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Osteoporosis guidelines on TCM drug therapies: a systematic quality evaluation and content analysis.Frontiers in Endocrinology 2023The aims of this study were to evaluate the quality of osteoporosis guidelines on traditional Chinese medicine (TCM) drug therapies and to analyze the specific...
OBJECTIVE
The aims of this study were to evaluate the quality of osteoporosis guidelines on traditional Chinese medicine (TCM) drug therapies and to analyze the specific recommendations of these guidelines.
METHODS
We systematically collected guidelines, evaluated the quality of the guidelines using the (AGREE) II tool, and summarized the recommendations of TCM drug therapies using the Patient-Intervention-Comparator-Outcome (PICO) model as the analysis framework.
RESULTS AND CONCLUSIONS
A total of 20 guidelines were included. Overall quality evaluation results revealed that four guidelines were at level A, four at level B, and 12 at level C, whose quality needed to be improved in the domains of "stakeholder involvement", "rigor of development", "applicability" and "editorial independence". Stratified analysis suggested that the post-2020 guidelines were significantly better than those published before 2020 in the domains of "scope and purpose", "stakeholder involvement" and "editorial independence". Guidelines with evidence systems were significantly better than those without evidence systems in terms of "stakeholder involvement", "rigor of development", "clarity of presentation" and "applicability". The guidelines recommended TCM drug therapies for patients with osteopenia, osteoporosis and osteoporotic fracture. Recommended TCM drugs were mainly Chinese patent medicine alone or combined with Western medicine, with the outcome mainly focused on improving bone mineral density (BMD).
Topics: Humans; Medicine, Chinese Traditional; Osteoporosis; Osteoporotic Fractures; Research Design
PubMed: 38317713
DOI: 10.3389/fendo.2023.1276631 -
Frontiers in Pharmacology 2024Several medications have been used for glucocorticoids-induced osteoporosis (GIO). However, the best therapeutic option for GIO is still controversial. A Bayesian...
Several medications have been used for glucocorticoids-induced osteoporosis (GIO). However, the best therapeutic option for GIO is still controversial. A Bayesian network meta-analysis was conducted to compare the efficacy and safety of denosumab, teriparatide and bisphosphonates for patients with GIO. Relevant randomized controlled trials published in PubMed, Embase, Cochrane Library and ClinicalTrials.gov up to August 2023 were searched. The following efficiency and safety outcomes were extracted for comparison: bone mineral density (BMD) percentage changes in lumbar spine, femur neck and total hip, and incidences of adverse events (AEs), serious adverse events (SAEs), vertebrae and non-vertebrae fracture. Bayesian random effects models were used for multiple treatment comparisons. 11 eligible RCTs involving 2,877 patients were identified. All the six medications including alendronate, risedronate, etidronate, zoledronate, teriparatide, and denosumab and were effective in increasing BMD. Teriparatide and denosumab were more effective in improving lumbar spine and femur neck BMD, and reducing vertebrae fracture. Alendronate and denosumab were more effective in improving total hip BMD. Alendronate and teriparatide had the lowest incidences of AEs and SAEs. Teriparatide denosumab and the bisphosphonates are all effective in improving BMD for GIO patients. Based on this network meta-analysis, teriparatide and denosumab have higher efficiency in improving lumbar spine and femur neck BMD, and reducing vertebrae fracture. 10.17605/OSF.IO/2G8YA, identifier CRD42023456305.
PubMed: 38313307
DOI: 10.3389/fphar.2024.1336075 -
Annals of Saudi Medicine 2024Cushing's disease is a rare endocrine disorder. This review aimed to examine sex-specific differences in Cushing's disease. (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVES
Cushing's disease is a rare endocrine disorder. This review aimed to examine sex-specific differences in Cushing's disease.
DESIGN AND SETTINGS
A meta-analysis was performed on published articles discussing the gender impact of Cushing's disease.
METHODS
A systematic search was conducted to identify studies from Medline, Embase, CENTRAL and Scopus. Nine studies enrolling 1047 patients diagnosed with Cushing's disease were included in this meta-analysis.
RESULTS
Male patients presented at a younger age (MD [mean difference]=-5.43; 95% CI [-5.78, -5.08]; <.00001) than females. Male patients had a significantly higher prevalence of osteoporosis (RR [risk ratio]=1.75; 95% CI [1.36, 225]; <.0001) and hypokalemia (RR=1.66; 95% CI [1.27, 2.16]; =.0002). In addition, males had significantly higher rates of negative magnetic resonance imaging (RR=1.53; 95% CI [1.18, 2.0]; =.002). No sex difference was observed in the prevalence of diabetes (RR=0.92; 95% CI [0.70, 1.22]); =.57) and dyslipidemia (RR=1.33; 95% CI [0.88, 2.0]; =.17).
CONCLUSION
Cushing's disease has a worse clinical presentation in males and more diagnostic difficulties compared to females.
Topics: Female; Humans; Male; Pituitary ACTH Hypersecretion; Sex Factors
PubMed: 38311874
DOI: 10.5144/0256-4947.2024.55 -
Journal of Cachexia, Sarcopenia and... Apr 2024Half of osteoporotic fractures occur in patients with normal/osteopenic bone density or at intermediate or low estimated risk. Muscle measures have been shown to... (Review)
Review
Half of osteoporotic fractures occur in patients with normal/osteopenic bone density or at intermediate or low estimated risk. Muscle measures have been shown to contribute to fracture risk independently of bone mineral density. The objectives were to review the measurements of muscle health (muscle mass/quantity/quality, strength and function) and their association with incident fragility fractures and to summarize their use in clinical practice. This scoping review follows the PRISMA-ScR guidelines for reporting. Our search strategy covered the three overreaching concepts of 'fragility fractures', 'muscle health assessment' and 'risk'. We retrieved 14 745 references from Medline Ovid SP, EMBASE, Web of Science Core Collection and Google Scholar. We included original and prospective studies on community-dwelling adults aged over 50 years that analysed an association between at least one muscle parameter and incident fragility fractures. We systematically extracted 17 items from each study, including methodology, general characteristics and results. Data were summarized in tables and graphically presented in adjusted forest plots. Sixty-seven articles fulfilled the inclusion criteria. In total, we studied 60 muscle parameters or indexes and 322 fracture risk ratios over 2.8 million person-years (MPY). The median (interquartile range) sample size was 1642 (921-5756), age 69.2 (63.5-73.6) years, follow-up 10.0 (4.4-12.0) years and number of incident fragility fractures 166 (88-277). A lower muscle mass was positively/not/negatively associated with incident fragility fracture in 28 (2.0), 64 (2.5) and 10 (0.2 MPY) analyses. A lower muscle strength was positively/not/negatively associated with fractures in 53 (1.3), 57 (1.7 MPY) and 0 analyses. A lower muscle function was positively/not/negatively associated in 63 (1.9), 45 (1.0 MPY) and 0 analyses. An in-depth analysis shows how each single muscle parameter was associated with each fragility fractures subtype. This review summarizes markers of muscle health and their association with fragility fractures. Measures of muscle strength and function appeared to perform better for fracture risk prediction. Of these, hand grip strength and gait speed are likely to be the most practical measures for inclusion in clinical practice, as in the evaluation of sarcopenia or in further fracture risk assessment scores. Measures of muscle mass did not appear to predict fragility fractures and might benefit from further research, on D3-creatine dilution test, lean mass indexes and artificial intelligence methods.
Topics: Humans; Aged; Middle Aged; Hand Strength; Prospective Studies; Artificial Intelligence; Risk Factors; Osteoporotic Fractures; Muscle, Skeletal
PubMed: 38284511
DOI: 10.1002/jcsm.13418 -
Diagnostics (Basel, Switzerland) Jan 2024(1) Background: This meta-analysis assessed the diagnostic accuracy of deep learning model-based osteoporosis prediction using plain X-ray images. (2) Methods: We... (Review)
Review
(1) Background: This meta-analysis assessed the diagnostic accuracy of deep learning model-based osteoporosis prediction using plain X-ray images. (2) Methods: We searched PubMed, Web of Science, SCOPUS, and Google Scholar from no set beginning date to 28 February 2023, for eligible studies that applied deep learning methods for diagnosing osteoporosis using X-ray images. The quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. The area under the receiver operating characteristic curve (AUROC) was used to quantify the predictive performance. Subgroup, meta-regression, and sensitivity analyses were performed to identify the potential sources of study heterogeneity. (3) Results: Six studies were included; the pooled AUROC, sensitivity, and specificity were 0.88 (95% confidence interval [CI] 0.85-0.91), 0.81 (95% CI 0.78-0.84), and 0.87 (95% CI 0.81-0.92), respectively, indicating good performance. Moderate heterogeneity was observed. Mega-regression and subgroup analyses were not performed due to the limited number of studies included. (4) Conclusion: Deep learning methods effectively extract bone density information from plain radiographs, highlighting their potential for opportunistic screening. Nevertheless, additional prospective multicenter studies involving diverse patient populations are required to confirm the applicability of this novel technique.
PubMed: 38248083
DOI: 10.3390/diagnostics14020207 -
International Journal of Spine Surgery Jan 2024As the elderly population grows, the increasing prevalence of osteoporosis presents a unique challenge for surgeons. Decreased bone strength and quality are associated...
BACKGROUND
As the elderly population grows, the increasing prevalence of osteoporosis presents a unique challenge for surgeons. Decreased bone strength and quality are associated with hardware failure and impaired bone healing, which may increase the rate of revision surgery and the development of complications. The purpose of this review is to determine the impact of osteoporosis on postoperative outcomes for patients with cervical degenerative disease or deformity.
METHODS
A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Medical Subject Headings terms involving spine surgery for cervical degenerative disease and osteoporosis were performed. This review focused on radiographic outcomes, as well as surgical and medical complications.
RESULTS
There were 16 studies included in the degenerative group and 9 in the deformity group. Across degenerative studies, lower bone mineral density was associated with increased rates of cage subsidence in osteoporotic patients undergoing operative treatment for cervical degenerative disease. Most studies reported varied results on the relationship between osteoporosis and other outcomes such as revision and readmission rates, costs, and perioperative complications. Our meta-analysis suggests that osteoporotic patients carry a greater risk of reduced fusion rates at 6 months and 1 year postoperatively. With respect to cervical deformity correction, although individual complication rates were unchanged with osteoporosis, the collective risk of incurring any complication may be increased in patients with poor bone stock.
CONCLUSIONS
Overall, the literature suggests that outcomes for osteoporotic patients after cervical spine surgery are multifactorial. Osteoporosis seems to be a significant risk factor for developing cage subsidence and pseudarthrosis postoperatively, whereas reports on medical and hospital-related metrics were inconclusive. Our findings highlight the challenges of caring for osteoporotic patients and underline the need for adequately powered studies to understand how osteoporosis changes the risk index of patients undergoing cervical spine surgery.
CLINICAL RELEVANCE
In patients undergoing cervical spine surgery for degenerative disease, osteoporosis is a significant risk factor for long-term postoperative complications-notably cage subsidence and pseudarthrosis. Given the elective nature of these procedures, interdisciplinary collaboration between providers should be routinely implemented to enable medical optimization of patients prior to cervical spine surgery.
PubMed: 38216297
DOI: 10.14444/8568 -
Journal of Orthopaedic Surgery and... Jan 2024Patients with haemophilia (PWH) may have lower bone mineral density (BMD). The risk of low BMD in PWH has not been comprehensively analysed. This study aimed to examine... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Patients with haemophilia (PWH) may have lower bone mineral density (BMD). The risk of low BMD in PWH has not been comprehensively analysed. This study aimed to examine the risk of low BMD and changes in BMD in PWH.
METHODS
A comprehensive systematic search was performed in 4 databases: PubMed, Embase, Web of Science, and Cochrane Library. The last search was carried out on 11 December 2022. Review Manager 5.4 and Stata 16 were used for meta-analysis. Odds ratios were calculated by the incidence of low BMD between the haemophilia and control groups in each study. A meta-analysis of the odds ratios for each study was performed to estimate pooled odds ratios. Fixed effects models or random effects models were used to assess outcomes. Heterogeneity was evaluated using Higgins' I. Subgroup analysis and sensitivity analysis were performed to interpret the potential source of heterogeneity. A funnel plot, Egger's regression test, and the trim-and-fill method were used to assess publication bias.
RESULTS
19 of 793 studies, published between 2004 and 2022, that were identified by search strategy were included in this meta-analysis. The risk for low BMD was approximately four times higher compared to controls. PWH have significantly lower lumbar spine, femoral neck, and total hip BMD. Subgroup analysis showed that the risk of low BMD did not increase significantly in developed countries. Very low heterogeneity was observed in the meta-analysis of the risk of low BMD. The result from Egger's regression test suggested that there may be publication bias. However, the meta-analysis results did not alter after the trim-and-fill correction and the findings were robust.
CONCLUSION
Haemophilia was associated with an increased risk of low BMD. However, the risk of low BMD did not increase significantly in developed countries. And BMD was reduced in PWH, regardless of age, region, or economic ability. For PWH, our concerns should extend beyond bleeding and osteoarthritis to encompass BMD starting at a young age.
Topics: Humans; Bone Density; Bone Diseases, Metabolic; Femur Neck; Hemophilia A; Osteoporosis
PubMed: 38212803
DOI: 10.1186/s13018-023-04499-6 -
A systematic review of community pharmacy interventions to improve peri- and post-menopausal health.Post Reproductive Health Mar 2024Menopause is defined as the permanent cessation of menstruation due to loss of ovarian follicular function. Symptoms include mood disorders, vaginal atrophy, hot flashes... (Review)
Review
Menopause is defined as the permanent cessation of menstruation due to loss of ovarian follicular function. Symptoms include mood disorders, vaginal atrophy, hot flashes and night sweats and can emerge during a gradual transition period called perimenopause. Community pharmacies are well placed to deliver a wide range of healthcare services, including supporting and educating menopausal women; however, to date, no systematic review has assessed the effectiveness of community pharmacy-led interventions in improving peri- and post-menopausal health. In accordance with PRISMA guidelines we evaluated community pharmacy-led interventions that targeted women in peri- or post-menopause. Electronic searches in EMBASE, MEDLINE, CINAHL and Cochrane Library were conducted on 13th February 2023. Additionally, we examined the included studies references and citation lists using Google Scholar. A total of 915 articles were identified and screened against the inclusion criteria. Two studies were included; one identified post-menopausal women at risk of developing osteoporosis (OP), and one evaluated the outcomes of a community pharmacy-based menopause education programme. Study one found 11 (11%) post-menopausal women were at risk of developing OP based on quantitative ultrasound screening offered by community pharmacists and referred to their physician. Study two reported that women had access to adequate personalised menopause counselling and increased knowledge of menopause topics because of the educational programme within community pharmacies. Both studies were of low quality. The lack of included studies reflects the need for high-quality research to determine whether community pharmacy-led interventions are feasible, effective and acceptable, to improve health outcomes of peri- or post-menopausal women.
Topics: Female; Humans; Postmenopause; Pharmacies; Menopause; Hot Flashes; Perimenopause
PubMed: 38185857
DOI: 10.1177/20533691231223681 -
Archives of Gerontology and Geriatrics Apr 2024Brachial aortic Pulse Wave Velocity (baPWV) and bone mineral density (BMD) are important indicators of cardiovascular health and bone strength, respectively. However,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Brachial aortic Pulse Wave Velocity (baPWV) and bone mineral density (BMD) are important indicators of cardiovascular health and bone strength, respectively. However, the gender-specific association between baPWV and BMD remains unclear. The aim of our study is to evaluate the relationship between baPWV and BMD in men and women populations METHODS: A comprehensive search was conducted in electronic databases for relevant studies published between the 1th and 30rd of April 2023. Studies reporting the correlation between baPWV and BMD in both males and females were considered. A random-effects model was used to calculate pooled correlation coefficients (r).
RESULTS
Relevant data for both genders were found in six articles. In all publications included in the meta-analysis, the total number of studied individuals was 3800, with 2054 women and 1746 men. Pooled correlation coefficient was -0,24 (95 % CI: -0.34; -0.15) in women population, and -0.12 (95 %CI: -0.16, -0.06) in men.
CONCLUSIONS
Based on the published data, we found that baPWV is negatively correlated with bone density in women. However, in men we do not find such a relationship. These findings suggest the importance of considering gender-specific factors when assessing the cardiovascular and bone health relationship.
Topics: Humans; Female; Male; Bone Density; Pulse Wave Analysis; Ankle Brachial Index; Vascular Stiffness; Risk Factors
PubMed: 38171030
DOI: 10.1016/j.archger.2023.105309 -
Neurology Jan 2024Bisphosphonates are routinely used to treat osteoporosis in patients with Duchenne muscular dystrophy (DMD), a rare, severely debilitating neuromuscular disease. We...
BACKGROUND AND OBJECTIVES
Bisphosphonates are routinely used to treat osteoporosis in patients with Duchenne muscular dystrophy (DMD), a rare, severely debilitating neuromuscular disease. We sought to synthesize and grade benefits and harms evidence of bisphosphonates in glucocorticoid-treated patients with DMD.
METHODS
In this systematic review (PROSPERO identifier: CRD42020157606), we searched MEDLINE, CINAHL, Embase, PsycINFO, Web of Science, and CENTRAL for articles published from inception up to and including March 31, 2023, reporting results in any language from any study type. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework.
RESULTS
We identified 19 publications involving 1,010 children and adults from 12 countries across all inhabited continents except South America. We found high-quality evidence that bisphosphonates significantly increase the areal lumbar spine bone mineral density (BMD) Z score in glucocorticoid-treated patients with DMD. The greatest improvements were recorded in controlled settings among patients treated with intravenous zoledronate. Evidence of benefits to fracture risks was inconclusive and/or of low quality, primarily due to lack of controlled data and small samples. Bisphosphonates were generally well-tolerated, although adverse events related to the first infusion (i.e., "acute phase reaction") were frequently reported.
DISCUSSION
There is high-quality evidence supporting the use of bisphosphonates to increase the areal lumbar spine BMD Z score in patients with DMD and glucocorticoid-induced osteoporosis. Our synthesis and grading affirm current recommendations put forward in the 2018 DMD Clinical Care Considerations and should be helpful in raising awareness about anticipated benefits of bisphosphonates, prevailing unmet needs, and potential safety issues in their use.
Topics: Adult; Child; Humans; Diphosphonates; Muscular Dystrophy, Duchenne; Glucocorticoids; Zoledronic Acid; Osteoporosis
PubMed: 38165327
DOI: 10.1212/WNL.0000000000207948