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1.
Arch Osteoporos ; 16(1): 58, 2021 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-33761007

RESUMO

Fracture Liaison Services are recommended to deliver best practice in secondary fracture prevention. This modified Delphi survey, as part of the iFraP (Improving uptake of Fracture Prevention drug Treatments) study, provides consensus regarding tasks for clinicians in a model Fracture Liaison Service consultation. PURPOSE: The clinical consultation is of pivotal importance in addressing barriers to treatment adherence. The aim of this study was to agree to the content of the 'model Fracture Liaison Service (FLS) consultation' within the iFraP (Improving uptake of Fracture Prevention drug Treatments) study. METHODS: A Delphi survey was co-designed with patients and clinical stakeholders using an evidence synthesis of current guidelines and content from frameworks and theories of shared decision-making, communication and medicine adherence. Patients with osteoporosis and/or fragility fractures, their carers, FLS clinicians and osteoporosis specialists were sent three rounds of the Delphi survey. Participants were presented with potential consultation content and asked to rate their perception of the importance of each statement on a 5-point Likert scale and to suggest new statements (Round 1). Lowest rated statements were removed or amended after Rounds 1 and 2. In Round 3, participants were asked whether each statement was 'essential' and percentage agreement calculated; the study team subsequently determined the threshold for essential content. RESULTS: Seventy-two, 49 and 52 patients, carers and clinicians responded to Rounds 1, 2 and 3 respectively. One hundred twenty-two statements were considered. By Round 3, consensus was reached, with 81 statements deemed essential within FLS consultations, relating to greeting/introductions; gathering information; considering therapeutic options; eliciting patient perceptions; establishing shared decision-making preferences; sharing information about osteoporosis and treatments; checking understanding/summarising; and signposting next steps. CONCLUSIONS: This Delphi consensus exercise has summarised for the first time patient/carer and clinician consensus regarding clearly defined tasks for clinicians in a model FLS consultation.


Assuntos
Osteoporose , Fraturas por Osteoporose , Cuidadores , Humanos , Osteoporose/terapia , Fraturas por Osteoporose/prevenção & controle , Encaminhamento e Consulta , Prevenção Secundária
2.
Osteoporos Int ; 32(3): 495-503, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33483796

RESUMO

We examined the effectiveness of coordinators' interventions to prevent secondary fractures in patients with fragility fractures. These coordinator-based interventions improved bone density assessment implementation and treatment rates, and enhanced treatment persistence rates in the early stages following fractures. INTRODUCTION: This study aimed to determine the efficiency of coordinator-based osteoporosis intervention in fragility fracture patients during a 2-year period. METHODS: A prospective intervention randomized control study was conducted at seven medical facilities from January 2015 to March 2017. Postmenopausal women and men over 50 years old with fragility fractures were randomly divided into the coordinator intervention (LI; 70 patients) and without intervention (non-LI; 71 patients) groups. The osteoporosis treatment rate, osteoporosis treatment persistence rate, fall rate, fracture incidence rate, and bone density measurement rate 3 months, 6 months, 1 year, and 2 years after registration were compared between the two groups. Non-parametric tests were used to analyze data at each inspection period. RESULTS: The osteoporosis treatment initiation rate was significantly higher in the LI group than in the non-LI group (85.7% vs. 71.8%; p = 0.04). The LI group had significantly higher bone density assessment implementation rates than the non-LI group at the time of registration (90.0% vs. 69.0%; p = 0.00) and 6 months after registration (50.0% vs. 29.6%; p = 0.01), but not 1 or 2 years after registration. In addition, no significant differences in fall or fracture incidence rates were found between the two groups. CONCLUSION: The coordinator-based interventions for fragility fractures improved bone density assessment implementation and treatment rates and enhanced treatment persistence rates in the early stages following bone fractures. The findings suggest that liaison intervention may help both fracture and osteoporosis physicians for the evaluation of osteoporosis and initiation and continuation of osteoporosis medication.


Assuntos
Conservadores da Densidade Óssea , Osteoporose , Fraturas por Osteoporose , Densidade Óssea , Conservadores da Densidade Óssea/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Estudos Prospectivos , Prevenção Secundária
3.
BMC Geriatr ; 21(1): 43, 2021 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-33435869

RESUMO

BACKGROUND: The economic and public health burden of fragility fractures of the hip in Germany is high. The likelihood of requiring long-term care and the risk of suffering from a secondary fracture increases substantially after sustaining an initial fracture. Neither appropriate confirmatory diagnostics of the suspected underlying osteoporosis nor therapy, which are well-recognised approaches to reduce the burden of fragility fractures, are routinely initiated in the German healthcare system. Therefore, the aim of the study FLS-CARE is to evaluate whether a coordinated care programme can close the prevention gap for patients suffering from a fragility hip fracture through the implementation of systematic diagnostics, a falls prevention programme and guideline-adherent interventions based on the Fracture Liaison Services model. METHODS: The study is set up as a non-blinded, cluster-randomised, controlled trial with unequal cluster sizes. Allocation to intervention group (FLS-CARE) and control group (usual care) follows an allocation ratio of 1:1 using trauma centres as the unit of allocation. Sample size calculations resulted in a total of 1216 patients (608 patients per group distributed over 9 clusters) needed for the analysis. After informed consent, all participants are assessed directly at discharge, after 3 months, 12 months and 24 months. The primary outcome measure of the study is the secondary fracture rate 24 months after initial hip fracture. Secondary outcomes include differences in the number of falls, mortality, quality-adjusted life years, activities of daily living and mobility. DISCUSSION: This study is the first to assess the effectiveness and cost-effectiveness/utility of FLS implementation in Germany. Findings of the process evaluation will also shed light on potential barriers to the implementation of FLS in the context of the German healthcare system. Challenges for the study include the successful integration of the outpatient sector as well as the future course of the coronavirus pandemic in 2020 and its influence on the intervention. TRIAL REGISTRATION: German Clinical Trial Register (DRKS) 00022237 , prospectively registered 2020-07-09.


Assuntos
Prestação Integrada de Cuidados de Saúde , Fraturas por Osteoporose , Atividades Cotidianas , Idoso , Alemanha/epidemiologia , Hospitais , Humanos , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Prevenção Secundária
4.
Rev Med Suisse ; 17(720-1): 63-67, 2021 Jan 13.
Artigo em Francês | MEDLINE | ID: mdl-33443834

RESUMO

New recommendations from the Swiss Association against Osteoporosis (SVGO) concerning fracture risk stratification and treatment delineate two new risk categories : very high risk (FRAX 10-years probability of fracture at least 20 % above the usual intervention threshold) and imminent risk (major osteoporotic fracture in the last 2 years). In these patients, parenteral therapies are recommended first. Among them, romosozumab is now available in Switzerland and is indicated for 1 year in absence of cardiovascular contra-indications, followed by an anti-resorptive. Regarding denosumab, several studies indicate that post-treatment bone loss may be, at least partially, prevented by zoledronate. Finally, monitoring BMD changes and the T-score reached on any therapy could be used as an indicator of anti-fracture efficacy.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Osteoporose/tratamento farmacológico , Densidade Óssea/efeitos dos fármacos , Denosumab/uso terapêutico , Aprovação de Drogas , Humanos , Infusões Parenterais , Fraturas por Osteoporose/prevenção & controle , Suíça , Ácido Zoledrônico/uso terapêutico
5.
J Urol ; 205(1): 22-29, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32960678

RESUMO

PURPOSE: The summary presented herein represents Part II of the two-part series dedicated to Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline discussing prognostic and treatment recommendations for patients with castration-resistant disease. Please refer to Part I for discussion of the management of patients with biochemical recurrence without metastatic disease after exhaustion of local treatment options as well as those with metastatic hormone-sensitive prostate cancer. RESULTS: The Advanced Prostate Cancer Panel created evidence- and consensus-based guideline statements to aid clinicians in the management of patients with advanced prostate cancer. Such statements are summarized in figure 1[Figure: see text] and detailed herein. MATERIALS AND METHODS: The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. A research librarian conducted searches in Ovid MEDLINE (1998 to January Week 5 2019), Cochrane Central Register of Controlled Trials (through December 2018), and Cochrane Database of Systematic Reviews (2005 through February 6, 2019). An updated search was conducted prior to publication through January 20, 2020. The methodology team supplemented searches of electronic databases with the studies included in the prior AUA review and by reviewing reference lists of relevant articles. CONCLUSIONS: This guideline attempts to improve a clinician's ability to treat patients diagnosed with advanced prostate cancer. Continued research and publication of high-quality evidence from future trials will be essential to improve the level of care for these patients.


Assuntos
Oncologia/normas , Osteoporose/prevenção & controle , Fraturas por Osteoporose/prevenção & controle , Neoplasias de Próstata Resistentes à Castração/terapia , Urologia/normas , Técnicas de Ablação/métodos , Técnicas de Ablação/normas , Antagonistas de Androgênios/administração & dosagem , Antagonistas de Androgênios/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimioterapia Adjuvante/efeitos adversos , Quimioterapia Adjuvante/métodos , Quimioterapia Adjuvante/normas , Consenso , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , Masculino , Oncologia/métodos , Gradação de Tumores , Estadiamento de Neoplasias , Osteoporose/diagnóstico , Osteoporose/etiologia , Fraturas por Osteoporose/etiologia , Prognóstico , Prostatectomia/normas , Neoplasias de Próstata Resistentes à Castração/diagnóstico , Neoplasias de Próstata Resistentes à Castração/mortalidade , Neoplasias de Próstata Resistentes à Castração/patologia , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Radioterapia Adjuvante/normas , Sociedades Médicas/normas , Resultado do Tratamento , Estados Unidos/epidemiologia , Urologia/métodos
6.
Maturitas ; 143: 184-189, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33308627

RESUMO

OBJECTIVE: To prevent osteoporotic fractures in nursing home residents a combination of bisphosphonates, calcium and vitamin D is recommended. This study assessed the prevalence of pharmacological osteoporosis prevention in nursing home residents from eight countries, and assessed its association with patient characteristics. DESIGN: Cross-sectional analyses of the SHELTER study data. We assessed the overall prevalence of osteoporosis medication (OM) use (vitamin D, calcium and bisphosphonates) in residents stratified for falls and fractures over last 30 days, health instability with high mortality risk, cognitive impairment, and dependence in walking. SETTING AND PARTICIPANTS: Nursing home residents in the Czech Republic, England, Finland, France, Germany, Italy, The Netherlands and Israel. RESULTS: Of 3832 eligible residents, vitamin D, calcium and bisphosphonates were used by 16.2%, 10.4%, and 4.5% respectively. All 3 classes of OM together were used by 1.5% of all residents. Of residents with a recent fracture, 9.5% used a bisphosphonate (2.7% all 3 OMs). In patients with recent falls, 20.8% used vitamin D and 15.3% calcium. In residents with severe cognitive impairment, 15.5% used vitamin D and 9.3% used calcium. Of the bisphosphonate users, 33.7% also used both vitamin D and calcium, 25.8% used only calcium in addition and 17.4% only vitamin D in addition. The use of any OM varied widely across countries, from 66.8% in Finland to 3.0% in Israel. CONCLUSIONS AND IMPLICATIONS: We found substantial pharmacological under-treatment of prevention of osteoporosis in residents with recent falls, fractures and dependence in walking. Only two-thirds of bisphosphonate users also took a vitamin D-calcium combination, despite guideline recommendations. On the other hand, possible over-treatment was found in residents with high mortality risk in whom preventive pharmacotherapy might not have still been appropriate. The prevalence of pharmacological prevention of osteoporosis differed substantially between countries. Efforts are needed to improve pharmacotherapy in residents.


Assuntos
Casas de Saúde/estatística & dados numéricos , Osteoporose/tratamento farmacológico , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Cálcio na Dieta/uso terapêutico , Difosfonatos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Europa (Continente) , Feminino , Humanos , Israel , Masculino , Osteoporose/prevenção & controle , Fraturas por Osteoporose/prevenção & controle , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico
7.
Aliment Pharmacol Ther ; 52(6): 964-975, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33119156

RESUMO

BACKGROUND: Crohn's disease (CD) is a predisposing factor for bone loss and muscle dysfunction, which could lead to osteoporotic fractures and physical disability, respectively. AIM: To assess the effect of 6 months of combined impact and resistance training on bone mineral density (BMD) and muscle function in adults with CD. METHODS: In this randomised controlled trial, 47 adults with stable CD were assigned to exercise (n = 23) or control (n = 24) groups and followed up for 6 months. The exercise group received usual care plus a 6-month combined impact and resistance training programme, involving three, 60-minute sessions per week and a gradual tapering of supervision to self-management. The control group received usual care alone. The primary outcomes were BMD (via dual energy X-ray absorptiometry) and muscle function (measures of upper and lower limb strength and endurance) at 6 months. RESULTS: At 6 months, BMD values were superior in the exercise group with statistical significance at lumbar spine (adjusted mean difference 0.036 g/cm2, 95% CI 0.024-0.048; P < 0.001), but not at femoral neck (0.018 g/cm2, 0.001-0.035; P = 0.059) or greater trochanter (0.013 g/cm2, -0.019 to 0.045; P = 0.415) after correcting for multiple outcomes. The exercise group also had superior values for all muscle function outcomes (P < 0.001; unadjusted mean differences ranging 22.6‒48.2%), and lower fatigue severity (P = 0.005). Three exercise-related adverse events were recorded: two instances of light-headedness and one of nausea. CONCLUSIONS: The intervention improved BMD and muscle function in adults with CD and appears as a suitable model of exercise for reducing future risk of osteoporotic fractures and disability. TRIAL REGISTRATION: ISRCTN11470370.


Assuntos
Densidade Óssea/fisiologia , Doença de Crohn/terapia , Fraturas por Osteoporose/prevenção & controle , Treinamento de Resistência , Absorciometria de Fóton , Adulto , Idoso , Exercício Físico , Fadiga/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
Artigo em Inglês | MEDLINE | ID: mdl-33105834

RESUMO

Osteoporosis is a public health concern all over the world. As a chronic condition, it generally requires prolonged medical interventions to limit the risks of further bone loss, impaired skeletal integrity and the onset of fractures. This problem is further complicated by the fact that the abrupt cessation of some therapies may be associated with an increased risk of harm. It is in this context that the COVID-19 pandemic has caused an unprecedented disruption to the provision of healthcare worldwide, exceeding our worst expectations in terms of the number of lives lost and the rapidity at which consolidated economies and healthcare systems are being significantly damaged. In this review, we assessed the challenges and strategies used in the management of osteoporosis and fragility fracture care during the COVID-19 pandemic. We also examined the available evidence and provided clinical recommendations that will require reassessment as the worldwide response to COVID-19 evolves.


Assuntos
Infecções por Coronavirus/epidemiologia , Osteoporose/terapia , Fraturas por Osteoporose/terapia , Pneumonia Viral/epidemiologia , Betacoronavirus , Humanos , Fraturas por Osteoporose/prevenção & controle , Pandemias
9.
Arch Osteoporos ; 15(1): 160, 2020 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-33040188

RESUMO

We introduced a standardised reporting system in the radiology department to highlight vertebral fractures and to signpost fracture prevention services. Our quality improvement project achieved improved fracture reporting, access to the FLS service, bone density assessment and anti-fracture treatment. PURPOSE: Identification of vertebral fragility fractures (VF) provides an opportunity to identify individuals at high risk who might benefit from secondary fracture prevention. We sought to standardise VF reporting and to signpost fracture prevention services. Our aim was to improve rates of VF detection and access to our fracture liaison service (FLS). METHODS: We introduced a standardised reporting tool within the radiology department to flag VFs with signposting for referral for bone densitometry (DXA) and osteoporosis assessment in line with Royal Osteoporosis Society guidelines. We monitored uptake of VF reporting during a quality improvement phase and case identification within the FLS service. RESULTS: Recruitment of individuals with VF to the FLS service increased from a baseline of 63 cases in 2017 (6%) to 95 (8%) in 2018 and 157 (8%) in 2019 and to 102 (12%) in the first 6 months of 2020 (p = 0.001). One hundred fifty-three patients with VFs were identified during the QI period (56 males; 97 females). Use of the terminology 'fracture' increased to 100% (mean age 70 years; SD 13) in computed tomography (n = 110), plain X-ray (n = 37) or magnetic resonance imaging (n = 6) reports within the cohort. Signposting to DXA and osteoporosis assessment was included in all reports (100%). DXA was arranged for 103/153; 12 failed to attend. Diagnostic categories were osteoporosis (31%), osteopenia (36%) or normal bone density (33%). A new prescription for bone protection therapy was issued in 63/153. Twelve of the series died during follow-up. CONCLUSIONS: Standardisation of radiology reporting systems facilitates reporting of prevalent vertebral fractures and supports secondary fracture prevention strategies.


Assuntos
Osteoporose , Fraturas por Osteoporose , Serviço Hospitalar de Radiologia , Fraturas da Coluna Vertebral , Idoso , Feminino , Humanos , Masculino , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Estudos Prospectivos , Estudos Retrospectivos , Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/prevenção & controle
11.
Arch Osteoporos ; 15(1): 150, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32989561

RESUMO

Since its development in 2008, FRAX has booked its place in the standard day to day management of osteoporosis. The FRAX tool has been appreciated for its simplicity and applicability for use in primary care, but criticised for the same reason, as it does not take into account exposure response. To address some of these limitations, relatively simple arithmetic procedures have been proposed to be applied to the conventional FRAX estimates of hip and major fracture probabilities aiming at adjustment of the probability assessment. However, as the list of these adjustments got longer, this has reflected on its implementation in the standard practice and gave FRAX a patchy look. Consequently, raises the need to re-think of the current FRAX and whether a second generation of the tool is required to address the perceived limitations of the original FRAX. This article will discuss both point of views of re-adjustment and re-thinking.


Assuntos
Fraturas do Quadril , Osteoporose , Fraturas por Osteoporose , Adulto , Densidade Óssea , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Osteoporose/terapia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Atenção Primária à Saúde , Medição de Risco
12.
Arch Osteoporos ; 15(1): 138, 2020 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-32888079

RESUMO

Many individuals prescribed osteoporosis pharmacotherapy either do not start or do not persist with treatment. In this study, women who attended a group medical visit at an osteoporosis center which involved fracture risk assessment and focused on autonomous decision-making made treatment decisions with high confidence. Those who started pharmacotherapy were highly persistent. PURPOSE: Adherence and persistence with osteoporosis pharmacotherapy is low, possibly reflecting lack of confidence in physicians' treatment recommendations. We evaluated treatment decisions, decisional confidence, and 12-month treatment adherence among women who attended a group bone health consultation that fostered autonomous decision-making. METHODS: We prospectively assessed postmenopausal women referred to an osteoporosis clinic who chose to attend a group medical visit in lieu of one-on-one consultation. The group visit was facilitated by a specialist physician and nurse, involving estimation of 10-year major osteoporotic fracture risk (using FRAX®) and extensive education regarding fracture consequences and potential advantages and disadvantages of pharmacotherapy. No direct advice was given by the specialist. Post-consult, participants made an autonomous decision regarding treatment intent and followed up with their family physician to enact their chosen plan. Intentions to initiate pharmacotherapy were assessed immediately post-consult. Treatment status and decisional confidence were evaluated 3 and 12 months later. Three-month treatment status was considered to reflect final treatment decision. Persistence was defined as proportion of participants on treatment at 3 months who remained treated at 12 months. RESULTS: One hundred one women (mean (SD) age, 62.7 years (5.8); median (IQR) FRAX®, 10.7% (8.3-17.6)) participated. Immediately post-consult, 27 (26.7%) intended to initiate treatment. At 3 months, 23 (22.8%) were treated, and at 12 months, 21 (91.3%) remained persistent. Of 89 questionnaire respondents at 12 months, 85 (95.5%) reported confidence in their treatment decision. CONCLUSION: When postmenopausal women are provided with individualized fracture risk estimates and enabled to make autonomous decisions regarding pharmacotherapy, ultimate decisions to receive treatment are made with confidence and result in high persistence at 12 months.


Assuntos
Conservadores da Densidade Óssea , Adesão à Medicação , Osteoporose Pós-Menopausa , Osteoporose , Fraturas por Osteoporose , Autonomia Pessoal , Conservadores da Densidade Óssea/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose/tratamento farmacológico , Osteoporose Pós-Menopausa/tratamento farmacológico , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Probabilidade , Encaminhamento e Consulta , Medição de Risco , Inquéritos e Questionários
13.
Med Clin North Am ; 104(5): 873-884, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773051

RESUMO

Osteoporosis and osteoporosis-related fractures are common causes of morbidity and mortality in older adults. Healthy adults should be counseled about measures to prevent osteoporosis. Women should be screened for osteoporosis beginning at age 65. Screening for osteoporosis in men should be considered when risk factors are present. Appropriate screening intervals are controversial. Women and men with osteoporosis should be offered pharmacologic therapy. Choice of therapy should be based on safety, cost, convenience, and other patient-related factors. Bisphosphonates are a first-line therapy for many patients with osteoporosis. Other treatments for osteoporosis include denosumab, teriparatide, abaloparatide, romosozumab, and selective estrogen receptor modulators.


Assuntos
Conservadores da Densidade Óssea/farmacologia , Osteoporose Pós-Menopausa/terapia , Osteoporose/terapia , Fraturas por Osteoporose/prevenção & controle , Idoso , Feminino , Avaliação Geriátrica/métodos , Humanos , Masculino , Fatores de Risco
14.
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
15.
Arch Osteoporos ; 15(1): 121, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32757143

RESUMO

Glucocorticoid use is a risk factor for osteoporosis and fractures. We studied whether women initiating glucocorticoid treatment also started anti-osteoporotic treatment, according to clinical guidelines. Women with versus without previous fracture were twice as likely to start anti-osteoporotic treatment within 1 year after initiating glucocorticoid treatment, but the cumulative incidences were low 9.1% vs. 4.6%, respectively. PURPOSE: Use of glucocorticoids (GC) is a risk factor for osteoporosis and fractures, and clinical guidelines suggest that preventive treatment with anti-osteoporotic drugs (AOD) should be considered when starting GC. Women with high risk of osteoporosis comprise those with previous fractures or a known inflammatory rheumatic disease, for whom the indication of AOD is even stronger. The purpose of these analyses was to investigate whether women initiating GC treatment also started AOD, especially those with high risk of osteoporosis. METHODS: We used data from the Norwegian Prescription Database to identify all women 55 years and older initiating GC treatment in Norway during 2010-2016 and to obtain information on use of AOD. Data from the Norwegian Patient Registry were used to obtain information on previous fractures and diagnoses. RESULTS: Among 105,477 women initiating GC treatment during 2010-2016, 3256 had started AOD and 79,638 had discontinued GC treatment after 1-year follow-up. Cumulative incidence of starting AOD after 1 year was 9.1% (95% CI: 7.9, 10.4) for women with vs. 4.6% (95% CI: 4.4%, 4.8%) for women without a previous fracture. Women with rheumatoid arthritis or another inflammatory rheumatic disease were more likely to start AOD than women with other indications. For the whole cohort, the probability of starting AOD treatment within 1 year after initiating GC increased on average 3% per year (HR = 1.03, CI: 1.01, 1.05) from 2010 to 2016. CONCLUSIONS: Having had a previous fracture or an inflammatory rheumatic disease increased the probability of treatment with AOD. However, the proportions starting AOD were much lower than clinically indicated.


Assuntos
Glucocorticoides/uso terapêutico , Osteoporose/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/uso terapêutico , Feminino , Fraturas Ósseas , Glucocorticoides/efeitos adversos , Humanos , Pessoa de Meia-Idade , Noruega/epidemiologia , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Fatores de Risco
19.
Arch Osteoporos ; 15(1): 118, 2020 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-32728971

RESUMO

Fracture liaison services (FLSs) were established to address the well-recognised gap in bone health management after a fragility fracture. However, it is unclear what happens to patients after discharge from an FLS. Our study suggests FLSs should include a patient bone health education session and a follow-up telephone call 12-18 months post-discharge to optimise management, in particular, to assess therapy adherence and to reinforce bone health advice. PURPOSE: While fracture liaison services (FLSs) have improved bone health management following fragility fracture, it is unclear what happens to patients following discharge from these services. We sought to determine patient self-reported medication adherence and the need for bone-specific health advice ≥ 12 months following discharge from one of the first FLSs in Australia. METHODS: Patients were contacted by telephone ≥ 12 months following discharge from the Coffs Fracture Prevention Clinic (CFPC)/FLS to determine if the patient was still taking prescribed bone protective therapy (BPT). Bone health advice was provided, if appropriate, during the telephone interview. RESULTS: Of the 516 consecutive patients seen in CFPC from July 2012-December 2018, 326 (63.2%) were assessed and discharged from the clinic. One hundred and two patients (19.8%) were lost to follow-up/uncontactable. Of 190 patients commenced on BPT at CFPC and who were discharged ≥ 12 months prior, 141 (74.2%) self-reported adherence with BPT. Bone health advice was required during the telephone call in 60/190 (31.6%) of these patients. Of the 141 adherent patients, 40 (28.4%) had attended a bone health education session, compared to 4/49 (8.2%) patients in the non-adherent group (p = 0.004). CONCLUSION: At 19 months following discharge from our FLS, self-reported adherence with treatment was 74%. One bone health education session at baseline was associated with increased treatment adherence. At time of telephone contact, one third of patients required further advice to optimise bone health.


Assuntos
Alta do Paciente , Assistência ao Convalescente , Densidade Óssea , Conservadores da Densidade Óssea , Seguimentos , Humanos , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Prevenção Secundária
20.
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
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