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Showing 1 - 200 of 2329 Journals sorted alphabetically
3D Research     Hybrid Journal   (Followers: 19, SJR: 0.214, h-index: 10)
4OR: A Quarterly J. of Operations Research     Hybrid Journal   (Followers: 9, SJR: 1.073, h-index: 25)
AAPS J.     Hybrid Journal   (Followers: 18, SJR: 1.192, h-index: 74)
AAPS PharmSciTech     Hybrid Journal   (Followers: 5, SJR: 0.718, h-index: 54)
Abdominal Imaging     Hybrid Journal   (Followers: 14, SJR: 0.723, h-index: 60)
Abhandlungen aus dem Mathematischen Seminar der Universitat Hamburg     Hybrid Journal   (Followers: 2, SJR: 0.447, h-index: 12)
Academic Psychiatry     Full-text available via subscription   (Followers: 22, SJR: 0.492, h-index: 32)
Academic Questions     Hybrid Journal   (Followers: 7, SJR: 0.135, h-index: 6)
Accreditation and Quality Assurance: J. for Quality, Comparability and Reliability in Chemical Measurement     Hybrid Journal   (Followers: 26, SJR: 0.378, h-index: 30)
Acoustical Physics     Hybrid Journal   (Followers: 10, SJR: 0.355, h-index: 20)
Acoustics Australia     Hybrid Journal  
Acta Analytica     Hybrid Journal   (Followers: 7, SJR: 0.387, h-index: 6)
Acta Applicandae Mathematicae     Hybrid Journal   (Followers: 1, SJR: 0.624, h-index: 34)
Acta Biotheoretica     Hybrid Journal   (Followers: 5, SJR: 0.419, h-index: 25)
Acta Diabetologica     Hybrid Journal   (Followers: 14, SJR: 1.318, h-index: 46)
Acta Endoscopica     Hybrid Journal   (Followers: 1, SJR: 0.113, h-index: 8)
acta ethologica     Hybrid Journal   (Followers: 4, SJR: 0.465, h-index: 23)
Acta Geochimica     Hybrid Journal   (Followers: 3)
Acta Geodaetica et Geophysica     Hybrid Journal   (Followers: 1, SJR: 0.294, h-index: 13)
Acta Geotechnica     Hybrid Journal   (Followers: 6, SJR: 1.818, h-index: 22)
Acta Informatica     Hybrid Journal   (Followers: 5, SJR: 0.524, h-index: 32)
Acta Mathematica     Hybrid Journal   (Followers: 10, SJR: 8.021, h-index: 47)
Acta Mathematica Hungarica     Hybrid Journal   (Followers: 2, SJR: 0.53, h-index: 29)
Acta Mathematica Sinica, English Series     Hybrid Journal   (Followers: 5, SJR: 0.406, h-index: 30)
Acta Mathematica Vietnamica     Hybrid Journal   (SJR: 0.451, h-index: 5)
Acta Mathematicae Applicatae Sinica, English Series     Hybrid Journal   (SJR: 0.22, h-index: 20)
Acta Mechanica     Hybrid Journal   (Followers: 18, SJR: 0.898, h-index: 52)
Acta Mechanica Sinica     Hybrid Journal   (Followers: 4, SJR: 0.426, h-index: 29)
Acta Metallurgica Sinica (English Letters)     Hybrid Journal   (Followers: 5, SJR: 0.525, h-index: 18)
Acta Meteorologica Sinica     Hybrid Journal   (Followers: 3, SJR: 0.524, h-index: 14)
Acta Neurochirurgica     Hybrid Journal   (Followers: 6, SJR: 0.833, h-index: 73)
Acta Neurologica Belgica     Hybrid Journal   (SJR: 0.348, h-index: 27)
Acta Neuropathologica     Hybrid Journal   (Followers: 3, SJR: 6.61, h-index: 117)
Acta Oceanologica Sinica     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 17)
Acta Parasitologica     Hybrid Journal   (Followers: 9, SJR: 0.581, h-index: 28)
Acta Physiologiae Plantarum     Hybrid Journal   (Followers: 2, SJR: 0.551, h-index: 39)
Acta Politica     Hybrid Journal   (Followers: 13, SJR: 0.658, h-index: 20)
adhäsion KLEBEN & DICHTEN     Hybrid Journal   (Followers: 5, SJR: 0.103, h-index: 4)
ADHD Attention Deficit and Hyperactivity Disorders     Hybrid Journal   (Followers: 20, SJR: 0.871, h-index: 15)
Adhesion Adhesives & Sealants     Hybrid Journal   (Followers: 7)
Administration and Policy in Mental Health and Mental Health Services Research     Partially Free   (Followers: 14, SJR: 0.795, h-index: 40)
Adsorption     Hybrid Journal   (Followers: 4, SJR: 0.774, h-index: 52)
Advances in Applied Clifford Algebras     Hybrid Journal   (Followers: 3, SJR: 0.319, h-index: 15)
Advances in Atmospheric Sciences     Hybrid Journal   (Followers: 34, SJR: 0.959, h-index: 44)
Advances in Computational Mathematics     Hybrid Journal   (Followers: 15, SJR: 1.255, h-index: 44)
Advances in Contraception     Hybrid Journal   (Followers: 2)
Advances in Data Analysis and Classification     Hybrid Journal   (Followers: 53, SJR: 1.113, h-index: 14)
Advances in Gerontology     Partially Free   (Followers: 8, SJR: 0.141, h-index: 3)
Advances in Health Sciences Education     Hybrid Journal   (Followers: 23, SJR: 1.397, h-index: 42)
Advances in Manufacturing     Hybrid Journal   (Followers: 3, SJR: 0.2, h-index: 4)
Advances in Polymer Science     Hybrid Journal   (Followers: 40, SJR: 0.637, h-index: 89)
Advances in Therapy     Hybrid Journal   (Followers: 5, SJR: 0.79, h-index: 44)
Aegean Review of the Law of the Sea and Maritime Law     Hybrid Journal   (Followers: 7)
Aequationes Mathematicae     Hybrid Journal   (Followers: 2, SJR: 0.882, h-index: 23)
Aerobiologia     Hybrid Journal   (Followers: 1, SJR: 0.511, h-index: 36)
Aesthetic Plastic Surgery     Hybrid Journal   (Followers: 8, SJR: 0.821, h-index: 49)
African Archaeological Review     Hybrid Journal   (Followers: 14, SJR: 0.612, h-index: 24)
Afrika Matematika     Hybrid Journal   (Followers: 1, SJR: 0.248, h-index: 6)
AGE     Hybrid Journal   (Followers: 7, SJR: 1.358, h-index: 33)
Ageing Intl.     Hybrid Journal   (Followers: 7, SJR: 0.337, h-index: 10)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
Aging Clinical and Experimental Research     Hybrid Journal   (Followers: 3, SJR: 0.529, h-index: 55)
Agricultural Research     Hybrid Journal   (Followers: 3)
Agriculture and Human Values     Hybrid Journal   (Followers: 12, SJR: 1.197, h-index: 49)
Agroforestry Systems     Hybrid Journal   (Followers: 20, SJR: 0.64, h-index: 56)
Agronomy for Sustainable Development     Hybrid Journal   (Followers: 10, SJR: 1.732, h-index: 59)
AI & Society     Hybrid Journal   (Followers: 7, SJR: 0.171, h-index: 19)
AIDS and Behavior     Hybrid Journal   (Followers: 13, SJR: 2.006, h-index: 71)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 3, SJR: 0.706, h-index: 19)
Akupunktur & Aurikulomedizin     Full-text available via subscription   (Followers: 1)
Algebra and Logic     Hybrid Journal   (Followers: 2, SJR: 0.566, h-index: 18)
Algebra Universalis     Hybrid Journal   (Followers: 2, SJR: 0.388, h-index: 22)
Algebras and Representation Theory     Hybrid Journal   (Followers: 1, SJR: 0.868, h-index: 20)
Algorithmica     Hybrid Journal   (Followers: 7, SJR: 0.898, h-index: 56)
Allergo J.     Full-text available via subscription   (Followers: 1, SJR: 0.183, h-index: 20)
Allergo J. Intl.     Hybrid Journal   (Followers: 2)
Alpine Botany     Hybrid Journal   (Followers: 4, SJR: 0.729, h-index: 20)
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 3, SJR: 1.392, h-index: 32)
AMBIO     Hybrid Journal   (Followers: 14, SJR: 1.094, h-index: 87)
American J. of Cardiovascular Drugs     Hybrid Journal   (Followers: 10, SJR: 0.864, h-index: 39)
American J. of Community Psychology     Hybrid Journal   (Followers: 24, SJR: 1.237, h-index: 83)
American J. of Criminal Justice     Hybrid Journal   (Followers: 7, SJR: 0.634, h-index: 13)
American J. of Cultural Sociology     Hybrid Journal   (Followers: 11, SJR: 0.283, h-index: 3)
American J. of Dance Therapy     Hybrid Journal   (Followers: 4, SJR: 0.175, h-index: 13)
American J. of Potato Research     Hybrid Journal   (Followers: 2, SJR: 0.558, h-index: 35)
American J. of Psychoanalysis     Hybrid Journal   (Followers: 21, SJR: 0.293, h-index: 13)
American Sociologist     Hybrid Journal   (Followers: 11, SJR: 0.18, h-index: 13)
Amino Acids     Hybrid Journal   (Followers: 7, SJR: 1.362, h-index: 83)
AMS Review     Partially Free   (Followers: 4)
Analog Integrated Circuits and Signal Processing     Hybrid Journal   (Followers: 5, SJR: 0.21, h-index: 37)
Analysis and Mathematical Physics     Hybrid Journal   (Followers: 4, SJR: 0.665, h-index: 7)
Analysis in Theory and Applications     Hybrid Journal  
Analysis of Verbal Behavior     Hybrid Journal   (Followers: 4)
Analytical and Bioanalytical Chemistry     Hybrid Journal   (Followers: 28, SJR: 1.096, h-index: 123)
Anatomical Science Intl.     Hybrid Journal   (Followers: 2, SJR: 0.301, h-index: 26)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3, SJR: 2.212, h-index: 69)
Animal Cognition     Hybrid Journal   (Followers: 15, SJR: 1.122, h-index: 55)
Annales françaises de médecine d'urgence     Hybrid Journal   (Followers: 1, SJR: 0.156, h-index: 4)
Annales Henri Poincaré     Hybrid Journal   (Followers: 3, SJR: 1.377, h-index: 32)
Annales mathématiques du Québec     Hybrid Journal   (Followers: 4)
Annali dell'Universita di Ferrara     Hybrid Journal   (SJR: 0.504, h-index: 14)
Annali di Matematica Pura ed Applicata     Hybrid Journal   (Followers: 1, SJR: 1.167, h-index: 26)
Annals of Behavioral Medicine     Hybrid Journal   (Followers: 12, SJR: 2.112, h-index: 98)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 18, SJR: 1.182, h-index: 94)
Annals of Combinatorics     Hybrid Journal   (Followers: 3, SJR: 0.849, h-index: 15)
Annals of Data Science     Hybrid Journal   (Followers: 8)
Annals of Dyslexia     Hybrid Journal   (Followers: 9, SJR: 0.857, h-index: 40)
Annals of Finance     Hybrid Journal   (Followers: 28, SJR: 0.686, h-index: 14)
Annals of Forest Science     Hybrid Journal   (Followers: 4, SJR: 0.929, h-index: 57)
Annals of Global Analysis and Geometry     Hybrid Journal   (Followers: 1, SJR: 1.136, h-index: 23)
Annals of Hematology     Hybrid Journal   (Followers: 13, SJR: 1.117, h-index: 62)
Annals of Mathematics and Artificial Intelligence     Hybrid Journal   (Followers: 6, SJR: 0.593, h-index: 42)
Annals of Microbiology     Hybrid Journal   (Followers: 9, SJR: 0.402, h-index: 26)
Annals of Nuclear Medicine     Hybrid Journal   (Followers: 5, SJR: 0.68, h-index: 45)
Annals of Operations Research     Hybrid Journal   (Followers: 8, SJR: 1.186, h-index: 78)
Annals of Regional Science     Hybrid Journal   (Followers: 7, SJR: 0.405, h-index: 42)
Annals of Software Engineering     Hybrid Journal   (Followers: 12)
Annals of Solid and Structural Mechanics     Hybrid Journal   (Followers: 10, SJR: 0.553, h-index: 8)
Annals of Surgical Oncology     Hybrid Journal   (Followers: 11, SJR: 1.902, h-index: 127)
Annals of Telecommunications     Hybrid Journal   (Followers: 7, SJR: 0.315, h-index: 25)
Annals of the Institute of Statistical Mathematics     Hybrid Journal   (Followers: 1, SJR: 0.931, h-index: 31)
Antonie van Leeuwenhoek     Hybrid Journal   (Followers: 5, SJR: 0.992, h-index: 87)
Apidologie     Hybrid Journal   (Followers: 4, SJR: 1.14, h-index: 57)
APOPTOSIS     Hybrid Journal   (Followers: 8, SJR: 1.554, h-index: 87)
Applicable Algebra in Engineering, Communication and Computing     Hybrid Journal   (Followers: 2, SJR: 0.354, h-index: 27)
Applications of Mathematics     Hybrid Journal   (Followers: 1, SJR: 0.274, h-index: 20)
Applied Biochemistry and Biotechnology     Hybrid Journal   (Followers: 44, SJR: 0.575, h-index: 80)
Applied Biochemistry and Microbiology     Hybrid Journal   (Followers: 17, SJR: 0.267, h-index: 26)
Applied Categorical Structures     Hybrid Journal   (Followers: 2, SJR: 0.361, h-index: 21)
Applied Composite Materials     Hybrid Journal   (Followers: 46, SJR: 0.705, h-index: 35)
Applied Entomology and Zoology     Partially Free   (Followers: 2, SJR: 0.554, h-index: 34)
Applied Geomatics     Hybrid Journal   (Followers: 3, SJR: 0.323, h-index: 9)
Applied Geophysics     Hybrid Journal   (Followers: 7, SJR: 0.541, h-index: 13)
Applied Intelligence     Hybrid Journal   (Followers: 14, SJR: 0.777, h-index: 43)
Applied Magnetic Resonance     Hybrid Journal   (Followers: 3, SJR: 0.358, h-index: 34)
Applied Mathematics & Optimization     Hybrid Journal   (Followers: 4, SJR: 0.955, h-index: 33)
Applied Mathematics - A J. of Chinese Universities     Hybrid Journal   (SJR: 0.275, h-index: 8)
Applied Mathematics and Mechanics     Hybrid Journal   (Followers: 4, SJR: 0.37, h-index: 26)
Applied Microbiology and Biotechnology     Hybrid Journal   (Followers: 61, SJR: 1.262, h-index: 161)
Applied Physics A     Hybrid Journal   (Followers: 7, SJR: 0.535, h-index: 121)
Applied Physics B: Lasers and Optics     Hybrid Journal   (Followers: 23, SJR: 0.983, h-index: 104)
Applied Psychophysiology and Biofeedback     Hybrid Journal   (Followers: 7, SJR: 0.677, h-index: 47)
Applied Research in Quality of Life     Hybrid Journal   (Followers: 10, SJR: 0.288, h-index: 15)
Applied Solar Energy     Hybrid Journal   (Followers: 15, SJR: 0.251, h-index: 6)
Applied Spatial Analysis and Policy     Hybrid Journal   (Followers: 4, SJR: 0.351, h-index: 9)
Aquaculture Intl.     Hybrid Journal   (Followers: 22, SJR: 0.613, h-index: 40)
Aquarium Sciences and Conservation     Hybrid Journal   (Followers: 1)
Aquatic Ecology     Hybrid Journal   (Followers: 30, SJR: 0.646, h-index: 44)
Aquatic Geochemistry     Hybrid Journal   (Followers: 3, SJR: 0.764, h-index: 39)
Aquatic Sciences     Hybrid Journal   (Followers: 12, SJR: 1.172, h-index: 53)
Arabian J. for Science and Engineering     Hybrid Journal   (Followers: 5, SJR: 0.345, h-index: 20)
Arabian J. of Geosciences     Hybrid Journal   (Followers: 1, SJR: 0.417, h-index: 16)
Archaeological and Anthropological Sciences     Hybrid Journal   (Followers: 21, SJR: 1.056, h-index: 15)
Archaeologies     Hybrid Journal   (Followers: 12, SJR: 0.397, h-index: 13)
Archiv der Mathematik     Hybrid Journal   (Followers: 1, SJR: 0.597, h-index: 29)
Archival Science     Hybrid Journal   (Followers: 52, SJR: 0.804, h-index: 22)
Archive for History of Exact Sciences     Hybrid Journal   (Followers: 7, SJR: 0.28, h-index: 15)
Archive for Mathematical Logic     Hybrid Journal   (Followers: 1, SJR: 0.946, h-index: 23)
Archive for Rational Mechanics and Analysis     Hybrid Journal   (SJR: 4.091, h-index: 66)
Archive of Applied Mechanics     Hybrid Journal   (Followers: 4, SJR: 0.865, h-index: 40)
Archives of Computational Methods in Engineering     Hybrid Journal   (Followers: 4, SJR: 2.841, h-index: 40)
Archives of Dermatological Research     Hybrid Journal   (Followers: 6, SJR: 0.9, h-index: 65)
Archives of Environmental Contamination and Toxicology     Hybrid Journal   (Followers: 10, SJR: 0.846, h-index: 84)
Archives of Gynecology and Obstetrics     Hybrid Journal   (Followers: 16, SJR: 0.695, h-index: 47)
Archives of Microbiology     Hybrid Journal   (Followers: 8, SJR: 0.702, h-index: 85)
Archives of Orthopaedic and Trauma Surgery     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 56)
Archives of Osteoporosis     Hybrid Journal   (Followers: 2, SJR: 1.092, h-index: 13)
Archives of Sexual Behavior     Hybrid Journal   (Followers: 9, SJR: 1.198, h-index: 74)
Archives of Toxicology     Hybrid Journal   (Followers: 16, SJR: 1.595, h-index: 76)
Archives of Virology     Hybrid Journal   (Followers: 5, SJR: 1.086, h-index: 90)
Archives of Women's Mental Health     Hybrid Journal   (Followers: 13, SJR: 1.264, h-index: 50)
Archivio di Ortopedia e Reumatologia     Hybrid Journal  
Archivum Immunologiae et Therapiae Experimentalis     Hybrid Journal   (Followers: 2, SJR: 1.2, h-index: 42)
ArgoSpine News & J.     Hybrid Journal   (SJR: 0.102, h-index: 3)
Argumentation     Hybrid Journal   (Followers: 5, SJR: 0.295, h-index: 18)
Arid Ecosystems     Hybrid Journal   (Followers: 3)
Arkiv för Matematik     Hybrid Journal   (Followers: 1, SJR: 0.948, h-index: 22)
Arnold Mathematical J.     Hybrid Journal   (Followers: 1)
Arthropod-Plant Interactions     Hybrid Journal   (Followers: 1, SJR: 0.797, h-index: 17)
Arthroskopie     Hybrid Journal   (Followers: 1, SJR: 0.145, h-index: 8)
Artificial Intelligence and Law     Hybrid Journal   (Followers: 10, SJR: 0.288, h-index: 25)
Artificial Intelligence Review     Hybrid Journal   (Followers: 15, SJR: 0.948, h-index: 48)
Artificial Life and Robotics     Hybrid Journal   (Followers: 8, SJR: 0.231, h-index: 14)
Asia Europe J.     Hybrid Journal   (Followers: 4, SJR: 0.247, h-index: 9)
Asia Pacific Education Review     Hybrid Journal   (Followers: 9, SJR: 0.371, h-index: 17)
Asia Pacific J. of Management     Hybrid Journal   (Followers: 11, SJR: 1.676, h-index: 50)
Asia-Pacific Education Researcher     Hybrid Journal   (Followers: 11, SJR: 0.353, h-index: 13)
Asia-Pacific Financial Markets     Hybrid Journal   (Followers: 2, SJR: 0.19, h-index: 15)
Asia-Pacific J. of Atmospheric Sciences     Hybrid Journal   (Followers: 20, SJR: 1.006, h-index: 14)
Asian Business & Management     Hybrid Journal   (Followers: 7, SJR: 0.41, h-index: 10)
Asian J. of Business Ethics     Hybrid Journal   (Followers: 7)
Asian J. of Criminology     Hybrid Journal   (Followers: 5, SJR: 0.263, h-index: 8)
AStA Advances in Statistical Analysis     Hybrid Journal   (Followers: 2, SJR: 0.681, h-index: 15)
AStA Wirtschafts- und Sozialstatistisches Archiv     Hybrid Journal   (Followers: 5, SJR: 0.195, h-index: 5)
ästhetische dermatologie & kosmetologie     Full-text available via subscription  
Astronomy and Astrophysics Review     Hybrid Journal   (Followers: 21, SJR: 4.511, h-index: 44)
Astronomy Letters     Hybrid Journal   (Followers: 19, SJR: 0.58, h-index: 30)
Astronomy Reports     Hybrid Journal   (Followers: 12, SJR: 0.473, h-index: 23)
Astrophysical Bulletin     Hybrid Journal   (Followers: 2, SJR: 0.469, h-index: 11)

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Journal Cover Archives of Osteoporosis
  [SJR: 1.092]   [H-I: 13]   [2 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1862-3514 - ISSN (Online) 1862-3522
   Published by Springer-Verlag Homepage  [2329 journals]
  • Association between lumbar bone mineral density and serum uric acid in
           postmenopausal women: a cross-sectional study of healthy Chinese
    • Authors: Wen Han; Xiaojuan Bai; Nan Wang; Lulu Han; Xuefeng Sun; Xiangmei Chen
      Abstract: Summary Partial correlation and regression analyses were used in this study. We showed that there is a linear relationship between bone mineral density and serum uric acid within the normal physiologic range, and higher serum uric acid levels had a protective effect on bone loss in postmenopausal osteoporosis. Purpose The significance of the relationship between lumbar bone mineral density (BMD) and serum uric acid (SUA) levels is unclear. The aims of this study were to investigate on a population-level the association between lumbar BMD and SUA within the normal physiologic range and to determine whether SUA plays a protective role in bone loss in healthy postmenopausal Chinese women. Methods This was a community-based cross-sectional study involving 390 healthy postmenopausal women, 47–89 years of age, conducted in Shenyang, China. The BMD was measured at the lumbar spine using dual-energy X-ray absorptiometry (DXA). The SUA levels were obtained at each DXA visit. Partial correlation and regression analyses were applied to determine the associations. Results The SUA levels were significantly different between the normal BMD, osteopenia, and osteoporosis groups. The lumbar BMD was positively correlated with SUA in postmenopausal women after adjustment for age (r = 0.212). After adjustment for age, body mass index, systolic blood pressure, diastolic blood pressure, hip circumference, cigarette smoking, alcohol consumption, milk intake, physical exercise, fracture history, total protein, total bilirubin, triglycerides, total cholesterol, high-density lipoprotein cholesterol, fasting blood glucose, serum calcium, and estimated glomerular filtration rate, the lumbar BMD was associated with SUA and the odds ratio of the third SUA quartile was 0.408 (95%CI, 0.198–0.841, P = 0.015), compared to the first quartile of SUA levels. Conclusion The lumbar BMD was linearly associated with SUA levels within the normal physiologic range of postmenopausal women. Higher SUA levels had a protective effect on bone loss in postmenopausal osteoporosis.
      PubDate: 2017-05-19
      DOI: 10.1007/s11657-017-0345-0
      Issue No: Vol. 12, No. 1 (2017)
  • Trends in and relation between hip fracture incidence and osteoporosis
           medication utilization and prices in Estonia in 2004–2015
    • Authors: Ott Laius; Heti Pisarev; Katre Maasalu; Sulev Kõks; Aare Märtson
      Abstract: Summary Osteoporosis medicines reduce osteoporotic fractures. There is a very strong negative correlation between the consumption of medicines and the price of an average daily dose indicating that affordability is a key factor that could increase consumption of antiosteoporotic medicines and, through that, reduce fractures. Purpose Osteoporosis is a major cause of morbidity and mortality in the modern world. Our study aims to describe the trends in incidence of hip fractures in relation to drug utilization patterns and the average price of antiosteoporotic medicines in Estonia. Methods Data on hip fractures was obtained from the medical claims database of Estonian Health Insurance Fund (EHIF). Consumption and price data was obtained from the Estonian State Agency of Medicines (SAM).Consumption is presented using WHO defined daily doses methodology, and the prices reflect the average wholesale price of medicines. Results From 2004 to 2010 there was a non-significant increasing trend in standardized hip fracture incidence in Estonia, but from 2010 to 2015, the trend turned to a significant decrease of 4.5% per year. The consumption of osteoporosis medication increased significantly from 2004 to 2009 by yearly average of 41.2%. After 2009, the consumption levelled. On contrast, the average price of one daily dose of osteoporosis medication decreased significantly from 2004 to 2009 by 16.9% per year and the decrease also levelled after 2009. This gives a very strong negative correlation of −0.93 (p < 0.001) between the consumption of antiosteoporotic medication and the average price of a daily dose of medication during the study period. Conclusions The statistically significant decline of standardized incidence of hip fractures from 2010 onward could at least in part be the result of the high increase in consumption of antiosteoporotic medicines which in turn is strongly negatively correlated with the average price of osteoporosis medicines.
      PubDate: 2017-05-11
      DOI: 10.1007/s11657-017-0341-4
      Issue No: Vol. 12, No. 1 (2017)
  • Hip fracture pattern at a major Tanzanian referral hospital: focus on
           fragility hip fractures
    • Authors: Munyaradzi Tsabasvi; Sonya Davey; Rogers Temu
      Abstract: Summary This study examined hip fractures during a 5-year period at Kilimanjaro Christian Medical Center (KCMC). There was a general increase in proportions of fragility hip fractures during this period. Purpose Fragility hip fractures are expected to increase in low-resource countries. This study examined hip fractures in the osteoporotic age group during a 5-year period at the Kilimanjaro Christian Medical Center (KCMC), which is located in Moshi, Tanzania. Methods We conducted a retrospective study of all hip fracture patients above the age of 50 who were admitted to KCMC between January 1, 2011 and December 31, 2015. Objective measures including patient demographics, mechanism of injury, and X-ray evaluation were used to differentiate high- and low-energy fractures. Low-energy hip fractures with no other suspected pathological processes on X-ray were labelled as fragility fractures. Results Three hundred forty patients were admitted in the study period and 222 patients met the inclusion criteria. Males contributed to 59.5% of hip fractures. Falls from standing height constituted the majority of fractures (76%) followed by injury from road traffic crashes (14%). Regardless of high- or low-energy aetiology, intertrochanteric fracture dominated representing 54.5% of all hip fractures. 75.6% (n = 168) of the analysed patients had fragility fractures. The fragility fractures were 55.8% (n = 96) intertrochanteric, 28.5% (n = 49) cervical, 9.9% (n = 17) subtrochanteric, and 5.8% (n = 10) mixed subtrochanteric with intertrochanteric. We noted a 2.34% per year increase in the proportions of fragility fractures among all included hip fractures over 5 years. Conclusion We concluded that men and women contributed almost equally to the fragility hip fracture burden. The dominant cause of hip fractures overall was low-energy injuries. There was an increase in proportions of fragility hip fractures in the period of January 2011 to December 2015.
      PubDate: 2017-05-08
      DOI: 10.1007/s11657-017-0338-z
      Issue No: Vol. 12, No. 1 (2017)
  • Hip fractures in young adults: a retrospective cross-sectional study of
           characteristics, injury mechanism, risk factors, complications and
    • Authors: Michael T. Wang; Sarah H. Yao; Phillip Wong; Anne Trinh; Peter R. Ebeling; Ton Tran; Frances Milat; Nora Mutalima
      Abstract: Summary This study characterises risk factors, complications and follow-up of minimal trauma hip fractures in young adults, adding to limited information examining the management framework. This group have severe systemic disease and significant risk of post-operative complications and subsequent fractures. Improved medical referral pathways enable management of osteoporosis and comorbid diseases. Aims There is a paucity of literature examining minimal trauma hip fractures in young adults, despite extensive management guidelines for older patients. This study aims to characterise risk factors, complications and follow-up of hip fractures to guide management pathways. Methods This is a retrospective study of patients presenting with hip fracture to a single institution from 2009 to 2015. Hip fractures were identified using ICD-10 codes and clinical information documented from medical records. Patients were categorised into minimal trauma (MTF) and high-energy fracture (HEF) groups based on mechanism of injury. Results Of 2512 patients admitted with hip fracture, 2.5% (n = 62) were aged 15–49 years. Two patients were excluded with pathological fractures, and seven were excluded with no recorded mechanism of injury. MTF occurred in 43 patients and 10 sustained HEF. These groups had similar demographics, fracture locations and treatments. The MTF group had higher American Society of Anaesthesiologists scores (MTF 2.44 ± 0.9; HEF 1.43 ± 0.5; p = 0.025) and higher rates of chronic endocrine disease (MTF 34.9%; HEF 0%; p = 0.046). Rates of post-operative surgical (MTF 24.0%; HEF 12.5%) and medical complications (MTF 27.8%; HEF 12.5%) were high in MTF patients. Subsequent fractures occurred in five (13.9%) MTF patients during the study period compared with none in the HEF group. Only 16 (44.4%) of the MTF patients were referred to endocrine care. Conclusion Young adults with MTF of the hip have more severe systemic disease and are at risk of post-operative complications and subsequent fractures. Referral of patients to endocrine care is recommended to manage osteoporosis and comorbid diseases.
      PubDate: 2017-05-04
      DOI: 10.1007/s11657-017-0339-y
      Issue No: Vol. 12, No. 1 (2017)
  • Public priorities for osteoporosis and fracture research: results from a
           general population survey
    • Authors: Zoe Paskins; Clare Jinks; Waheed Mahmood; Prakash Jayakumar; Caroline B. Sangan; John Belcher; Stephen Gwilym
      Abstract: Summary This is the first national study of public and patient research priorities in osteoporosis and fracture. We have identified new research areas of importance to members of the public, particularly ‘access to information from health professionals’. The findings are being incorporated into the research strategy of the National Osteoporosis Society. Purpose This study aimed to prioritise, with patients and public members, research topics for the osteoporosis research agenda. Methods An e-survey to identify topics for research was co-designed with patient representatives. A link to the e-survey was disseminated to supporters of the UK National Osteoporosis Society (NOS) in a monthly e-newsletter. Responders were asked to indicate their top priority for research across four topics (understanding and preventing osteoporosis, living with osteoporosis, treating osteoporosis and treating fractures) and their top three items within each topic. Descriptive statistics were used to describe demographics and item ranking. A latent class analysis was applied to identify a substantive number of clusters with different combinations of binary responses. Results One thousand one hundred eighty-eight (7.4%) respondents completed the e-survey. The top three items overall were ‘Having easy access to advice and information from health professionals’ (63.8%), ‘Understanding further the safety and benefit of osteoporosis drug treatments’ (49.9%) and ‘Identifying the condition early by screening’ (49.2%). Latent class analysis revealed distinct clusters of responses within each topic including primary care management and self-management. Those without a history of prior fracture or aged under 70 were more likely to rate items within the cluster of self-management as important (21.0 vs 12.9 and 19.8 vs 13.3%, respectively). Conclusion This is the first study of public research priorities in osteoporosis and has identified new research areas of importance to members of the public including access to information. The findings are being incorporated into the research strategy of the National Osteoporosis Society.
      PubDate: 2017-04-28
      DOI: 10.1007/s11657-017-0340-5
      Issue No: Vol. 12, No. 1 (2017)
  • The clinical benefits of denosumab for prophylaxis of steroid-induced
           osteoporosis in patients with pulmonary disease
    • Authors: Shigeo Ishiguro; Kentaro Ito; Shigenori Nakagawa; Osamu Hataji; Akihiro Sudo
      Abstract: Summary Previous reports demonstrated that bone density decreased rapidly during the initial few months of steroid therapy and continued decreasing at a rate of 2 to 4% annually. Our data indicates that denosumab can also play a role in the treatment of osteoporosis in the steroid-taking population. Introduction Respiratory physicians are often faced with the dilemma that long-term steroid use will deteriorate bone mineral density and quality. Previous reports demonstrated that bone density decreased 8 to 12% during the initial few months of steroid therapy then continued decreasing at a rate of 2 to 4% annually. Several prospective trials revealed that denosumab increased bone density in patients with osteoporosis [2–4] and decreased the rate of occurrence of fractures. The long-term efficacy of denosumab for glucocorticoid-induced osteoporosis, however, has not yet been proven. Materials This has been an ongoing prospective study since 2014. In our respiratory centre, the first preventative measure used to combat glucocorticoid-induced osteoporosis (GIO) is oral bisphosphonates. Thirty-six patients were enlisted, and their treatment courses were changed from oral bisphosphonate, if administered, to the subcutaneous injection of denosumab 60 mg every 6 months, combined with a daily oral intake of DENOTAS® chewable combination tablets. The primary efficacy measures were changes in lumbar spine (LS) bone mineral density (BMD) and femoral BMD from baseline at 4, 8, 12 and 28 months. Results At the 12-month follow-up, bone mineral density in the lumbar spine area of these patients increased by 3.2%, while bone mineral density in the hip area showed no significant increase. At the 28-month follow-up, 25 patients were still included in this study. Femoral BMD at 28 months increased significantly from the 12-month follow-up (P = 0.0259), though the first 12 months showed no significant increase. LS BMD continued to increase through the 28-month period. Conclusions Very little is known regarding the active prevention of GIO. Our data indicates that denosumab can play a promising role in the treatment of GIO.
      PubDate: 2017-04-19
      DOI: 10.1007/s11657-017-0336-1
      Issue No: Vol. 12, No. 1 (2017)
  • UK clinical guideline for the prevention and treatment of osteoporosis
    • Authors: J. Compston; The National Osteoporosis Guideline Group (NOGG); A. Cooper; C. Cooper; N. Gittoes; C. Gregson; N. Harvey; S. Hope; J. A. Kanis; E. V. McCloskey; K. E. S. Poole; D. M. Reid; P. Selby; F. Thompson; A. Thurston; N. Vine
      Abstract: Introduction In 2008, the UK National Osteoporosis Guideline Group (NOGG) produced a guideline on the prevention and treatment of osteoporosis, with an update in 2013. This paper presents a major update of the guideline, the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women and men age 50 years or over. Methods Where available, systematic reviews, meta-analyses and randomised controlled trials were used to provide the evidence base. Conclusions and recommendations were systematically graded according to the strength of the available evidence. Results Review of the evidence and recommendations are provided for the diagnosis of osteoporosis, fracture-risk assessment, lifestyle measures and pharmacological interventions, duration and monitoring of bisphosphonate therapy, glucocorticoid-induced osteoporosis, osteoporosis in men, postfracture care and intervention thresholds. Conclusion The guideline, which has received accreditation from the National Institute of Health and Care Excellence (NICE), provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals who are involved in its management.
      PubDate: 2017-04-19
      DOI: 10.1007/s11657-017-0324-5
      Issue No: Vol. 12, No. 1 (2017)
  • Effect of health literacy on adherence to osteoporosis treatment among
           patients with distal radius fracture
    • Authors: Young Hak Roh; Young Do Koh; Jung Ho Noh; Hyun Sik Gong; Goo Hyun Baek
      Abstract: Summary Patients with inadequate health literacy, those with medical comorbidities, or those with a previous history of adverse drug events have a higher likelihood of non-adherence to osteoporosis treatment after sustaining a distal radius fracture. Introduction Patients with a distal radial fracture (DRF) have a higher risk of subsequent fractures, which provides an important opportunity to begin treatment for osteoporosis. This study assessed the effect that health literacy of patients suffering from a DRF has on the subsequent adherence to osteoporosis treatment. Methods A total of 116 patients (female, over 50 years of age) presenting a DRF caused by low-energy trauma were enrolled. Their health literacy was measured using the Newest Vital Sign (NVS). Alendronate (70 mg, orally, once weekly) was prescribed to all patients for 1 year, and adherence was defined as taking at least 80% of the tablets for 12 months and returning for the visit on month 12. Multivariable analyses were conducted to determine whether the patients’ clinical, demographic, and health literacy factors influenced their adherence to osteoporosis treatment. Results About half (52%) of the participants who sustained a DRF exhibited an inadequate health literacy, and the rate of non-adherence to osteoporosis treatment was 38%. The rate of non-adherence for patients with inadequate literacy was significantly higher than for those with appropriate literacy (47 vs. 29%, p = 0.04). The results of the regression analysis indicate that limited health literacy, the presence of comorbidities, and prior history of adverse drug events are associated with a higher likelihood of non-adherence to osteoporosis treatment after sustaining a DRF. Conclusions Patients with inadequate health literacy, adverse drug events, or medical comorbidities had higher rates of non-adherence with alendronate treatment after sustaining a DRF. Further research is needed to show whether improvements in patient comprehension via informational intervention in patients with a DRF will improve adherence to osteoporosis treatment.
      PubDate: 2017-04-18
      DOI: 10.1007/s11657-017-0337-0
      Issue No: Vol. 12, No. 1 (2017)
  • Calcium intake, bone mineral density, and fragility fractures: evidence
           from an Italian outpatient population
    • Authors: Letizia Vannucci; Laura Masi; Giorgio Gronchi; Caterina Fossi; Anna Maria Carossino; Maria Luisa Brandi
      Abstract: Summary This study was performed in 1000 adult Italian subjects to focus on the effects of dietary calcium intake on bone health. A higher fracture risk appears to be associated with a reduced calcium intake. An adequate daily calcium intake is recommended to counteract osteoporotic fractures. Purpose The principal aim of the present study was to focus on the effects of dietary calcium intake on bone mineral density (BMD) and fragility fractures in a representative sample of an adult Italian outpatient population. Methods The study group consisted of 1000 consecutive adult Italian subjects [838 women (F) and 162 men (M)] referred to the Bone Metabolic Diseases Unit for the evaluation of their bone metabolism. Daily dietary calcium intake was assessed using a specific food frequency questionnaire (FFQ). Other evaluations included fracture risk, lumbar and femoral BMD, heel ultrasound, fragility fractures, plasma concentration of parathyroid hormone ([PTH]) and 25-hydroxy-vitamin D ([25(OH)D]), and urinary calcium. Results Only 10.4% of the subjects (n = 104; 71 F and 33 M) had a daily calcium intake adequate for adults (≥1000 mg/day). No correlation was found between calcium intake and BMD. The transition from a daily dietary calcium intake <400 mg/day to a daily dietary calcium intake ≥400 mg/day was associated with a reduced fracture probability ratio at any site [from 42 to 21% (p < 0.05)]. Subjects with one or more vertebral fractures had a significantly lower dietary calcium intake (<400 mg/day) than did subjects without vertebral fractures, and they practiced physical activity only occasionally (p = 0.030). Conclusions Daily dietary calcium intake is lower than the recommended daily intake in an Italian ambulatory population, and a higher fracture risk appears to be associated with a reduced calcium intake. An age-adequate daily calcium intake, combined with regular physical activity, is strongly recommended in order to counteract fragility fractures.
      PubDate: 2017-04-11
      DOI: 10.1007/s11657-017-0333-4
      Issue No: Vol. 12, No. 1 (2017)
  • Cessation rate of anti-osteoporosis treatments and risk factors in Spanish
           primary care settings: a population-based cohort analysis
    • Authors: Elisa Martín-Merino; Consuelo Huerta-Álvarez; Daniel Prieto-Alhambra; Dolores Montero-Corominas
      Abstract: Summary Among 95,057 patients ≥50 years with new anti-osteoporosis medications (AOM) (2001–2013) in primary care, 1-year cessation was 51% (28%–68%), higher in men, smokers, patients with missing lifestyle data, and out normal BMI, and lower in those aged 60–79, with recent fractures or other anti-osteoporotics, suggesting non-severe osteoporosis and less risk awareness. Purpose Low compliance to anti-osteoporosis medications (AOM) has been previously reported. We aimed to estimate 1-year cessation rates of different AOMs as used in Spanish healthcare settings, and to identify associated risk factors. Methods A cohort study was performed using primary care records data (BIFAP). Patients entered the cohort when aged 50 years in 2001–2013, with ≥1 year of data available, and identified as incident users of AOM (1-year washout). Participants were divided into six cohorts: alendronate, other oral bisphosphonates, selective oestrogen receptor modulators, strontium ranelate, teriparatide, and denosumab. Patients were followed from therapy initiation to the earliest of cessation (90-day refill gap), switching (to alternative AOM), loss to follow-up, death, or end of 2013. One-year therapy cessation was estimated using life tables. Hazard ratios (of cessation) according to age, sex, lifestyle factors, morbidity, and co-medication were estimated after stepwise backwards selection. Results A total of 95,057 AOM users were identified (91% women; mean age 68). One-year cessation was 51% overall, highest for strontium ranelate (68%), and lowest for denosumab (28%). Cessation probability was higher in men (14% to 2.1-fold), smokers (>6%), and patients with missing BMI (19–28%) or smoking (6–20%) data, and overweight/obese/underweight (7% to 2.6-fold increase compared to normal weight). Patients aged 60–79 years, with a recent fracture or other drugs used for osteoporosis, had better persistence. Conclusions Over half of the patients initiating AOM stopped therapy within the first year after initiation. The described risk factors for cessation could be proxies for non-severe osteoporosis, and/or disease/risk awareness, which could inform the targeting of high-risk patients for monitoring and/or interventions aimed at improving persistence.
      PubDate: 2017-04-11
      DOI: 10.1007/s11657-017-0331-6
      Issue No: Vol. 12, No. 1 (2017)
  • Screening for osteoporosis following non-vertebral fractures in patients
           aged 50 and older independently of gender or level of trauma energy—a
           Swiss trauma center approach
    • Authors: Christoph Hemmeler; Sabrina Morell; Felix Amsler; Thomas Gross
      Abstract: Summary Screening in a standardized manner for osteoporosis in non-vertebral fracture patients aged 50 and older independently of both gender and level of trauma energy yielded the indication for osteoporotic therapy for every fourth male high-energy fracture patient. Purpose This study aimed to identify the rate of osteoporosis in patients of both genders after fracture independently of the underlying level of trauma energy. Methods A random cohort of patients aged 50 or older with non-vertebral fractures participated in a standardized diagnostic protocol to evaluate the indication for treatment of osteoporosis (number needed to screen (NNS)). Univariate and multivariate analysis as well as correlation testing were performed to determine statistical relationships. Significance was set at p < 0.05. Results Of 478 fracture patients with a mean age of 69.3 ± 11.8 years, 317 (66.3%) were female and 161 (33.7%) male. One hundred nineteen patients (24.9%) sustained high-energy fractures (HEFs) and 359 (75.1%) low-energy fractures (LEFs). Twenty-eight percent of males and 47% of females qualified as osteoporotic in densitometry (dual-energy X-ray absorptiometry (DXA)), resulting in a NNS of 2.1 for women and 3.6 for men. The indication for treatment of osteoporosis increased to an NNS of 1.5 for females and 2.4 for males if the fracture risk assessment tool (FRAX) was included in the diagnostics (DXA and FRAX). With regard to the energy of trauma, the NNS for treatment following DXA and FRAX was 1.5 for LEF and 2.9 for HEF. Subgroup analysis revealed that HEF males within the decennia 50+ and 80+ had an NNS of around 3, i.e., comparable to females and about twice as high as LEF patients. Conclusions These preliminary findings appear to confirm the pragmatic approach to screening in a standardized manner for osteoporosis in all non-vertebral fracture patients aged 50 and older—independently of both gender and level of trauma energy.
      PubDate: 2017-04-08
      DOI: 10.1007/s11657-017-0334-3
      Issue No: Vol. 12, No. 1 (2017)
  • Changes and tracking of bone mineral density in late adolescence: the
           Tromsø Study, Fit Futures
    • Authors: Ole Andreas Nilsen; Luai Awad Ahmed; Anne Winther; Tore Christoffersen; Anne-Sofie Furberg; Guri Grimnes; Elaine Dennison; Nina Emaus
      Abstract: Summary Areal bone mineral density (aBMD) predicts future fracture risk. This study explores the development of aBMD and associated factors in Norwegian adolescents. Our results indicate a high degree of tracking of aBMD levels in adolescence. Anthropometric measures and lifestyle factors were associated with deviation from tracking. Purpose Norway has one of the highest reported incidences of hip fractures. Maximization of peak bone mass may reduce future fracture risk. The main aims of this study were to describe changes in bone mineral levels over 2 years in Norwegian adolescents aged 15–17 years at baseline, to examine the degree of tracking of aBMD during this period, and to identify baseline predictors associated with positive deviation from tracking. Methods In 2010–2011, all first year upper secondary school students in Tromsø were invited to the Fit Futures study and 1038 adolescents (93%) attended. We measured femoral neck (FN), total hip (TH), and total body (TB) aBMD as g/cm2 by DXA. Two years later, in 2012–2013, we invited all participants to a follow-up survey, providing 688 repeated measures of aBMD. Results aBMD increased significantly (p < 0.05) at all skeletal sites in both sexes. Mean annual percentage increase for FN, TH, and TB was 0.3, 0.5, and 0.8 in girls and 1.5, 1.0, and 2.0 in boys, respectively (p < 0.05). There was a high degree of tracking of aBMD levels over 2 years. In girls, several lifestyle factors predicted a positive deviation from tracking, whereas anthropometric measures appeared influential in boys. Baseline z-score was associated with lower odds of upwards drift in both sexes. Conclusions Our results support previous findings on aBMD development in adolescence and indicate strong tracking over 2 years of follow-up. Baseline anthropometry and lifestyle factors appeared to alter tracking, but not consistently across sex and skeletal sites.
      PubDate: 2017-04-08
      DOI: 10.1007/s11657-017-0328-1
      Issue No: Vol. 12, No. 1 (2017)
  • Awareness of osteoporosis among female head of household: an Iranian
    • Authors: Pouria Khashayar; Mostafa Qorbani; Abbasali Keshtkar; Patricia Khashayar; Amir Ziaee; Bagher Larijani
      Abstract: Summary More than 81% of the studied women had a poor knowledge of different aspects of osteoporosis and its complications, suggesting that more educational programs targeting women in particular are needed to help improve the osteoporosis practice in the societies and reduce the burden of the disease. Purpose The family structure has changed considerably in the past decade. But, women from Iran and many countries in the region and even families with similar cultural background living in other parts of the world are still responsible for childcare as well as the lifestyle adapted by the family. The present study was conducted to assess the awareness of the female head of household of osteoporosis and its complications. Methods As part of a population-based study in two Iranian cities, Arak and Sannandaj, to study osteoporosis and its risk factors, a questionnaire on the knowledge of female head of households of osteoporosis and its complications was completed. The subsample filled out the knowledge survey along with the questionnaire on their demographic data, socioeconomic status (SES), reproductive factors, bone-related lifestyle habits, family and personal medical history, medication use, and compliance with osteoporosis medication (if used) as well as a FFQ filled out for all the 2100 participants. They also underwent a bone mineral density (BMD) test, and their serum levels of vitamin D were calculated. These data were then used to assess the factors affecting their awareness level. Results The knowledge of 81.3% (473) of the studied women was found to be poor on different aspects of osteoporosis and its complications. Multivariate analysis revealed that each level increase in vit D intake tertile increases the chance of higher awareness level in K-Total by 1.5 times. Each level increase in physical activity tertile was associated with a 30.6% lower chance of having a good knowledge. Conclusion Considering the poor awareness level of the studied women and their poor practice of bone healthy behavior, one could conclude that more programs are needed or the content/delivery style of the existing ones should be optimized.
      PubDate: 2017-04-06
      DOI: 10.1007/s11657-017-0330-7
      Issue No: Vol. 12, No. 1 (2017)
  • Performance of risk assessment tools for predicting osteoporosis in south
           Indian rural elderly men
    • Authors: Anil Satyaraddi; Sahana Shetty; Nitin Kapoor; Kripa Elizabeth Cherian; Dukhabandhu Naik; Nihal Thomas; Thomas Vizhalil Paul
      Abstract: Summary Osteoporosis in elderly men is an under-recognized problem. In the current study, we intend to look at the performance of two risk assessment tools [OSTA and MORES] for the diagnosis of osteoporosis. Osteoporosis was seen in 1/4th of elderly men at spine and 1/6th of them at femoral neck. Both risk assessment tools were found to have good sensitivity in predicting osteoporosis at spine and femoral neck with good area under curve (AUC). Purpose This study attempts to look at the performance of osteoporosis self-assessment tool for Asians (OSTA) and male osteoporosis risk estimation score (MORES) for predicting osteoporosis in south Indian rural elderly men. Methods Five hundred and twelve men above 65 years of age from a south Indian rural community were recruited by cluster random sampling. All subjects underwent detailed clinical, anthropometric, and bone mineral density measurement at lumbar spine and femoral neck using dual-energy X-ray absorptiometry scan. A T score ≤ − 2.5 was diagnostic of osteoporosis. Scores for OSTA and MORES were calculated at various cut offs, and their sensitivities and specificities for predicting osteoporosis were derived. Results The prevalence of osteoporosis was found to be 16% at femoral neck and 23% at spine. OSTA with a cut-off value of ≤2 predicted osteoporosis with a sensitivity and specificity at lumbar spine of 94 and 17% and at femoral neck of 99 and 18%. The area under ROC curve for OSTA index for spine was 0.716 and for femoral neck was 0.778. MORES with a cut-off value of ≥6 predicted osteoporosis at spine with a sensitivity of 98% and specificity of 15%, and at femoral neck, they were 98 and 13%, respectively. The area under ROC curve for MORES for spine was 0.855 and for femoral neck was 0.760. Conclusion OSTA and MORES were found to be useful screening tools for predicting osteoporosis in Indian elderly men. These tools are simple, easy to perform, and cost effective in the context of rural Indian setting.
      PubDate: 2017-04-05
      DOI: 10.1007/s11657-017-0332-5
      Issue No: Vol. 12, No. 1 (2017)
  • Impact of air pollution on vitamin D deficiency and bone health in
    • Authors: Elham Feizabad; Arash Hossein-nezhad; Zhila Maghbooli; Majid Ramezani; Roxana Hashemian; Syamak Moattari
      Abstract: Summary The association between air pollution and bone health was evaluated in adolescents in the city of Tehran. This study is essentially ecological. Vitamin D deficiency among adolescents has been reported at higher rates in polluted areas than in non-polluted areas. Additionally, residence in polluted areas is associated with lower levels of bone alkaline phosphatase. Purpose The aim of this study was to evaluate the association between ambient air pollution and bone turnover in adolescents and to compare the prevalence of vitamin D deficiency between polluted and non-polluted areas of Tehran. Methods This cross-sectional population-based study was conducted on 325 middle- and high-school students (both girls and boys) in Tehran in the winter. During the study period, detailed daily data on air pollution were obtained from archived data collected by Tehran Air Quality Control Company (AQCC). Serum levels of calcium, phosphorus, parathyroid hormone (PTH), bone-specific alkaline phosphatase, 25(OH) vitamin D, osteocalcin, cross-linked C-telopeptide (CTX), total protein, albumin, and creatinine were obtained from the study group. Results Vitamin D deficiency was more prevalent in polluted areas than in non-polluted areas. After adjustment for age and sex, residence in the polluted area showed a statistically significant positive association with vitamin D deficiency and a statistically significant negative association with bone turnover. Interestingly, high calcium intake (>5000 mg/week) protects against the effects of air pollution on bone turnover. Conclusions Air pollution is a chief factor determining the amount of solar UVB that reaches the earth’s surface. Thus, atmospheric pollution may play a significant independent role in the development of vitamin D deficiency.
      PubDate: 2017-04-05
      DOI: 10.1007/s11657-017-0323-6
      Issue No: Vol. 12, No. 1 (2017)
  • Prevalence and risk factors associated with glucocorticoid-induced
           osteoporosis in Chinese patients with rheumatoid arthritis
    • Authors: Can-chen Ma; Sheng-qian Xu; Xun Gong; Ying Wu; Shan Qi; Wen Liu; Jian-hua Xu
      Abstract: Summary Usage of glucocorticoid (GC) is a strong risk factor of osteoporosis (OP) and osteoporotic fracture (OPF) in Chinese patients with rheumatoid arthritis (RA). Controlling GC daily dosage and shortening GC course are helpful in preventing glucocorticoid-induced osteoporosis (GIOP) and OPF for Chinese patients with RA. Introduction This study aims to investigate the prevalence and risk factors of GIOP, and also identify influences of GC daily dosage and GC treatment course for GIOP in Chinese patients with RA. Methods Seven hundred and ninety patients with RA and 158 normal subjects were enrolled in the study. Clinical and laboratory features and medications of GC were recorded in detail. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry in all subjects. Results BMD at all measured sites in RA was significantly lower than that in control group. Prevalence of OP was obviously higher in RA with GC group (41.6%), compared with RA without GC group (29.4%). Prevalence of OPF in group of RA with GC (21.0%) was higher than that in group of RA without GC (13.3%). Usage of GC, female, and age were risk factors for the occurrence of OP and OPF in RA, while body mass index (BMI) was the protective factor of OP. Prevalence of GIOP and OPF had statistical significance among groups of different treatment courses with GC, whereas no statistical difference was found among groups with different daily dosages of GC. Conclusions GIOP exists generally in Chinese patients with RA, which relates to treatment course not daily dosage of GC. Usage of GC is also the risk factor for the happening of OPF in Chinese patients with RA.
      PubDate: 2017-04-03
      DOI: 10.1007/s11657-017-0329-0
      Issue No: Vol. 12, No. 1 (2017)
  • Pre-fracture hospitalization is associated with worse functional outcome
           and higher mortality in geriatric hip fracture patients
    • Authors: Rene Aigner; Benjamin Buecking; Juliana Hack; Daphne Eschbach; Ludwig Oberkircher; Steffen Ruchholtz; Christopher Bliemel
      Abstract: Summary Hip fractures are common in elderly people. Despite great progress in surgical care, the outcomes of these patients remain disappointing. This study determined pre-fracture hospital admission as a prognostic variable for inferior functional outcomes and increased mortality rates in the perioperative phase and in the first postoperative year. Purpose The influence of a pre-fracture hospitalization on outcomes in hip fracture patients has not yet been investigated. Methods Four hundred two patients who were surgically treated for hip fracture were prospectively enrolled. Patients with a hospital stay within the last 3 months prior to a hip fracture were compared to patients without a pre-fracture hospitalization. Postoperative functional outcomes and mortality rates were compared between groups at the time of hospital discharge and additionally at the six- and twelve-month follow-up appointments. A multivariate regression analysis was performed. Results A pre-fracture hospitalization was reported by 67 patients (17%). In 63% of cases, patients were admitted due to non-surgical, general medical conditions. In 37% of cases, patients were treated due to a condition related to a surgical subject. In the multivariate analysis, pre-fracture hospitalization was an independent risk factor for reduced values on the Barthel Index at 6 months after surgery (B, −9.918; 95%CI of B, −19.001–−0.835; p = 0.032) and on the Tinetti Test at 6 months (B, −2.914; 95%CI of B, −1.992–−0.047; p = 0.047) and 12 months after surgery (B, −4.680; 95%CI of B, −8.042–−1.319; p = 0.007). Pre-fracture hospitalization was additionally associated with increased mortality rates at 6 months (OR 1.971; 95%CI 1.052–3.693; p = 0.034) and 12 months after surgery (OR 1.888; 95%CI 1.010–9.529; p = 0.046). Conclusions Hip fracture patients with a recent pre-fracture hospital admission are at a substantial risk for inferior functional outcomes and increased mortality rates not only in the perioperative phase but also in the first postoperative year. As a simple dichotomous variable, pre-fracture hospitalization might be a suitable tool for future geriatric hip fracture screening instruments.
      PubDate: 2017-03-27
      DOI: 10.1007/s11657-017-0327-2
      Issue No: Vol. 12, No. 1 (2017)
  • Thiazide increases serum calcium in anuric patients: the role of
           parathyroid hormone
    • Authors: Raquel F. V. Vasco; Eduardo T. Reis; Rosa M.A. Moyses; Rosilene M. Elias
      Abstract: Summary We evaluated the effect of hydrochlorothiazide in a sample of anuric patients on hemodialysis and found an increase in serum calcium, which occurred only in those with parathyroid hormone >300 pg/ml. This finding highlights the extra-renal effect of this diuretic and a possible role of parathyroid hormone in the mechanism. Purpose Thiazide diuretics are commonly used in patients with chronic kidney disease to treat hypertension. Their effects on calcium and bone metabolism are not well established, once calciuria may not fully explain levels of calcium and parathyroid hormone (PTH) in this population. A previous study has suggested that thiazides require the presence of PTH as a permissive condition for its renal action. In anuric patients, however, the role of PTH, if any, in the thiazide effect is unknown. Methods To assess thiazide extra renal effect on serum calcium and whether such an effect is reliant on PTH, hydrochlorothiazide (HCTZ) 100 mg was given orally once a day to a sample of 19 anuric patients on hemodialysis for 2 weeks. Laboratories’ analyses were obtained in three phases: baseline, after diuretic use, and after a 2-week washout phase. Results We demonstrated that serum calcium (Ca) increased in ten patients (52.6%) after HCTZ use, returning to previous levels after the washout period. Out of the 19 patients, ten presented PTH ≥ 300 pg/ml, and Ca has increased in eight of them, whereas in the other nine patients with PTH < 300 pg/ml, serum Ca has increased only in two individuals (RR risk of increase Ca 3.9; p = 0.012). Conclusions HCTZ was capable of increasing serum Ca in a sample of anuric patients on hemodialysis and seems this effect is highly dependent on PTH levels. Caution is required while interpreting this result, as the small sample size might implicate in a finding caused by chance.
      PubDate: 2017-03-25
      DOI: 10.1007/s11657-017-0326-3
      Issue No: Vol. 12, No. 1 (2017)
  • Awareness of osteoporosis in a polytechnic in Enugu, South East Nigeria
    • Abstract: Summary This study aims to determine the awareness of osteoporosis and factors that determine awareness of osteoporosis. Results showed that osteoporosis awareness was associated with age (p = 0.006) and occupation (p < 0.001) but not gender, marital status, and level of education. There is therefore need for educational interventions to improve awareness of osteoporosis. Introduction Osteoporosis is a bone disease in which the bone becomes porous, brittle, and more susceptible to fracture. It is the most common metabolic bone disease worldwide. Increased prevalence of disease is attributed to low awareness of disease among general population referred to as a ‘silent disease.’ There is paucity of evidence of osteoporosis awareness in Africa while level of knowledge in Nigeria is also minimal. Methods The study was carried out in a Polytechnic in Enugu, South East Nigeria, as one of the phases of ongoing awareness exercise on osteoporosis. Study design was descriptive cross-sectional study using stratified random sampling method for selection. The study made use of a structured, self-administered questionnaire using English language. Statistical analyses were carried out with SPSS version 22 software, using Chi square and Fischer exact tests of significance and alpha level set at p = 0.05. Results Out of a total number of 500 respondents, 187 (37.4%) had heard about osteoporosis, however, only 34 (18.2%) of those who have heard about osteoporosis knew the correct meaning of osteoporosis. Overall, only 34 (6.8%) out of 500 knew the correct meaning of osteoporosis. Osteoporosis awareness was highest among age group ≥51 years (33.3%) and least in age group ≤20 years (6.3%) (p = 0.006). Awareness was also highest among civil servants (17.9%) and least among unemployed respondents (0.0%) (p < 0.001). There was no gender preponderance in awareness level while marital status and level of education were not significantly associated with level of awareness. Conclusion While there was low knowledge of osteoporosis in the study area, awareness of osteoporosis was associated with age and occupation but not gender, marital status, or level of education. There is need for educational interventions to improve awareness of osteoporosis.
      PubDate: 2017-05-24
  • Effect of low appendicular lean mass, grip strength, and gait speed on the
           functional outcome after surgery for distal radius fractures
    • Abstract: Summary Patients with low appendicular lean mass plus slow gait speed or weak grip strength are at risk for poor functional recovery after surgery for distal radius fracture, even when they have similar radiologic outcomes. Introduction Loss of skeletal muscle mass and consequent loss in muscle function associate with aging, and this condition negatively impacts the activities of daily living and increases elderly individuals’ frailty to falls. Thus, patients with low appendicular lean mass would show different functional recovery compared to those without this condition after surgery for distal radius fracture (DRF). This study compares the functional outcomes after surgery for DRF in patients with or without low appendicular lean mass plus slowness or weakness. Methods A total of 157 patients older than 50 years of age with a DRF treated via volar plate fixation were enrolled in this prospective study. A definition of low appendicular lean mass with slowness or weakness was based on the consensus of the Asian Working Group for Sarcopenia. The researchers compared functional assessments (wrist range of motion and Michigan Hand Questionnaire [MHQ]) and radiographic assessments (radial inclination, volar tilt, ulnar variance, and articular congruity) 12 months after surgery between patients with and without low appendicular lean mass plus slowness or weakness. Multivariable regression analyses were performed to determine whether appendicular lean mass, grip strength, gait speed, patient demographic, or injury characteristics accounted for the functional outcomes. Results Patients with low appendicular lean mass plus slowness or weakness showed a significantly lower recovery of MHQ score than those in the control group throughout 12 months. There was no significant difference in the range of motion between the groups. The radiologic outcomes showed no significant difference between groups in terms of volar tilt, radial inclination, or ulnar variance. According to multivariable regression analysis, the poor recovery of MHQ score was associated with an increase in age, weak grip strength, and lower appendicular lean mass, and these three factors accounted for 37% of the variation in the MHQ scores. Conclusion Patients with low appendicular lean mass plus slowness or weakness are at risk for poor functional recovery after surgery for DRF, even when they have similar radiologic outcomes.
      PubDate: 2017-04-14
      DOI: 10.1007/s11657-017-0335-2
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