Association of COVID-19 and Development of Type 1 Diabetes: A Danish Nationwide Register Study.

OBJECTIVE: To compare the incidence of type 1 diabetes (T1D) before and during the coronavirus disease 2019 (COVID-19) pandemic and determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with T1D development. RESEARCH DESIGN AND METHODS: All Danish residents aged <30 years free of diabetes from 2015 to 2021 were included. Individuals were followed from 1 January 2015 or birth until the development of T1D, the age of 30, the end of the study (31 December 2021), emigration, development of type 2 diabetes, onset of any cancer, initiation of immunomodulating therapy, or development of any autoimmune disease. We compared the incidence rate ratio (IRR) of T1D using Poisson regression models. We matched each person with a SARS-CoV-2 infection with three control individuals and used a cause-specific Cox regression model to estimate the hazard ratio (HR). RESULTS: Among 2,381,348 individuals, 3,579 cases of T1D occurred. The adjusted IRRs for T1D in each quarter of 2020 and 2021 compared with 2015-2019 were as follows: January-March 2020, 1.03 (95% CI 0.86; 1.23); January-March 2021, 1.01 (0.84; 1.22), April-June 2020, 0.98 (0.80; 1.20); April-June 2021, 1.34 (1.12; 1.61); July-September 2020, 1.13 (0.94; 1.35); July-September 2021, 1.21 (1.01; 1.45); October-December 2020, 1.09 (0.91; 1.31); and October-December 2021, 1.18 (0.99; 1.41). We identified 338,670 individuals with a positive SARS-CoV-2 test result and matched them with 1,004,688 control individuals. A SARS-2-CoV infection was not significantly associated with the risk of T1D development (HR 0.90 [95% CI 0.60; 1.35]). CONCLUSIONS: There was an increase in T1D incidence during April-June 2021 compared with April-June 2015-2019, but this could not be attributed to SARS-CoV-2 infection.

[Monitoring anti-osteoporotic therapy: bone mineral density or markers of bone turnover].

This review discusses two methods of monitoring the effect of anti-osteoporotic treatment: bone mineral density (BMD) and bone turnover markers (BTMs). Both monitoring strategies are to some extent able to predict the treatment-induced change in risk of fracture. The use of BMD is commonplace, and clinicians are experienced in the interpretation of data. The use and knowledge of BTMs among clinicians is limited, but it allows for early testing while being practical and cheap. Further knowledge and implementation of BTMs in the clinical practice may improve the monitoring capabilities.

[Osteoporosis treatment can be discontinued based on an individual assessment].

In most patients, treatment of osteoporosis is a long-term challenge. Because alendronate and zoledronic acid accumulate in bone with some persistent antifracture efficacy after therapy, it is reasonable to consider a "drug holiday" for low-risk patients. It is recommended that the duration and length of drug holiday should be individualized for each patient. For all other bisphosphonates data are limited. For other antiresorptive and anabolic agents "drug holiday" is not recommended.

[Fracture prevention programmes can reduce the number of subsequent fractures]. / Frakturforebyggelsesprogrammer kan forebygge sekundære lavenergifrakturer

Once a fragility fracture has occurred after the age of 50 years, 41-85% of patients will experience another fracture. Patients who present at hospitals with a fragility fracture would benefit from introduction of fracture prevention programmes, as these programmes have been shown to reduce the number of subsequent fractures, reduce mortality, and furthermore are cost-effective. This paper presents the evidence for implementation of fracture prevention programmes and how these can be introduced successfully.

[Medical treatment of osteoporosis in men]. / Medicinsk behandling af osteoporose hos mænd.

One in five men over the age of 50 years will suffer an osteoporotic fracture during their lifetime, and men who sustain fractures have an increased mortality risk compared to women. Three bisphosphonates (alendronate, risedronate and zolendronic acid), denosumab, strontium ranelate and teriparatide are currently approved in Denmark for the treatment of osteoporosis in men. This review summarizes the available therapeutic options.

Inflammatory eye reactions in patients treated with bisphosphonates and other osteoporosis medications: cohort analysis using a national prescription database.

Ocular inflammatory reactions have been described in patients on bisphosphonate treatment. We estimated the incidence rate of ocular inflammation at 3 and 12 months in patients treated for osteoporosis using a register-based cohort linked to prescription data (hospitals and private practice) and hospital data. From January 1, 1997 to December 31, 2007, a total of 88,202 patients beginning osteoporosis therapy were identified. Of those patients, 82,404 (93%) began oral bisphosphonates and 5798 (7%) nonbisphosphonates. Within the first year of treatment, 4769 (5.4%) of patients on osteoporosis therapy filled one or more prescriptions for topical eye steroids (TES). TES treatment rates (per 1000 patient-years) in the first year of osteoporosis treatment were 44 (95% confidence interval [CI] 42 to 46) for alendronate, 40 (95% CI 38 to 43) for etidronate, 45 (95% CI 35 to 57) for risedronate, 32 (95% CI 27 to 37) for raloxifene, and 64 (95% CI 49 to 83) for strontium ranelate. After adjustment for age, Charlson index, and the number of comedications, pulmonary disease in men was associated with an increased use of TES (odds ratio [OR] = 1.48; 95% CI 1.17 to 1.86; p = 0.001). In women, malignant disease (OR = 1.27; 95% CI 1.02 to 1.60; p = 0.04) and pulmonary disease (OR = 1.32; 95% CI 1.07 to 1.62; p = 0.01) were significant predictors at 3 months and rheumatic diseases at 12 months (OR = 1.20; 95% CI 1.10 to 1.31; p < 0.001). There was no significant difference between the different drug classes (bisphosphonates versus nonbisphosphonates, alendronate versus nonalendronate-bisphosphonates) for risk of ocular inflammation, with age and the number of comedications being the only significant predictors. Hospital-treated uveitis (48 patients, or 0.05%) showed a similar trend. In conclusion, after initiation of treatment for osteoporosis, the risk of inflammatory eye reactions requiring TES is relatively low and not significantly different between bisphosphonate and nonbisphosphonate users. Patients with a rheumatic or pulmonary disease are at increased risk.

[Diagnosing and treating osteoporosis in patients with chronic obstructive pulmonary disease]. / Udredning og behandling af osteoporose hos patienter med kronisk obstruktiv lungesygdom.

Patients with chronic obstructive pulmonary disease have a high risk of osteoporosis and fractures. We present an algorithm for the prevention and treatment of osteoporosis in patients with chronic obstructive pulmonary disease.

[Medical therapy of osteoporosis in patients with mildly to moderate decreased renal function]. / Medicinsk behandling af osteoporose hos patienter med moderat til svaert nedsat nyrefunktion.

Both chronic kidney disease and osteoporosis are frequent conditions in the general population. Most drugs for treating osteoporosis seem safe in terms of affecting renal function for patients with mildly to moderate decreased renal function. There are very few data on the efficacy (reduction in fracture risk) or safety in patients with severely decreased renal function (glomerular filtration rate < 30 ml/min) or on dialysis.

[Treatment of mineral bone disorder with pharmaceuticals which influence the calcium phosphor turnover]. / Behandling af uraemisk osteodystrofi med laegemidler, som påvirker calcium-fosfor-omsaetningen.

This review discusses the mineral bone disorders in patients with chronic kidney disease. We focus on the management of these conditions by administration of calcium, vitamin D (ergocalciferol and cholecalciferol), vitamin D receptor activators (calcitriol, alphacalcidiol), phosphate binders and calcimimetics (cinacalcet).

Season of birth and the risk of hip fracture in danish men and women aged 65+.

Vitamin D status in pregnant women has been linked to childhood bone mineral density in their offspring but it is unclear if effects extend to fracture risk in adulthood or even old age. As vitamin D levels in the population show pronounced seasonal variation in Denmark, we performed an epidemiological analysis of hip fracture rates as a function of season of birth, age, and sex. We retrieved information on all hip fractures in the 9-year period between 1997 and 2005 in all men and women aged 65-95, excluded hip fractures that occurred in current and recent prednisolone users, and subsequently calculated fracture rates and relative risks. The analysis covered 541,109 men and 691,522 women. In women, we observed a small but statistically significant difference between fracture rates by season of birth for all age intervals expect the youngest (age 65-69). A similar pattern was seen in men, but this was only statistically significant in the two oldest age groups (age 85-89 and 90-95). These findings suggest that vitamin D availability in the first and second trimester of intrauterine life could have a small but lasting impact on bone health and the risk of osteoporotic fractures. Further studies are needed.

[Prevention and treatment of osteoporosis during treatment of non-metastatic prostate cancer]. / Udredning og behandling af osteoporose hos patienter med prostatacancer uden knoglemetastaser.

The prevention of cancer treatment-induced bone loss in patients with prostate cancer due to gonadotropin-releasing hormone (GnRH)-agonist, GnRH-antagonist and orchidectomi therapy has a high priority. We present an algorithm for the prevention and treatment of osteoporosis during treatment of non-metastatic prostate cancer.

[Diagnosis and treatment of osteoporosis in nonmetastatic breast cancer]. / Udredning og behandling af osteoporose ved cancer mammae uden knoglemetastaser.

The prevention of cancer-treatment-induced bone loss due to chemotherapy and long-term adjuvant breast cancer therapy has a high priority. We present an algorithm for the prevention and treatment of osteoporosis during treatment of nonmetastatic breast cancer.

[Assessment and treatment of osteoporotic hip fractures]. / Udredning og behandling af osteoporotiske hoftefrakturer.

INTRODUCTION: Osteoporosis is a major cause of low-energy hip fractures. Although there are pharmacologic agents available for both prevention and treatment, less than 10% of hip fracture cases initiate anti-osteoporotic treatment. MATERIAL AND METHODS: In 1995 and 2008, questionnaires were sent to all Danish orthopaedic surgery departments treating patients with low-energy hip fractures, asking them to explain a) whether patients with osteoporosis are identified, b) whether the patients identified are treated for osteoporosis, and c) whether physicians need more information about osteoporosis. RESULTS: 56 departments (97%) returned the questionnaires in 1995 and 25 (95%) in 2008. 40% of the departments did (12% in 1995) refer any patients with low-energy fractures to bone densitometry. 84% treated (11% in 1995) patients with hip fractures with calcium and D vitamin. In 2008, 28% (0% in 1995) of the departments used bisfosfonates after hip fractures (none used yearly zoledronate). More than 80% (54% in 1995) of the departments informed the patients about in the advantages of lifestyle changes. Half of the departments' doctors wanted more information about osteoporosis in 1995 compared with only 16% in 2008. In 2008, 48% of the departments informed the GPs that their patient with a low-energy fracture may have osteoporosis and that further evaluation and treatment may be needed. CONCLUSION: Medical treatment after fractures was more widespread in 2008 than in 1995. About half of the Danish departments with orthopaedic surgery functions refer patients to further investigation. There is, however, still room for improvement.

[Long term effects of raloxifen on the bones]. / Raloxifens langtidseffekter på knoglerne.

A set of now-completed, randomised clinical trials form the basis of our clinical understanding of the effects of raloxifen on the bones and are discussed in the paper.

[Treatment and prevention of osteoporosis in patients with decreased renal function]. / Behandling og forebyggelse af osteoporose hos patienter med nedsat nyrefunktion.

Decreased renal function and osteoporosis are both frequent conditions in the general population. Most drugs for treating osteoporosis seem safe for patients with mildly decreased renal function (glomerular filtration rate [GFR] 60-90 ml/min). In patients with a moderately decreased GFR of 30-60 ml/min, there are very few studies with BMD as endpoint. Most drugs seem safe in terms of affecting renal function. The aim should be to control calcium and vitamin D metabolism in patients with severely decreased renal function (GFR<30 ml/min) or on dialysis.