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1.
Arch Osteoporos ; 15(1): 156, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33026586

RESUMO

We investigated whether osteoporotic fractures declined during lockdown, among adults aged 50 years and older. We showed that fewer outpatients attended the Fracture Clinic, for non-hip fractures, during lockdown; in contrast, no change in admissions for hip fractures was observed. This could be due to fewer outdoors falls, during lockdown. PURPOSE: Many countries implemented a lockdown to control the spread of the COVID-19 pandemic. We explored whether outpatient attendances to the Fracture Clinic for non-hip fragility fracture and inpatient admissions for hip fracture declined during lockdown, among adults aged 50 years and older, in a large secondary care hospital. METHODS: In our observational study, we analysed the records of 6681 outpatients attending the Fracture Clinic, for non-hip fragility fractures, and those of 1752 inpatients, admitted for hip fracture, during the time frames of interest. These were weeks 1st to 12th in 2020 ("prior to lockdown"), weeks 13th to 19th in 2020 ("lockdown") and corresponding periods over 2015 to 2019. We tested for differences in mean numbers (standard deviation (SD)) of outpatients and inpatients, respectively, per week, during the time frames of interest, across the years. RESULTS: Prior to lockdown, in 2020, 63.1 (SD 12.6) outpatients per week attended the Fracture Clinic, similar to previous years (p value 0.338). During lockdown, 26.0 (SD 7.3) outpatients per week attended the Fracture Clinic, fewer than previous years (p value < 0.001); similar findings were observed in both sexes and age groups (all p values < 0.001). During lockdown, 16.1 (SD 5.6) inpatients per week were admitted for hip fracture, similar to previous years (p value 0.776). CONCLUSION: During lockdown, fewer outpatients attended the Fracture Clinic, for non-hip fragility fractures, while no change in inpatient admissions for hip fracture was observed. This could reflect fewer non-hip fractures and may inform allocation of resources during pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Fraturas do Quadril/epidemiologia , Fraturas por Osteoporose/epidemiologia , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias
2.
N Engl J Med ; 383(8): 743-753, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32813950

RESUMO

BACKGROUND: Bisphosphonates are effective in reducing hip and osteoporotic fractures. However, concerns about atypical femur fractures have contributed to substantially decreased bisphosphonate use, and the incidence of hip fractures may be increasing. Important uncertainties remain regarding the association between atypical femur fractures and bisphosphonates and other risk factors. METHODS: We studied women 50 years of age or older who were receiving bisphosphonates and who were enrolled in the Kaiser Permanente Southern California health care system; women were followed from January 1, 2007, to November 30, 2017. The primary outcome was atypical femur fracture. Data on risk factors, including bisphosphonate use, were obtained from electronic health records. Fractures were radiographically adjudicated. Multivariable Cox models were used. The risk-benefit profile was modeled for 1 to 10 years of bisphosphonate use to compare associated atypical fractures with other fractures prevented. RESULTS: Among 196,129 women, 277 atypical femur fractures occurred. After multivariable adjustment, the risk of atypical fracture increased with longer duration of bisphosphonate use: the hazard ratio as compared with less than 3 months increased from 8.86 (95% confidence interval [CI], 2.79 to 28.20) for 3 years to less than 5 years to 43.51 (95% CI, 13.70 to 138.15) for 8 years or more. Other risk factors included race (hazard ratio for Asians vs. Whites, 4.84; 95% CI, 3.57 to 6.56), height, weight, and glucocorticoid use. Bisphosphonate discontinuation was associated with a rapid decrease in the risk of atypical fracture. Decreases in the risk of osteoporotic and hip fractures during 1 to 10 years of bisphosphonate use far outweighed the increased risk of atypical fracture among Whites but less so among Asians. After 3 years, 149 hip fractures were prevented and 2 bisphosphonate-associated atypical fractures occurred in Whites, as compared with 91 and 8, respectively, in Asians. CONCLUSIONS: The risk of atypical femur fracture increased with longer duration of bisphosphonate use and rapidly decreased after bisphosphonate discontinuation. Asians had a higher risk than Whites. The absolute risk of atypical femur fracture remained very low as compared with reductions in the risk of hip and other fractures with bisphosphonate treatment. (Funded by Kaiser Permanente and others.).


Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Fraturas do Fêmur/induzido quimicamente , Fraturas do Quadril/prevenção & controle , Osteoporose Pós-Menopausa/tratamento farmacológico , Fraturas por Osteoporose/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Americanos Asiáticos , Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos/uso terapêutico , Grupo com Ancestrais do Continente Europeu , Feminino , Fraturas do Fêmur/epidemiologia , Fraturas do Fêmur/etnologia , Fraturas do Quadril/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Análise Multivariada , Osteoporose Pós-Menopausa/complicações , Fraturas por Osteoporose/induzido quimicamente , Fraturas por Osteoporose/epidemiologia , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Fatores de Tempo
3.
PLoS One ; 15(7): e0235163, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730257

RESUMO

OBJECTIVES: The purpose of this study was to reconfirm the association between the risk of fracture and proton pump inhibitor use and to establish evidence for defining a high-risk group of patients among proton pump inhibitor users. METHODS: A nested case-control study was performed using data from the National Health Insurance Sharing Service database from the period January 2007 to December 2017. The study population included elderly women aged ≥65 years with claims for peptic ulcer or gastro-esophageal reflux disease. The cases were all incidental osteoporotic fractures, and up to two controls were matched to each case by age, osteoporosis, and Charlson comorbidity index. Conditional logistic regression was used to calculate the adjusted odds ratio and 95% confidence interval (CI). RESULTS: A total of 21,754 cases were identified, and 43,508 controls were matched to the cases. The adjusted odds ratio of osteoporotic fractures related to the use of proton pump inhibitors was 1.15 (95% CI: 1.11-1.20). There was a statistically significant interaction between proton pump inhibitor and bisphosphonate use (p<0.01). The risk of fracture in patients using proton pump inhibitors was 1.15 (95% CI: 1.08-1.92) in bisphosphonate users and 1.11 (95% CI: 1.03-1.20) in bisphosphonate non-users. CONCLUSION: Concomitant use of bisphosphonates and proton pump inhibitors will likely increase the risk of osteoporotic fractures in women aged 65 and over, and caution should be exercised in this high-risk group of patients.


Assuntos
Difosfonatos/farmacologia , Refluxo Gastroesofágico/tratamento farmacológico , Fraturas por Osteoporose/epidemiologia , Úlcera Péptica/tratamento farmacológico , Inibidores da Bomba de Prótons/farmacologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Difosfonatos/uso terapêutico , Interações Medicamentosas , Feminino , Humanos , Pessoa de Meia-Idade , Razão de Chances , Fraturas por Osteoporose/prevenção & controle , Inibidores da Bomba de Prótons/uso terapêutico , República da Coreia/epidemiologia , Fatores de Risco
4.
Asia Pac J Public Health ; 32(2-3): 111-117, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32410508

RESUMO

There is an increase in the number of patients with osteoporotic fractures due to the aging population in Korea. This study investigated the burden of osteoporotic fractures including hip, spine, and wrist fractures in the Korean population by estimating disability-adjusted life years (DALYs). The DALY for a given condition in a population captures years of life lost due to premature death and years of life lived with a disability and its severity and duration. To calculate DALYs from all relevant data collected for the 3 conditions, we used a DALY calculation template provided by the World Health Organization in 2014. DALYs per 100 000 for vertebral fractures (3168) were higher than those of hip fractures (2496) in women. Wrist fractures (1038) had the least burden, and the difference between men and women was the lowest. The aging population is expected to increase the burden of osteoporosis.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Fraturas por Osteoporose/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , República da Coreia/epidemiologia
5.
N Z Med J ; 133(1515): 16-24, 2020 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-32438373

RESUMO

BACKGROUND: Little is known about the prevalence of renal impairment in patients presenting with osteoporotic fractures contraindicating bisphosphonate use in New Zealand, and their eligibility to denosumab. AIM: To assess the prevalence of renal impairment contraindicating bisphosphonate use in older adults presenting with osteoporotic fractures, differences in demographic variables between those with renal impairment and those who do not, and finally to assess eligibility for denosumab based on the current PHARMAC special authority criteria. METHOD: All patients 65 years and older with osteoporotic fractures treated by inpatient orthogeriatric service (IOS) and the outpatient fracture liaison service (FLS) at Middlemore Hospital between 1 February to 31 April 2019 were assessed. Following data was retrospectively collected-age, sex, ethnicity, preadmission residential status, type of acute osteoporotic fractures, history of previous osteoporotic fractures, cognitive impairment and its severity, history of falls, previous dual-energy x-ray absorptiometry (DEXA) scan and the worst documented T-scores over total hip, neck of femur or L1-4 spine and previous funded anti-resorptive therapy use. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault formula based on the ideal body weight according to the recorded height and serum creatinine level at the time of patient's presentation. Patients with CrCl below 35ml/min were assigned to the renal group, and those with CrCl above 35ml/min to the non-renal group. Current PHARMAC criteria for denosumab was used to assess the eligibility in the renal group. RESULTS: Total of 190 patients (102 IOS and 88 FLS) were assessed. Thirty-four patients (17.9%) had renal impairment with CrCl less than 35ml/min and were assigned to the renal group. There were no statistically significant differences in demographic variables between the renal and the non-renal group other than for age, where the renal group was significantly older (85.4 vs 77.5 years, P-value <0.0001). Two out of 34 patients were eligible for denosumab. Reasons for ineligibility to denosumab were as follows; not meeting the definition of severe established osteoporosis due to presenting with their first ever osteoporotic fracture (64.7%), no previous DEXA scans to quantify their bone mineral density (11.8%), measured bone mineral density T-score above -2.5 (5.9%); and no preceding treatment with a funded anti-resorptive therapy for at least 12 months prior to their osteoporotic fracture (11.8%). CONCLUSION: Considerable number of patients aged 65 years and older with osteoporotic fractures also had renal impairment contraindicating the use of bisphosphonates. There were no significant differences in demographic variables between the renal and non-renal group other than for age. Majority of patients in the renal group were ineligible for denosumab based on the current special authority criteria. These results highlight the need for further review and revision of the current PHARMAC criteria to improve access to denosumab in older adults with renal impairment and osteoporotic fractures.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Denosumab/uso terapêutico , Difosfonatos/efeitos adversos , Definição da Elegibilidade , Fraturas por Osteoporose/epidemiologia , Insuficiência Renal/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/efeitos adversos , Comorbidade , Contraindicações de Medicamentos , Creatinina/sangue , Feminino , Hospitais , Humanos , Masculino , Nova Zelândia/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Prevalência , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos
6.
PLoS One ; 15(5): e0232969, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32428007

RESUMO

OBJECTIVE: Hip fractures are among the most frequently occurring fragility fractures in older adults, associated with a loss of quality of life, high mortality, and high use of healthcare resources. The aim was to apply the superlearner method to predict osteoporotic hip fractures using administrative claims data and to compare its performance to established methods. METHODS: We devided claims data of 288,086 individuals aged 65 years and older without care level into a training (80%) and a validation set (20%). Subsequently, we trained a superlearner algorithm that considered both regression and machine learning algorithms (e.g., support vector machines, RUSBoost) on a large set of clinical risk factors. Mean squared error and measures of discrimination and calibration were employed to assess prediction performance. RESULTS: All algorithms used in the analysis showed similar performance with an AUC ranging from 0.66 to 0.72 in the training and 0.65 to 0.70 in the validation set. Superlearner showed good discrimination in the training set but poorer discrimination and calibration in the validation set. CONCLUSIONS: The superlearner achieved similar predictive performance compared to the individual algorithms included. Nevertheless, in the presence of non-linearity and complex interactions, this method might be a flexible alternative to be considered for risk prediction in large datasets.


Assuntos
Fraturas do Quadril/etiologia , Aprendizado de Máquina , Fraturas por Osteoporose/etiologia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Alemanha/epidemiologia , Fraturas do Quadril/epidemiologia , Humanos , Modelos Logísticos , Masculino , Dinâmica não Linear , Fraturas por Osteoporose/epidemiologia , Estudos Retrospectivos , Fatores de Risco
7.
Artigo em Inglês | MEDLINE | ID: mdl-32466196

RESUMO

Background: Osteoporosis is a skeletal disease. It is still not known which of the risk factors have the greatest impact on osteoporosis development. The study aimed to determine how the selected osteoporosis risk factors contribute to the development of the disease and to assess the risk of osteoporotic fractures in older women. Methods: A cohort of 99 older females was divided into two groups (with and without osteoporosis). The risk of osteoporosis was determined using assessment forms and bone densitometry data subjected to logistic regression. The risk of osteoporotic fractures was assessed by the FRAX tool (FRAX, Center for Metabolic Bone Diseases, University of Sheffield, UK). Results: The logistic regression analysis showed that the highest risk of developing osteoporosis associated with lifestyle, mainly cigarette smoking (odds ratio: OR = 2.12), past gynecological operations (OR = 1.46), corticosteroid therapies (OR = 1.38). More than half of participants were at a medium risk of femoral neck fractures (over 90% in the osteoporotic group). Conclusion: Most of the Polish women living in care facilities are at medium risk of low-energy fractures. Smoking appeared to have the strongest effect on osteoporosis among analyzed risk factors. The results may contribute to the creation of more appropriate prevention strategies.


Assuntos
Osteoporose , Fraturas por Osteoporose , Absorciometria de Fóton , Idoso , Densidade Óssea , Estudos Transversais , Feminino , Humanos , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Polônia/epidemiologia , Medição de Risco , Fatores de Risco
8.
Injury ; 51(7): 1414-1418, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32405089

RESUMO

INTRODUCTION: The severe disruptions caused by the SARS-CoV-2 coronavirus have necessitated a redistribution of resources to meet hospitals' current service needs during this pandemic. The aim of this study was to provide an overview of the impact of the pandemic, and its corresponding State of Emergency, on a tertiary traumatology emergency service. METHODS: An observational study was performed at a tertiary hospital within the Spanish National Health System. Four different periods were studied, including the first 20 days of Spain's current State of Emergency, from March 14 to April 02, 2020 (Period 4). This period was compared to the 20-day period prior to the State of Emergency (Period 3), and to matching periods in the two previous years (Periods 1 and 2). A total of 6,565 patient visits were analyzed: 1909 in Period 1 (29.1%), 2161 in Period 2 (32.9%), 1983 in Period 3 (30.2%), and 512 in Period 4 (7.8%). Variables collected included patient age and sex, insurance type, discharge destination and reason for hospital admission. RESULTS: The patients' mean age was 55.1 years old (Standard Deviation (SD): 22.1), and 51.8% were women (3495/6565). During the COVID-19 pandemic, there were significant reductions in total visits to the trauma emergency department, workplace accidents, traffic accidents and number of hospital admissions, particularly during Period 4. However, no statistically-significant differences were found in the number of osteoporotic hip fractures admitted between the four periods. The numbers of hospital admissions for osteoporotic hip fracture were 42 during Period 1, 41 during Period 2, 43 during Period 3 and 36 during Period 4. CONCLUSIONS: While most traumatological presentations decreased in frequency over the course of the outbreak, the number of osteoporotic hip fractures remained stable. Thus, contingency plans in times of crisis need to be carefully targeted, and to keep in mind certain public health issues that do not decrease, despite a State of Emergency, like osteoporotic hip fractures.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/organização & administração , Alocação de Recursos para a Atenção à Saúde/organização & administração , Fraturas do Quadril/epidemiologia , Fraturas por Osteoporose/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/epidemiologia , Betacoronavirus/patogenicidade , Procedimentos Clínicos , Assistência à Saúde , Feminino , Pesquisa sobre Serviços de Saúde , Fraturas do Quadril/cirurgia , Humanos , Controle de Infecções/organização & administração , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/cirurgia , Alocação de Recursos , Espanha/epidemiologia , Centros de Atenção Terciária , Ferimentos e Lesões/cirurgia
9.
Ann R Coll Surg Engl ; 102(5): 348-354, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233845

RESUMO

INTRODUCTION: Predicting when fracture incidence will rise assists in healthcare planning and delivery of preventative strategies. The aim of this study was to investigate the relationship between temperature and the incidence of hip and wrist fractures. METHODS: Data for adults presenting to our unit with a hip or wrist fracture over a seven and eight-year period respectively were analysed. Incidence rates were calculated and compared with meteorological records. A Poisson regression model was used to quantify the relationship between temperature and fracture rate. RESULTS: During the respective study periods, 8,380 patients presented with wrist fractures and 5,279 patients were admitted with hip fractures. All women (≥50 years: p<0.001; <50 years: p<0.001) and men aged ≥50 years (p=0.046) demonstrated an increased wrist fracture rate with reduced temperature. Men aged <50 years also had an increased wrist fracture rate with increased temperature (p<0.001).The hip fracture rate was highest in women aged ≥50 years but was not associated with temperature (p=0.22). In men aged ≥50 years, there was a significant relationship between reduced temperature and increased fracture rate (p<0.001). CONCLUSIONS: Fragility fracture of the wrist is associated with temperature. Compared with an average summer, an additional 840 procedures are performed for wrist fractures during an average winter in our trust with an additional 798 bed days taken up at a cost of £3.2 million. The winter increase seen in male hip fracture incidence requires approximately 888 surgical procedures, with 18,026 bed days, and costs £7.1 million. Hip fracture incidence in older women is not related to temperature.


Assuntos
Temperatura Baixa/efeitos adversos , Fraturas do Quadril/epidemiologia , Temperatura Alta/efeitos adversos , Fraturas por Osteoporose/epidemiologia , Fraturas do Rádio/epidemiologia , Traumatismos do Punho/epidemiologia , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação de Fratura/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/cirurgia , Estudos Prospectivos , Fraturas do Rádio/cirurgia , Fatores de Risco , Estações do Ano , Fatores Sexuais , Traumatismos do Punho/cirurgia , Adulto Jovem
10.
Arch Osteoporos ; 15(1): 59, 2020 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-32306163

RESUMO

This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five countries of the European Union plus Sweden (EU6). In 2017, new fragility fractures in the EU6 are estimated at 2.7 million with an associated annual cost of €37.5 billion and a loss of 1.0 million quality-adjusted life years. INTRODUCTION: Osteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fractures, which in turn, represent the main consequence of the disease. This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five EU countries and Sweden (designated the EU6). METHODS: A series of metrics describing the burden and management of fragility fractures were defined by a scientific steering committee. A working group performed the data collection and analysis. Data were collected from current literature, available retrospective data and public sources. Different methods were applied (e.g. standard statistics and health economic modelling), where appropriate, to perform the analysis for each metric. RESULTS: Total fragility fractures in the EU6 are estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; a 23% increase. The resulting annual fracture-related costs (€37.5 billion in 2017) are expected to increase by 27%. An estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures. The current disability-adjusted life years (DALYs) per 1000 individuals age 50 years or more were estimated at 21 years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. The treatment gap (percentage of eligible individuals not receiving treatment with osteoporosis drugs) in the EU6 is estimated to be 73% for women and 63% for men; an increase of 17% since 2010. If all patients who fracture in the EU6 were enrolled into fracture liaison services, at least 19,000 fractures every year might be avoided. CONCLUSIONS: Fracture-related burden is expected to increase over the coming decades. Given the substantial treatment gap and proven cost-effectiveness of fracture prevention schemes such as fracture liaison services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are appropriately assessed and treated.


Assuntos
Efeitos Psicossociais da Doença , Osteoporose/economia , Fraturas por Osteoporose/economia , Idoso , Europa (Continente)/epidemiologia , Feminino , Disparidades em Assistência à Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos , Suécia/epidemiologia
11.
Arch Osteoporos ; 15(1): 61, 2020 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-32323006

RESUMO

We assessed the rate of non-reported fractures in the FRISBEE cohort. Over a median follow-up period of 9.2 years, we registered 992 fractures. The global percentage of non-reported fractures was 21.3%. Underreporting of fracture event might influence any model of fracture risk prediction. INTRODUCTION: Most fracture cohort studies rely on participant self-report of fracture event. This approach may lead to fracture underreporting. The purpose of the study was to assess the rate of non-reported fractures in a well-characterized population-based cohort of 3560 postmenopausal women, aged 60-85 years, included in the Fracture Risk Brussels Epidemiological Enquiry (FRISBEE) study. METHODS: Incident low-traumatic or non-traumatic fractures were registered annually during phone calls. In 2018, we reviewed the medical files of 67.9% of our study participants and identified non-reported fractures ("false negatives fractures (FN)"). We also evaluated whether the rate of FN was influenced by baseline patients' characteristics and fracture risk factors. Generalized estimating equation (GEE) was used to calculate odds ratio (OR) and 95% CI. RESULTS: Over a median follow-up period of 9.2 years, we registered 992 fractures (781 by self-report, confirmed by a radiological report and 211 unreported). The global false negative rate for all fractures was 21.3%, including 22% for MOFs (major osteoporotic fractures), 13.1% for other major fractures, and 25.8% for minor fractures. The rate of non-reported fractures varied by fracture site: for MOFs, it was 2.7% (n = 2/73) at the hip, 5.3% at the proximal humerus (n = 5/94), 7.1% at the wrist (n = 11/154), and 46.5% at the spine (n = 100/215). For "other major" fractures, the highest rate of false negatives fractures was found at the pelvic bone (21%, n = 13/62), followed by the elbow (17.9%, n = 5/28), long bones (10.5%, n = 2/19), ankle (6.2%, n = 4/65), and knee (5.9%, n = 1/17). Older subjects (OR 1.7; 95% CI, 1.2-2.4; P = 0.003), subjects with early non-substituted menopause (OR 1.8; 95% CI, 1.0-3.3; P = 0.04), with a lower education level (OR 1.5; 95%CI, 1.1-2.2; P = 0.01), and those under drug therapy for osteoporosis (OR 1.5; 95% CI, 1.0-2.2; P = 0.05) were associated with a higher rate of FN. CONCLUSIONS: In conclusion, underreporting of a substantial proportion of fracture events will influence any model of fracture risk prediction and induce bias when estimating the associations between candidate risk factors and incident fractures.


Assuntos
Fraturas por Osteoporose/epidemiologia , Autorrelato/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Bélgica/epidemiologia , Regras de Decisão Clínica , Estudos de Coortes , Reações Falso-Negativas , Feminino , Seguimentos , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Humanos , Incidência , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/etiologia , Medição de Risco , Fatores de Risco
12.
Acta Orthop Traumatol Turc ; 54(1): 27-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32175894

RESUMO

OBJECTIVE: The study aimed to identify the prevalence of sarcopenia in patients with osteoporotic hip fractures, investigate the anthropometric differences between sarcopenic and non-sarcopenic patients, and evaluate and compare the surgical outcomes between the two groups. METHODS: The study included 135 patients (35 men and 100 women; mean age: 74.1 years (range; 25-96)) who received surgical treatment for hip fracture between March 2014 and October 2016 and underwent whole-body dual-energy X-ray absorptiometry (DEXA). The skeletal muscle mass index (SMI) for diagnosis of sarcopenia was measured using whole-body DEXA. The following data were collected to compare the preoperative details of the sarcopenic and non-sarcopenic groups: SMI, age, sex, type of fracture, type of operation, BMI, obesity, American society of Anesthesiologists (ASA) class, pre-injury mobility score, BMD, and follow-up period. We compared clinical outcomes, including Harris Hip Score (HSS) and the walking ability at the last follow-up visit and radiologic outcomes, including non-union and the time to union. RESULTS: The average HHS and Parker's mobility score at the last follow-up were 81.7 and 6.9 in the sarcopenic group, and 77.6 and 6.3 in the non-sarcopenic group, respectively (p=0.149 and 0.122). Non-union was identified 0 (0%) in sarcopenic group and 4 (10%) in non-sarcopenic group (p=0.288). The mean union timer of the patients in the sarcopenia group was 4.0 months and that of patients in the non-sarcopenic group was 4.4 months (p=0.210). Multiple regression analysis did not show any significant association between sarcopenia and postoperative surgical outcomes, including HHS, mobility score at the last follow up, non-union, and time to union. CONCLUSION: Although the present study showed that the prevalence of sarcopenia in hip fracture patients was 45.9% (62/135), there was no clinical association between sarcopenia and postoperative. Based on these results, the clinical impact of sarcopenia may be confined to increased risk of hip fracture occurrence and surgical outcomes of hip fracture may not be affected by sarcopenia. LEVEL OF EVIDENCE: Level III, Therapeutic Study.


Assuntos
Fraturas do Quadril , Fraturas por Osteoporose , Sarcopenia , Absorciometria de Fóton/métodos , Absorciometria de Fóton/estatística & dados numéricos , Idoso , Feminino , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Fraturas do Quadril/cirurgia , Humanos , Masculino , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/cirurgia , Prevalência , Estudos Retrospectivos , Medição de Risco , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia
13.
Arch Osteoporos ; 15(1): 34, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-32124074

RESUMO

INTRODUCTION: Vertebral fractures (VF) are the most common osteoporotic fracture. They are associated with significant morbidity and mortality and are an important predictor of future fractures. The epidemiology of VF in Ireland is limited and a greater understanding of their scale and impact is needed. Therefore, we conducted a systematic review of publications on osteoporotic VF in Ireland. METHODS: Systematic searches were conducted using PubMed, Medline, Embase, Scopus and Cochrane electronic databases to identify eligible publications from Ireland addressing osteoporotic VF. RESULTS: Twenty studies met the inclusion criteria out of 1558 citations. All studies were published since 2000. Data was obtained on 182,771 patients with fractures. Nine studies included more than 100 subjects and three included more than 1000. Females accounted for 70% with an overall mean age of 65.2 years (30-94). There was significant heterogeneity in study design, methods and outcome measures including the following: use of administrative claims data on public hospital admissions, surgical and medical interventions, the impact of a fracture liaison service and the osteoporosis economic burden. The prevalence of VF was difficult to ascertain due to definitions used and differences in the study populations. Only two studies systematically reviewed spine imaging using blinded assessors and validated diagnostic criteria to assess the prevalence of fractures in patient cohorts. CONCLUSIONS: Several studies show that VF are common when addressed systematically and the prevalence may be rising. However, there is a deficit of large studies systematically addressing the epidemiology and their importance in Ireland.


Assuntos
Fraturas por Osteoporose/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Feminino , Humanos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência
14.
Nat Rev Endocrinol ; 16(6): 333-339, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32203407

RESUMO

Approximately 50% of women experience at least one bone fracture postmenopause. Current screening approaches target anti-fracture interventions to women aged >60 years who satisfy clinical risk and bone mineral density criteria for osteoporosis. Intervention is only recommended in 7-25% of those women screened currently, well short of the 50% who experience fractures. Large screening trials have not shown clinically significant decreases in the total fracture numbers. By contrast, six large clinical trials of anti-resorptive therapies (for example, bisphosphonates) have demonstrated substantial decreases in the number of fractures in women not identified as being at high risk of fracture. This finding suggests that broader use of generic bisphosphonates in women selected by age or fracture risk would result in a reduction in total fracture numbers, a strategy likely to be cost-effective. The utility of the current bone density definition of osteoporosis, which neither corresponds with who suffers fractures nor defines who should be treated, requires reappraisal.


Assuntos
Osteoporose Pós-Menopausa/terapia , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea/efeitos dos fármacos , Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/epidemiologia , Osteoporose Pós-Menopausa/prevenção & controle , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Pós-Menopausa , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências
15.
Arch Osteoporos ; 15(1): 46, 2020 03 13.
Artigo em Inglês | MEDLINE | ID: mdl-32170512

RESUMO

Between 1 and 2% of people aged 50 years and over living at home in France are likely to experience a fragility fracture each year. Three-quarters of these individuals are not diagnosed with osteoporosis and lose the opportunity for appropriate care. PURPOSE: To estimate the incidence of fragility fractures in France and to describe the characteristics of individuals with such fractures and of their fractures. METHODS: In April-May 2018, a postal survey was performed in France targeting a representative panel of 15,000 individuals aged ≥ 50 years, who were invited to complete a questionnaire. If they reported experiencing a fracture in the previous 3 years, they were asked to provide information on demographics, fracture type, risk factors for fractures and osteoporosis diagnosis. Only fragility fractures were considered, and these were classified as major (associated with increased mortality) or minor, based on the fracture site. RESULTS: Around 13,914 panellists returned an exploitable questionnaire (92.8%). About 425 participants reported ≥ 1 fragility fracture (453 fractures), corresponding to a 12-month incidence rate of 1.4% [95%CI: 1.2, 1.6]. Incidence was higher in women (1.99% [1.87, 2.05]) than in men (0.69% [0.38, 0.86]) and increased with age. Around 157 fractures (34.6%) were classified as major. Participants reporting major fractures were older than those reporting minor fractures (mean age: 72.6 ± 11.3 vs 67.1 ± 10.6) and more likely to report previous corticosteroid use (odds ratio: 1.90 [95%CI: 1.13, 3.18]). No other patient characteristic was associated with fracture severity. About 117 participants with fractures (27.5%) had undergone bone densitometry, and 97 (22.8%) declared having received a diagnosis of osteoporosis. CONCLUSIONS: Around 340,000 people aged ≥ 50 years living at home in France are estimated to experience osteoporotic fractures each year. However, > 75% of panellists reporting fractures were never diagnosed with osteoporosis and thus did not have the opportunity to receive appropriate care.


Assuntos
Fraturas Ósseas/epidemiologia , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas Ósseas/psicologia , França/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Osteoporose/psicologia , Fraturas por Osteoporose/psicologia , Fatores de Risco
16.
Aliment Pharmacol Ther ; 51(6): 644-651, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32003028

RESUMO

BACKGROUND: Due to a substantial first-pass metabolism of oral budesonide, systemic bioavailability is low compared to other oral corticosteroids, thereby possibly avoiding adverse effects of systemic corticosteroid use. AIM: To determine whether use of oral budesonide is associated with osteoporotic fractures in patients with microscopic colitis (MC). METHODS: Applying data from the Danish nationwide health registries, we conducted a case-control study nested within a cohort of patients with MC from 2004 to 2012. We estimated odds ratios (ORs) for the association between budesonide use and osteoporotic fractures (hip, wrist and spinal fractures). RESULTS: We identified 417 cases with a first occurrence of an osteoporotic fracture. Eighty-six per cent were women and the median age was 78 years. The OR for the overall association between ever-use of budesonide and any osteoporotic fractures did not reach statistical significance (OR 1.13, CI: 0.88-1.47). The highest risk was observed for spinal fractures (OR 1.98, CI: 0.94-4.17), where a dose-response association seemed to exist, followed by hip and wrist fractures (OR 1.17 [CI: 0.79-1.73] and OR 0.99 [CI: 0.66-1.47] respectively). We generally found modestly increased ORs across subgroups at suspected high or low risk of fractures (1.00-2.49). No overall dose-response association was evident (OR for doubling of cumulative dose 0.93 (CI: 0.84-1.03). CONCLUSION: No overall association between use of oral budesonide and osteoporotic fractures was demonstrated among individuals with MC. There seemed to be an isolated adverse effect of budesonide on the risk of spinal fractures, which appears to be dose related.


Assuntos
Budesonida/administração & dosagem , Budesonida/efeitos adversos , Colite Microscópica/tratamento farmacológico , Colite Microscópica/epidemiologia , Fraturas por Osteoporose/induzido quimicamente , Fraturas por Osteoporose/epidemiologia , Administração Oral , Corticosteroides/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Colite Microscópica/patologia , Feminino , Humanos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
17.
Arch Osteoporos ; 15(1): 25, 2020 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-32095943

RESUMO

This is a cross-sectional study to look at the utility of DXA-VFA in addition to bone mineral density (BMD) in the evaluation of postmenopausal osteoporosis. Vertebral fracture (VF) was detected in more than two-thirds of postmenopausal women referred for DXA-BMD. Addition of DXA-VFA detected additional 27% with VF whose BMD were in the non-osteoporotic range. INTRODUCTION: VFs are the hallmark of osteoporotic fractures. Prevalent vertebral fractures are an independent risk factor for future fragility fractures. This study was conducted to look at the prevalence of VF by DXA-vertebral fracture assessment (VFA) and to study the utility of DXA-VFA in addition to bone mineral density (BMD) in the evaluation of osteoporosis. METHODS: A cross-sectional study of the postmenopausal women above the age of 50 years who were referred for BMD assessment by DXA. All subjects underwent VFA and BMD assessment by Hologic DXA. RESULTS: Four hundred postmenopausal women with a mean age of 62.7 ± 6.2 years underwent BMD and VFA assessment by DXA. Prevalent VF was seen in 261 (65.2%) subjects, of which 114 (28.5%) subjects, 135 (33.7%) subjects, and 12 (3%) subjects had mild, moderate, and severe VF, respectively. Among subjects with VF, 136 (52.1%) and 90 (34.5%) had BMD-defined osteoporosis at the spine and femur neck, respectively. Overall, 59% with VF had osteoporosis at either the spine or femur neck. Forty-one-percent subjects with VF had BMD in non-osteoporotic range at both sites, of which 20% had moderate-to-severe VF. Addition of DXA-VFA to BMD assessment detected additional 27% with VF whose BMD was in the non-osteoporotic range. CONCLUSION: VF was seen in more than two-thirds of the postmenopausal women referred for osteoporosis evaluation. VFA identified additional patients with VF whose BMD was not in the osteoporotic range. Incorporation of VFA to BMD will assist in documenting prevalent vertebral fracture which is an independent risk factor for incident fragility fracture irrespective of the BMD.


Assuntos
Absorciometria de Fóton/métodos , Densidade Óssea , Osteoporose Pós-Menopausa/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Idoso , Estudos Transversais , Feminino , Colo do Fêmur/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/complicações , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Prevalência , Fatores de Risco , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Coluna Vertebral/diagnóstico por imagem
18.
Arch Osteoporos ; 15(1): 27, 2020 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-32103347

RESUMO

Computerized alerts for primary care physicians, provided during visits of patients who met treatment guidelines based on their electronic medical records, are an efficient method to raise awareness to many otherwise missed cases, especially after fracture. PURPOSE: Measure the efficacy of an automated real-time alert which was developed to assist osteoporosis management in the community. METHODS: The study population included treatment naïve patients with T-score ≤ - 2.5 or hip or vertebral fracture in a 2 million member Israeli health fund. On each ambulatory visit to a primary care physician or endocrinologist, a pop-up screen reminded the caregiver to consider treatment initiation. A follow-up "smart-set" screen conveniently gathered links to common actions (namely, (a) issue first line therapy prescription, (b) referral to nutritionist consultation, (c) laboratory tests relevant for osteoporosis, and (d) printing an information page for the patient). Time till treatment initiation was compared between the 3 years prior to and following the intervention. RESULTS: Within 2 years since alert activation, a total of n = 21,070 cases were alerted, 52% of which were long standing cases: untreated for over 6 months since the event. During this period, a total of 30% initiated treatment purchases. As compared with the 3 years prior to the intervention, time till treatment initiation decreased following the intervention with HR = 1.05, 1.94, 1.29 (p values = 0.020, < 0.001, 0.005) for T-score, hip, and vertebral cases respectively. Initiation rates within 6 months increased from 52.0 to 59.8%, from 12.3 to 27.7%, and from 17.4 to 27.1% among T-score, hip, and vertebral cases, respectively (p value < 0.001). Male sex, nursing home residence, having diabetes or a cardiovascular disease and age younger than 60 or older than 80 were associated with lower treatment rates. CONCLUSIONS: A computerized decision support system can efficiently raise attention to many otherwise missed high-risk osteoporotic cases, particularly those after fractures.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Fraturas Ósseas/diagnóstico , Osteoporose/diagnóstico , Fraturas por Osteoporose/diagnóstico , Atenção Primária à Saúde/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia
19.
Arch Osteoporos ; 15(1): 28, 2020 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-32108268

RESUMO

A retrospective population-based survey was undertaken in a region of Bulgaria to determine the incidence of hip fracture. The estimated number of hip fractures nationwide for 2015 was 9322 and is predicted to increase to 11,398 in 2050. The hip fracture rates were used to create a FRAX model. OBJECTIVE: To describe the epidemiology of hip fractures in Bulgaria, which was then used to develop the country-specific fracture prediction FRAX® tool. METHODS: We carried out a retrospective population-based survey in Stara Zagora, Bulgaria, representing approximately 4.6% of the country's population. We identified hip fractures occurring in 2015, 2016 and 2017 from hospital registers and primary care sources held by the regional health insurance agency. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Bulgaria. Fracture probabilities were compared with those from neighbouring countries having FRAX models. RESULTS: The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 9322 and is predicted to increase to 11,398 in 2050. FRAX-based probabilities were higher in Bulgaria than those in Serbia or Romania, lower than those in Turkey and similar to those in Greece. CONCLUSION: The FRAX model should enhance accuracy of determining fracture probability among the Bulgarian population and help guide decisions about treatment.


Assuntos
Fraturas do Quadril/epidemiologia , Modelos Estatísticos , Fraturas por Osteoporose/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Bulgária/epidemiologia , Feminino , Grécia/epidemiologia , Fraturas do Quadril/etiologia , Hospitais/estatística & dados numéricos , Humanos , Incidência , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/etiologia , Probabilidade , Sistema de Registros , Estudos Retrospectivos , Romênia/epidemiologia , Sérvia/epidemiologia , Distribuição por Sexo , Turquia/epidemiologia
20.
Arch Osteoporos ; 15(1): 29, 2020 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-32108269

RESUMO

We examined effects of smoking habit change on fracture risk in men. Long-term quitters and never smokers showed decreased risk for overall fractures, lumbar fractures, and other site fractures. Short-term quitters did not show decreased risk. Longer time since smoking cessation may lead to decreased fracture risk in men. PURPOSE: Cigarette smoking is a well-known modifiable risk factor of osteoporosis and fractures. This study investigated the effects of change in smoking habits on risks of all types of fractures in men using a nationwide health claims database. METHODS: Retrospective study was performed using the Korean National Health Insurance Service-National Sample Cohort Data. Cox proportional hazards regression analyses were performed to estimate risks of all types of hospitalized fractures, hip fractures, lumbar fractures, and other site fractures (all other fractures excluding the lumbar and hip areas). RESULTS: Compared to continued smokers, long-term quitters and never smokers showed decreased risk for all types of fractures (adjusted hazard ratio (aHR) 0.83, 95% confidence interval (CI) 0.78-0.88 and aHR 0.84, 95% CI 0.80-0.89, respectively). According to skeletal site, long-term quitters and never smokers showed decreased risk for lumbar fractures (aHR 0.82, 95% CI 0.68-0.98 and aHR 0.85, 95% CI 0.73-0.99, respectively) and other site fractures (aHR 0.83, 95% CI 0.78-0.89 and aHR 0.85, 95% CI 0.81-0.90, respectively). Hip fractures were decreased in never smokers (aHR 0.77, 95% CI 0.62-0.94). Short-term quitters did not show decreased risk for fractures. CONCLUSIONS: Longer time since smoking cessation in men may lead to decreased risk for fractures, especially lumbar and other site fractures. Physicians should counsel patients at risk for fractures both to quit smoking and to maintain abstinence from smoking. Further studies may be required to help comprehend how smoking cessation can affect fracture risk.


Assuntos
Fraturas Ósseas/epidemiologia , Fraturas por Osteoporose/epidemiologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/efeitos adversos , Fatores de Tempo , Adulto , Idoso , Estudos de Coortes , Fraturas Ósseas/etiologia , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Osteoporose/etiologia , Fraturas por Osteoporose/etiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Comportamento de Redução do Risco , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia
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