Osteoporosis liaison service in Japan

A fracture liaison service (FLS) is a secondary fracture prevention program that is led by a coordinator. A program called the osteoporosis liaison service (OLS), which includes FLS, was first implemented in Japan and has become popular for solving problems related to osteoporosis treatment. OLS and FLS have the same purpose, namely preventing fragility fractures, but while FLS focuses mainly on secondary fracture prevention in fracture patients, OLS addresses this issue as well as primary fracture prevention at clinics and in communities.

Effectiveness of ultrasonographic skeletal muscle assessment in patients after total knee arthroplasty

OBJECTIVES: This study aimed to characterize the skeletal muscles of patients who underwent total knee arthroplasty (TKA) using ultrasonography in order to investigate the effectiveness of ultrasonographic skeletal muscle assessment after TKA. METHODS: This study included 50 TKA patients (TKA group) and 41 residents with osteoarthritis who have not received TKA (non-TKA group). Ultrasonography was used to assess the characteristics of several different muscles. Various postoperative outcomes were evaluated. Muscle thickness (MT) and echo intensity (EI) results were compared among operated knees in the TKA group, nonoperated knees in the TKA group, and more severely affected knees in the non-TKA group. For the TKA group, multiple regression was conducted to examine the association between skeletal muscle characteristics of operated knees and postoperative outcomes. RESULTS: The MTs of the vastus medialis, vastus intermedius, and rectus femoris (RF) were significantly smaller and the RF-EI was significantly greater for both operated and nonoperated knees in the TKA group compared with the non-TKA group (P < 0.017). Several parameters of physical function were significantly poorer in the TKA group than in the non-TKA group (P < 0.05). Multiple regression demonstrated that RF-MT was associated with knee range of motion, knee strength, and physical functional performance in the TKA group (P < 0.05). CONCLUSIONS: The quantity and quality of skeletal muscles were lower in the TKA group than in the non- TKA group. Ultrasonography may be useful for assessing skeletal muscles in TKA patients because MT assessed with ultrasonography was associated with various parameters of physical function.

Relationship between sarcopenia and pain catastrophizing in patients with lumbar spinal stenosis: A cross-sectional study

OBJECTIVES@#The purpose of this study is to clarify the psychological factors related to sarcopenia in patients with lumbar spinal stenosis (LSS).@*METHODS@#This cross-sectional study included 72 patients with LSS (38 males and 34 females; mean age, 70.4 ± 6.9 years). Demographic data, lower extremity pain, back pain, Japanese Orthopaedic Association score, Pain Catastrophizing Scale (PCS) score, Hospital Anxiety and Depression Scale (HADS) score, Fear-Avoidance Beliefs Questionnaire score, walking velocity, grip strength, walking distance, and appendicular muscle mass were assessed. Muscle mass was measured using bioelectrical impedance analysis. Patients were grouped based on sarcopenia status according to skeletal muscle mass index.@*RESULTS@#The prevalence of sarcopenia was 13.9% (10 of 72 patients). Sarcopenia was significantly more common in females. The incidence of dyslipidemia and cardiovascular disease were significantly higher in the sarcopenia group. The sarcopenia group had lower body weight, body mass index, grip strength, and walking distance than the control group. The sarcopenia group had higher PCS scores and HADS-anxiety scores. Multivariate analysis identified body weight, dyslipidemia, walking distance, and PCS score as significantly related to sarcopenia.@*CONCLUSIONS@#Pain catastrophizing might be the most relevant psychological factor in sarcopenia. Evaluation of both physical function and pain catastrophizing is needed when investigating sarcopenia in LSS.

<b>Validation Study of Claims-based Definitions of Suspected Atypical Femoral Fractures Using Clinical Information</b> / 薬剤疫学

<p><b>Objective</b>: Monitoring the incidence of atypical femoral fractures (AFFs) using medical claim databases is useful to assess the safety of long-term bisphosphonate exposure. Therefore, we aimed to validate the relationship between clinically-defined suspected AFFs and the candidate patients obtained from claims data at three hospitals in Japan.</p><p><b>Design</b>: A cross-sectional study involving three hospitals that perform bone fracture surgery and from which electronic medical record databases of diagnoses and procedures are available.</p><p><b>Methods</b>: Candidate patients were at the medical databases using two International Classification of Diseases, 10th Edition (ICD-10) codes (subtrochanteric fracture and fracture of shaft of femur) in the claims databases. These potential cases by claim-based definition were validated using clinically-confirmed information such as, the patient operation records, the discharge records, or radiographic imaging findings as suspected AFFs.</p><p><b>Results</b>: Among fracture cases in the hospitals, and 9 cases with subtrochanteric fracture and 23 cases with femoral shaft fracture were identified based on the ICD-10 codes in the claims databases. Clinically confirmed subtrochanteric fracture had a sensitivity of 81.8% (95% CI: 48.2-97.7%), and a specificity of 100.0% (95% CI: 99.9-100.0%). For femoral shaft fracture, the sensitivity was 82.1% (95% CI: 63.1-93.9%), and the specificity was 100.0% (95% CI: 99.9-100.0%). In subgroup analyses, the sensitivities in patients over the age of 50 years with a single fracture site and with osteoporosis were relatively higher than in other subgroups.</p><p><b>Conclusion</b>: The claims-based definitions of suspected AFFs are accurate, indicating the value of pharmacoepidemiological studies using the National Receipt Database.</p>

Locomotive syndrome presents a risk for falls and fractures in the elderly Japanese population

"Locomotive syndrome" is used to designate the condition of individuals with musculoskeletal disease who are highly likely to require nursing care. This article reviews screening, prevalence, causal and related factors, and the relationship between locomotive syndrome and falls and fractures in older adults with this syndrome. A few self-administered questionnaire tools are available to assess individuals for locomotive syndrome. Additionally, screening methods, including a physical functioning assessment, are appropriate for detailed discrimination of locomotive syndrome. The prevalence of locomotive syndrome is significantly higher in women than in men, and tends to increase markedly from 70 years of age. More severe locomotive syndrome is related to knee pain, osteoporosis, sarcopenia, and lumbar disease. The incidence of falling in locomotive syndrome is higher than the incidence for the older population in general. Locomotive training including squats and a unipedal standing exercise has been recommending to prevent locomotive syndrome. This training improves muscle strength and balance function for older people who have a risk for locomotive syndrome.

Response to the Editor

No abstract available.