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Advances in Nutrition (Bethesda, Md.) Jul 2023Alcohol consumption remains inconsistently correlated with fracture risk, and a dose-response meta-analysis for specific outcomes is lacking. The objective of this study... (Meta-Analysis)
Meta-Analysis
Alcohol consumption remains inconsistently correlated with fracture risk, and a dose-response meta-analysis for specific outcomes is lacking. The objective of this study was to quantitatively integrate the data on the relationship between alcohol consumption and fracture risk. Pertinent articles were identified in PubMed, Web of Science, and Embase databases up to 20 February 2022. Combined RRs and 95% CIs were estimated by random- or fixed-effects models. Restricted cubic splines were used to model linear or nonlinear relationships. Forty-four articles covering 6,069,770 participants and 205,284 cases of fracture were included. The combined RRs and 95% CIs for highest compared with lowest alcohol consumption were 1.26 (1.17-1.37), 1.24 (1.13-1.35), and 1.20 (1.03-1.40) for total, osteoporotic, and hip fractures, respectively. A linear positive relationship between alcohol consumption and total fracture risk was detected (P = 0.057); the risk was correlated with a 6% increase (RR, 1.06; 95% CI: 1.02, 1.10) per 14 g/d increment of alcohol consumption. J-shaped relationships of alcohol consumption with risk of osteoporotic fractures (P < 0.001) and hip fractures (P < 0.001) were found. Alcohol consumption of 0 to 22 g/d was linked to a reduced risk of osteoporotic fractures and hip fractures. Our findings show that any level of alcohol consumption is a risk factor for total fractures. Moreover, this dose-response meta-analysis shows that an alcohol consumption level of 0 to 22 g/d is related to a reduction in the risk of osteoporotic and hip fractures. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42022320623).
Topics: Humans; Alcohol Drinking; Hip Fractures; Osteoporotic Fractures; Prospective Studies; Risk Factors
PubMed: 36966875
DOI: 10.1016/j.advnut.2023.03.008 -
Age and Ageing Jun 2022despite fall history being a well-known risk factor for falls and fractures, the association between very recent falls and imminent fracture risk is not clearly...
BACKGROUND
despite fall history being a well-known risk factor for falls and fractures, the association between very recent falls and imminent fracture risk is not clearly elucidated.
OBJECTIVE
to study the very recent (<4 months) fall-related absolute risk of fractures in the following year.
METHODS
two large prospective cohort studies of women (Study of Osteoporotic Fractures [SOF]) and men (Osteoporotic Fractures in Men Study [MrOS]) aged 65 years or older were included. Data on falls were collected every 4 months, and the primary outcomes were any non-spine and hip fractures in the next 12 months.
RESULTS
a total of 9,704 women contributed 419,149, and 5,994 men contributed 223,885 four-monthly periods of observations during the 14.8-year SOF and 12.6-year MrOS follow-up. Falls within 4 months indicated a high risk of non-spine and hip fractures in the following year for both sexes; in women, a recent fall indicated an 8.1% absolute risk of a non-spine fracture within 1 year, a 2.5-fold higher risk than that in women without falls, a 2.5% absolute risk of hip fracture, and a 3.1-fold increased risk. Falls increased the risk of fractures regardless of whether a fracture occurred or not. Men had similar risk patterns, albeit with a lower absolute risk of fracture.
CONCLUSIONS
in older people, a fall within 4 months indicates a high risk of fracture in the next year, regardless of fracture occurrence. A recent fall warrants urgent evaluation and consideration of treatments to reduce the imminent risk of fractures.
Topics: Aged; Bone Density; Female; Hip Fractures; Humans; Male; Osteoporotic Fractures; Prospective Studies; Risk Factors
PubMed: 35753766
DOI: 10.1093/ageing/afac141 -
Best Practice & Research. Clinical... Sep 2022Osteoporosis care has evolved markedly over the last 50 years, such that there are now an established clinical definition, validated methods of fracture risk assessment,... (Review)
Review
Osteoporosis care has evolved markedly over the last 50 years, such that there are now an established clinical definition, validated methods of fracture risk assessment, and a range of effective pharmacological agents. However, it is apparent that both in the context of primary and secondary fracture prevention, there is a considerable gap between the population at high fracture risk and those actually receiving appropriate antiosteoporosis treatment. In this narrative review article, we document recent work describing the burden of disease, approaches to management, and service provision across Europe, emerging data on gaps in care, and existing/new ways in which these gaps may be addressed at the level of healthcare systems and policy. We conclude that although the field has come a long way in recent decades, there is still a long way to go, and a concerted, integrated effort is now required from all of us involved in this field to address these urgent issues to ensure the best possible outcomes for our patients.
Topics: Humans; Osteoporotic Fractures; Precision Medicine; Population Health; Osteoporosis; Secondary Prevention
PubMed: 35691824
DOI: 10.1016/j.berh.2022.101754 -
Journal of Orthopaedic Surgery and... Jan 2020Approximately 300 mg of calcium a day is provided into infants to maintain the physical development of infants, and 5 to 10% bone loss occurs in women during... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Approximately 300 mg of calcium a day is provided into infants to maintain the physical development of infants, and 5 to 10% bone loss occurs in women during breastfeeding. Hip fractures are considered the most serious type of osteoporotic fracture. We performed this meta-analysis to investigate the association between breastfeeding and osteoporotic hip fractures.
MATERIAL AND METHODS
PubMed and Embase were searched until May 1, 2019, for studies evaluating the relationship between breastfeeding and osteoporotic hip fracture in women. The quality of the included studies was evaluated by the methodological index for non-randomized studies (MINORS). For the dose-response meta-analysis, we used the "generalized least squares for trend estimation" method proposed by Greenland and Longnecker to take into account the correlation with the log RR estimates across the duration of breastfeeding.
RESULTS
Seven studies were moderate or high quality, enrolling a total of 103,898 subjects. The pooled outcomes suggested that breastfeeding can decrease the incidence of osteoporotic hip fracture (RR = 0.64 (95% CI 0.43, 0.95), P = 0.027). Dose-response analysis demonstrated that the incidence of osteoporotic hip fracture decreased with the increase of breastfeeding time. The RR and 95% CI for 3 months, 6 months, 12 months, and 24 months were RR = 0.93, 95% CI 0.88, 0.98; RR = 0.87, 95% CI 0.79, 0.96; RR = 0.79, 95% CI 0.67, 0.92; and RR = 0.76, 95% CI 0.59, 0.98, respectively, whereas no significant relationship was found between them when the duration of breastfeeding time was more than 25 months.
CONCLUSIONS
Our meta-analysis demonstrated that the incidence of osteoporotic hip fracture decreased with the extension of breastfeeding time. However, there is no significant relationship between them when the duration of breastfeeding time was more than 25 months.
Topics: Breast Feeding; Female; Hip Fractures; Humans; Incidence; Osteoporotic Fractures
PubMed: 31948457
DOI: 10.1186/s13018-019-1541-y -
PloS One 2016Biomechanical tests are widely used in animal studies on osteoporotic fracture healing. However, the biomechanical recovery process is still unknown, leading to... (Meta-Analysis)
Meta-Analysis Review
Biomechanical tests are widely used in animal studies on osteoporotic fracture healing. However, the biomechanical recovery process is still unknown, leading to difficulty in choosing time points for biomechanical tests and in correctly assessing osteoporotic fracture healing. To determine the biomechanical recovery process during osteoporotic fracture healing, studies on osteoporotic femur fracture healing with biomechanical tests in ovariectomized rat (OVX) models were collected from PUBMED, EMBASE, and Chinese databases. Quadratic curves of fracture healing time and maximum load were fitted with data from the analyzed studies. In the fitted curve for normal fractures, the predicted maximum load was 145.56 N, and the fracture healing time was 88.0 d. In the fitted curve for osteoporotic fractures, the predicted maximum load was 122.30 N, and the fracture healing time was 95.2 d. The maximum load of fractured femurs in OVX rats was also lower than that in sham rats at day 84 post-fracture (D84 PF). The fracture healing time was prolonged and maximum load at D84 PF decreased in OVX rats with closed fractures. The maximum load of Wister rats was higher than that of Sprague-Dawley (SD) rats, but the fracture healing time of SD and Wister rats was similar. Osteoporotic fracture healing was delayed in rats that were < = 12 weeks old when ovariectomized, and at D84 PF, the maximum load of rats < = 12 weeks old at ovariectomy was lower than that of rats >12 weeks old at ovariectomy. There was no significant difference in maximum load at D84 PF between rats with an osteoporosis modeling time <12 weeks and > = 12 weeks. In conclusion, fracture healing was delayed and biomechanical property decreased by osteoporosis. Time points around D95.2 PF should be considered for biomechanical tests of osteoporotic femur fracture healing in OVX rat models. Osteoporotic fracture healing in OVX rats was affected by the fracture type but not by the strain of the rat.
Topics: Animals; Biomechanical Phenomena; Female; Femur; Fracture Healing; Osteoporotic Fractures; Ovariectomy; Rats
PubMed: 27055104
DOI: 10.1371/journal.pone.0153120 -
Journal of Cachexia, Sarcopenia and... Dec 2021Obesity is protective of bone health; however, abdominal obesity is associated with a higher fracture risk. Little is known about whether body composition protects or...
BACKGROUND
Obesity is protective of bone health; however, abdominal obesity is associated with a higher fracture risk. Little is known about whether body composition protects or adversely affects osteoporotic fractures because of practical issues regarding assessment tools. This study aimed to evaluate the association of predicted body composition with fracture risk to determine the distinctive and differing effects of muscle or fat mass on bone health outcomes in the general population.
METHODS
This population-based, longitudinal cohort study used 2009-2010 Korean National Health Insurance Service data and follow-up data from 1 January 2011 to 31 December 2013, to determine the incidence of osteoporotic fracture (total, spine, and non-spine) defined using the International Classification of Diseases, Tenth Revision codes. The study participants were aged ≥50 years (men, 158 426; women, 131 587). The predicted lean body mass index (pLBMI), appendicular skeletal muscle index (pASMI), and body fat mass index (pBFMI) were used to assess body composition, using anthropometric prediction equations.
RESULTS
Over a 3 year follow-up, we identified 2350 and 6175 fractures in men and women, respectively. The mean age of the participants was 60.2 ± 8.3 and 60.7 ± 8.4 years in men and women, respectively. In a multivariable-adjusted Cox proportional hazards regression model, increasing pLBMI or pASMI was significantly associated with a decreased risk of total fractures in men and women. When comparing individuals in the lowest pLBMI and pASMI (reference groups), men with the highest pLBMI and pASMI had adjusted hazard ratios of 0.63 [95% confidence interval (CI) 0.47-0.83] and 0.62 (95% CI 0.47-0.82), and women with the highest pLBMI and pASMI had adjusted hazard ratios of 0.72 (95% CI 0.60-0.85) and 0.71 (95% CI 0.60-0.85), respectively, for total fractures. The pBFMI had no significant association with total fractures in men or women. Regarding sex-specific or site-specific differences, the protective effects of the pLBMI and pASMI on fractures were greater in men and reduced the risk of spinal fractures. An increased pBFMI was associated with an increased risk of spinal fractures in women.
CONCLUSIONS
An increased pLBMI or pASMI was significantly associated with decreased total osteoporotic fracture risk; however, the pBFMI showed no statistically significant association. Muscle mass was more important than fat mass in preventing future osteoporotic fractures based on anthropometric prediction equations.
Topics: Aged; Body Composition; Female; Humans; Longitudinal Studies; Male; Middle Aged; Muscles; Osteoporotic Fractures; Risk Factors
PubMed: 34706399
DOI: 10.1002/jcsm.12850 -
Medicine Nov 2023Vertebral osteoporotic fracture is a common type of fracture, and the incidence is higher in the elderly. However, the relationship between vertebral osteoporotic...
Vertebral osteoporotic fracture is a common type of fracture, and the incidence is higher in the elderly. However, the relationship between vertebral osteoporotic fractures and interleukin-8 (IL-8) remains unclear. A total of 163 patients with osteoporotic vertebral fractures were recruited. Clinical and follow-up data were recorded, and the expression levels of IL1, MMP9, IL-8, and C-reactive protein in blood were measured. Pearson Chi-square test and Spearman correlation coefficient were used to analyze the relationship between vertebral osteoporotic fractures and related parameters. Univariate and multivariate logistic regression and univariate and multivariate Cox proportional hazards regression were used for further analysis. Pearson chi-square test, Spearman correlation coefficient and Logistic regression analysis showed that IL1 and IL-8 were significantly associated with vertebral osteoporotic fractures. Univariate Cox regression analysis showed that age and IL-8 expression level were significantly associated with maintenance time from recovery to recurrence of vertebral osteoporotic fractures. Multivariate Cox regression analysis showed that IL-8 expression level was significantly associated with maintenance time from recovery to recurrence of vertebral osteoporotic fractures. The higher the expression level of IL-8, the more likely it is to develop vertebral osteoporotic fracture, and the more likely it is to relapse in a short time.
Topics: Aged; Humans; Fractures, Compression; Interleukin-8; Osteoporosis; Osteoporotic Fractures; Risk Factors; Spinal Diseases; Spinal Fractures
PubMed: 37933016
DOI: 10.1097/MD.0000000000035680 -
Journal of Endocrinological... Mar 2024FRAX®, a simple-to-use fracture risk calculator, was first released in 2008 and since then has been used increasingly worldwide. By calculating the 10-year... (Review)
Review
FRAX®, a simple-to-use fracture risk calculator, was first released in 2008 and since then has been used increasingly worldwide. By calculating the 10-year probabilities of a major osteoporotic fracture and hip fracture, it assists clinicians when deciding whether further investigation, for example a bone mineral density measurement (BMD), and/or treatment is needed to prevent future fractures. In this review, we explore the literature around osteoporosis and how FRAX has changed its management. We present the characteristics of this tool and describe the use of thresholds (diagnostic and therapeutic). We also present arguments as to why screening with FRAX should be considered. FRAX has several limitations which are described in this review. This review coincides with the release of a version, FRAXplus, which addresses some of these limitations.
Topics: Humans; Osteoporosis; Osteoporotic Fractures; Bone Density; Hip Fractures; Risk Assessment
PubMed: 37874461
DOI: 10.1007/s40618-023-02219-9 -
Journal of Neurosurgical Sciences Aug 2022This review aims to search for up-to-date information on epidemiology, natural course, and preventive measures of osteoporotic spine fractures. (Review)
Review
INTRODUCTION
This review aims to search for up-to-date information on epidemiology, natural course, and preventive measures of osteoporotic spine fractures.
EVIDENCE ACQUISITION
We reviewed the literature of the last ten years using keywords "natural course and osteoporotic vertebral fractures," "epidemiology and osteoporotic vertebral fractures" and "prevention and osteoporotic vertebral fractures." We then discussed the search results to reach an agreement in two consensus meetings on January and February 2021 of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. Finally, we utilized the Delphi method to administer the questionnaire to preserve a high degree of validity. We summarized seven papers on the natural course, 15 articles on epidemiology, and 84 papers on preventing osteoporotic vertebral fractures. Finally, the consensus results after voting are presented.
EVIDENCE SYNTHESIS
Natural course of acute osteoporotic vertebral fractures is benign; many patients may have sufficient pain relief during the first three months with conservative treatment. At the end of one year of conservative treatment, 40% may still have pain with VAS-scores ≥4. Since the populations are aging, the incidence of OVF continues to rise. Although the prevalence varies across the globe, the highest rates are from North America and some countries of Asia. Preventive treatment of OVF must involve an active lifestyle, adequate nutrition, prevention of immobilization with physical therapy, and pharmacological therapy. Oral calcium and vitamin D are first-line interventions to prevent the bone mass loss, especially in postmenopausal women. There are many pharmacological treatment options; the decision must be made by fracture risk assessment (clinical factors + BMD + BMI) alone or along with DXA (dual-energy X-ray absorptiometry) or history of previous fragility fractures. The indication of one respect to the others is based on patient preference, compliance, and risk of discontinuation related to adverse events and administration method.
CONCLUSIONS
The incidence of osteoporotic vertebral fractures increases with age and other factors. The natural course shows that most patients benefit from conservative therapy without any surgical intervention during the first three months. Preventive measures must include active lifestyle, adequate nutrition, prevention of immobilization with physical therapy, oral calcium, and vitamin D intake, and pharmacological therapy after fracture risk assessment.
Topics: Calcium; Female; Humans; Osteoporotic Fractures; Pain; Spinal Fractures; Vitamin D
PubMed: 35301844
DOI: 10.23736/S0390-5616.22.05643-0 -
Women's Health (London, England) Jul 2015Osteoporosis, a well-defined and growing public health problem, is a disease characterized by increased bone turnover and decreased bone mass with associated skeletal... (Review)
Review
Osteoporosis, a well-defined and growing public health problem, is a disease characterized by increased bone turnover and decreased bone mass with associated skeletal fragility, resulting in an increased risk of fracture. It is often unrecognized until the late stages when fragility fractures have occurred. In adults, early recognition of the disease prior to the occurrence of fractures followed by timely and efficient initiation of appropriate treatment can reduce fracture risk. In this article, we review clinical modalities available to effectively predict fracture risk in patients with osteoporosis. Bone mineral density and presence of clinical risk factors may be combined to provide a more comprehensive osteoporotic fracture risk assessment. Use of FRAX may serve as a general guideline for clinical management and deciding a threshold for cost-effective pharmacological intervention. Elevated bone turnover markers are predictive of high fracture risk and can provide additional clinical information as well.
Topics: Age Factors; Aged; Aged, 80 and over; Biomarkers; Body Mass Index; Bone Density; Bone Remodeling; Comorbidity; Female; Health Behavior; Humans; Life Style; Male; Middle Aged; Osteoporotic Fractures; Risk Factors
PubMed: 26236988
DOI: 10.2217/whe.15.14