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Journal of Orthopaedic Surgery and... Nov 2023The OPG/RANKL signal pathway was important regulation mechanism of bone remodeling cycle, but the effect of osteoprotegerin (OPG) and RANKL in osteoporosis was... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The OPG/RANKL signal pathway was important regulation mechanism of bone remodeling cycle, but the effect of osteoprotegerin (OPG) and RANKL in osteoporosis was uncertain. We did a systematic review with meta-analysis to assess the association between serum OPG/RANKL and osteoporosis.
METHODS
The systematic search, data extraction, critical appraisal, and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Randomized controlled studies were searched in PubMed, OvidMedline, Embase (1946 to present). Standard mean difference (SMD), and associated credible interval (CI) were calculated using RevMan statistical software to assess the continuous data. Heterogeneity in studies was measured by I values. Subgroup analysis was performed based on different bone turnover.
RESULTS
A total of 5 randomized controlled studies met the inclusion criteria. Both OPG and RANKL had no significant differences between the osteoporosis and control group, and the statistical heterogeneity was high in meta-analysis. However, RANKL had significant differences between the osteoporosis group with low bone turnover and control group (SMD = - 1.17; 95% CI - 1.77 to 0.57; P value < 0.01) in subanalysis. Furthermore, the OPG/RANKL ratio was significant lower in the osteoporosis group than in the control group (SMD = - 0.29; 95% CI - 0.57 to - 0.02; P value < 0.05), and the statistical heterogeneity was very low (Chi = 0.20, P = 0.66, I = 0%).
CONCLUSIONS
Our meta-analysis study supported OPG and RANKL were important modulatory factors of bone formation and resorption in bone turnover, respectively. Although the serum level of both OPG and RANKL were not associated with osteoporosis, but the OPG/RANKL ratio was associated with osteoporosis. In future, standardizing the test method and unit was good to clinical application.
Topics: Humans; Osteoprotegerin; Osteoporosis; Bone Remodeling; Osteogenesis; RANK Ligand; Bone Density
PubMed: 37932757
DOI: 10.1186/s13018-023-04179-5 -
Reumatismo Mar 2018Polymyalgia rheumatica (PMR) is the commonest inflammatory rheumatic disease affecting older people. The current mainstay of treatment is long-term oral glucocorticoid... (Review)
Review
Polymyalgia rheumatica (PMR) is the commonest inflammatory rheumatic disease affecting older people. The current mainstay of treatment is long-term oral glucocorticoid therapy. Management of these patients in clinical practice is often complicated by the presence of comorbidity. Comorbidity might be due to shared risk factors such as age, sex, or genetic background; to the presence of the disease itself; or to adverse effects of glucocorticoid therapy. Cardiovascular disease, osteoporosis/fracture, metabolic and ocular comorbidity are of particular interest to clinicians because of their relationship to glucocorticoid therapy and the relevance to clinical treatment decisions regarding glucocorticoid tapering. Patients at high risk of exacerbation of comorbidity by glucocorticoid therapy may be considered for adjunctive steroid-sparing therapies and thus may need specialist management. From a public health perspective, with the ageing population the prevalence of PMR is predicted to increase; accurate data on comorbidity will be needed for planning and delivery of healthcare services.
Topics: Aged; Cardiovascular Diseases; Comorbidity; Eye Diseases; Glucocorticoids; Humans; Metabolic Diseases; Neoplasms; Osteoporosis; Paraneoplastic Syndromes; Polymyalgia Rheumatica; Prevalence; Risk Factors; United Kingdom
PubMed: 29589401
DOI: 10.4081/reumatismo.2018.1039 -
Maedica Jun 2022As the population of Malaysia is aging, osteoporosis is becoming more common, prompting the development of various clinical practice guidelines for screening and...
As the population of Malaysia is aging, osteoporosis is becoming more common, prompting the development of various clinical practice guidelines for screening and diagnosing in primary care settings. Given the lack of a systematic assessment of recommendations, we aimed to determine the extent between the guidelines and actuarial screening and diagnosing among postmenopausal women in Malaysia. The present research is a systematic review following the Cochrane Handbook for Systematic Reviews and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) for clinical practice guidelines on the screening and diagnosing of osteoporosis in primary care settings (updated January 1, 2022). For this purpose, several databases were searched, including MEDLINE, EMBASE and CINAHL. Medical subject headings search terms were related to diagnosis and treatment of osteoporosis, clinical practice guidelines, primary settings and postmenopausal women. Two authors assessed records following consensus and evidence-based processes and reviewed the quality of identified studies using the Joanna Briggs Institute Critical Appraisal tools. Six cross-sectional studies were included in our review. All of them showed a fair level of osteoporosis screening among postmenopausal women in Malaysia primary care settings. Included studies reported that 50% of participants had been diagnosed as osteopenia or osteoporosis. Advancing age, increase of menopause years, low bone mass index, low calcium intake, low education level and low income are positive indicators for osteoporosis. The diagnosis of osteoporosis is influenced by the accessibility of primary care providers on osteoporosis care and knowledge of osteoporosis among postmenopausal women. This systematic review has confirmed that there was a fair screening status in Malaysia. A renewed effort in primary care is needed to reduce the explicit gap in practice and meet the osteoporosis guideline. However, further reviews are needed to best inform future practice, specifically examine the challenges of primary care providers in osteoporosis management.
PubMed: 36032605
DOI: 10.26574/maedica.2022.17.2.492 -
International Journal of Endocrinology 2021Previous studies have reached mixed conclusions regarding the association between metabolic syndrome (MS) and osteoporosis. We aimed to perform a meta-analysis based on... (Review)
Review
BACKGROUND
Previous studies have reached mixed conclusions regarding the association between metabolic syndrome (MS) and osteoporosis. We aimed to perform a meta-analysis based on published studies that explored the association between osteoporosis and MS.
METHODS
To identify related literature, a systematic search of PubMed, Cochrane Library, and EMBASE databases from inception to June 2020 was performed. Original studies that reported the risk estimates of osteoporosis morbidity for two or three categories of bone mineral density (BMD) in patients with MS were selected. Two independent investigators screened and selected the articles. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models.
RESULTS
Of 2632 identified studies, nine cross-sectional studies with 14 datasets were eligible for our meta-analysis. In seven studies (10 datasets), the summarized ORs of osteoporosis for MS were 0.72 (95% CI: 0.52-0.99). Subgroup analyses by gender showed that significant inverse associations were observed only in men (OR = 0.72, 95% CI: 0.55-0.96) but not in women (OR = 0.70, 95% CI: 0.41-1.22). The definition of MS, the source of the study population, and the adjustment of covariates affected the estimates. In two studies (4 datasets), there was no evidence for an association between MS and decreased BMD.
CONCLUSIONS
Our findings demonstrated that MS was significantly associated with a lower osteoporosis risk. There might be gender differences in the association between MS and osteoporosis. In addition, the association was likely to relate to the definition of MS, the source of the study population, and the adjustment of covariates.
PubMed: 34354749
DOI: 10.1155/2021/6691487 -
Calcified Tissue International Oct 2021It is acknowledged that the COVID-19 pandemic has caused profound disruption to the delivery of healthcare services globally. This has affected the management of many... (Review)
Review
It is acknowledged that the COVID-19 pandemic has caused profound disruption to the delivery of healthcare services globally. This has affected the management of many long-term conditions including osteoporosis as resources are diverted to cover urgent care. Osteoporosis is a public health concern worldwide and treatment is required for the prevention of further bone loss, deterioration of skeletal micro-architecture, and fragility fractures. This review provides information on how the COVID-19 pandemic has impacted the diagnosis and management of osteoporosis. We also provide clinical recommendations on the adaptation of care pathways based on experience from five referral centres to ensure that patients with osteoporosis are still treated and to reduce the risk of fractures both for the individual patient and on a societal basis. We address the use of the FRAX tool for risk stratification and initiation of osteoporosis treatment and discuss the potential adaptations to treatment pathways in view of limitations on the availability of DXA. We focus on the issues surrounding initiation and maintenance of treatment for patients on parenteral therapies such as zoledronate, denosumab, teriparatide, and romosozumab during the pandemic. The design of these innovative care pathways for the management of patients with osteoporosis may also provide a platform for future improvement to osteoporosis services when routine clinical care resumes.
Topics: Bone Density Conservation Agents; COVID-19; Humans; Osteoporosis; Osteoporotic Fractures; Pandemics; SARS-CoV-2; Teriparatide
PubMed: 34003337
DOI: 10.1007/s00223-021-00858-9 -
Journal of Mid-life Health 2017This systematic review was done to assess the strength of association between osteoporosis and chronic periodontitis in postmenopausal women, assessed by bone mineral... (Review)
Review
This systematic review was done to assess the strength of association between osteoporosis and chronic periodontitis in postmenopausal women, assessed by bone mineral density (BMD) and clinical attachment loss, respectively. The Pubmed, Cochrane central, EMBASE, and Google Scholar were searched from year 1990 to 2015 for studies on association between chronic periodontitis and osteoporosis. Studies measuring osteoporosis in terms of central BMD and periodontitis in terms of clinical attachment level were studied. Data were extracted and descriptive analysis was performed. Screening of 1188 articles resulted in 24 articles for review after reading the titles and abstracts. Fifteen studies were shortlisted for inclusion in systematic review. Ten of these studies showed an association between periodontitis and osteoporosis. It implies that patients with severe periodontitis should also be evaluated for systemic bone health and vice versa.
PubMed: 29307975
DOI: 10.4103/jmh.JMH_55_17 -
Stem Cell Research & Therapy Apr 2023The increasing incidence of osteoporosis in recent years has aroused widespread public concern; however, existing effective treatments are limited. Therefore, new... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The increasing incidence of osteoporosis in recent years has aroused widespread public concern; however, existing effective treatments are limited. Therefore, new osteoporosis treatment methods, including stem cell transplantation and exosome therapy, have been proposed and are gaining momentum. Exosomes are considered to have greater potential for clinical application owing to their immunocompatibility. This study summarises the latest evidence demonstrating the efficacy of exosomes in improving bone loss in the treatment of osteoporosis.
MAIN TEXT
This systematic review and meta-analyses searched PubMed, Embase, and Cochrane Library databases from inception to 26 March 2022 for osteoporosis treatment studies using stem cell-derived exosomes. Six endpoints were selected to determine efficacy: bone mineral density, trabecular bone volume/tissue volume fraction, trabecular number, trabecular separation, trabecular thickness, and cortical thickness. The search generated 366 citations. Eventually, 11 articles that included 15 controlled preclinical trials and 242 experimental animals (rats and mice) were included in the meta-analysis.
CONCLUSION
The results were relatively robust and reliable despite some publication biases, suggesting that exosome treatment increased bone mass, improved bone microarchitecture, and enhanced bone strength compared with placebo treatments. Moreover, stem cell-derived exosomes may favour anabolism over catabolism, shifting the dynamic balance towards bone regeneration.
Topics: Rats; Mice; Animals; Exosomes; Osteoporosis; Bone Density; Bone and Bones; Treatment Outcome
PubMed: 37038180
DOI: 10.1186/s13287-023-03317-4 -
BMC Public Health Oct 2016We conducted a systematic review and meta-analysis to obtain a reliable estimation of the prevalence of osteoporosis in China and to characterize its epidemiology. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We conducted a systematic review and meta-analysis to obtain a reliable estimation of the prevalence of osteoporosis in China and to characterize its epidemiology.
METHODS
We identified relevant studies via a search of literature published from 2003 to October 2015 in the PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang and Weipu databases. Both Chinese and WHO criteria were considered acceptable for the diagnosis of osteoporosis. Prevalence estimates were obtained using random effects models. Meta-regression analysis was used to explore the sources of heterogeneity, and publication bias was evaluated by visually inspecting funnel plots.
RESULTS
Overall, 69 articles were included in this study. An obvious increase in the prevalence of osteoporosis was identified over the past 12 years (prevalence of 14.94 % before 2008 and 27.96 % during the period spanning 2012-2015). The prevalence of osteoporosis was higher in females than in males (25.41 % vs. 15.33 %) and increased with age. Osteoporosis prevalence was higher in rural than in urban areas (20.87 % vs. 23.92 %) and higher in southern than in northern areas (23.17 % vs. 20.13 %). At present, the pooled prevalence of osteoporosis in people aged 50 years and older was more than twice the pooled prevalence identified in 2006 (34.65 % vs. 15.7 %). The application of different diagnostic criteria could have an impact on prevalence estimation (19.7 % vs. 29.3 %). Meta-regression suggested that study setting also influenced the estimation of point prevalence (P = 0.022).
CONCLUSIONS
The prevalence of osteoporosis in China has increased over the past 12 years, affecting more than one-third of people aged 50 years and older. The prevalence of osteoporosis increased with age and was higher in females than in males. Prevention and control measures have become all the more important given the increase in osteoporosis prevalence, and three-step prevention programmes should be implemented.
Topics: Adult; Age Distribution; Asian People; China; Female; Humans; Male; Middle Aged; Osteoporosis; Prevalence; Publication Bias; Regression Analysis; Rural Population; Sex Distribution; Urban Population
PubMed: 27716144
DOI: 10.1186/s12889-016-3712-7 -
Heliyon Nov 2023To evaluate the relationship between periodontitis and postmenopausal osteoporosis. (Review)
Review
OBJECTIVE
To evaluate the relationship between periodontitis and postmenopausal osteoporosis.
METHODS
This research was carried out according to the principles laid down by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline statement. We searched the Web of Science, Embase, PubMed, The Cochrane Library, CNKI, VIP, and WanFang databases from inception to July 1, 2023 to collect all relevant publications, with no restrictions on publication date or Languages. Cochrane's tool for assessing RoB was used to evaluate the RoB for RCTs. The Newcastle-Ottawa Scale was used to assess the RoB for cohort studies and case-control studies. Mean differences (MD) with 95 % confidence intervals (CI) were used for analysis of continuous data. Heterogeneity was measured using the I statistic. Revman 5.4 software was used for the meta-analysis.
RESULTS
28 observational studies with 19611 patients, including 5813 cases in the postmenopausal osteoporosis group and 13798 cases in the non-osteoporosis group. The studies showed that the degrees of clinical attachment loss (CAL), probing depth (PD), gingival recession (GR), simplified oral hygiene index (OHIS), and percentage of sites with bleeding on probing (BOP) in the postmenopausal osteoporosis group were higher than those in the non-osteoporosis group[CAL(MD = 0.89(mm), 95 % CI [0.48,1.30], < 0.00001), PD (MD = 0.27(mm), 95 % CI [0.13, 0.41], = 0.0001), GR (MD = 0.28(mm), 95 % CI [0.20, 0.35], < 0.00001), OHIS (MD = 1.32,95 % CI [1.12,1.51], < 0.00001), BOP(MD = 12.71(%), 95 % CI [3.24,22.18], = 0.009)]. Eleven studies found that bone mineral density (BMD) in the postmenopausal osteoporosis group was lower than that in non-osteoporosis group (MD = -0.41(U/cm), 95 % CI [-0.77,-0.05], p = 0.03). The combined analysis results of the studies in the two groups showed that there were no significant differences in the loss of alveolar crestal height (ACH)[(MD = -1.76(%),95%CI [-3.64,0.12], = 0.07)].
CONCLUSION
Postmenopausal osteoporosis patients are more likely to suffer from periodontitis, and the condition is easily aggravated.
PubMed: 37920517
DOI: 10.1016/j.heliyon.2023.e20922