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1.
  • Abdulla, N., et al. (author)
  • Epidemiology of hip fracture in Qatar and development of a country specific FRAX model
  • 2022
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 17:1
  • Journal article (peer-reviewed)abstract
    • A Summary Hip fracture data were retrieved from electronical medical records for the years 2017-2019 in the State of Qatar and used to create a FRAX (R) model to facilitate fracture risk assessment. Hip fracture rates were comparable with estimates from Saudi Arabia, Abu Dhabi, and Kuwait but fracture probabilities varied due to differences in mortality. Objective This paper describes the epidemiology of osteoporotic fractures in the State of Qatar that was used to develop the country-specific fracture prediction FRAX (R) tool. Methods Hip fracture data were retrieved from electronic medical records for the years 2017-2019 in the State of Qatar. The age and sex specific incidence of hip fracture in Qatari residents and national mortality rates were used to create a FRAX (R) model. Fracture probabilities were compared with those from neighboring countries having FRAX models. Results Hip fracture rates were comparable with estimates from Saudi Arabia, Abu Dhabi and Kuwait. In contrast, probabilities of a major osteoporotic fracture or hip fracture were lower in Qatar than in Kuwait but higher than those in Abu Dhabi and Saudi Arabia due to differences in mortality. Conclusion The FRAX model should enhance accuracy of determining fracture probability among the Qatari population and help guide decisions about treatment.
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2.
  • Al-Daghri, N. M., et al. (author)
  • The application of FRAX in Saudi Arabia
  • 2021
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 16:1
  • Journal article (peer-reviewed)abstract
    • A Summary Assessment and treatment pathways based on age-specific intervention thresholds in Saudi Arabi can be used to identify patients at high risk of fracture and avoid unnecessary treatment in those at low fracture risk. Purpose Intervention thresholds for the treatment of osteoporosis have historically been based on the measurement of bone mineral density. The aim of the present study was to explore treatment paths and characteristics of women eligible for treatment in Saudi Arabia based on fracture probabilities derived from FRAX (R). Methods The approach to the setting of intervention and assessment thresholds used the methodology adopted by the National Osteoporosis Guideline Group for FRAX-based guidelines in the UK but based on the epidemiology of fracture and death in Saudi Arabia. The methodology was applied to women age 40 years or more drawn from a tertiary referral population for skeletal assessment. Missing data for the calculation of FRAX was simulated using data from the referral and FRAX derivation cohorts. Results Intervention thresholds expressed as a 10-year probability of a major osteoporotic fracture ranged from 2.0% at the age of 50 years increasing to 7.6% at the age of 70 years. A total of 163 of 1365 women (11.9%) had a prior fragility fracture and would be eligible for treatment for this reason. An additional 5 women were eligible for treatment in that MOF probabilities lay above the upper assessment threshold. A BMD test would be recommended for 593 women (43.4%) so that FRAX could be recalculated with the inclusion of femoral neck BMD. Of these, 220 individuals would be eligible for treatment after a BMD test and 373 women categorised at low risk after a BMD test. Conclusion Probability-based assessment of fracture risk using age-specific intervention thresholds was developed for Saudi Arabia to help guide decisions about treatment.
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3.
  • Albaik, Mai, et al. (author)
  • Bone mass in Saudi women aged 20–40 years : the association with obesity and vitamin D deficiency
  • 2022
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 17:1
  • Journal article (peer-reviewed)abstract
    • Summary: This study describes that low bone density is prevalent in premenopausal Saudi women, especially women of normal weight and vitamin D deficiency. Although BMD is higher in obese young women, this may not be beneficial later in life in conjunction with persistent vitamin D deficiency. Introduction: Not attaining peak bone mass is one crucial factor contributing to the risk of developing osteoporosis and suffering fractures in later life. The objectives of this study were to describe the normal range of bone mineral density (BMD) and bone mineral content (BMC) in premenopausal Saudi women in relation to obesity and vitamin D insufficiency. Methods: A cross-sectional study involving 312 healthy Saudi women aged 20–40. All women were clinically examined. BMD (g/cm2) and BMC (g) assessed at total body (TB), femoral neck (FN) and lumbar spine (LS) were performed using dual-energy X-ray absorptiometry (DXA). Obesity was defined as BMI ≥ 30 kg/m2 and vitamin D deficiency defined as 25(OH)D < 50 nmol/L. Results: Almost half of the studied women were obese, and the majority (86.2%) were deficient in vitamin D. Mean BMD in TB 1.060 ± 0.091, FN 0.918 ± 0.153 and LS 1.118 ± 0.123 g/cm2, while TB-BMC 2077 ± 272 g. When classified by BMI, the proportion with low bone density was 2–3 times higher among the normal weight compared to the obese women, p < 0.001. In the cohort overall, ~ 19% of these young premenopausal women had osteopenia or osteoporosis at the femoral neck, but 26% in normal weight, vitamin D deficient women. Conclusion: This study shows low bone density in premenopausal Saudi women, particularly those with normal weight. While obesity appears to confer some protection against vitamin D deficiency at this age, this is assumed to change in later life.
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4.
  • Albergaria, B. H., et al. (author)
  • A new FRAX model for Brazil
  • 2023
  • In: Archives of Osteoporosis. - 1862-3522 .- 1862-3514. ; 18:1
  • Journal article (peer-reviewed)abstract
    • Summary : Fracture probabilities derived from the original FRAX model for Brazil were compared to those from an updated model based on more recent regional estimates of the incidence of hip fracture. Fracture probabilities were consistently lower in the updated FRAX model. Despite large differences between models, differences in the rank order of fracture probabilities were minimal. Objective: Recent epidemiological data indicate that the risk of hip fracture in Brazil is lower than that used to create the original FRAX model. This paper describes the epidemiology of hip fracture in Brazil and the synthesis of an updated FRAX model with the aim of comparing this new model with the original model. Methods: Hip fracture rates from three cities in three regions were combined, weighted by the population of each region. For other major fractures, incidence rates for Brazil were estimated using Swedish ratios for hip to other major osteoporotic fracture (humerus, forearm or clinical vertebral fractures). Mortality estimates were taken from the UN. Results: Compared to the original FRAX model, the updated model gave lower 10-year fracture probabilities in men and women at all ages. Notwithstanding, there was a very close correlation in fracture probabilities between the original and updated models (r > 0.99) so that the revisions had little impact on the rank order of risk. Conclusion: The disparities between the original and updated FRAX models indicate the importance of updating country-specific FRAX models with the advent of significant changes in fracture epidemiology.
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5.
  • Borgström, Fredrik, et al. (author)
  • Fragility fractures in Europe: burden, management and opportunities.
  • 2020
  • In: Archives of osteoporosis. - : Springer Science and Business Media LLC. - 1862-3514 .- 1862-3522. ; 15:1
  • Journal article (peer-reviewed)abstract
    • This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five countries of the European Union plus Sweden (EU6). In 2017, new fragility fractures in the EU6 are estimated at 2.7 million with an associated annual cost of €37.5 billion and a loss of 1.0 million quality-adjusted life years.Osteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fractures, which in turn, represent the main consequence of the disease. This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five EU countries and Sweden (designated the EU6).A series of metrics describing the burden and management of fragility fractures were defined by a scientific steering committee. A working group performed the data collection and analysis. Data were collected from current literature, available retrospective data and public sources. Different methods were applied (e.g. standard statistics and health economic modelling), where appropriate, to perform the analysis for each metric.Total fragility fractures in the EU6 are estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; a 23% increase. The resulting annual fracture-related costs (€37.5 billion in 2017) are expected to increase by 27%. An estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures. The current disability-adjusted life years (DALYs) per 1000 individuals age 50years or more were estimated at 21years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. The treatment gap (percentage of eligible individuals not receiving treatment with osteoporosis drugs) in the EU6 is estimated to be 73% for women and 63% for men; an increase of 17% since 2010. If all patients who fracture in the EU6 were enrolled into fracture liaison services, at least 19,000 fractures every year might be avoided.Fracture-related burden is expected to increase over the coming decades. Given the substantial treatment gap and proven cost-effectiveness of fracture prevention schemes such as fracture liaison services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are appropriately assessed and treated.
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6.
  • Bångsbo, Angela, et al. (author)
  • Professional Views on Patient Education in Osteoporosis
  • 2010
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3514 .- 1862-3522. ; 5:1-2, s. 101-110
  • Journal article (peer-reviewed)abstract
    • The aim of this study was to investigate patient education in osteoporosis, with a consensus-building Delphi survey. The results showed that the purposes of osteoporosis schools are to reduce the risk of falling, facilitate empowerment, increase levels of function and activity and teach participants to master or reduce pain.IntroductionAccording to the World Health Organization, osteoporosis is a major health problem. The morbidity is caused by fractures associated with pain and decreased physical function, social function and well-being. The aim of this study was to investigate and reach consensus about how so-called osteoporosis schools are run by professionals in Sweden with a focus on intervention and evaluation.MethodThe study design was a consensus-building, three-round Delphi survey. Questionnaires were sent by web and post to an expert panel comprising 15 nurses, occupational therapists and physiotherapists. In round 1, they were asked to write descriptions within the frame of eight domains related to intervention and evaluation. In the second and third rounds, the Delphi panel was asked to mark on a Likert scale the importance of 40 statements within these domains.ResultsThe answers showed that the purposes of osteoporosis schools are to reduce the risk of falling, facilitate empowerment, increase levels of function and activity and teach participants to master or reduce pain. The schools comprise theoretical elements as well as practical exercises. Patients with fractures related to osteoporosis are offered participation. There is a lack of a theoretical basis, as well as of evidence, for present treatment models. Evaluation ought to be done systematically, and for this purpose, different questionnaires are used. Experts assert that evaluations show that patients gain increased activity levels, function, knowledge about osteoporosis, empowerment and pain reduction.ConclusionsConsensus was reached in 29 of 40 items.
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8.
  • Chan, Ding Cheng Derrick, et al. (author)
  • Consensus on best practice standards for Fracture Liaison Service in the Asia-Pacific region
  • 2018
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 13:1
  • Journal article (peer-reviewed)abstract
    • Summary: The Fracture Liaison Service (FLS) Consensus Meeting endorsed by the International Osteoporosis Foundation (IOF), Asian Federation of Osteoporosis Societies (AFOS), and Asia Pacific Osteoporosis Foundation (APOF) was hosted by the Taiwanese Osteoporosis Association on October 14, 2017. International and domestic experts reviewed the 13 Best Practice Framework (BPF) standards and concluded that all standards were generally applicable in the Asia-Pacific region and needed only minor modifications to fit the healthcare settings in the region. Purpose: To review and generate consensus on best practices of fracture liaison service (FLS) in the Asia-Pacific (AP) region. Methods: In October 2017, the Taiwanese Osteoporosis Association (TOA) invited experts from the AP region (n = 23), the Capture the Fracture Steering Committee (n = 2), and the USA (n = 1) to join the AP region FLS Consensus Meeting in Taipei. After two rounds of consensus generation, the recommendations on the 13 Best Practice Framework (BPF) standards were reported and reviewed by the attendees. Experts unable to attend the on-site meeting reviewed the draft, made suggestions, and approved the final version. Results: Because the number of FLSs in the region is rapidly increasing, experts agreed that it was timely to establish consensus on benchmark quality standards for FLSs in the region. They also agreed that the 13 BPF standards and the 3 levels of standards were generally applicable, but that some clarifications were necessary. They suggested, for example, that patient and family education be incorporated into the current standards and that communication with the public to promote FLSs be increased. Conclusions: The consensus on the 13 BPF standards reviewed in this meeting was that they were generally applicable and required only a few advanced clarifications to increase the quality of FLSs in the region.
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10.
  • Chotiyarnwong, P., et al. (author)
  • Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group
  • 2022
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 17:1
  • Journal article (peer-reviewed)abstract
    • A Summary The IOF Epidemiology and Quality of Life Working Group has reviewed the potential role of population screening for high hip fracture risk against well-established criteria. The report concludes that such an approach should strongly be considered in many health care systems to reduce the burden of hip fractures. Introduction The burden of long-term osteoporosis management falls on primary care in most healthcare systems. However, a wide and stable treatment gap exists in many such settings; most of which appears to be secondary to a lack of awareness of fracture risk. Screening is a public health measure for the purpose of identifying individuals who are likely to benefit from further investigations and/or treatment to reduce the risk of a disease or its complications. The purpose of this report was to review the evidence for a potential screening programme to identify postmenopausal women at increased risk of hip fracture. Methods The approach took well-established criteria for the development of a screening program, adapted by the UK National Screening Committee, and sought the opinion of 20 members of the International Osteoporosis Foundation's Working Group on Epidemiology and Quality of Life as to whether each criterion was met (yes, partial or no). For each criterion, the evidence base was then reviewed and summarized. Results and Conclusion The report concludes that evidence supports the proposal that screening for high fracture risk in primary care should strongly be considered for incorporation into many health care systems to reduce the burden of fractures, particularly hip fractures. The key remaining hurdles to overcome are engagement with primary care healthcare professionals, and the implementation of systems that facilitate and maintain the screening program.
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11.
  • Chotiyarnwong, P., et al. (author)
  • Temporal changes in access to FRAX (R) in Thailand between 2010 and 2018
  • 2019
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 14:1
  • Journal article (peer-reviewed)abstract
    • The usage of FRAX (R) tool in Thailand and other countries was explored using Google Analytics data. Over the period 2010-2018, Thailand ranked 35th in the world for FRAX usage (the US is ranked first). Incorporation of FRAX into a national osteoporosis guideline in Thailand appears to have increased its usage.PurposeTo document access to the web-based FRAX (R) tool and specifically its access in Thailand between 2010 and 2018.MethodsA descriptive retrospective study using data from Google Analytics that provides numerical and geographical information on internet access to the FRAX tool website worldwide.ResultIn Thailand, Bangkok is the highest ranked site for FRAX access with more than 20,000 usage sessions since 2010 (3.6 usage session per 1000 population) followed by Khon Kaen and Chiang Mai. It has been accessed from within 76 out of 77 provinces (98.7%). There was a steady increase in access to FRAX from within Thailand of approximately 1000 usage sessions per year between 2010 and 2016. After the FRAX fracture risk calculation was included in the national guideline for osteoporosis management published in late 2016, the rate of increase in access was four-fold higher compared with the previous period. In world ranking, the USA is the country with the most frequent access to the FRAX tool, whereas Thailand was ranked 35th in the world. There were weak but significant correlations between the absolute number of FRAX sessions and population size (r=0.165, p=0.011) and land area (r=0.375, p<0.001).ConclusionAccess to the FRAX tool website is increasing in Thailand. The incorporation of FRAX into national guidelines, in parallel to the adoption of osteoporosis fracture prevention into national policy, has had a rapid and significant impact on its use.
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12.
  • Demeke, Taye, et al. (author)
  • Lower bone mineral density in Somali women living in Sweden compared with African-Americans.
  • 2015
  • In: Archives of osteoporosis. - : Springer Science and Business Media LLC. - 1862-3514 .- 1862-3522. ; 10:4
  • Journal article (peer-reviewed)abstract
    • Vitamin D deficiency can lead to osteomalacia. Bone mineral density was lower in Somali women, living in Sweden, in relation to both the American and the African-American reference populations. The majority, 73 %, had vitamin D deficiency, and supplementation should be considered to prevent from osteomalacia, osteoporosis and future fractures.Low vitamin D can lead to osteomalacia. The hypothesis was that bone mineral density (BMD) in Somali women living in Sweden was lower in comparison with different ethnic reference populations.Women from Somalia, n=67, median age 35.8 years (range 18 to 56), latitude 0-10° North living in Gothenburg, Sweden, latitude 57° North, >2 years were studied. All wore traditional Islamic clothing and had skin photo type V. BMD was recorded as the Z-score and compared with white American and African-American women, respectively, using standard data from the dual energy X-ray absorptiometry (DXA) manufacturer (Lunar Prodigy enCORETM, GE Healthcare, LU44663). A fasting blood test was drawn for analysis of serum 25(OH)D.The median Z-score compared with the American white population was -0.9 SD of the lumbar spine (p<0.00001), 0.1 SD of the left hip and 0.0 SD of the right hip (ns). The median Z-score compared with the African-American population was -1.6 SD of the lumbar spine (p<0.00001), -0.9 SD of the left hip and -0.9 SD of the right hip (p<0.001). The majority, 73 %, had vitamin D deficiency, serum 25(OH)D <25 nmol/l (<10 ng/ml). BMD did not correlate to vitamin D levels or to the number of years in Sweden. One wrist fracture was reported.BMD was lower in these fairly young immigrant women from Somalia, living in Sweden, in relation to both the American and the African-American reference populations. Vitamin D supplementation should be considered to prevent from osteomalacia, osteoporosis and future fractures.
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13.
  • Dimai, H. P., et al. (author)
  • Osteoporosis treatment in Austria-assessment of FRAX-based intervention thresholds for high and very high fracture risk
  • 2022
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 17:1
  • Journal article (peer-reviewed)abstract
    • A Summary The adoption of the management pathway proposed by the National Osteoporosis Guideline Group (NOGG), UK applied using the Austrian FRAX (R) tool in a referral population of Austrian women categorises 22-29% of women age 40 years or more eligible for treatment of whom 28-34% are classified at very high risk. Purpose The aim of this study is to provide a reference document for the further development of existing guidelines for the management of osteoporosis in Austria, considering FRAX-based intervention thresholds for high and very high fracture risk. Methods The model development was based on two Austrian hospital referral cohorts. Baseline information was collected to compute the 10-year probability (using the Austrian FRAX model) of a major osteoporotic fracture (MOF) and hip fracture both with and without the inclusion of femoral neck bone mineral density (BMD). Assessment thresholds for BMD testing were defined, as well as intervention thresholds. In addition, thresholds that characterise men and women at high and very high fracture risk were established. The management pathway followed that currently recommended by the UK National Osteoporosis Guideline Group (NOGG). Results The two cohorts comprised a total of 1306 women and men with a mean age of 66.7 years. Slightly more than 50% were eligible for treatment by virtue of a prior fragility fracture. In those women without a prior fracture, 22% (n = 120) were eligible for treatment based on MOF probabilities. Of these, 28% (n = 33) were found to be at very high risk. When both MOF and hip fracture probabilities were used to characterise risk, 164 women without a prior fracture were eligible for treatment (29%). Of these, 34% (n = 56) were found to be at very high risk. Fewer men without prior fracture were eligible for treatment compared with women. Conclusion The management pathway as currently outlined is expected to reduce inequalities in patient management. The characterisation of very high risk may aid in the identification of patients suitable for treatment with osteoanabolic agents.
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14.
  • Elliott, J. A., et al. (author)
  • Risk factors for loss of bone mineral density after curative esophagectomy
  • 2019
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 14:1
  • Journal article (peer-reviewed)abstract
    • .Summary Micronutrient and fat malabsorption and altered enteroendocrine signaling occur after esophagectomy for cancer; however, the impact of malnutrition on bone health in this cohort has not been previously investigated. In this study, the prevalence of osteoporosis increased after curative surgery, associated with disease-specific, treatment-related, and population risk factors.PurposeImproved oncologic outcomes in esophageal cancer (EC) have resulted in increased survivorship and a focus on long-term quality of life. Malnutrition and micronutrient malabsorption are common among patients with EC, but the effect on bone metabolism is not known. The aim of this study was to characterize changes in bone mineral density (BMD) following curative esophagectomy.MethodsConsecutive disease-free patients who underwent esophagectomy with gastric conduit for pathologically node-negative disease from 2000 to 2014 were included. BMD was assessed at vertebral levels T12-L5 by computed tomography using a simple trabecular region-of-interest attenuation technique, and serum markers of nutritional status and bone metabolism were examined. Independent risk factors for osteoporosis were identified by multivariable logistic regression.ResultsSeventy-five consecutive patients were studied. Osteoporosis was present in 25% at diagnosis. BMD declined at 1 and 2years postoperatively (144.345.8 versus 128.6 +/- 46.2 and 122.7 +/- 43.5 Hounsfield Units (HU), P<0.0001), with increased osteoporosis prevalence to 38% and 44% (P=0.049), respectively. No significant postoperative change in vitamin D, calcium, or phosphate was observed, but alkaline phosphatase increased significantly (P<0.001). While female sex (P=0.004) and ASA grade (P=0.043) were independently associated with osteoporosis at diagnosis, age (P=0.050), female sex (P=0.023), smoking (P=0.024), and pathologic T stage (P=0.023) were independently predictive of osteoporosis at 1year postoperatively.Conclusions p id=Par5 Osteoporosis is prevalent among disease-free patients post-esophagectomy for EC, associated with disease-specific, treatment-related, and population risk factors. Strategies which minimize BMD decline should be considered to avoid fragility fractures in this cohort.
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17.
  • Gavilanez, E. L., et al. (author)
  • An assessment of intervention thresholds for high fracture risk in Chile
  • 2023
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 18:1
  • Journal article (peer-reviewed)abstract
    • Summary: Assessment and treatment pathways using FRAX-based intervention thresholds in Chile can be used to identify patients at high risk of fracture and avoid unnecessary treatment in those at low fracture risk. Purpose: The aim of the present study was to explore treatment paths and characteristics of women eligible for treatment in Chile based on major osteoporotic fracture (MOF) probabilities derived from FRAX®. Methods: Intervention and assessment thresholds were derived using methods adopted by the National Osteoporosis Guideline Group for FRAX-based guidelines in the UK but based on the epidemiology of fracture and death in Chile. Age-dependent and hybrid assessment and intervention thresholds were applied to 1998 women and 1122 men age 50years or more drawn from participants in the National Health Survey 2016–2017. Results: Approximately 12% of men and women had a prior fragility fracture and would be eligible for treatment for this reason. Using age-dependent thresholds, an additional 2.6% of women (0.3% of men) were eligible for treatment in that MOF probabilities lay above the upper assessment threshold. A BMD test would be recommended in 5% of men and 38% of women. With hybrid thresholds, an additional 13% of women (3.6% of men) were eligible for treatment and BMD recommended in 11% of men and 42% of women. Conclusion: The application of hybrid intervention thresholds ameliorates the disparity in fracture probabilities seen with age-dependent thresholds. Probability-based assessment of fracture risk, including the use of the hybrid intervention thresholds for Chile, is expected to help guide decisions about treatment.
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18.
  • Gavilanez, E. L., et al. (author)
  • Assessing the risk of osteoporotic fractures: the Ecuadorian FRAX model
  • 2019
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 14:1
  • Journal article (peer-reviewed)abstract
    • The FRAX tool incorporates data on the incidence of fractures and mortality in each country. The epidemiology of fractures changes over time, this makes it necessary to update the specific FRAX model of each population. It is shown that there are differences between old and new FRAX models in older individuals. Purpose A new FRAX (R) model for Ecuador was released online in April 2019. This paper describes the data used to build the revised model, its characteristics, and how intervention and assessment thresholds were constructed. Methods The national rates of hip fracture incidence standardized by age and sex from the age of 40 years for 2016 were used to synthesize a FRAX model for Ecuador. For other major fractures, Ecuadorian incidence rates were calculated using ratios obtained in Malmo, Sweden, for other major osteoporotic fractures. The new FRAX model was compared with the previous model released in 2012. Assessment and intervention thresholds were based on age-specific probabilities of a major osteoporotic fracture equivalent to women with a previous fracture. Results Fracture incidence rates increase with age. The probability of hip or major fractures at 10 years increased in patients with a clinical risk factor, lower BMI, female sex, a higher age, and a lower BMD T-score. Compared to the previous model, the new FRAX model gave similar 10-year fracture probabilities in men and women age less than70 years but substantially higher above this age. Notwithstanding, there were very close correlations in fracture probabilities between the two models (> 0.99) so that the revision had little impact on the rank order of risk. Conclusions The FRAX tool provides a country-specific fracture prediction model for Ecuador. This update of the model is based on the original FRAX methodology, which has been validated externally in several independent cohorts. The FRAX model is an evolving tool that is being continuously refined, as the databases of each country are updated with more epidemiological information.
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19.
  • Gill, C.E., et al. (author)
  • Experience of a systematic approach to care and prevention of fragility fractures in New Zealand
  • 2022
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 17:1
  • Journal article (peer-reviewed)abstract
    • Summary: This narrative review describes efforts to improve the care and prevention of fragility fractures in New Zealand from 2012 to 2022. This includes development of clinical standards and registries to benchmark provision of care, and public awareness campaigns to promote a life-course approach to bone health. Purpose: This review describes the development and implementation of a systematic approach to care and prevention for New Zealanders with fragility fractures, and those at high risk of first fracture. Progression of existing initiatives and introduction of new initiatives are proposed for the period 2022 to 2030. Methods: In 2012, Osteoporosis New Zealand developed and published a strategy with objectives relating to people who sustain hip and other fragility fractures, those at high risk of first fragility fracture or falls and all older people. The strategy also advocated formation of a national fragility fracture alliance to expedite change. Results: In 2017, a previously informal national alliance was formalised under the Live Stronger for Longer programme, which includes stakeholder organisations from relevant sectors, including government, healthcare professionals, charities and the health system. Outputs of this alliance include development of Australian and New Zealand clinical guidelines, clinical standards and quality indicators and a bi-national registry that underpins efforts to improve hip fracture care. All 22 hospitals in New Zealand that operate on hip fracture patients currently submit data to the registry. An analogous approach is ongoing to improve secondary fracture prevention for people who sustain fragility fractures at other sites through nationwide access to Fracture Liaison Services. Conclusion: Widespread participation in national registries is enabling benchmarking against clinical standards as a means to improve the care of hip and other fragility fractures in New Zealand. An ongoing quality improvement programme is focused on eliminating unwarranted variation in delivery of secondary fracture prevention. © 2022, International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.
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20.
  • Hallkvist, Olle M., et al. (author)
  • Dairy product intake and bone properties in 70-year-old men and women
  • 2018
  • In: Archives of Osteoporosis. - : Springer. - 1862-3514 .- 1862-3522. ; 13:1
  • Journal article (peer-reviewed)abstract
    • SUMMARY: In the present population-based study including 70-year-old men and women, total dairy product intake was associated with a weak positive association with tibia trabecular and cortical cross-sectional areas.PURPOSE: Milk consumption has recently been suggested to increase fracture risk. Therefore, we aimed to investigate associations between dairy product consumption and peripheral bone properties. Furthermore, we explored whether consumption of milk and fermented dairy products affected bone properties differently.METHODS: The Healthy Aging Initiative is a population-based, cross-sectional study investigating the health of 70-year-old men and women. Out of the 2904 individuals who met the inclusion criteria, data on self-reported daily dairy product consumption (dl/day), peripheral quantitative computed tomography (pQCT) examinations at the 4 and 66% scan sites of the tibia and radius, and dual-energy X-ray absorptiometry (DXA) scans were collected from 2040 participants. Associations between dairy product consumption and bone properties were examined using multiple linear regression models adjusted for sex, muscle area, meal size, dietary protein proportion, current smoking status, and objectively measured physical activity.RESULTS: Total dairy product intake was associated with larger trabecular (2.296 (95% CI, 0.552-4.039) mm2, per dl/day increase, p = 0.01) and cortical cross-sectional areas (CSAs) in the tibia (1.757 (95% CI, 0.683-2.830 mm2, p = 0.001) as measured by pQCT and higher areal bone mineral density (aBMD) of the radius (3.231 (95% CI, 0.764-5.698) mg/cm2, p = 0.01) as measured by DXA. No other measurement in the tibia, radius, femoral neck, or lower spine was associated significantly with dairy product intake. Bone properties did not differ according to the type of dairy product consumed.CONCLUSION: No evidence of a negative association between dairy product consumption and bone health was found. Furthermore, total dairy product consumption was associated with increased CSAs in the tibia, regardless of dairy product type. Collectively, our findings indicate the existence of a weak but significant positive association between dairy product consumption bone properties in older adults.
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22.
  • Issayeva, S, et al. (author)
  • Epidemiology of osteoporotic fracture in Kazakhstan and development of a country specific FRAX model.
  • 2020
  • In: Archives of osteoporosis. - : Springer Science and Business Media LLC. - 1862-3514 .- 1862-3522. ; 15:1
  • Journal article (peer-reviewed)abstract
    • Retrospective and prospective population-based survey in a region of the Republic of Kazakhstan determined the incidence of fractures at the hip, proximal humerus and distal forearm. The hip fracture rates were used to create a FRAX® model to enhance fracture risk assessment in Kazakhstan.This paper describes the epidemiology of osteoporotic fractures in the Republic of Kazakhstan that was used to develop a country specific FRAX® tool for fracture prediction.We carried out a retrospective population-based survey in Taldykorgan in the Republic of Kazakhstan representing approximately 1% of the country's population. Hip, forearm and humerus fractures were identified retrospectively in 2015 and 2016 from hospital registers and the trauma centre. Hip fractures were prospectively identified in 2017 from the same sources and additionally from primary care data. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Kazakhstan. Fracture probabilities were compared with those from neighbouring countries having FRAX models.The difference in hip fracture incidence between the retrospective and prospective survey indicated that approximately 25% of hip fracture cases did not come to hospital attention. The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50years for 2015 was 11,690 and is predicted to increase by 140% to 28,000 in 2050. Hip fracture incidence was a good predictor of forearm and humeral fractures in men but not in women.The FRAX model should enhance accuracy of determining fracture probability among the Kazakh population and help guide decisions about treatment.
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23.
  • Johansson, H., et al. (author)
  • FRAX-based fracture probabilities in South Africa
  • 2021
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 16:1
  • Journal article (peer-reviewed)abstract
    • The hip fracture rates in South Africa were used to create ethnic-specific FRAX (R) models to facilitate fracture risk assessment.IntroductionThe aim of this study was to develop FRAX models to compute the 10-year probability of hip fracture and major osteoporotic fracture and assess their potential clinical application.MethodsAge- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for the White, Black African, Coloured and Indian population of South Africa. Age-specific 10-year probabilities of a major osteoporotic fracture were calculated in women to determine fracture probabilities at a femoral neck T score of -2.5 SD, or those equivalent to a woman with a prior fragility fracture. Fracture probabilities were compared with those from selected countries.ResultsProbabilities were consistently higher in Indian than in Coloured men and women, in turn, higher than in Black South Africans. For White South Africans, probabilities were lower than in Indians at young ages up to the age of about 80 years. When a BMD T score of -2.5 SD was used as an intervention threshold, FRAX probabilities in women age 50 years were approximately 2-fold higher than in women of the same age but with an average BMD and no risk factors. The increment in risk associated with the BMD threshold decreased progressively with age such that, at the age of 80 years or more, a T score of -2.5 SD was no longer a risk factor. Probabilities equivalent to women with a previous fracture rose with age and identified women at increased risk at all ages.ConclusionsThese FRAX models should enhance accuracy of determining fracture probability amongst the South African population and help guide decisions about treatment.
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24.
  • Johansson, Jonas, et al. (author)
  • Self-reported protein intake and properties of bone in community-dwelling older individuals
  • 2018
  • In: Archives of Osteoporosis. - : Springer. - 1862-3514 .- 1862-3522. ; 13:1
  • Journal article (peer-reviewed)abstract
    • SUMMARY:This study revealed that a quick and simple estimation of protein intake was related to measures of bone density and area in 70-year-old individuals. Furthermore, these associations were mediated by muscle mass when investigating peripheral measurement sites such as arms and legs.PURPOSE: Recent evidence suggests that dietary protein is beneficial for bone health in older individuals, but less is known about the influence of muscle mass on this relationship. This cross-sectional study aimed to investigate associations among protein intake, bone health, and muscle mass in 2332 men and women aged 70 years.METHODS: Volumetric bone mineral density of the radius and tibia was measured using peripheral quantitative computed tomography. Using dual-energy X-ray absorptiometry, we measured areal bone mineral density (aBMD) at the L1-L4 vertebrae, radius, and femoral neck, together with appendicular lean mass. Participants reported their average meal size and proportion of meat/fish intake. Associations were investigated using multiple linear regression models, adjusted for multiple covariates.RESULTS: Self-reported protein intake was associated with aBMD of the femoral neck (β = 0.082) and L1-L4 vertebrae (β = 0.063) in men (both p < 0.05) after adjusting for multiple covariates, including appendicular muscle mass. No significant association was detected among women. In addition, protein intake was associated with tibial cortical area (β = 0.08), periosteal circumference (β = 0.072), radial aBMD (β = 0.064), and trabecular area (β = 0.078) in men (all p < 0.05), although these associations were attenuated after adjustment for appendicular muscle mass (all p > 0.05).CONCLUSION: Self-reported protein intake was associated with bone properties in 70-year-old men. The strength of these associations in peripheral bone sites may be partially mediated by muscle mass from protein intake.
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25.
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26.
  • Jonsson, Emma, et al. (author)
  • Swedish osteoporosis care
  • 2015
  • In: ARCHIVES OF OSTEOPOROSIS. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 10:1
  • Journal article (peer-reviewed)abstract
    • Mini-abstract The objective of this study was to review and describe the current state of Swedish osteoporosis care and to highlight ongoing challenges. This report encompasses quantitative health outcomes based on Swedish registry data as well as organizational and management aspects. Executive summary Swedish osteoporosis care is characterized by a significant burden of disease, difficulties in identifying high-risk patients, and fragmented pathways for patients in need of secondary fracture prevention. This report aimed to describe the current state, gaps, and challenges in Swedish osteoporosis care, using Swedish national databases, questionnaires, and interviews with healthcare representatives. A secondary aim was to develop quality and process measures to compare differences between counties and to use those measures to describe the interaction between quantitative health outcomes and aspects of care organization and management. In conjunction with fractures, a considerably smaller proportion of men are treated than women, and a smaller proportion of older women are treated compared to younger groups. Between 3 and 16 % of patients receive treatment after a fracture, and the treatment rate in this patient group can likely increase. In addition to an unsatisfactory treatment rate, a limited number of those treated continue treatment throughout the recommended treatment durations, leading to increased risk of fracture. With a substantial variation between counties, there is a clear difficulty to identify non-persistent patients and switch to an alternative treatment. Collaboration around the patient across specialties has been lacking, and systems for secondary prevention have been concentrated to a few counties. However, when this study was conducted, there was a general trend towards implementing regional care programs. This report suggests possible strategies for improving quality of care and, hopefully, it can provide a basis for future evaluations and regional improvement of osteoporosis care in Sweden and other countries.
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27.
  • Kaijser Alin, Christina, et al. (author)
  • Effect of treatment on back pain and back extensor strength with a spinal orthosis in older women with osteoporosis: a randomized controlled trial
  • 2019
  • In: ARCHIVES OF OSTEOPOROSIS. - : SPRINGER LONDON LTD. - 1862-3522 .- 1862-3514. ; 14:1
  • Journal article (peer-reviewed)abstract
    • The treatment effect of an activating spinal orthosis on back pain and back extensor strength was compared to a training group and to a control group. Between the groups, there was no significant difference in back pain, back extensor strength, or kyphosis index after the 6months of treatment.PurposeThe aim of this study was to study the effect of treatment with an activating spinal orthosis on back pain, back extensor strength, and kyphotic index. Our hypothesis was that an activating spinal orthosis may be an alternative treatment to decrease back pain and increase back extensor strength.MethodsA total of 113 women aged 60years with back pain and osteoporosis, with or without vertebral fractures, were randomized to three groups: a spinal orthosis group, an equipment training group, and a control group. All three groups were examined at baseline and followed up after 3 and 6months. Statistical analyses were performed with a mixed model for repeated measures according to intention to treat (ITT) and per protocol (PP).ResultsA total of 96 women completed the study. Between the groups, there was no significant difference in baseline characteristics. Comparison between groups showed no significant difference in back pain, back extensor strength, or kyphosis index at the follow-up after 6months according to ITT and PP analyses. Analysis in each group showed that the back extensor strength had increased by 26.9% in the spinal orthosis group, by 22.1% in the exercise training group and by 9.9% in the control group.ConclusionsSix months treatment by an activating spinal orthosis showed no significant difference in back pain, back extensor strength, or kyphosis index between the three groups. In the spinal orthosis group, present back pain decreased slightly and back extensor strength increased by 26.9% which indicates that the spinal orthosis may become an alternative training method.Clinicaltrials.com ID: NCT03263585
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28.
  • Kaijser Alin, Christina, et al. (author)
  • Experiences of using an activating spinal orthosis in women with osteoporosis and back pain in primary care
  • 2020
  • In: ARCHIVES OF OSTEOPOROSIS. - : SPRINGER LONDON LTD. - 1862-3522 .- 1862-3514. ; 15:1
  • Journal article (peer-reviewed)abstract
    • Women with osteoporosis and back pain took part in focus group interviews and described their experiences of using and handling an activating spinal orthosis. The women described the back orthosis as being like a "close friend", a support in everyday life and a reminder to maintain a good posture. Purpose The purpose of this study was to describe and gain a deeper understanding of the views of older women with osteoporosis and back pain seeking primary care regarding their use and handling of an activating spinal orthosis. Method We chose a qualitative method whereby information was gathered via focus group interviews and analysed using inductive content analysis. Women who previously participated in a randomised controlled trial and wore an activating spinal orthosis for 6 months were asked. Out of 31 women, 18 agreed to participate. Five focus group interviews were conducted. Results The analysis resulted in an overall theme in which the experiences of wearing the spinal orthosis were described as follows: "A well-adapted spinal orthosis could develop into a long-lasting friendship that provided support and help in daily life". The overall theme was based on three main categories: impact on daily life, individual adaptation and personal relationship. The main categories were well differentiated from each other but had an interdependency. All three categories involved cases in which the spinal orthosis was perceived as relieving symptoms and making daily life easier, as well as when it was perceived as being hard to manage and provided no symptom relief. Conclusion In older women with osteoporosis and back pain, an activating spinal orthosis could be perceived as being a "close friend" and a support in everyday life. To facilitate acceptance of the spinal orthosis, it was important for it to be well adapted and for follow-ups to be carried out regularly.
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29.
  • Kanis, J. A., et al. (author)
  • SCOPE 2021: a new scorecard for osteoporosis in Europe
  • 2021
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 16:1
  • Journal article (peer-reviewed)abstract
    • Summary: This scorecard summarises key indicators of the burden of osteoporosis and its management in the 27 member states of the European Union, as well as the UK and Switzerland. The resulting scorecard elements, assembled on a single sheet, provide a unique overview of osteoporosis in Europe. Introduction: The scorecard for osteoporosis in Europe (SCOPE) is a project of the International Osteoporosis Foundation (IOF) that seeks to raise awareness of osteoporosis care in Europe. The aim of this project was to develop a scorecard and background documents to draw attention to gaps and inequalities in the provision of primary and secondary prevention of fractures due to osteoporosis. Methods: The SCOPE panel reviewed the information available on osteoporosis and the resulting fractures for each of the 27 countries of the European Union plus the UK and Switzerland (termed EU27+2). The information obtained covered four domains: background information (e.g. the burden of osteoporosis and fractures), policy framework, service provision and service uptake, e.g. the proportion of men and women at high risk that do not receive treatment (the treatment gap). Results: There was a marked difference in fracture risk among the EU27+2 countries. Of concern was the marked heterogeneity in the policy framework, service provision and service uptake for osteoporotic fracture that bore little relation to the fracture burden. For example, despite the wide availability of treatments to prevent fractures, in the majority of the EU27+2, only a minority of patients at high risk receive treatment even after their first fracture. The elements of each domain in each country were scored and coded using a traffic light system (red, orange, green) and used to synthesise a scorecard. The resulting scorecard elements, assembled on a single sheet, provide a unique overview of osteoporosis in Europe. Conclusions: The scorecard enables healthcare professionals and policy makers to assess their country’s general approach to the disease and provide indicators to inform the future provision of healthcare. © 2021, The Author(s).
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30.
  • Kanis, J. A., et al. (author)
  • Use of age-dependent FRAX-based intervention thresholds for Singapore
  • 2020
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 15:1
  • Journal article (peer-reviewed)abstract
    • The Summary Assessment and treatment pathways based on age-specific intervention thresholds in Singapore using FRAX paths can be used to identify patients at high risk of fracture and avoid unnecessary treatment in those at low risk. Purpose Intervention thresholds for the treatment of osteoporosis have been based historically on the measurement of bone mineral density. The development of FRAX (R) has permitted a more accurate assessment of fracture risk. The aim of the present study was to explore treatment paths and characteristics of women selected for treatment in Singapore based on FRAX. Methods The approach to the setting of intervention and assessment thresholds used the methodology adopted by the National Osteoporosis Guideline Group for FRAX-based guidelines in the UK but based on the epidemiology of fracture and death in Singapore. The methodology was applied to women age 50 years or more drawn from the population-based Singapore Chinese Health Study (SCHS) cohort. Missing data for the calculation of FRAX was simulated using data from Chinese cohorts from Hong Kong. Results Intervention thresholds expressed as a 10-year probability of a major osteoporotic fracture ranged from 2.9% at the age of 50 years increasing to 32% at the age of 90 years. A total of 1927 of 29,323 women (7%) had a prior fragility fracture and would be eligible for treatment for this reason. An additional 3019 women (10.3%) would be eligible for treatment on the basis of age-dependent thresholds. The mean BMD T-score of women so selected was -2.94. Conclusion Probability-based assessment of fracture risk using age-specific intervention thresholds was developed for Singapore to help guide decisions about treatment.
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31.
  • Kanis, JA, et al. (author)
  • SCOPE: a scorecard for osteoporosis in Europe
  • 2013
  • In: Archives of osteoporosis. - : Springer Science and Business Media LLC. - 1862-3514 .- 1862-3522. ; 8:1-2, s. 144-
  • Journal article (peer-reviewed)
  •  
32.
  •  
33.
  • Khan, Jalaluddin A., et al. (author)
  • Osteoporosis knowledge and awareness among university students in Saudi Arabia
  • 2019
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 14:1
  • Journal article (peer-reviewed)abstract
    • Awareness and knowledge about any disease is the first step to prevent and treat it, so this study evaluates osteoporosis awareness and knowledge in university students. Our results showed a high awareness and good knowledge of osteoporosis. Females were better informed than males. Knowledge increased with increasing education level. PURPOSE: Osteoporosis is a worldwide health problem, including Saudi Arabia where vitamin D deficiency is common. Prevention of osteoporosis must begin by increasing awareness of the disease from a young age. This study aimed to assess awareness and knowledge of osteoporosis among young adults (18-30 years) attending Saudi universities, exploring the relationship between education and gender and the sources of information in this age group. METHODS: A cross-sectional survey was conducted in 337 students (176 females; 161 males) randomly selected from four Saudi universities during January-December 2017. Education level ranged from preparatory year to undergraduate and postgraduate levels. A self-reported questionnaire was designed to assess awareness and knowledge of osteoporosis across several domains, including risk factors for the disease, prevalence, symptoms, prevention, and treatment. RESULTS: Overall, 92% of students had some awareness of osteoporosis through a variety of sources, predominantly via friends. Just over half of all students had a good or high knowledge level overall (53.4 ± 16.6%). Knowledge score correlated with education (r2 = 0.28) and gender (r2 = 0.27); p < 0.0001. Females were better informed than males (57.7 ± 15.4% vs 48.8 ± 16.8%; p < 0.0001). Knowledge increased with increasing education level (preparatory year (47.8 ± 15.3%), undergraduate (53.5 ± 16.5%), and postgraduate (61.8 ± 15.8%); all p < 0.0001). CONCLUSION: Knowledge of osteoporosis was good among university students in Saudi Arabia, higher in females and with increasing years of education. Overall, students were more knowledgeable about risk factors compared to other aspects such as symptoms, prevention, or treatment of osteoporosis.
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34.
  • Kirilova, E, et al. (author)
  • Epidemiology of hip fractures in Bulgaria: development of a country-specific FRAX model.
  • 2020
  • In: Archives of osteoporosis. - : Springer Science and Business Media LLC. - 1862-3514 .- 1862-3522. ; 15:1
  • Journal article (peer-reviewed)abstract
    • A retrospective population-based survey was undertaken in a region of Bulgaria to determine the incidence of hip fracture. The estimated number of hip fractures nationwide for 2015 was 9322 and is predicted to increase to 11,398 in 2050. The hip fracture rates were used to create a FRAX model.To describe the epidemiology of hip fractures in Bulgaria, which was then used to develop the country-specific fracture prediction FRAX® tool.We carried out a retrospective population-based survey in Stara Zagora, Bulgaria, representing approximately 4.6% of the country's population. We identified hip fractures occurring in 2015, 2016 and 2017 from hospital registers and primary care sources held by the regional health insurance agency. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Bulgaria. Fracture probabilities were compared with those from neighbouring countries having FRAX models.The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50years for 2015 was 9322 and is predicted to increase to 11,398 in 2050. FRAX-based probabilities were higher in Bulgaria than those in Serbia or Romania, lower than those in Turkey and similar to those in Greece.The FRAX model should enhance accuracy of determining fracture probability among the Bulgarian population and help guide decisions about treatment.
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35.
  • Kristjansdottir, Hallgerdur Lind, et al. (author)
  • Anemia is associated with increased risk of non-vertebral osteoporotic fractures in elderly men: the MrOS Sweden cohort
  • 2022
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 17:1
  • Journal article (peer-reviewed)abstract
    • This study includes 1005 men from the Gothenburg part of the Osteoporotic Fracture in Men Study (MrOS). Included are 66 men with anemia (hemoglobin < 130 g/L). The follow-up time was up to 16 years, and the main results are that anemia is associated with all fractures and non-vertebral osteoporotic fractures. Introduction Anemia and osteoporotic fractures are conditions that are associated with increased morbidity and mortality. Clinical studies have suggested that anemia can be used as a predictor of future osteoporotic fractures. Method Men from the Osteoporotic Fractures in Men Study (MrOS) Sweden, Gothenburg, with available hemoglobin (Hb) values (n = 1005, median age 75.3 years (SD 3.2)), were included in the current analyses. Of these, 66 suffered from anemia, defined as Hb < 130 g/L. Median follow-up time for fracture was 10.1 years and the longest follow-up time was 16.1 years. Results Men with anemia had, at baseline, experienced more falls and had a higher prevalence of diabetes, cancer, prostate cancer, hypertension, and stroke. Anemia was not statistically significantly associated with bone mineral density (BMD). Men with anemia had higher serum levels of fibroblast growth factor 23 (iFGF23) (p < 0.001) and phosphate (p = 0.001) and lower serum levels of testosterone (p < 0.001) and estradiol (p < 0.001). Moreover, men with anemia had an increased risk of any fracture (hazard ratio (HR) 1.97, 95% CI 1.28-3.02) and non-vertebral osteoporotic fracture (HR 2.15, 95% CI 1.18-3.93), after adjustment for age and total hip BMD, in 10 years. The risk for any fracture was increased in 10 and 16 years independently of falls, comorbidities, inflammation, and sex hormones. The age-adjusted risk of hip fracture was increased in men with anemia (HR 2.32, 95% CI 1.06-5.12), in 10 years, although this was no longer statistically significant after further adjustment for total hip BMD. Conclusions Anemia is associated with an increased risk for any fracture and non-vertebral osteoporotic fracture in elderly men with a long follow-up time. The cause is probably multifactorial and our results support that anemia can be used as a predictor for future fracture.
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36.
  • Launonen, AP, et al. (author)
  • Epidemiology of proximal humerus fractures
  • 2015
  • In: Archives of osteoporosis. - : Springer Science and Business Media LLC. - 1862-3514 .- 1862-3522. ; 10:1, s. 209-
  • Journal article (peer-reviewed)
  •  
37.
  • Lauppe, Rosa, et al. (author)
  • Differing impact of clinical factors on the risk of fracture in younger and older women in the general population and an osteoporosis clinic population
  • 2019
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 14:1
  • Journal article (peer-reviewed)abstract
    • Summary: This study assesses the impact of risk factors for fracture in women aged 80+ and 60–79. The results suggest that risk assessment which fits younger women may not be suited for the 80+ strata as many common risk factors are less predictive in the older compared to the younger cohort. Purpose: This study assesses whether the impact of classical risk factors for fracture due to osteoporosis is different in women aged 80+ and women aged 60–79. Since most prior research on the contribution of risk factors is based on patients below 80 years of age, this study aims to fill this knowledge gap to increase the accuracy of risk assessment in the oldest old. Methods: Retrospective, observational cohort study using Swedish national health register data and BMD data from osteoporosis clinics. Women aged at least 60 were identified from a random sample of the general population and from the BMD databases and allocated to two populations representing patients at different stages of risk assessment. The relative impact of risk factors on fracture risk was assessed using multivariate competing risk regression with fracture as outcome and death as competing event. Results: A total of 163,329 women were included from the general population (52,499 aged 80+) and 22,378 from the BMD databases (4563 aged 80+). The clinical risk factors with relatively highest effect on fracture risk in the older patients were prior fracture and hip T-score below − 2.5 SD. Other included risk factors showed lower impact in the older compared to the younger strata. Conclusions: This study confirms our understanding of the key risk factors for fracture: age, prior fracture, and a low T-score. Regarding remaining risk factors, risk assessment which fits younger women may not be suited for the 80+ strata as many common risk factors are less predictive in the older compared to the younger cohort.
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38.
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39.
  • Leslie, W D, et al. (author)
  • Direct comparison of eight national FRAX® tools for fracture prediction and treatment qualification in Canadian women.
  • 2013
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3514 .- 1862-3522. ; 8:1-2, s. 145-
  • Journal article (peer-reviewed)abstract
    • We compared the calibration of FRAX tools from Canada, the US (white), UK, Sweden, France, Australia, New Zealand, and China when used to assess fracture risk in 36,730 Canadian women. Our data underscores the importance of applying country-specific FRAX tools that are based upon high-quality national fracture epidemiology.
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40.
  • Lesnyak, O., et al. (author)
  • A surrogate FRAX model for the Kyrgyz Republic
  • 2020
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 15:1
  • Journal article (peer-reviewed)abstract
    • The hip fracture rates from Kazakhstan were used to create a surrogate FRAX (R) model for the Kyrgyz Republic. Introduction The International Society for Clinical Densitometry and International Osteoporosis Foundation recommend utilizing a surrogate FRAX model, based on the country-specific risk of death, and fracture data based on a country where fracture rates are considered to be representative of the index country. Objective This paper describes a surrogate FRAX model for the Kyrgyz Republic. Methods The FRAX model used the incidence of hip fracture from the neighbouring country of Kazakhstan and the death risk for the Kyrgyz Republic. Results Compared with the model for Kazakhstan, the surrogate model gave somewhat higher 10-year fracture probabilities for men between 60 and 80 years of age and lower probabilities for men above the age of 80. For women the probabilities were similar up to the age of 75-80 years and then lower. There were very close correlations in fracture probabilities between the surrogate and authentic models (1.00) so that the use of the Kyrgyz model had little impact on the rank order of risk. It was estimated that 2752 hip fractures arose in 2015 in individuals over the age of 50 years in the Kyrgyz Republic, with a predicted increase by 207% to 8435 in 2050. Conclusion The surrogate FRAX model for the Kyrgyz Republic provides the opportunity to determine fracture probability among the Kyrgyz population and help guide decisions about treatment.
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41.
  • Moberg, Louise M.E., et al. (author)
  • Primary screening for increased fracture risk by the FRAX® questionnaire—uptake rates in relation to invitation method
  • 2019
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 14
  • Journal article (peer-reviewed)abstract
    • Summary: The aim of the study was to evaluate the feasibility and most efficient way of offering middle-aged Swedish women a primary fracture screening program via a questionnaire. Two out of five invited women returned the FRAX questionnaire and those contacted directly by mail were most prone to respond. Purpose: Osteoporosis and its associated fractures are increasing, and this study aims to explore ways to identify women at an increased risk of fracture using the FRAX® algorithm. Methods: Three thousand middle-aged women were invited and presented a questionnaire distributed by three different methods–by mail, at routine mammography, or internet-based. Results: In total, 1120 (37.3%) women responded to the questionnaire and agreed to participate. The response rates for the mail, mammography, and internet-based groups were 39.1%, 35.7%, and 25.2% respectively. Women in the mammography group weighed more, were slightly older than the other women, and also had a higher BMI than women from the mail and internet-based groups. No difference was observed between the groups regarding previous fracture, family history for fracture, current smoking, glucocorticoid use, and alcohol usage. The mammography group had a higher median (interquartile range) major osteoporotic FRAX® score (10.0% (7.8–17.0)) than the mail group (9.7% (7.1–15.0); p = 0.005) and the internet-based group (8.7% (6.7–14.0); p = 0.001). Conclusions: Two out of five early postmenopausal women returned the questionnaire and women contacted directly by mail were more prone to respond. Out of the participants, 26.6% had a 10-year fracture risk score ≥ 15% according to the FRAX® algorithm.
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42.
  • Naureen, G., et al. (author)
  • A surrogate FRAX model for Pakistan
  • 2021
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 16:1
  • Journal article (peer-reviewed)abstract
    • Summary: A surrogate FRAX® model for Pakistan has been constructed using age-specific hip fracture rates for Indians living in Singapore and age-specific mortality rates from Pakistan. Introduction: FRAX models are frequently requested for countries with little or no data on the incidence of hip fracture. In such circumstances, the International Society for Clinical Densitometry and International Osteoporosis Foundation have recommended the development of a surrogate FRAX model, based on country-specific mortality data but using fracture data from a country, usually within the region, where fracture rates are considered to be representative of the index country. Objective: This paper describes the development and characteristics of a surrogate FRAX model for Pakistan. Methods: The FRAX model used the ethnic-specific incidence of hip fracture in Indian men and women living in Singapore, combined with the death risk for Pakistan. Results: The surrogate model gave somewhat lower 10-year fracture probabilities for men and women at all ages compared to the model for Indians from Singapore, reflecting a higher mortality risk in Pakistan. There were very close correlations in fracture probabilities between the surrogate and authentic models (r ≥ 0.998) so that the use of the Pakistan model had little impact on the rank order of risk. It was estimated that 36,524 hip fractures arose in 2015 in individuals over the age of 50 years in Pakistan, with a predicted increase by 214% to 114,820 in 2050. Conclusion: The surrogate FRAX model for Pakistan provides an opportunity to determine fracture probability within the Pakistan population and help guide decisions about treatment. © 2021, The Author(s).
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43.
  • Saleh, Y. A. L., et al. (author)
  • Incidence of hip fracture in Saudi Arabia and the development of a FRAX model
  • 2022
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 17:1
  • Journal article (peer-reviewed)abstract
    • A prospective hospital-based survey in representative regions of Saudi Arabia determined the incidence of fractures at the hip. The hip fracture rates were used to create a FRAX (R) model to facilitate fracture risk assessment in Saudi Arabia. Objective This paper describes the incidence of hip fracture in the Kingdom of Saudi Arabia that was used to characterize the current and future burden of hip fracture, to develop a country-specific FRAX (R) tool for fracture prediction and to compare fracture probabilities with neighbouring countries. Methods During a 2-year (2017/2018) prospective survey in 15 hospitals with a defined catchment population, hip fractures in Saudi citizens were prospectively identified from hospital registers. The number of hip fractures and future burden was determined from national demography. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Saudi Arabia. Fracture probabilities were compared with those from Kuwait and Abu Dhabi. Results The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 2,949 and is predicted to increase nearly sevenfold to 20,328 in 2050. Hip fracture rates were comparable with estimates from Abu Dhabi and Kuwait. By contrast, probabilities of a major osteoporotic fracture or hip fracture from the age of 70 years were much lower than those seen in Abu Dhabi and Kuwait due to higher mortality estimates for Saudi Arabia. Conclusion A country-specific FRAX tool for fracture prediction has been developed for Saudi Arabia which is expected to help guide decisions about treatment.
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44.
  •  
45.
  • Spångeus, Anna, 1975-, et al. (author)
  • Adherence to and persistence with zoledronic acid treatment for osteoporosis-reasons for early discontinuation
  • 2020
  • In: ARCHIVES OF OSTEOPOROSIS. - : SPRINGER LONDON LTD. - 1862-3522 .- 1862-3514. ; 15:1
  • Journal article (peer-reviewed)abstract
    • This retrospective study reports 81% long-term (> 3 years) adherence to and 77% persistence with zoledronic acid (ZA) treatment in osteoporosis patients, with ZA being costfree for patients. Eight percent of patients discontinued treatment because of adverse events (AEs), with a tendency of higher discontinuation rate in older patients. Purpose This study investigated (1) long-term adherence to and persistence with ZA treatment in a real-world setting, (2) extent to which an adverse reaction to ZA impacted on adherence and persistence, and (3) whether there were sex or age differences in patients that had early treatment termination (ETT) due to AEs and those who adhered to the regimen. Methods All patients treated with ZA at the Endocrinology Department at Linkoping University Hospital, Linkoping, Sweden between 2012 and 2017 were included. ETT was defined as < 3 ZA infusions, which was confirmed from patients medical records. Results A total of 414 patients were treated with ZA, with 81% receiving > 3 ZA infusions. Three-year persistence was 77% for a treatment window of 365 days +/- 90 days (75% with 365 days +/- 60 days window). The most common reason for ETT was AEs (8%), followed by medical conditions (5%), biological aging (3%), and other (e.g., lost to follow-up [3%]). Most patients who discontinued treatment because of AEs reported symptoms of acute-phase reaction, and tended to be older than those who adhered to treatment (74 +/- 9 vs 70 +/- 13 years, p = 0.064). There was no difference in sex ratio between the 2 groups (85% vs 90% females, p = 0.367). Conclusion Rates of long-term adherence to and persistence with ZA treatment were high with a pre-scheduled 3-year treatment regimen in the tax-financed Swedish healthcare system. AEs-mainly acute-phase reaction-were the most common reason for ETT, occurring in nearly 1 out of 10 patients.
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  • Swenne, Ingemar, et al. (author)
  • Bone metabolism markers in adolescent girls with eating disorders and weight loss : effects of growth, weight trend, developmental and menstrual status
  • 2012
  • In: Archives of Osteoporosis. - : Springer Science and Business Media LLC. - 1862-3514 .- 1862-3522. ; 7:1-2, s. 125-133
  • Journal article (peer-reviewed)abstract
    • SUMMARY:Serum concentrations of osteocalcin (OC) decrease and those of C-terminal telopeptide of type 1 collagen (CTX) increase during weight loss in adolescent girls with eating disorders (ED). The impact of weight loss on bone metabolism markers is greatest in premenarcheal girls.INTRODUCTION:Adolescents with ED stand a risk of not reaching optimal peak bone mass and develop osteoporosis. Previous investigations are contradictory as to how markers of bone formation and resorption change during weight loss and nutritional rehabilitation.METHODS:Serum OC and CTX were measured at assessment of 461 adolescent girls with ED and during treatment of 55 girls with anorexia nervosa. Bone metabolism was related to weight, weight change and growth rate.RESULTS:At assessment, OC concentrations were positively correlated with growth rate and inversely with age and (rate of) weight loss. Growth rate was the only predictor of CTX concentrations in premenarcheal girls. In postmenarcheal girls, CTX concentrations were inversely correlated with age and rate of weight loss. During weight gain, there was an increase of OC concentrations. CTX concentrations decreased at the onset of weight gain and increased when near normal weight was reached.CONCLUSIONS:Bone formation markers decrease and resorption markers increase during weight loss. The effects are independent of menstrual status but the impact on bone formation markers is greater in young, premenarcheal girls. Markers are normalised during weight gain but it is conceivable that repeated and/or prolonged weight loss in adolescents reduces peak bone mass.
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