Validation of the Hungarian Version of the SarQoL® Questionnaire and Its Association with the SARC-F Screening Tool.

BACKGROUND: Following the publication of a culturally adapted version of the original SarQoL® questionnaire in Hungarian language, we aimed to test its psychometric properties and its association with the SARC-F screening instrument. DESIGN: This cross-sectional validation study recruited elderly people from 2 nursing homes and an endocrinology clinic. All participants were screened for sarcopenia with the SARC-F tool, had their muscle mass measured with bioelectrical impedance analysis, as well as grip strength and gait speed. Sarcopenia was diagnosed with the EWGSOP2 criteria. Participants completed the SarQoL questionnaire, the SF-36, the EQ-5D and the EQ-VAS. Validation consisted of analyzing discriminative power, internal consistency, construct validity and floor- and ceiling effects. A multivariate regression model was used to evaluate the association between QoL, the SARC-F questionnaire, and a number of demographic and clinical variables. RESULTS: A total of 70 participants, aged 80.00 (68.50 - 82.50) years, were included. Discriminative power between sarcopenic and nonsarcopenic subjects was found for all domains, except domain 7 (Fears) when dividing study population based on the SARC-F score. We also found significantly lower QoL for domains 4 (Functionality) and 5 (Activities of daily living) when splitting participants based on muscle strength (Probable sarcopenia - EWGSOP2 definition). All domains showed a strong or moderate correlation with the total SarQoL score. Conceptually similar domains of other generic QoL questionnaires significantly correlated with the total SarQol score, confirming its convergent validity. Low correlations were found with different domains (divergent validity). No floor or ceiling effects were observed. Using a regression model, the components "strength" and "stair climbing" of the SARC-F questionnaire were significantly associated with the QoL of our patients assessed with the SarQoL instrument. CONCLUSION: Sarcopenia risk assessed with the Sarc-F instrument was significantly associated with QoL measured with the SarQol questionnaire. High internal consistency, convergent and divergent validity and no floor and ceiling effects characterised the Hungarian language SarQoL® questionnaire. Due to some limitations, further multi-center designed studies are needed to verify the validity of the SarQol questionnaire.

FAMILY HISTORY - BMD INDEPENDENTLY - INFLUENCES FRACTURE RISK.

Context: Parental history of osteoporosis is associated with an increased risk of fracture. However, there are not many data on the mechanism of action.Our objective was to determine if heredity influences fracture rate: independently or through the bone mineral density; to identify also the strongest independent risk factors of osteoporotic fractures among our study population. Methods: We processed data of 541 women outpatients with an average age of 55 years, participating in an osteoporosis screening program.Our results confirm that the presence of family history significantly increases fracture prevalence, (37% vs. 17%, p<0.001, OR 2.853, p=0.001) and decreases BMD scores. Fractures occur at higher (better) T and Z-scores. The risk of having T values in the range of (0- -1) and Z values in (-1--2) is much higher in the positive group. The logistic regression analysis confirms the BMD-independent influence of heredity on fracture risk. Conclusions: Parental history of osteoporosis negatively affects bone density and significantly increases the incidence of fractures. The latter happens also independently of the bone density values. Timely intervention in these easy-to-detect cases may be the most effective prevention of osteoporotic fractures.

ROMANIAN TRANSLATION AND VALIDATION OF THE SARC-F QUESTIONNAIRE.

CONTEXT: Several studies have addressed the impact of sarcopenia on various health outcomes. As the most critical issue is the early identification of individuals, a short screening tool may help clinicians to simply test for sarcopenia and start early management of the disease. Recently, a simple questionnaire, Sarc-F was provided that may adequately realize this aim. SUBJECTS AND METHODS: To validate the questionnaire we translated the original Sarc-F according to the recommended methodology. A total of 80 people, aged 65+ were evaluated for sarcopenia. Muscle mass, strength, and physical performance were measured. Volunteers completed the Sarc-F as well as other two questionnaires. Discriminative power, reliability, construct validity analyses, specificity, sensitivity, negative and positive predictive value evaluations were made. RESULTS: A good discriminative power and internal consistency were found. With the functional sarcopenia diagnostic criteria the test demonstrates a high specificity (84%). The positive and negative predictive values were: 78% and 77%. Using the more conservative diagnostic criteria the negative predictive value was: 85.4%, sufficient to rule out those not at risk of having sarcopenia and eliminate the need for further investigations. CONCLUSIONS: A valid Romanian Sarc-F questionnaire is now available to simply detect patients at risk/no risk of sarcopenia.

Honeycomb sterna: an unusual case of a developmental abnormality in the sternum.

This report details an unusual case of a human sternal developmental abnormality of an anatomical specimen part of the skeletal collection curated by University College London, Anthropology Department skeletal collection. This rarely reported developmental abnormality is caused by the non-fusion of lateral ossification centres in the sternebrae, resulting in the mesosternum having a honeycomb-like appearance. Sternal defects are typically underreported in the clinical literature as many cases being asymptomatic that they are typically diagnosed incidentally, as such there is a dearth in our current understanding of the development and anatomical variants of the sternum. Although in recent years, large-scale CT studies have investigated the prevalence of sternal developmental abnormalities, these studies have not reported sternal defects similar to the individual presented in this report. While most sternal defects are clinically uneventful, the lack of awareness of these variants can result in misinterpretation of radiological and pathological findings as such an understanding of anatomical variants even when asymptomatic is vital.

Determinants, consequences and potential solutions to poor adherence to anti-osteoporosis treatment: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF).

Many patients at increased risk of fractures do not take their medication appropriately, resulting in a substantial decrease in the benefits of drug therapy. Improving medication adherence is urgently needed but remains laborious, given the numerous and multidimensional reasons for non-adherence, suggesting the need for measurement-guided, multifactorial and individualized solutions. INTRODUCTION: Poor adherence to medications is a major challenge in the treatment of osteoporosis. This paper aimed to provide an overview of the consequences, determinants and potential solutions to poor adherence and persistence to osteoporosis medication. METHODS: A working group was organized by the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) to review consequences, determinants and potential solutions to adherence and to make recommendations for practice and further research. A systematic literature review and a face-to-face experts meeting were undertaken. RESULTS: Medication non-adherence is associated with increased risk of fractures, leading to a substantial decrease in the clinical and economic benefits of drug therapy. Reasons for non-adherence are numerous and multidimensional for each patient, depending on the interplay of multiple factors, suggesting the need for multifactorial and individualized solutions. Few interventions have been shown to improve adherence or persistence to osteoporosis treatment. Promising actions include patient education with counselling, adherence monitoring with feedback and dose simplification including flexible dosing regimen. Recommendations for practice and further research were also provided. To adequately manage adherence, it is important to (1) understand the problem (initiation, implementation and/or persistence), (2) to measure adherence and (3) to identify the reason of non-adherence and fix it. CONCLUSION: These recommendations are intended for clinicians to manage adherence of their patients and to researchers and policy makers to design, facilitate and appropriately use adherence interventions.