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Journal of Managed Care & Specialty... Dec 2023People with multiple sclerosis (MS) are often prescribed medications associated with adverse effects on bone health. However, it is unclear whether these medications... (Meta-Analysis)
Meta-Analysis
BACKGROUND
People with multiple sclerosis (MS) are often prescribed medications associated with adverse effects on bone health. However, it is unclear whether these medications incur decreases in areal bone mineral density (aBMD) and higher fracture risk in this population.
OBJECTIVE
To investigate the effects of commonly used medications on aBMD and fracture risk among people with MS.
METHODS
MEDLINE, Embase, Scopus, CINAHL, and Web of Science were searched from their inception until February 5, 2023. We included randomized controlled trials as well as cross-sectional, retrospective, and prospective studies investigating whether glucocorticoids, immunomodulators, antidepressants, anticonvulsants, anxiolytics, opioids, or antipsychotics influenced aBMD or fracture risk in people with MS. Data were pooled using random effects meta-analyses to determine hazard ratios (HRs) and 95% CIs.
RESULTS
We included 22 studies (n = 18,193). Six studies were included in the meta-analyses of glucocorticoid use and aBMD, whereas 2 studies were included in the medication use and fracture risk meta-analyses. No studies assessed the effect of antidepressants, anxiolytics, anticonvulsants, opioids, and antipsychotics on aBMD, and no studies assessed the effect of immunomodulators on fracture risk. Glucocorticoid use was significantly negatively associated with femoral neck aBMD (correlation = -0.21 [95% CI = -0.29 to -0.13]), but not with lumbar spine aBMD (correlation = -0.21 [95% CI = -0.50 to 0.12]). There were no differences in fracture risk between users of glucocorticoids (HR = 1.71 [95% CI = 0.04 to 76.47]), antidepressants (HR = 1.84 [95% CI = 0.09 to 38.49]), or anxiolytics (HR = 2.01 [95% CI = 0.06 to 64.22]), compared with nonusers.
CONCLUSIONS
The available evidence is insufficient to support a relationship between greater fracture risk for people with MS taking glucocorticoid, antidepressant, or anxiolytic medication, compared with nonusers, and it is unclear whether these medications are associated with bone loss in people with MS, beyond that in the general population. Additional high-quality studies with homogenous methodology exploring how medications influence aBMD and fracture risk in people with MS are required.
Topics: Humans; Bone Density; Prospective Studies; Anticonvulsants; Anti-Anxiety Agents; Retrospective Studies; Cross-Sectional Studies; Glucocorticoids; Multiple Sclerosis; Fractures, Bone; Antidepressive Agents; Immunologic Factors
PubMed: 38058136
DOI: 10.18553/jmcp.2023.29.12.1331 -
Medicine Mar 2016Several observational studies have investigated the relation between cadmium exposure and risk of any fracture. However, the results from epidemiological studies for the... (Meta-Analysis)
Meta-Analysis Review
Several observational studies have investigated the relation between cadmium exposure and risk of any fracture. However, the results from epidemiological studies for the association are inconsistent.We conducted a meta-analysis to evaluate the relationship between cadmium exposure and risk of any fracture. The pertinent studies were identified by a search of PubMed and Embase databases from 1966 to June 2015.Seven articles involving 21,941 fracture cases and 504,346 participants were included. The meta-analysis showed that the pooled relative risk of any fracture for the highest versus lowest category of cadmium concentration was 1.30 (95% confidence interval = 1.13-1.49). In subgroup analyses, the significant association remained consistent when stratified by study type, geographical region, method of cadmium exposure assessment, and gender.Our meta-analysis showed that a high cadmium exposure may be a risk factor for any fracture. However, this result should be interpreted cautiously because of the heterogeneity among studies and existence of publication bias. Additional large, high-quality prospective studies are needed to evaluate the association between cadmium exposure and the risk of development of fracture.
Topics: Cadmium; Fractures, Bone; Humans; Observational Studies as Topic
PubMed: 26962791
DOI: 10.1097/MD.0000000000002932 -
The American Journal of Clinical... Dec 2009There has been a resurgence of interest in the controversial relation between dietary protein and bone health. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There has been a resurgence of interest in the controversial relation between dietary protein and bone health.
OBJECTIVE
This article reports on the first systematic review and meta-analysis of the relation between protein and bone health in healthy human adults.
DESIGN
The MEDLINE (January 1966 to September 2007) and EMBASE (1974 to July 2008) databases were electronically searched for all relevant studies of healthy adults; studies of calcium excretion or calcium balance were excluded.
RESULTS
In cross-sectional surveys, all pooled r values for the relation between protein intake and bone mineral density (BMD) or bone mineral content at the main clinically relevant sites were significant and positive; protein intake explained 1-2% of BMD. A meta-analysis of randomized placebo-controlled trials indicated a significant positive influence of all protein supplementation on lumbar spine BMD but showed no association with relative risk of hip fractures. No significant effects were identified for soy protein or milk basic protein on lumbar spine BMD.
CONCLUSIONS
A small positive effect of protein supplementation on lumbar spine BMD in randomized placebo-controlled trials supports the positive association between protein intake and bone health found in cross-sectional surveys. However, these results were not supported by cohort study findings for hip fracture risk. Any effects found were small and had 95% CIs that were close to zero. Therefore, there is a small benefit of protein on bone health, but the benefit may not necessarily translate into reduced fracture risk in the long term.
Topics: Bone Density; Cross-Sectional Studies; Dietary Proteins; Fractures, Bone; Humans; Risk
PubMed: 19889822
DOI: 10.3945/ajcn.2009.27799 -
Journal of Neurology, Neurosurgery, and... Oct 2014Parkinson's disease (PD) and osteoporosis are chronic diseases associated with increasing age. Single studies have reported associations between them and the major... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Parkinson's disease (PD) and osteoporosis are chronic diseases associated with increasing age. Single studies have reported associations between them and the major consequence, namely, increased risk of fractures. The aim of this systematic review and meta-analysis was to evaluate the relationship of PD with osteoporosis, bone mineral density (BMD) and fracture risk.
METHODS
A literature search was undertaken on 4 September 2012 using multiple indexing databases and relevant search terms. Articles were screened for suitability and data extracted where studies met inclusion criteria and were of sufficient quality. Data were combined using standard meta-analysis methods.
RESULTS
23 studies were used in the final analysis. PD patients were at higher risk of osteoporosis (OR 2.61; 95% CI 1.69 to 4.03) compared with healthy controls. Male patients had a lower risk for osteoporosis and osteopenia than female patients (OR 0.45; 95% CI 0.29 to 0.68). PD patients had lower hip, lumbar spine and femoral neck BMD levels compared with healthy controls; mean difference, -0.08, 95% CI -0.13 to -0.02 for femoral neck; -0.09, 95% CI -0.15 to -0.03 for lumbar spine; and -0.05, 95% CI -0.07 to -0.03 for total hip. PD patients were also at increased risk of fractures (OR 2.28; 95% CI 1.83 to 2.83).
CONCLUSIONS
This systematic review and meta-analysis demonstrate that PD patients are at higher risk for both osteoporosis and osteopenia compared with healthy controls, and that female patients are at greater risk than male patients. Patients with PD also have lower BMD and are at increased risk of fractures.
Topics: Bone Density; Bone Diseases, Metabolic; Case-Control Studies; Female; Fractures, Bone; Humans; Male; Odds Ratio; Osteoporosis; Parkinson Disease
PubMed: 24620034
DOI: 10.1136/jnnp-2013-307307 -
Lifestyle-Related Metabolic Disorders, Osteoporosis, and Fracture Risk in Asia: A Systematic Review.Value in Health Regional Issues May 2016The prevalence of both lifestyle-related metabolic disorders and osteoporosis is increasing in Asia. (Review)
Review
BACKGROUND
The prevalence of both lifestyle-related metabolic disorders and osteoporosis is increasing in Asia.
OBJECTIVES
To conduct a systematic review of the published literature to identify studies examining disorders of glucose and lipid metabolism (type 2 diabetes, hyperglycemia, hypercholesterolemia, hyperlipidemia, dyslipidemia, metabolic syndrome [MetS], and atherosclerosis) as risk factors for osteoporosis and fracture in Asian populations. Studies examining the relationship between metabolic disorders and bone mineral density (BMD) were also included.
METHODS
EMBASE (including MEDLINE) and the Cochrane Library were searched. Studies conducted only within Asia, which reported multivariate analysis with a sample size of 200 or more subjects, were included.
RESULTS
A total of 32 studies were included. All six studies examining diabetes and fracture found that subjects with diabetes had a significantly higher risk of fracture than did subjects without diabetes (risk estimate range 1.26-4.73). Two studies found that subjects with atherosclerosis had a significantly higher risk of fracture (risk estimate range 1.10-2.52). Studies consistently reported that MetS is likely associated with osteoporosis or decreased BMD in men but not women. No consistent association was found for diabetes and BMD, with studies reporting contrasting results. There was limited evidence investigating lipid metabolism and hyperglycemia and risk of fracture or bone loss in Asian populations.
CONCLUSIONS
These findings suggest that diabetes is a risk factor for fracture in Asian populations. MetS may be associated with bone loss in Asian men and atherosclerosis associated with increased fractures; however, caution is needed interpreting these findings given limitations in study design.
Topics: Asia; Bone Density; Diabetes Mellitus, Type 2; Female; Fractures, Bone; Humans; Life Style; Male; Metabolic Diseases; Osteoporosis; Risk
PubMed: 27881259
DOI: 10.1016/j.vhri.2015.09.005 -
Academic Emergency Medicine : Official... Feb 2014Scaphoid fractures are the most common carpal fracture, representing 70% of carpal bone fractures. The diagnostic accuracy of physical examination findings and emergency... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Scaphoid fractures are the most common carpal fracture, representing 70% of carpal bone fractures. The diagnostic accuracy of physical examination findings and emergency medicine (EM) imaging studies for scaphoid fracture has not been previously described in the EM literature. Plain x-rays are insufficient to rule out scaphoid fractures in a patient with a suggestive mechanism and radial-sided tenderness on physical examination. This study was a meta-analysis of historical features, physical examination findings, and imaging studies for scaphoid fractures not visualized on plain x-ray in adult emergency department (ED) patients, specifically to address which types of imaging tests should be recommended in patients with persistent concern for acute fracture after ED discharge.
METHODS
A medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED and EMBASE. The original studies' bibliographies were reviewed for additional references and unpublished manuscripts were located via a hand search of EM research abstracts from national meetings. All abstracts were independently reviewed by the two physicians, and Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used to assess individual study quality. When two or more qualitatively similar studies were identified, meta-analysis was conducted using Meta-DiSc software. Primary outcomes were sensitivity, specificity, and likelihood ratios (LRs) for predictors of scaphoid fracture detected on follow-up in patients with normal ED x-rays.
RESULTS
A total of 957 unique citations were identified, yielding 75 studies eligible for inclusion in this systematic review. Studies were significantly heterogeneous in design, study population, and criterion standard. The majority of studies were conducted in non-ED settings (e.g., orthopedic clinics). No studies used accepted diagnostic research publishing guidelines, and the overall QUADAS-2 methodologic quality was low, indicating an increased risk of bias in the estimates of diagnostic accuracy. The prevalence of scaphoid fractures ranged from 12% to 57% with the point estimate of 25% pretest probability for adult ED patients with concern for scaphoid injuries, nondiagnostic index x-rays, and scaphoid fractures on later imaging studies. Except for the absence of snuffbox tenderness (LR- = 0.15), physical examination findings lack accuracy to rule in or rule out scaphoid fractures, and no validated clinical decision rules exist. In patients with persistent concern for injury, magnetic resonance imaging (MRI) is superior to bone scan, computed tomography (CT), or ultrasound (US) to both rule in and rule out scaphoid fractures. Both MRI and CT share the added benefit of identifying alternative etiologies for posttraumatic wrist pain.
CONCLUSIONS
Except for the absence of snuffbox tenderness, which can significantly reduce the probability of scaphoid fracture, history and physical examination alone are inadequate to rule in or rule out scaphoid fracture. MRI is the most accurate imaging test to diagnose scaphoid fractures in ED patients with no evidence of fracture on initial x-rays. If MRI is unavailable, CT is adequate to rule in scaphoid fractures, but inadequate for ruling out scaphoid fractures.
Topics: Adult; Emergency Service, Hospital; False Negative Reactions; False Positive Reactions; Fractures, Bone; Humans; Likelihood Functions; Magnetic Resonance Imaging; Medical History Taking; Physical Examination; Scaphoid Bone; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography; Wrist Injuries
PubMed: 24673666
DOI: 10.1111/acem.12317 -
BMJ Open May 2017To evaluate the evidence for the resuscitation of patients with hip fracture in the preoperative or perioperative phase of their treatment and its impact on mortality. (Review)
Review
UNLABELLED
To evaluate the evidence for the resuscitation of patients with hip fracture in the preoperative or perioperative phase of their treatment and its impact on mortality.
DESIGN
We searched MEDLINE, EMBASE, CENTRAL and PROSPERO databases using a systematic search strategy for randomised trials and observational studies investigating the fluid resuscitation of any patient with hip fracture. No language limits were applied to the search, which was complemented by manually screening the reference lists of appropriate studies.
OUTCOME MEASURES
Mortality at 1 week, 30 days and 1 year following surgery.
RESULTS
Two hundred and ninety-eight citations were identified, and 12 full manuscripts were reviewed; no studies satisfied the inclusion criteria. The background literature showed that the mortality for these patients at 30 days is approximately 8.5% and that bone cement implantation syndrome is insufficient to explain this. The literature was explored to define the need for an interventional investigation into the preoperative resuscitation of patients with hip fracture.
CONCLUSIONS
Patients with hip fracture show similar physiological disturbance to major trauma patients. Nineteen per cent of patients presenting with hip fracture are hypoperfused and 50% show preoperative anaemia suggesting that under resuscitation is a common problem that has not been investigated. A properly conducted interventional trial could improve the outcome of these vulnerable patients.
Topics: Age Factors; Anemia; Biomedical Research; Comorbidity; England; Evidence-Based Medicine; Hip Fractures; Humans; Postoperative Complications; Resuscitation
PubMed: 28473523
DOI: 10.1136/bmjopen-2017-015906 -
Nutrients Sep 2017This systematic review aimed to investigate the association of fish and sea fish dietary patterns (FishDiet) and meat or processed meat dietary patterns (MeatDiet) with... (Review)
Review
This systematic review aimed to investigate the association of fish and sea fish dietary patterns (FishDiet) and meat or processed meat dietary patterns (MeatDiet) with bone mineral density (BMD) and/or risk of fractures (RF). This review includes 37 studies with a total of 432,924 subjects. The results suggest that MeatDiet and FishDiet did not affect BMD or RF in 48.2% of the subjects with MeatDiet and in 86.5% of the subjects with FishDiet. Positive effects on bone were found in 3% of subjects with MeatDiet and in 12% with FishDiet. Negative effects on bone were observed in 2.7% of FishDiet and in 47.9% of MeatDiet. Major negative effects of MeatDiet were found in subjects located in the Netherlands, Greece, Germany, Italy, Norway, UK and Spain who do not sustain a Mediterranean diet (92.7%); in Korea (27.1%); in Brazil and Mexico (96.4%); and in Australia (62.5%). This study suggests that protein intake from fish or meat is not harmful to bone. Negative effects on bone linked to FishDiet are almost null. Negative effects on bone were associated to MeatDiet in the setting of a Western Diet but not in Mediterranean or Asian Diets.
Topics: Animals; Bone Density; Diet; Diet, Mediterranean; Dietary Proteins; Fishes; Fractures, Bone; Humans; Meat Products; Red Meat; Risk Factors; Seafood
PubMed: 29358568
DOI: 10.3390/nu9091029 -
Transplant International : Official... Aug 2021To investigate the efficacy of bisphosphonates and compare oral and IV formulations on bone mineral density (BMD) and fracture incidence in post-orthotopic liver... (Meta-Analysis)
Meta-Analysis
To investigate the efficacy of bisphosphonates and compare oral and IV formulations on bone mineral density (BMD) and fracture incidence in post-orthotopic liver transplant (OLT) patients. Electronic databases were searched, and six RCTs and three cohort studies were included out of 711 articles. Main outcomes included post-OLT BMD changes, fracture incidence, and treatment adverse reactions. Pairwise meta-analysis was conducted for binary and continuous outcomes, while pooled fracture incidence utilized single-arm meta-analysis. Post-OLT fracture incidence was reported in nine studies (n = 591). Total fracture incidence was 6.6% (CI: 3.4-12.4%) in bisphosphonate group and 19.1% (CI: 14.3-25.1%) in calcium and vitamin D group. Total fractures were significantly lower in patients on bisphosphonate, compared to calcium and vitamin D (n = 591; OR = 0.037; CI: 0.18-0.77; P = 0.008). Overall fractures were significantly lower in the oral group (n = 263; OR = 0.26; CI: 0.08-0.85; P = 0.02) but not in the IV group (n = 328; OR = 0.45; CI: 0.16-1.26; P = 0.129). Both oral and IV bisphosphonates are effective in reducing fracture incidence post-OLT compared to calcium and vitamin D. Oral formulations may also have an advantage over IV in reducing bone loss and fracture incidence post-OLT.
Topics: Bone Density; Bone Density Conservation Agents; Diphosphonates; Fractures, Bone; Humans; Liver Transplantation
PubMed: 33884669
DOI: 10.1111/tri.13887 -
Medicine Dec 2023Accomplish a thorough review on the existing biomechanical and clinical studies about coronal plane fractures of the distal femur.
BACKGROUND
Accomplish a thorough review on the existing biomechanical and clinical studies about coronal plane fractures of the distal femur.
METHODS
We performed an electronic search of PubMed/MEDLINE database from April to June, 2023. The terms for the database search included "Hoffa fractures," OR "Busch-Hoffa fractures" OR "coronal plane fractures of the distal femur."
RESULTS
The search identified 277 potentially eligible studies. After application of inclusion and exclusion criteria, 113 articles were analyzed in terms of the most important topics related to coronal plane fractures of the distal femur.
CONCLUSION
Lateral coronal plane fractures of the distal femur are more frequent than medial, present a more vertical fracture line, and usually concentrate on the weight bearing zone of the condyle. The Letenneur system is the most used classification method for this fracture pattern. Posterior-to-anterior fixation using isolated lag screws (for osteochondral fragments-Letenneur type 2) or associated with a posterior buttressing plate (when the fracture pattern is amenable for plate fixation-Letenneur types 1 and 3) is biomechanically more efficient than anterior-to-posterior fixation. Anterior-to-posterior fixation using lag screws complemented or not by a plate remains a widely used treatment option due to the surgeons' familiarity with the anterior approaches and lower risk of iatrogenic neurovascular injuries. There is no consensus in the literature regarding diameter and number of screws for fixation of coronal plane fractures of the distal femur.
Topics: Humans; Femoral Fractures; Hoffa Fracture; Fracture Fixation, Internal; Bone Screws; Femur; Bone Plates
PubMed: 38050206
DOI: 10.1097/MD.0000000000036161