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Hip Structural Changes and Fracture Risk in Osteopenia and Osteoporosis  [cached]
Meltem Esenyel,Aynur Ozen,Cem Zeki Esenyel,Aylin Rezvani
Eurasian Journal of Medicine , 2011,
Abstract: Objective: Although bone mineral density (BMD) is an important predictor of hip fracture, there is a large overlap of BMD values between those who fracture their hips and those who do not. The aim of this study was to evaluate differences in the structural parameters of the hip in patients with osteopenia and osteoporosis in the hip region and to assess their relationship with osteoporotic fracture risk, age and gender.Materials and Methods: In this observational retrospective study, 150 patients with osteopenia (100 postmenopausal women and 50 men ≥ 50 years of age) and 125 patients with osteoporosis in the hip (100 postmenopaussal women and 25 men ≥ 50 years of age) were included. In addition to densitometry measurements by DEXA (Dual Energy X-ray Absorbimetry), structural variables were determined using the Hip Strength Analysis program (HSA). Results: In logistic regression analyses, the femoral neck BMD (odds ratio (OR), 2.6; 95% Confidence Interval (CI) 1.8-3.8), age (OR per 10 years 1.4; 95% CI, 1.1-1.9), femoral neck shaft angle (NSA) (OR 1.5; 95% CI, 1.2-2.1), Femur Strength Index (FSI) (OR 1.6; 95% CI 1.3-2.2), and Cross sectional area (CSA) (OR 1.6; 95% CI 1.2-2.1) were all associated with osteoporotic fractures in women and men. Osteopenic patients had smaller femoral neck-shaft angles (NSA) compared to osteoporotic patients (p<0.05). This angle was larger in women (p<0.05); and women had decreased (FSI) (p<0.001) and CSA (p<0.05), which cause increased fracture risk. Conclusion: Spatial distribution of bone tissue is a useful determinant of fracture risk.
Factors associated with treatment of women with osteoporosis or osteopenia from a national survey
Eric S Meadows, Beth D Mitchell, Susan C Bolge, Joseph A Johnston, Nananda F Col
BMC Women's Health , 2012, DOI: 10.1186/1472-6874-12-1
Abstract: This retrospective analysis of the United States 2007 National Health and Wellness Survey included women age ≥ 40 years who reported having a diagnosis of osteoporosis (69% of 3276) or osteopenia (31% of 3276). Patients were stratified by whether they were or were not taking prescription treatment for osteoporosis/osteopenia. Using 34 patient characteristics as covariates, logistic regression was used to determine factors associated with treatment.Current prescription treatment was reported by 1800 of 3276 (54.9%) women with osteoporosis/osteopenia. The following factors were associated with receiving prescription treatment: patient-reported diagnosis of osteoporosis (versus osteopenia); previous bone mineral density test; ≥ 2 fractures since age 50; older age; lower body mass index; better physical functioning; postmenopausal status; family history of osteoporosis; fewer comorbidities; prescription insurance coverage; higher total prescription count; higher ratio of prescription costs to monthly income; higher income; single status; previous visit to a rheumatologist or gynecologist; and 1 or 2 outpatient visits to healthcare provider (vs. none) in the prior 6 months. Glucocorticoid, tobacco, and daily alcohol use were risk factors for fracture that were not associated with treatment.There is a mismatch between those women who could benefit from treatment for osteoporosis and those who are actually treated. For example, self-reported use of glucocorticoids, tobacco, and alcohol were not associated with prescription treatment of osteoporosis. Other clinical and socioeconomic factors were associated with treatment (e.g. prescription drug coverage and higher income) or not (e.g. comorbid osteoarthritis and anxiety) and could be opportunities to improve care.Osteoporosis is a systemic skeletal disorder characterized by low bone mass, structural deterioration of bone tissue, and an increased vulnerability to low-trauma fractures [1,2]. In the United States (US), an esti
Osteopenia and osteoporosis in people living with HIV: multiprofessional approach
Lima AL, Oliveira PR, Plapler PG, Marcolino FM, Meirelles ES, Sugawara A, Gobbi RG, Godoy-Santos AL, Camanho GL
HIV/AIDS - Research and Palliative Care , 2011, DOI: http://dx.doi.org/10.2147/HIV.S6617
Abstract: teopenia and osteoporosis in people living with HIV: multiprofessional approach Review (3156) Total Article Views Authors: Lima AL, Oliveira PR, Plapler PG, Marcolino FM, Meirelles ES, Sugawara A, Gobbi RG, Godoy-Santos AL, Camanho GL Published Date December 2011 Volume 2011:3 Pages 117 - 124 DOI: http://dx.doi.org/10.2147/HIV.S6617 Ana Lucia Lei Munhoz Lima, Priscila Rosalba D de Oliveira, Perola Grimberg Plapler, Flora Maria D Andrea Marcolino, Eduardo de Souza Meirelles, André Sugawara, Riccardo Gomes Gobbi, Alexandre Leme Godoy dos Santos , Gilberto Luis Camanho Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of S o Paulo School of Medicine, S o Paulo, Brazil Abstract: Increasing bone mineralization abnormalities observed among people living with HIV (PLWHIV) result from various factors relating to the host, the virus, and the antiretrovirals used. Today, HIV infection is considered to be a risk factor for bone mineralization disorders. The test most recommended for diagnosing osteoporosis is measurement of bone mineral density by means of dual energy X-ray absorptiometry at two sites. Osteoporosis treatment has the aims of bone mass improvement and fracture control. A combination of calcium and vitamin D supplementation may reduce the risk of fractures. Antiresorptive drugs act by blocking osteoclastic activity and reducing bone remodeling. On the other hand, bone-forming drugs stimulate osteoblastogenesis, thereby stimulating the formation of bone matrix. Mixed-action medications are those that are capable of both stimulating bone formation and inhibiting reabsorption. Antiresorptive drugs form the group of medications with the greatest quantity of scientific evidence confirming their efficacy in osteoporosis treatment. Physical activity is a health promotion strategy for the general population, but only preliminary data on its real value and benefit among PLWHIV are available, especially in relation to osteoporosis.
Osteopenia and osteoporosis in people living with HIV: multiprofessional approach  [cached]
Lima AL,Oliveira PR,Plapler PG,Marcolino FM
HIV/AIDS - Research and Palliative Care , 2011,
Abstract: Ana Lucia Lei Munhoz Lima, Priscila Rosalba D de Oliveira, Perola Grimberg Plapler, Flora Maria D Andrea Marcolino, Eduardo de Souza Meirelles, André Sugawara, Riccardo Gomes Gobbi, Alexandre Leme Godoy dos Santos , Gilberto Luis CamanhoInstitute of Orthopedics and Traumatology, Hospital das Clínicas, University of S o Paulo School of Medicine, S o Paulo, BrazilAbstract: Increasing bone mineralization abnormalities observed among people living with HIV (PLWHIV) result from various factors relating to the host, the virus, and the antiretrovirals used. Today, HIV infection is considered to be a risk factor for bone mineralization disorders. The test most recommended for diagnosing osteoporosis is measurement of bone mineral density by means of dual energy X-ray absorptiometry at two sites. Osteoporosis treatment has the aims of bone mass improvement and fracture control. A combination of calcium and vitamin D supplementation may reduce the risk of fractures. Antiresorptive drugs act by blocking osteoclastic activity and reducing bone remodeling. On the other hand, bone-forming drugs stimulate osteoblastogenesis, thereby stimulating the formation of bone matrix. Mixed-action medications are those that are capable of both stimulating bone formation and inhibiting reabsorption. Antiresorptive drugs form the group of medications with the greatest quantity of scientific evidence confirming their efficacy in osteoporosis treatment. Physical activity is a health promotion strategy for the general population, but only preliminary data on its real value and benefit among PLWHIV are available, especially in relation to osteoporosis.Keywords: osteoporosis, HIV/AIDS, diagnosis, treatment, exercise
Evaluation of periodontal condition of menopause women with osteoporosis and osteopenia and comparison with control group
Khorsand A.,Paknejad M.,Vakili F.
Journal of Dental Medicine , 2006,
Abstract: Background and Aim: Several risk factors directly affect the development of periodontal diseases. Also some systemic diseases act indirectly as predisposing and aggrevating factors. Osteoporosis is one of these factors and one of its main causes is lack of physical activity in postmenopause period. The incidence of osteoporosis is increasing in our country. The goal of this study was to evaluate the periodontal condition of women with osteoporosis and osteopenia referred to bone densitometric division of Loghman hospital in 2003 and compare to control group. Materials and Methods: In this case control study based on BMD (Bone Mineral Density) measurement of back and thigh using DEXA method, 60 patients referred to bone densitometric division of Loghman hospital, were randomly selected. Cases were divided into three groups, 20 with osteoporosis, 20 with osteopenia and 20 normal cases. Periodontal indices consisting of plaque index (PI), tooth loss (TL), gingival recession (GR), probing pocket depth (PPD) and papilla bleeding index (PBI) were evaluated by clinical and radiographic examination. Data were analyzed by Kruskall Wallis and Dunn tests with p<0.05 as the limit of significance. Results: PBI, PI and TL were significantly higher in osteoporotic group than osteopenic and normal group. PPD was not different in the three groups. Due to the low prevalence of recession in our study, this parameter was not included in the statistical analysis. Conclusion: It seems that osteoporosis does not increase the incidence of periodontal diseases because it affects bone quality rather than quantity. In osteoporosis calcium deficiency and increasing age lead to decreased physical activity and ultimately affect the patient's oral hygiene performance. Thus, periodontal manifestations are presented as gingival bleeding and gingivitis.
Preliminary screening of osteoporosis and osteopenia in urban women from Jammu using calcaneal QUS  [cached]
Sharma Sudhaa,Tandon Vishal,Mahajan Annil,Kour Avinash
Indian Journal of Medical Sciences , 2006,
Abstract: BACKGROUND: Osteoporosis is a major public health problem, associated with substantial morbidity and socio-economic burden. An early detection can help in reducing the fracture rates and overall socio-economic burden in such patients. AIM: The present study was carried out to screen the bone status (osteopenia and osteoporosis) above the age of 25 years in urban women population in this region. MATERIALS AND METHODS: A hospital based study was carried out in 158 women by calculating T-scores utilizing calcaneal QUS as diagnostic tool. RESULTS: The result suggested that a substantial female population had oesteopenia and osteoporosis after the age of 45 years. The incidence of osteoporosis was (20.25%) and osteopenia (36.79%) with maximum number of both osteoporosis and osteopenic women recorded in the age group of (55-64 years). After the age of 65 years, there was an almost 100% incidence of either osteopenia or osteoporosis, indicating that it increases with age and in postmenopausal period, thereby suggesting lack of estrogenic activity might be responsible for this increasing trend. Religion, caste and diet had an influence on the outcome of osteopenic and osteoporosis score in present study, but still it has to be substantiated by conducting larger randomized clinical trials in future. CONCLUSION: A substantial female population was screened for osteoporosis and osteopenia using calcaneal QUS method utilizing same WHO T score criteria that otherwise shall remain undiagnosed and face the complications and menace of osteoporosis.
Time of Progression to Osteopenia/Osteoporosis in Chronically HIV-Infected Patients: Screening DXA Scan  [PDF]
Eugenia Negredo, Anna Bonjoch, Moisés Gómez-Mateu, Carla Estany, Jordi Puig, Nuria Perez-Alvarez, Joaquin Rosales, Silvana di Gregorio, Luis del Rio, Guadalupe Gómez, Bonaventura Clotet
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0046031
Abstract: Background Algorithms for bone mineral density (BMD) management in HIV-infected patients are lacking. Our objective was to assess how often a dual-energy x-ray absorptiometry (DXA) scan should be performed by assessing time of progression to osteopenia/osteoporosis. Methods All DXA scans performed between 2000 and 2009 from HIV-infected patients with at least two DXA were included. Time to an event (osteopenia and osteoporosis) was assessed using the Kaplan–Meier method. Strata (tertiles) were defined using baseline minimum T scores. Differences between strata in time to an event were compared with the log-rank test. Results Of 391 patients (1,639 DXAs), 49.6% had osteopenia and 21.7% osteoporosis at their first DXA scan. Of the 112 (28.6%) with normal BMD, 35.7% progressed to osteopenia; median progression time was 6.7 years. These patients were stratified: “low-risk" (baseline minimum T score >?0.2 SD), “middle-risk" (between ?0.2 and ?0.6 SD), and “high-risk" (from ?0.6 to ?1 SD); median progression time to osteopenia was 8.7, >7.2, and 1.7 years, respectively (p<0.0001). Of patients with osteopenia, 23.7% progressed to osteoporosis; median progression time was >8.5 years. Progression time was >8.2 years in “low-risk" tertile (T score between ?1.1 and ?1.6 SD), >8.5 years in “middle-risk" (between ?1.6 and ?2), and 3.2 years in “high-risk" (from ?2 to ?2.4) (p<0.0001). Conclusions Our results may help to define the BMD testing interval. The lowest T score tertiles would suggest recommending a subsequent DXA in 1–2 years; in the highest tertiles, ≥6 years. Early intervention in patients with bone demineralization could reduce fracture–related morbidity/mortality.
Prevalence of osteoporosis-osteopenia at lumbar spine and femur in an urban female population. An epidemiological study in the Athens Metropolitan area, Greece  [cached]
Ioannis Legakis,Vasilis Papadopoulos,Vasilis Tataridas,Kyriakos Strigaris
Endocrinology Studies , 2012, DOI: 10.4081/es.2012.e1
Abstract: The aim of this study is to determine the prevalence of osteoporosis and osteopenia in a female urban population. Dual energy X-ray absorptiometry measurements were done at the lumbar spine (6920 females) and at the femur (3222 females) Bone mineral density (BMD) and corresponding T-scores were analysed using multivariate regression models. In females, the prevalence rate of osteoporosis was 15.3% at the lumbar spine and of osteopenia 36.5%. In females osteoporosis rate at the femur was 17.7% for the neck, 30.65% for the ward’s triangle and 1.86% for the tronchater, whereas the osteopenic rates were 53.3%, 44.7% and 32.09% respectively. A polynominal cubic model performed for age showed the steepest decline at the age of 55 years for the spine BMD (-0.973% change, 95% CI -1.031/-0.915) and at the age of 64 years for the femur BMD (-0.726% change, 95% CI - 0.793/-0.658). Actually sensitive interventions for prevention of osteoporosis in urban population need serious concern.
Efficacy of long-term osteopenia/osteoporosis treatment in the Slovene HIV-infected male population
M Maver,T Vovko,M Pfeifer,G Volcansek
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.6.18326
Abstract: Purpose of study: In our study from 2006, high prevalence of reduced bone mineral density (BMD) among Slovene HIV-infected male population was observed. The aim of the present study was to evaluate bone status six years after treatment intervention. Methods: 69 HIV-infected male patients (out of 96, studied in 2006) were assessed for change in BMD using dual X-ray absorptiometry and markers of bone turnover. The effects of HIV-associated factors (time since infection, ART duration, viral load, CD4+count), changes in life-style risk factors (smoking, physical activity, alcohol consumption, amount of milk in diet) and treatment of osteopenia/osteoporosis were assessed. Therapy for osteopenia/osteoporosis was used in 30 patients; vitamin D and calcium supplementation in 20 patients with osteopenia and additionally bisphophonates in 15 patients with osteoporosis or androgens in case of hypogonadism, respectively. 39 patients were not treated. Summary of results: Therapy of osteopenia/osteoporosis maintained BMD values in 18 (66.7%) patients, as compared to only 8 (25%) patients without therapy (p=0.002). Lumbar spine BMD increased by 4.1% during the 6-year period for patients with therapy, as compared with an increase of 0.9% for patients without therapy (p=0.033). The difference in total hip values was even more significant, with a 2.6% increase in BMD with therapy, compared to a 1.95% decrease without therapy (p<0.0001). Some increase in the physical activity and milk consumption among HIV-infected population was observed, while the smoking rate and alcohol consumption remained the same. Risk-factors associated with life-style did not have any effect on BMD change. According to the logistic regression model, long-term vitamin D and calcium supplementation was the most significant factor associated with maintaining BMD values (p=0.010; OR= 14.4). Conclusions: Long-term treatment, especially with vitamin D and calcium, was safe and efficient in the treatment of osteopenia/osteoporosis in HIV infected patients. As BMD values decreased in a majority of individuals without therapy, and given the absence of any association between life-style change and BMD improvement, early vitamin D and calcium supplementation in the HIV-infected population is required.
Experience with alendronate treatment for four years among Japanese men with osteoporosis or osteopenia and clinical risk factors for fractures
Jun Iwamoto, Yoshihiro Sato, Mitsuyoshi Uzawa, et al
Therapeutics and Clinical Risk Management , 2010, DOI: http://dx.doi.org/10.2147/TCRM.S15812
Abstract: ience with alendronate treatment for four years among Japanese men with osteoporosis or osteopenia and clinical risk factors for fractures Original Research (3389) Total Article Views Authors: Jun Iwamoto, Yoshihiro Sato, Mitsuyoshi Uzawa, et al Published Date December 2010 Volume 2010:6 Pages 593 - 600 DOI: http://dx.doi.org/10.2147/TCRM.S15812 Jun Iwamoto1 Yoshihiro Sato2 Mitsuyoshi Uzawa3 Tsuyoshi Takeda1 Hideo Matsumoto1 1Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo; 2Department of Neurology, Mitate Hospital, Fukuoka; 3Department of Orthopaedic Surgery, Keiyu Orthopaedic Hospital, Gunma, Japan Purpose: A retrospective study based on a conventional medical practice was performed to evaluate the outcome of alendronate treatment for four years in Japanese men with osteoporosis or osteopenia and clinical risk factors for fractures. Methods: Twenty-nine Japanese men with osteoporosis or osteopenia and clinical risk factors for fractures (mean age at baseline 61.0 years) who had been treated with alendronate for over four years in our outpatient clinic were studied. Lumbar spine or total hip bone mineral density (BMD) was measured using dual energy x-ray absorptiometry, and urinary levels of cross-linked N-terminal telopeptides of type I collagen (NTX) and serum levels of bone-specific alkaline phosphatase were monitored during the four-year treatment period. Results: Urinary NTX and serum bone-specific alkaline phosphatase levels decreased (-44.4% at three months and -61.2% at four years, respectively) and lumbar spine and total hip BMD increased (+13.9% and +9.2% at four years, respectively), compared with baseline values. No serious adverse events were observed, including osteonecrosis of the jaw, femoral diaphysis atypical fractures, or atrial fibrillation. Conclusion: To our knowledge, this is the first report of the outcome of alendronate treatment for four years in Japanese men with an increased risk for fractures. Alendronate suppressed bone turnover and increased lumbar spine and total hip BMD from baseline over the course of the four-year treatment period without causing any severe adverse events in Japanese men with osteoporosis or osteopenia and clinical risk factors for fractures.
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