Osteoporosis and Fragility Fractures in Mexico: A Call to Action.

Osteoporosis (OP) is a chronic disease that affects older adults' quality of life, with fragility fractures (FF) being its most significant consequence due to their impact on healthcare systems in terms of morbidity, and economic and caregiving burden. FF are defined as fractures resulting from low-energy trauma, defined as falls from a standing height or less, and are usually considered osteoporotic (1). World demographic projections warn of a significant increase in adults aged 65 and older by 2050. These demographic changes mean that OP and FF will soon become an even greater challenge for healthcare systems, where prevention programs should be a priority. In Mexico, FF is also a public health challenge, with an initial reported incidence of nearly 2,000 cases per 100,000 population, and a projected seven-fold increase by 2050. Given this scenario, there is an urgent need for policy- and decision-makers to change their approach and formulate health policies that guarantee that people aged 65 and older are screened for fractures and have access to appropriate care. These policies should be part of a strategy to minimize FF and ensure active and healthy aging according to the WHO's Decade of Healthy Ageing. In this context, a group of Mexican experts representing different health organizations interested in the burden of OP and FF met to discuss possible strategies to reduce their burden for the next decade and summarize them in this Call to Action to promote public policies that prioritize an evidence-based approach to the prevention and treatment of OP and FF.

Sustained IL-6 and sTNF-αR1 levels after hip fracture predict 5-year mortality: A prospective cohort study from the Baltimore Hip Studies.

BACKGROUND: Persistent inflammation is associated with adverse health outcomes, but its impact on mortality has not been investigated previously among hip fracture patients. This article aims to investigate the influence of changes in levels of cytokines in the 2 months after a hip fracture repair on 5-year mortality. METHODS: This is a prospective cohort study from the Baltimore Hip Studies (BHS) with 191 community-dwelling older men and women (≥65 years) who had recently undergone surgical repair of an acute hip fracture, with recruitment from May 2006 to June 2011. Plasma interleukin-6 (IL-6), soluble tumor necrosis factor alpha receptor1 (sTNFα-R1), and interleukin-1 receptor agonist (IL-1RA) were obtained within 22 days of admission and at 2 months. All-cause mortality over 5 years was determined. Logistic regression analysis tested the associations between the cytokines' trajectories and mortality over 5 years, adjusted for covariates (age, sex, education, body mass index, lower extremity physical activities of daily living, and Charlson comorbidity index). RESULTS: High levels of IL-6 and sTNFα-R1 at baseline with small or no decline at 2 months were associated with higher odds of 5-year mortality compared with those with lower levels at baseline and greater decline at 2 months after adjustment for age, and other potential confounders (OR = 4.71, p = 0.01 for IL-6; OR = 15.03, p = 0.002 for sTNFα-R1). Similar results that failed to reach significance were found for IL-1RA (OR = 2.40, p = 0.18). Those with higher levels of cytokines at baseline with greater decline did not have significantly greater mortality than the reference group, those with lower levels at baseline and greater decline. CONCLUSION: Persistent elevation of plasma IL-6 and sTNFα-R1 levels within the first 2 months after hospital admission in patients with hip fracture is associated with higher 5-year mortality. These patients may benefit from enhanced care and earlier intensive interventions to reduce the risk of death.

Challenges in Delivering Effective Care for Older Persons with Fragility Fractures.

Fragility fractures occur because of low-impact trauma or even spontaneously in individuals with osteoporosis. Caring for older persons with fragility fractures can present several challenges due to the unique needs and vulnerabilities of this population. Older individuals commonly have multiple medical conditions, such as osteoporosis, arthritis, cardiovascular diseases, and diabetes. These comorbidities can complicate fracture management and increase the risk of complications. Fracture repair through surgery may be more complex in older patients due to poor bone quality, decreased tissue elasticity, and higher chances of anesthesia complications. In addition, mobility and functional limitations post-fracture are highly prevalent in this population, affecting their independence and increasing their risk of institutionalization. Addressing these challenges requires a multidisciplinary approach involving orthopedic surgeons, geriatricians, physical and rehabilitation physicians, physiotherapists, occupational therapists, dieticians, social workers, and caregivers. Preventive measures, such as fall prevention strategies and osteoporosis management, can also play a vital role in reducing the incidence of fragility fractures in older persons.

Associations between living alone, social interactions, and physical performance differ by sex: Results from the Baltimore Hip Studies.

BACKGROUND: There is mixed evidence on whether living arrangements and social interactions are associated with poorer health outcomes after hip fracture repair. Distinct social profiles among male and female older adults may explain some of the differences. However, prior studies did not evaluate these differences by sex. This article aims to assess if the associations between living alone, social interaction, and physical performance differ by sex among hip fracture survivors. METHODS: This prospective cohort study is part of the Baltimore Hip Studies seventh cohort, with 168 male and 171 female hip fracture patients assessed at baseline (≤22 days after hospitalization) and at 2, 6, and 12 months post admission. Living arrangements and interaction with children or siblings and others in the past 2 weeks were collected at all visits. Physical performance was measured in the follow-up visits with the Short Physical Performance Battery (SPPB). Linear mixed models tested associations of living alone and social interaction with SPPB over time adjusted for age, education, comorbidities, physical functioning pre-fracture, cognitive function, self-rated health, and time. RESULTS: For men only, living alone was associated with worse performance (0.7 points lower SPPB scores, p = 0.05). Higher social interaction was associated with 0.8 and 1.2 point higher SPPB scores for men and women, respectively (p < 0.05). Visiting with friends was significantly associated with better function among males, while visiting with children or siblings was associated with worse SPPB among females. CONCLUSIONS: Living arrangements and types of social interaction are differentially associated with physical function for older men and women. Screening for social isolation/integration and including interventions that promote social interaction and participation should be considered in healthcare programs for hip fracture survivors.

A description of the risk factors related to fragility fractures in adults and their associated costs

Objective: to identify bone fragility risk factors associated with increased total fracture care costs at a clinic in Medellín, Colombia. Design: an observational study with retrospective and prospective measurements taken from the medical charts of patients admitted for fractures and followed until discharge. Frame of reference: Hospital Alma Mater de Antioquia, Medellín, Colombia. Participants: four hundred fifty-two patients diagnosed with fragility fractures on admission. Main measurements: the prevalence of bone fragility risk factors, a description of the total care cost by risk factor and an estimate of the association between the risk factors and total costs. Results: Diabetes (24.3%) and active or passive smoking (21%) were the most prevalent fragility risk factors. Hip fractures were the most frequent and costly (36%, Md: COP 7,882,579). Fracture care was more costly for active or passive smokers (Md: COP 7,484,185), and those 75 years old or older (Md: COP7,057,678). According to the significant adjusted estimates (p<0.05), the median cost for active or passive smokers exceeds that of nonsmokers by more than COP 2,300,000, and every year of age increases the median cost by more than COP 90,000. Conclusions: this study emphasized that bone fragility is a public health problem. Factors like active or passive smoking and age were found to increase fragility fracture care costs, implying more complications and need for services. This adds to the evidence for strengthening monitoring programs to reduce the morbidity, mortality and direct costs of this disease in Colombia. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2351).

Objetivo: identificar factores de riesgo de fragilidad ósea asociados al aumento de costos totales de atención de fracturas en una clínica de Medellín, Colombia. Diseño: estudio observacional con medidas retrospectivas y prospectivas tomadas de la historia clínica de pacientes atendidos por fractura y seguidos hasta su egreso. Marco de referencia: Hospital Alma Máter de Antioquia, Medellín, Colombia. Participantes: cuatrocientos cincuenta y dos pacientes diagnosticados con fracturas por fragi lidad al ingreso. Mediciones principales: prevalencia de factores de riesgo de fragilidad ósea, descripción de costos totales de atención según factores de riesgo, y estimación de asociaciones entre factores de riesgo y costos totales. Resultados: diabetes (24.3%) y tabaquismo activo o pasivo (21%) fueron los factores de riesgo de fragilidad más prevalentes. Las fracturas de cadera fueron las más frecuentes y costosas (36%, Md: COP7 882 579). La atención de fracturas fue más costosa para pacientes fumadores activos o pasivos (Md: COP7 484 185), y de 75 años o más (Md: COP7 057 678). Según las estimaciones ajustadas significativas (p<0.05), los fumadores activos o pasivos tienen una mediana de costos de más de COP2 300 000 mayor que la de no fumadores, y cada año de edad incrementa la mediana de costos más de COP90 000. Conclusiones: este estudio enfatizó que la fragilidad ósea es un problema de salud pública. Se identificó que factores como fumar activa o pasivamente, y la edad aumenta los costos de atención de fractura por fragilidad implicando mayores complicaciones y necesidad de servicios. Esto añade a la evidencia para fortalecer los programas de vigilancia que reduzcan la morbimortalidad y costos directos de esta enfermedad en Colombia. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2351).

How to initiate and develop Fracture Liaison Services (FLS). Recommendations from the IOF Capture the Fracture® FLS Mentors in Brazil.

Expected number of fragility fractures in Brazil, raising the healthcare prioritization for interventions that reduce fracture risk. An FLS is dedicated to managing patient with fragility fracture to reduce risk of another fracture. We review FLSs cost-effectiveness and describe key components to effectively set up FLS in Brazil. PURPOSE: To create a guideline to show health professionals, hospital managers, and stakeholders in Brazil the importance of secondary fracture prevention and how to implement a Fracture Liaison Service. METHODS: We review the cost-effectiveness for FLSs in Brazil. We describe the key components needed to set up an effective FLS including methods for identification, investigation, treatment indication, including bone drugs, supplementation, physical activity, fall prevention, and monitoring. The staffing of FLSs, value of regional clinical networks and quality improvement are also described as a guide for healthcare professionals and decision makers in Brazil. RESULTS: An FLS is a service dedicated to identifying, assessing, recommending treatment, and monitoring patient who present with a fragility fracture reducing the risk of another fracture. FLS has been implemented in Brazil since 2012 overcoming a large geography and a complex health system. Even the limitations, restrictions, differences, and characteristics of each region, it is possible for health institutions to initiate an FLS, adapted to own available resources and meet the stages of identification, investigation, treatment, and monitoring. CONCLUSION: The peculiarity of the Brazilian healthcare system means FLS implementation needs to be tailored to local reality. However, even with limitations, any attempt to capture patients who suffer a fracture due to bone fragility is effective and reduces the risk of further fractures.

Short- and long-term prognostic factors associated with functional recovery in elderly patients with hip fracture: A systematic review.

This systematic review aimed to identify short- and long-term associated factors to functional recovery of elderly hip fracture patients after discharge. We identified 43 studies reporting 74 associated factors to functional recovery; most of them were biological, sociodemographic, or inherent factors to patients' baseline characteristics, including their pre-facture functional capacity. PURPOSE: This systematic review aimed to identify short- and long-term associated factors to functional recovery of elderly hip fracture patients after hospital discharge. We assessed the use of the hip fracture core-set and key-performance indicators for secondary fracture reduction. METHODS: A search was performed in seven electronic databases. Observational studies reporting predictors after usual care of elderly patients with hip fracture diagnoses receiving surgical or conservative treatment were included. Primary outcomes considered were part of the domains corresponding to functional capacity. RESULTS: Of 3873 references identified, and after the screening and selection process, 43 studies were included. Sixty-one functional measures were identified for ten functional outcomes, including BADLs, IADLs, ambulation, and mobility. Biological characteristics such as age, sex, comorbidities, cognitive status, nutritional state, and biochemical parameters are significantly associated. Determinants such as contact and size of social network and those related to institutional care quality are relevant for functional recovery at six and 12 months. Age, pre-fracture function, cognitive status, and complications continue to be associated five years after discharge. We found 74 associated factors to functional recovery of elderly hip fracture patients. Ten of the studies reported rehabilitation programs as suggested in KPI 9; none used the complete hip fracture core-set. CONCLUSION: Most of the associated factors for functional recovery of elderly hip fracture were biological, sociodemographic, or inherent factors to patients' baseline characteristics, including their pre-facture functional capacity. For the core-set and KPI's, we found an insufficient use and report. This study reports 61 different instruments to measure functional capacity. REGISTRATION NUMBER: PROSPERO (CRD42020149563).

Fragility fractures: proposal of the best practice through the fracture coordination units: the experience of Mexico.

Fragility fractures represent a health problem in Mexico and in the world. This paper reviews and puts forward the implementation of Fracture Liaison Services (FLS) as a feasible and cost-effective alternative in health institutions in our country through the identification, treatment, and follow-up of this type of fractures.

Osteoporotic fractures in rheumatoid arthritis patients in Argentina: a matched retrospective cohort study.

BACKGROUND: To compare the incidence of osteoporotic fractures in patients with rheumatoid arthritis (RA) with matched controls from a university hospital. METHODS: Consecutive RA patients (n = 100) were matched (age and sex) with controls (1:2). The follow-up period began at the index date, defined as the date of diagnosis for RA patients and the date of the first medical claim at the Health Management Organization (HMO) for non-RA patients. Fracture incidence rates per 1000 persons-years (PY) for distinct types of fractures were calculated. Multivariate cox regression analysis was performed to identify factors associated with fractures. RESULTS: One hundred RA patients were followed for a total of 975.1 patients-years and 200 controls for 1485.7 patients-years. No difference was found in the overall fracture incidence rate per 1000 PY between RA and controls (19.5, 95% CI 12.7-28.6 vs 12.1, 95% CI 7.7-18.7, p = 0.07). In the Cox regression analysis, only age (HR 1.06, 95% CI 1.02-1.11, p = 0.006) and history of a prior fracture (HR 9.85, 95% CI 2.97-32.64, p <  0.001) were associated with fractures after the index date. The stratified analysis of the fractures by location showed that only the vertebral fractures were more frequent in RA patients compared with controls (12.9 per 1000 PY, 95% CI 8.9-25.8, vs. 3.4, 95% CI 1.4-8.1, respectively, p = 0.01). CONCLUSION: Patients with RA didn't show an overall increased risk of osteoporotic fractures compared with matched controls, but vertebral fractures were more frequently observed in patients with RA.

Osteoporotic fractures in rheumatoid arthritis patients in Argentina: a matched retrospective cohort study

Abstract Background: To compare the incidence of osteoporotic fractures in patients with rheumatoid arthritis (RA) with matched controls from a university hospital. Methods: Consecutive RA patients (n = 100) were matched (age and sex) with controls (1:2). The follow-up period began at the index date, defined as the date of diagnosis for RA patients and the date of the first medical claim at the Health Management Organization (HMO) for non-RA patients. Fracture incidence rates per 1000 persons-years (PY) for distinct types of fractures were calculated. Multivariate cox regression analysis was performed to identify factors associated with fractures. Results: One hundred RA patients were followed for a total of 975.1 patients-years and 200 controls for 1485.7 patients-years. No difference was found in the overall fracture incidence rate per 1000 PY between RA and controls (19.5, 95% CI 12.7-28.6 vs 12.1, 95% CI 7.7-18.7, p =0.07). In the Cox regression analysis, only age (HR 1.06, 95% CI 1.02-1.11, p = 0.006) and history of a prior fracture (HR 9.85, 95% CI 2.97-32.64, p < 0.001) were associated with fractures after the index date. The stratified analysis of the fractures by location showed that only the vertebral fractures were more frequent in RA patients compared with controls (12.9 per 1000 PY, 95% CI 8.9-25.8, vs. 3.4, 95% CI 1.4-8.1, respectively, p =0.01). Conclusion: Patients with RA didn't show an overall increased risk of osteoporotic fractures compared with matched controls, but vertebral fractures were more frequently observed in patients with RA.

Hip fractures in the elderly Chilean population: a projection for 2030.

Using national databases, we projected the magnitude of hip fractures among the elderly Chilean population by 2030. Hip fractures will increase by 27.5% from 2018 to 9862 cases (95% CI = 8760 to 10,965). The most substantial growth is expected to occur in patients older than 80 years of age. INTRODUCTION: There is scarce information regarding the magnitude of hip fractures that will be observed in Latin American countries in the near future. The aim of this study is to project the volume of hip fractures in the elderly Chilean population by the year 2030. METHODS: The database of the Chilean Department of Statistics and Health Information, which includes all hospital discharges within Chile, was employed to evaluate the volume of hip fractures observed from 2012 to 2018 in the elderly population (≥ 65 years old). The annual incidence was determined by combining the volume of fractures with census data. Linear regression analysis was performed to determine the projected volume of hip fractures for 2030. RESULTS: For 2030, hip fractures among the elderly population are projected to grow 27.5% (R2 = 0.92) to 9862 cases (95% CI = 8760 to 10,965). In the group from 65 to 79 years old, hip fractures are expected to grow 21.6% (R2 = 0.87) to 3046 cases (95% CI = 2686 to 3405). In patients ≥ 80 years of age, hip fractures are expected to grow 30.1% (R2 = 0.9) to 6817 cases (95% CI = 5889 to 7744). CONCLUSIONS: A substantial growth in the volume of hip fractures is expected for the next decade among the elderly Chilean population, especially in patients ≥ 80 years of age. A national healthcare strategy should consider efforts to mitigate the impact of the future burden related to patients' care.

Lo que debe conocer un traumatólogo sobre osteoporosis y fracturas por fragilidad ósea / What an Orthopedic Surgeon Should Know of Osteoporosis and Bone Fragility Fractures

RESUMEN Introducción: La osteoporosis es la enfermedad ósea más común de los adultos mayores y constituye un importante problema de salud pública en todo el mundo. Objetivo: Actualizar algunos conceptos sobre osteoporosis y su tratamiento. Métodos: Se realizó una revisión de publicaciones entre 2010-2020 en inglés, con los términos: "osteoporosis", "tratamiento de la osteoporosis", "fracturas por osteoporosis". Resultados: La osteoporosis tiene gran impacto no solamente desde el ámbito clínico, sino también económico y social. Su tratamiento incluye medidas generales y el empleo de diversos grupos de fármacos. La posibilidad de fracturas por fragilidad en muñeca, columna y cadera es considerable lo que determina morbilidad y mortalidad elevadas(AU)

ABSTRACT Introduction: Osteoporosis is the most common bone disease in aged adults and it constitutes a major public health problem throughout the world. Objective: To update concepts on osteoporosis and treatment. Methods: A review of publications from 2010 to 2020 in English was carried out, using the terms "osteoporosis", "treatment of osteoporosis", "osteoporosis fractures". Results: Osteoporosis has great impact not only clinically, but economically and socially as well. Its treatment includes general measures and the use of various groups of drugs. The possibility of fragility fractures in the wrist, spine and hip is significant, which determines high morbidity and mortality(AU)

Fragility fractures in psoriatic arthritis patients: a matched retrospective cohort study.

OBJECTIVE: To compare incidental fragility fractures in psoriatic arthritis (PsA) patients with matched controls from a university hospital. METHODS: Consecutive PsA patients were matched (age and sex) with controls (1:2). Follow-up began at index date, defined as the date of PsA diagnosis for cases and their respective controls, until the last hospital visit, death or the end of the study (31 December 2017). Electronic medical records were reviewed for osteoporotic fractures. Incidence rates per 100,000 persons-years (PY) of distinct types of fractures after index dates were calculated and compared between groups. A multivariate Cox regression analysis was performed to investigate determinants of fractures. RESULTS: Ninety-two PsA patients and 184 controls were included. No difference was found in the overall fracture incidence rate per 100,000 PY between PsA and controls (1020 95% CI 510-1930, vs 870 95% CI 520-1390, p = 0.36). Vertebral fractures were numerically more frequent in PsA patients with an incidence rate of 1020 (95% CI 510-1930) per 100,000 PY versus 460 (95% CI 240-920), per 100,000 PY in the control group but it did not reach statistical significance (p = 0.06). In the Cox regression analysis, after adjusting for bisphosphonate use, only age (HR 1.10, 1.05-1.16, p < 0.001) and female sex (HR 3.94, 1.11-13.91, p = 0.03) were associated with fractures while PsA diagnosis and use of glucocorticoids were not. CONCLUSION: In this cohort of PsA patients, no overall increased risk of fractures was found in comparison with matched controls. Key Points • PsA could have different effects on bone, leading to confusing results in bone densitometry readings contributing to the difficulty in establishing the real prevalence of OP in PsA. • Vertebral fractures were more frequent in PsA patients compared to controls, but it did not reach statistical significance. No difference was found in the overall fracture incidence rate.

Fractura de cadera y geriatría: una unión necesaria / Hip fracture and geriatrics: a necessary union

Las personas mayores con fractura de cadera tienen un aumento del riesgo de mortalidad de 5 a 8 veces por todas las causas, y un riesgo mucho mayor de institucionalización por pérdida funcional, ya que solo el 50% de los pacientes que sobreviven, recuperan la actividad de la vida diaria previa a la fractura. Las intervenciones para prevenir dichos resultados, incluyendo una segunda fractura, se transforma en el objetivo principal en estos pacientes. El modelo de atención de ortogeriatría es un enfoque de atención multidimensional para los pacientes que sufren una fractura de cadera, que por lo general, es secundario a una caída desde su propia altura, conocida como fractura por fragilidad. Este modelo de atención desarrollado por geriatras y traumatólogos con la asistencia de un equipo multidisciplinario, incluye una evaluación integral perioperatoria y un equipo de enfermería centrada en la función premórbida del paciente, la cognición, las comorbilidades, que permite crear un plan individualizado, para ser monitorizado y asegurar su cumplimiento, los primeros dos años después de la fractura. Este esquema de trabajo ha demostrado mejorar el retorno a la función previa y la disminución de la mortalidad, con un costo reducido o un aumento de utilidad expresada en calidad de vida, por lo que es la atención más rentable para los pacientes que sufren una fractura de cadera.

Older people with hip fracture have an increased risk of mortality 5 to 8 times, for all causes and a much higher risk of institutionalization due to functional loss, because only 50% of patients who survive, recover the activity of daily life before the fracture. Interventions to prevent such results, including a second fracture, become the principal objective in these patients. The orthogeriatric care model, is a multidimensional approach for patients who suffer a hip fracture, which is usually secondary to a fall from their own height, known as a fragility fracture. This model of care developed by geriatricians and traumatologists with help of a multidisciplinary team, includes a comprehensive perioperative assessment and a nursing team focused on the premorbid patient state, cognition, comorbidities, which allows creating an individualized plan, to be monitored and ensure compliance, the first 2 years. This work scheme has been shown to improve the return of the function and the reduction of mortality at a reduced cost or an expressed utility in quality of life, making it the most cost-effective care for patients suffering from a hip fracture.

Low rate of densitometric diagnosis and treatment in patients with severe osteoporosis in Colombia.

Our study describes the clinical characteristics of patients with fragility fractures. It also shows there is a low knowledge about osteoporosis and its relation to fractures, in addition to the very poor adherence to medical advice and treatment. INTRODUCTION: Osteoporosis is a systemic skeletal disease associated with an increased risk of fragility fractures and is a public health problem worldwide due to population aging. Early osteoporosis diagnosis and treatment is very important for reducing the incidence of fragility fractures and the resulting complications. Our study describes the clinical characteristics of patients with fragility fractures and their risk factors, evaluates the level of knowledge that patients have about osteoporosis, and follows-up on each case to establish if, after the fracture, a densitometric diagnosis was made and the patient received specific treatment in his outpatient follow-up through his health insurance plan. METHODS: A descriptive cross-sectional study was carried out in a university hospital in Bogotá, Colombia. The data was collected by means of a questionnaire, administered to all patients admitted by the orthopedic emergency department with a diagnosis of fragility fracture. After discharge, a telephone follow-up was done every 3 months for 1 year, and patients were asked if they had already had the dual X-ray absorptiometry (DXA) scan and if they had begun osteoporosis treatment. RESULTS: A total of 111 patients with an average age of 74.4 years (± 11.3 years), of which 84 (75.6%) were women, all consulted for osteoporotic fracture at the orthopedic emergency department of the hospital. Hip fracture was the most frequent (51.4%), followed by vertebral (23.4%), wrist (22.5%), and humerus (4.5%) fracture. A total of 49.5% (n = 55) of the patients did not know what osteoporosis is; 58.6% (n = 65) did not know that fracture is the main complication of this disease, and 62.2% (n = 69) did not associate fractures with osteoporosis. All patients were educated about osteoporosis and the importance of diagnosing and treating it. Patients were given a medical order to have a DXA scan upon discharge; however, only 24.3% (n = 27) had the DXA scan in the first year of the fracture. A total of 33.3% (n = 37) received calcium plus vitamin D, and only 9.9% (n = 11) received osteoporosis treatment (7 bisphosphonate patients and 4 denosumab). No patient received osteoformative therapy. CONCLUSIONS: Our study shows that Colombian patients have little knowledge about osteoporosis and its relationship with fragility fractures. It also shows that densitometries are not done and, what is worse, patients with a diagnosis of fracture have limited access to treatment after discharge.

Increased rate of osteoporosis, low lean mass, and fragility fractures in COPD patients: association with disease severity.

A very high rate of osteoporosis, fractures, and low lean mass was observed in patients with chronic obstructive pulmonary disease (COPD). Disease severity was associated with bone and muscle adverse outcomes, while age ≥ 63.5 years old, low lean mass, higher iPTH, and a T-score below - 2.5 were all associated with higher risk of fracture. INTRODUCTION: Osteoporosis is frequently neglected in patients with COPD. We aimed at evaluating the rate of osteoporosis, fractures, and low lean mass in patients with COPD. METHODS: Ninety-nine patients with COPD (53 women, 64.5 ± 9.6 years old, and 46 men, 65.9 ± 8.0 years old) underwent bone densitometry (DXA) with body composition analyses. Healthy individuals (N = 57) not exposed to tobacco matched by sex, age, and body mass index (BMI) were used as controls. Spirometry, routine laboratory workout, and conventional thoracolumbar radiography surveying for vertebral deformities were performed in all patients. RESULTS: Osteoporosis was found in 40.4% of the COPD patients against only 13.0% of the healthy controls (p = 0.001). Vertebral fractures were seen in 24.4% of the men and 22.0% of the women with COPD. Disease severity (GOLD 3 and 4) was significantly associated with higher risk of vitamin D deficiency (p = 0.032), lower BMD (both men and women at all sites), higher frequency of osteoporosis (in women at all sites), lower skeletal mass index, and higher rate of low lean mass (in both men and women) than healthy controls and COPD patients with milder disease (GOLD 1 and 2). Age was a main predictor of vertebral fractures (OR = 1.164 (1.078-9.297); p < 0.001), while high plasma iPTH (OR = 1.045 (1.005-1.088); p = 0.029) and low ALM (OR = 0.99965 (0.99933-0.99997); p = 0.031) were predictors of non-vertebral fractures. CONCLUSION: Highly prevalent in COPD, osteoporosis and low lean mass were associated with FEV1% < 50%. Age, low lean mass, high iPTH, and low bone mass were all significantly associated with fractures in COPD patients.

Osteoporosis en el hombre, un tema poco visible: a little visible issue / Osteoporosis in men: a little visible issue

Con el envejecimiento de la población, la osteoporosis y las fracturas por fragilidad constituyen un problema grave de salud, en particular, en la mujer; no obstante, en los hombres esta entidad se asocia con mayor discapacidad y mortalidad. En nuestro medio la información médica y las publicaciones relativas a la osteoporosis en el hombre adulto mayor son escasas. Se propone, con este artículo, actualizar el tema a partir de los resultados de publicaciones nacionales, e identificar la frecuencia de la mortalidad por fracturas por osteoporosis en el hombre adulto mayor cubano. En la base de datos Scielo Cuba, mediante el descriptor osteoporosis, se obtuvieron todos los artículos relacionados con el tema. En los anuarios de salud se buscaron la mortalidad por accidentes, así como la morbilidad por fracturas. En ambos casos la búsqueda estuvo restringida a los años 2000-2016. En la base de datos Scielo Cuba se identificaron 23 artículos, y en ninguno el objetivo estuvo relacionado con la osteoporosis en el hombre, aunque en 5/14 de los artículos originales entre los sujetos hubo hombres adultos mayores. La Guía cubana para diagnóstico y tratamiento de la osteoporosis, no incluye criterios para ser aplicados en los varones. En los anuarios de salud no fue posible identificar la osteoporosis como entidad. Con independencia de los beneficios que para la salud tiene la población cubana en lo relacionado con la osteoporosis, en el hombre adulto mayor se identifican espacios de vacío, tanto epidemiológicos como clínicos(AU)

With population aging, osteoporosis and fractures caused by fragility are a serious health problem, particularly in women; nevertheless, in men, this entity is associated with greater disability and mortality. In our environment, medical information and publications related to osteoporosis in elder men are scarce. The purpose of this article is to update the topic based on the results of national publications, and to identify the frequency of mortality due to osteoporotic fractures in Cuban elder men. In the Scielo Cuba database, through the osteoporosis descriptor, all the articles related to the topic were found. In the health yearbooks, mortality due to accidents was sought, as well as morbidity due to fractures. In both cases, the search was restricted to the years 2000-2016. In the Scielo Cuba database, 23 articles were identified, and in none of them the objective was related to osteoporosis in men, although in 5/14 of the original articles among the subjects there were elder men. The Cuban Guide for diagnosis and treatment of osteoporosis does not include criteria to be applied in men. In the health yearbooks it was not possible to identify osteoporosis as an entity. Regardless the health benefits Cuban population has in relation to osteoporosis, in the particular case of elder men gaps are been identified, both epidemiological and clinical(AU)