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PubMed2005

Can an educational program for residents of assisted living facilities improve drug utilization for osteoporosis?

OBJECTIVE: To examine the utilization of medications for prevention or treatment of osteoporosis in assisted living facilities and to determine the effect of an educational program for residents on changes in the use of osteoporosis medications. SETTING: Assisted living facilities. PARTICIPANTS: All residents living in 21 assisted living facilities. PRACTICE INNOVATION: Assisted living facilities were randomized into an intervention or control group. The intervention group received an education program on osteoporosis. The control group received usual care. Drug utilization for prevention or treatment of osteoporosis was determined before the intervention and at two and six months post-intervention. MAIN OUTCOME MEASURES: Drug use before and after the educational program. RESULTS: Of 1,284 residents, only 17% were receiving prescription medication for prevention or treatment of osteoporosis, and only 4.6% of residents were receiving calcium supplementation. The educational intervention did not alter osteoporosis drug use over a six-month period. CONCLUSION: A single educational program for residents of assisted living facilities did not improve drug therapy use.

Journal Article↗
PubMed2003

[Pathophysiology, diagnosis and treatment of osteoporosis].

Patients with rheumatoid arthritis (RA) develop both generalized and periarticular osteoporosis. Osteoporosis in RA causes by increase of bone resorption, however the decrease of bone formation has been concerned in development of osteoporosis. Drug therapy have to bigin as early as osteopenia, and a potent inhibitor of bone resorption will be effective to suppress the increse of bone resorption in RA patients. RA-associated osteoporosis including grucocorticoid induced osteoporosis decreases bone formation, vitamin D and parathyroid hormon would become the useful drug for promoting the bone formation by examination of new agents, method and dosage of treatment for osteoporosis in RA patients.

English Abstract↗
PubMed2002

[Osteoporosis in Thailand].

Osteoporosis is a health problem which is becoming more prevalent in Thailand. A number of differences compared to Caucasian populations, however, exist which include the burden and the diagnosis of osteoporosis, genetics of osteoporosis, vitamin D status and calcium intake. Thai postmenopausal women suffer less hip fractures despite lower bone mineral density (BMD). Other environmental or genetic factor are likely to play modulatory role on the determination of osteoporotic fractures besides BMD. Distal renal tubular acidosis is prevalent in certain parts of Thailand. The disorder in which low BMD is a clinical feature needs to be excluded before the diagnosis of osteoporosis based on bone densitometry can be made. Genetic factors play important role in the determination of osteoporosis and osteoporotic fractures. The cohort of genes involved in osteoporosis and their impact are likely to be different among populations with different ethnic background. Besides genetic factors, environmental factors such as calcium intake and vitamin status are also crucial. Thailand is situated in a geographic area with abundant sunlight exposure and vitamin D deficiency is not commonly found in our elderly who are still active and ambulatory. Due to adequate vitamin D status, favorable vitamin D receptor genotype and less urinary calcium loss because of smaller body built, the optimal calcium in Thais may not be as high as that recommended in Caucasians.

English Abstract↗
PubMed2001

[The concept of severe osteoporosis].

In diagnostic criteria of primary osteoporosis in Japan, there is no expression of severe osteoporosis. In the primary osteoporosis, the criteria of WHO is difficult to use in our daily medical care. In 1992, we opened "The osteoporosis dock" in the department of osteopaedics of National Nishisaitama Chuo Hospital. From experience of our osteoporosis dock, we tried to answer the question with "what is the concept of severe osteoporosis?".

English Abstract↗
PubMed2001

[Drug therapy for osteoporosis associated with rheumatoid arthritis (vitamin D)].

A various factors are related to osteoporosis with Rheumatoid Arthritis (RA) complicatedly. Improvement of bone decrease does not become only the bone fracture prevention and leads to the prevention of joint destruction. Osteoporosis in RA causes by increase of bone resorption. However, the decrease of bone formation has been found to osteoporosis in many RA patients containing steroid induced osteoporosis. The treatment for osteoporosis in RA with vitamin D may be letting the bone formation decreased in RA normalize by regulatory of immunity. The vitamin D would become the useful drug for promoting the bone formation by examination of new agents, method and dosage of treatment for osteoporosis in RA patients.

English Abstract↗
PubMed1998

Reliability of an Osteoporosis-Targeted Quality of Life Survey Instrument for use in the community: OPTQoL.

A brief Osteoporosis-Targeted Quality of Life (OPTQoL) questionnaire was previously developed as a cross-sectional survey instrument to assess the community impact of osteoporosis on quality of life in women. The initial development process involving item generation through focus groups, item reduction, and content and construct validation yielded a 36-item questionnaire with three domains (physical difficulty, adaptations and fears) and 10 health-related questions. In the present study, test-retest reliability and internal consistency of the questionnaire were assessed in a mail-based study with two clinical sites. Two hundred women (50 with severe osteoporosis, 50 with osteopenia, 50 with normal bone mineral density (BMD) and 50 with osteoarthritis and normal BMD), aged 43-84 years, completed the self-administered questionnaire initially and again about 2 weeks later. Using weighted kappas, agreement between questionnaire administrations ranged from 0.60 to 0.80 for most of the individual items. Intraclass correlation coefficients to assess reliability for the domain scores were 0.93 (physical difficulty), 0.82 (adaptations) and 0.88 (fears). Internal consistency of each of the domains was also high, with Cronbach's alpha coefficients ranging from 0.89 to 0.91. Four items were dropped from the 36-item questionnaire due to high percentage of 'not applicable' responses. Results of the analyses support the validity and reliability of this instrument as a cross-sectional survey tool for assessing the impact of osteoporosis on quality of life in women living in the community. The questionnaire has been translated and culturally adapted into seven languages to allow cross-cultural studies of the community impact of osteoporosis.

Activities of Daily Living↗
PubMed1998

[Epidemiology of osteoporosis].

Epidemiological studies have identified osteoporosis as a disease of significant public health impact and have delineated numerous potential risk factors. Nevertheless, it has proven difficult to establish preventive strategies for several reasons. First, there has been no final agreement on the definition of osteoporosis, which has hampered efforts to characterize the magnitude of the problem as a whole. Secondly, as osteoporosis is a multifactorial chronic disorder, effective programs for risk assessment and intervention depend on the development of complex disease models. In summarizing the contributions of epidemiological studies to the current understanding of osteoporosis this review intends to outline the scientific background for the European Vertebral Osteoporosis Study (EVOS) and its successors.

Cross-Sectional Studies↗
PubMed2001

[Secondary osteoporosis induced by anticoagulants?].

Generalized osteoporosis is a result of different causes and pathogenic mechanisms, which often combine forces to become clinically relevant. Among the different exogenic factors, drugs play an important role, frequently in connection with other factors such as immobilization or pregnancy. It has been suggested that anticoagulation therapy with heparins or coumarins may induce osteoporotic changes or enhance the development of osteoporosis for other reasons. According to in vitro experiments, preclinical trials, and clinical investigations, it seems reasonable to assume that heparins induce increased bone loss in a time- and dose-related manner. Low-molecular-weight heparins most likely have less effect on bone turnover when compared to unfractionated heparin. Oral anticoagulation therapy with vitamin K-antagonists is believed to have a weak effect on induction of osteoporosis, but clinical studies are contradictory. In spite of the fact that a relevant effect of these drugs on the induction of osteoporosis is questionable, it must be taken into consideration that anticoagulant drugs may enhance the negative effects on bone density of other risk factors capable of inducing osteoporosis such as immobilization, pregnancy, or endocrinological disorders.

Administration, Oral↗
PubMed2003

Prevalence of osteoporosis and its reproductive risk factors among Jordanian women: a cross-sectional study.

Extensive differences in the osteoporosis epidemiological pattern among geographic and ethnic groups have been reported. The evidence concerning association of multiple pregnancies, lactations, and other menstrual history factors with low bone mineral density (BMD) remains inconclusive. Previous local studies addressing these issues in Jordan are very restricted. We present a cross-sectional study of Jordanian women who visited outpatient clinics between August 2000 and August 2002 at two community hospitals in Amman City. BMD measurement was performed for all subjects, while comprehensive appraisal of clinical issues related to reproductive status and past medical history was carried out using a structured questionnaire administered to 50% of the subjects. We also attempted to examine the current hypothesis of possible influence of hyperlipidemia and thyroid abnormalities on decreased BMD. According to WHO criteria, 119 (29.6%) were identified as having osteoporosis, 176 (43.8%) were osteopenic, and 107 (26.6%) had normal BMD. The multiple-linear regression analyses at different bone sites revealed that age, years of menopause, low-density lipoprotein (LDL), and follicle-stimulating hormone (FSH) have strong independent associations with decreased BMD at all lumbar and femoral neck regions. The negative effect associated with number of children (live births) and frequency of lactations was only evident at femoral neck. Although years of menstruation, age at menopause, days of menstrual cycle, number of pregnancies, and duration of hormone replacement therapy (HRT) were positively correlated with BMD, they had weaker associations than previous variables. Moreover, in the final multivariable logistic regression model, variables which rendered significantly independent risk factors after adjustment for age and BMI were: current smokers of more that 25 cigarettes/day, postmenopausal women irrespective of HRT use, menopausal years of > or =5 year intervals, natural early menopause, gastrointestinal disease, rheumatoid arthritis, osteoarthritis, hypertension, and thyroid replacement therapy. Ever-lactation, frequent lactation of 4 or more times, duration of lactation interval of 1-6 months and clinical hyperthyroidism were significant protective factors. Hysterectomy with or without oophorectomy, premature ovarian failure, gravidity, menstrual flow pattern, family history of osteoporosis, clinical hypothyroidism, hyperlipidemia, HRT, and corticosteroids therapy were not independent predictors of osteoporosis among our population. It was concluded that the prevalence of this worldwide public health problem among the Jordanian female population is extremely high, and is even found in younger age categories compared to previous international surveys. Though, the number of pregnancies in our multiparous female population showed a negative impact on femoral neck BMD, no evidence of increased risk of osteoporosis among ever-pregnant women was noted. Conversely, the current data analysis highlight many potential risk factors including associated medical illnesses, and other hormonal alterations experienced during menopausal period. Therefore, increased health awareness and intensive screening programs are mandatory for early detection of low bone mass.

Adult↗
PubMed2003

Peptic ulcer disease and calcium intake as risk factors of osteoporosis in women.

INTRODUCTION: Low dietary intake and decreased absorption of calcium are known as important risk factors of osteoporosis. Peptic ulcer disease may be accompanied by dietary restrictions influencing negatively calcium intake. Inflammation of gastric and duodenal mucosa as well as alkali used may significantly decrease calcium absorption. Additionally, bone metabolism may be changed by inflammatory mediators released as a result of mucosal inflammation. AIMS: Comparison of bone mineral density and calcium dietary intake in women with and without (control group) peptic ulcer disease. METHODS: Two hundred and sixty-three women were studied: 143 (mean age 60.3 years) with peptic ulcer disease diagnosed by endoscopy and/or upper gastrointestinal X-ray, and 120 (mean age 58.4 years) as controls. History of alimentary tract diseases and presence of risk factors of osteoporosis, as well as history of hormone replacement therapy, were collected based on specially designed questionnaires. Women with present risk factors of secondary osteoporosis and with previously diagnosed osteoporosis were excluded. The calcium dietary intake was determined using a standard questionnaire assessing milk and milk products intake as well as calcium supplementation when used. Bone mineral density of the lumbar spine and femoral bone was determined by DXA. RESULTS: Women with peptic ulcer disease not using hormone replacement therapy had lower bone mineral density in all studied regions as compared to control group without peptic ulcer disease. In the subgroup not using hormone replacement therapy all studied values differed significantly. In the smaller subgroup of women using hormone replacement therapy not all values were statistically significant. There was no statistical significance between studied groups in dietary calcium intake as milk, milk products, and calcium supplements. CONCLUSIONS: Calcium intake in women with ulcer disease is similar to healthy subjects. Peptic ulcer disease is an independent risk factor for osteoporosis in women.

Adult↗
PubMed2003

Burden of osteoporosis and fractures.

Osteoporosis currently affects up to one in three women and one in 12 men. In 1990, there were 1.6 million hip fractures per annum worldwide and this number is estimated to reach 6 million by 2050. This increase in the number of fractures is due to an increase in the number of elderly people in the population, improved survival, and an increase in the age-specific fracture rates of unknown etiology. The rising number of osteoporotic fractures and their associated morbidity will place a heavy burden on future health care resources. In the United States, the cost for the management of osteoporosis has been estimated at $17 billion. The majority of this cost is spent on the acute surgical and medical management following hip fracture, and the subsequent rehabilitation. Currently, only minimal costs are utilized for treatment and prevention of osteoporosis. Hopefully, however, an accurate assessment of the burden of osteoporosis on the individual and the health care system will enable the targeting of resources to tackle this growing problem. With an increasing number of effective pharmaceutical interventions, it is critical that these agents are targeted to those at greatest risk for future fracture. This will ultimately reduce the burden of osteoporosis in future years.

Age Distribution↗
PubMed2000

Update on the epidemiology of osteoporosis.

Osteoporosis is a major public health problem that affects the entire aging population. This report provides an update on the epidemiology of osteoporosis and its associated fractures. Published studies from 1997 to the present are highlighted. The current US prevalence estimates for osteoporosis, trends in fracture incidence rates, and latest reports on the morbidity, mortality, and costs attributable to osteoporotic fractures are discussed. Recent advances in our understanding of risk factors associated with osteoporosis and related fractures are reviewed. Special attention is paid to the rapid progress being made in the field of genetics, the growing importance of nutrition, and the new questions being raised as to the influence of hormonal factors on bone mineral density and fracture risk. New studies linking osteoporosis to several other important diseases in women including breast cancer, osteoarthritis, and stroke are also reviewed.

Aged↗
PubMed2003

Secondary osteoporosis.

Bone loss occurs during the normal aging process. The term "primary" osteoporosis refers to osteoporosis that results from the involutional losses associated with aging and, in women, additional losses related to natural menopause. Osteoporosis that is caused or exacerbated by other disorders or medication exposures is referred to as "secondary" osteoporosis. This article describes the major causes and provides a framework for the diagnostic investigation of patients with suspected of having secondary osteoporosis.

Bone Diseases↗
PubMed2003

Osteoporosis: still a typical complication of primary biliary cirrhosis?

BACKGROUND: Osteoporosis is a recognized complication of primary biliary cirrhosis but it has been suggested that its prevalence may overlap that observed among postmenopausal women. AIM: To evaluate prevalence and risk factors of osteoporosis in primary biliary cirrhosis. PATIENTS: A total of 133 female patients (age 53+/-10 years, menopausal status 70%, histological stage I-II 61%, portal hypertension 28%, Mayo Risk Score 4.11+/-0.59) were enrolled. METHODS: Dual X-ray absorptiometry of the lumbar spine. RESULTS: Mean bone mineral density, T and Z score were 0.861+/-0.160 g/cm2, -1.87+/-1.45 and -0.78+/-2.63, respectively. At multivariate analysis, bone mineral density was inversely correlated with age (p<0.05). Osteoporosis was present in 39/92 (41%) postmenopausal and 8/41 (20%) premenopausal patients. In the premenopausal group, osteoporosis was significantly correlated with serum albumin (p<0.05) and Mayo Risk score (p<0.005). No significant correlation was present in the postmenopausal group. CONCLUSIONS: Despite the accepted wisdom that osteoporosis is a common complication of primary biliary cirrhosis, its frequency in post-menopausal patients overlaps that observed in the general population, but is much more frequent in premenopausal patients, where it appears to be related to severity of liver disease and cholestasis.

Adult↗
PubMed2000

[Steroid-induced osteoporosis: pathogenesis and therapeutic consequences].

Many chronic inflammatory diseases require treatment with steroids, however, a remarkable proportion of steroid-treated patients suffer from osteoporosis as major complication after longterm treatment. Steroid-induced osteoporosis represents one of the most important secondary causes of osteoporosis. The pathogenesis is complex, there exists evidence that steroids cause a reduction of circulating testosterone and estrogen concentration and adversely affect calcium balance. The most important mechanism is a decrease in osteoblastic activity. As a consequence loss of bone mineral density and increased risk of fracture develop. In spite of better understanding of the causal relationships preventive strategies were infrequently applied. If we care for patients with steroid therapy we have both to consider the problem of steroid-induced osteoporosis and to focus on strategies to evaluate patients at risk. The dosage of the steroid, life style factors (such as lack of exercise, alcohol consumption and smoking), menopausal status, low bone mineral density at baseline and previous osteoporotic fractures predispose for the manifestation of steroid-induced osteoporosis. Therapeutic decisions depend on risk factors of the individual patient. Supplementation of calcium and vitamin D is usually appropriate, and postmenopausal women should be offered hormone replacement therapy. The prescription of bisphosphonates is strongly recommended to patients at elevated risk.

Estrogen Replacement Therapy↗
PubMedDate not supplied

Alendronate in the treatment of osteoporosis: a review of the clinical trials.

Osteoporosis is a highly prevalent disease. More than half of postmenopausal women will experience fractures. Women at high risk (osteoporosis as measured by bone density, low trauma fractures of any type, or certain other risk factors) often require pharmacological therapy. However, surveys show that most women who have recently had fractures are currently not being treated. Recent results from the first megatrial of osteoporosis with >6400 participants, the Fracture Intervention Trial (FIT), have provided important advances in our understanding of osteoporosis and the efficacy of alendronate. The FIT study and other large clinical trials show that alendronate effectively increases bone density, reduces the risk of hip and vertebral fractures by approximately half within the first 12-18 months, and, most importantly, reduces the health consequences of fractures. Alendronate is also effective for preventing bone loss in early postmenopausal women. Thus, alendronate represents an important option for preventing and treating this common and debilitating disease. This article summarizes the wealth of data from FIT and other studies of alendronate in the context of the burden of illness associated with osteoporosis.

Alendronate↗
PubMed2002

Combination treatment of osteoporosis: a clinical review.

OBJECTIVE: Because of the limited efficacy of available agents and to limit toxicity, there is considerable interest in combination pharmacotherapy for osteoporosis. METHODS: A search was performed for randomized controlled trials in MEDLINE (1966-present) using the keywords osteoporosis treatment and combination. RESULTS: Twenty-four randomized controlled trials evaluated osteoporosis medications in combination. Study duration ranged from 1 to 4 years. No serious adverse events were definitively attributable to study drugs. Fracture reduction outcome is not shown for any combination regimen. The literature was mixed regarding bone density augmentation. Combinations of nandrolone decanoate plus calcitonin, calcitonin plus growth hormone (GH), or pamidronate plus GH may be contradictory or detrimental to bone mineral density (BMD). For postmenopausal osteoporosis or osteopenia, four combinations appear to increase hip and lumbar BMD: 10 mg alendronate with 0.625 mg conjugated equine estrogens (CEE), cyclic etidronate with 0.625mg CEE, 10 mg alendronate with 2 mg estradiol (E(2)), and tibolone with fluoride. For steroid-related osteoporosis, intermittent etidronate with fluoride increases lumbar BMD. CONCLUSIONS: The few trials including Food and Drug Administration (FDA)-approved medications suggest that 10 mg/day alendronate with estrogen (equivalent of 0.625 mg CEE daily) can increase BMD moreso than each medication given singly in postmenopausal osteoporotic women. Estrogen dose and type must be controlled in future trials. Long-term safety data are lacking. The utility of these combinations rests on whether bone density changes will translate into decreased fracture rates.

Alendronate↗
PubMed2005

Evaluation of web-based osteoporosis educational materials.

BACKGROUND: Many women are unaware of risk factors for and consequences of osteoporosis. Hence, patient education is an essential step in preventing and managing osteoporosis. Unfortunately, numerous studies have demonstrated a mismatch between the reading difficulty of typical patient education materials and the reading ability of many American adults. METHODS: We examined the readability and quality of web-based information on osteoporosis using the Suitability Assessment of Materials (SAM) and DISCERN instruments. The three most widely used Internet search engines, Google, Yahoo, and MSN, were selected based on popularity according to Nielsen/Net Ratings. The search term osteoporosis was entered to generate the first 30 websites listed by each of the three search engines. Several websites appeared on all three search engines; we identified 27 unique websites. RESULTS: Overall, 51.9% of materials were rated by the SAM as not suitable. Most materials scored poorly for their reading level (82.6% were rated not suitable), with an average reading level at grade 11.5 +/- 2.8. The mean DISCERN score for overall description of treatment options was 35.7 +/- 18.0, indicating inadequate quality. Most materials had low quality in a number of indicators, including accuracy and biased presentation of information. CONCLUSIONS: Web-based osteoporosis information is written above the reading ability of most American adults, and much of it lacks adequate quality.

Comprehension↗