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PubMed2003

Evaluation and management of osteoporosis following hospitalization for low-impact fracture.

OBJECTIVE: To evaluate the pattern of osteoporosis evaluation and management in postmenopausal women who present with low-impact (minimal trauma) fracture. DESIGN: Retrospective chart review of patients admitted with a fracture in the absence of trauma or bone disease. Telephone follow-up survey was conducted at 12 months after discharge to collect information on physician visits, pharmacological therapies for osteoporosis, functional status, and subsequent fractures. PATIENTS/PARTICIPANTS: Postmenopausal women admitted to a hospital in St. Paul, Minnesota between June 1996 and December 1997 for low-impact fractures were identified. Low-impact fracture was defined as a fracture occurring spontaneously or from a fall no greater than standing height. Retrospective review of 301 patient medical records was conducted to obtain data on pre-admission risk factors for osteoporosis and/or fracture, and osteoporosis-related evaluation and management during the course of hospitalization. Follow-up 1 year after the incident fracture was obtained on 227 patients. MEASUREMENTS AND MAIN RESULTS: Two hundred twenty-seven women were included in the study. Osteoporosis was documented in the medical record in 26% (59/227) of the patients at hospital discharge. Within 12 months of hospital discharge, 9.6% (22/227) had a bone mineral density test, and 26.4% (60/227) were prescribed osteoporosis treatment. Of those who were prescribed osteoporosis treatment, 86.6% (52/60) remained on therapy for 1 year. Nineteen women suffered an additional fracture. Compared to women without a prior fracture, women with at least 1 fracture prior to admission were more likely to have osteoporosis diagnosed and to receive osteoporosis-related medications. CONCLUSION: Despite guidelines that recommend osteoporosis evaluation in adults experiencing a low-trauma fracture, we report that postmenopausal women hospitalized for low-impact fracture were not sufficiently evaluated or treated for osteoporosis during or after their hospital stay. There are substantial opportunities for improvement of care in this high-risk population to prevent subsequent fractures.

Aged↗
PubMed2003

Diagnosis and treatment of osteoporosis in patients with vertebral compression fractures.

OBJECTIVES: To determine whether patients with vertebral compression fractures are diagnosed with or treated for osteoporosis. DESIGN: Retrospective cohort study. SETTING: Two primary care practices in Massachusetts. PARTICIPANTS: Two hundred six patients with vertebral compression fractures noted on routine radiographs in 1997-1998. MEASUREMENTS: Percentage of patients diagnosed with osteoporosis and treated with prescription medications (estrogen, bisphosphonates, raloxifene, or calcitonin). Factors associated with missed osteoporosis diagnosis and treatment, including risk factors for osteoporosis, comorbidities, vertebral fracture severity, and processes of care communication were also examined. RESULTS: The median patient age was 76, 71% of the cohort was female, and 13% of patients had a history of corticosteroid use. Thirty-eight percent of subjects (46% of women and 19% of men) were diagnosed with osteoporosis and 32% (39% of women and 14% of men) received prescription medications for osteoporosis. Of women who were diagnosed with osteoporosis, 69% received prescription medications. In adjusted analyses women younger than 50 (adjusted odds ratio (AOR) = 0.09; 95% confidence interval (CI) = 0.01-0.71) and 90 and older (AOR = 0.27; 95% CI = 0.08-0.98) were less likely to be diagnosed with osteoporosis, whereas women with a prior hip or radial fracture (AOR = 3.65; 95% CI = 1.28-10.38) or back pain (AOR = 2.84; 95% CI = 1.38-5.85) were more likely to be diagnosed with osteoporosis. CONCLUSIONS: Physicians frequently did not diagnose osteoporosis in primary care patients with vertebral fractures, missing an important preventive opportunity for patients at high risk for future fractures. Efforts targeted to improving diagnosis of osteoporosis could improve patient care.

Aged↗
PubMed2004

Welfare implications of avian osteoporosis.

Cage layer fatigue was first noticed after laying hens began to be housed in cages in the mid-20th century. Hens producing eggs at a high rate were most susceptible to the disease. Early research revealed that cage layer fatigue was associated with osteoporosis and bone brittleness. Severe osteoporosis leads to spontaneous bone fractures commonly in the costochondral junctions of the ribs, the keel, and the thoracic vertebrae. Vertebral fracture may damage the spinal cord and cause paralysis. Osteoporosis appears to be inevitable in highly productive caged laying hens. The condition can be made worse by metabolic deficiency of calcium, phosphorus, or vitamin D. Hens in housing systems that promote physical activity tend to have less osteoporosis and rarely manifest cage layer fatigue. Genetic selection may produce laying hens that are less prone to bone weakness. The welfare implications of osteoporosis stem from pain, debility, and mortality associated with bone fracture. The chicken has well-developed neural and psychological systems specialized to respond to pain associated with trauma and inflammation. Although studies on the chicken have not focused on pain due to bone fracture, physiological and behavioral similarities to other species allow inference that a hen experiences both acute and chronic pain from bone fracture. There is little information on osteoporosis in commercial caged layer flocks, however, evidence suggests that it may be widespread and severe. If true, most caged laying hens suffer osteoporosis-related bone fracture during the first laying cycle. Osteoporosis also makes bone breakage a serious problem during catching and transport of hens prior to slaughter. Estimates of mortality due to osteoporosis in commercial caged layer flocks are few, but range up to a third of total mortality. Many of these deaths would be lingering and attended by emaciation and possibly pain. Osteoporosis-related bone breakage during processing has reduced the marketability of spent caged laying hens, contributing to the need to develop humane on-farm killing methods to support alternative means of spent hen disposition. Overall, the evidence indicates that cage layer osteoporosis is a serious animal welfare problem. A determined effort must be made to make the laying hen no longer susceptible to the harmful effects of excessive bone loss.

Animal Feed↗
PubMed1999

Spinal curvatures and quality of life in women with vertebral fractures secondary to osteoporosis.

STUDY DESIGN: A prospective cross-sectional case-control study. OBJECTIVES: To compare spinal curvatures in women with osteoporosis and control subjects with a new instrument, the curviscope. SUMMARY OF BACKGROUND DATA: Few instruments are available for measuring spinal curvatures in the sagittal plane. Most of them have poor reproducibility, and they have been poorly investigated in osteoporosis. METHODS: Ninety-eight postmenopausal women were evaluated. They were divided into two groups, according to their bone status: women with osteoporosis with at least one vertebral fracture (n = 51) and control subjects (n = 47). Women with osteoporosis were divided into two subgroups, according to the delay since the last vertebral fracture had occurred (i.e., more or less than 3 months). Quality of life was assessed by using a generic instrument, the Nottingham Health Profile, in patients with osteoporosis only. RESULTS: Reproducibility of the curviscope was satisfactory. For kyphosis measurements, the coefficients of variation were 2.8% and 2.4% in control subjects and women with osteoporosis, respectively. Kyphosis values were significantly higher in women with osteoporosis than in age-matched control subjects (63 degrees +/- 13 degrees vs. 52 degrees +/- 11 degrees, respectively; P < 0.005). Nottingham Health Profile scores were significantly different (P < 0.05) in women with osteoporosis with a recently diagnosed vertebral fracture, compared with other women with osteoporosis in two aspects, physical mobility and energy. Kyphosis measurements were significantly correlated with age in the whole group (r = 0.26; P < 0.05). In the Nottingham Health Profile, physical mobility was significantly correlated with kyphosis (r = 0.35; P < 0.05). CONCLUSIONS: The curviscope is a reliable tool, particularly useful in the assessment of osteoporosis. Moreover, kyphosis angles measured with the curviscope are markedly increased in women with osteoporosis, compared with control subjects. Finally, an increase of kyphosis angles is associated with decreased physical mobility.

Aged↗
PubMed2005

Utility of testing for monoclonal bands in serum of patients with suspected osteoporosis: retrospective, cross sectional study.

OBJECTIVE: To determine whether measuring monoclonal bands (M component) in serum should be part of the investigation of patients referred to osteoporosis clinics. DESIGN: Retrospective, cross sectional, observational study. SETTING: Referral centre for osteoporosis in a university hospital, Denmark. PARTICIPANTS: 799 people (685 women) aged 19 to 94 years newly referred with suspected osteoporosis. MAIN OUTCOME MEASURES: Proportion of patients fulfilling the Nordic Myeloma Study Group definition for target condition and proportion of patients with other important haematological conditions. RESULTS: 4.9% (18 of 366) of patients with osteoporosis and 2.2% (9 of 408) of patients without osteoporosis had M component in serum (chi2 = 3.66, P = 0.04). Multiple myeloma was diagnosed in three patients with osteoporosis (absolute risk 0.8%, 95% confidence interval 0.11% to 1.7%). The relative risk of multiple myeloma in patients presenting with osteoporosis was 75 (10 to 160). As a diagnostic test for multiple myeloma in patients with osteoporosis, M component in serum had a specificity of 95.0% and a positive predictive value of 17.6%. 122 blood electrophoreses were carried out for each case of multiple myeloma diagnosed. All patients with multiple myeloma had a history of fragility fractures. If lymphoma was included as a target condition, the specificity increased to 95.3% and the positive predictive value increased to 23.5%. Monoclonal gammopathy of undetermined significance was diagnosed in 13 (3.6%) participants with osteoporosis and in eight (2.0%) participants with normal bone mineral density or osteopenia. CONCLUSIONS: Patients presenting with osteoporosis should be tested for M component in serum, as 1 in 20 patients with newly diagnosed osteoporosis had multiple myeloma or monoclonal gammopathy of undetermined significance.

Adult↗
PubMed2005

Interventions to improve osteoporosis treatment following hip fracture. A prospective, randomized trial.

BACKGROUND: Treatment of osteoporosis following a hip fracture has been notoriously poor. Many efforts have been made to improve treatment rates. The purpose of this study was to determine whether a perioperative inpatient intervention program, involving patient education and providing a list of questions for the primary care physician, increased the percentage of patients in whom osteoporosis was addressed following a hip fracture. METHODS: A prospective, randomized trial involving eighty patients who had been admitted to an academic medical center with a low-energy hip fracture was conducted. During their hospitalization, the study group patients were engaged in a fifteen-minute discussion regarding the association between osteoporosis and hip fractures, the efficacy of dual-energy x-ray absorptiometry scans in the diagnosis of osteoporosis and of bisphosphonates in its treatment, and the importance of medical follow-up for osteoporosis management. These patients were also provided with five questions regarding osteoporosis treatment to be given to their primary medical physician, and they were reminded about the questions during a follow-up telephone call six weeks later. The patients in the control group received a brochure describing methods for preventing falls. Both groups were contacted by telephone at six months after discharge to determine whether osteoporosis had been addressed. Positive indicators of intervention included assessment of bone mineral density with dual-energy x-ray absorptiometry and initiation of antiresorptive therapy. RESULTS: The average age in each group was eighty-two years, and 78% of the patients were female. Four patients in each group did not survive through the six-month follow-up period and were excluded from the trial. Fifteen (42%) of the thirty-six patients who had been randomized to the study group, compared with only seven (19%) of the thirty-six patients in the control group, had their osteoporosis addressed by their primary physician. This difference between the groups was significant (p = 0.036). CONCLUSIONS: Patients who were provided with information and questions for their primary care physician about osteoporosis were more likely to receive appropriate therapeutic intervention than were patients who had not received the information and questions. Orthopaedic surgeons have a unique opportunity to improve the rate of osteoporosis treatment in the perioperative period following a hip fracture by educating patients and directing them toward channels for long-term osteoporosis management.

Accidental Falls↗
PubMed2005

Male osteoporosis: new trends in diagnosis and therapy.

Osteoporosis is a common condition in men affecting approximately 2 million males in the US. Compared with women, osteoporosis develops later in life and the incidence of osteoporosis-related fractures is lower in men. The morbidity and mortality associated with osteoporotic fractures are much greater in men compared with women, and secondary causes of osteoporosis are more frequently (in approximately 50% of cases) identified in men compared with women with osteoporosis. Excessive alcohol consumption, glucocorticoid excess and hypogonadism are the most commonly identified causes. Primary osteoporosis in men has been linked to changes in sex steroid secretion, the growth hormone-insulin-like growth factor-1 (GH-IGF-1) axis and the vitamin D-parathyroid hormone (PTH) 25-hydroxyvitamin D [25(OH)D]-PTH system. Diagnosing osteoporosis in men is complicated by an ongoing debate on whether to use sex-specific reference values for bone mineral density (BMD) or female reference values. The International Society for Clinical Densitometry recommended using a T score of -2.5 or less of male reference values to diagnose osteoporosis in men who are > or =65 years of age. However, this definition is yet to be validated in terms of fracture incidence and prevalence. Ensuring adequate calcium and vitamin D intake is the cornerstone of any regimen aimed at preventing or treating osteoporosis in men. Bisphosphonates are currently the therapy of choice for treatment of male osteoporosis. A short course of parathyroid hormone (1-34) [teriparatide] may be indicated for men with very low BMD or in those in whom bisphosphonate therapy is unsuccessful. The use of testosterone-replacement therapy for the prevention and treatment of male osteoporosis remains controversial but likely to benefit osteoporotic men with evident hypogonadism.

Aged↗
PubMedDate not supplied

Osteoporosis among male Saudi Arabs: a pilot study.

BACKGROUND: Little attention has been paid to the problem of male osteoporosis in Saudi Arabia. In this prospective study we assessed the prevalence of male osteoporosis among Saudi Arabs. SUBJECTS AND METHODS: We studied Saudi Arabian males >50 years of age attending outpatient clinics at King Fahd Hospital of the University, Al-Khobar, between 1 May 2005 and 30 January 2006. We determined body mass index (BMI) and tests were done to rule out secondary osteoporosis. All subjects had a bone mineral density (BMD) measurement of the hip area and the lumbar spine using dual energy X-ray absorptiometry (DEXA). A T-score of < or = -2.5 SD that of young, healthy adults was taken as osteoporotic and scores between -1 to -2.5 SD were taken as osteopenic. RESULTS: One hundred fifteen patients (mean age, 61.8+/-0.75 years; range, 50 to 76 years) had a mean BMI of 24.7+/-0.35 (range, 18.5 to 31). Based on hip scans, the prevalence of osteoporosis was 24.3%. Sixty- four percent were osteopenic. Based on scans of the lumbar spine, the prevalence of osteoporosis was 37.4% and 33.9% were osteopenic. Spinal osteoporosis was more common than hip osteoporosis. CONCLUSIONS: Our study indicates that the prevalence of osteoporosis among Saudi Arabian males is higher than among Western males. More studies are needed to determine the national prevalence of male osteoporosis. It is recommended that serious measures to be undertaken to prevent male osteoporosis to stop any future epidemic of catastrophic osteoporosis-related fractures.

Absorptiometry, Photon↗
PubMedDate not supplied

Risk assessment for osteoporosis by quantitative ultrasound of the heel in ankylosing spondylitis.

OBJECTIVE: The aim of this cross-sectional cohort study is to assess the potential of quantitative ultrasound (QUS) of the calcaneus in pre-screening for vertebral/non-vertebral fractures, and in discriminating osteoporotic from normal bone density in patients with ankylosing spondylitis (AS); a second objective is to determine the prevalence of osteoporosis using dual-energy X-ray absorptiometry (DEXA) in this patient group. RESULTS: Included are 50 consecutive AS patients with no history of osteoporosis: mean (SD) age 52 (12) yrs, range 26-75 yr; female/male ratio 15/35. The mean (SD) DEXA T score in the lumbar spine (AP view) was -0.82 (1.73), mean (SD) DEXA T score in femoral neck -1.46 (1.12). The mean (SD) calcaneal QUS T score was -0.73 (0.95). In our population of AS patients the prevalence of femoral neck osteoporosis according to the WHO definition (DEXA T < -2.5) was 20%. Osteoporosis criteria were met at the femoral neck in 10 (20%) patients, and 7 of them (70%) were correctly diagnosed using QUS, with T < -1.0 as cut-off value; normal bone density at the femoral neck was found in 15 AS patients (30%), yet in 2 of them the calcaneal QUS T was < -1.0. In AS the 20% pretest probability of having femoral neck osteoporosis increased using calcaneal QUS, with a cut-off level T < -1.0 (70% sensitivity, 68% specificity), and then rose to 35% as the predictive value of a positive test, yielding a net result of QUS testing of +15%. The predictive value of a negative QUS test result was 90%, which makes QUS applicable to exclude severe osteoporosis. Vertebral and/or non-vertebral fractures occurred in 12 out of 50 AS patients (24%); 5 of them (10%) were associated with osteoporosis as defined by WHO criteria measured via DEXA. CONCLUSION: The performance of QUS is similar to DEXA in finding patients with osteoporosis-associated fractures: the sensitivity of QUS T < -1.0 in finding the fracture is 80%, and the sensitivity of femoral neck DEXA T < -2.5 in finding fractured patients is 60%. We conclude that both osteoporosis and fractures are common sequelae in AS. Calcaneal QUS offers a promising approach to screen for osteoporosis, and may be applied to exclude osteoporosis-associated high fracture risk in AS.

Adult↗
PubMed2004

[Bone histology in postmenopausal osteoporosis--variations in cellular activity].

AIM: Modern understanding of the etiology of postmenopausal osteoporosis is based on the imbalance between bone resorption and formation due to estrogen deficiency, which may take several forms and combinations of decreased and/or increased activity of both or one cell type. Studies of postmenopausal osteoporosis have pointed to the existence of heterogeneity in the remodeling imbalance. Bone histology analyzed in a group of women with established postmenopausal osteoporosis undergoing bone biopsy is part of the diagnostic procedure. Data were compared and grouped according to the published histomorphometric classification of postmenopausal osteoporosis. METHODS: The study included 43 postmenopausal women aged 44-71 years with osteoporosis established by densitometry of the lumbar spine and hip. Secondary causes of osteoporosis were ruled out. Full thickness transiliacai bone biopsy specimens were obtained after double labeling regime with oxytetracycline (Geomycin, Pliva). Biopsy specimens were processed for undecalcified embedding in resin and sections stained by Goldner trichrome and toluidine blue, or used for fluorescence microscopy. A grid attached to the microscope eyepiece was used for histomorphometry. The following parameters were assessed according to the recommendations of the American Society for Bone and Mineral Research: bone volume (BV/TV, %), osteoid surface (OS/BS, %), osteoblast surface (Ob. S/BS, %), osteoid volume (OV/BV, %), osteoid thickness (O. Th, m), osteoclast surface (Oc. S/BS, %), mineral apposition rate (MAR, m/day). Thus obtained data were compared to published reference data for normal healthy population and also expressed as z-scores (the number of standard deviations by which the value differs from the mean of the normal age and sex matched controls). The study was approved by the hospital ethics committee. All patients signed an informed consent to take part in the clinical study. DISCUSSION: Histomorphometric analysis of bone biopsy demonstrated that on an average bone resorption, i.e. osteoclast surface, was considerably increased and osteoid volume moderately increased. The remaining histomorphometric parameters studied were generally normal for age and sex as compared to the published reference data. Increased osteoclast surface in 65% of patients indicated that bone loss was an active and prevailing process in these postmenopausal women, which was considerably more pronounced than in the normal age-matched population. Results of the histomorphometric analysis were categorized according to the published classification of postmenopausal osteoporosis. The percentage of patients in each group differed from literature data, most probably due to the sample size and choice. None of the patients had histomorphometric features of reduced osteoblastic and osteoclastic activity, but in 37% of postmenopausal women osteoclastic activity was increased while osteoblastic activity was normal, a feature not described in the original histomorphometric classification of postmenopausal osteoporosis. CONCLUSIONS: Histomorphometric analysis of bone biopsy in women with postmenopausal osteoporosis revealed bone resorption as a predominant finding. Different groups were recognized based on the diversity of bone cell activity. The difference in the frequencies in study groups, and observation of a distinct group not included in the histomorphometric classification of postmenopausal osteoporosis probably resulted from sample size and nonspecific population traits. Histomorphometric analysis of bone in postmenopausal osteoporosis is an important contribution to better understanding of this most common bone disorder.

Adult↗
PubMed2005

Effectiveness of an osteoporosis intervention among older adults residing in assisted living facilities.

OBJECTIVES: To describe demographic and clinical risk factors for osteoporosis among persons aged 60 years and older residing in assisted living facilities and to compare the frequency of bone-mineral density (BMD) testing and initiation of pharmacotherapy for osteoporosis (prevention/treatment) in both a control and experimental cohort. DESIGN: Prospective cohort study. SETTING: Sixteen separate assisted living facilities from November 2001 through July 2002. PARTICIPANTS: Assisted living facility ambulatory residents (N = 111) aged 60 years and older. INTERVENTION: Based on the subject's risk factors for osteoporosis and FRACTURE Index score (female subjects only), written recommendations were made from a multidisciplinary team to increase the percentage of residents evaluated (via central dual-energy x-ray absorptiometry [DEXA] scan) and/or treated for osteoporosis. MAIN OUTCOME MEASURES: FRACTURE Index was calculated on all female participants and reported with BMD or without BMD results by convention. An investigator-developed osteoporosis risk-factor assessment questionnaire was used to evaluate risk factors present for each participant. Numbers of subjects being evaluated for osteoporosis via DEXA scan and numbers of subjects having pharmacotherapy altered to prevent or treat osteoporosis were recorded. RESULTS: One hundred eleven older adults (average age 84 [range 60-94], SD = 6.5 years) participated in the study. As a group the female cohort with no known previous diagnosis of osteoporosis were at high risk for fracture over the next five years as evidenced by an average FRACTURE Index score of 6.6 and 7.2 (control and intervention group, respectively) without BMD, and 9.9 and 10.3 (control and intervention group, respectively) with BMD, respectively. At study end, a significant number of participants in the intervention group had initiated the use of calcium or vitamin D supplements (P = 0.016 and P = 0.031, respectively). The initiation of bisphosphonates in eight subjects over the six-month study period was also significant (P = 0.008) in the intervention group. No significant changes in the use of calcium or vitamin D or specific osteoporosis therapies were realized in the control group. In the intervention group, physician contact did not result in a significant increase in the numbers of participants receiving a BMD evaluation. CONCLUSION: As a whole, residents residing in assisted living facilities are at high risk of having osteoporosis and/or sustaining a fracture. When assessment of osteoporosis and fracture risk is communicated to a physician, use of therapies aimed to improve bone health increases. In this study, there was a significant increase in the use of calcium, vitamin D, and bisphosphonates in the intervention cohort. However, physician contact did not result in more participants receiving a BMD evaluation.

Journal Article↗
PubMed2006

Epidemiology, treatment and costs of osteoporosis in Germany--the BoneEVA Study.

INTRODUCTION: In Germany, accurate data on the prevalence and treatment of osteoporosis, as well as the cost of this illness, are not available. The aim of this study is to give a valid estimation of these items for the year 2003. METHODS: Routine data from a German sickness fund covering 1.5 million beneficiaries and billing data for outpatient visits were used to obtain estimates of prevalence for osteoporosis. Claims data for patients with osteoporosis (M80, M81) or an osteoporosis-related fracture diagnosis (S22, S32, S42, S52, S72, S82) or treatment with anti-osteoporosis drugs were examined. Costs were calculated from the perspective of the German health insurance system and the German nursing care insurance system, respectively. Only direct costs of osteoporosis were considered. RESULTS: In 2003, 7.8 million Germans (6.5 million women) were affected by osteoporosis. Of them, 4.3% experienced at least one clinical fracture. Only 21.7% were treated with an anti-osteoporosis drug. The total direct costs attributable to osteoporosis amounted to euros 5.4 billion. CONCLUSION: This study confirms that osteoporosis is underdiagnosed, undertreated and imposes a considerable economic burden on the health system in Germany. Effective strategies for the prevention and management of this disease are needed.

Age Distribution↗
PubMed2004

Osteoporosis prevalence and levels of treatment in primary care: the Australian BoneCare Study.

UNLABELLED: The level of recognition and treatment of osteoporosis is not well characterized in primary care. In data from a large sample of postmenopausal women attending 927 primary care physicians, 29% of women reported one or more fractures after menopause. The great majority (72%) were not on any osteoporosis-specific therapy. INTRODUCTION: Osteoporosis is often first recognized at the time of a low-trauma fracture. However, by this stage, the risk of subsequent fractures has already risen substantially. Moreover, in many countries, only a small proportion of women, who have already sustained fractures, receive a treatment shown to reduce this increased risk of further fractures. MATERIALS AND METHODS: This project was initiated to examine the prevalence of osteoporotic fractures, risk factors for osteoporosis, and use of antifracture therapy among postmenopausal Australian women. More than 88,000 women from 927 primary care physicians returned over 69,358 surveys. Of these, 57,088 reported the presence of a postmenopausal fracture or risk factors. RESULTS: Among these randomly selected postmenopausal women, 29% reported having had one or more low-trauma fractures after menopause (44% substantiated in current records). One-third of these women reported multiple fractures. The prevalence of all types of fractures, except rib and ankle, increased with age and low body weight. Those who reported fractures were also more likely to report early menopause, corticosteroid use, and a family history of osteoporosis. Moreover, those with vertebral fractures were more likely to record height loss, kyphosis, and back pain. Physical inactivity, low calcium intake, and smoking had no consistent relationship with any fracture outcome. Of the women who reported a fracture after menopause, only 28% were on any specific therapy for osteoporosis, and 7% were on calcium alone. Of those who had been told they had osteoporosis by a doctor, 40% were receiving specific osteoporosis therapy. CONCLUSIONS: In this large study of postmenopausal Australian women attending primary care physicians, 29% reported at least one low-trauma fracture after menopause. Less than one-third of these women were on specific treatment for osteoporosis, and only 40% were ever told they had osteoporosis. Therefore, osteoporotic fractures are common in postmenopausal Australian women, and few, despite their substantially increased risk of further fractures, are on any specific anti-osteoporotic therapy. These data support the need for more effective education for the community and medical practitioners of the clinical significance of osteoporotic fractures and alternatives for treatment.

Age Factors↗
PubMed1998

[Economic aspects of osteoporosis].

BACKGROUND: The objective of this study was to evaluate expenditures and efficacy of osteoporosis treatment in the Czech Republic (CZ) (1.38 million women and 0.99 million men > 55 years of age). METHODS AND RESULTS: Demographic data, incidence of hip fractures and prevalence of osteoporosis and osteopenia in Czech women and men, cost burden to healthcare agencies due to hip fractures and costs of diagnostic procedures, preventive measures and therapies of osteoporosis were obtained from published data and from database of the main health insurance agency (VZP) and the State Institute for Drug Control. The direct costs for treatment of hip fractures in the CZ in 1997 averaged Kc (Czech Crown) 2.5 billion, diagnosis of osteoporosis, Kc 150 million, prevention of osteoporosis using hormone replacement therapy, Kc 66 million, and treatments of osteoporosis which has been applied to less than 5% of osteoporosis patients, 482 million. However, despite the continuously increasing expenditures for treatments of osteoporosis, the incidence of hip fractures doubled in the last 10 years. This is mainly due to increased life expectancy in Czech women and men. CONCLUSIONS: The results of this first economic evaluation of diagnosis, treatment and consequences of osteoporosis in the CZ indicate a need for conceptual decisions in both treatment and prevention of osteoporosis.

Aged↗
PubMed2003

Low frequency of treatment of osteoporosis among postmenopausal women following a fracture.

BACKGROUND: Osteoporosis is a major cause of morbidity. Treatment of osteoporosis reduces the risk of fracture, particularly for postmenopausal women with a history of fracture. METHODS: A retrospective study was conducted using the automated databases of 7 health maintenance organizations to evaluate the use of drugs recommended for secondary prevention of osteoporotic fracture. Women 60 years and older with an inpatient or outpatient diagnostic code for a fracture of the hip, vertebra, or wrist between October 1, 1994, and September 30, 1996, and at least 1 year of continuous enrollment with a drug benefit plan following the date of fracture, were identified. The frequency of use of medications for the treatment of osteoporosis (estrogen replacement therapy, bisphosphonates, and calcitonin) during the 1-year period following the date of the initial fracture was estimated overall and according to patient age, fracture site, and year of fracture. RESULTS: During the study period, 3492 women 60 years and older were diagnosed with a fracture of the hip, vertebra, or wrist, and met the inclusion criteria. Of these patients, 822 (24%) received a drug for osteoporosis treatment during the year following the fracture. The proportion of women receiving treatment for osteoporosis was approximately 2-fold higher among those with a fracture of the vertebra (44%) than among those with a fracture of the hip (21%) or wrist (23%) (P<.001). Of the 2605 women who had not been treated for osteoporosis in the 90 days before a fracture, 14% received treatment for osteoporosis in the year following a fracture. Increasing age was associated with a reduced likelihood of receiving osteoporosis treatment (P<.001). CONCLUSIONS: Most of the older women who had experienced a fracture of the hip, vertebra, or wrist did not receive drug treatment for osteoporosis within 1 year following the fracture. Interventions to improve the detection and treatment of osteoporosis in high-risk patients need to be developed.

Aged↗
PubMed2001

Testing the effectiveness of an osteoporosis educational program for nursing students in Thailand.

OBJECTIVE: Osteoporosis, a health problem that is on the rise, has received considerable attention among the health care community and the public. The majority of primary prevention programs for osteoporosis have been focused on women in mid-life. A concern is that young women may not be aware of osteoporosis risk factors and therefore may not be engaging in preventive behaviors. The purpose of this study was to test the effectiveness of an osteoporosis educational program for young women. METHODS: A sample of 100 female undergraduate students who were enrolled in the first year of a nursing program in Thailand were randomly assigned to a control group or an experimental group. Participants in the experimental group participated in a 3-hour osteoporosis educational program (OEP). At entry to and exit from the study, all participants completed the Osteoporosis Knowledge Test, the Osteoporosis Health Belief Scale, and the Osteoporosis Self-Efficacy Scale. RESULTS: The experimental group had higher change scores for knowledge, health belief, and self-efficacy than the control group. The OEP increased knowledge of osteoporosis in these young women. CONCLUSION: These findings indicate the need for further health education concerning the importance of dietary calcium and exercise on osteoporosis prevention in young women.

Adult↗
PubMed2005

General characteristics, clinical features and related factors of osteoporosis in a group of elderly Turkish men.

BACKGROUND AND AIMS: Osteoporosis is an important problem for men as well as women, but data and trials for male osteoporosis, prevalence, evaluation and prognosis are limited. There are insufficient randomized placebo-controlled, multicenter trial data. The aim of this study was to determine the frequency of osteoporosis in patients admitted to the Division of Geriatric Medicine of Hacettepe University, to compare osteoporosis in men and women, and to determine risk factors, relations with social and cultural differences, body weight and functional status. METHODS: A retrospective study was conducted from February 2002 through July 2003. Participants were 783 female and 464 male patients aged 65 years and over. BMD measures were performed using dual-energy X-ray absorptiometry at femoral neck and lumbar spine. Data on calcium intake, history of fractures, smoking, alcohol habits, other possible risk factors, serum 25OH-Vitamin D and iPTH levels were obtained. Creatinine clearance was calculated with the Cockcroft-Gaut formula. Functional status was evaluated by geriatric evaluation scales. RESULTS: 29.5% of cases of osteoporosis were found in males; 45.9% of male patients had osteoporosis, 36.6% had osteopenia. Risk factors for male osteoporosis were evaluated. Men with low body weight (< 57 kg), BMI < 19, physically inactive, and poorly educated men were significantly more osteoporotic. No relationships between 25OH-Vitamin D, iPTH levels, creatinine clearance, quality of life scales or osteoporosis were found. CONCLUSIONS: Geriatrists and internists should focus on male as well as female osteoporosis. Nutritional support and physical activity should be encouraged. Age over 65 is identified as a major risk factor. Every man over 65 years of age should undergo BMD testing for osteoporosis screening.

Aged↗
PubMed2006

Assessment of osteoporosis-website quality.

INTRODUCTION: The Internet provides great opportunities for patient healthcare education, but poses risks that inaccurate, outdated, or harmful information will be disseminated. Osteoporosis is a topic of great interest to patients, many of whom use the Internet to obtain medical information. The aim of this study was to develop and evaluate measurement tools to determine the quality of osteoporosis websites for patients. METHODS: Quality indicators in the categories of content, credibility, navigability, currency, and readability were incorporated into separate evaluation tools for healthcare professionals and for patients. Websites were selected from an Internet search. Interobserver reliability and validity were assessed, and a sample of osteoporosis websites was evaluated by an osteoporosis nurse educator and compared to patient evaluations. RESULTS: For the quality indicators, there was 79% agreement between the osteoporosis nurse educators, 88% agreement between the physician osteoporosis experts, and 71% agreement comparing the osteoporosis nurse educators to the physician osteoporosis experts. Quality scores for evaluated websites ranged from 18-96 (maximum possible=100), with a mean of 66. Websites with Uniform Resource Locator (URL) suffix .com scored significantly lower compared to those with .gov (P<0.05), .edu (P<0.01), and .org (P<0.01). Healthcare professionals and patients were in agreement on the quality of the highest-rated websites, with less agreement for lower-rated websites. CONCLUSIONS: In summary, a tool for measuring the quality of medical websites was developed and evaluated. Significant variability in osteoporosis-website quality was observed. Higher-quality scores were associated with a higher level of search engine match and specific URL suffixes. A validated tool for evaluating medical websites may have value in assisting patients to select high-quality osteoporosis educational information on the Internet, and may encourage website developers to improve the quality of information that is provided.

Evaluation Studies as Topic↗