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1.
Arch Osteoporos ; 16(1): 11, 2021 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-33415510

RESUMO

This is a survey study concerning osteoporosis care during the COVID-19 pandemic in the Netherlands. Respondents reported that osteoporosis care stagnated and lower quality of care was provided. This leads to the conclusion that standardization of osteoporosis care delivery in situations of crisis is needed. PURPOSE: During the initial phase of the COVID-19 pandemic, there was no guidance of professional societies or guidelines on the organization of osteoporosis care in case of such a crisis, and treatment relied on local ad hoc strategies. Experiences from the current pandemic need to be taken into account for the near future, and therefore, a national multidisciplinary survey was carried out in the Netherlands. METHODS: A survey of 17 questions concerning the continuation of bone mineral density measurements by Dual Energy X-ray absorptiometry (DXA), outpatient clinic visits, and prescription of medication was sent to physicians, nurses, nurse practitioners, and physician assistants working in the field of osteoporosis. RESULTS: 77 respondents finished the questionnaire, of whom 39 (50.6%) reported a decline in DXA-scanning and 36 (46.8%) no scanning at all during the pandemic. There was an increase in remote consultations for both new and control patient visits (n = 48, 62.3%; n = 62, 81.7% respectively). Lower quality of care regarding fracture prevention was reported by more than half of the respondents (n = 44, 57.1%). Treatment with intravenous bisphosphonates and denosumab was delayed according to 35 (45.4%) and 6 (6.3%) of the respondents, respectively. CONCLUSION: During the COVID-19 pandemic, osteoporosis care almost completely arrested, especially because of the discontinuation of DXA-scanning and closing of outpatient clinics. More than half of the respondents reported a substantial lower quality of osteoporosis care during the COVID pandemic. To prevent an increase in fracture rates and a decrease in patient motivation, adherence and satisfaction, standardization of osteoporosis care delivery in situations of crisis is needed.


Assuntos
Osteoporose , Absorciometria de Fóton , Humanos , Países Baixos/epidemiologia , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Pandemias , Inquéritos e Questionários
2.
Osteoporos Int ; 32(1): 1-6, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33146750

RESUMO

The COVID-19 pandemic has resulted in huge disruption to healthcare provision, including to dual-energy X-ray absorptiometry (DXA) imaging. Increased waiting lists for DXA from the pandemic mean potential long and uncertain delays in treatment for osteoporosis. To address these increased waiting lists, we propose a rapid, simple, one-stop algorithm incorporating medication use (aromatase inhibitor, corticosteroid) and clinical risk stratification supplementing a standard FRAX assessment. Our pragmatic algorithm produces a recommendation to treat empirically, image with DXA, or observe. If applied, we model a significant reduction in DXA scan requirements with a corresponding reduction in treatment delays for those awaiting DXA. We estimate this will reduce DXA scan numbers by about 50%, whilst pragmatically ensuring those with the highest clinical need correctly receive treatment without delay. This algorithm will help many clinicians including general practitioners/family physicians prioritise DXA when they may not always have the expertise to make this judgement based on clinical information alone. Although we have used UK guidelines as an example, this approach is flexible enough for adaptation by other countries based on their local guidelines, licensing, prescribing requirements, and DXA waiting list times. There are some limitations to our proposal. However, it represents one way of managing the uncertainty of the current COVID-19 pandemic.


Assuntos
Absorciometria de Fóton , Tomada de Decisão Clínica/métodos , Osteoporose/diagnóstico por imagem , Algoritmos , Inibidores da Aromatase/efeitos adversos , Glucocorticoides/efeitos adversos , Humanos , Fraturas por Osteoporose/diagnóstico por imagem , Pandemias , Medição de Risco , Fatores de Risco , Telefone , Listas de Espera
3.
Life Sci ; 264: 118680, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33130075

RESUMO

AIMS: Osteoporosis is considered a common skeletal disease. Ortho-silicic acid has been found to enhance the osteogenic differentiation of osteoblasts. However, the molecular mechanism of osteogenesis induced by ortho-silicic acid is still undefined totally. MicroRNAs (miRs) play a key role in osteogenesis of osteoblasts. This study investigated the role of miR-130b in promoting osteogenesis induced by ortho-silicic acid. MAIN METHODS AND KEY FINDINGS: In this study, we found ortho-silicic acid enhanced osteogenesis of osteoblasts in vitro and promoted preventing and treating osteoporosis in vivo. Furthermore, the expression of miR-130b increased under application of ortho-silicic acid. In vitro, experiments demonstrated miR-130b overexpression or inhibition significantly promoted or suppressed osteogenic differentiation of osteoblasts under application of ortho-silicic acid, respectively. Consistently, downregulation of miR-130b in ovariectomy (OVX) rats dropped off the beneficial effect of ortho-silicic acid against bone loss. Mechanistically, we identified phosphatase and tensin homologue deleted on human chromosome 10 (PTEN) as the direct target of miR-130b during osteogenesis induced by ortho-silicic acid. SIGNIFICANCE: In conclusion, our findings reveal that ortho-silicic acid promotes the osteogenesis of osteoblasts mediated by the miR-130b/PTEN signaling axis, which identifies a new target to prevent and treat osteoporosis.


Assuntos
MicroRNAs/biossíntese , Osteoblastos/metabolismo , Osteogênese/fisiologia , Osteoporose/metabolismo , PTEN Fosfo-Hidrolase/biossíntese , Ácido Silícico/farmacologia , Animais , Relação Dose-Resposta a Droga , Feminino , Camundongos , Osteoblastos/efeitos dos fármacos , Osteogênese/efeitos dos fármacos , Osteoporose/diagnóstico por imagem , Osteoporose/tratamento farmacológico , Ratos , Ratos Wistar , Ácido Silícico/uso terapêutico , Regulação para Cima/efeitos dos fármacos , Regulação para Cima/fisiologia , Microtomografia por Raio-X/métodos
4.
Ter Arkh ; 92(6): 33-36, 2020 Jul 09.
Artigo em Russo | MEDLINE | ID: mdl-33346490

RESUMO

AIM: Determine whether bone mineral density (BMD) assessed by dual-energy x-ray absorptiometry can be used as predictor of increased risk of death in hemodialysis patients. MATERIALS AND METHODS: A prospective study was performed of 516 patients with chronic kidney disease treated with hemodialysis (men 265, women 251, mean age 44.811.4 years) who were observed for 5.73.2 years. Before inclusion in the study, in all patients was analyzed bone mineral density using dual-energy X-ray absorptiometry in three standard departments: lumbar vertebrae, proximal femur and distal forearm. The probability analysis of the outcome was carried out using the KaplanMeier method and Cox. RESULTS: During follow-up period 111 (21.5%) patients died, 50.5% from cardiovascular events. Survival analysis by KaplanMeier method allowed to prove the increased risk of death from cardiovascular pathology in hemodailysis patients with low bone mineral density of all evaluated areas. Step-by-step multivariate Cox regression analysis showed that the T score of the femur, showing the difference of BMD of the patient with normal value of BMD for young adult, had the greatest prognostic significance. CONCLUSION: Reduced bone mineral density in patients receiving hemodialysis is associated with an increased risk of death from cardiovascular disease. Dual energy x-ray absorptiometry can be used for assessment of this risk.


Assuntos
Doenças Cardiovasculares , Osteoporose , Absorciometria de Fóton , Adulto , Densidade Óssea , Doenças Cardiovasculares/diagnóstico por imagem , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Osteoporose/diagnóstico por imagem , Estudos Prospectivos , Diálise Renal , Adulto Jovem
6.
PLoS One ; 15(11): e0241635, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33137162

RESUMO

BACKGROUND: Imaging for osteoporosis has two major aims, first, to identify the presence of low bone mass (osteopenia), and second, to quantify bone mass using semiquantitative (conventional radiography) or quantitative (densitometry) methods. In young children, densitometry is hampered by the lack of reference values, and high-quality radiographs still play a role although the evaluation of osteopenia as a marker for osteoporosis is subjective and based on personal experience. Medical experts questioned in court over child abuse, often refer to the literature and state that 20-40% loss of bone mass is warranted before osteopenia becomes evident on radiographs. In our systematic review, we aimed at identifying evidence underpinning this statement. A secondary outcome was identifying normal references for cortical thickness of the skeleton in infants born term, < 2 years of age. METHODS: We undertook systematic searches in Medline, Embase and Svemed+, covering 1946-2020. Unpublished material was searched in Clinical trials and International Clinical Trials Registry Platform (ICTRP). Both relevant subject headings and free text words were used for the following concepts: osteoporosis or osteopenia, radiography, children up to 6 years. RESULTS: A total 5592 publications were identified, of which none met the inclusion criteria for the primary outcome; the degree of bone loss warranted before osteopenia becomes visible radiographically. As for the secondary outcome, 21 studies were identified. None of the studies was true population based and none covered the pre-defined age range from 0-2 years. However, four studies of which three having a crossectional and one a longitudinal design, included newborns while one study included children 0-2 years. CONCLUSIONS: Despite an extensive literature search, we did not find any studies supporting the assumption that a 20-40% bone loss is required before osteopenia becomes visible on radiographs. Reference values for cortical thickness were sparse. Further studies addressing this important topic are warranted.


Assuntos
Absorciometria de Fóton/normas , Doenças Ósseas Metabólicas/diagnóstico por imagem , Osteoporose/diagnóstico por imagem , Absorciometria de Fóton/métodos , Densidade Óssea , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Padrões de Referência
7.
Arch Osteoporos ; 15(1): 155, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-33025208

RESUMO

We compared the effect of anthropometric factors on osteoporosis diagnosis by quantitative computed tomography (QCT) and dual energy X-ray absorptiometry (DXA) and found QCT spine volumetric bone mineral density (vBMD) was not associated with body weight, body mass index (BMI) or DXA anteroposterior spine thickness. In contrast, DXA spine and hip areal bone mineral density (aBMD) were strongly associated with all three factors. Adjustment of DXA aBMD measurements improved consistency with QCT vBMD. PURPOSE: Although the diagnosis of osteoporosis using DXA T scores preferentially targets patients with BMI, there is evidence that obesity is not protective against fractures. The aim of this study was to compare the effect of anthropometric factors on osteoporosis diagnosis by QCT and DXA and investigate whether adjustment of DXA aBMD can achieve a more even distribution of diagnoses between slimmer and heavier individuals consistent with QCT. METHODS: The participants were 964 men and 682 women referred for low-dose chest CT and DXA examinations as part of their employers' health check-up programs. QCT vBMD was measured in the L1-L2 vertebrae and DXA aBMD in the spine and hip. The prevalence of osteoporosis in each tertile of BMI in participants aged > 50 years was evaluated based on their QCT and DXA findings, and then re-evaluated after adjustment to the mean BMI in each sex. Similar investigations were performed for body weight and DXA anteroposterior (AP) spine thickness. The effect of the adjustment of DXA aBMD for anthropometric factors on the correlation with QCT vBMD was also examined. RESULTS: For spine QCT, correlations of age adjusted vBMD residuals against BMI were not statistically significant in men (P = 0.44) or women (P = 0.32). In contrast, slopes for aBMD residuals were all highly statistically significant (P < 0.001). There were similar findings for weight and AP spine thickness. Adjustment of DXA aBMD for anthropometric factors resulted in a more equal spread of diagnoses of osteoporosis and greater consistency with QCT. CONCLUSION: Our study highlights differences between DXA and QCT in their correlation with anthropometric factors and its effect on the diagnosis of osteoporosis. Adjustment of DXA T scores for anthropometric factors gave greater consistency with QCT vBMD. Further studies are required into whether adjusting DXA aBMD for anthropometric factors has a beneficial impact on the discriminative or predictive power for vertebral fracture.


Assuntos
Osteoporose , Absorciometria de Fóton , Antropometria , Densidade Óssea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Tomografia Computadorizada por Raios X
8.
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
9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2194-2197, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018442

RESUMO

Dental panoramic radiography (DPR) images have recently attracted increasing attention in osteoporosis analysis because of their inner correlation. Many approaches leverage machine learning techniques (e.g., deep convolutional neural networks (CNNs)) to study DPR images of a patient to provide initial analysis of osteoporosis, which demonstrates promising results and significantly reduces financial cost. However, these methods heavily rely on the trabecula landmarks of DPR images that requires a large amount of manual annotations by dentist, and thus are limited in practical application. Addressing this issue, we propose to automatically detect trabecular landmarks in DPR images. In specific, we first apply CNNs-based detector for trabecular landmark detection and analyze its limitations. Using CNNs-based detection as a baseline, we then introduce a statistic shape model (SSM) for trabecular landmark detection by taking advantage of spatial distribution prior of trabecular landmarks in DPR images and their structural relations. In experiment on 108 images, our solution outperforms CNNs-based detector. Moreover, compared to CNN-based detectors, our method avoids the needs of vast training samples, which is more practical in application.


Assuntos
Osteoporose , Humanos , Aprendizado de Máquina , Redes Neurais de Computação , Osteoporose/diagnóstico por imagem , Radiografia , Radiografia Panorâmica
10.
Arch Osteoporos ; 15(1): 137, 2020 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-32860546

RESUMO

As a result of the current demographics, increased projections of osteoporosis (OP) and prevalence of the disease in Turkey, a panel of multidisciplinary experts developed a thorough review to assist clinicians in identifying OP and associated fracture risk patients, diagnosing the disease with the appropriate available diagnostic methods, classifying the disease, and initiating appropriate treatment. The panel expects to increase the awareness of this prevalent disease, decrease consequences of OP with corresponding cost savings and, ultimately, decrease the overall burden of OP and related fractures in Turkey. BACKGROUND: OP is not officially accepted as a chronic disease in Turkey despite the high prevalence and predicted increase in the following years. However, there are areas where the country is performing well, such as having a country-specific fracture risk assessment model, DXA access, and the uptake of FRAX. Additional efforts are required to decrease the existing treatment gap estimating 75-90% of patients do not receive pharmacological intervention for secondary prevention, and the diagnosis rate is around 25%. METHODS: A selected panel of Turkish experts in fields related to osteoporosis was provided with a series of relevant questions to address prior to the multi-day conference. Within this conference, each narrative was discussed and edited by the entire group, through numerous drafts and rounds of discussion until a consensus was achieved. Represented in the panel were a number of societies including The Turkish Osteoporosis Society, The Society of Endocrinology and Metabolism of Turkey (SEMT), and The Turkish Society of Physical Medicine and Rehabilitation. RESULTS: Standardized general guidelines to identify OP and related fractures and at-risk population in Turkey, which will enable clinicians to accurately and effectively diagnose the disease, treat the appropriate patients with available pharmacological and non-pharmacological treatments and decrease the burden of the disease. CONCLUSIONS: This manuscript provides a review of the current state of OP and related fractures in Turkey. Moreover, this manuscript reviews current international guidelines and national studies and proposes a number of helpful country-specific classifications that can be used by healthcare providers caring for the at-risk population. Additionally, the panel proposes practical recommendations that should be implemented nationally in order to decrease the burden of OP and related fractures and effectively preventing the burden in future generations.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Cálcio/uso terapêutico , Osteoporose/diagnóstico por imagem , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/tratamento farmacológico , Vitamina D/uso terapêutico , Consenso , Suplementos Nutricionais , Fraturas Ósseas/etiologia , Humanos , Masculino , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Guias de Prática Clínica como Assunto , Prevalência , Medição de Risco , Sociedades Médicas , Resultado do Tratamento , Turquia/epidemiologia
11.
Arch Osteoporos ; 15(1): 135, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32833113

RESUMO

A guide to the clinician on the use of dual-energy x-ray absorptiometry bone densitometry for the management of osteoporosis and the importance of recognizing its pitfalls. PURPOSE: Osteoporosis is a major risk factor for severe fractures in the aging population worldwide, posing a serious public health issue. Dual-energy X-ray absorptiometry (DXA) is and remains the main tool for screening of osteoporosis and monitoring of osteoporosis treatment through quantitative measurement of bone mineral density (BMD). Employing DXA to measure BMD is not without pitfalls. We set out to analyze and classify the potential pitfalls of DXA acquisitions and BMD measurements encountered in clinical practice in our institution. METHODS: Technical inaccuracies and discrepancies in BMD interpretation in the history of our department were analyzed and classified into different categories of pitfalls. RESULTS: We found that major pitfalls of BMD acquisition and interpretation using DXA can be classified into technical, patient, and interpretive factors. These are illustrated with case examples. CONCLUSION: Good technical understanding of BMD measurements using DXA and recognition of potential pitfalls allow for greater technical and interpretive accuracy, which together hopefully increases the precision of osteoporosis management when practiced in accordance with established clinical guidelines.


Assuntos
Absorciometria de Fóton/métodos , Densidade Óssea/fisiologia , Osteoporose/diagnóstico por imagem , Idoso , Competência Clínica , Erros de Diagnóstico , Fraturas Ósseas/diagnóstico por imagem , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Valor Preditivo dos Testes , Medição de Risco
12.
Arch Osteoporos ; 15(1): 132, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32812073

RESUMO

The osteoporosis self-assessment tool was more accurate than hand grip strength, gait speed, and calf circumference in predicting osteoporosis in women. Hand grip strength was more accurate than the osteoporosis self-assessment tool, gait speed, and calf circumference in predicting osteoporosis in men. PURPOSE: The osteoporosis self-assessment tool, functional assessment, and anthropometric measurement are different techniques to identify those at risk of osteoporosis. This study aimed to compare the performance of these techniques in predicting osteoporosis. METHODS: In this cross-sectional, hospital-based study including 1109 participants, the bone mineral density of the spine and hips was evaluated using the dual-energy X-ray absorptiometry. The Osteoporosis Self-Assessment Tool was used as a simple clinical risk assessment tool to screen for osteoporosis. Gait speed and hand grip strength were used as functional assessments to predict osteoporosis. Calf circumference was used as an anthropometric measurement to predict osteoporosis risk. RESULTS: In women, the Osteoporosis Self-Assessment Tool was better than hand grip strength, gait speed, and calf circumference in predicting osteoporosis. In contrast, in men, hand grip strength was better than the Osteoporosis Self-Assessment Tool, gait speed, and calf circumference. CONCLUSION: The application of simple, cost-effective techniques for the identification of osteoporosis risk will be beneficial for both screening and patient care when dual-energy X-ray absorptiometry is not available. We suggest that the Osteoporosis Self-Assessment Tool can be used to identify the risk of osteoporosis in women and hand grip strength measurement can be used for men.


Assuntos
Absorciometria de Fóton/métodos , Antropometria , Densidade Óssea/fisiologia , Força da Mão , Programas de Rastreamento/métodos , Osteoporose/diagnóstico por imagem , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Autoavaliação Diagnóstica , Feminino , Marcha/fisiologia , Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Autoavaliação , Coluna Vertebral/diagnóstico por imagem , Velocidade de Caminhada
13.
AJR Am J Roentgenol ; 215(3): 582-594, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755187

RESUMO

OBJECTIVE. The purpose of this article is to review the emerging field of opportunistic CT, which can be used to screen patients for osteoporosis and sarcopenia. CONCLUSION. Although body composition measurements are not routinely obtained using CT, quantitative assessment of bone and muscle biomarkers on CT can add value to patient care. Automated bone and muscle measurements promise to transform the everyday practice of radiology without resulting in additional cost or radiation exposure for patients.


Assuntos
Osteoporose/diagnóstico por imagem , Sarcopenia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Biomarcadores , Composição Corporal , Densidade Óssea , Humanos , Programas de Rastreamento/métodos
14.
Arch Osteoporos ; 15(1): 111, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32699999

RESUMO

Many developing countries, including Vietnam, lack DXA resources for the diagnosis of osteoporosis, which poses difficulties in the treatment and prevention of osteoporosis at the individual level. We have developed and validated a prediction model for individualized assessment of osteoporosis based on age and body weight for men and women. PURPOSE: To estimate the prevalence of osteoporosis and to develop and validate a prediction model for estimating the absolute risk of osteoporosis in the Vietnamese population. METHODS: The study involved 1477 women and 669 men aged 50 years and older, who were recruited from the general population in Ho Chi Minh City (Vietnam). Bone mineral density (BMD) at the femoral neck, total hip, and lumbar spine was measured by DXA (Hologic Horizon). The diagnosis of osteoporosis was based on BMD T-score (T-score ≤ - 2.5) at the femoral neck or lumbar spine which was derived from a published reference range for the Vietnamese population. The logistic regression model was used to develop the prediction model for men and women separately. The bootstrap method was used to evaluate the model performance using 3 indices: the area under the receiver's operating characteristic curve (AUC), Brier score, and R-squared values. RESULTS: The prevalence of osteoporosis at any site was 28.3% in women and 15.5% in men. The best predictors of osteoporosis risk were age and body weight. Using these indices, a cut-off of 0.195 for women yielded an AUC of 0.825, Brier score = 0.112, and it explained 33.8% of total variance in risk of osteoporosis between individuals. Similarly, in men, the internal validation with a cut-off of 0.09 yielded good accuracy, with AUC = 0.858, Brier score = 0.040, and R-squared = 30.3%. CONCLUSION: We have developed and validated a prediction model for individualized assessment of osteoporosis. In settings without DXA, this model can serve as a useful screening tool to identify high-risk individuals for DXA scan.


Assuntos
Osteoporose , Absorciometria de Fóton , Idoso , Densidade Óssea , Feminino , Colo do Fêmur , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Medição de Risco
15.
Radiology ; 296(3): 499-508, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32662758

RESUMO

Background Osteoporosis is a prevalent, under-diagnosed, and treatable disease associated with increased fracture risk. Bone mineral density (BMD) derived from cardiac CT may be used to determine fracture rate. Purpose To assess the association between fracture rate and thoracic BMD derived from cardiac CT. Materials and Methods This prospective cohort study included consecutive participants referred for cardiac CT for evaluation of ischemic heart disease between September 2014 and March 2016. End of follow-up was June 30, 2018. In all participants, volumetric BMD of three thoracic vertebrae was measured by using quantitative CT software. The primary and secondary outcomes were any incident fracture and any incident osteoporosis-related fracture registered in the National Patient Registry, respectively. Hazard ratios were assessed by using BMD categorized as very low (<80 mg/cm3), low (80-120 mg/cm3), or normal (>120 mg/cm3). The study is registered at ClinicalTrials.gov (identifier: NCT02264717). Results In total, 1487 participants (mean age, 57 years ± 9; age range, 40-80 years; 52.5% women) were included, of whom 179 (12.0%) had very low BMD. During follow-up (median follow-up, 3.1 years; interquartile range, 2.7-3.4 years; range, 0.2-3.8 years), 80 of 1487 (5.3%) participants were diagnosed with an incident fracture and in 31 of 80 participants, the fracture was osteoporosis related. In unadjusted Cox regressions analyses, very low BMD was association with a greater rate of any fracture (hazard ratio, 2.6; 95% confidence interval [CI]: 1.4, 4.7; P = .002) and any osteoporosis-related fracture (hazard ratio, 8.1; 95% CI: 2.4, 26.7; P = .001) compared with normal BMD. After adjusting for age and sex, very low BMD remained associated with any fracture (hazard ratio, 2.1; 95% CI: 1.1, 4.2) and any osteoporosis-related fracture (hazard ratio, 4.0; 95% CI: 1.1, 14.6). Conclusion Routine cardiac CT can be used to help measure thoracic bone mineral density (BMD) to identify individuals who have low BMD and a greater fracture rate. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Bredella in this issue.


Assuntos
Densidade Óssea/fisiologia , Fraturas por Osteoporose/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Vértebras Torácicas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Imagem Cardíaca , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos Prospectivos , Tomografia Computadorizada por Raios X
16.
Sci Rep ; 10(1): 8889, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32483372

RESUMO

In preclinical mouse models, a synergistic anabolic response to PTH(1-34) and tibia loading was shown. Whether combined treatment improves bone properties with oestrogen deficiency, a cardinal feature of osteoporosis, remains unknown. This study quantified the individual and combined longitudinal effects of PTH(1-34) and loading on the bone morphometric and densitometric properties in ovariectomised mice. C57BL/6 mice were ovariectomised at 14-weeks-old and treated either with injections of PTH(1-34); compressive loading of the right tibia; both interventions concurrently; or both interventions on alternating weeks. Right tibiae were microCT-scanned from 14 until 24-weeks-old. Trabecular metaphyseal and cortical midshaft morphometric properties, and bone mineral content (BMC) in 40 different regions of the tibia were measured. Mice treated only with loading showed the highest trabecular bone volume fraction at week 22. Cortical thickness was higher with co-treatment than in the mice treated with PTH alone. In the mid-diaphysis, increases in BMC were significantly higher with loading than PTH. In ovariectomised mice, the osteogenic benefits of co-treatment on the trabecular bone were lower than loading alone. However, combined interventions had increased, albeit regionally-dependent, benefits to cortical bone. Increased benefits were largest in the mid-diaphysis and postero-laterally, regions subjected to higher strains under compressive loads.


Assuntos
Osso Esponjoso/efeitos dos fármacos , Osso Cortical/efeitos dos fármacos , Osteoporose/terapia , Ovariectomia/efeitos adversos , Hormônio Paratireóideo/administração & dosagem , Treinamento de Resistência/métodos , Animais , Densidade Óssea/efeitos dos fármacos , Terapia Combinada , Modelos Animais de Doenças , Feminino , Camundongos , Camundongos Endogâmicos C57BL , Osteogênese/efeitos dos fármacos , Osteoporose/diagnóstico por imagem , Hormônio Paratireóideo/farmacologia , Tíbia/diagnóstico por imagem , Tíbia/efeitos dos fármacos , Microtomografia por Raio-X
17.
Sci Rep ; 10(1): 10441, 2020 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-32591573

RESUMO

Screw loosening due to broken pedicles is a common complication resulting from the insertion of screws either with inadequate diameters or into an osteoporotic pedicle. In this novel in vitro study, we tried to clarify the contribution of the pedicle to screw fixation and subsequent salvage strategies using longer or larger-diameter screws in broken pedicles. Sixty L4 fresh-frozen lumbar vertebrae harvested from mature pigs were designed as the normal-density group (n = 30) and decalcified as the osteoporosis group (n = 30). Three modalities were randomly assigned as intact pedicle (n = 30), semi-pedicle (n = 15), and non-pedicle (n = 15) in each group. Three sizes of polyaxial screws (diameter × length of 6.0 mm × 45 mm, 6.0 mm × 50 mm, and 6.5 mm × 45 mm) over five trials were used in each modality. The associations between bone density, pedicle modality and screw pullout strength were analyzed. After decalcification for 4 weeks, the area bone mineral density decreased to approximately 56% (p < 0.05) of the normal-density group, which was assigned as the osteoporosis group. An appropriate screw trajectory and insertional depth were confirmed using X-ray imaging prior to pullout testing in both groups. The pullout forces of larger-diameter screws (6.5 mm × 45 mm) and longer screws (6.0 mm × 50 mm) were significantly higher (p < 0.05) in the semi- and non-pedicle modalities in the normal-density group, whereas only longer screws (6.0 mm × 50 mm) had a significantly higher (p < 0.05) pullout force in the non-pedicle modalities in the osteoporosis group. The pedicle plays an important role in both the normal bone density group and the osteoporosis group, as revealed by analyzing the pullout force percentage contributed by the pedicle. Use of a longer screw would be a way to salvage a broken pedicle of osteoporotic vertebra.


Assuntos
Vértebras Lombares/cirurgia , Osteoporose/cirurgia , Parafusos Pediculares/efeitos adversos , Terapia de Salvação/métodos , Humanos , Vértebras Lombares/diagnóstico por imagem , Osteoporose/diagnóstico por imagem , Falha de Prótese , Radiografia , Terapia de Salvação/instrumentação
18.
World Neurosurg ; 140: e121-e128, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32376379

RESUMO

BACKGROUND: Pedicle screw loosening is a common postoperative complication for osteoporotic patients, and several studies have identified the important role of fusion length in internal fixation failure, but the relationship between the number of fusion segments and the potential risks remains unclear. This study aimed to investigate the rate and risk factors of screw loosening in osteoporotic patients with different levels of degenerative lumbar disease. METHODS: The total cohort of 217 patients was divided into 3 groups according to the different fusion levels: single-level (group A; 100 cases), double-level (group B; 73 cases), and multilevel group (group C; 44 cases). Patient baseline demographic characteristics and assessments with a visual analog scale (VAS) and the Oswestry Disability Index (ODI) before operation and at the last follow-up were compared among the 3 groups. RESULTS: Compared with preoperative values, VAS and ODI scores at the last follow-up were significantly improved in all 3 groups. Operative time, blood loss, length of hospital stay, screw loosening rate, fusion rate, and VAS and ODI scores at the last follow-up obviously increased with the increasing number of fusion segments (group C> group B> group A). Of note, all the screw loosening was observed in cranial and caudal vertebra. Furthermore, multivariate logistic regression analysis identified lumbosacral fixation, larger pelvic incidence (PI)-lumbar lordosis (LL) difference (PT-LL), and greater postoperative pelvic tilt (PT) as independent predictors of screw loosening. However, sex, bone mineral density, body mass index, LL, sacral slope, PI, the change in LL, and preoperative PT were not relevant to screw loosening (P > 0.05). CONCLUSIONS: Owing to the high rate of screw loosening in cranial and caudal vertebra, osteoporotic patients with double-level or multilevel pedicle screw fixation benefited less than those with single-level pedicle screw fixation. Larger PI-LL, larger PT, and lumbosacral fixation are other risk factors for screw loosening. An instrument with stronger holding strength at cranial and caudal pedicle screws is recommended for those high-risk patients.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Osteoporose/diagnóstico por imagem , Osteoporose/cirurgia , Parafusos Pediculares , Fusão Vertebral/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/métodos , Fatores de Tempo , Resultado do Tratamento
19.
J Bone Miner Res ; 35(6): 1009-1013, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32406536

RESUMO

Osteoporosis is a chronic condition that reflects reduced bone strength and an associated increased risk for fracture. As a chronic condition, osteoporosis generally requires sustained medical intervention(s) to limit the risks for additional bone loss, compromise of skeletal integrity, and fracture occurrence. Further complicating this issue is the fact that the abrupt cessation of some therapies can be associated with an increased risk for harm. It is in this context that the COVID-19 pandemic has brought unprecedented disruption to the provision of health care globally, including near universal requirements for social distancing. In this Perspective, we provide evidence, where available, regarding the general care of patients with osteoporosis in the COVID-19 era and provide clinical recommendations based primarily on expert opinion when data are absent. Particular emphasis is placed on the transition from parenteral osteoporosis therapies. It is hoped that these recommendations can be used to safely guide care for patients with osteoporosis until a return to routine clinical care standards is available. © 2020 American Society for Bone and Mineral Research.


Assuntos
Infecções por Coronavirus , Osteoporose/terapia , Pandemias , Pneumonia Viral , Absorciometria de Fóton , Biomarcadores/sangue , Densidade Óssea , Conservadores da Densidade Óssea/administração & dosagem , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Denosumab/efeitos adversos , Denosumab/uso terapêutico , Gerenciamento Clínico , Esquema de Medicação , Terapia de Reposição de Estrogênios/efeitos adversos , Fraturas Espontâneas/prevenção & controle , Fraturas Espontâneas/terapia , Serviços de Assistência Domiciliar , Humanos , Imunossupressão/efeitos adversos , Osteoporose/sangue , Osteoporose/diagnóstico por imagem , Osteoporose/tratamento farmacológico , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Cloridrato de Raloxifeno/efeitos adversos , Cloridrato de Raloxifeno/uso terapêutico , Recidiva , Telemedicina , Trombofilia/induzido quimicamente , Trombofilia/etiologia , Procedimentos Desnecessários
20.
Arch Osteoporos ; 15(1): 79, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32458096

RESUMO

Clinicians and patients want to know if therapy is working early in their course of treatment. We found that early changes in bone turnover markers at 6 months were associated with long-term changes in bone mineral density but not trabecular bone score at 12 and 24 months. PURPOSE: We sought to examine the association between shorter-term changes in markers of bone turnover and longer-term changes in bone mineral density (BMD) and microstructure in a cohort of frail elderly women with multiple comorbid conditions including osteoporosis. METHODS: We performed a secondary analysis of a 2-year zoledronic acid trial for osteoporosis in 155 women residents of long-term care communities (mean age 86.9 years). We examined the association of the 6-month change in serum C-terminal crosslinking telopeptide of type I collagen (CTX) and serum intact procollagen type I N propeptide (PINP) with the 12- and 24-month changes in BMD at the spine and hip and the trabecular bone score (TBS), an indirect measure of bone microstructure. RESULTS: For every 0.2-ng/ml 6-month CTX decrease, the corresponding increase in spine BMD at 12 and 24 months was 0.2% (p = 0.7210) and 1.1% (p = 0.0396), respectively; total hip BMD 1.1% (p = 0.0279) and 0.9% (p = 0.0716); and femoral neck BMD 1.7% (p = 0.0079) and 0.9% (p = 0.1698). Similarly, for every 20-ng/ml 6-month PINP decrease, the corresponding increase in spine BMD at 12 and 24 months was 0.9% (p = 0.0286) and 1.4% (p = 0.0012), respectively; total hip BMD 1.4% (p = 0.0005) and 1.4% (p = 0.0006); and femoral neck BMD 2.3% (p < 0.0001) and 2.0% (p < 0.0001). Bone marker changes were not consistently associated with TBS changes. CONCLUSION: Shorter-term 6-month changes in bone turnover markers are associated with the long-term changes in BMD over 1-2 years in the spine and hip but not with TBS.


Assuntos
Osteoporose , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Densidade Óssea , Remodelação Óssea , Osso Esponjoso/diagnóstico por imagem , Feminino , Idoso Fragilizado , Humanos , Osteoporose/diagnóstico por imagem
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