-
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 -
Medicina Oral, Patologia Oral Y Cirugia... Nov 2011Osteoporosis is a systemic bone disease that is characterized by a generalized reduction of the bone mass. It is the main cause of fractures in elderly women. Bone... (Review)
Review
UNLABELLED
Osteoporosis is a systemic bone disease that is characterized by a generalized reduction of the bone mass. It is the main cause of fractures in elderly women. Bone densitometry is used in the lumbar spine and hip in order to detect osteoporosis in its early stages. Different studies have observed a correlation between the bone mineral density of the jaw (BMD) and that of the lumbar spine and/or hip. On the other hand, there are studies that evaluate the findings in the orthopantomograms and perapical X-rays, correlating them with the early diagnosis of osteoporosis and highlighting the role of the dentist in the early diagnosis of this disease.
MATERIALS AND METHODS
A search was carried out in the Medline-Pubmed database in order to identify those articles that deal with the association between the X-ray findings observed in the orthopantomograms and the diagnosis of the osteoporosis, as well as those that deal with the bone mineral density of the jaw.
RESULTS
There were 406 articles, and with the limits established, this number was reduced to 21. Almost all of the articles indicate that when examining oral X-rays, it is possible to detect signs indicative of osteoporosis.
DISCUSSION
The radiomorphometric indices use measurements in orthopantomograms and evaluate possible loss of bone mineral density. They can be analyzed alone or along with the visual indices. In the periapical X-rays, the photodensimetric analyses and the trabecular pattern appear to be the most useful. There are seven studies that analyze the densitometry of the jaw, but only three do so independently of the photodensitometric analysis.
CONCLUSIONS
The combination of mandibular indices, along with surveys on the risk of fracture, can be useful as indicators of early diagnosis of osteoporosis. Visual and morphometric indices appear to be especially important in the orthopantomograms. Photodensitometry indices and the trabecular pattern are used in periapical X-rays. Studies on mandibular dual-energy X-ray absorptiometry are inconclusive.
Topics: Early Diagnosis; Humans; Mandibular Diseases; Osteoporosis; Radiography, Panoramic
PubMed: 21743400
DOI: 10.4317/medoral.17304 -
Annals of Internal Medicine May 2008Screening for low bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) is the primary way to identify asymptomatic men who might benefit from... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Screening for low bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) is the primary way to identify asymptomatic men who might benefit from osteoporosis treatment. Identifying men at risk for low BMD and fracture can help clinicians determine which men should be tested.
PURPOSE
To identify which asymptomatic men should receive DXA BMD testing, this systematic review evaluates 1) risk factors for osteoporotic fracture in men that may be mediated through low BMD and 2) the performance of non-DXA tests in identifying men with low BMD.
DATA SOURCES
Studies identified through the MEDLINE database (1990 to July 2007).
STUDY SELECTION
Articles that assessed risk factors for osteoporotic fracture in men or evaluated a non-DXA screening test against a gold standard of DXA.
DATA EXTRACTION
Researchers performed independent dual abstractions for each article, determined performance characteristics of screening tests, and assessed the quality of included articles.
DATA SYNTHESIS
A published meta-analysis of 167 studies evaluating risk factors for low BMD-related fracture in men and women found high-risk factors to be increased age (>70 years), low body weight (body mass index <20 to 25 kg/m2), weight loss (>10%), physical inactivity, prolonged corticosteroid use, and previous osteoporotic fracture. An additional 102 studies assessing 15 other proposed risk factors were reviewed; most had insufficient evidence in men to draw conclusions. Twenty diagnostic study articles were reviewed. At a T-score threshold of -1.0, calcaneal ultrasonography had a sensitivity of 75% and specificity of 66% for identifying DXA-determined osteoporosis (DXA T-score, -2.5). At a risk score threshold of -1, the Osteoporosis Self-Assessment Screening Tool had a sensitivity of 81% and specificity of 68% to identify DXA-determined osteoporosis.
LIMITATION
Data on other screening tests, including radiography, and bone geometry variables, were sparse.
CONCLUSION
Key risk factors for low BMD-mediated fracture include increased age, low body weight, weight loss, physical inactivity, prolonged corticosteroid use, previous osteoporotic fracture, and androgen deprivation therapy. Non-DXA tests either are too insensitive or have insufficient data to reach conclusions.
Topics: Absorptiometry, Photon; Biomedical Research; Bone Density; Calcaneus; Fractures, Bone; Humans; Male; Mass Screening; Middle Aged; Osteoporosis; Risk Factors; Ultrasonography
PubMed: 18458282
DOI: 10.7326/0003-4819-148-9-200805060-00009 -
Journal of General Internal Medicine Jul 2004To identify potential obstacles to bone mineral density (BMD) testing, we performed a structured review of current osteoporosis screening guidelines, studies of BMD... (Review)
Review
OBJECTIVES
To identify potential obstacles to bone mineral density (BMD) testing, we performed a structured review of current osteoporosis screening guidelines, studies of BMD testing patterns, and interventions to increase BMD testing.
DESIGN
We searched medline and HealthSTAR from 1992 through 2002 using appropriate search terms. Two authors examined all retrieved articles, and relevant studies were reviewed with a structured data abstraction form.
MEASUREMENTS AND MAIN RESULTS
A total of 235 articles were identified, and 51 met criteria for review: 24 practice guidelines, 22 studies of screening patterns, and 5 interventions designed to increase BMD rates. Of the practice guidelines, almost one half (47%) lacked a formal description of how they were developed, and recommendations for populations to screen varied widely. Screening frequencies among at-risk patients were low, ranging from 1% to 47%. Only eight studies assessed factors associated with BMD testing. Female patient gender, glucocorticoid dose, and rheumatologist care were positively associated with BMD testing; female physicians, rheumatologists, and physicians caring for more postmenopausal patients were more likely to test patients. Five articles described interventions to increase BMD testing rates, but only two tested for statistical significance and no firm conclusions can be drawn.
CONCLUSIONS
This systematic review identified several possible contributors to suboptimal BMD testing rates. Osteoporosis screening guidelines lack uniformity in their development and content. While some patient and physician characteristics were found to be associated with BMD testing, few articles carefully assessed correlates of testing. Almost no interventions to improve BMD testing to screen for osteoporosis have been rigorously evaluated.
Topics: Bone Density; Densitometry; Female; Humans; Male; Mass Screening; Osteoporosis; Practice Guidelines as Topic
PubMed: 15209594
DOI: 10.1111/j.1525-1497.2004.30240.x -
Endokrynologia Polska 2023The antifracture efficacy of vitamin D is still controversial. The aim of this systematic review was to examine if the vitamin D trials were designed adequately to...
INTRODUCTION
The antifracture efficacy of vitamin D is still controversial. The aim of this systematic review was to examine if the vitamin D trials were designed adequately to reliably assess its antifracture activity.
MATERIAL AND METHODS
The electronic databases PubMed, Medline, Embase, Web of Science, and Cochrane Library were searched to identify clinical trials evaluating the antifracture efficacy of vitamin D in adults. We compared the protocols of the trials against the opinions of the American Society for Bone and Mineral Research (ASBMR), International Society for Clinical Densitometry (ISCD), National Osteoporosis Foundation (NOF), European Medicines Agency (EMEA) experts, and the consensus statement from the 2nd International Conference on Controversies in Vitamin D, and against the protocols of the trials of the medications with proven antifracture efficacy (bisphosphonates, teriparatide, abaloparatide, raloxifene, denosumab, romosozumab). We assessed the prospective character, study design, group description, number of patients, study duration, and vitamin D (serum examination and dosage) supplementation. A description of the desired characteristics of the study protocol was presented.
RESULTS
Thirteen eligible trials were identified. All but 2 were conducted in the elderly population only. Nine trials were included in the final analysis. Serum 25-hydroxy vitamin D (25OHD) was not measured in a representative number of subjects before (except in 2 studies), during, or after treatment in any study.
CONCLUSIONS
The analysed studies did not conclusively assess the vitamin D antifracture efficacy in patients with prestudy low serum vitamin levels, due to the lack of assessment of whether sufficient doses of vitamin D were used. They informed about the relevant doses and preparations of vitamin D in particular groups (specific fracture risk, age, place of residence) only.
Topics: Humans; Adult; Aged; Prospective Studies; Vitamin D; Osteoporosis; Vitamins; Fractures, Bone; Bone Density Conservation Agents
PubMed: 37779375
DOI: 10.5603/ep.95639 -
Clinical Rheumatology May 2021Medical overuse leads to a burden on healthcare costs and potentially is harmful to patients. We wanted to address medical overuse in musculoskeletal disease and...
Medical overuse leads to a burden on healthcare costs and potentially is harmful to patients. We wanted to address medical overuse in musculoskeletal disease and rheumatology. We performed a systemic literature review from PubMed and Embase to study medical overuse. On the initial screen, 1499 studies were identified, 839 of them were related to medical overuse. Out of these, 52 were related to overuse in musculoskeletal diseases. Finally, 20 articles were chosen for this systemic review that reported overuse in rheumatology. The article identifies issues with overtesting, including the use of dual-energy X-ray absorptiometry to screen for osteoporosis in women younger than 65 years old and the use of magnetic resonance imaging to evaluate for osteoarthritis. Studies related to overtreatment reported over-prescription of vitamin D supplements resulting in vitamin D toxicity and increased risk of inappropriate prescriptions in patients with osteoarthritis and rheumatoid arthritis. Overtreating osteoporosis was reported after industry-sponsored education. Articles describing methods to reduce overuse included a study showing the reduction of unnecessary dual-energy X-ray absorptiometry scans after the introduction of the Choosing Wisely Campaign. Our findings suggest that there is some evidence that overtesting and overtreatment may be present in the field of rheumatology. This review aims to highlight this and help rheumatologists to be aware of overuse practices and provide appropriate evidence-based healthcare.
Topics: Absorptiometry, Photon; Aged; Delivery of Health Care; Female; Humans; Medical Overuse; Osteoporosis; Rheumatic Diseases; Rheumatology
PubMed: 33569709
DOI: 10.1007/s10067-021-05638-2 -
British Journal of Sports Medicine Jan 2006Seventy five articles on the effect of oral contraceptives and other hormone replacement on bone density in premenopausal and perimenopausal women were reviewed. The... (Review)
Review
Seventy five articles on the effect of oral contraceptives and other hormone replacement on bone density in premenopausal and perimenopausal women were reviewed. The evidence was appraised using the Oxford Centre for Evidence-Based Medicine levels of evidence. There is good evidence for a positive effect of oral contraceptives on bone density in perimenopausal women, and fair evidence for a positive effect in "hypothalamic" oligo/amenorrhoeic premenopausal women. There is limited evidence for a positive effect in healthy and anorexic premenopausal women. In hypothalamic oligo/amenorrhoeic women, baseline bone density has been shown to be significantly lower than that in healthy controls, therefore the decision to treat is clinically more important. The ideal formulation(s) and duration of treatment remain to be determined by further longitudinal and prospective randomised controlled trials in larger subject populations.
Topics: Absorptiometry, Photon; Adolescent; Adult; Amenorrhea; Anorexia Nervosa; Bone Density; Contraceptives, Oral; Exercise; Female; Hormone Replacement Therapy; Humans; Middle Aged; Perimenopause; Premenopause; Randomized Controlled Trials as Topic; Sports
PubMed: 16371485
DOI: 10.1136/bjsm.2005.020065 -
British Journal of Sports Medicine Aug 2002This systematic review examines and compares the bone mineral changes in children and adolescents, as measured by dual energy x ray absorptiometry, reported in exercise... (Review)
Review
This systematic review examines and compares the bone mineral changes in children and adolescents, as measured by dual energy x ray absorptiometry, reported in exercise intervention studies. The effects of hormonal factors and growth on bone mineral change during puberty are examined, and the possibility of a critical period during which bone is especially adaptable to exercise is discussed.
Topics: Absorptiometry, Photon; Adolescent; Anthropometry; Bone Density; Bone Development; Calcification, Physiologic; Child; Exercise; Humans; Puberty; Weight-Bearing
PubMed: 12145113
DOI: 10.1136/bjsm.36.4.250 -
Nutricion Hospitalaria Sep 2015in recent years, research about muscle mass has gained popularity for their relationship to health. Thus precise measurement of muscle mass may have clinical application... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
in recent years, research about muscle mass has gained popularity for their relationship to health. Thus precise measurement of muscle mass may have clinical application once may interfere with the diagnosis and prescription drug or drug treatment.
OBJECTIVE
to conduct a systematic review of the methods most used for evaluation of muscle mass in randomized controlled trials, with its advantages and disadvantages.
METHODS
we conducted a search of the data bases Pub- Med, Web of Science and Scopus, with words "muscle mass", "measurement", "assessment" and "evaluation", combined in this way: "muscle mass" AND (assessment OR measurement OR evaluation).
RESULTS
23 studies were recovered and analyzed, all in English. 69.56% only used a method for quantification of muscle mass; 69.57% used dual X-ray absorptiometry (DXA); in 45.46% the type of measure used was the body lean mass; and 51.61% chose the whole body as a site of measurement.
CONCLUSIONS
in the randomized controlled trials analyzed the majority used just one method of assessment, with the DXA being the method most used, the body lean mass the measurement type most used and total body the most common site of measure.
Topics: Absorptiometry, Photon; Anthropometry; Humans; Muscle, Skeletal; Organ Size; Randomized Controlled Trials as Topic
PubMed: 26319809
DOI: 10.3305/nh.2015.32.3.9322 -
Indian Heart Journal 2023Heart Failure (HF) is emerging as a crucial factor promoting muscle wasting and dysfunction contributing to sarcopenia. This modulates disease severity and reduces...
OBJECTIVE
Heart Failure (HF) is emerging as a crucial factor promoting muscle wasting and dysfunction contributing to sarcopenia. This modulates disease severity and reduces exercise capacity and leading to poorer outcomes. Therefore, we aimed to systematically investigate the overall prevalence of sarcopenia in HF.
METHODS
An electronic search was carried out in selected databases until 21st January, 2021. Data was pooled from the included articles and represented as pooled prevalence of sarcopenia. Subgroup analysis was undertaken between methods of diagnosis of sarcopenia, gender, ejection fraction, median time point and geographical region.
RESULTS
Amongst 32,643 citations imported from selected databases, 12 articles were included in final analysis. Analysis for prevalence of sarcopenia was 34%, with prevalence rates ranging from 10.1% to 68%. Subgroup analysis revealed strong associations between Dual-energy X-ray Absorptiometry (DXA) and Asian Working Group for Sarcopenia (AWGS) (chi square = 3.24; p < 0.001), with a good level of agreement (kappa = 0.76 [95% CI: 0.70-0.82]; p < 0.001). Gender wise analysis revealed higher prevalence of sarcopenia among males (66%) than females (34%).
CONCLUSION
Sarcopenia is highly prevalent among those with HF (irrespective of type of HF) and is more commonly seen in males compared to females.
Topics: Male; Female; Humans; Sarcopenia; Muscle, Skeletal; Prevalence; Absorptiometry, Photon; Heart Failure
PubMed: 36567064
DOI: 10.1016/j.ihj.2022.12.004