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PubMed1996

[Spongiosa structure and polyostotic heterogeneity in osteoporosis. Mechanism of bone transformation, morphology, clinical significance].

Osteoporosis is the most frequent generalized bone disease. The clinical expression of postmenopausal osteoporosis is characterized by spontaneous fractures of the vertebral bodies which affect mainly the trabecular bone structure. Thus the morphological bone transformation in osteoporosis is of clinical relevance. The object of this study was to analyze quantitatively and qualitatively the distribution of three-dimensional structure of cancellous bone in the human spine in osteoporosis. Therefore the complete anterior column of the spine and bone biopsies of the iliac crest of 11 autopsy cases with proven osteoporosis and 26 autopsy cases without primary or secondary bone disease were removed. A 1-mm-thick prepared sagittal section through the center of all vertebral bodies was embedded undecalcified in plastic and stained on the surface using a modification of the von Kossa method. This technique allowed combined two- and three-dimensional measurements simultaneously; these included evaluation of trabecular bone volume, trabecular interconnection, trabecular thickness, and trabecular number. The quantitative spine deformity index and qualitative analysis of the trabecular bone structure completed the investigation. The bone loss in osteoporosis is a loss of structure and the loss of whole trabeculae caused by perforations. The age-related decrease of trabecular bone mass is due to the transformation from plates to rods. Patient with osteoporosis show pathologically diminished trabecular bone volume and apparently reduced trabecular interconnection, while trabecular thickness and trabecular number show age-dependent change. The polyostotic heterogeneity in osteoporosis is immense. Neighboring vertebral bodies show differences of up to 100% in bone volume and bone structure. Due to this fact it is impossible to define a threshold for osteoporotic fractures. At the moment the transformation and loss of trabecular bone structure in osteoporosis is assumed to be irreversible; therefore, early prophylaxis is necessary to prevent clinical manifestations of these changes of bone.

Adolescent↗
PubMed2002

Secondary osteoporosis in women. A retrospective analysis.

Secondary osteoporosis comprises a minority of all osteoporosis cases. In this study we summarize the causes of secondary osteoporosis we encountered in patients currently on follow-up in our osteoporosis outpatient clinic. A total of 1015 female patients are involved in the study. Recorded data of the patients are evaluated retrospectively. Patients with spine bone mineral density (BMD) 2.5 standard deviation below a reference range established using our own data obtained from a Turkish population of normal healthy women using dual energy X-ray absorptiometry (T score less than -2.5) were accepted as having osteoporosis. We detected osteoporosis in 384 (38%) of the female patients. A secondary cause for osteoporosis has been found in 33 (8.6%) of the 384 osteoporotic patients. Thyrotoxicosis (n=10), parathyroid adenoma (n=10), and glucocorticoid administration (n=7) constituted 82% of the causes of osteoporosis. The data obtained in our study indicate that appropriate search for secondary causes of osteoporosis is essential because different modalities are needed for treatment.

Absorptiometry, Photon↗
PubMed2004

Osteoporosis: gender-specific aspects.

Traditionally, osteoporosis has been regarded as a disease of postmenopausal women; nevertheless, although osteoporosis is more common in women than in men, osteoporosis in men is a frequent and a severe condition. Osteoporosis generally can be characterized as either primary or secondary; in men secondary osteoporosis is more frequent than in women. The role of estrogen deficiency in the pathogenesis of postmenopausal osteoporosis is clearly established; remarkably, evidence accumulated over the past years strongly suggests that estrogen also plays the dominant role in regulating the male skeleton. Several independent studies observed decreased serum estradiol levels in men with idiopathic osteoporosis. In contrast to postmenopausal osteoporosis, there are only few studies on the treatment of osteoporosis in men; two different compounds (alendronate and teriparatide) appear to be equally effective in men and women.

Adult↗
PubMedDate not supplied

Prevalence of osteopenia and osteoporosis in Thai women.

OBJECTIVE: To determine the age-specific and age-adjusted prevalence of osteopenia and osteoporosis in pre- and postmenopausal Thai women. METHODS: This was a descriptive study of 1,935 Thai women ranging in age from 40 to 80 years, with randomly selected strata using multistage sampling and stratifying from six representative provinces of the country. After recruiting, all the women were interviewed by a well-trained interviewer using structured questionnaires. Bone mineral density (BMD) of lumbar spine 1-4 and nondominant hip was measured by a dual energy photon absorptiometer. The investigators were trained and standardized; inter- and intraobserver variations were measured periodically. Every BMD outcome was re-examined by the specialist. Age-specific prevalence of osteoporosis and osteopenia were determined using both Thai and Western standard BMD values. Age-adjusted prevalence of osteopenia and osteoporosis was calculated using the age-adjusted direct method. RESULTS: Using the Thai BMD reference, the age-specific prevalence of osteoporosis among Thai women rose progressively with increasing age to more than 50% after the age of 70. The age-adjusted prevalence of osteoporosis also rose progressively. It was 19.8%, 13.6%, and 10% for lumbar spine, femoral neck, and intertrochanteric. The age-adjusted prevalence of osteoporosis indicates the overall magnitude of that condition in the population or country. In our study, using a Western BMD reference resulted in a misleadingly high prevalence of osteoporosis in the population of Asian countries. CONCLUSION: It is important to calculate the age-adjusted prevalence of osteopenia and osteoporosis to address the overall magnitude of the problem in Thai women. This will allow us to predict the socioeconomic impact of preventable chronic conditions such as osteoporosis. The results obtained from this study are important data for public health policy: maximizing bone mass throughout life as well as detection of important risk factors is essential.

Adult↗
PubMed2006

How can osteoporosis patients benefit more from their therapy? Adherence issues with bisphosphonate therapy.

OBJECTIVE: To review the evidence on adherence with bisphosphonates and evolving dosing strategies for osteoporosis treatment. DATA SOURCES: Articles were identified by searching MEDLINE (1975-December 2005) using the following terms: osteoporosis, postmenopausal, fracture, adherence, compliance, persistence, drug therapy, bisphosphonates, alendronate, risedronate, ibandronate, and zoledronate. Additional data included bibliographies from identified articles. STUDY SELECTION AND DATA EXTRACTION: All pertinent English-language articles that discussed adherence issues in patients with osteoporosis were included. Both those that reviewed overall issues of medication adherence in osteoporosis and those that focused specifically on adherence to bisphosphonates were included, as were articles that addressed strategies for overcoming nonadherence. DATA SYNTHESIS: Inadequate diagnosis and treatment of osteoporosis result in a higher risk of fractures than is necessary. Even patients who are diagnosed and beginning treatment often do not persist with their osteoporosis medication because they perceive their fracture risk to be low and, given the asymptomatic nature of osteoporosis, do not experience the benefit of symptom reduction after taking the drugs. Factors that affect adherence to osteoporosis therapy include drug costs, adverse effects, dosing frequency, disease education, patient follow-up, and patient involvement in treatment decisions. CONCLUSIONS: By considering and implementing strategies that can improve adherence and persistence, primary care providers and pharmacists (via counseling) may enhance long-term outcomes for patients with osteoporosis.

Adult↗
PubMed2001

Periodontal diseases and osteoporosis: association and mechanisms.

There is increasing evidence that osteoporosis, and the underlying loss of bone mass characteristic of this disease, is associated with periodontal disease and tooth loss. Periodontitis has long been defined as an infection-mediated destruction of the alveolar bone and soft tissue attachment to the tooth, responsible for most tooth loss in adult populations. Current evidence including several prospective studies supports an association of osteoporosis with the onset and progression of periodontal disease in humans. The majority of studies have shown low bone mass to be independently associated with loss of alveolar crestal height and tooth loss. However studies that focus on the relation of clinical attachment loss and osteoporosis are less consistent. To date, the majority of studies on the relationship between periodontal disease and osteoporosis have been hindered by small sample sizes, limited control of other potential confounding factors, varying definitions of both periodontal disease and osteoporosis, and few prospective studies where the temporality of the association can be established. Potential mechanisms by which host factors may influence onset and progression of periodontal disease directly or indirectly include underlying low bone density in the oral cavity, bone loss as an inflammatory response to infection, genetic susceptibility, and shared exposure to risk factors. Systemic loss of bone density in osteoporosis, including that of the oral cavity, may provide a host system that is increasingly susceptible to infectious destruction of periodontal tissue. Studies have provided evidence that hormones, heredity, and other host factors influence periodontal disease incidence and severity. Both periodontal disease and osteoporosis are serious public-health concerns in the United States. Prevalence of both osteoporosis and tooth loss increase with advancing age in both women and men. Understanding the association between these common diseases and the mechanisms underlying those associations will aid health professionals to provide improved means to prevent, diagnose, and treat these very common diseases. This paper reviews the current evidence on the association between periodontal disease and osteoporosis.

Adult↗
PubMed1999

[Osteoporosis in Mexican postmenopausal women. Magnitude of the problem. Multicenter study].

Incidencia of osteoporosis induced fractures increases with age; risk increases exponentially as bone mass decreases. Women are prone to osteoporosis 2 to 3 times more than men, due to lower "peak" bone mass and the accelerated loss that occurs after the menopause. The prevalence of osteoporosis in with Caucasian postmenopausal women varies from 16 to 30% depending upon the number of sites measured (lumbar spine/hip and/or forearm). The aim of this study was to estimate the prevalence of osteopenia and osteoporosis in pre and postmenopausal Mexican women in relation to men, and to that reported in Caucasia women. The study involved 4,821 apparently healthy subjects (without known risk factors for osteoporosis), 4,467 females and 354 males from 11 different centers of Mexican Republic, 20 to 90 years old, using DXA bone densitometry of lumbar spine and hip. Prevalence of osteoporosis in women is twice that in men (P < 0.001), and it increases with age, particularly after the menopause (P < 0.0001). Our study found a prevalence of osteoporosis of the lumbar spine and/or hip in apparently healthy postmenopausal Mexican women over 50 years of age of 16%, increasing to 20% in those women with or without risk factors who attended voluntarily or by suggestion of their physician to be studied. The prevalence values obtained seem to be lower than those reported for Caucasian women, 30%. We found a prevalence of osteoporosis of 16% and of osteopenia of 57% in women 50 years of age and older. We also found a higher prevalence of osteoporosis in women of the south east part of the county.

Female↗
PubMed1994

Bone turnover in cortical and trabecular bone in normal women and in women with osteoporosis.

UNLABELLED: This study is based on the assumption that is bone turnover, shown by the uptake of 99mTc-MDP, indicates a high rate of bone loss in patients with osteoporosis, it could potentially predict bone loss in patients at risk before significant bone loss has occurred. METHODS: Quantitative bone SPECT (QBS) using 99mTc-MDP, expressed as the %ID/cc x 10(-3), was performed in 71 women who had osteoporosis in the lumbar vertebrae, the femoral neck or both, and in 54 age-matched normal female controls. Of the women with osteoporosis, 42 had postmenopausal osteoporosis and 29 had primary hyperparathyroidism (HPT) and osteoporosis. RESULTS: QBS increased with age in the cortical bone and decreased in the trabecular bone of the normal women. Quantitative bone SPECT in the femoral neck was 3.18 +/- 1.20 and was 2.73 +/- 1.06 in the femoral shaft in 20 women with postmenopausal osteoporosis of the femoral neck. In 19 women with HPT and osteoporosis of the femoral neck, the QBS value in the femoral neck was 3.57 +/- 0.92 and in the femoral shaft 3.38 +/- 1.12. These values were also significantly higher for the femoral neck and for the femoral shaft than those of normals. Although QBS values were higher in the lumbar region in 39 women with postmenopausal osteoporosis (4.59 +/- 1.45) and in 27 women with HPT (4.30 +/- 1.52), as compared with the normal group (4.28 +/- 1.61), the difference was not statistically significant. CONCLUSION: This study shows that bone turnover is significantly higher in the cortical bone of women with osteoporosis than in normal women.

Bone Density↗
PubMed1994

Knowledge, beliefs, and behaviors among college women concerning the prevention of osteoporosis.

OBJECTIVE: To assess the knowledge of osteoporosis risk factors among young women, their beliefs about the disease, and to what extent they practice preventive behaviors, such as adequate calcium intake and physical activity. DESIGN: Cross-sectional survey. SETTING/PARTICIPANTS: One hundred twenty-seven women (mean age, 19.6 years; 92% were white) enrolled in a required undergraduate health course at a midwestern state university. RESULTS: One hundred fourteen (90%) of the survey respondents had heard about osteoporosis, but only 49 (43%) of the 114 had received information from either a health care provider or a school. There was a significant relationship between receiving osteoporosis information and the ability to correctly identify risk factors (P < or = .006). Only 6.7% of the women reported getting both adequate "osteoprotective" exercise per week and the recommended 1200 mg of calcium per day. Respondents believed that it was unlikely that osteoporosis would develop in them. They also expressed less responsibility and concern about osteoporosis and believed that it is less serious than other common causes of morbidity and mortality in women, such as heart disease and breast cancer (P < or = .02). There was no significant relationship between risk-factor identification and exercise habits, calcium intake, or beliefs about osteoporosis. CONCLUSIONS: The majority of young women are not consuming the recommended daily amount of calcium and are lacking sufficient osteoprotective exercise for building healthy bone. Health care providers and educational institutions either have missed opportunities to educate young women about osteoporosis or such information has not been received and retained. Increasing levels of osteoporosis awareness may not be associated with influencing beliefs or behaviors. However, because of the importance of building an adequate bone mass in early life, our data suggest that the development and evaluation of comprehensive osteoporosis educational interventions targeted at younger women are warranted.

Adolescent↗
PubMed2002

Parathyroid hormone for treatment of osteoporosis.

BACKGROUND: Osteoporosis is a common condition associated with multiple deleterious consequences. No therapy entirely abolishes fracture risk. METHODS: A MEDLINE database (1966 to the present) search was performed for randomized controlled trials in humans using the keywords osteoporosis and parathyroid hormone (PTH) or parathyroid hormone and fracture. The Cochrane database was searched using the search terms osteoporosis and parathyroid hormone. RESULTS: Parathyroid hormone (usually subcutaneous) dosages varied markedly across the 20 randomized controlled trial studies retrieved. In the range of 50 to 100 micro g/d, effects may be dose-related. Results of larger trials (up to 1637 patients) were conflicting as to whether effects were limited to the spine and suggested detrimental effects on radius bone mineral density. Little data analyzed the effects of PTH in older vs younger subjects or directly compared the effects by sex. Increases in spine bone mineral density are induced by PTH in postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, and idiopathic osteoporosis. Parathyroid hormone may protect against gonadotropin-releasing hormone agonist-related bone loss. Effects are less clear at nonspine sites when PTH is used as part of combination or sequential therapies or for treatment of glucocorticoid-induced osteoporosis. Parathyroid hormone decreased the incidence of radiographically detected spinal fractures. The numbers of nonvertebral fractures were too low to be broken down by individual site. Parathyroid hormone injections were difficult for some patients to comply with. Occasionally, PTH-associated hypercalcemia may be dose-dependent, often manifesting early in treatment. An increase in cancer risk from PTH is not reported in humans. CONCLUSIONS: Parathyroid hormone decreases vertebral fractures and increases spinal bone density in postmenopausal osteoporosis and glucocorticoid-induced osteoporosis, but at the expense of a decrease in radius bone density. The long-term safety and nonvertebral fracture efficacy are unknown.

Adult↗
PubMed2004

Knowledge about osteoporosis in a cohort of Polish females: the influence of age, level of education and personal experiences.

In this study, a group of 1065 women aged 16-72 years recruited from patients attending general practitioners was studied to investigate knowledge of osteoporosis and attitude towards methods of preventing the disease. The interviews were carried out by students of the Silesian School of Medicine, using a structured questionnaire. The average number of correct answers in the whole population was 7.05, and in women with established osteoporosis 6.89. In the whole population, the majority of answers were correct and ranged from 60% to 95% in seven out of ten questions. The answers for three questions were incorrect in about half or more of the cohort: 53% of subjects considered that osteoporosis could be cured; for 50% of women osteoporosis is a minor health problem (except for the youngest women and women with university education--74% and 69% of correct answers, respectively); and 58% of women considered that those with osteoporosis should not engage in physical activity due to the risk of falling and causing a fracture. A simple chi-squared test was used to show the role of age, level of education and personal experiences with osteoporosis on answers given by the subjects studied. Age (six out of ten answers), level of education (seven out of ten answers) and personal experience (four out of ten answers) significantly affected answers given. The number of correct answers decreased with age and increased with level of education, and there was no systematic influence of personal experience. In summary, data collected provide important information about knowledge of osteoporosis. Generally, the level of knowledge about osteoporosis was high. Higher level of education and younger age improve the knowledge of osteoporosis with no systematic influence of personal experience with the disease.

Adolescent↗
PubMed2004

The need for clinical guidance in the use of calcium and vitamin D in the management of osteoporosis: a consensus report.

A European Union (EU) directive on vitamins and minerals used as ingredients of food supplements with a nutritional or physiological effect (2002/46/EC) was introduced in 2003. Its implications for the use of oral supplements of calcium and vitamin D in the prevention and treatment of osteoporosis were discussed at a meeting organized with the help of the World Health Organization (WHO) Collaborating Center for Public Health Aspects of Rheumatic Diseases (Liège, Belgium) and the support of the WHO Collaborating Center for Osteoporosis Prevention (Geneva, Switzerland). The following issues were addressed: Is osteoporosis a physiological or a medical condition? What is the evidence for the efficacy of calcium and vitamin D in the management of postmenopausal osteoporosis? What are the risks of self-management by patients in osteoporosis? From their discussions, the panel concluded that: (1) osteoporosis is a disease that requires continuing medical attention to ensure optimal therapeutic benefits; (2) when given in appropriate doses, calcium and vitamin D have been shown to be pharmacologically active (particularly in patients with dietary deficiencies), safe, and effective for the prevention and treatment of osteoporotic fractures; (3) calcium and vitamin D are an essential, but not sufficient, component of an integrated management strategy for the prevention and treatment of osteoporosis in patients with dietary insufficiencies, although maximal benefit in terms of fracture prevention requires the addition of antiresorptive therapy; (4) calcium and vitamin D are a cost-effective medication in the prevention and treatment of osteoporosis; (5) it is apparent that awareness of the efficacy of calcium and vitamin D in osteoporosis is still low and further work needs to be done to increase awareness among physicians, patients, and women at risk; and (6) in order that calcium and vitamin D continues to be manufactured to Good Manufacturing Practice standards and physicians and other health care professionals continue to provide guidance for the optimal use of these agents, they should continue to be classified as medicinal products.

Aged↗
PubMed2006

A randomized controlled trial of mailed osteoporosis education to older adults.

INTRODUCTION: Osteoporosis represents a growing public health concern; however, current rates of management are sub-optimal. The aim of our study was to assess, in a randomized controlled trial, the effect of a mailed educational intervention on older adults' knowledge, attitudes, and preventive behaviors regarding osteoporosis. The setting was a large publicly funded state pharmacy benefits program. The patients were 31,715 Medicare beneficiaries from Pennsylvania who participated in a drug benefits program for low-to-moderate income elderly people. METHODS: All women aged over 65 years, and all men and women with a history of fracture or long-term oral use of glucocorticoid, were included. Approximately half of the participants (intervention group) were randomly selected to receive three mailings aimed at improving knowledge of osteoporosis and enhancing preventive activities, such as using calcium and vitamin D, reducing fall risks in the home, obtaining a bone mineral density (BMD) test, and taking medications when necessary. The other participants did not receive the intervention mailings and served as controls. We surveyed a sample of intervention and control subjects to determine the effects of the intervention on knowledge, attitudes, self-efficacy (confidence in one's ability to perform specific activities), and behavior regarding osteoporosis prevention and treatment. Six hundred randomly selected participants in the intervention group and an equal number in the control group were invited to participate. RESULTS: Twenty-six had died and 636 of the remaining 1,185 (54%) completed the survey. Respondents and non-respondents did not differ significantly with respect to measured sociodemographic factors. All scales had good reliability (all Cronbach's alphas>0.65). Knowledge of osteoporosis was generally very good and did not differ between intervention (mean=65% correct responses) and control subjects (mean=67% correct; P=0.4). Perceived susceptibility to osteoporosis was relatively high and similar across groups (P=0.4). Self-efficacy for participating in osteoporosis prevention and treatment was very strong in both the intervention (mean=4.3 on a 0-5 scale) and control (mean=4.2, P=0.03) groups . On average, subjects in the intervention group reported participating in 3.5 of 6 preventive osteoporosis activities compared with 3.4 in the control group (P=0.5). CONCLUSIONS: Compared with the controls, a mailed educational intervention for osteoporosis was not associated with better knowledge, higher perceived susceptibility, or performance of preventive measures among the at-risk older adults that we studied. The intervention group demonstrated a small increase in self-efficacy. More intensive patient interventions or intervention aimed at other aspects of the care process may be required to bring about changes that lead to a reduction in fractures.

Aged↗
PubMed2006

A randomized study of two different information-based interventions on the management of osteoporosis in minimal and moderate trauma fractures.

INTRODUCTION: Despite the high risk for subsequent fracture following an initial osteoporotic fracture, the majority of subjects with minimal trauma fractures receive no treatment for osteoporosis. The primary aim of this investigation was to determine whether an information-based intervention could change post-fracture management of osteoporosis. A secondary aim was to define participant- and doctor-related barriers to osteoporosis management. METHODS: Consecutive fracture patients (n=254) from the outpatient fracture clinic at St Vincent's Hospital, Sydney were interviewed over a 15-month period (February 2002-July 2003). Fracture risk factors, prior investigation and treatment for osteoporosis were collected at baseline. Participants were initially contacted after 3 months to ascertain follow-up management. All those not investigated or treated by their primary care physician were then randomized to either a personalized letter or the same letter plus an offer of a free bone mineral density (BMD) test. Participants were contacted after 9 months to record further investigations or treatment for osteoporosis. RESULTS: Less than 20% of the participants had a primary care physician follow-up 3 months after the fracture, leaving 159 who were randomized to a personalized letter (n=79) and a personalized letter plus the offer of a free BMD test (n=80). There was a significant increase in the number of people investigated for osteoporosis in the group receiving the letter plus BMD offer [38% (letter + BMD) vs. 7% (letter only); p=0.001). A high proportion of those tested had low BMD (49% osteopenia and 17% osteoporosis). However, the rates of treatment in both groups were very low (6%). Furthermore, even among the few individuals (23%) who contacted their primary care physician, only 25% were recommended treatment. The belief that the fracture was osteoporotic was an independent predictor of having a BMD test, a primary care physician follow-up and treatment. Other independent predictors were age over 50 years for a primary care physician follow-up, female sex for having a BMD test and having had a BMD test for treatment. CONCLUSION: This study demonstrates that an information-based intervention led to a modest increase in the proportion of people investigated for osteoporosis; however. there was no significant effect on treatment rates. The offer of a free BMD assessment was associated with a significantly higher rate of investigation than a personalized letter alone (odds ratio: 8.5; 95% confidence interval: 3.1-24.5), but this investigation did not affect treatment rate. The low uptake of either a BMD or a visit to a primary care physician together with low rates of treatment recommendation even among people who contacted their primary care physician reflects significant participant and doctor-related barriers to osteoporosis management.

Adult↗
PubMed2007

A nomogram for predicting osteoporosis risk based on age, weight and quantitative ultrasound measurement.

INTRODUCTION: Quantitative ultrasound measurement (QUS) or clinical risk index alone are not reliable tools for the identification of women with osteoporosis. This study examined the prognostic value of combined QUS and clinical risk index for predicting osteoporosis risk in Thai women. METHODS: The study was designed as a cross-sectional investigation with 300 women of Thai background, aged between 38 and 85 years (mean age: 58). Femoral neck bone mineral density (BMD) was measured by DXA (Hologic QDR-4500; Bedford, MA, USA). A femoral neck BMD T-scores <or= -2.5 was defined as "osteoporosis"; otherwise, "non-osteoporosis". QUS was measured by Achilles+ (GE Lunar, Madison, WI, USA) and converted to T-score. Three models for predicting osteoporosis were considered: model I included age, weight and QUS, model II included age and weight, and model III included only QUS. The prognostic performance among the models was assessed by the area under the receiver operating characteristic curve (AUC). RESULTS: The prevalence of osteoporosis was 12.7% (n=38/300) by femoral neck BMD. Age, weight and QUS were each significantly associated with osteoporosis risk. The AUC+/-SE value for model I was 0.86 +/- 0.03, which was significantly higher (p=0.02) than that for model II (AUC = 0.80 +/- 0.04) or model III (AUC = 0.79 +/- 0.04). Based on the estimated parameters of model I, a nomogram was constructed for predicting osteoporosis. CONCLUSION: These data suggest that the combination of QUS and age and weight could significantly improve the prognosis of osteoporosis in Asian women, and that the nomogram can assist primary care physicians in the identification of high-risk women.

Adult↗
PubMed1999

Incomplete renal tubular acidosis in 'primary' osteoporosis.

Chronic metabolic acidosis may increase alkali mobilization from bone and thus promote the development of osteoporosis. While it is undisputed that overt metabolic acidosis is associated with metabolic bone disease, renal acidification in patients with idiopathic osteoporosis has not been studied systematically. The purpose of this study was to investigate the prevalence of renal acidification defects in patients with 'primary' osteoporosis. Thirty-two women (including 10 premenopausal women) and 16 men who were referred to our department for investigation of osteoporosis were enrolled in this study. Patients with obvious or possible secondary osteoporosis were excluded. None of the patients had overt metabolic acidosis. In random urine samples 12 of the 48 patients had pH levels below 5.5 and were therefore considered to have normal renal acidification. The remaining 36 patients underwent further testing by a short-course oral ammonium chloride load. In this test nine of these 36 patients (7 men and 2 premenopausal women) failed to lower urinary pH below 5.5 despite the induction of systemic metabolic acidosis. In these patients, therefore, the diagnosis of incomplete distal renal tubular acidosis was made (RTA I). Patients with incomplete RTA I had significantly lower spontaneous plasma pH (7.38 +/- 0.0081 vs 7.41 +/- 0.004, mean +/- SEM, p = 0.002), a lower serum bicarbonate concentration (21.9 +/- 0.49 mmol/l vs 23.1 +/- 0.24 mmol/l, p = 0.034), a lower base excess (-2.33 +/- 0.42 mmol/l vs -0.55 +/- 0.21 mmol/l, p = 0.001) and lower Z-scores in bone densitometry (-2.18 +/- 0.27 vs -1.40 +/- 0.15, p = 0.028) than patients with normal renal acidification. In conclusion, a high prevalence of incomplete RTA I (in 44% of the male patients, 20% of the premenopausal female patients and 6% of all female patients) was found in patients with osteoporosis who, without testing, would have been diagnosed as having 'primary' osteoporosis. The mild metabolic acidosis observed in these patients may have contributed to loss of bone mass by a compensatory mobilization of alkali and calcium from bone. Because of possible therapeutic consequences (e.g., administration of alkali salts and high doses of vitamin D) we propose that measurements of urinary pH and, if necessary, ammonium chloride testing should be included in the diagnostic investigation especially of male and of premenopausal female patients with osteoporosis. Since referral bias, although unlikely, cannot be excluded in our study, the prevalence of RTA I in unselected patients with osteoporosis needs to be determined at primary screening institutions.

Absorptiometry, Photon↗
PubMed2001

Opinions and experiences in general practice on osteoporosis prevention, diagnosis and management.

We determined to survey the general practice population regarding their attitudes to and knowledge of osteoporosis as a baseline prior to publication of national guidelines for the management of osteoporosis. All 2515 general practitioners registered in the 10 Health Authorities of the North Thames region, London, UK were surveyed by a postal questionnaire. Responses relating to epidemiology, public health and education on osteoporosis were analyzed. The overall response was 1153 (46%). General practitioners who responded were younger, predominantly female and in group practice. There is considerable awareness of the importance of preventing osteoporosis. General practitioners are active in identifying groups at risk, particularly those who are aged 40 years and older. A prevention strategy for osteoporosis is viewed as effective. However, two thirds of general practitioners remain unconvinced about the efficacy of drug therapy. Education on osteoporosis is considered inadequate. General practitioners would welcome further information on management issues and access to osteoporosis services. In conclusion, educational initiatives will be important both at undergraduate and postgraduate levels to increase awareness and knowledge of osteoporosis. General practitioners are aware of the public health impact of this condition and express a preference for educational material of direct relevance to the care of their patients. Therefore better cooperation between primary and secondary care should lead to ways of breaking down barriers to change in clinical practice and promoting fully integrated care of patients with osteoporosis.

Attitude of Health Personnel↗
PubMed2002

The decision to accept treatment for osteoporosis following hip fracture: exploring the woman's perspective using a stage-of-change model.

Despite the availability of medications that reduce fracture risk, most women who sustain a hip fracture are not evaluated or treated for osteoporosis. While a number of studies have attributed this to a lack of physician awareness, no studies have evaluated this problem from the patient's perspective. To explore the process a woman negotiates when deciding to accept pharmacologic treatment for osteoporosis after hip fracture, we used a stage-of-change model to characterize a consecutive series of 70 postmenopausal women (mean age 85 years) admitted to a tertiary care hospital with an acute low-impact hip fracture between May 2000 and August 2000. We measured stage-of-change using a modified form of the Weinstein Precaution Adoption Process Model (PAPM). The majority of patients (65%) were ineligible because of dementia or delirium; only 29 were eligible and 21 were enrolled. Most women (62%) were in stages 1 or 2 of the PAPM, indicating that they were unaware of osteoporosis or had never considered pharmacologic treatment for it. The only factors associated with a more advanced PAPM stage (indicating active consideration or currently taking treatment) were a previous bone mineral density (BMD) evaluation ( p = 0.007) and a diagnosis of osteoporosis ( p = 0.001). Although 48% of women had a previous fragility fracture and osteoporosis knowledge was poor overall (mean score 52% correct), neither was associated with a more advanced PAPM stage in this sample. In conclusion, women evaluated after hip fracture were not ready to accept pharmacologic treatment for osteoporosis; they were unaware that they had osteoporosis or had never considered treatment for it. For a woman to advance through the behavior change process, she must first be made aware of the problem that requires a change in behavior. Physicians play a crucial role in promoting awareness of the diagnosis of osteoporosis after fracture, which in turn is associated with patient advancement through the behavior change process and the decision to accept pharmacologic intervention. The large number of cognitively impaired patients in this population, however, will certainly make efforts to improve osteoporosis awareness, diagnosis and intervention more challenging.

Aged↗