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Diagnostics (Basel, Switzerland) Apr 2021Although frequently silent, mineral and bone disease (MBD) is one of the most precocious complication of chronic kidney disease (CKD) and is omnipresent in patients with... (Review)
Review
Although frequently silent, mineral and bone disease (MBD) is one of the most precocious complication of chronic kidney disease (CKD) and is omnipresent in patients with CKD stage 5. Its pathophysiology is complex, but basically, disturbances in vitamin D, phosphate, and calcium metabolism lead to a diverse range of clinical manifestations with secondary hyperparathyroidism usually being the most frequent. With the decline in renal function, CKD-MBD may induce microstructural changes in bone, vascular system and soft tissues, which results in macrostructural lesions, such as low bone mineral density (BMD) resulting in skeletal fractures, vascular and soft tissue calcifications. Moreover, low BMD, fractures, and vascular calcifications are linked with increased risk of cardiovascular mortality and all-cause mortality. Therefore, a better characterization of CKD-MBD patterns, beyond biochemical markers, is helpful to adapt therapies and monitor strategies as used in the general population. An in-depth characterization of bone health is required, which includes an evaluation of cortical and trabecular bone structure and density and the degree of bone remodeling through bone biomarkers. Standard radiological imaging is generally used for the diagnosis of fracture or pseudo-fractures, vascular calcifications and other features of CKD-MBD. However, bone fractures can also be diagnosed using computed tomography (CT) scan, magnetic resonance (MR) imaging and vertebral fracture assessment (VFA). Fracture risk can be predicted by bone densitometry using dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QTC) and peripheral quantitative computed tomography (pQTC), quantitative ultrasound (QUS) and most recently magnetic resonance micro-imaging. Quantitative methods to assess bone consistency and strength complete the study and adjust the clinical management when integrated with clinical factors. The aim of this review is to provide a brief and comprehensive update of imaging techniques available for the diagnosis, prevention, treatment and monitoring of CKD-MBD.
PubMed: 33925796
DOI: 10.3390/diagnostics11050772 -
Osteoporosis International : a Journal... Oct 2004Fragility fractures are a strong indicator of underlying osteoporosis (OP). With the risk of future fracture being increased 1.5- to 9.5-fold following a fragility... (Review)
Review
Fragility fractures are a strong indicator of underlying osteoporosis (OP). With the risk of future fracture being increased 1.5- to 9.5-fold following a fragility fracture, the diagnosis and treatment of OP in men and women with fragility fractures provides the opportunity to prevent future fragility fractures. This review describes the current status of practice in investigation and diagnosis of OP in men and women with fragility fractures, the rates and types of postfracture treatment in patients with fragility fractures and OP, interventions undertaken in this population, and the barriers to OP identification and treatment. A literature search performed in Medline, Healthstar, CINAHL, EMBASE, PreMedline, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews identified 37 studies on OP diagnosis, treatment, and interventions. The studies varied in design methodology, study facilities, types of fractures, and pharmacological treatments. Some studies revealed that no patients with fragility fractures received investigation or treatment for underlying OP. Investigation of OP by bone mineral density was low: 14 of 16 studies reported investigation of less than 32% of patients. Investigation by bone mineral density resulted in high rates of OP diagnosis (35-100%), but only moderate use of calcium and vitamin D (8-62%, median 18%) and bisphosphates (0.5-38%) in patients investigated postfracture. Studies on barriers to OP identification and treatment focused on various groups of health practitioners. Barriers included the cost of therapies, time and cost of resources for diagnosis, concerns about medications, and the lack of clarity regarding the responsibility to undertake this care.
Topics: Absorptiometry, Photon; Bone Density; Calcium; Diphosphonates; Female; Fractures, Bone; Humans; Male; Osteoporosis; Practice Patterns, Physicians'; Research Design; Vitamin D
PubMed: 15258724
DOI: 10.1007/s00198-004-1675-5 -
JAMA Jun 2018Osteoporotic fractures cause significant morbidity and mortality. (Review)
Review
IMPORTANCE
Osteoporotic fractures cause significant morbidity and mortality.
OBJECTIVE
To update the evidence on screening and treatment to prevent osteoporotic fractures for the US Preventive Services Task Force.
DATA SOURCES
PubMed, the Cochrane Library, EMBASE, and trial registries (November 1, 2009, through October 1, 2016) and surveillance of the literature (through March 23, 2018); bibliographies from articles.
STUDY SELECTION
Adults 40 years and older; screening cohorts without prevalent low-trauma fractures or treatment cohorts with increased fracture risk; studies assessing screening, bone measurement tests or clinical risk assessments, pharmacologic treatment.
DATA EXTRACTION AND SYNTHESIS
Dual, independent review of titles/abstracts and full-text articles; study quality rating; random-effects meta-analysis.
MAIN OUTCOMES AND MEASURES
Incident fractures and related morbidity and mortality, diagnostic and predictive accuracy, harms of screening or treatment.
RESULTS
One hundred sixty-eight fair- or good-quality articles were included. One randomized clinical trial (RCT) (n = 12 483) comparing screening with no screening reported fewer hip fractures (2.6% vs 3.5%; hazard ratio [HR], 0.72 [95% CI, 0.59-0.89]) but no other statistically significant benefits or harms. The accuracy of bone measurement tests to identify osteoporosis varied (area under the curve [AUC], 0.32-0.89). The pooled accuracy of clinical risk assessments for identifying osteoporosis ranged from AUC of 0.65 to 0.76 in women and from 0.76 to 0.80 in men; the accuracy for predicting fractures was similar. For women, bisphosphonates, parathyroid hormone, raloxifene, and denosumab were associated with a lower risk of vertebral fractures (9 trials [n = 23 690]; relative risks [RRs] from 0.32-0.64). Bisphosphonates (8 RCTs [n = 16 438]; pooled RR, 0.84 [95% CI, 0.76-0.92]) and denosumab (1 RCT [n = 7868]; RR, 0.80 [95% CI, 0.67-0.95]) were associated with a lower risk of nonvertebral fractures. Denosumab reduced the risk of hip fracture (1 RCT [n = 7868]; RR, 0.60 [95% CI, 0.37-0.97]), but bisphosphonates did not have a statistically significant association (3 RCTs [n = 8988]; pooled RR, 0.70 [95% CI, 0.44-1.11]). Evidence was limited for men: zoledronic acid reduced the risk of radiographic vertebral fractures (1 RCT [n = 1199]; RR, 0.33 [95% CI, 0.16-0.70]); no studies demonstrated reductions in clinical or hip fractures. Bisphosphonates were not consistently associated with reported harms other than deep vein thrombosis (raloxifene vs placebo; 3 RCTs [n = 5839]; RR, 2.14 [95% CI, 0.99-4.66]).
CONCLUSIONS AND RELEVANCE
In women, screening to prevent osteoporotic fractures may reduce hip fractures, and treatment reduced the risk of vertebral and nonvertebral fractures; there was not consistent evidence of treatment harms. The accuracy of bone measurement tests or clinical risk assessments for identifying osteoporosis or predicting fractures varied from very poor to good.
Topics: Absorptiometry, Photon; Adult; Aged; Aged, 80 and over; Area Under Curve; Bone Density Conservation Agents; Diphosphonates; Female; Humans; Male; Mass Screening; Middle Aged; Osteoporosis; Osteoporotic Fractures; Postmenopause; Risk Assessment
PubMed: 29946734
DOI: 10.1001/jama.2018.6537 -
Osteoporosis International : a Journal... May 2016This systematic review was performed to compare the diagnostic accuracy of vertebral fracture assessment (VFA) with that of spinal radiography for identification of... (Comparative Study)
Comparative Study Review
UNLABELLED
This systematic review was performed to compare the diagnostic accuracy of vertebral fracture assessment (VFA) with that of spinal radiography for identification of vertebral fractures (VFs). VFA appeared to have moderate sensitivity and high specificity for detecting VFs when compared with spinal radiography.
INTRODUCTION
VFs are recognized as the hallmark of osteoporosis, and a previous VF increases the risk of a future fracture. Therefore, the timely detection of VFs is important for prevention of further fractures. This systematic review examined the diagnostic accuracy of VFA using dual X-ray absorptiometry (DXA) to identify VFs.
METHODS
We searched for potentially relevant studies using electronic databases, including Ovid-Medline, Ovid-EMBASE, Cochrane library, and four Korean databases, from their inception to May 2013. We compared the diagnostic accuracy of VFA with that of spinal radiography for detection of VFs by analyzing the sensitivity and specificity using a 2 × 2 contingency table. Subgroup analyses were also performed on studies with a low risk of bias and applicability.
RESULTS
Twelve studies were analyzed for the diagnostic accuracy of VFA. The sensitivity and specificity were 0.70-0.93 and 0.95-1.00, respectively, analyzed on a per-vertebra basis, and 0.65-1.00 and 0.74-1.00 on a per-patient basis. The sensitivity and specificity of five studies in subgroups with a low risk of bias in the intervention test were 0.70-0.84 and 0.96-0.99, respectively. In studies with a low risk of bias in the patient selection, those based on a per-vertebra basis in three studies were 0.70-0.93 and 0.96-1.00, respectively.
CONCLUSIONS
VFA had moderate sensitivity and high specificity for detecting VF when compared with spinal radiography. However, the present findings are insufficient to assess whether spinal radiography should be replaced by VFA.
Topics: Absorptiometry, Photon; Female; Humans; Male; Osteoporosis, Postmenopausal; Osteoporotic Fractures; Radiography; Sensitivity and Specificity; Spinal Fractures
PubMed: 26782682
DOI: 10.1007/s00198-015-3436-z -
Journal of Neurosurgical Anesthesiology Oct 2021Aneurysmal subarachnoid hemorrhage (aSAH) often causes cardiopulmonary dysfunction. Therapeutic strategies can be guided by standard (invasive arterial/central venous... (Meta-Analysis)
Meta-Analysis
Aneurysmal subarachnoid hemorrhage (aSAH) often causes cardiopulmonary dysfunction. Therapeutic strategies can be guided by standard (invasive arterial/central venous pressure measurements, fluid balance assessment), and/or advanced (pulse index continuous cardiac output, pulse dye densitometry, pulmonary artery catheterization) hemodynamic monitoring. We conducted a systematic review and meta-analysis of the literature to determine whether standard compared with advanced hemodynamic monitoring can improve patient management and clinical outcomes after aSAH. A literature search was performed for articles published between January 1, 2000 and January 1, 2019. Studies involving aSAH patients admitted to the intensive care unit and subjected to any type of hemodynamic monitoring were included. A total of 14 studies were selected for the qualitative synthesis and 3 randomized controlled trials, comparing standard versus advanced hemodynamic monitoring, for meta-analysis. The incidence of delayed cerebral ischemia was lower in the advanced compared with standard hemodynamic monitoring group (relative risk [RR]=0.71, 95% confidence interval [CI]=0.52-0.99; P=0.044), but there were no differences in neurological outcome (RR=0.83, 95% CI=0.64-1.06; P=0.14), pulmonary edema onset (RR=0.44, 95% CI=0.05-3.92; P=0.46), or fluid intake (mean difference=-169 mL; 95% CI=-1463 to 1126 mL; P=0.8) between the 2 groups. In summary, this systematic review and meta-analysis found only low-quality evidence to support the use of advanced hemodynamic monitoring in selected aSAH patients. Because of the small number and low quality of studies available for inclusion in the review, further studies are required to investigate the impact of standard and advanced hemodynamic monitoring-guided management on aSAH outcomes.
Topics: Brain Ischemia; Cardiac Output; Central Venous Pressure; Hemodynamic Monitoring; Humans; Subarachnoid Hemorrhage
PubMed: 32011413
DOI: 10.1097/ANA.0000000000000679 -
International Breastfeeding Journal Dec 2023During the breastfeeding period, important transient changes in calcium homeostasis are verified in the maternal skeleton, to meet the demand for calcium for breastmilk... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
During the breastfeeding period, important transient changes in calcium homeostasis are verified in the maternal skeleton, to meet the demand for calcium for breastmilk production. The literature is inconclusive regarding the causes and percentages of involvement of bone densitometry resulting from exclusive breastfeeding (4 to 6 months).
METHODS
This article aims to systematically review the literature, to determine the occurrence, intensity, and factors involved in alterations in maternal bone mineral density (BMD), during a period of 4 to 6 months of exclusive breastfeeding. The search descriptors "woman", "breastfeeding", "human milk", and "bone mineral density" were used in the electronic databases of the Virtual Health Library, Scielo (Scientific Electronic Library Online), CAPES Periodicals Portal, LILACS, Embase, PubMed/Medline, Cochrane, Scopus, and Web of Science in June 2023. Inclusion criteria for breastfeedingmothers were; aged to 40 years, primigravida, exclusively breastfeeding, with BMD assessments using dual-energy X-ray absorptiometry (DXA), with values expressed at baseline and from 4 to 6 months postpartum. The Jadad scale, Newcastle-Ottawa Scale, and Oxford Centre for Evidence-based Medicine - levels of evidence were adopted to assess the quality of the studies. For the meta-analytical study, statistical calculations were performed.
RESULTS
Initially, 381 articles were found using the search strategy and 26 were read in full. After risk of bias analysis, 16 articles remained in the systematic review and four were included in the meta-analysis. The studies showed a reduction in bone mass in the lumbar spine in the first months postpartum (4 - 6 months), when compared with a longer period of breastfeeding (12-18 months). The breastfeeding group presented a greater impact in the meta-analysis than the control group (non-breastfeeding, pregnant, or immediate postpartum), with a reduction in BMD in the lumbar spine of -0.18 g/cm (-0.36, -0.01 g/cm); 95% Confidence Interval, on a scale from 0 to 10.
CONCLUSIONS
Our results demonstrated a transitory reduction in bone densitometry of the lumbar spine during exclusive breastfeeding for 4 to 6 months, which was gradually restored later in the postpartum period. More prospective studies are needed to better understand the topic.
TRIAL REGISTRATION
PROSPERO platform (nº CRD42021279199), November 12th, 2021.
Topics: Pregnancy; Female; Humans; Aged; Bone Density; Breast Feeding; Calcium; Lumbar Vertebrae; Postpartum Period
PubMed: 38111005
DOI: 10.1186/s13006-023-00607-8 -
Journal of Obesity 2013Simple methods to assess both fat (FM) and fat-free mass (FFM) are required in paediatric populations. Several bioelectrical impedance instruments (BIAs) and... (Review)
Review
A PRISMA-driven systematic review of predictive equations for assessing fat and fat-free mass in healthy children and adolescents using multicomponent molecular models as the reference method.
Simple methods to assess both fat (FM) and fat-free mass (FFM) are required in paediatric populations. Several bioelectrical impedance instruments (BIAs) and anthropometric equations have been developed using different criterion methods (multicomponent models) for assessing FM and FFM. Through childhood, FFM density increases while FFM hydration decreases until reaching adult values. Therefore, multicomponent models should be used as the gold standard method for developing simple techniques because two-compartment models (2C model) rely on the assumed adult values of FFM density and hydration (1.1 g/cm(3) and 73.2%, respectively). This study will review BIA and/or anthropometric-based equations for assessing body composition in paediatric populations. We reviewed English language articles from MEDLINE (1985-2012) with the selection of predictive equations developed for assessing FM and FFM using three-compartment (3C) and 4C models as criterion. Search terms included children, adolescent, childhood, adolescence, 4C model, 3C model, multicomponent model, equation, prediction, DXA, BIA, resistance, anthropometry, skinfold, FM, and FFM. A total of 14 studies (33 equations) were selected with the majority developed using DXA as the criterion method with a limited number of studies providing cross-validation results. Overall, the selected equations are useful for epidemiological studies, but some concerns still arise on an individual basis.
Topics: Absorptiometry, Photon; Adiposity; Adolescent; Adolescent Development; Age Factors; Biomedical Research; Body Composition; Body Water; Child; Child Development; Electric Impedance; Female; Humans; Male; Models, Biological; Models, Statistical; Pediatric Obesity; Predictive Value of Tests; Reference Values; Reproducibility of Results; Sex Factors; Skinfold Thickness
PubMed: 23844282
DOI: 10.1155/2013/148696 -
Osteoporosis International : a Journal... Feb 2020This systematic review and meta-analysis showed a significant reduction of (major) osteoporotic fractures and hip fractures after screening using fracture risk... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis showed a significant reduction of (major) osteoporotic fractures and hip fractures after screening using fracture risk assessment and bone densitometry compared with usual care. The results indicate that screening is effective for fracture risk reduction, especially hip fractures. To perform a systematic review and meta-analysis of population screening for high fracture risk on fracture prevention compared with usual care. MEDLINE and Embase were searched for studies published until June 20th 2019. Randomized studies were selected that screened for high fracture risk using at least bone densitometry, screened in a general population, provided subsequent treatment with anti-osteoporosis medication, had a usual care group as comparator, and had at least one fracture-related outcome (all fractures, (major) osteoporotic fractures, or hip fractures). The primary assessment was the hazard ratio (HR) for fracture-related outcomes. All-cause mortality was a secondary outcome. Random-effects models were used to estimate pooled HRs. We identified 1186 potentially eligible articles and included three randomized studies: the ROSE study, the SCOOP study, and the SOS with a total number of N = 42,009 participants. Respectively, 11%, 15%, and 18% of the participants in the intervention group started medication. Meta-analysis showed a statistically significant and clinically relevant reduction of osteoporotic fractures (HR = 0.95, 95% confidence interval (CI) = 0.89-1.00), major osteoporotic fractures (HR = 0.91; 95%CI = 0.84-0.98), and hip fractures (HR = 0.80; 95%CI = 0.71-0.91), but no reduction of all fractures (HR = 0.95; 95%CI = 0.89-1.02). The pooled HR for the secondary outcome all-cause mortality was 1.04 (95% CI = 0.95-1.14). Numbers needed to screen to prevent one fracture were 247 and 272 for osteoporotic fractures and hip fractures, respectively (corresponding to 113 and 124 performed bone densitometry examinations, and 25 and 28 persons being treated). This meta-analysis showed that population screening is effective to reduce osteoporotic fractures and hip fractures. Implementation of screening in older women should be considered as serious option to prevent osteoporotic fractures, especially hip fractures.
Topics: Aged; Aged, 80 and over; Female; Hip Fractures; Humans; Mass Screening; Osteoporosis; Osteoporotic Fractures; Proportional Hazards Models; Risk Assessment
PubMed: 31838551
DOI: 10.1007/s00198-019-05226-w -
The Journal of Pediatrics Dec 2019To assess the evidence regarding the differences in areal bone mineral density (aBMD) between children and adolescents with cystic fibrosis (CF) compared with their... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the evidence regarding the differences in areal bone mineral density (aBMD) between children and adolescents with cystic fibrosis (CF) compared with their healthy peers, based on data from longitudinal studies.
STUDY DESIGN
We searched MEDLINE, SPORTDiscus, the Cochrane Library, PEDro (Physiotherapy Evidence Database), and Embase databases. Observational studies addressing the change of aBMD in children with CF and healthy children and adolescents were eligible. The DerSimonian and Laird method was used to compute pooled estimates of effect sizes (ES) and 95% CIs for the change of whole body (WB), lumbar spine (LS), and femoral neck (FN) aBMD.
RESULTS
Six studies with participants with CF and 26 studies with healthy participants were included in the systematic review and meta-analysis. For the analysis in children with CF, the pooled ES for the change of WB aBMD was 0.29 (95% CI -0.15 to 0.74), for the change of LS aBMD was 0.13 (95% CI -0.16 to 0.41), and for the change of FN aBMD was 0.09 (95% CI -0.39 to 0.57). For the analysis in healthy children, the pooled ES for the change of WB aBMD was 0.37 (95% CI 0.26-0.49), for the change of LS aBMD was 0.13 (95% CI -0.16 to 0.41), and for the change of FN aBMD was 0.52 (95% CI 0.19-0.85).
CONCLUSIONS
aBMD development might not differ between children and adolescents with CF receiving medical care compared with their healthy peers. Further longitudinal studies in a CF population during growth and development are required to confirm our findings.
Topics: Absorptiometry, Photon; Bone Density; Child; Cystic Fibrosis; Femur Neck; Humans; Lumbar Vertebrae
PubMed: 31519442
DOI: 10.1016/j.jpeds.2019.07.073 -
Journal of Science and Medicine in Sport May 2013Participation in gymnastics prior to puberty offers an intriguing and unique model, particularly in girls. The individuality comes from both upper and lower limbs being... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Participation in gymnastics prior to puberty offers an intriguing and unique model, particularly in girls. The individuality comes from both upper and lower limbs being exposed to high mechanical loading through year long intensive training programs, initiated at a young age. Studying this unique model and the associated changes in musculoskeletal health during growth is an area of specific interest. Previous reviews on gymnastics participation and bone health have been broad; and not limited to a particular maturation period, such as pre-puberty.
OBJECTIVES
To determine the difference in skeletal health between pre-pubertal girls participating in gymnastics compared with non-gymnasts.
DESIGN
Meta-analysis.
METHODS
Following a systematic search, 17 studies were included in this meta-analysis. All studies used dual-energy X-ray absorptiometry to assess bone mineral density and bone mineral content. In addition, two studies included peripheral quantitative computed tomography.
RESULTS
Following the implementation of a random effects model, gymnasts were found to have greater bone properties than non-gymnasts. The largest difference in bone health between gymnasts and non-gymnasts was observed in peripheral quantitative computed tomography-derived volumetric bone mineral density at the distal radius (d=1.06).
CONCLUSIONS
Participation in gymnastics during pre-pubertal growth was associated with skeletal health benefits, particularly to the upper body.
Topics: Absorptiometry, Photon; Adaptation, Physiological; Bone Density; Bone and Bones; Child; Female; Gymnastics; Humans; Randomized Controlled Trials as Topic; Tomography, X-Ray Computed
PubMed: 22951266
DOI: 10.1016/j.jsams.2012.07.006