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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 -
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 -
Influence of physical training on bone mineral density in healthy young adults: a systematic review.Revista Da Associacao Medica Brasileira... Sep 2019
Topics: Absorptiometry, Photon; Bone Density; Exercise; Exercise Therapy; Female; Humans; Male; Osteoporosis; Young Adult
PubMed: 31531609
DOI: 10.1590/1806-9282.65.8.1102 -
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 -
JAMA Network Open Aug 2019Hormone therapy (HT) has been suggested for protection against age-related muscle weakness in women. However, the potential for HT-associated health risks necessitates a... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Hormone therapy (HT) has been suggested for protection against age-related muscle weakness in women. However, the potential for HT-associated health risks necessitates a better understanding of the direction and magnitude of the association between HT and health outcomes, such as lean body mass (LBM).
OBJECTIVE
To determine whether HT was associated with reduced LBM loss compared with not receiving HT among postmenopausal women aged 50 years and older.
DATA SOURCES
MEDLINE, Embase, AgeLine, CINAHL, and SportDiscus (searched from inception until April 25, 2018).
STUDY SELECTION
For this systematic review and meta-analysis, randomized clinical trials including postmenopausal women undergoing HT and control groups of women not receiving HT were selected by 2 reviewers. Studies were included if LBM or fat-free mass were measured as an outcome. Studies with participants from hospitals, long-term care facilities, or with specific diseases were excluded.
DATA EXTRACTION AND SYNTHESIS
Information regarding study characteristics and outcome measures were extracted by 1 reviewer and verified by another. Risk of bias was evaluated. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used to abstract data and assess data quality/validity. Data were pooled using a fixed-effects model.
MAIN OUTCOMES AND MEASURES
The primary study outcome was the overall absolute change in LBM (measured in kilograms), captured by dual-energy x-ray absorptiometry, dual-photon absorptiometry, or bioelectrical impedance analysis imaging.
RESULTS
Of 8961 studies that met selection criteria, 12 were included, with a total of 4474 recruited participants. Of the participants, mean (SD) age was 59.0 (6.1) years. Data on ethnicity were collected by 2 of the studies. Of the 22 HT intervention arms, 15 used estrogen-progesterone combination HT and 7 used estrogen-only HT. Control participants were women who received no HT at all or who received placebo. The median follow-up duration was 2 years (range, 6 months to 6 years). Seven treatment arms showed a loss of LBM, and 14 were protective. Overall, HT users lost 0.06 kg (95% CI, -0.05 to 0.18) less LBM compared with control participants, but the difference was not statistically significant (P = .26). The results were unchanged when stratified based on treatment type and dosage, duration of follow-up, time since menopause, study quality, and type of LBM measurement, with HT users losing between 0.06 kg more to 0.20 kg less LBM compared with control participants for all strata. The quality of evidence based on GRADE was low.
CONCLUSIONS AND RELEVANCE
This systematic review and meta-analysis did not show a significant beneficial or detrimental association of HT with muscle mass. Although muscle retention in aging women is of crucial importance, these findings suggest that interventions other than HT should be explored.
Topics: Absorptiometry, Photon; Aged; Body Composition; Case-Control Studies; Electric Impedance; Estrogen Replacement Therapy; Estrogens; Female; Follow-Up Studies; Hormone Replacement Therapy; Humans; Middle Aged; Muscle Weakness; Muscle, Skeletal; Outcome Assessment, Health Care; Placebos; Postmenopause; Prospective Studies; Randomized Controlled Trials as Topic
PubMed: 31461147
DOI: 10.1001/jamanetworkopen.2019.10154 -
BMC Nephrology Aug 2019Patients treated with conventional hemodialysis have poor physical performance, explained by insufficient metabolic clearance and shortage of time by time-consuming...
BACKGROUND
Patients treated with conventional hemodialysis have poor physical performance, explained by insufficient metabolic clearance and shortage of time by time-consuming dialysis. Nocturnal hemodialysis improves metabolic control and results in increased spare time. Our aim is to investigate whether physical performance in nocturnal hemodialysis is superior to conventional hemodialysis.
METHODS
A systematic search was conducted in MEDLINE, Embase, CINAHL, PhycInfo and Web of Science until January 2018. Primary outcomes were physical performance, activity, strength and muscle mass in home or in-center nocturnal hemodialysis. Methodological quality was assessed with the Newcastle-Ottawa scale.
RESULTS
Ten studies met the inclusion criteria, including 2 RCTs, evaluating 526 nocturnal hemodialysis patients with a mean follow-up of 15, 3 months. The methodological quality of 4 studies was limited. Physical capacity tests were done in 3 studies with different methodology: short-physical performance battery, exercise spirometry and 6-min walk test. The latter 2 showed significant improvements in physical performance. Four studies assessed lean mass using dual-energy X-ray absorptiometry (2×) and bioelectrical impedance analysis (2×), of which 1 demonstrated increased lean body and skeletal muscle mass. In 5 studies a Quality of Life questionnaire was used, of which 2 showed improved physical component score.
CONCLUSIONS
The evidence on the effect of nocturnal hemodialysis on physical performance is either of insufficient methodological quality or only measures isolated aspects of physical performance. As literature emphasizes the importance of physical activity on clinical outcomes, it is necessary to conduct larger studies of high methodological quality using capacity tests for answering the question whether nocturnal hemodialysis can improve physical performance of patients with end-stage renal disease.
TRIAL REGISTRATION
NTR4715, Netherlands Trial Register. Registered 30 July 2014.
Topics: Absorptiometry, Photon; Bias; Electric Impedance; Humans; Muscle Strength; Muscle, Skeletal; Physical Functional Performance; Quality of Life; Renal Dialysis; Spirometry; Thinness; Time Factors; Walk Test
PubMed: 31412793
DOI: 10.1186/s12882-019-1518-4 -
HPB : the Official Journal of the... Dec 2019Numerous studies have suggested an association between sarcopenia in pancreatic cancer and adverse outcomes. This systematic review examines the evidence for the impact... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Numerous studies have suggested an association between sarcopenia in pancreatic cancer and adverse outcomes. This systematic review examines the evidence for the impact of sarcopenia on post-operative complications and survival METHODS: A systematic literature search was conducted to identify randomised and non-randomised studies of sarcopenia in pancreatic cancer. Meta-analyses of intra- and post-operative outcomes were performed (operating time, all complications, major complications, pancreatic fistulae, peri-operative mortality, overall survival).
RESULTS
Forty-two studies reported the assessment of body composition in 7619 patients. Methods used to assess body composition in patients with pancreatic cancers were computerized tomography (n = 34), bioelectrical impedance analysis (n = 7), and dual-energy-X-ray-absorptiometry (n = 1). Only 10 studies reported the impact of pre-operative sarcopenia upon post-operative outcomes. Sarcopenia was associated with increased peri-operative mortality (OR: 2.40, CI:1.19-4.85, p < 0.01) and decreased overall survival by univariable (HR: 1.95, CI:1.35-2.81, p < 0.001) and multivariable analysis (HR: 1.78, CI:1.54-2.05). Sarcopenia was not significantly associated with all complications (OR: 0.96, CI:0.78-1.19) or pancreatic fistula (OR: 0.95, CI: 0.59-1.54).
CONCLUSIONS
Assessment of sarcopenia in pancreatic cancer provides prognostic value but, more importantly, may provide a basis for therapeutic intervention. However, variation in the methods of assessing and reporting sarcopenia in this patient group limits the assessment of post-operative outcomes currently.
Topics: Absorptiometry, Photon; Body Composition; Electric Impedance; Humans; Intraoperative Complications; Pancreatic Neoplasms; Postoperative Complications; Sarcopenia; Tomography, X-Ray Computed
PubMed: 31266698
DOI: 10.1016/j.hpb.2019.05.018 -
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 -
Nutrition Journal Feb 2019Celiac disease (CD) is known as a reason of metabolic osteopathy. Progression of non-invasive methods such as bone densitometry has shown that an important ratio of CD...
BACKGROUND
Celiac disease (CD) is known as a reason of metabolic osteopathy. Progression of non-invasive methods such as bone densitometry has shown that an important ratio of CD cases is faced with impaired bone mass and such cases are prone to bone fractures. Variety of low bone mineral density in CD is probably because of ignored confounding factors such as age, menopause, and drug. The aim of our study was to systematically review the osteoporosis and osteopenia incidences among premenopausal females and males with CD.
METHODS
This systematic review was done based on preferred reporting items for systematic reviews (PRISMA) guidelines. PubMed and Scopus and Cochran databases were searched according to the relevant medical subject headings (MeSH) of CD and bone mineral density until 2018. Prevalence of osteopenia and osteoporosis were used as effect size for meta-analysis. Cochrane Q (p < 0.05) and I index were presented to reveal the heterogeneity.
RESULTS
54 eligible full text reviews were included and nineteen selected for data extraction. Eleven articles didn't have our inclusion criteria and had ignored confounding factors like age and menopause, and we excluded; data extraction was done in eight studies. A total of 563 premenopausal women and men who were from, UK, Brazil, India, Hungary, and Poland were included. The pooled prevalence of osteoporosis was 14.4% [95%CI: 9-20.5%] (Cochrane Q = 7.889, p = 0.96, I = 49.29%), and osteopenia was 39.6% [31.1-48.8%] (Cochrane Q = 14.24, p = 0.07, I = 71.92%), respectively.
CONCLUSION
Our findings suggest that bone loss is more prevalent in celiac disease and can be associated with increased risk of fracture. However, but results are pooled prevalence and we need more case -control studies with more sample size and consideration of confounding factors.
Topics: Adult; Aged; Bone Density; Bone Diseases, Metabolic; Brazil; Celiac Disease; Female; Fractures, Bone; Humans; Hungary; India; Male; Middle Aged; Osteoporosis; Poland; Premenopause; Risk Factors; United Kingdom
PubMed: 30732599
DOI: 10.1186/s12937-019-0434-6 -
Journal of Bone and Mineral Research :... Apr 2019Meta-analyses conducted >15 years ago reported that improvements in bone mineral density (BMD) were associated with reduction in vertebral and nonvertebral fractures in... (Meta-Analysis)
Meta-Analysis
Meta-analyses conducted >15 years ago reported that improvements in bone mineral density (BMD) were associated with reduction in vertebral and nonvertebral fractures in osteoporosis trials. Numerous studies have been conducted since then, incorporating new therapies with different mechanisms of action and enrolling many more subjects. To extend these prior analyses, we conducted a meta-regression of 38 placebo-controlled trials of 19 therapeutic agents to determine the association between improvements in BMD and reductions in fracture risk. We used a linear model to examine the relationship between mean percent difference in BMD change between treatment and placebo groups and the logarithm of the relative risk. We found that greater improvements in BMD were strongly associated with greater reductions in vertebral and hip fractures but not nonvertebral fractures. For vertebral fracture, the r values for total hip, femoral neck, and lumbar spine BMD change were 0.56, 0.54, and 0.63, respectively (p ≤ 0.0002). For a 2% or 6% improvement in total hip BMD, we might expect a 28% or 66% reduction, respectively, in vertebral fracture risk. For hip fracture, the r values for total hip, femoral neck, and lumbar spine BMD change were 0.48 (p = 0.01), 0.42 (p = 0.02), and 0.22 (ns), respectively. For a 2% or 6% improvement in total hip BMD, we might expect a 16% or 40% reduction in hip fracture risk. In conclusion, our results extend prior observations that larger improvements in dual-energy X-ray absorptiometry (DXA)-based BMD are associated with greater reductions in fracture risk, particularly for vertebral and hip fractures. Although these results cannot be directly applied to predict the treatment benefit in an individual patient, they provide compelling evidence that improvements in BMD with osteoporosis therapies may be useful surrogate endpoints for fracture in trials of new therapeutic agents. © 2019 American Society for Bone and Mineral Research.
Topics: Absorptiometry, Photon; Bone Density; Hip Fractures; Humans; Osteoporosis; Osteoporotic Fractures; Randomized Controlled Trials as Topic; Risk Factors; Spinal Fractures
PubMed: 30674078
DOI: 10.1002/jbmr.3641