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PubMed2006

Mechanisms of osteoporosis in spinal cord injury.

Osteoporosis is a known complication of spinal cord injury (SCI), but its mechanism remains unknown. The pathogenesis of osteoporosis after SCI is generally considered disuse. However, although unloading is an important factor in the pathogenesis of osteoporosis after SCI, neural lesion and hormonal changes also seem to be involved in this process. Innervation and neuropeptides play an important role in normal bone remodelling. SCI results in denervation of the sublesional bones and the neural lesion itself may play a pivotal role in the development of osteoporosis after SCI. Although upper limbs are normally loaded and innervated, bone loss also occurs in the upper extremities in patients with paraplegia, indicating that hormonal changes may be associated with osteoporosis after SCI. SCI-mediated hormonal changes may contribute to osteoporosis after SCI by different mechanisms: (1) increased renal elimination and reduced intestinal absorption of calcium leading to a negative calcium balance; (2) vitamin D deficiency plays a role in the pathogenesis of SCI-induced osteoporosis; (3) SCI antagonizes gonadal function and inhibits the osteoanabolic action of sex steroids; (4) hyperleptinaemia after SCI may contribute to the development of osteoporosis; (5) pituitary suppression of TSH may be another contributory factor to bone loss after SCI; and (6) bone loss after SCI may be caused directly, at least in part, by insulin resistance and IGFs. Thus, oversupply of osteoclasts relative to the requirement for bone resorption and/or undersupply of osteoblasts relative to the requirement for cavity repair results in bone loss after SCI. Mechanisms for the osteoporosis following SCI include a range of systems, and osteoporosis after SCI should not be simply considered as disuse osteoporosis. Unloading, neural lesion and hormonal changes after SCI result in severe bone loss. The aim of this review is to improve understanding with regard to the mechanisms of osteoporosis after SCI. The understanding of the pathogenesis of osteoporosis after SCI can help in the consideration of new treatment strategies. Because bone resorption after SCI is very high, intravenous bisphosphonates and denosumab should be considered for the treatment of osteoporosis after SCI.

Biomechanical Phenomena↗
PubMed2002

Quality-of-life assessment in osteoporosis: health-status and preference-based measures.

Health-status and preference-based approaches to assessing health-related quality of life (HR-QOL) in osteoporosis are reviewed. Osteoporosis-targeted health-status instruments [i.e. Osteoporosis Quality-of-Life Questionnaire (OQLQ), Osteoporosis Assessment Questionnaire (OPAQ), Quality-of-Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO), Osteoporosis-Targeted Quality-of-Life Questionnaire (OPTQoL), Osteoporosis Functional Disability Questionnaire (OFDQ), Quality-of-Life Questionnaire in Osteoporosis (QUALIOST)], which have been utilised to document the adverse impact of osteoporosis on HR-QOL in diverse clinical and epidemiological studies, are described first. Preference-based approaches to osteoporosis health-outcome measurement are then considered in both clinical and health policy settings. In the clinical setting, direct preference assessments [i.e. visual analogue scale (VAS), time tradeoff (TTO), standard gamble (SG)] using either experienced or described health outcomes have consistently shown significantly lower values for osteoporosis-related health states relative to usual or ideal health. In the health-policy context, preference-classification systems [i.e. EuroQoL (EQ-5D), Health Utilities Index (HUI)] for valuing health in economic studies are reviewed. At present, there is little evidence to guide the choice of one system over another for assessing the cost effectiveness of osteoporosis interventions; however, use of a consistent set of health-state values is essential. Further research is needed to characterise associations between osteoporosis-targeted health-status instruments and preference-based health-outcome measures. In addition, the longitudinal impact of osteoporosis and related fractures on HR-QOL must be documented.

Fractures, Bone↗
PubMed2026

The Anti-Osteoporosis Effects of Panax japonicus via Downregulation of Inflammatory Factors: A Network Pharmacology and Ovariectomized Rat Model Study.

OBJECTIVE: Osteoporosis is a major and growing public health problem characterized by decreased bone mineral density and destroyed bone microarchitecture. Panax japonicus has been clinically used in the treatment of bone diseases, especially osteoporosis. However, there is a lack of study on the mechanism of osteoporosis treatment with Panax japonicus. MATERIALS AND METHODS: A network pharmacology approach was employed to identify the targets of osteoporosis and Panax japonicus. Cytoscape 3.7.2 and DAVID were used to visualize the pharmacological mechanism of Panax japonicus in treating osteoporosis by building up compound-target and protein-protein interaction (PPI) networks and conducting Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. An ovariectomized SD rat osteoporosis model was used to assess the potential therapeutic effect of Panax japonicus in vivo. The biomechanical properties, pathological changes, inflammatory cytokines, bone density, and bone microstructural parameters in rat bone tissue were carefully measured. The biochemical markers of bone metabolism in serum were detected by Enzyme-Linked Immunosorbent Assay (ELISA). RESULTS AND DISCUSSION: Fifty-two active components and sixty-five target genes of Panax japonicus involved in the treatment of osteoporosis were identified. The PPI network revealed IL-6, TNF, NR3C1, IL-1β, CASP3, ESR1, PGR, and AR to be involved in the treatment of osteoporosis with Panax japonicus. Chikusetsusaponin IVa and Radix ginsenoside-Ro were the main saponins found in Panax japonicus. Panax japonicus was found to exert potent preventive effects on osteoporosis by maintaining biomechanical properties, increasing bone mineral density, and protecting the trabecular microstructure in an ovariectomized rat osteoporosis model. Panax japonicus hindered the initiation of osteoporosis induced by ovariectomy by regulating bone metabolism and downregulating the expression of IL-6 and TNF-α. CONCLUSION: Panax japonicus was found to contain 52 compounds and 65 targets in the treatment of osteoporosis. The administration of Panax japonicus could mitigate osteoporosis in rats induced by ovariectomy, and one of the mechanisms was associated with downregulating the expression of inflammatory factors.

Animals↗
PubMedDate not supplied

Health beliefs and attitudes toward the prevention of osteoporosis in older women.

OBJECTIVE: A pilot study to determine health belief factors associated with osteoporosis prevention behaviors in peri-and postmenopausal women. DESIGN: We administered a survey to a convenience sample of 60 women aged 40-95 years old in an urban family practice center and an associated retirement community. The self-reported questionnaire addressed demographics, osteoporosis risk factors, current preventive behaviors for osteoporosis, and health beliefs. RESULTS: The majority of women (89%) believed that osteoporosis is a serious condition, but only 29% perceived a personal susceptibility. Women were less concerned about osteoporosis when compared with cancer, cardiovascular disease, and neurologic disorders. Only 40% of women were taking active measures to prevent osteoporosis. There was no significant relationship between active osteoporosis prevention behaviors and five health belief factors (motivation, barrier, active participant in health care, frustration, and benefit) (p >or= 0.43). However, active behaviors to prevent osteoporosis were found to correlate with the single item "I am worried about developing osteoporosis" (p = 0.03). Most women surveyed would be willing to exercise and take calcium and a multivitamin to prevent osteoporosis. CONCLUSION: Few women are taking active measures to prevent osteoporosis despite their belief that it is a serious condition. Our data suggest that most women do not perceive a personal susceptibility to the disease. Only women who reported actively worrying about developing osteoporosis were more likely to be engaged in significant osteoporosis preventive behaviors.

Adult↗
PubMedDate not supplied

The cost of treating osteoporosis in a managed health care organization.

OBJECTIVE: To measure the differences in direct health care costs and resource utilization among female enrollees in a health maintenance organization who were aged 45 through 65 years and had either osteoporosis or an osteoporosis-related fracture. METHODS: One year of medical and pharmacy claims (October 1, 1998, to September 30, 1999) from a mixed-model health plan located in the Midwest were evaluated. Diagnoses were determined from medical claims with ICD-9 codes specific to either osteoporosis or osteoporosis-related fracture. Aggregate costs specific to osteoporosis were compared to all costs incurred by the members regardless of the disease states. RESULTS: We identified 600 women who had consumed a total of $4.6 million in health care resources and $411,684 in direct costs specifically related to osteoporosis. The highest total average disease-specific costs were found for women with a fracture ($939 per patient per year [PPPY]) compared to those with osteoporosis only ($645 PPPY). Outpatient costs accounted for the highest percentage of mean total annual costs of care, representing up to 38% of the total health care resources consumed. Average medical costs for women with a fracture were highest for the 60 to 64 years age category, the oldest age category in the study population ($17,403 PPPY, P=.0379). Estrogen was the most utilized drug for treatment of osteoporosis, accounting for 41% of the total osteoporosis-specific prescription utilization. CONCLUSION: The costs of care for members with osteoporosis-related fractures were, on average, higher than for women with osteoporosis only. The component costs included outpatient services, inpatient services, and prescription costs. Women not receiving drug therapy for management of osteoporosis incurred slightly higher total health care costs than women who did not receive drug therapy for osteoporosis.

Aged↗
PubMed2004

Validation of the OSTA index for discriminating between high and low probability of femoral neck and lumbar spine osteoporosis among Thai postmenopausal women.

RATIONALE: Bone mineral density (BMD) measurement of postmenopausal women is needed to diagnose osteoporosis. This is an expensive procedure and available in only a few hospitals in Thailand. The Osteoporosis Self-Assessment Tool for Asians (OSTA) index, based on age and weight, has been developed for screening of postmenopausal Asian women to identify women for whom there is little advantage in undergoing bone densitometry. This index was developed for prediction of neck of the femur osteoporosis and did not include spinal osteoporosis, which is also common. Furthermore, the index was based on data from a sample of mainly ethnic Chinese. There is evidence that the BMD of Thai women is significantly higher for the same age and weight than that of women of several other Asian ethnics, thus there is a need to validate the appropriateness of the OSTA index for both femur and spinal osteoporosis among the Thai population. OBJECTIVE: To determine the properties of the OSTA index as a screening tool among postmenopausal women in southern Thailand. PATIENTS: Three-hundred-and-eighty-eight postmenopausal women, with no history of disease or use of drugs associated with secondary osteoporosis and no history of treatment for osteoporosis, attending the postmenopausal clinic or internal medicine out-patient department of Songklanagarind Hospital, a teaching hospital in southern Thailand, between November 2000 and April 2002. METHOD: BMD t-scores of the neck of the femur and lumbar spine were collected retrospectively and a diagnosis of osteoporosis made according to WHO criteria. Sensitivity and specificity and their 95% confidence limits were calculatedfor the dichotomized OSTA index. RESULTS: Thirty-one percent of the women were detected as having osteoporosis, comprising neck of the femur (12 percent) and lumbar spine (31 percent). Twenty nine women (7.5 percent) had evidence of spinal fracture. The OSTA index at the standard cut-point of < or = -1 had a sensitivity and specificity of 0.93 (95% CI: 0.82 - 0.99) and 0.61 (95% CI: 0.56-0.66) respectively for neck of the femur but only 0.80 (95% CI: 0.72-0.87) and 0.70 (95% CI: 0.64-0.75) respectively for lumbar spine. Raising the cut-point to < or = 0 reduced the high false negative rate (0.20) in prediction of lumbar spine osteoporosis to 0.07 (95% CI: 0.03-0.13) and identified 27 percent (95% CI: 23-32 percent) of all women at low risk of osteoporosis at either site. These women may not need to undergo BMD measurement. CONCLUSION: The standard cut-point of the OSTA index could identify most Thai postmenopausal women with osteoporosis of the neck of the femur. However, to improve the sensitivity of detection of osteoporosis of the lumbar spine, the cut-point of < or = 0 may be more appropriate.

Adult↗
PubMed2005

National patterns of calcium use in osteoporosis in the United States.

OBJECTIVE: Although calcium intake is considered integral to appropriate management of osteoporosis, we hypothesized that the recent therapeutic dominance of bisphosphonates in osteoporosis treatment may have led calcium to be neglected as a component of effective management. STUDY DESIGN: Two national databases were used to assess the adequacy of calcium intake in patients with osteoporosis. Trends in reported supplemental calcium use among physician visits by patients with osteoporosis were assessed using nationally representative 1994-2004 IMS HEALTH National Disease and Therapeutic Index data. Quantity of calcium intake, from both supplements and food, among individuals with osteoporosis (n = 38 men and 376 women) was estimated using the 1999-2002 National Health and Nutrition Examination Survey (NHANES). RESULTS: Physician visits for osteoporosis in the United States increased 4.5-fold between 1994 (1.3 million visits) and 2004 (5.8 million visits). During this time the proportion of osteoporosis visits in which bisphosphonates were prescribed increased from 14% to 81%, while reported calcium use fell from 43% to 23% of visits. Among osteoporosis patients in NHANES, 64% reported using calcium-containing supplements. Reported median calcium intake was 433 (interquartile range: 295, 705) mg/d for calcium supplement nonusers and 1,319 (845, 1,874) mg for calcium supplement users. Overall, only 40% of osteoporosis patients had calcium intake exceeding 1,200 mg/d. CONCLUSION: While osteoporosis is increasingly identified and treated with effective medications, calcium is being neglected as a component of osteoporosis management. Despite the fact that the efficacy of new osteoporosis medications depends on adequate calcium intake, reported calcium intake in osteoporosis patients is far below recommended levels.

Bone Density Conservation Agents↗
PubMedDate not supplied

Osteoporosis prevention in young women.

PURPOSE: To assess whether young women who participate in an osteoporosis prevention program based on the Health Belief (Rosenstock, 1966) and Self-Efficacy Models (Bandura, 1977) demonstrate higher levels of knowledge regarding osteoporosis prevention than young women who do not participate in such a program. DESIGN: A classic experimental design with one treatment group and one control group was used to test the efficacy of the osteoporosis prevention program. Pretest data on knowledge, health belief attitudes (7 subscales), and self-efficacy (2 subscales) were collected in the treatment and control groups. SAMPLE: A convenience sample of 31 young college women were randomly assigned to an experimental group or to a control group to receive an osteoporosis prevention program. METHOD: Subjects in the experimental and control groups completed the Osteoporosis Knowledge Test, the Osteoporosis Health Belief Scale, and the Osteoporosis Self-Efficacy Scale (Kim et al., 1991) at two times. The experimental group received an osteoporosis prevention program. MAIN RESEARCH CLASSIFICATIONS: Osteoporosis, Health Belief, Self-Efficacy, Women's Health. FINDINGS: Subjects in the experimental group had significantly higher knowledge and health belief scores after receiving the intervention than their pretest scores while subjects in the control group had no change in scores. CONCLUSION: The osteoporosis program was effective in increasing awareness of osteoporosis prevention in this group of young women. IMPLICATIONS FOR NURSING RESEARCH: The results may be useful for developing young women's awareness and knowledge of osteoporosis prevention. Future research could include developing osteoporosis prevention programs at an earlier age when girls are in grade school and junior high school. Teaching health promotion strategies for bone health is essential to all women across the life span.

Adolescent↗
PubMed2000

The diagnosis and management of osteoporosis.

Osteoporosis is a prevalent disease, which can cause considerable morbidity due to osteoporotic fractures. Knowledge of the cause of osteoporotic bone loss would help implementation of the appropriate treatment. There are two pathogenic mechanisms involved in the development of osteoporosis: 1) achievement of a relatively low peak bone density in young adulthood which increases the risk of osteoporosis because only a modest bone loss later in life results in bone densities in the osteoporotic range, and 2) a rapid bone loss rate at menopause and/or later in life. Most patients exhibiting osteoporosis have some combination of these two pathogenic mechanisms. There are basically two causes for osteoporosis: 1) a normal peak bone mass with rapid bone loss, and 2) low peak bone mass with a normal bone loss rate. Proper management of osteoporosis involves early diagnosis of the disease and appropriate treatments. With respect to diagnosis of osteoporosis, we now have two important diagnostic tools: a) instruments that measure bone density with high precision, and b) serum and urine biochemical markers of bone formation and resorption assays that allows rapid and frequent monitoring of bone turnover rates. Bone density measurements allow the diagnosis of osteoporosis before fractures occur. Biomarkers can identify patients with a high bone turnover, a situation that leads to rapid bone loss. These two diagnostic tools together can help identify osteoporosis in its earliest form so that preventative measures can be instituted. With respect to treatment of osteoporosis, we now have several forms of effective therapies, such as estrogens, bisphosphonates, calcitonins, and vitamin D (and/or active vitamin D metabolites), that are approved for the use in the prevention and/or treatment of osteoporosis. Consequently, most patients with osteoporosis can now be treated with effective therapies that will have a positive impact on the disease.

Adult↗
PubMed2006

Osteoporosis management in patients with rheumatoid arthritis: Evidence for improvement.

OBJECTIVE: Osteoporosis in patients with rheumatoid arthritis (RA) is increasingly recognized as a major comorbidity. We examined past management patterns for glucocorticoid-induced osteoporosis and attempted to improve care through an educational intervention. The goal was to examine the frequency of osteoporosis management in patients with RA treated at a large academic rheumatology practice. METHODS: We performed a structured chart review on randomly selected patients seen during 2004 for RA. Osteoporosis management was defined as a bone mineral density test or receipt of a medication for osteoporosis in the prior 24 months. The frequency of osteoporosis management among our study group was assessed. We also examined how glucocorticoid dosage affected osteoporosis management in adjusted models. RESULTS: We reviewed the records for 193 patients, 99 had not used glucocorticoids in the prior 24 months, and 94 had used them. Of the total study population, 48% had received a bone mineral density test or medication for osteoporosis. Some form of osteoporosis management was present for 64% of patients taking > or =5 mg prednisone for > or =3 months compared with 38% for patients taking none (P = 0.002). Predictors of osteoporosis management included older age, female sex, glucocorticoid dosage, and prior osteoporosis diagnosis or fracture. CONCLUSION: The frequency of osteoporosis management appears to have increased compared with a prior chart review.

Aged↗
PubMed2003

Awareness and health beliefs of women towards osteoporosis.

A population-based survey was conducted to determine the awareness, knowledge of risk factors, and attitudes toward osteoporosis in middle-aged and elderly women in Singapore. Chinese women aged 45 years and above ( n=1,376) living in Teban Gardens (community on the western side of Singapore) were randomly sampled. Household interviews were conducted and questions on socioeconomic status, knowledge of osteoporosis, identification of risk factors for osteoporosis, and health beliefs were assessed. There were 946 (68.8%) women who were postmenopausal and 430 (31.2%) who were not. Fifty-eight percent of the sample had heard of osteoporosis. Women who were younger, better educated, who exercised regularly, or who were single were more likely to have heard of osteoporosis. The main sources of information about osteoporosis were the mass media and friends. The identification of risk factors ranged from fair to good: 85.7% of women identified low calcium intake, 43.7% identified lack of exercise, and 30.5% identified family history of osteoporosis as risk factors for osteoporosis. Most women (79.1%) were concerned about developing osteoporosis but only 15.2% thought that osteoporosis was more serious than cancer. Community-based health education programs on osteoporosis that target a wide audience including the less well educated, could be implemented. Increasing the awareness of osteoporosis and its risk factors may be essential in efforts to decrease the incidence of this disease.

Age Factors↗
PubMed2003

Effect of hospitalist consultation on treatment of osteoporosis in hip fracture patients.

The objective of this study was to determine if hospitalist consultation during admission for hip fracture results in improved treatment for osteoporosis. This was a retrospective chart review, carried out in a university-based academic hospital. Administrative discharge data was used to identify patients discharged between 1 September 1999 and 1 September 2001, discharged with the diagnosis of hip fracture. Eighty-two patient charts were reviewed after exclusion for traumatic and pathologic fractures. Treatment for osteoporosis consisted of medications recommended by the National Osteoporosis Foundation (NOF), including calcium (+/-vitamin D), estrogen, raloxifene, calcitonin, alendronate and risedronate. Osteoporosis treatment improvement was defined as the addition of a medication for osteoporosis that strengthened treatment. Twenty-nine percent of patients in our study received treatment for osteoporosis at the time of discharge from the hospitalization for hip fracture. While 20% received calcium, only 7% received a bisphosphonate. Twelve percent received improvement in osteoporosis treatment from admission to discharge. Those that received hospitalist consultation did not have a significant improvement in osteoporosis treatment (P=0.314), but had significantly more co-morbid illnesses and were significantly older than those receiving no consultation (P<0.05). Identification of osteoporosis as a medical problem was significantly associated with osteoporosis treatment (P<0.05). Potential barriers to hospitalist consultation's effect on osteoporosis treatment included patient age and co-morbidities. Further research is needed to identify and overcome barriers to effective osteoporosis treatment in patients with fractures.

Aged↗
PubMed2004

Health care utilization and expenditures in the United States: a study of osteoporosis-related fractures.

BACKGROUND: More than 1.5 million fractures occur due to osteoporosis each year. This study examines the annual health care utilization and associated expenditures of osteoporotic patients who sustain a new fragility fracture and of those without a new fracture. METHODS AND PROCEDURES: The study sample from commercial claims databases consisted of patients enrolled in US plans between January 1, 1997, and December 31, 2001. Patients with both an osteoporosis diagnosis and a related fracture were classified as "osteoporosis with concurrent fracture"; all other osteoporosis patients were classified as "osteoporosis without concurrent fracture." Annual utilization and expenditures for the concurrent-fracture cohort were compared with those without concurrent fracture, as well as with a group of patients without osteoporosis (controls) that was matched to the concurrent-fracture cohort based on age, gender, US region, health plan type, and length of enrollment. Exponential conditional mean models were used to compute regression-adjusted total expenditures across the groups. The differences in adjusted expenditures were used to generate the economic burden-of-illness estimates. RESULTS: Osteoporosis patients with concurrent fracture incurred more than twice the overall health care expenditures in the study period, compared with those without fracture (US $15,942 vs $6,476), and nearly three times those of the control group (US $15,942 vs $4,658). Approximately 25% of the overall health care expenditures (US $4,014 of $15,942) for the concurrent-fracture group were osteoporosis-related expenditures, leading to the conclusion that comorbid conditions in osteoporosis patients with concurrent fracture contribute significantly to overall health care costs. Some of these comorbidity-related costs were likely due to pain-related disorders, which occurred significantly more frequently in the concurrent-fracture cohort than in the other groups. CONCLUSION: Osteoporosis-related expenditures, particularly those related to fracture, were substantial. However, non-osteoporosis-related expenditures to treat comorbid conditions constituted 75% of the overall health care costs in the year after an osteoporosis-related fracture, which warrants further investigation.

Adolescent↗
PubMed2004

Performance of osteoporosis risk assessment tools in postmenopausal women aged 45-64 years.

Osteoporosis risk factor assessment is of uncertain utility in women under 65 years of age. Previous comparative studies of osteoporosis risk assessment tools were not stratified by age. We compared the discriminatory ability of three previously validated osteoporosis risk assessment tools in a referral population of postmenopausal women aged 45-64 years (n=2539) and aged 65-96 years (n=1496) seen at a university-based outpatient osteoporosis center in Belgium. Risk scores for the Osteoporosis Self-assessment Tool, Osteoporosis Risk Assessment Instrument, and Simple Calculated Osteoporosis Risk Estimation were calculated for each patient. The reference standard was osteoporosis at the femoral neck, defined as a T-score < or =-2.5 based on bone mineral density measured by dual energy X-ray absorptiometry. Osteoporosis was present in 139 of 2539 (5.5%) women aged 45-64 years and 241 of 1496 (16.1%) women aged 65 years or older. The tools had similar overall discriminatory ability to identify women with osteoporosis [area under the ROC curve 0.750-0.768, P=0.23 for women aged 45-64 years; area under the ROC curve 0.745-0.762, P=0.06 for women aged 65 years or older (P>0.05 indicates no difference among tools)]. The likelihood ratios for the high-risk score categories ranged from 3.60 to 6.73 for the younger women and 3.45 to 6.99 for the older women when different score thresholds were set to maximize the performance of each tool in each age group. We conclude that the diagnostic accuracy of three osteoporosis risk assessment tools was similar in postmenopausal women aged 45-64 years and women aged 65 years or older. Use of structured risk assessment tools to identify women at high risk of osteoporosis in the early postmenopausal period warrants further study. Of the three tools evaluated, the OST is the simplest and has the best potential for use in clinical practice.

Aged↗
PubMed2004

Osteoporosis and renal dysfunction in a general population exposed to cadmium in China.

Osteoporosis is a common metabolic disease characterized by low bone mass and microarchitectural deterioration of bone tissue. Many factors are involved in the occurrence of osteoporosis. Cadmium can cause both osteomalacia and osteoporosis and these effects have long been investigated through various epidemiological or experimental studies. The present study examines a possible relationship between cadmium nephropathy and its effects on the skeleton in populations living in a polluted area in southeast China. Monophoton absorptiometry was used to measure bone mineral density in the population and the Z score (the number of SD from the difference between the measured bone density of the individual and the group mean value for sex- and age-matched controls) was introduced to define osteoporosis (Z score < -2). Osteoporosis caused by cadmium exposure was demonstrated in this study on a general population environmentally exposed to cadmium in China. It was found that there were significant differences in the prevalence of osteoporosis among the different urinary cadmium groups (chi2 = 18.84, P = 0.0008). The linear trend test gave chi2 = 16.281, P = 0.00005. There was a dose-response relationship between cadmium exposure (urinary cadmium) and prevalence of osteoporosis. Of 31 subjects with osteoporosis, 23 subjects were suffering from renal dysfunction. The prevalence of renal dysfunction (74.19%) was significantly higher than that in those without osteoporosis (chi2 = 16.53, P < 0.001). Stratum analysis was performed to further assess the relationship between bone damage and renal impairment caused by cadmium. There was a significant difference between those with and without tubular damage (chi2 = 19.92, P = 0.000) but not in those with and without glomerular damage (chi2 = 0.08, P = 0.114). This showed that glomerular dysfunction plays a smaller role than tubular dysfunction in the causation of bone damage. It was found that the prevalence of osteoporosis increases with increasing values of parameters of tubular damage. Osteoporosis caused by cadmium is thus related to kidney dysfunction and especially to tubular damage and its severity but not to glomerular damage. The present study has thus demonstrated the combined adverse effects (osteoporosis and renal dysfunction) caused by environmental exposure to cadmium for the first time in Asia outside the endemic area in Japan.

Adult↗
PubMed2006

The need for increasing awareness of osteoporosis in men.

Awareness of the need to evaluate men for osteoporosis is almost nonexistent among health care providers. Osteoporosis is a silent disorder in both men and women until fracture occurs. Yet, screening for osteoporosis is particularly important in men because fragility fractures are more likely to lead to fatal consequences than in women. Without a diagnosis of osteoporosis, treatment interventions that can prevent fractures in men are not initiated. Advancement of better health outcomes for men at risk for osteoporosis begins with a greater awareness of the need for osteoporosis screening and treatment whenever appropriate. The primary objective of this review article is to report on study findings that document the need for more clinical attention to osteoporosis in men. It is important to know how osteoporosis in men differs from osteoporosis in women, the classification into type 1 and type 2 primary osteoporosis and secondary osteoporosis, and how to measure bone mineral density in men. In addition, there is a great need to develop evidence-based guidelines for the diagnosis and treatment of osteoporosis in men.

Absorptiometry, Photon↗
PubMed2001

How well are community-living women treated for osteoporosis after hip fracture?

OBJECTIVES: To examine whether women with recent hip fracture are receiving adequate treatment for osteoporosis. To examine patient and physician characteristics associated with adequate treatment for osteoporosis. DESIGN: Cross-sectional study with prospective and retrospective data collection. SETTING: Hartford County, Connecticut. PARTICIPANTS: Sixty community-living women age 65 and older identified from hospital databases with an International Classification of Diseases, Ninth Revision, code for nontraumatic hip fracture. MEASUREMENTS: Treatment for osteoporosis, healthcare utilization, primary care physician's specialty, Katz activities of daily living scale, Lawton instrumental activities of daily living scale, Short Portable Mental Status Questionnaire, Medical Outcomes Study Short Form 12, and Physical Activity Scale for the Elderly. RESULTS: Only 13% of participants were receiving adequate treatment for osteoporosis as defined by the National Osteoporosis Foundation (NOF) guidelines for osteoporosis, 47% reported partial treatment that did not meet NOF guidelines, and 40% were receiving no treatment for osteoporosis. No patient or physician characteristics were associated with the adequacy of treatment for osteoporosis in this small sample. CONCLUSIONS: Few of the women in our study were receiving adequate treatment for osteoporosis after hip fracture. There exists an opportunity to educate postmenopausal women and physicians about the importance of treatment for osteoporosis to increase the number of women offered and receiving osteoporosis treatment, especially older postmenopausal women with established, severe osteoporosis as evidenced by recent hip fracture.

Activities of Daily Living↗
PubMed2003

Prevention and treatment of osteoporosis in primary care offices.

OBJECTIVES: To examine the use of medications for prevention and treatment of osteoporosis and testing for osteoporosis for postmenopausal women in primary care offices. METHOD: This cross-sectional survey study uses electronic medical records data over a 1-year period (January-December 2000) of women >/=55 years of age, either with (n = 31) or without (n = 782) a diagnosis of osteoporosis, who were active patients of two family practice and three gynecology offices in Delaware (n = 813). It presents documented use of medications for prevention or treatment of osteoporosis (estrogens, bisphosphonates, raloxifene, calcitonin, or calcium) and receipt of bone mineral density (BMD) testing. RESULTS: Of women without osteoporosis, 27.4% were taking prescription osteoporosis-related medications, and 32.9% were taking prescription medications or calcium supplements or both. Women were less likely to be taking these medications if they were >70 years of age (adjusted odds ratio [OR] = 0.42, p < 0.01) or were patients of gynecologists (adjusted OR = 0.48, p < 0.01). They were not more likely to take medications if they had risk factors for osteoporosis. Of women with osteoporosis, 58.1% were taking prescription osteoporosis-related medications, and 61.3% were taking prescription medications or calcium or both. BMD testing was done for 34% of all women and was not more likely for those with risk factors. CONCLUSIONS: In family medicine and gynecology offices, most postmenopausal women do not take preventive medications or get testing for osteoporosis. Even among those with known osteoporosis, many do not take medications for treatment of their osteoporosis.

Absorptiometry, Photon↗