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1.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(4): 431-438, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32985155

RESUMO

OBJECTIVE: To investigate the relationship between sleep quality and bone mineral density (BMD) in urban residents. METHODS: Data of 28 756 Han adults (14 355 males and 14 401 females), who completed both Pittsburgh sleep quality index (PSQI) assessment and radial BMD tests by dual energy X-ray absorptiometry in the Health Management Center of Southwest China University from June 2012 to June 2019 were retrospectively analyzed. The degree of sleep disorder was determined based on PSQI scores, while osteopenia and osteoporosis was diagnosed according to BMD T-value. The χ2 test and multiple regression model were used to investigate the relationship between sleep quality and BMD. RESULTS: The numbers of normal BMD, osteoponia and osteoporosis were 17 039 (59.3%), 7916(27.5%) and 3801(13.2%), respectively. The mean PSQI score was 5.6±1.4 points. According to PSQI scores, there were 15 936 subjects without sleep disorder (55.4%), 5965 with mild (20.7%), 4897 with moderate (17.0%) and 1958 with severe sleep disorder (6.8%), respectively. There was no significant difference in osteoponia/osteoporosis rate between subjects with mild sleep disorder and normal ones (χ2=0.948, P>0.05), while the rate of osteoporosis in moderate sleep disorder group was higher than that in mild group (χ2=525.583, P<0.01), and the rate of osteoponia/osteoporosis in severe sleep disorder group was much higher than that in moderate group (χ2=1124.877, P<0.01). Multiple regression results showed that female, elders, mental labor, smoking and higher PSQI scores were independently associated with lower T-value (all P<0.05), while moderate to intense daily physical activity was associated with higher T-value (P<0.05). CONCLUSIONS: Sleep disturbances may be a major risk factor for BMD loss in urban residents, indicating that it would be a potential target of osteoporosis prevention.


Assuntos
Densidade Óssea , Osteoporose/complicações , Transtornos do Sono-Vigília/complicações , Sono , População Urbana/estatística & dados numéricos , Absorciometria de Fóton , Adulto , Idoso , China/epidemiologia , Feminino , Humanos , Masculino , Osteoporose/epidemiologia , Estudos Retrospectivos , Transtornos do Sono-Vigília/epidemiologia
2.
Medicine (Baltimore) ; 99(35): e20841, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871858

RESUMO

BACKGROUND: This study aimed to provide reliable estimates for dietary antioxidant vitamin (vitamins A, C, and E) intake and their effect on fracture risk at various sites. METHODS: The PubMed, EMBASE, and Cochrane Library databases were searched to identify prospective cohort studies published throughout October 2019. The pooled relative risk (RR) with its 95% confidence interval (CI) was calculated using a random-effects model. RESULTS: In total, 13 prospective cohort studies involving 384,464 individuals were selected for this meta-analysis. The summary RR indicated that increased antioxidant vitamin intake was associated with a reduced fracture risk (RR: 0.92; 95% CI: 0.86-0.98; P = .015). When stratified by the vitamin types, increased vitamin E intake was found to be associated with a reduced fracture risk (RR: 0.66; 95% CI: 0.46-0.95; P = .025), whereas increased vitamin A and C intake did not affect this risk. Increased antioxidant vitamin intake was associated with a reduced fracture risk, irrespective of fracture sites (HR: 0.90; 95% CI: 0.86-0.94; P < .001); however, it did not affect hip fracture risk. Furthermore, increased antioxidant vitamin intake was associated with a reduced fracture risk in men (RR: 0.81; 95% CI: 0.68-0.96; P = .017) and combined men and women (RR: 0.83; 95%CI: 0.73-0.93; P = .002); however, it did not affect fracture risk in women. CONCLUSION: Fracture risk at any site is significantly reduced with increased antioxidant vitamin intake, especially vitamin E intake and in men.


Assuntos
Suplementos Nutricionais/efeitos adversos , Fraturas Ósseas/epidemiologia , Osteoporose/tratamento farmacológico , Vitaminas/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Antioxidantes/efeitos adversos , Ácido Ascórbico/administração & dosagem , Ácido Ascórbico/uso terapêutico , Feminino , Fraturas Ósseas/prevenção & controle , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/epidemiologia , Osteoporose/prevenção & controle , Prevalência , Estudos Prospectivos , Fatores de Risco , Vitamina A/administração & dosagem , Vitamina A/uso terapêutico , Vitamina E/administração & dosagem , Vitamina E/uso terapêutico , Vitaminas/uso terapêutico
3.
PLoS One ; 15(8): e0237454, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764814

RESUMO

There is growing interest in "osteosarcopenia" as the coexistence of osteoporosis and sarcopenia exacerbates negative outcomes. However, limited information is available regarding the risk factors of osteosarcopenia development in patients with osteoporosis. Therefore, we retrospectively reviewed 276 consecutive patients with postmenopausal osteoporosis who regularly visited Showa University Hospital. Patients were eligible for the study if they were ≥65 years of age and underwent dual-energy X-ray absorptiometry, blood sampling, and physical performance assessment. Patients were divided into the osteosarcopenia and osteoporosis alone groups according to the diagnostic criteria of the Asian Working Group for Sarcopenia. Of the 276 patients with osteoporosis, 54 patients (19.6%) had osteosarcopenia. Patients in the osteosarcopenia group had a greater risk of frailty than did those in the osteoporosis alone group (odds ratio 2.33; 95% confidence interval, 1.13-4.80, P = 0.028). Low body mass index seemed to be the strongest factor related to the development of osteosarcopenia, and none of the patients in the osteosarcopenia group were obese (BMI ≥27.5 kg/m2). Multiple logistic analyses revealed that patients aged 65-74 years who had comorbidities such as kidney dysfunction and high levels of HbA1c were at risk of developing osteosarcopenia. Thus, we strongly recommend the assessment of the key components of the diagnosis of osteosarcopenia in an osteoporosis clinic for patients with low body mass index. Furthermore, appropriate assessments, including comorbidities, will help in identifying patients at greater risk of developing osteosarcopenia.


Assuntos
Osteoporose/diagnóstico , Osteossarcoma/diagnóstico , Absorciometria de Fóton , Acidentes por Quedas/estatística & dados numéricos , Idoso , Índice de Massa Corporal , Feminino , Fragilidade/complicações , Fragilidade/diagnóstico , Humanos , Fator de Crescimento Insulin-Like I/análise , Modelos Logísticos , Força Muscular , Razão de Chances , Osteoporose/complicações , Osteossarcoma/complicações , Pós-Menopausa , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/complicações , Sarcopenia/diagnóstico
4.
Bone Joint J ; 102-B(7): 881-889, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600138

RESUMO

AIMS: Conservative treatment of moderately displaced proximal humeral head fractures yields good clinical results, but secondary fragment displacement may occur. Identification of those fractures at risk of displacement may influence initial decision-making. METHODS: A total of 163 shoulders in 162 patients with conservatively treated isolated proximal humeral fractures were included. The fractures occurred between January 2015 and May 2018. The mean age of the patients was 69 years (26 to 100) and the mean follow-up was 144 days (42 to 779). The fractures were classified according to Neer. Scores for osteoporosis (Tingart, Deltoid Tuberosity Index (DTI)) and osteoarthritis (OA) of the glenohumeral joint were assessed. Translation of the head on follow-up radiographs of more than 10 mm was defined as displacement. Eccentric head index (EHI) describes the offset of the humeral head centre in relation to the diaphyseal axis. The ratio was estimated on anteroposterior (AP) and Neer views. Medial hinge was considered intact if the medial cortex proximal and distal to the fracture was in line on AP view. RESULTS: Secondary fracture displacement occurred in 41 patients (25.2%). Clinical risk factors were alcohol abuse (odds ratio (OR) 6.8; 95% confidence interval (CI) 1.3 to 36; p = 0.025) and previously diagnosed osteoporosis (OR 4.6; 95% CI 0.6 to 34; p = 0.136). Age (OR 1.1; 95% CI 1.0 to 1.1; p = 0.003) and sex (OR 0.9; 95% CI 0.3 to 2.8; p = 0.867) were not independent factors. Radiological risk factors were OA grade 3 (OR 16.4; 95% CI 0.25 to 37.6; p = 0.107) and osteoporosis with the DTI (OR 10; 95% CI 0.8 to 250; p = 0.031) being more predictive than the Tingart score (OR 2.3; 95% CI 0.8 to 4.7; p = 0.041). A high EHI (AP/Neer > 0.4, OR 18.9; 95% CI 2.1 to 30.9/3.0; 95% CI 1.1 to 8.0; p = 0.002/p = 0.033) and a disrupted medial hinge (OR 3.7; 95% CI 1.1 to 12.6; p = 0.039) increased the risk of secondary displacement significantly. Neer classification had no influence. CONCLUSION: During conservative treatment, a quarter of patients showed secondary fracture displacement of at least 10 mm. Patients with alcohol abuse, severe OA, and osteoporosis are at risk. Newly defined EHI and disrupted medial hinge are relevant predictors for secondary displacement. Cite this article: Bone Joint J 2020;102-B(7):881-889.


Assuntos
Tratamento Conservador , Fraturas do Ombro/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoporose/complicações , Recidiva , Fatores de Risco , Fraturas do Ombro/diagnóstico por imagem
5.
Intern Med ; 59(14): 1677-1685, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32669514

RESUMO

Objective The association between frailty and abdominal symptoms has not been evaluated. Methods We conducted a hospital-based, retrospective cross-sectional study of consecutive outpatients ≥65 years old at the Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center from 2017 to 2019. Patients were included in the study if all of the following information was available from their medical records: patient's profile, the evaluation of osteoporosis, sarcopenia, frailty, nutritional status, findings of upper gastrointestinal endoscopy, and questionnaire results for abdominal symptoms [Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) and Constipation Scoring System (CSS)]. We divided the subjects into frailty and non-frailty groups and investigated the risk factors for frailty. Results Of the 313 eligible study subjects [134 men (42.8%) and 179 women (57.2%); mean age, 75.7±6.0 years; mean body mass index, 22.8±3.6 kg/m2], frailty was noted in 71 cases (22.7%). In a univariate analysis, an older age (p<0.001), female gender (p=0.010), successful eradication of Helicobacter pylori (p=0.049), proton pump inhibitor (PPI) use (p<0.001), laxative/prokinetics use (p=0.008), sarcopenia (p<0.001), osteoporosis (p<0.001), hypozincemia (p=0.002), hypoalbuminemia (p<0.001), low lymphocytes (p=0.004), a high CONUT score (p<0.001), a high FSSG score (p=0.001), and a high CSS score (p<0.001) were significantly associated with frailty. A multivariate logistic regression analysis showed that an older age [odds ratio (OR) 1.16; 95% confidence interval (CI) 1.08-1.24, p<0.001], PPI use (OR 2.42; 95% CI 1.18-4.98, p=0.016), sarcopenia (OR 7.35; 95% CI 3.30-16.40, p<0.001), hypozincemia (OR 0.96; 95% CI 0.92-0.99, p=0.027), a high FSSG score (OR 1.08; 95% CI 1.01-1.16, p=0.021), and a high CSS score (OR 1.13; 95% CI 1.03-1.23, p=0.007) were significantly associated with frailty. Conclusion Advanced age, PPI user, sarcopenia, hypozincemia, a high FSSG score, and high CSS score are associated with frailty.


Assuntos
Constipação Intestinal/complicações , Fragilidade , Refluxo Gastroesofágico/complicações , Sarcopenia/complicações , Zinco/deficiência , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Refluxo Gastroesofágico/tratamento farmacológico , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Estado Nutricional , Razão de Chances , Osteoporose/complicações , Inibidores da Bomba de Prótons/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários
6.
Maturitas ; 138: 14-25, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32631584

RESUMO

This narrative review discusses several aspects of the management of osteoporosis in patients under 50 years of age. Peak bone mass is genetically determined but can also be affected by lifestyle factors. Puberty constitutes a vulnerable period. Idiopathic osteoporosis is a rare, heterogeneous condition in young adults due in part to decreased osteoblast function and deficient bone acquisition. There are no evidence-based treatment recommendations. Drugs use can be proposed to elderly patients at very high risk. Diagnosis and management of osteoporosis in the young can be challenging, in particular in the absence of a manifest secondary cause. Young adults with low bone mineral density (BMD) do not necessarily have osteoporosis and it is important to avoid unnecessary treatment. A determination of BMD is recommended for premenopausal women who have had a fragility fracture or who have secondary causes of osteoporosis: secondary causes of excessive bone loss need to be excluded and treatment should be targeted. Adequate calcium, vitamin D, and a healthy lifestyle should be recommended. In the absence of fractures, conservative management is generally sufficient, but in rare cases, such as chemotherapy-induced osteoporosis, antiresorptive medication can be used. Osteoporosis in young men is most often of secondary origin and hypogonadism is a major cause; testosterone replacement therapy will improve BMD in these patients. Diabetes is characterized by major alterations in bone quality, implying that medical therapy should be started sooner than for other causes of osteoporosis. Primary hyperparathyroidism, hyperthyroidism, Cushing's syndrome and growth hormone deficiency or excess affect cortical bone more often than trabecular bone.


Assuntos
Osteoporose/tratamento farmacológico , Densidade Óssea , Conservadores da Densidade Óssea/uso terapêutico , Fraturas Ósseas/etiologia , Humanos , Osteoporose/complicações , Osteoporose/diagnóstico , Pré-Menopausa
7.
Expert Opin Pharmacother ; 21(14): 1725-1737, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32605401

RESUMO

INTRODUCTION: Rheumatoid arthritis (RA) is a chronic disabling disease characterized by a symmetrical articular involvement due to ongoing joint inflammation, if left insufficiently treated. Local and generalized bone loss is one of the main extra-articular complications of RA and leads to an increased risk for fragility fractures, which further impair functional ability, quality of life, and life expectancy. Therefore, there is an urgent need for good fracture risk management in the vulnerable RA patient. AREAS COVERED: The authors review: the epidemiology and pathophysiology (i.e. risk factors) of osteoporosis (OP), fracture, and vertebral fracture risk assessment, the effects of anti-rheumatic drugs on bone loss, pharmacological treatment of OP in RA including both bisphosphonates (BP) and newer drugs including anti-resorptives and osteoanabolic treatment options. EXPERT OPINION: Patients with active RA have elevated bone resorption and local bone loss. Moreover, these patients are at increased risk for generalized bone loss, vertebral and non-vertebral fractures. Since general risk factors (such as low BMI, fall risk) and RA-related factors play a role, optimal fracture prevention in RA patients is based on optimal diagnostics based on both of these factors, and on the use of adequate non-medical and medical treatment options.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Difosfonatos/uso terapêutico , Fraturas Ósseas/prevenção & controle , Glucocorticoides/uso terapêutico , Osteoporose/tratamento farmacológico , Absorciometria de Fóton , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Densidade Óssea/efeitos dos fármacos , Feminino , Fraturas Ósseas/etiologia , Humanos , Osteoporose/complicações , Osteoporose/epidemiologia , Qualidade de Vida , Fatores de Risco , Resultado do Tratamento
8.
Eur Rev Med Pharmacol Sci ; 24(10): 5778-5782, 2020 May.
Artigo em Inglês | MEDLINE | ID: covidwho-541069

RESUMO

Since the end of 2019, China and other regions around the world have been facing a pandemic of novel coronavirus pneumonia (COVID-19). The virus is highly transmissible, and the human population is generally susceptible. Most patients with osteoporosis are postmenopausal women or elderly people with hypoimmunity, so the osteoporosis clinic has become a new hotspot for corona virus infection. During the COVID-19 pandemic, it is necessary to establish standardized out-patient protocols to provide safe and effective treatment for osteoporosis patients and medical staff. In an osteoporosis clinic, we advocate the following suggestions to prevent and control osteoporosis during the pandemic period: (1) specialized diagnosis and treatment techniques for osteoporosis patients in the outpatient care, including enhancing the prevention for outpatient medical staff, strengthening awareness of COVID-19 prevention, strictly screening outpatients with COVID-19 infection, and insistent administration of anti-osteoporosis drugs during outbreaks; (2) home prevention for osteoporosis patients including keeping windows open, exposing them to sunlight, supplementing them with enough protein, exercising regularly, and administrating calcium supplements; and (3) simplifying the follow-up and evaluation of osteoporosis using online platforms.


Assuntos
Infecções por Coronavirus/diagnóstico , Osteoporose/patologia , Pneumonia Viral/diagnóstico , Betacoronavirus , Conservadores da Densidade Óssea/uso terapêutico , Cálcio/administração & dosagem , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Suplementos Nutricionais , Humanos , Estilo de Vida , Corpo Clínico/psicologia , Medicina Tradicional Chinesa , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Pacientes Ambulatoriais , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Vitamina D/administração & dosagem
9.
PLoS One ; 15(6): e0233501, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497105

RESUMO

INTRODUCTION: People living with HIV (PLWH) had a higher prevalence and incidence rate of bone fracture compared to general population. Although several studies have explored this phenomenon, the prevalence and incidence rate of fracture were varied. OBJECTIVE: The aim of the study is to determine and analyze the pooled prevalence, incidence rate of fracture and fracture risk factors among people living with HIV (PLWH). METHODS: PubMed, Cochrane Library, CINAHL with full Text, and Medline databases for studies published up to August 2019 were searched. Studies reporting the prevalence or incidence of fracture among PLWH were included. Study quality was assessed using the Joanna Briggs Institute (JBI) appraisal tool. A meta-analysis with random-effects model was performed to determine pooled estimates of prevalence and incidence rates of fracture. A meta-regression was performed to determine the source of heterogeneity. RESULTS: The pooled estimated prevalence of fracture among PLWH was 6.6% (95% CI: 3.8-11.1) with pooled odds ratio of 1.9 (95%CI: 1.1-3.2) compared to the general population. The pooled estimates of fracture incidence were 11.3 per 1000 person-years (95% CI: 7.9-14.5) with incidence rate ratio (IRR) of 1.5 (95% CI: 1.3-1.8) compared to the general population. Risk factors for fracture incidence were older age (aHR 1.4, 95% CI: 1.3-1.6), smoking (aHR 1.3, 95% CI: 1.1-1.5), HIV/HCV co-infection (aHR 1.6, 95% CI: 1.3-1.9), and osteoporosis (aHR 3.3, 95% CI: 2.2-5.1). CONCLUSIONS: Our finding highlights a higher risk of fracture among PLWH compared to the general population. Osteoporosis, smoking and HIV/HCV coinfection as the significant modifiable risk factors should be prioritized by the HIV health providers when care for PLWH.


Assuntos
Fraturas Ósseas/epidemiologia , Infecções por HIV/epidemiologia , Adolescente , Adulto , Comorbidade , Feminino , Fraturas Espontâneas/epidemiologia , Fraturas Espontâneas/etiologia , Humanos , Incidência , Masculino , Osteoporose/complicações , Osteoporose/epidemiologia , Prevalência , Viés de Publicação , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Adulto Jovem
10.
Proc Natl Acad Sci U S A ; 117(25): 14386-14394, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32513693

RESUMO

We report that two widely-used drugs for erectile dysfunction, tadalafil and vardenafil, trigger bone gain in mice through a combination of anabolic and antiresorptive actions on the skeleton. Both drugs were found to enhance osteoblastic bone formation in vivo using a unique gene footprint and to inhibit osteoclast formation. The target enzyme, phosphodiesterase 5A (PDE5A), was found to be expressed in mouse and human bone as well as in specific brain regions, namely the locus coeruleus, raphe pallidus, and paraventricular nucleus of the hypothalamus. Localization of PDE5A in sympathetic neurons was confirmed by coimmunolabeling with dopamine ß-hydroxylase, as well as by retrograde bone-brain tracing using a sympathetic nerve-specific pseudorabies virus, PRV152. Both drugs elicited an antianabolic sympathetic imprint in osteoblasts, but with net bone gain. Unlike in humans, in whom vardenafil is more potent than tadalafil, the relative potencies were reversed with respect to their osteoprotective actions in mice. Structural modeling revealed a higher binding energy of tadalafil to mouse PDE5A compared with vardenafil, due to steric clashes of vardenafil with a single methionine residue at position 806 in mouse PDE5A. Collectively, our findings suggest that a balance between peripheral and central actions of PDE5A inhibitors on bone formation together with their antiresorptive actions specify the osteoprotective action of PDE5A blockade.


Assuntos
Disfunção Erétil/tratamento farmacológico , Osteogênese/efeitos dos fármacos , Osteoporose/tratamento farmacológico , Inibidores da Fosfodiesterase 5/farmacologia , Envelhecimento/fisiologia , Animais , Densidade Óssea/efeitos dos fármacos , Densidade Óssea/fisiologia , Osso e Ossos/citologia , Osso e Ossos/efeitos dos fármacos , Osso e Ossos/metabolismo , Encéfalo/citologia , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Diferenciação Celular/efeitos dos fármacos , Nucleotídeo Cíclico Fosfodiesterase do Tipo 5/química , Nucleotídeo Cíclico Fosfodiesterase do Tipo 5/metabolismo , Reposicionamento de Medicamentos , Disfunção Erétil/complicações , Humanos , Masculino , Camundongos , Pessoa de Meia-Idade , Modelos Animais , Modelos Moleculares , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Osteoblastos/efeitos dos fármacos , Osteoblastos/fisiologia , Osteoclastos/efeitos dos fármacos , Osteoclastos/fisiologia , Osteoporose/complicações , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/prevenção & controle , Inibidores da Fosfodiesterase 5/química , Inibidores da Fosfodiesterase 5/uso terapêutico , Cultura Primária de Células , Tadalafila/química , Tadalafila/farmacologia , Tadalafila/uso terapêutico , Dicloridrato de Vardenafila/química , Dicloridrato de Vardenafila/farmacologia , Dicloridrato de Vardenafila/uso terapêutico
11.
Eur Rev Med Pharmacol Sci ; 24(10): 5778-5782, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32495915

RESUMO

Since the end of 2019, China and other regions around the world have been facing a pandemic of novel coronavirus pneumonia (COVID-19). The virus is highly transmissible, and the human population is generally susceptible. Most patients with osteoporosis are postmenopausal women or elderly people with hypoimmunity, so the osteoporosis clinic has become a new hotspot for corona virus infection. During the COVID-19 pandemic, it is necessary to establish standardized out-patient protocols to provide safe and effective treatment for osteoporosis patients and medical staff. In an osteoporosis clinic, we advocate the following suggestions to prevent and control osteoporosis during the pandemic period: (1) specialized diagnosis and treatment techniques for osteoporosis patients in the outpatient care, including enhancing the prevention for outpatient medical staff, strengthening awareness of COVID-19 prevention, strictly screening outpatients with COVID-19 infection, and insistent administration of anti-osteoporosis drugs during outbreaks; (2) home prevention for osteoporosis patients including keeping windows open, exposing them to sunlight, supplementing them with enough protein, exercising regularly, and administrating calcium supplements; and (3) simplifying the follow-up and evaluation of osteoporosis using online platforms.


Assuntos
Infecções por Coronavirus/diagnóstico , Osteoporose/patologia , Pneumonia Viral/diagnóstico , Betacoronavirus , Conservadores da Densidade Óssea/uso terapêutico , Cálcio/administração & dosagem , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Suplementos Nutricionais , Humanos , Estilo de Vida , Corpo Clínico/psicologia , Medicina Tradicional Chinesa , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Pacientes Ambulatoriais , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Vitamina D/administração & dosagem
12.
Injury ; 51(8): 1698-1704, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32563519

RESUMO

PURPOSE: Amid the outbreak of coronavirus disease 2019 (COVID-19), effective measures have been taken in China to suggest people wearing masks and staying at home. The majority of the people stayed at home, which had an obvious impact on the occurrence of traumatic fractures. This study aimed to describe the epidemiologic characteristics of traumatic fractures during the COVID-19, and provide reference for targeted control measures for the whole world by proposing China's experiences. METHODS: This was a retrospective & comparative multi-center study with data obtained from 11 hospitals in five provinces of China. Patients were enrolled into this study, who sustained fractures from 20 January to 19 February 2020 and the same period in 2019 (based on Chinese lunar calendar). All patients were divided into two groups: epidemic group (admitted in 2020) and control group (admitted in 2019). The data of patients' demographics (age and gender), injury related data (fracture type, fractured site, osteoporosis fracture, concurrent fractures, injury mechanism, places where fracture occurred, ISS score, Gustilo-Anderson Classification for open fracture), mortality and treatment modality were compared between the two groups. RESULTS: A total of 2,489 patients with 2,590 fractures were included. In the epidemic group, there were 865 patients, including 483 (55.8%) males and 382 (44.2%) females with an average age of 53.1 ± 23.1 years (range, 1 to 105). In the control group, there were 1,624 patients, including 876 (53.9%) males and 748 (46.1%) females with an average age of 51.2 ± 21.5 years (range, 1 to 98). Patients in the epidemic group was significantly older than those in the control group (t=-2.046, P = 0.045). For epidemic group, the mostly commonly involved age group was elderly patients, whereas it was middle-aged adults for the control group (χ2 = 14.642, P = 0.002). For epidemic group, a total of 576 (66.6%) patients had their fracture occurring at home, while in the control group there was 183 (11.3%). The proportion rates of low energy injuries (79.1%, 684/865), osteoporotic fractures (32.5%, 294/906) and closed fractures (94.5%, 817/865) in the epidemic group were significantly higher when compared to the control group, respectively (34.4%, 559/1624; 26.9%, 453/1684; 91.9%, 1,493/1692; all P<0.05). The proportion rates of Gustilo-Anderson classification (5.5%, 16/865), concurrent fractures (2.3%, 20/865), and injury severity score (15.6 ± 6.7) in epidemic group were significantly lower than those in the control group, respectively (52.8%, 199/1624; 3.9%, 63/1624; 20.1 ± 8.7; all P<0.05). No positive case with COVID-19 was diagnosed in the epidemic group. The mortality rate in the epidemic group (0.46%) was similar with that in the control group (0.43%). CONCLUSIONS: Our findings confirmed the importance of the measures to restrict people's movement and wear masks in the prevention of the spread of COVID-19. The epidemiological characteristics of traumatic fractures amid the epidemic changes dramatically, and more attempts should be focused on the prevention of low energy injuries of elderly population.


Assuntos
Infecções por Coronavirus/transmissão , Fraturas Ósseas/epidemiologia , Hospitalização/estatística & dados numéricos , Osteoporose/epidemiologia , Pneumonia Viral/transmissão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças , Feminino , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/cirurgia , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Quarentena , Estudos Retrospectivos
13.
Arch Osteoporos ; 15(1): 56, 2020 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-32291527

RESUMO

A pilot study on the use of P-EU to identify patients without osteoporosis and/or a subclinical vertebral fracture after a recently sustained non-vertebral fracture (NVF). INTRODUCTION: Screening with portable devices at emergency departments or plaster rooms could be of interest to limit referrals for dual X-ray absorptiometry (DXA) and vertebral fracture assessment (VFA). We calculated the number of negative tests for osteoporosis and/or subclinical vertebral fractures (VFs) using pulse-echo ultrasonometry (P-UE) at different thresholds. PATIENTS AND METHODS: In this cross-sectional study, 209 consecutive women of 50-70 years with a recent non-vertebral fracture (NVF) were studied at the Fracture Liaison Service (FLS) of one hospital. All women received DXA/VFA and P-EU (Bindex®) assessments. Various P-EU thresholds (based on the density index (DI, g/cm2)) were analyzed to calculate the best balance between true negative (indeed no osteoporosis and/or subclinical VF) and false negative tests (osteoporosis and/or subclinical VF according to DXA/VFA). RESULTS: Eighty-three women had osteoporosis (40%) and 17 women at least one VF (8%). Applying the manufacturer's recommended P-EU threshold (DI 0.844 g/cm2) being their proposed cut-off for not having hip osteoporosis resulted in 77 negative tests (37%, 31% true negative and 6% false negative tests). A DI of 0.896 g/cm2 resulted in 40 negative tests (19.3%) (38 true negative (18.3%) and 2 false negative tests (1.0%)). CONCLUSION: The application of P-EU enables the identification of a substantial proportion of women with recent non-vertebral fractures at the FLS who would not need a DXA/VFA referral because they had no osteoporosis and/or subclinical vertebral fractures. The most conservative P-EU threshold resulted in 18.3% true negative tests verified by DXA/VFA against 1% false negative test results.


Assuntos
Programas de Rastreamento/métodos , Osteoporose/diagnóstico por imagem , Encaminhamento e Consulta/estatística & dados numéricos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Ultrassonografia/estatística & dados numéricos , Idoso , Densidade Óssea , Estudos Transversais , Diagnóstico Diferencial , Reações Falso-Negativas , Feminino , Fraturas Ósseas/complicações , Humanos , Pessoa de Meia-Idade , Osteoporose/complicações , Projetos Piloto , Testes Imediatos , Valores de Referência , Fraturas da Coluna Vertebral/etiologia , Ultrassonografia/métodos
14.
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
15.
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
16.
Nat Rev Endocrinol ; 16(8): 437-447, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32286516

RESUMO

Glucocorticoids are widely used to suppress inflammation or the immune system. High doses and long-term use of glucocorticoids lead to an important and common iatrogenic complication, glucocorticoid-induced osteoporosis, in a substantial proportion of patients. Glucocorticoids mainly increase bone resorption during the initial phase (the first year of treatment) by enhancing the differentiation and maturation of osteoclasts. Glucocorticoids also inhibit osteoblastogenesis and promote apoptosis of osteoblasts and osteocytes, resulting in decreased bone formation during long-term use. Several indirect effects of glucocorticoids on bone metabolism, such as suppression of production of insulin-like growth factor 1 or growth hormone, are involved in the pathogenesis of glucocorticoid-induced osteoporosis. Fracture risk assessment for all patients with long-term use of oral glucocorticoids is required. Non-pharmacological interventions to manage the risk of fracture should be prescribed to all patients, while pharmacological management is reserved for patients who have increased fracture risk. Various treatment options can be used, ranging from bisphosphonates to denosumab, as well as teriparatide. Finally, appropriate monitoring during treatment is also important.


Assuntos
Glucocorticoides/efeitos adversos , Osteoporose/induzido quimicamente , Osteoporose/terapia , Apoptose/efeitos dos fármacos , Reabsorção Óssea/induzido quimicamente , Osso e Ossos/efeitos dos fármacos , Osso e Ossos/metabolismo , Feminino , Fraturas Ósseas , Humanos , Masculino , Pessoa de Meia-Idade , Osteoblastos/efeitos dos fármacos , Osteoclastos/efeitos dos fármacos , Osteócitos/efeitos dos fármacos , Osteoporose/complicações , Fraturas por Osteoporose/prevenção & controle , Pós-Menopausa , Medição de Risco
17.
J Bone Miner Metab ; 38(5): 695-701, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32335754

RESUMO

INTRODUCTION: To evaluate the differences in the associations of combinations of co-existent osteopenia, obesity, and/or sarcopenia with insulin resistance (IR) according to different criteria of obesity. MATERIALS AND METHODS: Among 4500 Korean men and postmenopausal women who were aged ≥ 50 years and did not have diabetes mellitus, osteopenia, sarcopenia, and obesity were defined using bone mineral density, skeletal mass index, and body fat % (or BMI). Body composition groups were generated based on the combinations of these components. IR was defined using the HOMA-IR ≥ 2.5. RESULTS: When obesity was defined by body fat % and the relationships were adjusted for age, sex, education, and health behaviors, the odds ratios (ORs) for IR was highest in the groups with obesity and osteopenic obesity, followed by sarcopenic obesity and osteosarcopenic obesity, followed by osteopenia and sarcopenia, and followed by osteosarcopenia. When BMI was additionally adjusted, the ORs for IR were not significantly different between body composition groups except for osteopenia: those groups had higher ORs for IR compared to osteopenia. When obesity was defined by BMI, obesity co-existent groups had higher ORs for IR than the obesity non-coexistent groups. The ORs for IR were not significantly different within obesity co-existent groups or obesity non-coexistent groups. CONCLUSIONS: Combinations of co-existent osteopenia, obesity, and/or sarcopenia had different associations with IR according to obesity classification methods and consideration of BMI adjustment. Osteosarcopenic obesity may not have a stronger association with IR compared to obesity only and obesity co-existent other conditions.


Assuntos
Doenças Ósseas Metabólicas/complicações , Resistência à Insulina , Obesidade/complicações , Osteoporose/complicações , Sarcopenia/complicações , Idoso , Idoso de 80 Anos ou mais , Composição Corporal , Densidade Óssea , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade
18.
World Neurosurg ; 139: e643-e651, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32325261

RESUMO

OBJECTIVE: In Taiwan (my country), the proportion of people 65 years or older was over 14% in 2018, which is known as entering "aged society." More and more thoracolumbar burst fractures in the setting of osteoporosis happen nowadays. In this study, a finite element model on thoracolumbar burst fracture was established and 4 types of posterior short-segment fixations were tested under normal bone quality and osteoporotic conditions. METHODS: The intact T11-L1 spine finite element model was created, and one-half of the spongy bone of the T12 vertebra was removed to simulate burst fracture. Four fixation models with posterior fusion devices were established: 1) a link (S-L); 2) intermediate bilateral screws (S-I); 3) a link and calcium sulfate cement (S-L-C); and 4) intermediate bilateral screws and calcium sulfate cement (S-I-C). The Young modulus of the osteoporotic cancellous bone was set at 70 MPa. Range of motion, as well as the maximum value and distribution of the implant stress on T11 and L1, were compared between normal bone and osteoporotic status. RESULTS: The strongest construct was the S-I-C group of both normal bone and osteoporosis condition. In osteoporotic status, the range of motion of construct in 4 types would be increased when comparing with normal bone. The stress on pedicle screws at the T11 and L1 level would also be increased in osteoporosis. The value of the maximal von Mises stress on the superior vertebral body (T11) for all loading conditions was larger than that on the inferior vertebral body (L1) in both normal bone and osteoporosis. CONCLUSIONS: The S-I-C provided the strongest construct even in osteoporosis status. But osteoporosis would result in weakness for spinal construct, which might lead to implant failure.


Assuntos
Fixadores Internos , Vértebras Lombares/lesões , Osteoporose/complicações , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Cimentos para Ossos , Parafusos Ósseos , Sulfato de Cálcio , Simulação por Computador , Módulo de Elasticidade , Análise de Elementos Finitos , Fraturas por Compressão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Amplitude de Movimento Articular , Fusão Vertebral , Tomografia Computadorizada por Raios X
19.
Medicine (Baltimore) ; 99(16): e19762, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311979

RESUMO

BACKGROUND: Osteoporosis, as a metabolic disease, has become one of the most rapidly growing complications of diabetes mellitus. Previously, we conducted a systematic review to report the estimated prevalence of osteoporosis among patients with type 2 diabetes mellitus (T2DM) from 2001 to 2016. However, some newer studies have been reported, and more potential risk factors for osteoporosis remain controversial and vague. Therefore, the presented review is tailored to synthesize available evidence regarding the pooled prevalence and related risk factors of osteoporosis among T2DM patients in mainland China. METHODS: Both cross-sectional study and cohort study reporting on the prevalence of osteoporosis among patients with T2DM in mainland China, published in Chinese or English, will be considered for inclusion. Records from 4 English databases and 2 Chinese databases will be retrieved from their inceptions to March 2020. The process of study selection, data extraction, and methodologic quality assessment will be independently executed by 2 reviewers. The pooled prevalence of osteoporosis and the prevalence in the exposed and unexposed groups for each potential risk factor will be calculated by the software Stata version 12.0. RESULTS: The current systematic review and meta-analysis will provide more precise prevalence rates and associated risk factors of osteoporosis among people with T2DM in mainland China. CONCLUSION: The study will offer high-quality and explicit evidence for assisting diabetic patients to prevent osteoporosis in mainland China. OSF REGISTRATION: DOI 10.17605/OSF.IO/5ZKJ6.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Osteoporose/epidemiologia , China/epidemiologia , Humanos , Metanálise como Assunto , Osteoporose/complicações , Prevalência , Revisões Sistemáticas como Assunto
20.
Arch Osteoporos ; 15(1): 53, 2020 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-32198547

RESUMO

We introduced an electronic triage system into our osteoporosis service to actively manage referral demand in a busy outpatient service. Our study demonstrated the effectiveness of e-triage in supporting alternative management pathways, through use of virtual advice and direct to investigation services, to improve patient access. PURPOSE: Osteoporosis referrals are increasing with awareness of the potential for prevention of fragility fracture and with complex decision making around management with long-term bisphosphonate therapy. We examined whether active triage of referrals might improve referral management processes and patient access to osteoporosis services. METHODS: We implemented electronic triage (e-triage) of referrals to our osteoporosis service using the Northern Ireland electronic health care record. This included the option of 'advice only', direct to investigation with DXA or face-to-face appointments at the consultant-led complex osteoporosis service. We anticipated that there was scope to manage patient flow direct to investigation, or to provide referring clinicians with clinical advice without the need for a face-to-face assessment, at the consultant-led specialist service. RESULTS: We reviewed e-triage outcomes of 809 referrals (692 F; 117 M) to osteoporosis specialist services (mean age 65 ± 16.5 years) over a 12-month period. There was a high degree of agreement for the triage category between the referring clinician and specialist services (741/809). 73.3% attended a face-to-face appointment at the consultant-led clinic, while active triage enabled direct to investigation (18.4%) or discharge (8.3%) in the remainder. The mean time between receipt of an electronic referral and e-triage was 3 days over the 12-month period as compared with 2.1 days (median 1.1 days) when annual leave periods were excluded. CONCLUSION: E-triage supports effective referral management in a busy osteoporosis service. Efficiency is limited by reliance on a sole clinician and 5 day working at present. There is scope to further improve systems access through multidisciplinary team working, virtual clinics and future information technology developments.


Assuntos
Assistência Ambulatorial/métodos , Osteoporose/terapia , Telemedicina/métodos , Triagem/métodos , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Assistência à Saúde , Feminino , Fraturas Ósseas/prevenção & controle , Acesso aos Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Avaliação de Processos e Resultados em Cuidados de Saúde , Encaminhamento e Consulta
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