scholarly journals The Effects of Trends in Osteoporosis Treatment on the Incidence of Fractures

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Akira Horikawa ◽  
Naohisa Miyakoshi ◽  
Michio Hongo ◽  
Yuji Kasukawa ◽  
Yoichi Shimada ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Osteoporosis Treatment ◽  
Fracture Prevention ◽  
Mineral Density ◽  
Awareness Campaign ◽  
Subcutaneous Injections ◽  
Oral Medications ◽  
Number Of Patients ◽  
Fracture Assessment ◽  
Hospital Registry

Summary. We analyzed the data about the preferences of medication and incidence of fractures between osteoporosis patients from 2012 to 2016. Our results suggested that the number of patients treated with intravenous and subcutaneous injections increased and the incidence of fracture was lower in intravenous and subcutaneous injections than oral medications. Objective. This study focused on the trends in antiosteoporosis drug preferences and compared the incidence of fractures between patients treated orally and those who were exposed to an awareness campaign and assigned to intravenous/subcutaneous treatment. Methods. Our hospital registry included 1,716 osteoporotic women who were over 65 years of age without preexisting vertebral and nonvertebral fractures over 1 year before this study, with bone mineral density (BMD) < −2.5 standard deviation (SD) and fracture assessment tool (FRAX) score > 20%, who were given 1,337 oral and 379 intravenous/subcutaneous prescriptions to treat their osteoporosis. Self-administered surveys (2012, 2013, 2014, 2015, and 2016) collected data on trends of preferences among nine drugs and fracture prevention using relative risk reduction (RRR). Results. The number of patients taking oral prescriptions decreased gradually from 2012 to 2016, while the number of patients treated with intravenous and subcutaneous injections increased. The incidence of fracture was lower in patients receiving intravenous and subcutaneous injections than in patients taking oral medications. Conclusion. These findings indicate a decrease in oral prescriptions for osteoporosis treatment and that treatment for osteoporosis using intravenous or subcutaneous injections of antiosteoporosis drugs is more effective for preventing fractures.

Osteoporosis treatment and the older patient

2011 ◽  
Vol 21 (3) ◽  
pp. 233-245
Author(s):  
Roger H Jay ◽  
Sarah L Marrinan
Keyword(s):  
Older People ◽  
Population Group ◽  
Osteoporosis Treatment ◽  
Fracture Prevention ◽  
Assessment Tools ◽  
Mineral Density ◽  
Older Patient ◽  
Treatment Of Osteoporosis ◽  
Risk Assessment Tools ◽  
Proven Benefit

SummaryOsteoporosis is a common, chronic condition. Fracture risk assessment tools are increasingly being used to identify those patients who may benefit from treatment, but in older patients clinical judgement is still essential in deciding whom to treat. The treatment of osteoporosis in older people has seen several important developments in recent years. Whilst bisphosphonates are the mainstay of treatment, several newer medications have proven benefit in terms of increases in bone mineral density and fracture prevention. Additionally, some of the newer therapies have characteristics that particularly lend themselves to use in an older population group. This article focuses upon treatment of osteoporosis in older people with an emphasis on newer drug and therapeutic options.

Impact of Pharmacist Intervention on Osteoporosis Treatment after Fragility Fracture

2005 ◽  
Vol 138 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Karen Riley ◽  
Janet Martin ◽  
Lori D. Wazny
Keyword(s):  
Fragility Fracture ◽  
Intervention Group ◽  
Osteoporosis Treatment ◽  
Pharmacist Intervention ◽  
Control Group ◽  
Mineral Density ◽  
Post Discharge ◽  
Historical Cohort ◽  
Number Of Patients ◽  
Significant Difference

Objective and Background: The objective of this study was to evaluate whether increasing patient, nurse, and family physician awareness about osteoporosis had an effect on post-discharge initiation of osteoporosis treatment after fragility fracture. A recent study had found that less than 20% of patients with osteoporosis who were treated in hospital for bone fracture received subsequent investigation and treatment of their osteoporosis. Methods: The subjects consisted of a historical cohort of 33 patients and a prospective intervention group of 33 patients admitted to a community hospital with a diagnosis of fragility fracture. Data were analyzed for 28 patients in the historical control group and 27 patients in the intervention group. All patients in the latter group gave verbal consent to discuss risk factors and treatment options for osteoporosis. Subjects were included if they were at least 50 years of age and had been admitted to hospital because of hip, wrist, or ankle fracture. Patients were excluded if they had traumatic fractures or fractures related to cancer and if they had dementia or Alzheimer's disease. Patients in the intervention group received education from the pharmacist about osteoporosis. Patients in both groups received a follow-up phone assessment six months after the initial hospital admission. The main outcome measures were number of patients who received bone mineral density (BMD) tests and the number for whom osteoporosis treatment was initiated. Results: No significant difference was observed between the groups in terms of the number of BMD tests ordered ( p = 0.49), however, significantly more patients in the pharmacist intervention group had started treatment for osteoporosis at six months after the fragility fracture ( p = 0.001). Conclusions: When pharmacists provided education about osteoporosis to patients and nurses and provided information about osteoporosis to family physicians, the proportion of patients receiving treatment for osteoporosis after a fragility fracture was significantly greater than when such information was not provided.

scholarly journals SAT0082 FRAX AND DAS IN MOROCCAN RHEUMATOID ARTHRITIS PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 975.1-975
Author(s):  
H. Azzouzi ◽  
O. Lamkhanat ◽  
I. Linda
Keyword(s):  
Rheumatoid Arthritis ◽  
Fracture Risk ◽  
Disease Activity ◽  
Descriptive Analysis ◽  
Cross Sectional Study ◽  
Fracture Probability ◽  
Mineral Density ◽  
Cross Sectional ◽  
Risk Probability ◽  
Fracture Assessment

Background:Rheumatoid Arthritis (RA) is one of the risk factors for the calculation of the 10 years fracture probability assessed by the FRAX tool.Objectives:The aim was to study the association of disease activity and the 10 year fracture risk probability by the FRAX tool in our RA patients and their impact on fracture prevalence.Methods:Cross-sectional study of the association FRAX and disease activity score (DAS 28 CRP) was designed. Patients with RA were included. Mean DAS was calculated for each patient adjusted on his follow-up duration. Data about patients (demographic, disease characteristics and fracture assessment) were collected. The 10 year fracture risk probability for major osteoporotic fracture was calculated with and without BMD (bone mineral density) using the FRAX tool for Morocco. Descriptive analysis and regressions were performed with SPSS.20. p<0.05 was considered significant.Results:One hundred and ninety nine RA patients were included with mean age of 55.5±12 years. Women represented 91% and 40.1% had osteoporosis. Remission was observed in 86.4% with 95.5% taking methotrexate. 17.1% had vertebral fractures. FRAX and DAS were associated (p=0.03), and both explained vertebral fracture (VF) prevalence. When adjusted on disease parameters, FRAX with and without BMD explained the vertebral prevalence (p=0.02, OR=1.09[1.01-1.19]). However, age remains the only predictor of VF when adjusted on osteoporosis factors (DAS28CRP, menopause, BMI, smoking, diabetes, gender, steroid use, HAQ) and FRAX BMD.Conclusion:Persistent disease activity was associated to high 10 year fracture risk probability calculated by the FRAX tool in RA.Disclosure of Interests:None declared

scholarly journals Effect of Self-referral on Bone Mineral Density Testing and Osteoporosis Treatment

Medical Care ◽  
2014 ◽  
Vol 52 (8) ◽  
pp. 743-750 ◽  
Author(s):  
Amy H. Warriner ◽  
Ryan C. Outman ◽  
Adrianne C. Feldstein ◽  
Douglas W. Roblin ◽  
Jeroan J. Allison ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Osteoporosis Treatment ◽  
Mineral Density ◽  
Bone Mineral Density Testing

151 Optimising Bone Health on Sheffield Frailty Unit Through Quality Improvement

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C M Orton ◽  
N E Sinson ◽  
R Blythe ◽  
J Hogan ◽  
N A Vethanayagam ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Fracture Risk ◽  
Fragility Fracture ◽  
Bone Health ◽  
Assessment Tool ◽  
Health Assessment ◽  
Fragility Fractures ◽  
Improvement Project ◽  
Number Of Patients ◽  
Fracture Risk Assessment Tool

Abstract Introduction NICE and the National Osteoporosis Guidance Group (NOGG) advise on evaluation of fracture risk and osteoporosis treatment1,2, with evidence suggesting that screening and treatment reduces the risk of fragility fractures 3,4,5. However, it is often overlooked in the management of older patients within secondary care. Audit data from Sheffield Frailty Unit (SFU) in 2018 showed that national guidance was not routinely followed. Fracture Risk Assessment Tool (FRAX®) scores were not calculated and bone health was poorly managed. Therefore, we undertook a quality improvement project aiming to optimise bone health in patients presenting to SFU. Method & Intervention In January 2019 we collaborated with Sheffield Metabolic Bone Centre (MBC) to develop a pathway aiming to improve bone health assessment and management in patients presenting to SFU with a fall or fragility fracture. This included a user-friendly flow chart with accompanying guidelines, alongside education for staff. Performance was re-evaluated in May 2019, following which a tick box prompt was added to post take ward round documentation. A re-audit was performed in March 2020. Results In March 2018 0% of patients presenting with a fall had a FRAX® score calculated and only 40% of those with a new fragility fracture were managed according to guidelines. In May 2019, this had improved to 18% and 100% respectively. In March 2020 86% of patients had a FRAX® score calculated appropriately and 100% of fragility fractures were managed according to guidelines. In both re-audits 100% of FRAX® scores were acted on appropriately. Conclusions There has been a significant increase in the number of patients who have their bone health appropriately assessed and managed after presenting to SFU. However, achieving optimum care is under constant review with the aim to deliver more treatment on SFU, thereby reducing the need for repeat visits to the MBC.

Radiology of Osteoporosis

2016 ◽  
Vol 67 (1) ◽  
pp. 28-40 ◽  
Author(s):  
Thomas M. Link
Keyword(s):  
Computed Tomography ◽  
Fracture Risk ◽  
New Technologies ◽  
Assessment Tool ◽  
Quantitative Computed Tomography ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Bone Architecture ◽  
Mineral Density ◽  
Fracture Risk Assessment Tool

The radiologist has a number of roles not only in diagnosing but also in treating osteoporosis. Radiologists diagnose fragility fractures with all imaging modalities, which includes magnetic resonance imaging (MRI) demonstrating radiologically occult insufficiency fractures, but also lateral chest radiographs showing asymptomatic vertebral fractures. In particular MRI fragility fractures may have a nonspecific appearance and the radiologists needs to be familiar with the typical locations and findings, to differentiate these fractures from neoplastic lesions. It should be noted that radiologists do not simply need to diagnose fractures related to osteoporosis but also to diagnose those fractures which are complications of osteoporosis related pharmacotherapy. In addition to using standard radiological techniques radiologists also use dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT) to quantitatively assess bone mineral density for diagnosing osteoporosis or osteopenia as well as to monitor therapy. DXA measurements of the femoral neck are also used to calculate osteoporotic fracture risk based on the Fracture Risk Assessment Tool (FRAX) score, which is universally available. Some of the new technologies such as high-resolution peripheral computed tomography (HR-pQCT) and MR spectroscopy allow assessment of bone architecture and bone marrow composition to characterize fracture risk. Finally radiologists are also involved in the therapy of osteoporotic fractures by using vertebroplasty, kyphoplasty, and sacroplasty. This review article will focus on standard techniques and new concepts in diagnosing and managing osteoporosis.

scholarly journals The Effect of Caudal Epidural Pulsed Radiofrequency Stimulation in Patients with Refractory Chronic Idiopathic Axonal Polyneuropathy

2018 ◽  
Vol 1 (21;1) ◽  
pp. E57-E62
Author(s):  
Min Cheol Chang
Keyword(s):  
Neuropathic Pain ◽  
Repeated Measures ◽  
Rating Scale ◽  
Axonal Neuropathy ◽  
Pulsed Radiofrequency ◽  
Oral Medications ◽  
Axonal Polyneuropathy ◽  
Number Of Patients ◽  
Good Score ◽  
Caudal Epidural

Background: Many patients with chronic idiopathic axonal polyneuropathy (CIAP) suffer from neuropathic pain, which is managed using several oral medications and modalities. However, despite these treatments, pain persists in some patients. Objective: In the clinical field, clinicians frequently meet patients with neuropathic pain caused by CIAP. The authors investigated the effect of caudal epidural pulsed radiofrequency (PRF) for the management of CIAP-induced refractory neuropathic pain. Study Design: This is a prospective study. Setting: The outpatient clinic of a single academic medical center in Korea Methods: Twenty patients with neuropathic pain and a diagnosis of refractory CIAP were recruited. For PRF stimulation, a 22-gauge cannula was inserted into the epidural space through the sacral hiatus under fluoroscopic guidance. PRF stimulation was administered once at 5 Hz with a 5-ms pulse width for 600 seconds at 55 V. The effect of stimulation was evaluated using a numeric rating scale (NRS) at 2 weeks and 1, 2, and 3 months after the procedure. Successful pain relief was defined as a reduction in the NRS score of ≥ 50% as compared with the score prior to treatment. In addition, at 3 months after treatment, patient satisfaction levels were examined; patients that reported “very good” (score = 7) or “good” (score = 6) results were considered to be satisfied with the procedure. Results: Neuropathic pain was significantly reduced at 2 weeks and at 1, 2, and 3 months followup after PRF (P < 0.001, repeated measures one-factor analysis). In addition, at 3 months post-PRF, half of the patients achieved a successful response (≥ 50% pain reduction) and were satisfied with treatment results. Limitations: A small number of patients were recruited, and we did not perform long-term follow-up. Conclusion: Caudal epidural PRF may be a good treatment option for managing neuropathic pain induced by CIAP, especially when pain is unresponsive to oral medications. Key words: Pulsed radiofrequency, chronic idiopathic axonal neuropathy, caudal epidural stimulation, neuropathic pain chronic pain, refractory pain

scholarly journals Instrumental diagnosis of osteosarcopenia in diagrams and tables

2021 ◽  
pp. 358-364
Author(s):  
A. V. Naumov ◽  
D. V. Demenok ◽  
Yu. S. Onuchina ◽  
N. O. Khovasova ◽  
V. I. Moroz ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Physical Performance ◽  
Assessment Tool ◽  
Mass Function ◽  
Dual Energy ◽  
Whole Body ◽  
Mineral Density ◽  
X Ray ◽  
Fracture Risk Assessment Tool ◽  
History Of

Osteoporosis and sarcopenia are age-associated diseases of the musculoskeletal system. Osteosarcopenia, the presence of osteopenia/osteoporosis and sarcopenia. The prevalence of osteosarcopenia in older adults with failing was 37% and associated with higher rate of death. Diagnosis of osteosarcopenia consists of describing medical history of fractures, providing x-ray of the spine (if it is needed) and bone densitometry, calculation of Fracture Risk Assessment Tool (FRAX), evaluating muscle strength, mass, function. The most common exam which is used to measure bone mineral density (BMD) is dual-energy x-ray absorptiometry (DXA or DEXA). Screening using the FRAX is recommended in all postmenopausal women and mеn over 50 in order to identify individuals with high probability of fractures. It is recommended to diagnose osteoporosis in patients with fragility fracture of large bones of the skeleton. Diagnosis of sarcopenia is consist of measures for three parameters: muscle strength, muscle quantity/quality and physical performance as an indicator of severity. Muscle strength can be measured with carpal dynamometry. Muscle mass can be evaluated dual-energy X-ray absorptiometry (program «Whole body»). Muscle function can be evaluated with short physical performance battery (SPPB) tests. In this article described algorithm of diagnosis of osteosarcopenia.

Analysis of the molecular mechanisms by flavonoids with potential use for osteoporosis prevention or therapy

2021 ◽  
Vol 28 ◽  
Author(s):  
Valeria Rodríguez ◽  
María Rivoira ◽  
Gabriela Picotto ◽  
Gabriela Díaz de Barboza ◽  
Alejandro Collin ◽  
...  
Keyword(s):  
Molecular Mechanisms ◽  
Osteoporosis Treatment ◽  
Epidemiological Studies ◽  
Common Mechanism ◽  
Osteoporotic Bone ◽  
Osteoporosis Prevention ◽  
Mineral Density ◽  
Pubmed Database ◽  
Molecular Aspects ◽  
Potential Use

Background: Osteoporosis is the most common skeletal disorder worldwide. Flavonoids have the potential to alleviate bone alterations in osteoporotic patients with the advantage of being safer and less expensive than the conventional therapies. Objective: The main objective is to analyze the molecular mechanisms triggered in bone by different subclasses of flavonoids. In addition, this review provides an up-to-date overview on the cellular and molecular aspects of osteoporotic bones versus healthy bones, and a brief description of some epidemiological studies indicating that flavonoids could be useful for osteoporosis treatment. Methods: The PubMed database was searched in the range of years 2001- 2021 using the keywords osteoporosis, flavonoids, and their subclasses such as flavones, flavonols, flavanols, isoflavones, flavanones and anthocyanins, focusing the data on the molecular mechanisms triggered in bone. Results: Although flavonoids comprise many compounds that differ in structure, their effects on bone loss in postmenopausal women or in ovariectomized-induced osteoporotic animals are quite similar. Most of them increase bone mineral density and bone strength, which occur through enhancement of osteoblastogenesis and osteoclast apoptosis, decrease in osteoclastogenesis as well as increase in neovascularization on the site of the osteoporotic fracture. Conclusion: Several molecules of signaling pathways are involved in the effect of flavonoids on osteoporotic bone. Whether all flavonoids have a common mechanism or they act as ligands of estrogen receptors remain to be established. More clinical trials are necessary to know better their safety, efficacy, delivery and bioavailability in humans, as well as comparative studies with conventional therapies.

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