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Clinical Rheumatology May 2021Medical overuse leads to a burden on healthcare costs and potentially is harmful to patients. We wanted to address medical overuse in musculoskeletal disease and...
Medical overuse leads to a burden on healthcare costs and potentially is harmful to patients. We wanted to address medical overuse in musculoskeletal disease and rheumatology. We performed a systemic literature review from PubMed and Embase to study medical overuse. On the initial screen, 1499 studies were identified, 839 of them were related to medical overuse. Out of these, 52 were related to overuse in musculoskeletal diseases. Finally, 20 articles were chosen for this systemic review that reported overuse in rheumatology. The article identifies issues with overtesting, including the use of dual-energy X-ray absorptiometry to screen for osteoporosis in women younger than 65 years old and the use of magnetic resonance imaging to evaluate for osteoarthritis. Studies related to overtreatment reported over-prescription of vitamin D supplements resulting in vitamin D toxicity and increased risk of inappropriate prescriptions in patients with osteoarthritis and rheumatoid arthritis. Overtreating osteoporosis was reported after industry-sponsored education. Articles describing methods to reduce overuse included a study showing the reduction of unnecessary dual-energy X-ray absorptiometry scans after the introduction of the Choosing Wisely Campaign. Our findings suggest that there is some evidence that overtesting and overtreatment may be present in the field of rheumatology. This review aims to highlight this and help rheumatologists to be aware of overuse practices and provide appropriate evidence-based healthcare.
Topics: Absorptiometry, Photon; Aged; Delivery of Health Care; Female; Humans; Medical Overuse; Osteoporosis; Rheumatic Diseases; Rheumatology
PubMed: 33569709
DOI: 10.1007/s10067-021-05638-2 -
Indian Heart Journal 2023Heart Failure (HF) is emerging as a crucial factor promoting muscle wasting and dysfunction contributing to sarcopenia. This modulates disease severity and reduces...
OBJECTIVE
Heart Failure (HF) is emerging as a crucial factor promoting muscle wasting and dysfunction contributing to sarcopenia. This modulates disease severity and reduces exercise capacity and leading to poorer outcomes. Therefore, we aimed to systematically investigate the overall prevalence of sarcopenia in HF.
METHODS
An electronic search was carried out in selected databases until 21st January, 2021. Data was pooled from the included articles and represented as pooled prevalence of sarcopenia. Subgroup analysis was undertaken between methods of diagnosis of sarcopenia, gender, ejection fraction, median time point and geographical region.
RESULTS
Amongst 32,643 citations imported from selected databases, 12 articles were included in final analysis. Analysis for prevalence of sarcopenia was 34%, with prevalence rates ranging from 10.1% to 68%. Subgroup analysis revealed strong associations between Dual-energy X-ray Absorptiometry (DXA) and Asian Working Group for Sarcopenia (AWGS) (chi square = 3.24; p < 0.001), with a good level of agreement (kappa = 0.76 [95% CI: 0.70-0.82]; p < 0.001). Gender wise analysis revealed higher prevalence of sarcopenia among males (66%) than females (34%).
CONCLUSION
Sarcopenia is highly prevalent among those with HF (irrespective of type of HF) and is more commonly seen in males compared to females.
Topics: Male; Female; Humans; Sarcopenia; Muscle, Skeletal; Prevalence; Absorptiometry, Photon; Heart Failure
PubMed: 36567064
DOI: 10.1016/j.ihj.2022.12.004 -
Scientific Reports Sep 2019The association between objective measures of body composition (BC) with type 2 diabetes (T2DM) is inconclusive. We conducted a systematic review and meta-analysis to... (Meta-Analysis)
Meta-Analysis
The association between objective measures of body composition (BC) with type 2 diabetes (T2DM) is inconclusive. We conducted a systematic review and meta-analysis to examine the association between several body composition (BC) indices assessed using dual energy X-ray absorptiometry (DXA), and T2DM. Using PRISMA guidelines, we searched for observational studies investigating BC measures, including total body fat mass (BFM), visceral fat mass (VFM), subcutaneous fat mass (SFM), and fat free mass (FFM); and T2DM. Of 670 titles initially identified, 20 were included. High VFM was consistently associated with T2DM. For every kg increase in VFM, the odds of having T2DM increased by two-fold for males (OR 2.28 [95% CI 1.42 to 3.65], p = 0.001) and more than 4-fold for females (OR 4.24 [1.64 to 11.02], p = 0.003). The presence of T2DM was associated with 2-fold higher odds of low FFM (OR 2.38 [1.44 to 3.95]). We found evidence that greater VFM is a risk factor for prevalent and incident T2DM. While the presence of T2DM is associated with reduced FFM; the relationship between FFM and BFM with T2DM remains unclear. Reducing VFM and increasing FFM through lifestyle changes may reduce the risk of T2DM and mitigate its deleterious effect on BC, respectively.
Topics: Absorptiometry, Photon; Adiposity; Body Composition; Diabetes Mellitus, Type 2; Female; Humans; Male; Middle Aged; Muscles; Observational Studies as Topic; Odds Ratio; Organ Size
PubMed: 31477766
DOI: 10.1038/s41598-019-49162-5 -
Osteoporosis International : a Journal... Mar 2024This review aims to evaluate the accuracy of various mandibular radiomorphometric indices in comparison with DEXA BMD measurements in the diagnosis of osteopenia and... (Meta-Analysis)
Meta-Analysis Review
This review aims to evaluate the accuracy of various mandibular radiomorphometric indices in comparison with DEXA BMD measurements in the diagnosis of osteopenia and osteoporosis based on a meta-analysis of the sensitivity and specificity of the indices. PRISMA statement was followed. The materials for analysis were collected in August 2023 by searching three databases: PubMed Central, Web of Science, and Scopus. The selection of studies consisted of three selection stages, and 64 articles were finally obtained. Quality assessment was performed with the QUADAS-2 tool, and the general methodological quality of retrieved studies was low. Statistical analysis was performed based on 2 × 2 tables and estimated sensitivity and specificity were obtained using SROC curves. The most used indices were MCI, MCW and PMI. The best results in detecting reduced BMD obtained for MCW ≤ 3 mm, estimated sensitivity and specificity were 0.712 (95% CI, 0.477-0.870) and 0.804 (95% CI, 0.589-0.921), respectively. The most prone to the risk of bias is the MCI due to the examiner's subjectivism. Radiomorphometric indices of the mandible can be useful as a screening tool to identify patients with low BMD, but should not be used as a diagnostic method. Further research needs to focus on analysing the ability of the indices to detect osteoporosis and also in combination the indices with clinical parameters.
Topics: Humans; Bone Density; Absorptiometry, Photon; Radiography, Panoramic; Osteoporosis; Mandible
PubMed: 37870561
DOI: 10.1007/s00198-023-06949-7 -
PloS One 2023The aim of this review was to summarise the methods used to predict and assess maturity status and timing in adolescent, male, academy soccer players. A systematic... (Review)
Review
The aim of this review was to summarise the methods used to predict and assess maturity status and timing in adolescent, male, academy soccer players. A systematic search was conducted on PubMed, Scopus, Web of Science, CINAHL, Medline and SPORTDiscus. Only experimental studies including male, academy players aged U9-U18 years registered with a professional soccer club were included. The methodological quality of the included studies was assessed using guidelines from the Framework of Potential Biases. Fifteen studies fulfilled our inclusion criteria. Studies were mainly conducted in European countries (n = 12). In total, 4,707 players were recruited across all 15 studies, with an age range of 8-18 years. Five studies were longitudinal, two studies were mixed-method designs and eight studies were cross-sectional. Due to high heterogeneity within the studies, a meta-analysis was not performed. Our findings provided no equivalent estimations of adult height, skeletal age, or age at PHV. Discrepancies were evident between actual and predicted adult height and age at PHV. The Bayley-Pinneau [1952], Tanner-Whitehouse 2 [1983] and Khamis-Roche [1994] methods produced estimates of adult height within 1cm of actual adult height. For age at PHV, both Moore [2015] equations produced the closest estimates to actual age at PHV, and the Fransen [2018] equation correlated highly with actual age at PHV (>90%), even when the period between chronological age and age at PHV was large. Medical imaging techniques (e.g., Magnetic Resonance Imaging, X-Ray, Dual energy X-ray Absorptiometry) demonstrated high intra/inter-rater reliability (ICC = 0.83-0.98) for skeletal maturity assessments. The poor concordance between invasive and non-invasive methods, is a warning to practitioners to not use these methods interchangeably for assessing maturational status and timing in academy soccer players. Further research with improved study designs is required to validate these results and improve our understanding of these methods when applied in this target population.
Topics: Adolescent; Humans; Adult; Male; Aged; Child; Reproducibility of Results; Soccer; Research Design; Absorptiometry, Photon; Academies and Institutes
PubMed: 37682962
DOI: 10.1371/journal.pone.0286768 -
Bone Feb 2024To determine the effects of high velocity resistance training (HVRT) on bone mineral density (BMD) in older adults. (Review)
Review
OBJECTIVE
To determine the effects of high velocity resistance training (HVRT) on bone mineral density (BMD) in older adults.
METHODS
A systematic review was conducted using five databases. Records were screened by two independent reviewers.
INCLUSION CRITERIA
adults ≥50 years old, HVRT defined as rapid concentric and slow eccentric phase against an external load, control group and/or other intervention group, BMD measured using dual X-ray absorptiometry, and ≥6 months.
RESULTS
25 studies met the inclusion criteria. 12 were original intervention studies (8 RCTs) with n = 1203 people. 13 papers were follow up studies of these original interventions. Heterogeneity of studies meant no meta-analysis was performed. Moderate evidence suggests a small statistically significant effect of HVRT on BMD in older adults at the lumbar spine, total hip, and femoral neck ranging from 0.9 % to 5.4 %. BMD measurements significantly decreased post-intervention in follow-up studies where the interventions had ceased. Dose-response of HVRT was shown to positively impact BMD when ≥2 sessions per week are completed.
CONCLUSIONS
HVRT plays a role in increasing BMD of the lumbar spine, femoral neck, and total hip. Doses of higher intensity exercise performed ≥2 sessions per week will yield the most skeletal benefits, and if exercise is stopped for >6 months, benefits achieved may be lost.
Topics: Humans; Aged; Middle Aged; Bone Density; Resistance Training; Absorptiometry, Photon; Femur Neck; Lumbar Vertebrae
PubMed: 38070720
DOI: 10.1016/j.bone.2023.116986 -
Dento Maxillo Facial Radiology Feb 2020A systematic review and meta-analysis of diagnostic test accuracy studies was conducted to assess if the radiomorphometric indexes observed in panoramic radiographies... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
A systematic review and meta-analysis of diagnostic test accuracy studies was conducted to assess if the radiomorphometric indexes observed in panoramic radiographies could estimate reduced bone mineral density (BMD) similarly to standard technique the bone densitometry (dual energy X-ray absorptiometry) in females older than 30 years.
METHODS
A systematic search in four databases was conducted until January 2019. Two evaluators performed data extraction and evaluation of risk of bias independently, and agreement was achieved by consensus. Data were synthesized on a subgroup meta-analysis with a random effect model and the hierarchical summary receiver-operating characteristic curve was used to calculate pooled estimates of studies.
RESULTS
Thirty three studies were included and 12 different radiomorphometric indexes identified, including Mandibular Cortical Index (MCI). The final number of cases pooled for the analysis was 5266 females.The MCI for BMD loss (osteopenia) presented values of sensitivity 0.81 [95% confidence interval (CI), 0.78-0.84] and specificity 0.48 (95% CI, 0.45-0.50), while for osteoporosis sensitivity 0.35 (95% CI, 0.30-0.40) and specificity 0.88 (95% CI, 0.86-0.90). The mandibular cortical width presented values of sensitivity 0.58 (95% CI, 0.40-0.73), specificity 0.73 (95% CI, 0.60-0.83) for osteopenia, while for osteoporosis sensitivity 0.57 (95% CI, 0.36-0.76) and specificity 0.83 (95% CI, 0.68-0.92). Due to the high sensitivity, MCI presented a potential value as a screening tool for initial BMD loss (osteopenia), once tests presenting high sensitivity are described as rarely missing subjects with the disease. To the other hand, MCI to osteoporosis and Mandibular Cortical Width for both conditions are not recommended because presented specificity higher than sensitivity.
CONCLUSION
The MCI can be recommended as a feasible tool to screen initial BMD loss (osteopenia) in females above 30 years old using panoramic radiography exams.
Topics: Absorptiometry, Photon; Adult; Bone Density; Bone Diseases, Metabolic; Female; Humans; Mandible; Osteoporosis; Radiography, Panoramic
PubMed: 31596133
DOI: 10.1259/dmfr.20190149 -
Annals of Physical and Rehabilitation... May 2021Poor nutritional status is a problem in a high number of children with cerebral palsy (CP) and impairs their well-being. Therefore, periodic assessment of nutritional... (Review)
Review
BACKGROUND
Poor nutritional status is a problem in a high number of children with cerebral palsy (CP) and impairs their well-being. Therefore, periodic assessment of nutritional status and especially body composition is essential. However, we lack consensus on the best method to assess body composition in clinical practice.
OBJECTIVE
We aimed to systematically review the available evidence on the criterion validity of equation-based skinfold measurement and bioelectrical impedance analysis (BIA) to estimate body composition in children with CP.
METHODS
In a systematic review (MEDLINE, Cochrane Library and EMBASE), we identified studies that reported on the agreement between the estimation of body composition by equations of skinfold thickness or impedance values of BIA with a gold standard (isotope techniques or dual-energy-X-ray-absorptiometry [DXA]) in children with CP. We included only studies that provided correlations or agreement between estimations of body compartments (e.g., percentage body fat [%BF] or fat mass). Limits of agreement of 2.5%BF points were considered acceptable. Study quality was assessed by using the Quality Assessment of Diagnostic Accuracy Studies 2.
RESULTS
We included reports of 9 studies describing 3 skinfold equations and 4 equations to estimate body composition with BIA. Neither skinfold equations nor BIA could be reliably used to assess body composition in an individual child with CP at one point in time. On a population level, the Gurka skinfold equation was valid in ambulant children with CP, and the Kushner and Fjeld BIA equations were valid in a heterogeneous group of children with CP. Conclusions The future role of skinfold equations and BIA to assess and monitor body composition in an individual child with CP needs to be further investigated.
Topics: Absorptiometry, Photon; Body Composition; Cerebral Palsy; Child; Electric Impedance; Humans; Reproducibility of Results; Skinfold Thickness
PubMed: 31158551
DOI: 10.1016/j.rehab.2019.05.003 -
PloS One 2020Imaging for osteoporosis has two major aims, first, to identify the presence of low bone mass (osteopenia), and second, to quantify bone mass using semiquantitative...
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.
Topics: Absorptiometry, Photon; Bone Density; Bone Diseases, Metabolic; Child, Preschool; Female; Humans; Infant; Male; Osteoporosis; Reference Standards
PubMed: 33137162
DOI: 10.1371/journal.pone.0241635 -
Osteoporosis International : a Journal... Jan 2021The fragility fracture discriminative ability of radius quantitative ultrasound (QUS) was evaluated in a systematic review of 13 studies, including 16,681 individuals... (Meta-Analysis)
Meta-Analysis
The fragility fracture discriminative ability of radius quantitative ultrasound (QUS) was evaluated in a systematic review of 13 studies, including 16,681 individuals and 1296 fractures. The radial speed of sound (SOS) per standard deviation (SD) decrease contributed to an increased risk of total and hip fracture by 32% and 66% in women. Osteoporotic fracture, as a devastating consequence of osteoporosis, brings severe socio-economic burden. The availability of dual-energy X-ray absorptiometry (DXA), as the gold standard of diagnosis, was quite limited in remote areas. Radius QUS measured by SOS shows potential in fracture discriminative ability where DXA equipment is not available. This study aimed to provide a comprehensive evaluation of the association between radius QUS and fracture risk. A detailed article search was carried out on PubMed, EMBASE, Cochrane Libraries, CNKI, Wan-Fang database, VIP, and SinoMed for studies published between January 1980 and February 2020. We determined the estimated relative risk (RR) for fracture per each radial SOS SD decrease. A meta-analysis of studies was performed under the random-effects model. A total of 16,681 individuals were included in this review. Among the participants, 5892 were male and 10,789 were female. A total of 1296 cases of fragility fracture were included. With each SD decrease in radial SOS, the risk of overall fragility fracture and hip fracture was increased by 21% and 55%, respectively. Particularly, the risk was increased by 32% and 66% for women. The association was even stronger for postmenopausal women. Radius QUS showed great potential as an effective tool for fracture risk evaluation, especially for women.
Topics: Absorptiometry, Photon; Bone Density; Case-Control Studies; Cohort Studies; Female; Humans; Male; Osteoporosis, Postmenopausal; Radius; Ultrasonography
PubMed: 32728897
DOI: 10.1007/s00198-020-05559-x