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PubMed1991

The prevalence of osteoporosis risk factors and physician intervention.

To determine the prevalence of osteoporosis risk factors and the probability of physician risk recognition and intervention, the medical records of a cohort of 243 women aged 40 to 65 years were reviewed retrospectively. A historical cohort design was used. Risk factors present before the start of the study were identified. Osteoporosis risk recognition (discussion, problem list), osteoporosis specific intervention (counseling about risk, or estrogen or calcium supplementation), or nonspecific intervention (dietary, exercise, smoking, or alcohol counseling) were recorded over a 3-year follow-up period. Seventy-four percent of the women had two or more risk factors. The most common were perimenopausal or postmenopausal status (73%) and absence of estrogen supplementation (ever) (65%). During the period of the study, 46 women (19%) had received an osteoporosis-specific intervention. One hundred eleven women (46%) had received one of the above or a less specific intervention. The medical records of only 25 women (10%) documented an assessment of osteoporosis risk. Only menopausal status predicted osteoporosis intervention, and the probability of intervention decreased as the total number of risk factors increased. The data identify three groups of women who could benefit from increased risk-reduction strategies: premenopausal women, perimenopausal or postmenopausal women who have never previously taken supplemental estrogens, and women with multiple risk factors.

Adult↗
PubMedDate not supplied

[Differential therapy of osteoporosis--an overview based on recent findings regarding the pathogenesis].

Osteoporosis had long been considered as an unavoidable consequence of aging for which no prevention was possible, whereas it has recently been recognized as a disease that can be prevented and treated. It is of outstanding importance to choose a therapy tailored to the individual patient based on new findings on the pathogenesis of the different types of osteoporosis and the differential diagnosis related to these. During phases of rapid bone loss, usually at the beginning of postmenopause, but sometimes also in older patients, it is useful to use therapeutic drugs to slow down the high bone turnover to a physiological level when osteoporosis is imminent or manifest. The ideal therapy of established osteoporosis should stimulate bone formation and increase bone mass as well as correct changes in the architecture so that the incidence of new fractures will be reduced or even prevented. In case of an increased fragility, it is especially advantageous to increase the cortical bone mass and to stimulate periosteal bone formation in particular. Therapies increasing cortical porosity such as the administration of fluoride in large doses weaken the bones. Therapies reducing bone remodeling in the long term can inhibit bone reparation and compensatory periosteal bone formation, however. Future prospects for the therapy of osteoporosis using drugs are, on the one hand, an improved exploitation of present strategies by means of new galenical types of application, changes in the daily dosage, the introduction of interval therapies, and synergistic effects due to suitable combinations. On the other hand, new developments achieved by varying chemical structures, e.g., the structures of bisphosphonates and vitamin D metabolites and, above all, new strategies leading to increased bone mass while maintaining or even improving bone structure are urgently required. In addition to the vitamin D metabolites, mainly the parathyroid hormone fragments and growth hormones seem to be promising to achieve this aim. The direct use of cytokines (IGF-1, IGF-2, TGF-beta, etc.) is not yet possible because there is no suitable "drug targeting". An increase in bone mass that has been clinically documented does not necessarily indicate an increased mechanical stability. Bone quality results from a complex relationship between bone mass, bone structure, and the strength of the individual structure elements. Its quantitative measurement and influencing by therapies will be a great challenge to future osteoporosis research.

Adolescent↗
PubMed1994

[An epidemiological study on osteoporosis using ultrasound bone densitometry].

Ultrasonic bone density measurements were performed in a population to study the relationship of bone density to age, body size, fracture, hip and back pain, and their diagnostic value for osteoporosis. In additions other factors related with osteoporosis diagnosed using ultrasonic measurements values were examined. The study subjects were thirty-eight men and sixty-three women who participated in community health examinations in 1993 in Akabane, Aichi prefecture. Indices evaluated for ultrasonic bone density measurement were speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness index (SI). 1) In men, means for SOS and SI values declined with age from the forties to the seventies, but BUA was not related to age. In premenopausal women, SOS, BUA and SI were not related to age, but an age related decline was observed in postmenopausal women. 2) BUA was positively related to body weight in men and women, while the relationship with SOS and SI was not as strong. 3) Two postmenopausal women experienced fractures due to osteoporosis, and their SI values were less than 59%. About fifty percent of the subjects had hip and back pain but no clear association of SI to prevalence rate was observed. 4) Osteoporosis was diagnosed using SI values. Cases of osteoporosis were relatively older, had more years since menopause, were lower in height, body weight and thickness of skinfolds, but had higher serum total cholesterol levels others. 5) Further prospective epidemiological studies should be performed to evaluate the validity of this diagnostic criterion using SI values, and to clarify the relationship of lifestyles to ultrasonic bone density measurement and osteoporosis.

Adult↗
PubMed1994

[Bone density and osteoporosis. An opinion].

Osteoporosis is a serious health problem for women over 45 years of age. It is divided in type I, affecting mainly cancellous bone and type II, affecting cancellous and cortical bone. Type I osteoporosis is related mainly with menopause, meanwhile, type II osteoporosis is related with ageing in both sexes. Osteoporosis has a major impact in the quality of life and the independence of the individuals, being the best treatment its prevention. All women at the beginning of the menopause should receive hormonal replacement treatment and calcium, in order to avoid type I osteoporosis, since treatment for women with established osteoporosis is aimed to halt the process of bone loss. Bone density may be measured in a reliable way by different techniques, allowing to the practitioner an accurate and reproducible measurement in different segments of the body. The main indications for bone densitometry suggested by the NOF are commented, as well as, the variability that may occur in different populations and the concept of normal values of bone density.

Adult↗
PubMed1996

[Osteoporosis. Knowledge and attitudes of the Norwegian population].

In March 1994, a random sample of 1,514 Norwegians aged 16-79 years were interviewed about their knowledge of osteoporosis and their attitudes towards prevention of this disease. About 85% answered correctly that osteoporosis can be prevented, but only 57% knew that it cannot be cured. Women had better knowledge of osteoporosis than men had. Two thirds of the women were positive to the use of long-term hormone replacement therapy to prevent osteoporosis. The majority of women aged 60 years or more preferred walking to other physical activities to prevent the disease. Although the data demonstrated fairly good general knowledge of osteoporosis in the population, the oldest women, those at the highest risk of developing the disease, knew less about osteoporosis than the younger women did.

Adolescent↗
PubMed1997

[Sex hormones and osteoporosis: a physiological perspective for prevention and therapy].

Estrogen deficiency is the main cause of post-menopausal osteoporosis and hormone replacement therapy is consensually regarded as the first line choice for its prevention. Hormone-replacement has also been shown to prevent bone loss associated with rheumatoid arthritis (RA) and corticotherapy. The rationale for its use in RA is reinforced by evidence of beneficial effects on disease activity. Estrogens also have bone-protective effects in males. C-19 progestagens seem to potentiate the skeletal effects of estrogens whereas C-21 derivatives appear to have no significant influence. Progestagens may be particularly useful in the prevention of steroid-induced osteopenia. Testosterone is an effective treatment for male osteoporosis associated with hypogonadism and is also promising in the treatment of osteoporosis in aged eugonadal males. The association of this hormone potentiates the effects of estrogens on bone mineral density in post-menopausal women. However, anabolic androgens have been preferred in this condition, due to a lower androgenizing effect. They represent a valid therapeutic alternative, particularly in cases of cortical osteoporosis with low bone turnover and in the aged and frail. In general, the different modalities of hormonal therapy clearly deserve a higher degree of preference in the treatment and prevention of osteoporosis than common present practice in our country. It is time to reassess this matter, clear unfounded fears and reinforce the physiological and scientific foundations of our therapeutic options for osteoporosis.

Androgens↗
PubMed2005

Compliance with osteoporosis medications.

BACKGROUND: Long-term compliance with pharmacologic treatments for many asymptomatic conditions may be suboptimal, but little is known about compliance with medications used for osteoporosis. This study was undertaken to assess the level and determinants of compliance with drugs prescribed for osteoporosis. METHODS: This retrospective cohort study used pharmacy claims data from US Medicare and filled prescriptions from a state pharmaceutical benefits program. We included persons 65 years or older who initiated use of a medication for osteoporosis (alendronate sodium, calcitonin, hormone therapy, raloxifene hydrochloride, or risedronate) from January 1, 1996, through December 31, 2002. The outcome of interest was suboptimal medication compliance, defined as equal to or less than 66% of days with medication during a 60-day period. RESULTS: One year after initiating treatment for osteoporosis, 45.2% of the 40,002 patients were not continuing to fill prescriptions. Five years after initiation, 52.1% of patients were not continuing to fill prescriptions for an osteoporosis medication. Several characteristics independently predicted compliance: female sex, younger age, fewer comorbid conditions, using fewer nonosteoporosis medications, bone mineral density testing before and after initiating a medication, a fracture before and after initiating a medication, and nursing home residence during the 12 months before initiating a medication. However, models adjusted for the significant patient variables explained only 6% of the variation in compliance. CONCLUSIONS: Most patients who initiate a medication for osteoporosis do not continue to take it as prescribed. Although several patient characteristics significantly correlated with compliance, adjusted models explained little of the variation.

Age Distribution↗
PubMed2006

Patient treatment preferences for osteoporosis.

OBJECTIVE: To examine patient preferences for currently available and promising osteoporosis treatment options. METHODS: We recruited patients who had recently (within 2 weeks) undergone bone densitometry and were found to have osteoporosis. Consenting participants completed an Adaptive Conjoint Analysis questionnaire to determine their treatment preferences for oral bisphosphonates taken once per week, intravenous bisphosphonates administered every 3 months, intravenous bisphosphonates administered once per year, and subcutaneous recombinant human parathyroid hormone (rhPTH). We performed simulations based on respondents' values for route of administration, absolute reduction in risk of vertebral and hip fractures over 5 years, and risk of adverse effects to predict each respondent's treatment choice. RESULTS: The study sample included 201 women and 11 men (median age 73). Patients' treatment preferences were strongly influenced by route of administration. Patients' preferred treatment option, across all simulations, was bisphosphonates. Among 80 treatment-naive participants, 52 (65%) preferred an annual infusion over oral weekly bisphosphonates. Participants with poorer perceived health status, those with a high perceived risk of future fracture, and participants preferring to treat health problems without doctors or prescription drugs were more likely to prefer an annual infusion over weekly pills. CONCLUSION: Patient preferences for osteoporosis treatment options are strongly influenced by route of administration. Therefore, despite the added benefits of rhPTH, patients' preferred treatment option for osteoporosis is bisphosphonates. Among those preferring bisphosphonates, many preferred annual infusions over weekly oral medications, emphasizing the need to incorporate individual patient preferences into treatment decisions for osteoporosis. The latter is especially important given the poor rates of long-term adherence to osteoporosis medications.

Administration, Oral↗
PubMed2005

Physician practices of bone density testing and drug prescribing to prevent or treat osteoporosis during androgen deprivation therapy.

BACKGROUND: Androgen deprivation therapy (ADT) is a strong risk factor for osteoporosis. The current study identified physician practices in preventing or treating osteoporosis during ADT. The practices of interest are the uses of dual-energy X-ray absorptiometry (DXA) scans, bisphosphonates, calcium or vitamin D supplement, calcitonin, or estrogen. METHODS: A retrospective medical record review was conducted. Patients were included if they had received ADT with goserelin injection for >/= 1 year. Multivariable logistic regression analysis was performed to identify independent predictors of receiving at least one intervention. RESULTS: Analyses included 184 patients. Most were the elderly with multiple risk factors for osteoporosis. Only 8.7% (95% confidence interval [CI], 4.6-13.0%) of patients received a DXA scan at least once during the past 3 years. Oral and intravenous bisphosphonates were prescribed in 4.9% (95%CI, 1.8-8.0%) and 0.5% (95%CI, 0-2.0%) of patients, respectively, during the past year. Overall, 14.7% of patients (95%CI, 9.5-20.0%) received at least one intervention. Concurrent risk factors for osteoporosis, including smoking, alcoholism, advanced age, low body mass index, long duration of ADT, multiple comorbidities, history of fractures, and steroid use, were not independent predictors of having received interventions. However, bone metastasis was, with a hazard ratio of 5.6 (95%CI, 1.99-15.6%). Primary care physicians provided the greatest number of interventions and cancer-related specialists provided the fewest. CONCLUSIONS: The majority of patients with prostate carcinoma undergoing ADT did not receive interventions to prevent or treat osteoporosis. Having other concurrent risk factors for osteoporosis was not predictive of receiving these few interventions.

Absorptiometry, Photon↗
PubMedDate not supplied

Beliefs, perceptions, and practices related to osteoporosis risk reduction among women with multiple sclerosis.

Women with multiple sclerosis (MS) are at increased risk for osteoporosis and fracture; in turn, osteoporosis has the potential to exacerbate the physical limitations imposed by MS. This qualitative study explored the understanding of osteoporosis risk and risk reduction, strategies being used to reduce risk, and related beliefs among 27 women with MS. Participants were recruited at a regional MS Society meeting. The women completed personal data forms, and responded to open-ended questions during taped interviews, which were transcribed and subjected to comparative content analysis. Five themes emerged from the data: knowledge about osteoporosis, sense of vulnerability, interactions with healthcare providers, preventive actions, and sense of control. All of the women had some knowledge about osteoporosis risk reduction, and most of the women were actively attempting to reduce their risk. However, few of the women had full knowledge, or were doing all that they might do, to minimize their risk. Few of their healthcare providers had discussed the issue or responded to their concerns, even when women had histories of multiple fractures. The women did comprehened their increased risk and most attempted to manage it, although input was lacking from healthcare providers about osteoporosis risk reduction.

Adult↗
PubMed1990

What do physicians in practice do to prevent osteoporosis?

Osteoporosis-associated fractures are a major public health problem in the United States. Although clinicians and policy groups have advocated estrogen replacement therapy and other clinical measures to prevent osteoporosis, few studies have assessed whether these measures are being adopted by physicians in practice. The purpose of this study is to evaluate physicians' use of osteoporosis prevention measures and to assess the impact of physician specialty and practice setting on osteoporosis prevention performance. A survey of nearly 300 physicians was carried out in a large metropolitan area. Gynecologists, general internists, and cardiopulmonary specialists were included from one of three practice settings: fee-for-service private practice, full-time academic medicine, or a large health maintenance organization. Most physicians, regardless of clinical specialty or practice setting, report that they advocate exercise and calcium supplementation. Few physicians prescribe estrogen replacement therapy (ERT) for the majority of their postmenopausal patients. Although there are minimal differences among the three types of practice settings examined, ERT varies markedly by clinical specialty. Of the gynecologists surveyed, 37% report prescribing ERT for the majority of their postmenopausal patients to prevent osteoporosis compared to only 7 and 5% of general internists and cardiopulmonary specialists, respectively (chi 2 = 45.3, p less than 0.0001). Although the efficacy of exercise and calcium supplementation to prevent osteoporotic fractures has not been well established, these measures are commonly advocated by both generalists and subspecialists. Although gynecologists are significantly more likely to prescribe ERT to prevent osteoporosis than the other clinical specialists, in general very few physicians prescribe ERT for most postmenopausal patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiology↗
PubMed1993

Skeletal osteoporosis.

Osteoporosis is characterized by decreased bone mass and increased susceptibility to fractures. The clinical consequences of osteoporosis are fracture, most commonly seen at the wrist, the spine, and the hip. The prevalence of osteoporotic fracture is extremely high with 30%-40% of 70-year-old women having had at least one osteoporotic fracture. The prevalence in men is lower but may constitute a larger problem than expected. Osteoporotic fracture is, therefore, a significant cause of morbidity and mortality and represents a major problem of health care. Bone is the site of substantial metabolic exchanges, with bone resorption and formation continuing throughout life. The turnover processes are carried out by osteoclasts and osteoblasts in specialized cellular units. After cessation of growth, the skeleton probably consolidates to reach the peak bone mass at the age of 35-40 years. The relatively slow subsequent age-related bone loss occurs in both men and women, but women are additionally exposed to accelerated bone losses after the menopause. Estrogen deficiency is the dominating pathogenetic factor for osteoporosis in women. The role of disturbances in the calcium-regulating hormones and vitamin D deficiency is less sure. The pathophysiologic mechanisms of osteoporosis in men are not well investigated. Those who are endowed with a low peak bone mass and/or are exposed to a large bone loss are at particular risk of developing symptomatic osteoporosis. Several risk factors have been recognized but are insufficiently sensitive and specific to predict an individual's overall risk of developing osteoporosis.

Bone and Bones↗
PubMed2001

Relation of polymorphism in the promotor region for the human osteocalcin gene to bone mineral density and occurrence of osteoporosis in postmenopausal Chinese women in Taiwan.

Osteoporosis is a common disorder with a strong genetic component. Our aim was to evaluate the correlation of the HindIII osteocalcin gene polymorphism to bone mineral density (BMD) and their relationship to osteoporosis. We determined the HindIII osteocalcin gene polymorphism using polymerase chain reaction (PCR)-based restriction analysis in postmenopausal Chinese women in Taiwan. The osteocalcin gene polymorphism was detected by the restriction enzyme HindIII, where the H allele indicated the absence of the cuttable site and the h allele indicated its presence. We then related the genotypes to BMD and occurrence of osteoporosis in these women. The allelic frequencies for postmenopausal Chinese women in Taiwan were 64% for h and 36% for H in HindIII restriction fragment length polymorphisms. The prevalence of each genotype in the study population was 37.7% hh, 52.6% Hh, and 9.7% HH. The subjects with genotype hh had the greatest BMD at the lumbar spine and the femoral neck, and those with HH had the smallest BMD at the femoral neck, but these differences did not reach statistical significance. The HindIII osteocalcin genotype showed a significant effect on the prevalence of osteoporosis in the subjects at the femoral neck, that is, women with genotype HH had a 6.4 times greater risk for osteoporosis (P < 0.05), and those with genotype Hh had a 1.2 times greater risk than women with genotype hh. In conclusion, the HindIII osteocalcin gene polymorphism is associated with reduced BMD and predisposes women to osteoporosis at the femoral neck.

Aged↗
PubMed1988

Treatment of denervation/disuse osteoporosis in the rat with a capacitively coupled electrical signal: effects on bone formation and bone resorption.

Utilizing a sciatic neurectomy model of disuse osteoporosis, the effects on rates of bone formation and bone resorption were examined when a capacitively coupled electrical signal was applied to the denervated tibia in the rat. It was found that a low-voltage, symmetrical sine wave, 60-kHz, capacitively coupled signal had no significant effect on the amount of bone resorption occurring in denervated right tibiae in rats previously labeled with [3H]tetracycline. This was true whether the signal was applied while osteoporosis was developing (prevention of osteoporosis) or after it had been established (treatment of osteoporosis). If a similar capacitively coupled signal was applied to rats in which osteoporosis was well established, and the rats were labeled with [3H]tetracycline daily during a 12-day treatment period, it was found that there was statistically significant enhancement of the amount of new bone formation (increased [3H]tetracycline incorporation) in the tibiae that received the signal as compared with that of the controls. These results indicate that prevention or amelioration of disuse osteoporosis that occurs with a capacitively coupled electrical signal is due not to a change in the rate of bone resorption, but to an increase in the rate of bone formation.

Animals↗
PubMed2000

Ability of osteoclast formation from peripheral monocytes using anti-fusion regulatory protein-1/CD98/4F2 monoclonal antibodies in patients with osteoporosis.

We investigated the difference in osteoclast formation between patients with osteoporosis and two healthy control groups by inducing it from peripheral blood monocytes with use of anti-fusion regulatory protein- monoclonal antibody. The group of patients with osteoporosis consisted of 35 women and excluded secondary osteoporosis, and the control groups consisted of 12 young healthy volunteers (control I) or 10 individuals age-matched to the patients with osteoporosis (control II). Osteoclast formation declined with age between the two control groups, but this decline was not significant. Fusion rate and the mean number of nuclei in osteoclasts were significantly less in the patients with osteoporosis than in the young or age-matched controls. It was clearly demonstrated that the ability of monocytes to fuse declines significantly in patients with osteoporosis.

Adult↗
PubMed2002

Knowledge of osteoporosis in a Swedish municipality--a prospective study.

BACKGROUND: As a part of the Vadstena Osteoporosis Prevention Project, the knowledge of osteoporosis was examined before the intervention program started, after 5 and 10 years. METHODS: At baseline (in 1989) 15% of the population in two Swedish municipalities was randomly invited to the study. The participants in the study group were invited for examination by forearm bone densitometry and a questionnaire concerning lifestyle and risk factors for osteoporosis and also knowledge of osteoporosis, while the subjects in the control group were examined only by questionnaire. Follow-ups were made in 1994 and in 1999. Meanwhile education about osteoporosis was given to the study group, to the public, and to various professionals in the study community. RESULTS: There was a difference in the level of knowledge between the groups prior to the intervention. The rate of increment did not differ significantly between the groups for the study period. Previous participants had 0.58 higher score than new participants in the study group in 1994 (P = 0.031) and 0.76 higher score in 1999 (P < 0.001) regarding the total number of correct answers. The women in the study group had 0.63 higher score than the men in 1994 (P = 0.016) and 1.03 higher score in 1999 (P < 0.001) regarding the total number of correct answers. CONCLUSION: There was no significant effect of a general intervention program concerning the knowledge of osteoporosis in participants in the intervention area compared to the control area.

Absorptiometry, Photon↗
PubMed1996

Classification of osteoporosis in the elderly is dependent on site-specific analysis.

Vertebral osteoporosis accounts for over 500,000 spinal fractures annually, the majority of which occur in older women. Despite these statistics, data regarding the rate of spinal bone loss in this population are conflicting. Moreover, the site of skeletal evaluation may significantly alter classification of osteoporosis in this age group. To examine trabecular-rich spinal bone loss with a measurement less affected by age-related artifacts than the AP spine, we measured lateral lumbar spine bone density (BMD) using dual-energy X-ray absorptiometry in 120 healthy, ambulatory, community-dwelling women 65 years of age and older (mean 70 +/- 5 years, range 65-88). We also examined cortical-rich sites in the forearm and total body along with AP spine and femoral BMD to assess the impact of site specificity using the World Health Organization (WHO) classification of osteoporosis. Significant losses in BMD were observed at the lateral spine (-1.1%/year, P < 0.01), forearm (-0. 77%/year, P </= 0.01), total hip (-0.75%/year, P </= 0.01), femoral neck (-0.70%/year, P </= 0.05), and trochanter (-0.78%/year, P </= 0. 01), but not the AP spine. Using the WHO criteria, lateral spine BMD determinations classified 66% of women with osteoporosis in contrast to 29% using the AP projection. Osteoporosis was diagnosed in 55% of women using measurements of the femoral neck, 43% using the total radius, and 19% using the total body. We conclude that elderly women lose bone at trabecular- and cortical-rich sites (lateral spine and total radius, respectively) in addition to sustaining significant age-related bone loss at mixed cortical/trabecular sites such as the hip. Classification of osteoporosis in this age group more than doubles using lateral versus AP spinal projections, supporting the necessity of developing more uniform agreement on site-specific analyses.

Absorptiometry, Photon↗
PubMed1998

Are arm span measurements useful in the prediction of osteoporosis in postmenopausal women?

A consensus report on osteoporosis in The Netherlands recommends general practitioners to use an arm span-height difference of at least 3 cm as one of the criteria for suspecting osteoporosis. In this study it was investigated how well this criterion discriminates between patients with established osteoporosis and controls in a group of postmenopausal women. When the Dutch general practitioners criterion of arm span-height difference exceeding 3 cm was applied in a logistic regression analysis to predict the probability of having osteoporosis, a resultant sensitivity of 58% and a specificity of 56% were found. In order to improve the predicted probability of osteoporosis, two more predictors in addition to the arm span-height difference were introduced in the logistic regression model. The first additional predictor related to information whether subject's age was below or above 70 years, and the second whether the arm span was below or above 160 cm. All three predictors appeared to be highly significant. It was shown that the predicted probability of osteoporosis by this model could be considerably improved when the age category and the arm span category were also taken into account, leading to a sensitivity of 81% while the specificity amounts to 64%. This seems quite satisfactory for such a simple method and clearly improves on the original single criterion of arm span-height difference.

Age Factors↗