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Journal of Orthopaedic Surgery and... Jul 2023Prevalence information is the first step in developing preventive procedures or health services. This study was conducted to systematically evaluate the epidemiology of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Prevalence information is the first step in developing preventive procedures or health services. This study was conducted to systematically evaluate the epidemiology of osteoporotic fractures in Chinese elderly aged ≥ 60 years and to provide evidence-based evidence for the prevention and treatment of osteoporotic fractures.
METHODS
We identified relevant studies by searching the literature published in PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Data, and VIP databases from the establishment of the database until August 2022. We used a random-effects model to obtain prevalence estimates and identified sources of heterogeneity and comparisons of prevalence among different groups through subgroup analysis and sensitivity analysis.
RESULTS
A total of 29 articles were included in this study, and the prevalence of osteoporosis fractures in elderly Chinese was high (18.9%). The prevalence has increased significantly over the past decade (from 13.2% in 2000-2010 to 22.7% in 2012-2022). The prevalence of osteoporosis is higher in women than in men (18.5% vs 14.3%) and increases with age. The northern region was higher than the southern region (20.3% vs 18.9%), and the spine, hip, and distal forearm were the most common sites of fracture.
CONCLUSION
The prevalence of osteoporotic fractures in the Chinese elderly is 18.9%, and timely prevention and treatment are necessary.
Topics: Aged; Male; Humans; Female; Osteoporotic Fractures; Prevalence; Osteoporosis; China; Spine
PubMed: 37501170
DOI: 10.1186/s13018-023-04030-x -
Frontiers in Endocrinology 2023Circulating adipokines and ghrelin affect bone remodeling by regulating the activation and differentiation of osteoblasts and osteoclasts. Although the correlation... (Meta-Analysis)
Meta-Analysis
CONTEXT
Circulating adipokines and ghrelin affect bone remodeling by regulating the activation and differentiation of osteoblasts and osteoclasts. Although the correlation between adipokines, ghrelin, and bone mineral density (BMD) has been studied over the decades, its correlations are still controversial. Accordingly, an updated meta-analysis with new findings is needed.
OBJECTIVE
This study aimed to explore the impact of serum adipokine and ghrelin levels on BMD and osteoporotic fractures through a meta-analysis.
DATA SOURCES
Studies published till October 2020 in Medline, Embase, and the Cochrane Library were reviewed.
STUDY SELECTION
We included studies that measured at least one serum adipokine level and BMD or fracture risk in healthy individuals. We excluded studies with one or more of the following: patients less than 18 years old, patients with comorbidities, who had undergone metabolic treatment, obese patients, patients with high physical activities, and a study that did not distinguish sex or menopausal status.
DATA EXTRACTION
We extracted the data that include the correlation coefficient between adipokines (leptin, adiponectin, and resistin) and ghrelin and BMD, fracture risk by osteoporotic status from eligible studies.
DATA SYNTHESIS
A meta-analysis of the pooled correlations between adipokines and BMD was performed, demonstrating that the correlation between leptin and BMD was prominent in postmenopausal women. In most cases, adiponectin levels were inversely correlated with BMD. A meta-analysis was conducted by pooling the mean differences in adipokine levels according to the osteoporotic status. In postmenopausal women, significantly lower leptin (SMD = -0.88) and higher adiponectin (SMD = 0.94) levels were seen in the osteoporosis group than in the control group. By predicting fracture risk, higher leptin levels were associated with lower fracture risk (HR = 0.68), whereas higher adiponectin levels were associated with an increased fracture risk in men (HR = 1.94) and incident vertebral fracture in postmenopausal women (HR = 1.18).
CONCLUSIONS
Serum adipokines levels can utilize to predict osteoporotic status and fracture risk of patients.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021224855, identifier CRD42021224855.
Topics: Male; Humans; Female; Adolescent; Bone Density; Leptin; Adipokines; Adiponectin; Ghrelin; Osteoporotic Fractures
PubMed: 37181034
DOI: 10.3389/fendo.2023.1044039 -
Osteoporosis International : a Journal... Feb 2021Methotrexate (MTX)-related osteopathy is rare, defined by the triad of pain, osteoporosis, and "atypical fractures" when it was first described in the 1970s in children... (Review)
Review
INTRODUCTION
Methotrexate (MTX)-related osteopathy is rare, defined by the triad of pain, osteoporosis, and "atypical fractures" when it was first described in the 1970s in children treated with high doses MTX for acute leukemia. Since then, several cases have been reported in patients treated with low-dose MTX for inflammatory diseases.
METHODS
A systematic research of cases of MTX-related osteopathy was performed in records of Rheumatology Department of Rennes University Hospital. Data collection focused on demographic data, corticosteroid doses, MTX doses and intake method, cumulative doses, year of diagnosis, fracture location, bone densitometry value, and osteoporosis treatment if necessary. A literature review was also conducted to identify other cases in literature and try to understand the pathophysiological mechanisms of this rare entity.
RESULTS
We report 5 cases identified between 2011 and 2019, which represents the largest cohort described excluding oncology cases. Fracture locations were atypical for osteoporotic fractures. All patients improved in the following months with MTX withdrawal. All patients except one were treated with antiresorptives (bisphosphonates, denosumab). Two patients, treated with bisphosphonates, had a recurrence of fracture, once again of atypical location. Twenty-five cases were collected in literature with similar clinical presentation. The cellular studies that investigated the bone toxicity of MTX mainly showed a decrease in the number of osteoblasts, osteocytes, and chondrocytes in the growth plate and an increase in the number and activity of osteoclasts. In vitro, consequences of mechanical stimulation on human trabecular bone cells in the presence of MTX showed an alteration in mechano-transduction, with membrane hyperpolarization, acting on the integrin pathway. In contrast with our report, the cases described in the literature were not consistently associated with a decrease in bone mineral density (BMD).
CONCLUSION
MTX osteopathy while rare must be known by the rheumatologist, especially when using this treatment for inflammatory conditions. The mechanisms are still poorly understood, raising the question of a possible remnant effect of MTX on osteo-forming bone cells, potentially dose-dependent. Methotrexate (MTX) osteopathy, described as a clinical triad, pain, osteoporosis, and atypical stress fractures, while rare, must be known by the rheumatologist. Our cohort of 5 cases represent the largest series of the literature. Pathophysiological studies raised the question of a dose-dependent remnant effect of MTX on osteo-forming bone cells.
Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Bone Density; Bone Diseases; Child; Humans; Methotrexate; Osteoporosis
PubMed: 33128074
DOI: 10.1007/s00198-020-05664-x -
Journal of the American Board of Family... Feb 2023There are multiple classes of pharmacologic agents approved for treatment of osteoporosis, but their costs vary widely, and systematic data on their efficacy compared... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There are multiple classes of pharmacologic agents approved for treatment of osteoporosis, but their costs vary widely, and systematic data on their efficacy compared with the traditional standard, bisphosphonates, for reducing fractures in postmenopausal women are lacking. The objective was to perform a systematic review and meta-analysis assessing the efficacy of denosumab compared with bisphosphonates.
METHODS
Researchers selected randomized controlled trials (RCTs) comparing denosumab to bisphosphonates that included information on clinical and/or osteoporotic fracture events over the follow-up period. Each clinical outcome was meta-analyzed using a fixed-effects analysis, with clinical and osteoporotic fractures as the outcomes of interest. A meta-regression was performed using change in bone mineral density (BMD) as the moderator variable.
RESULTS
Seven RCTs were included. Denosumab was not associated with a reduction in clinical or osteoporotic fractures compared with bisphosphonates. There was no association between the change in BMD with denosumab and bisphosphonates and denosumab's effect on both osteoporotic and clinical fractures.
DISCUSSION
Existing data do not support the use of the more expensive denosumab as a first-line agent over bisphosphonates for reduction of fractures in postmenopausal women with osteoporosis. One limitation in this study was each RCT was not individually powered for fracture incidences.
Topics: Female; Humans; Diphosphonates; Osteoporotic Fractures; Bone Density Conservation Agents; Postmenopause; Osteoporosis, Postmenopausal; Osteoporosis; Bone Density
PubMed: 36653115
DOI: 10.3122/jabfm.2022.220099R1 -
Pain Physician Sep 2021The management of pain after osteoporotic thoracolumbar burst fracture has not reached a treatment consensus. Percutaneous kyphoplasty has been shown to be efficient in...
BACKGROUND
The management of pain after osteoporotic thoracolumbar burst fracture has not reached a treatment consensus. Percutaneous kyphoplasty has been shown to be efficient in reducing acute pain after burst fracture, although the topic remains highly controversial in this field.
OBJECTIVE
This study aimed to conduct a systematic review of the current literature to evaluate the effectiveness and safety of percutaneous kyphoplasty on the treatment of osteoporotic thoracolumbar burst fracture.
STUDY DESIGN
A systematic review.
SETTING
University hospital.
METHODS
A comprehensive literature search was performed through PubMed, EMBASE, Web of Science, and Cochrane library without time restriction. Among the studies meeting the eligible criteria, any study in which percutaneous kyphoplasty was utilized alone in the treatment of osteoporotic thoracolumbar burst fracture was included in the current review. For radiographic outcome evaluation, vertebral height and kyphotic angle were analyzed. VAS (Visual Analog Scale) and ODI (Oswestry Disability Index) were utilized for clinical outcome evaluation. Complications such as cement leakage and adjacent vertebral fracture or relapse were also analyzed.
RESULTS
In total, 289 patients (338 vertebral bodies) were included in the 8 studies. Clinical outcomes indicated that patients achieved pain relief (VAS) from 6.8 preoperatively to 1.1 postoperatively, and improvement of quality of life (ODI) ranged from 87.0 ± 6.0% to 23.9 ± 4.4%. The radiological outcome indicated that anterior vertebral height restoration ranged from 20.1 ± 2.3 to 85.3 ± 10.6, and posterior vertebral height restoration ranged from 27.3 ± 1.7 to 83.3 ± 7.4. Kyphotic angle achieved correction ranged from 21.7 ± 7.8° preoperatively to 3.17° postoperatively. The main complications after PKP were cement leakage and adjacent vertebral fracture or relapse, which had an incidence of 7.7% -45.4% and 4.3% -74.1%, respectively.
LIMITATIONS
Due to the good quality of the English publications, only English-language research searches were conducted, but they do not unduly affect our aggregate results impact. More prospective randomized controlled trials are needed to provide higher evidence for clinical practice.
CONCLUSIONS
To osteoporotic thoracolumbar burst fracture is absolutely not a contraindication to percutaneous kyphoplasty. Percutaneous kyphoplasty can obtain satisfactory effectiveness for the treatment of osteoporotic thoracolumbar burst fractures. Complications can be effectively decreased by meticulous evaluation, careful manipulation, and appropriate precautionary measures.
Topics: Bone Cements; Contraindications; Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Prospective Studies; Quality of Life; Retrospective Studies; Spinal Fractures; Treatment Outcome
PubMed: 34554685
DOI: No ID Found -
Aging and Disease Jul 2022Osteoporotic fractures (OF) are a global public health problem currently. Many risk prediction models for OF have been developed, but their performance and... (Review)
Review
Osteoporotic fractures (OF) are a global public health problem currently. Many risk prediction models for OF have been developed, but their performance and methodological quality are unclear. We conducted this systematic review to summarize and critically appraise the OF risk prediction models. Three databases were searched until April 2021. Studies developing or validating multivariable models for OF risk prediction were considered eligible. Used the prediction model risk of bias assessment tool to appraise the risk of bias and applicability of included models. All results were narratively summarized and described. A total of 68 studies describing 70 newly developed prediction models and 138 external validations were included. Most models were explicitly developed (n=31, 44%) and validated (n=76, 55%) only for female. Only 22 developed models (31%) were externally validated. The most validated tool was Fracture Risk Assessment Tool. Overall, only a few models showed outstanding (n=3, 1%) or excellent (n=32, 15%) prediction discrimination. Calibration of developed models (n=25, 36%) or external validation models (n=33, 24%) were rarely assessed. No model was rated as low risk of bias, mostly because of an insufficient number of cases and inappropriate assessment of calibration. There are a certain number of OF risk prediction models. However, few models have been thoroughly internally validated or externally validated (with calibration being unassessed for most of the models), and all models showed methodological shortcomings. Instead of developing completely new models, future research is suggested to validate, improve, and analyze the impact of existing models.
PubMed: 35855348
DOI: 10.14336/AD.2021.1206 -
Pain Physician May 2023Percutaneous balloon kyphoplasty (PKP) is widely used to treat osteoporotic vertebral compression fractures (OVCFs). In addition to rapid and effective pain relief, the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Percutaneous balloon kyphoplasty (PKP) is widely used to treat osteoporotic vertebral compression fractures (OVCFs). In addition to rapid and effective pain relief, the ability to recover the lost height of fractured vertebral bodies and reduce the risk for complications are believed to be the main advantages of this procedure. However, there is no consensus on the appropriate surgical timing for PKP.
OBJECTIVES
This study systematically evaluated the relationship between the surgical timing of PKP and clinical outcomes to provide more evidence for clinicians to choose the intervention timing.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
The PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched for relevant randomized controlled trials and prospective, and retrospective cohort trials published up to November 13, 2022. All included studies explored the influence of PKP intervention timing for OVCFs. Data regarding clinical and radiographic outcomes and complications were extracted and analyzed.
RESULTS
Thirteen studies involving 930 patients with symptomatic OVCFs were included. Most patients with symptomatic OVCFs achieved rapid and effective pain relief after PKP. In comparison to delayed PKP intervention, early PKP intervention was associated with similar or better outcomes in terms of pain relief, improvement of function, restoration of vertebral height, and correction of kyphosis deformity. The meta-analysis results showed there was no significant difference in cement leakage rate between early PKP and late PKP (odds ratio [OR] = 1.60, 95% CI, 0.97-2.64, P = 0.07), whereas delayed PKP had a higher risk for adjacent vertebral fractures (AVFs) than early PKP (OR = 0.31, 95% CI: 0.13-0.76, P = 0.01).
LIMITATIONS
The number of included studies was small, and the overall quality of the evidence was very low.
CONCLUSIONS
PKP is an effective treatment for symptomatic OVCFs. Early PKP may achieve similar or better clinical and radiographic outcomes for treating OVCFs than delayed PKP. Furthermore, early PKP intervention had a lower incidence of AVFs and a similar rate of cement leakage compared with delayed PKP. Based on current evidence, early PKP intervention might be more beneficial to patients.
Topics: Humans; Kyphoplasty; Fractures, Compression; Spinal Fractures; Retrospective Studies; Prospective Studies; Osteoporotic Fractures; Treatment Outcome; Bone Cements; Pain
PubMed: 37192225
DOI: No ID Found -
Journal of Clinical Orthopaedics and... Apr 2021Cement augmentation of internal fixation of hip fracture has reported to improve fracture stability in osteoporotic hip fractures, reducing the risk of cut-out of the... (Review)
Review
BACKGROUND
Cement augmentation of internal fixation of hip fracture has reported to improve fracture stability in osteoporotic hip fractures, reducing the risk of cut-out of the sliding screw through the femoral head. The purpose of present study was to perform a systematic literature review on the effects of augmentation technique in patients with osteoporotic hip fractures.
MATERIAL AND METHODS
A comprehensive literature search was systematically performed to evaluate all papers published in English language included in the literature between January 2010 and July 2020, according to the PRISMA 2009 guidelines. In vivo and in vitro studies, case reports, review articles, cadaveric studies, biomechanical studies, histological studies, oncological studies, technical notes, studies dealing with radiological classifications and studies on revision surgery were excluded.
RESULTS
A total of 5 studies involving 301 patients were included. Patients had a mean age of 84.6 years and were followed up for a mean period of 11 months. The proximal femoral fractures were stabilized with implantation of the PFNA or Gamma nail and augmentation was performed with two different cements: polymethylmethacrylate (PMMA) in 4 studies and calcium phosphate (CP) in one study. Overall, 57.5% of patients reached the same or greater preoperative mobility, and postoperative Parker Mobility Score and Harris Hip Score were acceptable. No significantly complications were observed, and no additional surgery related to the implant was required.
CONCLUSION
The results of this systematic review show that cement augmentation is a safe and effectiveness method of fixation to treat trochanteric fractures
PubMed: 33717919
DOI: 10.1016/j.jcot.2020.10.034 -
BMJ Open Dec 2023Early identification of fracture risk in patients with osteoporosis is essential. Machine learning (ML) has emerged as a promising technique to predict the risk, whereas... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Early identification of fracture risk in patients with osteoporosis is essential. Machine learning (ML) has emerged as a promising technique to predict the risk, whereas its predictive performance remains controversial. Therefore, we conducted this systematic review and meta-analysis to explore the predictive efficiency of ML for the risk of fracture in patients with osteoporosis.
METHODS
Relevant studies were retrieved from four databases (PubMed, Embase, Cochrane Library and Web of Science) until 31 May 2023. A meta-analysis of the C-index was performed using a random-effects model, while a bivariate mixed-effects model was used for the meta-analysis of sensitivity and specificity. In addition, subgroup analysis was performed according to the types of ML models and fracture sites.
RESULTS
Fifty-three studies were included in our meta-analysis, involving 15 209 268 patients, 86 prediction models specifically developed for the osteoporosis population and 41 validation sets. The most commonly used predictors in these models encompassed age, BMI, past fracture history, bone mineral density T-score, history of falls, BMD, radiomics data, weight, height, gender and other chronic diseases. Overall, the pooled C-index of ML was 0.75 (95% CI: 0.72, 0.78) and 0.75 (95% CI: 0.71, 0.78) in the training set and validation set, respectively; the pooled sensitivity was 0.79 (95% CI: 0.72, 0.84) and 0.76 (95% CI: 0.80, 0.81) in the training set and validation set, respectively; and the pooled specificity was 0.81 (95% CI: 0.75, 0.86) and 0.83 (95% CI: 0.72, 0.90) in the training set and validation set, respectively.
CONCLUSIONS
ML has a favourable predictive performance for fracture risk in patients with osteoporosis. However, most current studies lack external validation. Thus, external validation is required to verify the reliability of ML models.
PROSPERO REGISTRATION NUMBER
CRD42022346896.
Topics: Humans; Bone Density; Reproducibility of Results; Osteoporosis; Osteoporotic Fractures; Risk Assessment
PubMed: 38070927
DOI: 10.1136/bmjopen-2022-071430 -
Clinical Nutrition (Edinburgh, Scotland) Jul 2023Chronic pancreatitis results in irreversible pancreatic dysfunction and malnutrition which, alongside excess alcohol intake, can increase the risk of low bone density.... (Meta-Analysis)
Meta-Analysis
BACKGROUND & AIMS
Chronic pancreatitis results in irreversible pancreatic dysfunction and malnutrition which, alongside excess alcohol intake, can increase the risk of low bone density. Osteoporosis increases the risk of fractures and chronic bone pain, reduces quality of life, and poses considerable costs to healthcare. Despite this, there remains a paucity of literature evaluating bone health in this patient population. This systematic review and meta-analysis evaluated the prevalences of osteopaenia, osteoporosis and fractures in patients with chronic pancreatitis.
METHODS
A comprehensive search of Medline, Embase, ClinicalTrials.gov, and CENTRAL databases was undertaken to identify eligible studies from January 2000 to May 2022. The prevalences of osteopenia, osteoporosis and fragility fractures were extracted from the included studies. Where available, a subgroup analysis was performed to compare the likelihood of developing osteoporosis in patients with chronic pancreatitis compared with control.
RESULTS
Nineteen studies reporting on 2,027,764 participants (20,460 with chronic pancreatitis and 2,007,304 controls) were included. The pooled prevalence of osteoporosis was 19% (95% CI 13 to 26%; I = 94%). Patients with chronic pancreatitis were more likely to have osteoporosis when compared with those in the control group (OR 2.80, 95% CI 1.86 to 4.21; I = 21%). The prevalences of osteopaenia and fractures in patients with chronic pancreatitis were 37% (95% CI 31 to 44%; I = 81%) and 14% (95% CI 7 to 22%; I = 99%) respectively.
CONCLUSION
The prevalences of osteopenia and osteoporosis are significant in patients with chronic pancreatitis and can increase the risk of developing fractures. Further population-based studies are required to evaluate the disease burden of osteoporotic fractures and associated morbidity and mortality in chronic pancreatitis.
Topics: Humans; Osteoporotic Fractures; Quality of Life; Bone Density; Osteoporosis; Bone Diseases, Metabolic; Pancreatitis, Chronic
PubMed: 37271708
DOI: 10.1016/j.clnu.2023.05.019