JournalTOCs

Archives of Osteoporosis
Journal Prestige (SJR): 0.71

Citation Impact (citeScore): 2
Number of Followers: 1

Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1862-3514 - ISSN (Online) 1862-3522
Published by Springer-Verlag

[2469 journals]

The association between depression and bone metabolism: a US nationally
representative cross-sectional study
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  Abstract: Summary This population-based study investigated the association between depression and bone mineral density (BMD), fractures, and osteoporosis in the US population. We found that participants with depression had lower BMD and were more likely to have fractures and osteoporosis. Background Depression, fractures, and osteoporosis are common in middle-aged and elderly, but their associations remained unclear. Objective To investigate the association between depression and bone mineral density (BMD), osteoporosis, and fracture in a middle-aged and elderly US population. Methods A nationally representative cross-sectional study used the National Health and Nutrition Examination Survey (NHANES) datasets. Depression was assessed and stratified using the Patient Health Questionnaire (PHQ-9). The multiple logistic regression models and the logistic binary regression models were used to analyze the association between depression and BMD, fractures, and osteoporosis. Gender, age, race, educational level, poverty ratio, body mass index (BMI), smoke, alcohol use, physical activity, and diabetes were included as covariates. Subgroup analysis was also conducted on gender, age, race, and education level. Results In total, 9766 participants were included after a series of exclusions, and 4179 (42.79%) had at least mild depressive symptoms. Compared to the participants without depression, those with depression had a lower total femur, femoral neck, and total spine BMD after adjusting multiple covariates. The multivariable-adjusted logistic binary regression models demonstrated that participants with depression more likely have hip fractures (OR = 1.518, 95% CI: 1.377–2.703, P = 0.000), spine fractures (OR = 1.311, 95% CI: 1.022–1.678, P = 0.030), and osteoporosis (OR = 1.621, 95% CI: 1.388–1.890, P = 0.000). Subgroup analysis revealed that depressed participants who were males, non-Hispanic White, ≤ 70 years, and not highly educated had a lower BMD and easily had osteoporosis. Conclusion Depression was associated with lower BMD, particularly in the spine, males, Hispanic-White, and not highly educated populations. Moreover, people with depression were more likely to have fractures and osteoporosis.
  PubDate: 2022-08-13
Association between prior cancer diagnosis and osteoporosis: a matched
case–control study
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  Abstract: Summary Epidemiological studies show an inconsistent association between cancer and osteoporosis. In this nationally representative population-based study, we found that a prior cancer diagnosis was not associated with osteoporosis. This finding may primarily apply to cancer survivors seen many years after their cancer diagnosis. Background Epidemiological studies show an inconsistent association between cancer and osteoporosis. We examined the association between a prior cancer diagnosis and osteoporosis in population-based data. Methods We performed an age- and sex-matched case–control study (1:2 matching ratio) using the National Health and Nutrition Examination Survey, 2011–2018. Cases were determined by self-reported prior diagnosis of cancer; all controls were free of cancer at the time of bone density measurement with dual-energy x-ray absorptiometry. We defined osteoporosis as a T-score ≤ − 2.5 at femoral neck, total hip, or lumbar spine. Unconditional multivariable logistic regression was used to test the association between a prior cancer diagnosis and osteoporosis. Results We identified 246 prior cancer cases and 492 controls (mean age: 65.8 years) in females, and 243 prior cancer cases and 486 controls (mean age: 68.0 years) in males. The most common types of cancer in females and males were breast cancer and prostate cancer, respectively. Osteoporosis prevalences were comparable between cases and controls among females (19.1% in cases vs. 18.7% in controls; P = 0.894) and males (5.8% in cases vs. 6.8% in controls; P = 0.594). After adjusting for covariates, a prior cancer diagnosis was not associated with osteoporosis in females (odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.54–1.29) or males (OR: 1.09; 95% CI: 0.51–2.30). Results were unaffected by cancer severity, cancer type, or time since cancer diagnosis. Conclusions A prior cancer diagnosis was not associated with osteoporosis in this nationally representative population.
  PubDate: 2022-08-12
One-year mortality after hip fracture surgery: urban–rural
differences in the Colombian Andes
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  Abstract: Summary To determine urban–rural differences influencing mortality in patients with hip fracture in Colombian Andes Mountains over a 1-year period. Purpose To identify the urban–rural differences of sociodemographic variables, fracture-related characteristics, and preoperative and postoperative clinical factors associated with 1-year mortality in patients over 60 years old who underwent hip fracture surgery in the Andes Mountains. Methods A total of 126 patients with a fragility hip fracture during 2019–2020 were admitted to a tertiary care hospital. They were evaluated preoperatively and followed up until discharge. Those who survived were contacted by telephone at 1, 3, and 12 months. Univariate, bivariate, and Kaplan–Meier analyses with survival curves were performed. Relative risk was calculated with a 95% confidence interval. Results A total of 32.5% of the patients died within 1 year after surgery, with a significant difference between those who resided in rural areas (43.1%) and those who resided in urban areas (23.5%) (RR 1.70; 95% CI, 1.03 to 2.80, p = 0.036). In the multivariate analysis, anemia (hemoglobin level ≤ 9.0 g/dL during hospitalization) (RR 6.61; 95% CI, 1.49–29.37, p = 0.003), a blood transfusion requirement (RR 1.47; 95% CI, 1.07 to 2.01, p = 0.015), the type of fracture (subtrochanteric fracture (RR = 4.9, 95% CI = 1.418–16.943, p = 0.005)), and postoperative acute decompensation of chronic disease (RR 1.60; 95% CI, 1.01 to 2.53, p = 0.043) were found to be independent predictive factors of 1-year mortality after surgery. Conclusions There was a difference in 1-year mortality between patients from rural and urban areas. More studies must be conducted to determine whether rurality behaves as an independent risk factor or is related to other variables, such as the burden of comorbidities and in-hospital complications.
  PubDate: 2022-08-09
Trends in osteoporotic fracture and related in-hospital complications
during the COVID-19 pandemic in Alberta, Canada
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  Abstract: Summary Fragility fractures (i.e., low-energy fractures) account for most fractures among older Canadians and are associated with significant increases in morbidity and mortality. Study results suggest that low-energy fracture rates (associated with surgical intervention and outcomes) declined slightly, but largely remained stable in the first few months of the COVID-19 pandemic. Purpose/introduction This study describes rates of low-energy fractures, time-to-surgery, complications, and deaths post-surgery in patients with fractures during the coronavirus disease (COVID-19) pandemic in Alberta, Canada, compared to the three years prior. Methods A repeated cross-sectional study was conducted using provincial-level administrative health data. Outcomes were assessed in 3-month periods in the 3 years preceding the COVID-19 pandemic and in the first two 3-month periods after restrictions were implemented. Patterns of fracture- and hospital-related outcomes over the control years (2017–2019) and COVID-19 restrictions periods (2020) were calculated. Results Relative to the average from the control periods, there was a slight decrease in the absolute number of low-energy fractures (n = 4733 versus n = 4308) during the first COVID-19 period, followed by a slight rise in the second COVID-19 period (n = 4520 versus n = 4831). While the absolute number of patients with low-energy fractures receiving surgery within the same episode of care decreased slightly during the COVID-19 periods, the proportion receiving surgery and the proportion receiving surgery within 24 h of admission remained stable. Across all periods, hip fractures accounted for the majority of patients with low-energy fractures receiving surgery (range: 58.9–64.2%). Patients with complications following surgery and in-hospital deaths following fracture repair decreased slightly during the COVID-19 periods. Conclusions These results suggest that low-energy fracture rates, associated surgeries, and surgical outcomes declined slightly, but largely remained stable in the first few months of the pandemic. Further investigation is warranted to explore patterns during subsequent COVID-19 waves when the healthcare system experienced severe strain.
  PubDate: 2022-08-03
Trends in osteoporosis care patterns during the COVID-19 pandemic in
Alberta, Canada
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  Abstract: Purpose/introduction The objective of this study was to describe osteoporosis-related care patterns during the coronavirus disease 2019 (COVID-19) pandemic in Alberta, Canada, relative to the 3-year preceding. Methods A repeated cross-sectional study design encompassing 3-month periods of continuous administrative health data between March 15, 2017, and September 14, 2020, described osteoporosis-related healthcare resource utilization (HCRU) and treatment patterns. Outcomes included patients with osteoporosis-related healthcare encounters, physician visits, diagnostic and laboratory test volumes, and treatment initiations and disruptions. The percent change between outcomes was calculated, averaged across the control periods (2017–2019), relative to the COVID-19 periods (2020). Results Relative to the average control March to June period, all HCRU declined during the corresponding COVID-19 period. There was a reduction of 14% in patients with osteoporosis healthcare encounters, 13% in general practitioner visits, 9% in specialist practitioner visits, 47% in bone mineral density tests, and 13% in vitamin D tests. Treatment initiations declined 43%, 26%, and 35% for oral bisphosphonates, intravenous bisphosphonates, and denosumab, respectively. Slight increases were observed in the proportion of patients with treatment disruptions. In the subsequent June to September period, HCRU either returned to or surpassed pre-pandemic levels, when including telehealth visits accounting for 33–45% of healthcare encounters during the COVID periods. Oral bisphosphonate treatment initiations remained lower than pre-pandemic levels. Conclusions This study demonstrates the COVID-19 pandemic and corresponding public health lockdowns further heightened the “crisis” around the known gap in osteoporosis care and altered the provision of care (e.g., use of telehealth and initiation of treatment). Summary Osteoporosis has a known substantial care and management disparity, which has been classified as a crisis. The COVID-19 pandemic created additional burden on osteoporosis patient care with healthcare encounters, physician visits, diagnostic and laboratory tests, and treatment initiations all declining during the initial pandemic period, relative to previous years.
  PubDate: 2022-08-03
Experience of a systematic approach to care and prevention of fragility
fractures in New Zealand
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  Abstract: Summary This narrative review describes efforts to improve the care and prevention of fragility fractures in New Zealand from 2012 to 2022. This includes development of clinical standards and registries to benchmark provision of care, and public awareness campaigns to promote a life-course approach to bone health. Purpose This review describes the development and implementation of a systematic approach to care and prevention for New Zealanders with fragility fractures, and those at high risk of first fracture. Progression of existing initiatives and introduction of new initiatives are proposed for the period 2022 to 2030. Methods In 2012, Osteoporosis New Zealand developed and published a strategy with objectives relating to people who sustain hip and other fragility fractures, those at high risk of first fragility fracture or falls and all older people. The strategy also advocated formation of a national fragility fracture alliance to expedite change. Results In 2017, a previously informal national alliance was formalised under the Live Stronger for Longer programme, which includes stakeholder organisations from relevant sectors, including government, healthcare professionals, charities and the health system. Outputs of this alliance include development of Australian and New Zealand clinical guidelines, clinical standards and quality indicators and a bi-national registry that underpins efforts to improve hip fracture care. All 22 hospitals in New Zealand that operate on hip fracture patients currently submit data to the registry. An analogous approach is ongoing to improve secondary fracture prevention for people who sustain fragility fractures at other sites through nationwide access to Fracture Liaison Services. Conclusion Widespread participation in national registries is enabling benchmarking against clinical standards as a means to improve the care of hip and other fragility fractures in New Zealand. An ongoing quality improvement programme is focused on eliminating unwarranted variation in delivery of secondary fracture prevention.
  PubDate: 2022-08-02
Patient-specific factors affecting survival following hip fractures—a
14-year follow-up study in Finland
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  Abstract: Summary The mortality of elderly hip fracture patients is high. Eighty-five percent of all patients were followed until death. The three most protective factors for 1-year survival were ASA class; BMI; and age, and the four most protective factors for 14-year survival were age; BMI; ASA class; and subtrochanteric fracture type. Objective Hip fractures are associated with increased mortality. The purpose of this study was to evaluate the protective preoperative factors regarding the survival of short-term (1 year) and long-term (14 years) follow-up in a hip fracture cohort in Finland. Methods A total of 486 patients, operated on in 2005 and 2006, were retrospectively evaluated. Survival was analyzed using Bayesian multivariate analysis and relative survival with the life table method. All patients were followed for a minimum of 14 years. Results We analyzed 330 women and 156 men, whose mean ages were 82.4 and 72.0 years, respectively. The overall mortality rate was 7% at 1 month, 22% at 12 months, and 87% at 14 years. Protective factors against mortality at 1 year were ASA class (1–3), BMI ≥ 20 kg/m2, age < 85 years, alcohol involvement, Alzheimer’s disease, no comorbidities, certain operative methods, and female sex. Factors promoting survival at 14 years were age < 75 years, BMI ≥ 20 kg/m2, ASA class (1–2), subtrochanteric fracture, certain operative methods, alcohol involvement, and no comorbidities. Conclusions Protective factors for 1-year survival in order of importance were ASA class, BMI, and age, and, correspondingly, for 14-year survival, age, certain operative methods, BMI, and ASA class. The relative survival of hip fracture patients was lower than that of the general population.
  PubDate: 2022-08-01
Bibliometric analysis of the top 100 most-cited articles on the treatment
of osteoporosis
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  Abstract: Purpose To perform a bibliometric analysis of the top 100 (T100) most-cited articles on the treatment of osteoporosis published between 1980 and 2021 to reveal major developments and trends in the field and to contribute to the methodologies and hypotheses of future studies. Methods On 15.12.2021, a search was conducted on the Web of Science database using the keyword “osteoporosis treatment” to screen articles published between 1980 and 2021. The title of the article, year of publication, total number and names of the authors, total number of citations and citation index, name and Q index of the journals, H-index, impact factor, country of authors, types of articles, and sources of funding were recorded. Results The most-cited article was “Osteoporosis Prevention, Diagnosis, And Therapy.” The article with the highest citation index was “Clinician’s Guide to Prevention and Treatment of Osteoporosis.. The majority of the articles were randomized controlled clinical trials. The journal with the highest number of articles included in the T100 was The New England Journal of Medicine, with 19 articles. The USA had the highest number of articles. There was a strong correlation between the number of citations and citation index of articles (p < 0.001). Conclusions This study, which examined the T100 most-cited articles on the treatment of osteoporosis, found that the articles primarily focused on the prevention, diagnosis, and follow-up of osteoporosis; search for antiresorptive and anabolic pharmacological agents; investigation of the efficacy and reliability of these agents on specific subpopulations; and surgical treatment options.
  PubDate: 2022-08-01
Sarcopenic osteoporosis, sarcopenic obesity, and sarcopenic osteoporotic
obesity in the Camargo cohort (Cantabria, Spain)
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  Abstract: Summary The associations of sarcopenia with osteoporosis or obesity have a very low prevalence. No trend towards an association between osteoporosis and sarcopenia is observed. Sarcopenia and obesity tend not to coincide, as if they were antagonistic disorders. Purpose To know (a) the prevalence in our region of sarcopenic osteoporosis (association of sarcopenia and osteoporosis (T-score < − 2.5)), sarcopenic obesity, and the association of osteoporosis, sarcopenia, and obesity; (b) the tendency of osteoporosis, sarcopenia, and obesity to associate with each other; and (c) the bone mineral density (BMD), the components of sarcopenia, and the prevalence of fragility fractures in these associations. Methods The study was performed in the Camargo cohort. Osteoporosis was diagnosed by DXA, sarcopenia by the EWGSOP-1 criteria, and obesity by body mass index (BMI) and fat percentage. Fractures were verified radiographically or by consulting the medical records. Results The prevalence of sarcopenic osteoporosis was 2.8% and the OR for this association 1.03 (p = 0.89). The prevalence of sarcopenic obesity by BMI was 1.4% and by fat percentage 5.9% (corresponding ORs: 0.18 (p < 0.0001) and 0.58 (p < 0.003) respectively). The prevalence of the association of osteoporosis, sarcopenia, and obesity was 0.0% when assessed by BMI and 0.8% when assessed by fat percentage. Patients with sarcopenic osteoporosis have less muscle mass and more fragility fractures than sarcopenic patients overall. In patients with sarcopenic obesity by fat percentage, muscle mass and strength, as well as physical performance, were similar to those of sarcopenic patients overall. Neither BMD nor fracture prevalence showed differences between patients with sarcopenic obesity and patients with sarcopenia or obesity in general. Conclusion Our study supports the idea that the prevalence of the mixed disorders studied is low. No significant association between osteoporosis and sarcopenia was found. Sarcopenia and obesity seem to tend to occur in different people, as if suffering from one of them hinders suffering from the other.
  PubDate: 2022-07-29
An observational study of vertebroplasty and kyphoplasty for osteoporotic
spinal fractures: utilisation and outcomes in England using an
administrative dataset
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  Abstract: Summary We reviewed outcomes for vertebroplasty and balloon kyphoplasty for the surgical treatment of osteoporotic spinal fracture. Our study of 5792 vertebroplasty and 3136 balloon kyphoplasty procedures conducted in England over a 7-year period found no evidence that the patient outcomes studied were poorer for vertebroplasty than for balloon kyphoplasty. Purpose To investigate use, safety and functional outcomes of vertebroplasty (VP) and balloon kyphoplasty (BKP) techniques for osteoporotic spinal fracture for patients operated on within the National Health Service in England. Methods This was an observational analysis of administrative data. Data were extracted from the Hospital Episodes Statistics database for the period 1st April 2011 to 31st March 2018 for all VP and BKP procedures. Patients aged < 19 years, with metastatic carcinoma and undergoing other decompression procedures, were excluded. The primary outcome was repeat spinal surgery within 1 year. Secondary outcomes were 30-day emergency readmission, death within 1 year, extended hospital stay, post-procedural pain within 30 days and post-procedural haemorrhage or infection within 30 days. Multilevel, multivariable logistic regression was used to adjust for covariates. Results Data were available for 5792 VP and 3136 BKP patients operated on at 96 hospital trusts. In the 63 trusts that conducted more than 20 procedures during the study period, the proportion of procedures conducted as BKP varied from 0 to 100%. There was no difference in any of the outcomes between VP and BKP patients or between trusts performing ≥ 70% and ≤ 30% of procedures as BKP. Conclusions With regard to the outcomes studied, there is no evidence that VP is associated with poorer outcomes than BKP.
  PubDate: 2022-07-29
Efficacy of generic teriparatide and alendronate in Chinese postmenopausal
women with osteoporosis: a prospective study
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  Abstract: Summary The efficacy of generic teriparatide in improving BMD at lumbar spine in patients with osteoporosis was similar to that of alendronate. It provided a new choice for osteoporosis treatment in Chinese population. Introduction To determine whether the efficacy of generic teriparatide is noninferior to alendronate for Chinese postmenopausal women with osteoporosis. Methods Eligible patients were randomly assigned (2:1) in a 48-week, open-label design to receive 20 µg sc daily teriparatide or 70 mg oral weekly alendronate. Primary outcome was percentage change in BMD at the lumbar spine from baseline to 48 weeks and was assessed for non-inferiority. The same outcome was further assessed for superiority as a secondary endpoint. Results Three hundred ninety-one and 196 participants were randomly assigned to the teriparatide or alendronate group, of whom 379 and 194 receiving at least one dose of teriparatide and alendronate treatment were eligible for the efficacy analysis. Teriparatide was non-inferior to alendronate for BMD change at lumbar spine (treatment difference: 0.7%, 95% CI: − 0.3 to 1.7%), which excluded the predefined non-inferiority margin of − 1.5%. However, teriparatide was not statistically superior to alendronate in improving BMD at lumbar spine (P = 0.169). At 48 weeks, changes in BMD at total hip were − 1.0% and 2.2% in teriparatide and alendronate group, respectively (P < 0.001). The incidence of new fracture showed no statistical difference between groups (P = 0.128). Serum P1NP and β-CTX levels significantly increased in the teriparatide group and markedly decreased in alendronate group (all P < 0.001 vs baseline). The adverse events (AEs) and serious AEs were more common in the teriparatide group than in the alendronate group, which were mainly teriparatide-related hypercalcemia, elevated alkaline phosphatase or parathyroid hormone, dizziness, and arthralgia. Conclusions Teriparatide was not inferior to alendronate in increasing BMD at lumbar spine in Chinese postmenopausal women, and they achieved these effects through different mechanisms.
  PubDate: 2022-07-28
Effects of physical exercise on bone mineral density in older
postmenopausal women: a systematic review and meta-analysis of randomized
controlled trials
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  Abstract: Summary Osteoporosis or decreased bone mineral density (BMD) is the most important risk factor for fractures, especially in older postmenopausal women (PMW). However, the interactions between exercise training and bone mineral density are not completely understood. We evaluated the effects of physical exercise on BMD in women aged ≥ 60 years postmenopausal. Purpose This systematic review and meta-analysis sets out to determine the effects of physical exercise on BMD in older postmenopausal women. Methods A systematic search was conducted in Medline, Science Direct, Cochrane, PubMed, CINAHL, Google Scholar, Scopus, and ProQuest up to December 25, 2021. Fifty-three studies, which assessed a total of 2896 participants (mean age: between 60 and 82 years), were included and analyzed using a random-effects model to estimate weighted mean differences (WMD) with 95% confidence intervals (CI). Results The meta-analysis found that exercise training significantly (p < 0.05) increased femoral neck (WMD: 0.01 g/cm2; 95% CI, 0.00 to 0.01], p = 0.0005; I2 = 57%; p < 0.0001), lumbar spine (WMD: 0.01 g/cm2, 95% CI, 0.01 to 0.02], I2 = 81%; p = 0.0001), and trochanter (WMD: 0.01 g/cm2, 95% CI 0.00, 0.02]; p = 0.009; I2 = 17%; p = 0.23). There were no significant differences between the intervention and control groups for total body and total hip BMD. Conclusion Our findings suggest that exercise training may improve bone mineral density in older PMW. This improvement is mediated by increases in the femoral neck, lumbar spine, and trochanter BMD. Further long-term studies are required to confirm these findings.
  PubDate: 2022-07-27
Reconsidering vitamin D optimal values based on parathyroid hormone levels
in a North Algerian cohort: stratification by gender and season
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  Abstract: Summary “Health-based threshold value” is used to define the optimal cutoff of vitamin D. This approach is based on the hypothesis of a secondary hyperparathyroidism associated with hypovitaminosis D. We define the optimal values in a North Algerian population. The optimal value is 25.0 ng/ml in men and 30.0 ng/ml in women. Purpose/Introduction There is no consensus defining the vitamin D optimal values. The aim of this study is to establish vitamin D optimal values in the Northern Algerian population, based on its skeletal effects as represented by the inverse relationship between 25-hydroxy vitamin D (25(OH) D) and parathyroid hormone (PTH). Methods 451 healthy volunteers of both genders, aged 19 to 79 years, were enrolled in a cross-sectional study conducted at the medical analysis laboratory of the University Hospital of Blida, Algeria. 25(OH) D was assessed by a sequential competitive immuno-fluoroassay technique. Determination of vitamin D optimal values was performed based on the kinetic relationship between 25(OH) D and PTH, as explored by inverse nonlinear regression on a spline plots curve. The optimal value represents the 25(OH) D level at which PTH ceases to increase and reaches a virtual plateau. Results In men and women, respectively, the 25 (OH) D thresholds are estimated at 25.0 ng/ml and 30 ng/ml, above this value, PTH stabilizes in a virtual plateau, estimated at 22.3 pg/ml and 26.8 pg/ml. In warm and cold seasons, respectively, the 25 (OH) D cut-offs are estimated at 30.0 ng/ml and 25.0 ng/ml, from these values, the PTH stabilizes in a virtual plateau, estimated at 21.5 pg/ml and 27.7 pg/ml. Conclusion In this study, the optimal values of 25(OH) D were defined for the first time in a North Algerian adult population. The optimal value is 25.0 ng/ml in men and 30.0 ng/ml in women.
  PubDate: 2022-07-27
The effectiveness of an orthogeriatric service in Ain Shams University,
Egypt: a quality improvement study
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  Abstract: Summary This quality improvement study assessed the effectiveness of an orthogeriatric service regarding fracture care and outcomes in terms of time to surgery, length of hospital stay, postoperative pain score improvement, depression and treatment decisions. The findings showed a significant reduction in time to surgery and mean length of stay following the implementation of orthogeriatric services (OGS). Introduction Osteoporosis is a metabolic bone disease prevalent amongst the elderly, more commonly females, and puts them at increased risk of fragility fractures. OGS are recommended as a model of best practice for primary and secondary fracture care. Methods This quality improvement study, conducted in our facility at Ain Shams University Hospital, Cairo, aimed to determine the effectiveness of an orthogeriatric service. We compared fracture care and outcomes before and after the implementation of OGS in terms of time to surgery, length of hospital stay, degree of postoperative pain score improvement, depression and treatment decisions. We included 128 patients aged 60 and above presenting to the emergency department with a fracture. Results We found a significant reduction in the median time to surgery in the post-OGS group (p < 0.001) and a significant decrease in the mean length of stay in favour of the post-OGS group (p < 0.001). However, no significant difference was found between the two groups regarding the number of patients treated operatively, degree of postoperative pain improvement or susceptibility to depression. Conclusion Since the orthogeriatric service began, preliminary data have been encouraging, with significant reductions in time to surgery and length of stay. This along with preoperative medical optimisation and collaborative discharge recommendations has improved overall patient outcomes even though more research is needed.
  PubDate: 2022-07-27
Relationship between body mass index and fracture risk at different
skeletal sites: a nationwide cohort study
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  Abstract: Summary The association between obesity and fracture was skeletal site-specific with no gender difference. Obesity was associated with a higher risk of proximal humerus fractures but not for wrist or clinical vertebral fractures. Purpose The association between body mass index (BMI) and the risk of clinical fractures at different sites is unclear. This study aimed to examine associations between BMI and fractures at different sites in Korean men and women. Methods This study analyzed 285,643 Korean adults (aged 50–80 years) who participated in health examinations from 2002 to 2003 and were followed up until 2015. The incidences of osteoporotic fractures were assessed using the International Classification of Diseases (10th revision; ICD-10) and procedure or radiographic codes. After adjusting for confounders, hazard ratios (HRs) were calculated using Cox proportional hazard models for fracture risk. Results Site-specific associations between BMI and fractures were found without gender difference. Specifically, an L-shaped association was found for clinical vertebral fractures, wherein the adjusted HRs per 5 kg/m2 increase were 0.80 (95% confidence interval [CI] = 0.76–0.83) in BMI groups < 25 kg/m2 and 0.97 (95% CI = 0.92–1.03) in BMI ≥ 25 kg/m2. A linear inverse correlation for wrist fractures was observed, wherein the HRs were 0.83 (95% CI = 0.81–0.86) per 5 kg/m2 increase. For proximal humerus fractures, a non-linear U-shape association was found, wherein the adjusted HRs per 5 kg/m2 increase were 0.66 (95% CI = 0.50–0.88) in BMI groups < 23 kg/m2 and 1.25 (95% CI = 1.08–1.45) in BMI ≥ 23 kg/m2. Conclusion Low BMI was a risk factor for all tested fractures. Obesity was a risk factor for proximal humerus fracture, but it is a protective factor for wrist fracture.
  PubDate: 2022-07-27
Risk factors of refracture after a fragility fracture in elderly
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  Abstract: Summary The study examined the risk factors of recurrent fragility fractures in elderly. Female and older age increased the risk of refracture. Older age at the first fracture also resulted in shorter time to the second fracture. The prevention program should be emphasized. Purpose The study examined the characteristics of the fragility fractures and refractures and the factors affecting the incidence and duration to the second fragility fracture. Methods The retrospective cohort study reviewed electronic medical records from Nan Provincial Public Health Office, Thailand. Patients aged ≥ 60 years with fragility fractures (hip, wrist, vertebra, and proximal humerus) from low-energy injuries between 1 January 2009 and 31 December 2018 were included. The characteristics of the first and second fractures and the factors that had effect on refracture incidence and duration were investigated. Results Among 4322 patients, 306 patients (7%) had subsequent fragility fractures. Risk factors of refracture included female (adjusted odd ratio 1.79, 95%CI 1.304–2.467) and older age at the first fracture (adjusted odd ratio 1.016, 95%CI 1.003–1.029). Factor resulted in shorter time to second fracture was older age at the first fracture (β-coefficient − 0.96, 95%CI − 1.4–(− 0.5)). Any type of the first fracture resulted in similar risk and duration to subsequent fracture. Half (48%) and two-third (65%) of the second fractures occurred within 3 and 4 years, respectively. Conclusion Female and older age were risk factors of subsequent fragility fracture. Older age resulted in shorter time to the second fracture. Refracture prevention program should be initiated in patients with any type of first fragility fracture and should be continued for at least 3–4 years.
  PubDate: 2022-07-25
Correction to: Development of a data-driven case-mix adjustment model for
comparison of hospital performance in hip fracture care
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  PubDate: 2022-07-19
Trends in osteoporosis diagnosis and management in Australia
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  Abstract: Summary Trends in bone mineral density monitoring, and drug treatment for osteoporosis, in Australia were examined. Rates of DEXA scanning have increased in response to changes to government policy affecting reimbursement. The drug denosumab is being utilised at an increasing rate, while bisphosphonate use has declined. Osteoporosis prevalence remained stable over the same timeframe, while rate of hip fractures declined, suggesting that introduction of osteoporosis screening was associated with a reduction in adverse osteoporosis outcomes, but may also have been associated with overutilisation. Introduction Radiology interventions to diagnose and medications to manage osteoporosis in Australia are reimbursed under the Medicare benefits schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). Monitoring of these databases enables changes in utilisation of these practices to be monitored over time. Methods This study examined rates of utilisation for bone mineral density (BMD) measurement and osteoporosis pharmacotherapy subsidised under the MBS. Rates of osteoporosis and hip fracture were estimated using data reported by the Australian Bureau of Statistics (ABS) and Australian Institute for Health and Welfare (AIHW). Results Rates of BMD measurement increased since the technology was first reimbursed, with changes to policy regarding reimbursement for screening for individuals over 70 leading to an increase in BMD measurement after 2007. Prescribing rates also increased over time, initially with the introduction of oral bisphosphonates and subsequently for denosumab, which has subsequently become the most commonly prescribed agent for osteoporosis management in Australia, while bisphosphonate use has declined. Osteoporosis prevalence in Australia has remained relatively static at 3–4% of the population since 2001 to 2017, while rates of minimal trauma hip fracture hospitalisations have declined from 195 per 100,000 to 174 per 100,000 in the same timeframe. Conclusion Available data indicates that osteoporosis screening rates changed over time from 2001 to 2018 and that changes to government policy had a significant effect on the rates at which screening was performed. Over the same timeframe, there was a sustained reduction in hip fracture hospitalisation rates, with no change to reported osteoporosis prevalence. This suggests that policy changes permitting unlimited access to BMD measurement were associated with a reduction in osteoporotic fractures, but may also have been associated with overutilisation. Prospective studies to assess the efficacy of specific policies to ensure screening is performed in accordance with best-practice guidelines may be desirable.
  PubDate: 2022-07-19
Patients undergoing surgical treatment for low-energy distal radius
fractures are more likely to receive a referral and participate in a
fracture liaison service program
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  Abstract: Introduction Patients often do not receive osteoporosis screening after a low-energy distal radius fracture (DRF). The effect of osteoporosis on the healing of DRFs remains a debate, and it is unclear if surgical treatment of this injury affects the referral and participation rates in a fracture liaison service (FLS) program. The purpose of this study is to report on a large cohort of low-energy DRFs and identify demographic, clinical, and treatment factors that affect referral and participation rates in an FLS program. Methods A retrospective review identified patients over 50 years old who sustained a low-energy DRF between 2013 and 2018. Patients with high-energy or unknown injury mechanisms were excluded. The primary outcome was the effect of DRF surgical treatment on referral and participation rates in an FLS program. Secondary outcomes included patient demographic and clinical characteristic effects on referral and participation rates in an FLS program. Results In total, 950 patients met inclusion criteria. Two hundred thirty patients (24.2%) were referred and 149 (15.7%) participated in the FLS program. Patients who underwent surgery were more likely to be referred to the FLS (OR 1.893, CI 1.403–2.555, p < 0.001) and participate in the FLS program (OR 2.47, CI 1.723–3.542, p < 0.001) compared to patients who received non-operative treatment of their DRF. Conclusions Patients who undergo surgical treatment of a low-energy DRF are more likely to be referred and participate in a FLS program. Further study is needed to identify why surgical treatment may affect referral and participation rates.
  PubDate: 2022-07-19
Prevalence and treatment of fragility fractures in Spanish primary care:
PREFRAOS study
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  Abstract: Summary In Spanish primary care (PC), the prevalence of fragility fractures (FF) in subjects ≥ 70 years old is high, especially in women. One-third of subjects with an FF lacked osteoporosis (OP) diagnosis and >50% were not currently receiving OP medication. An improvement of the FF management in this population is needed. Purpose In Spanish PC, the prevalence of FF is high, especially in women. One-third of subjects with a FF lacked an OP diagnosis and more than half were not currently receiving OP medication. Several studies reported underdiagnosis/undertreatment of OP in PC among elderly subjects with FF. To date, no such data exist for Spain. The purpose is to estimate the prevalence of FF in the elderly population (≥ 70 years old) and to describe the characteristics, risk factors, comorbidities, and OP diagnosis and treatment rates of subjects with FF in Spanish PC centers. Methods This is an observational, retrospective study in Spain consisting of two phases. Phase A included all subjects ≥ 70 years old listed in the center’s medical records from November 2018 to March 2020. Phase B included subjects with FF and prior consultation at the center for any reason. Subjects were excluded only if they had previously participated in another study. Primary outcomes were prevalence of FF (phase A) and characteristics of subjects with at least one FF (phase B). Results The overall prevalence of FF was 17.7% among subjects visiting medical centers for any reason (24.1% women vs. 8.0% men) (30 PC centers from 14 Spanish regions). Vertebral (5.1%) was the most prevalent fracture. Of 665 subjects in phase B, most (87%) were women and ≥ 80 years old (57%), suffered mainly major OP fracture (68%), and had multiple comorbidities (≥ 2, 89.2%). While two-thirds had OP diagnosis and 61.1% received OP medication anytime in the past, 56.8% were not currently receiving OP medication. Diagnosis and treatment rates were lower among men (43% and 38% vs. 70% and 65%, respectively). Conclusion Prevalence of FF was high, especially in women. One-third of subjects lacked OP diagnosis and ≥ 50% were not receiving OP treatment; diagnosis and treatment gaps were larger among men. This reinforces the need to improve the management of FF in the elderly population. However, as PC centers participating in this study had high OP experience that have the potential to do better in terms of diagnosis and treatment, caution in the generalization of these data should be taken.
  PubDate: 2022-07-15