubMed2005

Forearm single X-ray absorptiometry in the identification of postmenopausal women with osteoporosis at the hip and spine: a correlation study.

The International Society for Clinical Densitometry (ISCD) has stated that forearm bone mineral density (BMD) testing combined with a thorough clinical evaluation may be an option for the diagnosis of osteoporosis when central bone density (CBD) testing is not available. This study assessed the performance of two different forearm sites in identifying subjects with spinal and femoral osteoporosis, and defined the 90% sensitivity point for the DTX-100 bone densitometer in the detection of central osteoporosis. Four hundred and two postmenopausal Bulgarian women between the ages of 50 and 81 yr (mean age 60.24 +/- 10.48 yr) participated in this study. Forearm BMD (distal and ultradistal forearm) was measured with a DTX-100 device (Osteometer Meditech, USA) and central BMD (lumbar spine and proximal femur) with a Hologic QDR 4500 A device. Linear T-score correlations among sites, sensitivity and specificity of the forearm site were analyzed. T-score correlations between the forearm and the central sites ranged from 0.32 to 0.69 (p < or = 0.05 for all correlations in age group 50-59). The forearm site sensitivity increased slightly with advancing age, but specificity decreased. When the distal forearm BMD cut point (0.340 g/cm2) was set to achieve 90% sensitivity to identify total hip osteoporosis, specificity was 40%; when the distal forearm BMD cut point (0.410 g/cm2) was set to achieve 90% sensitivity to identify spinal osteoporosis, specificity was 55.4%; when ultradistal forearm BMD cut points (0.280 and 0.320 g/cm2) were set to achieve 90% sensitivity to identify total hip and spinal osteoporosis, specificity was 40.8 and 59.2%, respectively. Forearm bone density measures may be useful to selectively screen for patients with central osteoporosis.

Absorptiometry, Photon↗

PubMed2005

Osteoporosis screening and education in community pharmacies using a team approach.

STUDY OBJECTIVES: To develop a model for osteoporosis screening and education in community pharmacies using a team approach, compare bone mineral density T-scores between quantitative ultrasound (QUS) and dual-energy x-ray absorptiometry (DXA), and determine patient satisfaction with this pharmacist-provided osteoporosis screening and education program. DESIGN: Prospective, cross-sectional study. SETTING: Community pharmacies and outpatient family medicine, internal medicine, and obstetrics and gynecology clinics in Amarillo, Texas. PATIENTS: Women aged 55 years or older with no previous diagnosis of osteoporosis or osteopenia who had at least one additional risk factor for osteoporosis and had not been screened in the previous 3 years. INTERVENTION: Patients were referred from family medicine, internal medicine, and obstetrics and gynecology clinics to a community pharmacy. Osteoporosis screening using heel QUS and education regarding disease prevention and treatment were provided by pharmacists. Screening results, recommendations for confirmatory DXA, and potential treatments options were provided to the referring physicians. MEASUREMENTS AND MAIN RESULTS: A total of 100 patients (mean age 66.2+/-7.9 yrs) were enrolled in the study; three were subsequently excluded. Of the 97 study patients who were screened using QUS, 45 (46%) patients were at moderate risk (T-score<-1 to>-2.5) and nine (9%) were at high risk (T-score<or=-2.5). Of 54 patients recommended for DXA referral, 20 (37%) completed the scan. All 20 were diagnosed with either osteopenia (9 patients [45%]) or osteoporosis (11 patients [55%]). Correlation was moderate between T-scores obtained by QUS and DXA of lumbar vertebrae 1-4 (r=0.45, p=0.026). Counseling regarding risk factors, screening results, smoking cessation, calcium intake, exercise, and caffeine intake was perceived by patients as valuable or highly valuable (medians for all items ranged from 4-5 on a 5-point Likert scale). Of 84 patients assessed (13 were lost to follow-up), 81 (96%) said they would recommend this service to others. CONCLUSION: Osteoporosis screening and education in community pharmacies are effective in detecting undiagnosed disease and are perceived by patients as highly useful.

Absorptiometry, Photon↗

PubMed2000

Role of genetic factors in the pathogenesis of osteoporosis.

Osteoporosis is a common disease with a strong genetic component characterised by low bone mass, microarchitectural deterioration of bone tissue and an increased risk of fracture. Twin and family studies have shown that genetic factors play an important role in regulating bone mineral density and other determinants of osteoporotic fracture risk, such as ultrasound properties of bone, skeletal geometry and bone turnover. Osteoporosis is a polygenic disorder, determined by the effects of several genes, each with relatively modest effects on bone mass and other determinants of fracture risk. It is only on rare occasions that osteoporosis occurs as the result of mutations in a single gene. Linkage studies in man and experimental animals have defined multiple loci which regulate bone mass but the genes responsible for these effects remain to be defined. Population-based studies and case-control studies have similarly identified polymorphisms in several candidate genes that have been associated with bone mass or osteoporotic fracture, including the vitamin D receptor, oestrogen receptor and collagen type IalphaI gene. The individual contribution of these genes to the pathogenesis of osteoporosis is small however, reflected by the fact that the relationship between individual candidate genes and osteoporosis has been inconsistent in different studies. An important aim of future work will be to define how the genes which regulate bone mass, bone turnover and other aspects of bone metabolism interact with each other and with environmental variables to cause osteoporosis in individual patients. If that aim can be achieved then there is every prospect that preventative therapy could be targeted to those at greatest risk of the osteoporosis, before fractures have occurred.

Animals↗

PubMed2000

Treatment of osteoporosis: are physicians missing an opportunity?

BACKGROUND: Medical treatment of women with established osteoporosis may decrease the incidence of future fractures. Postmenopausal women who have sustained a distal radial fracture have decreased bone-mineral density and nearly twice the risk of a future hip fracture. The purpose of this study was to evaluate the adequacy of diagnosis and treatment of osteoporosis in postmenopausal women following an acute fracture of the distal part of the radius. METHODS: A retrospective cohort study was performed with use of a claims database that includes more than three million patients, from thirty states, enrolled in multiple health plans. All women, fifty-five years of age or older, who sustained a distal radial fracture between July 1, 1994, and June 30, 1997, were identified in the database. Only patients with at least six months of continuous and complete medical and pharmaceutical health-care coverage from the date of the fracture were enrolled, to ensure that all health-care claims would be captured in the database. This cohort of patients was then evaluated to determine the proportion who had undergone either a diagnostic bone-density scan or treatment with any recommended medication for established osteoporosis (estrogen, a bisphosphonate, or calcitonin) within six months following the fracture. RESULTS: A search of the database identified 1,162 women, fifty-five years of age or older, who had a distal radial fracture. Of these 1,162 patients, thirty-three (2.8 percent) underwent a bone-density scan and 266 (22.9 percent) were treated with at least one of the medications approved for treatment of established osteoporosis. Twenty women had both a bone-density scan and drug treatment. Therefore, only 279 (24.0 percent) of the 1,162 women who sustained a distal radial fracture underwent either diagnostic evaluation or treatment of osteoporosis. There was a significant decrease in the rate of treatment of osteoporosis with increasing patient age at the time of the fracture (p < 0.0001). CONCLUSIONS: Current physician practice may be inadequate for the diagnosis and treatment of osteoporosis in postmenopausal women who have sustained a distal radial fracture.

Aged↗

PubMed1994

Management of osteoporosis and Paget's disease. An appraisal of the risks and benefits of drug treatment.

Osteoporosis is a major public health problem occurring primarily among the postmenopausal population. Osteoporosis is a preventable disease, but despite several advances in its prevention, treatment of the established disease to date remains a major challenge to be managed by primary care physicians. Stabilisation of bone mass and prevention of falls are of paramount importance in any therapeutic programme for osteoporotic patients with established vertebral fractures. Drug therapy for osteoporosis can be divided operationally into 2 main categories: those that inhibit bone resorption, and thus reduce bone turnover, and those that stimulate bone formation, exerting an anabolic effect. Therapeutic agents that inhibit bone remodeling would appear to be best suited to those patients with high turnover osteoporosis (about 30%). Included in this category are calcium, vitamin D and its metabolites, gonadal steroids, calcitonin, ipriflavone and bisphosphonates. Although estrogen replacement therapy has been proven to be effective in older females, calcitonin appears to be the treatment of choice for this population since it stabilises or increases bone mass and also has reported analgesic properties. Drugs that stimulate bone remodeling or bone formation would be best suited to patients with low turnover osteoporosis (about 70%). The agent in this class that is widely used is sodium fluoride. New therapies include intermittent injections of synthetic parathyroid hormone, and cyclic bisphosphonates to activate then depress resorption and formation. Any attempts to stabilise the skeleton with any drug regimen must be accompanied by an adequate calcium supply, i.e. 1200 to 1500 mg/day). The theoretical basis of tailoring treatment for osteoporosis to the underlying histology has not yet been fully proven, but there is increasing experimental support to this approach. Drugs that inhibit bone turnover, such as calcitonin, appear to be effective in increasing bone mass for 1.5 to 2 years, about the time it would take to replenish the remodeling space in a patient with high turnover osteoporosis. In contrast, although bone mass appears to increase for as long as 5 years in patients treated with sodium fluoride, there has been no consistent reduction in occurrence of vertebral or hip fractures. Paget' disease of bone is a focal disorder of the skeleton characterised by excessive resorption and subsequently disorganised formation of bone. The aetiology of the disease is unknown. Paget's disease may be mono-ostotic or polyostotic; pain and bone deformities due to enlargement of skeletal segments represent the main clinical aspects. However, in many patients the disease may be asymptomatic.(ABSTRACT TRUNCATED AT 400 WORDS)

Bone Development↗

PubMed1998

Osteoporosis in men. New insights into aetiology, pathogenesis, prevention and management.

Osteoporosis is increasingly recognised in men. Low bone mass, risk factors for falling and factors causing fractures in women are likely to cause fractures in men. Bone mass is largely genetically determined, but environmental factors also contribute. Greater muscle strength and physical activity are associated with higher bone mass, while radial bone loss is greater in cigarette smokers or those with a moderate alcohol intake. Sex hormones have important effects on bone physiology. In men, there is no abrupt cessation of testicular function or 'andropause' comparable with the menopause in women; however, both total and free testosterone levels decline with age. A common secondary cause of osteoporosis in men is hypogonadism. There is increasing evidence that estrogens are important in skeletal maintenance in men as well as women. Peripheral aromatisation of androgens to estrogens occurs and osteoblast-like cells can aromatise androgens into estrogens. Human models exist for the effects of estrogens on the male skeleton. In men aged > 65 years, there is a positive association between bone mineral density (BMD) and greater serum estradiol levels at all skeletal sites and a negative association between BMD and testosterone at some sites. It is crucial to exclude pathological causes of osteoporosis, because 30 to 60% of men with vertebral fractures have another illness contributing to bone disease. Glucocorticoid excess (predominantly exogenous) is common. Gastrointestinal disease predisposes patients to bone disease as a result of intestinal malabsorption of calcium and colecalciferol (vitamin D). Hypercalciuria and nephrolithiasis, anticonvulsant drug use, thyrotoxicosis, immobilisation, liver and renal disease, multiple myeloma and systemic mastocytosis have all been associated with osteoporosis in men. It is possible that low-dose estrogen therapy or specific estrogen receptor-modulating drugs might increase BMD in men as well as in women. In the future, parathyroid hormone peptides may be an effective treatment for osteoporosis, particularly in patients in whom other treatments, such as bisphosphonates, have failed. Men with idiopathic osteoporosis have low circulating insulin-like growth factor-1 (IGF-1; somatomedin-1) concentrations, and IGF-1 administration to these men increases bone formation markers more than resorption markers. Studies of changes in BMD with IGF-1 treatment in osteoporotic men and women are underway. Osteoporosis in men will become an increasing worldwide public health problem over the next 20 years, so it is vital that safe and effective therapies for this disabling condition become available. Effective public health measures also need to be established and targeted to men at risk of developing the disease.

Adult↗

PubMed2005

Pharmacological management of severe postmenopausal osteoporosis.

The most devastating consequence of osteoporosis is bone fracture, particularly at the vertebral or femoral level. As defined by the WHO, patients with osteoporosis who have had one or more fragility fractures have severe osteoporosis. Those who sustain a vertebral fracture represent a particularly vulnerable group whose risk of another vertebral fracture within the following year is increased by a factor of 3-5. In addition, the presence of a vertebral fracture is associated with an increased risk of hip fracture. In light of these data, treatment of established osteoporosis is extremely important to prevent other fragility fractures. This review examines the therapies approved by the US FDA for the treatment of osteoporosis that have been shown to reduce the incidence of new fractures in patients with established osteoporosis. We evaluated the mechanisms of action, available formulations, efficacy in preventing fractures and increasing bone mineral density (BMD), duration of treatment, adverse effects and contraindications to use of alendronic acid (alendronate), risedronic acid (risedronate), calcitonin, raloxifene and teriparatide. All these drugs are able to prevent new vertebral fractures in patients with established osteoporosis. Only alendronic acid and risedronic acid have also been shown to reduce the risk of fracture at the femoral level, but they are contraindicated in patients with upper gastrointestinal diseases. Calcitonin is a good option in subjects with back pain because of its analgesic effect. Raloxifene is useful when patients have high plasma lipid levels or a family history of breast cancer. Teriparatide is indicated in subjects with very low BMD and multiple vertebral fractures. Patient characteristics should determine selection of therapy but the decision is always difficult and fraught with uncertainty.

Aged↗

PubMed2005

Osteoporosis in children and adolescents: etiology and management.

Bone mass increases progressively during childhood, but mainly during adolescence when approximately 40% of total bone mass is accumulated. Peak bone mass is reached in late adolescence, and is a well recognised risk factor for osteoporosis later in life. Thus, increasing peak bone mass can prevent osteoporosis. The critical interpretation of bone mass measurements is a crucial factor for the diagnosis of osteopenia/osteoporosis in children and adolescents. To date, there are insufficient data to formally define osteopenia/osteoporosis in this patient group, and the guidelines used for adult patients are not applicable. In males and females aged <20 years the terminology 'low bone density for chronologic age' may be used if the Z-score is less than -2. For children and adolescents, this terminology is more appropriate than osteopenia/osteoporosis. Moreover, the T-score should not be used in children and adolescents. Many disorders, by various mechanisms, may affect the acquisition of bone mass during childhood and adolescence. Indeed, the number of disorders that have been identified as affecting bone mass in this age group is increasing as a consequence of the wide use of bone mass measurements. The increased survival of children and adolescents with chronic diseases or malignancies, as well as the use of some treatment regimens has resulted in an increase in the incidence of reduced bone mass in this age group. Experience in treating the various disorders associated with osteoporosis in childhood is limited at present. The first approach to osteoporosis management in children and adolescents should be aimed at treating the underlying disease. The use of bisphosphonates in children and adolescents with osteoporosis is increasing and their positive effect in improving bone mineral density is encouraging. Osteoporosis prevention is a key factor and it should begin in childhood. Pediatricians should have a fundamental role in the prevention of osteoporosis, suggesting strategies to achieve an optimal peak bone mass.

Adolescent↗

PubMed2004

Validation of dental panoramic radiography measures for identifying postmenopausal women with spinal osteoporosis.

OBJECTIVE: Measurements of mandibular inferior cortical shape and width detected on dental panoramic radiographs may be a useful screening tool for spinal osteoporosis in postmenopausal women. The purposes of this study were to clarify whether these measures are validated compared with simple screening tools based on questionnaires, such as the osteoporosis self-assessment tool (OST) and whether these measures can be used in postmenopausal women with histories of hysterectomy, oophorectomy, or estrogen use. SUBJECTS AND METHODS: We calculated the diagnostic performances of panoramic measurements and the OST for identifying women with spinal osteoporosis in both 159 healthy postmenopausal and 157 postmenopausal women with histories of hysterectomy, oophorectomy, or estrogen use. Spinal osteoporosis was defined as a bone mineral density T score of -2.5 or less at the lumbar spine. Cortical shape and width were evaluated on dental panoramic radiographs. Receiver operating characteristic curve analyses were used to determine the optimal cutoff thresholds for cortical width and the OST in healthy postmenopausal women. RESULTS: The sensitivity and specificity, respectively, for identifying women with spinal osteoporosis were 89.5% and 33.9% for cortical width, 86.8% and 57.8% for the OST, and 86.8% and 63.6% for cortical shape in healthy postmenopausal women. Sensitivity and specificity, respectively, were 92.5% and 35.0% for cortical width, 72.5% and 58.1% for the OST, and 80.0% and 64.1% for cortical shape in postmenopausal women with histories of hysterectomy, oophorectomy, or estrogen use. CONCLUSION: Dentists may be able to refer postmenopausal women with suspected spinal osteoporosis for bone densitometry on the basis of dental panoramic radiographs with diagnostic performance similar to that of osteoporosis screening tools based on questionnaires.

Adult↗

PubMed1992

Is postmenopausal osteoporosis related to pineal gland functions?

There is currently considerable interest in the pathogenesis of postmenopausal osteoporosis, which is the most common metabolic bone disease. Osteoporosis affects approximately 20 million persons in the United States, 90% of whom are postmenopausal women. Although there is evidence that estrogen deficiency is an important contributory factor, the pathogenesis of osteoporosis is multifactorial and presently poorly understood. There is evidence that pineal melatonin is an anti-aging hormone and that the menopause is associated with a substantial decline in melatonin secretion and an increased rate of pineal calcification. Animal data indicate that pineal melatonin is involved in the regulation of calcium and phosphorus metabolism by stimulating the activity of the parathyroid glands and by inhibiting calcitonin release and inhibiting prostaglandin synthesis. Hence, the pineal gland may function as a "fine tuner" of calcium homeostasis. In the following communication, we propose that the fall of melatonin plasma levels during the early stage of menopause may be an important contributory factor in the development of postmenopausal osteoporosis. Consequently, plasma melatonin levels taken in the early menopause could be used as an indicator or perhaps as a marker for susceptibility to postmenopausal osteoporosis. Moreover, light therapy, administration of oral melatonin (2.5 mg at night) or agents which induce a sustained release of melatonin secretion such as 5-methoxypsoralen, could be useful agents in the prophylaxis and treatment of postmenopausal osteoporosis. Finally, since application of external artificial magnetic fields has been shown to synchronize melatonin secretion in experimental animals and humans, we propose that treatment with artificial magnetic fields may be beneficial for postmenopausal osteoporosis.

Aged↗

PubMed1996

The development of a European questionnaire for quality of life in patients with vertebral osteoporosis.

The complaints of vertebral osteoporosis usually result from wedge or crush fractures and biconcave deformities. These are caused by a decrease of bone mass and deterioration of bone structure leading to loss of strength. Treatment of osteoporosis should result in an increase of bone mass, and the incidence of new vertebral fractures should diminish. However, new vertebral fractures are not always accompanied by pain, and disability does not well correlate with the number of vertebral fractures. Patients with osteoporosis often have other problems e.g. with taking a shower, preparing meals, gardening, walking stairs, visiting friends and attending social activities. In addition, pain and disability may influence mood and lead to depression. The assessment of quality of life should be a primary endpoint in clinical trials in patients with osteoporosis and in individual patients care. Recently, the European Foundation for Osteoporosis (EFFO) has decided a develop a questionnaire for patients with vertebral osteoporosis, i.e. patients with vertebral deformities. The questionnaire is meant for use in clinical trials. A questionnaire was made including 48 questions and 6 visual analogue scales. The questions concern the following domains: pain, activities of daily living, jobs around the house, moving, leisure and social activities, general health perception and mood. The questionnaire ("Qualeffo") has now entered the validation phase. The first study in 8 centres concerns the within-subject reproducibility, the internal coherence, and the specificity by comparing osteoporotic patients with a control group not suffering from osteoporosis or backpain.

Humans↗

PubMed2006

[Very old patients with osteoporosis should be treated with alendronate].

Although alendronate treatment for the prevention of osteoporotic fracture has been considered to be first line treatment, there is little knowledge whether very old osteoporosis should be treated with alendronate or not. To elucidate this question, we investigated the effectiveness of osteoporotic drugs in terms of effects of treatment on bone mineral density (BMD), bone resorption markers and fracture prevention in osteoporosis aged over 75 years old or less. A total of 1,041 postmenopausal osteoporosis cases were classified into 4 categories, Young controls (n = 165) and Old controls (n = 95) (Control group), Young (n = 309) and Old osteoporosis (n = 110) treated with alendronate (ALN group), and Young (n = 238) and Old osteoporosis (n = 124) treated with vitamins D3 or K2 (VDK group). We followed their lumbar BMD, urinary excretion of NTX and incident vertebral fracture rate for three years. The effects of the ALN treatment on lumbar BMD and on urinary NTX were not different between the two age-categorized osteoporosis groups, namely, the lumbar BMD increased by around 6-7% after ALN treatment in both Old and Young groups. The urinary excretion of NTX was decreased by 50% from baseline in both Old and Young ALN treated groups. Those effects of ALN were significantly superior to those in the controls and VDK-treated groups of both age categories. Therefore, ALN biological effects on bone were not age-dependent and the effects of ALN were strongest than the other treatments. The effects on fracture prevention in the Old ALN-treated group showed a 66.7% risk reduction rate (RRR) (p< 0.05) when the fracture incidence rate in the control group (50%) was taken as 100%, while it was 18.8% RRR (ns) in VDK-treated Old group. The Young group treated with ALN showed a 35.6% RRR from the Young control group (25% as 100%) (p<0.05). The VDK treated group did not show a significant RRR of incident fracture (24.4%). Thus, alendronate was the only effective modality to prevent fractures in both young and old osteoporosis. These results clearly indicated that very old osteoporotics should be treated with alendronate at this moment.

Age Factors↗

PubMed2005

A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis.

OBJECTIVES: To establish the clinical effectiveness and cost-effectiveness of selective oestrogen receptor modulators, bisphosphonates and parathyroid hormone (subject to licensing) for the prevention and treatment of osteoporosis and the prevention of osteoporotic fractures in postmenopausal women. DATA SOURCES: Electronic databases. REVIEW METHODS: Studies that met the review's entry criteria were eligible for inclusion in the meta-analyses provided that they reported fracture incidence in terms of the number of patients suffering fractures. Meta-analysis was carried out using the random-effects model. A model was constructed to estimate the cost-effectiveness of osteoporosis interventions. The model calculated the number of fractures that occurred and provided the costs associated with osteoporotic fractures, and the quality-adjusted life-years (QALYs). In addition, the conditions of breast cancer and coronary heart disease (CHD) were modelled, as some interventions have been shown to affect the risk of these conditions. RESULTS: Ninety randomised controlled trials (RCTs) met the inclusion criteria. They related to the five interventions (alendronate, etidronate, risedronate, raloxifene and teriparatide) and to five comparators (calcium, calcium plus vitamin D, calcitriol, hormone replacement therapy and exercise), as well as placebo or no treatment. All five interventions have been shown to reduce the risk of vertebral fracture in women with severe osteoporosis with adequate calcium intakes. However, none of these drugs has been demonstrated, by direct comparison, to be significantly more effective than either each other or the other active interventions reviewed in this report. The intervention costs of treating all osteoporotic women, for a period of 5 years, were in the region of pound 900-1500 million for alendronate, etidronate, risedronate and raloxifene. The cost per QALY ratios fell dramatically with age. Assuming the risks of a woman with severe osteoporosis at the threshold of osteoporosis, no treatment had a cost per QALY below pound 35,000 at 50 years of age. At 60 years of age, the cost per QALY of raloxifene was pound 26,000 assuming no impact on hip fractures, and pound 31,000 assuming an adverse effect. However, these results are driven by the effect on breast cancer and the assumptions made regarding this disease state. No other intervention had a cost per QALY below pound 35,000. When analyses were conducted assuming that the fracture risk is doubled at each site, alendronate and risedronate had cost per QALY ratios below pound 30,000 at all ages. For women at the threshold of osteoporosis, without a prior fracture and aged 70 years, the cost per QALY of the three bisphosphonates ranged from pound 34,000 to pound 41,000. Raloxifene had a cost per QALY of pound 23,000, assuming no effect on hip fracture, given assumptions regarding breast cancer. At 80 years of age, the cost per QALY of alendronate and risedronate was below pound 20,000. This was true for etidronate when incorporating observational data, but the value rose to pound 69,000 when only RCT data were used. No other intervention had a cost per QALY below pound 35,000. It was assumed that doubling the risk of fracture for women without a prior fracture would give results similar to patients at the threshold of osteoporosis with a prior fracture. CONCLUSIONS: Of the five interventions, only raloxifene appeared to reduce the risk of vertebral fracture in postmenopausal women unselected for low bone mineral density (BMD). However, as the full data have not been made public, there is some uncertainty regarding this result. None of the five interventions has been shown to reduce the risk of non-vertebral fracture in women unselected for low BMD. All of the proposed interventions provided gains in QALYs compared with no treatment in women with sufficient calcium and vitamin D intakes. The size of the QALY gain for each intervention was strongly related to the age of the patient. The estimated costs varied widely for the interventions. These net costs were markedly different by age, with some interventions becoming cost-saving at higher age ranges in patients with a prior fracture. Areas for future research include: the evidence base for the efficacy of fracture prevention in the very elderly, reanalysis of raloxifene using a dedicated breast cancer and CHD model, and more trials considering the cost-effectiveness of teriparatide.

Age Factors↗

PubMed2005

Is osteoporosis a peculiar association with primary biliary cirrhosis?

AIM: (1) To compare the prevalence of osteoporosis (t-score < or =-2.5 SD) between stage IV PBC patients, and two groups of age- and sex-matched controls: one with hepatitis C virus (HCV)-related cirrhosis, and the other one consisting of a group of healthy subjects from the general population; (2) to identify the main risk factors for the development of bone loss. METHODS: Thirty-five stage IV PBC patients (mean age 52.5+/-10 years), 49 females with HCV-related cirrhosis (mean age 52.9+/-5.8 years) and 33 healthy females (mean age 51.8+/-2.22 years) were enrolled in the study. Bone metabolism was evaluated by measuring serum calcium corrected for serum albumin (Ca corr.), 25-hydroxy vitamin D (25-OH vit D), parathyroid hormone, osteocalcin. Bone mineral density (BMD) was assessed at the lumbar spine by dual-photon X-ray absorptiometry. RESULTS: Osteoporosis was present in 5/35 PBC patients (14.2%) and in 7/49 HCV-related cirrhotic patients (14.3%), without any statistical difference between the two groups. Among healthy control subjects, none had osteoporosis. No difference was found between the three groups in serum parameters of bone metabolism. Univariate analysis showed that menopausal state and low BMI were significantly correlated with osteoporosis. Multivariate regression analysis showed that menopausal status, BMI <23, and old age were independent variables significantly correlated with osteoporosis. CONCLUSION: PBC in itself has no negative influence on BMD. End-stage liver disease patients carry a disease-specific risk for osteoporosis, but have an effective risk of bone loss in relation to individual potential risk for each patient. A practical message should be taken into account, that is, every effort should be made to prevent osteoporosis when a patient has simple osteopenia, or if it is a woman in or near menopausal age.

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