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Archives of Osteoporosis May 2024We present comprehensive guidelines for osteoporosis management in Qatar. Formulated by the Qatar Osteoporosis Association, the guidelines recommend the age-dependent...
UNLABELLED
We present comprehensive guidelines for osteoporosis management in Qatar. Formulated by the Qatar Osteoporosis Association, the guidelines recommend the age-dependent Qatar fracture risk assessment tool for screening, emphasizing risk-based treatment strategies and discouraging routine dual-energy X-ray scans. They offer a vital resource for physicians managing osteoporosis and fragility fractures nationwide.
PURPOSE
Osteoporosis and related fragility fractures are a growing public health issue with an impact on individuals and the healthcare system. We aimed to present guidelines providing unified guidance to all healthcare professionals in Qatar regarding the management of osteoporosis.
METHODS
The Qatar Osteoporosis Association formulated guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men above the age of 50. A panel of six local rheumatologists who are experts in the field of osteoporosis met together and conducted an extensive review of published articles and local and international guidelines to formulate guidance for the screening and management of postmenopausal women and men older than 50 years in Qatar.
RESULTS
The guidelines emphasize the use of the age-dependent hybrid model of the Qatar fracture risk assessment tool for screening osteoporosis and risk categorization. The guidelines include screening, risk stratification, investigations, treatment, and monitoring of patients with osteoporosis. The use of a dual-energy X-ray absorptiometry scan without any risk factors is discouraged. Treatment options are recommended based on risk stratification.
CONCLUSION
Guidance is provided to all physicians across the country who are involved in the care of patients with osteoporosis and fragility fractures.
Topics: Humans; Female; Qatar; Risk Assessment; Male; Middle Aged; Osteoporotic Fractures; Aged; Osteoporosis, Postmenopausal; Absorptiometry, Photon; Osteoporosis; Bone Density; Bone Density Conservation Agents; Practice Guidelines as Topic
PubMed: 38698101
DOI: 10.1007/s11657-024-01389-0 -
Acta Orthopaedica Feb 2005During pregnancy and lactation, changes occur in a variety of factors which have great potential to influence bone mineral density (BMD). Smoking habits, the level of... (Review)
Review
During pregnancy and lactation, changes occur in a variety of factors which have great potential to influence bone mineral density (BMD). Smoking habits, the level of alcohol consumption, the level of physical activity, body weight, soft tissue composition and hormone levels are all factors that change during the course of these conditions. Some of these factors are capable of increasing BMD, and some can reduce it. Due to these various changes, it is virtually impossible to predict the development in BMD that will occur during a pregnancy and lactation. However, longitudinal studies have suggested that both pregnancy and lactation are associated with a BMD loss of up to 5%, albeit that the BMD recovers after weaning. Cross-sectional studies have indicated that women with many children and a long total period of lactation have similar or higher BMD and similar or lower fracture risk than their peers who have not given birth. As the studies showing this trend have been observational and cross sectional case-control studies, the conclusions can only be regarded as being suggestive, and no causality can be proven.
Topics: Bone Density; Breast Feeding; Cross-Sectional Studies; Female; Fractures, Spontaneous; Gravidity; Humans; Lactation; Osteoporosis; Osteoporosis, Postmenopausal; Parity; Pregnancy; Prospective Studies; Risk Factors
PubMed: 15788303
DOI: 10.1080/00016470510030274 -
The Journal of the American Osteopathic... Jan 2000Key to effect management of osteoporosis is early diagnosis. Careful assessment of risk and determination of bone mineral density can enable the clinician to recognize... (Review)
Review
Key to effect management of osteoporosis is early diagnosis. Careful assessment of risk and determination of bone mineral density can enable the clinician to recognize this disease before it manifests with fractures. Treatment strategies have been shown to reduce fracture rates and potentially improve bone mineral content. Effective nonpharmacologic treatment includes nutritional considerations, exercise, prevention of falls, behavioral alterations, and osteopathic manipulative treatment. Approved pharmacologic strategies include estrogen replacement therapy, alendronate, and calcitonin. Because of the multiple health benefits of estrogen replacement therapy, unless contraindicated, it should be used whenever possible. The effectiveness of combination therapy is yet to be determined. Serial determinations of bone mineral density and the use of urinary biomarkers are effective to monitor therapy. A "four-step approach" to management is proposed. The primary physician can play a key role in the early recognition and treatment of this potentially devastating disorder.
Topics: Aged; Female; Humans; Osteoporosis; Osteoporosis, Postmenopausal
PubMed: 10705680
DOI: 10.7556/jaoa.2000.100.1.16s -
Drugs Jan 2011Osteoporosis is a systemic bone disease characterized by low bone mass and bone mineral density, and deterioration of the underlying structure of bone tissue. These... (Review)
Review
Osteoporosis is a systemic bone disease characterized by low bone mass and bone mineral density, and deterioration of the underlying structure of bone tissue. These changes lead to an increase in bone fragility and an increased risk for fracture, which are the clinical consequences of osteoporosis. The classical triad for consideration in osteoporosis is morbidity, mortality and cost. Vertebral fracture is an important source of morbidity in terms of pain and spinal deformity. On the other hand, hip fracture is associated with the worst outcomes and is widely regarded as a life-threatening event in the elderly; it is the source of the bulk of the cost of the disease in contemporary healthcare. The prevention of osteoporosis-associated fracture should include fall prevention, calcium supplementation and lifestyle advice, as well as pharmacological therapy using agents with proven antifracture efficacy. The most commonly used osteoporosis treatments in Europe are the bisphosphonates alendronate, risedronate, ibandronate and zoledronic acid; the selective estrogen receptor modulator (SERM) raloxifene; teriparatide; and strontium ranelate. Recent additions include the biological therapy denosumab and the SERM bazedoxifene. In this review, we explore the antifracture efficacy of these agents with the aim of simplifying treatment decisions. These treatments can be broadly divided according to their mode of action. The antiresorptive agents include the bisphosphonates, the SERMs and denosumab, while the bone-forming agents include parathyroid hormone and teriparatide. Strontium ranelate appears to combine both antiresorptive and anabolic activities. We collated data on vertebral and hip fracture efficacy from the pivotal 3-year phase III trials, all of which had a randomized, double-blind, placebo-controlled design. The relative reductions in risk in the osteoporosis trials range from 30% to 70% for vertebral fracture and 30% to 51% for hip fracture. This translates into 3-year number needed to treat values of between 9 and 21 for vertebral fracture and from 48 upwards for hip fracture. International guidelines agree that agents that have been shown to decrease vertebral, nonvertebral and hip fractures should be used preferentially over agents that only demonstrate vertebral antifracture efficacy. This is the case for alendronate, risedronate, zoledronic acid, denosumab and strontium ranelate. Finally, therapeutic decisions should be based on a balance between benefits and risks of treatment, which must be carefully considered in each particular case both by the physician and the patient. Indeed, no single agent is appropriate for all patients and, therefore, treatment decisions should be made on an individual basis, taking into account all measures of treatment effect and risk before making informed judgments about the best individual treatment option.
Topics: Bone Density; Bone Density Conservation Agents; Clinical Trials, Phase III as Topic; Diphosphonates; Female; Fractures, Bone; Humans; Osteoporosis, Postmenopausal; Randomized Controlled Trials as Topic; Selective Estrogen Receptor Modulators; Treatment Outcome
PubMed: 21175240
DOI: 10.2165/11587570-000000000-00000 -
The Journal of Clinical Endocrinology... Jun 2022Premenopausal women with idiopathic osteoporosis (PreMenIOP) have marked deficits in bone density, microstructure, and strength. (Randomized Controlled Trial)
Randomized Controlled Trial
CONTEXT
Premenopausal women with idiopathic osteoporosis (PreMenIOP) have marked deficits in bone density, microstructure, and strength.
OBJECTIVE
To define effects of treatment with teriparatide followed by denosumab on lumbar spine (LS) volumetric bone mineral density (vBMD) and stiffness by finite element analysis assessed on central quantitative computed tomography (cQCT) scans.
DESIGN, SETTINGS, AND PARTICIPANTS
Ancillary analysis of baseline, post-teriparatide, and post-denosumab cQCT scans from a randomized trial of 41 women allocated to teriparatide (20 mcg daily; n = 28) or placebo (n = 11). After 6 months, those on teriparatide continued for 18 months, and those on placebo switched to teriparatide for 24 months. After completing teriparatide, 33 enrolled in a Phase 2B extension with denosumab (60 mg every 6 months) for 12 months.
MAIN OUTCOME MEASURES
Primary outcomes were percentage change from baseline in LS trabecular vBMD and stiffness after teriparatide and between end of teriparatide and completing denosumab. Percentage change from baseline in LS trabecular vBMD and stiffness after sequential teriparatide and denosumab were secondary outcomes.
FINDINGS
There were large increases (all Ps < 0.001) in trabecular vBMD (25%), other vBMD parameters, and stiffness (21%) after teriparatide. Statistically significant increases in trabecular vBMD (10%; P < 0.001) and other vBMD parameters (P = 0.03-0.001) were seen after denosumab, while stiffness increased by 7% (P = 0.068). Sequential teriparatide and denosumab led to highly significant (all Ps < 0.001) increases LS trabecular vBMD (43%), other vBMD parameters (15-31%), and stiffness (21%).
CONCLUSIONS
The large and statistically significant increases in volumetric density and stiffness after sequential treatment with teriparatide followed by denosumab are encouraging and support use of this regimen in PreMenIOP.
Topics: Bone Density; Bone Density Conservation Agents; Denosumab; Female; Humans; Lumbar Vertebrae; Osteoporosis; Osteoporosis, Postmenopausal; Teriparatide
PubMed: 35428889
DOI: 10.1210/clinem/dgac232 -
Drug Design, Development and Therapy 2011Bisphosphonates have a long history in the treatment of osteoporosis and bone-related disease. This review focuses on the use of a specific nonaminobisphosphonate,... (Review)
Review
Bisphosphonates have a long history in the treatment of osteoporosis and bone-related disease. This review focuses on the use of a specific nonaminobisphosphonate, clodronate, which appears to be much better tolerated than other bisphosphonates and free of high-risk contraindications. Specifically, this paper reviews its use in the prevention of osteoporosis in postmenopausal women, taking into account its tolerability profile and recent safety issues arising regarding the use of bisphosphonates.
Topics: Clodronic Acid; Diphosphonates; Female; Humans; Male; Osteoporosis; Osteoporosis, Postmenopausal
PubMed: 22087064
DOI: 10.2147/DDDT.S12139 -
Journal of Internal Medicine Mar 1997
Topics: Bone Density; Female; Hip Fractures; Humans; Male; Osteoporosis; Osteoporosis, Postmenopausal; Predictive Value of Tests; Prognosis; Risk; Sensitivity and Specificity
PubMed: 9104429
DOI: 10.1046/j.1365-2796.1997.147131000.x -
Psychiatria Polska Jun 2022Osteoporosis is a chronic disease and affects an increasing number of people in the ageing population. Due to its ‛quiet' progress, it gradually impacts on the...
OBJECTIVES
Osteoporosis is a chronic disease and affects an increasing number of people in the ageing population. Due to its ‛quiet' progress, it gradually impacts on the patient's daily functioning, resulting in reduction, then abandoning of existing forms of life activities and deterioration of mental state. The aim of the study was to analyze the levels of disease acceptance and satisfaction with life in women with postmenopausal osteoporosis depending on their body mass index.
METHODS
The study included a group of 198 women, 72.3 ± 8.59 years old, diagnosed with postmenopausal osteoporosis treated in two Osteoporosis Treatment Centers in the city of Lodz. The study used the Acceptance of Illness Scale (AIS), the Satisfaction with Life Scale (SWLS), the Visual Analogue Scale (VAS), and a self-made survey.
RESULTS
The mean AIS score was 25.95 ± 10.20 points, which indicated a moderate level of acceptance and adjustment to the disease in the study group. The average level of satisfaction with life assessed on the SWLS was 19.37 ± 7.31 points and indicated moderate life satisfaction. The lowest acceptance of the disease (24.38 ± 11.3 points) was presented by underweight persons, while the lowest satisfaction with life (17.75 ± 7.50 points) was presented by overweight women. The subjects presented a mild level of pain according to the VAS scale (4.87 ± 2.39 points). The highest acceptance of the disease and satisfaction with life was presented by normal weight persons.
CONCLUSIONS
The levels of disease acceptance and satisfaction with life in women with postmenopausal osteoporosis do not differ statistically significantly depending on body mass index. It was indicated that greater acceptance of the disease was accompanied by greater satisfaction with life in people with osteoporosis. Psychological aspects (AIS, SWLS) should be an important component of the assessment of therapy effectiveness in women undergoing a long-term treatment for postmenopausal osteoporosis.
Topics: Female; Humans; Middle Aged; Aged; Aged, 80 and over; Osteoporosis, Postmenopausal; Personal Satisfaction; Body Mass Index; Quality of Life; Osteoporosis
PubMed: 36342989
DOI: 10.12740/PP/OnlineFirst/130158 -
Journal of Healthcare Engineering 2021Postmenopausal osteoporosis (PMOP) is a systemic chronic bone metabolic disease caused by the imbalance between bone formation and bone resorption mediated by estrogen... (Review)
Review
Postmenopausal osteoporosis (PMOP) is a systemic chronic bone metabolic disease caused by the imbalance between bone formation and bone resorption mediated by estrogen deficiency. Both exercise and natural extracts are safe and effective means to prevent and control PMOP. The additive effect of exercise synergy extract against PMOP may be no less than that of traditional medicine. However, the mechanism of action of this method has not been clarified in detail. A large number of studies have shown that the pathogenesis of PMOP mainly involves the OPG-RANKL-RANK system, inflammation, and oxidative stress. Based on the abovementioned approaches, the present study reviews the anti-PMOP effects and mechanisms of exercise and natural extracts. Finally, it aims to explore the possibility of the target of the two combined anti-PMOP through this approach, thereby providing a new perspective for joint intervention research and providing a new direction for the treatment strategy of PMOP.
Topics: Bone Density; Exercise; Female; Humans; Osteoporosis, Postmenopausal; Plant Extracts
PubMed: 34956564
DOI: 10.1155/2021/2852661 -
Archives of Endocrinology and Metabolism Nov 2022Several drugs are available for the treatment of osteoporosis in postmenopausal women. Over the last decades, most patients requiring pharmacological intervention were...
Definition and management of very high fracture risk in women with postmenopausal osteoporosis: a position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Association of Bone Assessment and Metabolism (ABRASSO).
Several drugs are available for the treatment of osteoporosis in postmenopausal women. Over the last decades, most patients requiring pharmacological intervention were offered antiresorptive drugs as first-line therapy, while anabolic agents were considered a last resource for those with therapeutic failure. However, recent randomized trials in patients with severe osteoporosis have shown that anabolic agents reduce fractures to a greater extent than antiresorptive medications. Additionally, evidence indicates that increases in bone mineral density (BMD) are maximized when patients are treated with anabolic agents first, followed by antiresorptive therapy. This evidence is key, considering that greater increases in BMD during osteoporosis treatment are associated with a more pronounced reduction in fracture risk. Thus, international guidelines have recently proposed an individualized approach to osteoporosis treatment based on fracture risk stratification, in which the stratification risk has been refined to include a category of patients at very high risk of fracture who should be managed with anabolic agents as first-line therapy. In this document, the Brazilian Society of Endocrinology and Metabolism and the Brazilian Association of Bone Assessment and Metabolism propose the definition of very high risk of osteoporotic fracture in postmenopausal women, for whom anabolic agents should be considered as first-line therapy. This document also reviews the factors associated with increased fracture risk, trials comparing anabolic versus antiresorptive agents, efficacy of anabolic agents in patients who are treatment naïve versus those previously treated with antiresorptive agents, and safety of anabolic agents.
Topics: Humans; Female; Osteoporosis, Postmenopausal; Bone Density Conservation Agents; Anabolic Agents; Brazil; Osteoporosis; Osteoporotic Fractures; Bone Density
PubMed: 36191263
DOI: 10.20945/2359-3997000000522