Low self-awareness of osteoporosis and fracture risk among postmenopausal women.

UNLABELLED: Postmenopausal women with a high risk of fractures may not perceive their risk. This study showed no concordance between the perceived and calculated risk of fracture. Almost 80 % of the women identified as a high risk of fracture by the FRAX algorithm tool perceived themselves to have little risk. PURPOSE: This study aimed to assess the concordance between self-perception of osteoporosis and fracture risk and the 10-year risk of fractures calculated by the FRAX algorithm. METHODS: A cross-sectional study was conducted in Santa Maria, RS, Brazil, between March 1 and August 31, 2013. Postmenopausal women over 55 years of age who have had at least one appointment at primary care in the 2 years prior to the enrolment were recruited. We excluded women with cognitive impairment. A standardized questionnaire regarding the perception of personal risk of osteoporosis and fractures was used. We also evaluated previous fractures, family history of fracture, smoking, alcohol consumption, use of glucocorticoids, and secondary causes of osteoporosis. Weight and height of the participants were measured. The risk of fractures of each participant was calculated using the FRAX algorithm (Fracture Risk Assessment Tool). RESULTS: Of the 1301 invited women, 1057 completed the survey. The average (mean [SD]) age and BMI were 67.2 (7.6) years and 29.3 (5.5) kg/m(2), respectively. Only 16.9 and 19.9 % participants believed themselves to be at a high risk of osteoporosis and fractures, respectively. There was no agreement between the perceived risk of fractures and the calculated FRAX risk of fractures. Moreover, almost 79.3 % of the women identified with a high risk of fractures by the FRAX algorithm perceived themselves as having little risk. CONCLUSION: These results show that postmenopausal women underestimate their risk of osteoporotic fractures when compared with their 10-year fracture risk according to FRAX algorithm.

Osteoporosis knowledge in patients with a first fragility fracture in Puerto Rico.

PURPOSE: To determine the level of knowledge about osteoporosis and factors associated with low level of knowledge in patients with a first osteoporotic fracture. METHODS: A cross-sectional study in adult patients with a first osteoporotic fracture admitted to the University Hospital of the Puerto Rico Medical Center, San Juan, Puerto Rico was performed. Socio-demographic parameters, clinical features, and pharmacologic treatment were examined. A validated questionnaire was used to assess subjects' level of knowledge about osteoporosis. Differences between study groups were evaluated using chi-square and Student's t tests, as appropriate. RESULTS: A total of 54 patients participated in the study. The mean (SD) age was 73.7 (10.7) years; 77.8% were females. Overall, 61.1% of the participants had a low level of knowledge about osteoporosis. Patients with low level of knowledge were more likely to have the Puerto Rico Government health insurance, lower level of education, and higher hip FRAX scores than those with mid/high level of knowledge. Also, they were less likely to receive osteoporosis counseling by their primary care physicians (PCP), have prior BMD measurement, receive bisphosphonates/raloxifene treatment, and to take calcium and vitamin D supplements. CONCLUSIONS: In this population of Hispanic patients with a first osteoporotic fracture, the majority had a low level of knowledge about osteoporosis. Low knowledge was associated with low socio-economic status, lack of counseling about osteoporosis by PCP, prior BMD measurement, and osteoporosis treatment. Better efforts should be undertaken to educate, identify, and manage patients at risk for osteoporotic fractures.

Validation of the Portuguese version of the quality of life questionnaire of the European foundation for osteoporosis (QUALEFFO-41) in Brazilian women with postmenopausal osteoporosis with vertebral fracture.

To validate the Portuguese version of the quality of life questionnaire of the European foundation for osteoporosis (QUALEFFO-41) in Brazilian women with osteoporotic vertebral fractures (VF). A questionnaire validation study of 86 postmenopausal women was conducted. Women were divided into two groups: 43 in a group with VF and 43 in a group without osteoporosis, age-matched (±3 years). The QUALEFFO-41 questionnaire was administered twice in 4 weeks and compared to a generic questionnaire SF-36. For analysis of the QUALEFFO-41, internal consistency, repeatability, and discriminant capacity between VF patients and control patients were assessed. The significance level adopted was 5 %. The mean age of the women was 66.1 ± 7.2 years for the group with VF and 64.9 ± 6.3 years for the control group (p = 0.4259). The QUALEFFO showed adequate internal consistency in all domains (Cronbach's α of 0.74 to 0.84) and good repeatability (ICC of domains = 0.67-0.90). Of the total questions, 92.6 % demonstrated satisfactory convergent validity, and 95 % of the questions showed good discriminant validity. The mean scores of both questionnaires were significantly higher in the group with VF. There was a good correlation among the QUALEFFO-41 domains and their corresponding SF-36 domains, except for social function. All QUALEFFO-41 domains were significantly predictive of VF on assessment of the ROC curve. The Portuguese version of the QUALEFFO-41 may be used in Brazilian women with osteoporotic VF because it shows good reliability, repeatability, and validity. It was also shown to impair quality of life (QOL) in women with VF and had good ability to discriminate QOL in women with osteoporotic VF.

Effects of D-003 (10 mg/day) on bone mineral density of the lumbar spine and femoral neck in postmenopausal women: a randomized, double-blinded study.

BACKGROUND/AIMS: Increased osteoclast activity is a pivotal finding in osteoporosis. This increase is mediated via the mevalonate-to-cholesterol pathway, which is involved in producing the intermediates required for osteoclast activity. D-003, a mixture of high molecular weight sugarcane wax acids, has been shown to inhibit cholesterol synthesis prior to mevalonate production, resulting in a reduction of bone loss and resorption in ovariectomized rats. Moreover, previous studies have demonstrated that short-term D-003 treatment reduces urinary excretion of deoxypyridinoline/creatinine in postmenopausal women. METHODS: We performed a double-blinded, placebo-controlled study to investigate the effects of D-003 (10 mg/day) treatment for 3 years on bone mineral density (BMD) in 83 postmenopausal women with low BMD. RESULTS: Over 3 years, D-003 treatment increased lumbar spine BMD (5.1%, p < 0.01) and improved osteoporosis-related quality of life scores as compared with placebo-treated controls. D-003 was also well tolerated; the frequency of adverse events in the bone, joints, or muscle with D-003 treatment (p < 0.05) was lower than in the placebo group. CONCLUSIONS: D-003 treatment (10 mg/day) for 3 years increased lumbar spine BMD and produced clinical improvements in postmenopausal women with low BMD. Further studies, however, will be required to confirm these results.

[Monthly ibandronate attachment to Mexican and Chilean women with osteoporosis, with or without a biofeedback strategy]. / Apego al ibandronato mensual en mujeres mexicanas y chilenas con osteoporosis, con o sin una estrategia de bio-retroalimentación.

BACKGROUND: Osteoporosis affects 1 in 3 postmenopausal women and is associated with significant morbidity and mortality. The utility of bisphosphonates is often affected by lack of attachment and acceptance of treatment. OBJECTIVE: To analyze the impact of biofeedback in the adherence to once-monthly oral ibandronate treatment. PATIENTS AND METHOD: We designed an open-label, prospective, randomized, multicenter clinical study to investigate the impact of biofeedback with bone turnover markers on adherence to once-monthly oral ibandronate treatment in 781 Mexican and Chilean patients with postmenopausal osteoporosis (BOHEMIA study). They were enrolled at 25 centers in Mexico (700 patients) and 24 centers in Chile (81 patients). All patients received once-monthly oral ibandronate 150 mg for 6 months. Patients without previous bisphosphonate treatment, previous bisphosphonate users, or current bisphosphonate users were included. Patients were randomly divided into two arms at baseline, either to receive biofeedback or not. RESULTS: A statistically significant improvement in adherence was found in patients who received biofeedback when compared with those who did not (98.8 to 99.8% [95% CI] and 95.5 to 97.5%, respectively [p < 0.001]). CONCLUSIONS: Even though biofeedback with bone turnover markers was associated with a significantly greater adherence, it was not great enough to recommend biofeedback as a strategy to achieve optimal adherence. Once-monthly ibandronate by itself can achieve an adequate therapeutic adherence.

Quality of life in women with postmenopausal osteoporosis: correlation between QUALEFFO 41 and SF-36.

OBJECTIVE: To evaluate quality of life (QoL) in women with postmenopausal osteoporosis, correlating the QUALEFFO 41 with the short-form health survey 36 (SF-36) and evaluated some factors that can influenced the QoL of women with osteoporosis. METHODS: A cross-sectional study was conducted in 220 postmenopausal women (ages ranging from 55 to 80 years). Of the total number, 110 women had osteoporosis and 110 women did not have osteoporosis and these women were age-matched (+/-3 years). Two questionnaires were administered to all subjects for evaluation of QoL: the quality of life questionnaire of the European foundation for Osteoporosis 41 (QUALEFFO 41) and the short-form health survey 36 (SF-36). For data analysis, a significance level of 5% was set (p<0.05). RESULTS: Clinical characteristics between the groups were similar, with statistically significant differences only in body mass index (BMI), race, school education, age at menopause and use of hormone therapy (HT) (p<0.001). Women with osteoporosis had a worse QoL both in the QUALEFFO 41 and in the SF-36, in all domains studied. Data was adjusted for BMI, race, school education and use of HT (p<0.001). There was a significant correlation between all domains in the QUALEFFO 41 questionnaire and their corresponding domains in the SF-36 (p<0.001). The only factors related to worse QoL were BMI>25 and sedentary lifestyle. In contrast, paid work was associated with a better QoL (CI=95%). CONCLUSION: Women with osteoporosis had an impaired QoL, especially relating to the physical, psychological and social aspects. The factors associated with QoL were obesity, sedentary lifestyle and paid work.

Depressive symptoms as a risk factor for osteoporosis and fractures in older Mexican American women.

INTRODUCTION AND HYPOTHESIS: Despite higher rates of depression, lower hormone replacement therapy (HRT) use, and inadequate knowledge of factors associated with osteoporosis, Mexican Americans have been understudied with regards to the association between depression, osteoporosis, and fractures. We hypothesized that depression increases the risk for osteoporosis and fractures among older Mexican American women. METHODS: Seven years of prospective data (1993-2001) from the Hispanic Established Populations for Epidemiologic Studies of the Elderly were analyzed for 1,350 women in the Southwest United States who had complete data for at least the first follow-up interview. RESULTS: Respondents (mean age:75) were generally poorly educated, had low income, and reported poor or fair health. High levels of depressive symptoms were reported by 31%, while new diagnosis of osteoporosis and new fractures were reported by 18 and 13%, respectively. Logistic regression analyses showed that predictors of newly diagnosed osteoporosis included age, high school (HS) education, ever having been an alcoholic, early menopause, hormone replacement therapy, and high levels of depressive symptoms. Factors predictive of new fractures included age, HS education, diabetes, early menopause, and high levels of depressive symptoms. CONCLUSIONS: Depressive symptoms were associated with increased risk of osteoporosis and new fractures, even after controlling for other predictive factors.

[Psychosocial aspects in osteoporosis]. / Aspectos psicosociales en pacientes con osteoporosis, implicancias clínicas.

Osteoporosis is a disease characterized by a decrease in bone mineral density which results in an increase in bone fracture. Its etiology is still unknown. Several risks factors have been described: increase in coffee intake, decrease in calcium intake, a sedentary lifestyle, a decrease in estrogen secretion and genetic factors. It has been recently shown that mood disorders, such as Major Depression associated with high levels of cortisone, constitute a risk factor for the development of osteoporosis. Psychoneuroimmunoendocrinology considers an integrated human being, a biopsychosocial unit permanently related to his environment, overcoming the cause - effect relationship. Taking into account this point of view we studied the psychoaffective and psychodynamic aspects in patients with osteoporosis. Several disorders have been found, an increase in anxiety indexes, depression, alexithymia, a larger number of early traumatic life events, a decrease in the support network and lower quality of life. Consequently, this pathology should be dealt with within an interdisciplinary framework. It is equally important to detect osteoporosis at an early stage in patients showing mood disorders.