107 results on '"McCloskey, E"'
Search Results
2. A new FRAX model for Brazil
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Albergaria, B. H., Zerbini, C. A. F., Lazaretti-Castro, M., Eis, S. R., Vilaca, T., Johansson, H., Harvey, N. C., Liu, E., Vandenput, L., Lorentzon, M., Schini, M., McCloskey, E., and Kanis, J. A.
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- 2023
- Full Text
- View/download PDF
3. Dynapenic Abdominal Obesity as a Risk Factor for Falls
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Dowling, Lisa, McCloskey, E., Cuthbertson, D. J., and Walsh, J. S.
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- 2023
- Full Text
- View/download PDF
4. Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan
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Vandenput, L., Johansson, H., McCloskey, E. V., Liu, E., Åkesson, K. E., Anderson, F. A., Azagra, R., Bager, C. L., Beaudart, C., Bischoff-Ferrari, H. A., Biver, E., Bruyère, O., Cauley, J. A., Center, J. R., Chapurlat, R., Christiansen, C., Cooper, C., Crandall, C. J., Cummings, S. R., da Silva, J. A. P., Dawson-Hughes, B., Diez-Perez, A., Dufour, A. B., Eisman, J. A., Elders, P. J. M., Ferrari, S., Fujita, Y., Fujiwara, S., Glüer, C.-C., Goldshtein, I., Goltzman, D., Gudnason, V., Hall, J., Hans, D., Hoff, M., Hollick, R. J., Huisman, M., Iki, M., Ish-Shalom, S., Jones, G., Karlsson, M. K., Khosla, S., Kiel, D. P., Koh, W.-P., Koromani, F., Kotowicz, M. A., Kröger, H., Kwok, T., Lamy, O., Langhammer, A., Larijani, B., Lippuner, K., Mellström, D., Merlijn, T., Nordström, A., Nordström, P., O’Neill, T. W., Obermayer-Pietsch, B., Ohlsson, C., Orwoll, E. S., Pasco, J. A., Rivadeneira, F., Schei, B., Schott, A.-M., Shiroma, E. J., Siggeirsdottir, K., Simonsick, E. M., Sornay-Rendu, E., Sund, R., Swart, K. M. A., Szulc, P., Tamaki, J., Torgerson, D. J., van Schoor, N. M., van Staa, T. P., Vila, J., Wareham, N. J., Wright, N. C., Yoshimura, N., Zillikens, M. C., Zwart, M., Harvey, N. C., Lorentzon, M., Leslie, W. D., and Kanis, J. A.
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- 2022
- Full Text
- View/download PDF
5. Population screening for fracture risk in postmenopausal women — a logical step in reducing the osteoporotic fracture burden?
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McCloskey, E. V., Chotiyarnwong, P., Harvey, N. C., Lorentzon, M., and Kanis, J. A.
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- 2022
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6. Improved fracture risk prediction by adding VFA-identified vertebral fracture data to BMD by DXA and clinical risk factors used in FRAX
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Johansson, L., Johansson, H., Axelsson, K. F., Litsne, H., Harvey, N. C., Liu, E., Leslie, W. D., Vandenput, L., McCloskey, E., Kanis, J. A., and Lorentzon, M.
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- 2022
- Full Text
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7. Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group
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Chotiyarnwong, P., McCloskey, E. V., Harvey, N. C., Lorentzon, M., Prieto-Alhambra, D., Abrahamsen, B., Adachi, J. D., Borgström, F., Bruyere, O., Carey, J. J., Clark, P., Cooper, C., Curtis, E. M., Dennison, E., Diaz-Curiel, M., Dimai, H. P., Grigorie, D., Hiligsmann, M., Khashayar, P., Lewiecki, E. M., Lips, P., Lorenc, R. S., Ortolani, S., Papaioannou, A., Silverman, S., Sosa, M., Szulc, P., Ward, K. A., Yoshimura, N., and Kanis, J. A.
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- 2022
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8. One leg standing time predicts fracture risk in older women independent of clinical risk factors and BMD
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Larsson, B.A.M., Johansson, L., Mellström, D., Johansson, H., Axelsson, K.F., Harvey, N., Vandenput, L., McCloskey, E., Liu, E., Sundh, D., Kanis, J.A., and Lorentzon, M.
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- 2022
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9. FRAX-based intervention thresholds for Pakistan
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Johansson, H., Naureen, G., Iqbal, R., Jafri, L., Khan, A. H., Umer, M., Liu, E., Vandenput, L., Lorentzon, M., McCloskey, E. V., Kanis, J. A., and Harvey, N. C.
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- 2022
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10. Fracture-related hospitalisations in de novo advanced or metastatic hormone-sensitive prostate cancer: Secondary analysis of the STAMPEDE abiraterone acetate plus prednisone +/- enzalutamide and M1|RT phase 3 trials using health systems data
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Jones, C., primary, Dutey-Magni, P., additional, Murphy, L., additional, Murray, M., additional, Brown, J., additional, Mccloskey, E., additional, Parmar, M.K.B., additional, Parker, C., additional, Attard, G., additional, James, N.D., additional, Sydes, M.R., additional, Brown, L.C., additional, Clarke, N.W., additional, and Sachdeva, A., additional
- Published
- 2024
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11. An assessment of intervention thresholds for very high fracture risk applied to the NOGG guidelines: A report for the National Osteoporosis Guideline Group (NOGG)
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Kanis, J. A., Johansson, H., Harvey, N. C., Lorentzon, M., Liu, E., Vandenput, L., and McCloskey, E. V.
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- 2021
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12. Impact of population-based or targeted BMD interventions on fracture incidence
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Harvey, N. C., Kanis, J. A., Liu, E., Vandenput, L., Lorentzon, M., Cooper, C., McCloskey, E., and Johansson, H.
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- 2021
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13. A meta-analysis of previous falls and subsequent fracture risk in cohort studies
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Vandenput, L., Johansson, H., McCloskey, E. V., Liu, E., Schini, M., Åkesson, K.E., Anderson, F. A., Azagra, R., Bager, C. L., Beaudart, C., Bischoff-Ferrari, H. A., Biver, E., Bruyère, O., Cauley, J. A., Center, J. R., Chapurlat, R., Christiansen, C., Cooper, C., Crandall, C. J., Cummings, S. R., da Silva, J. A. P., Dawson-Hughes, B., Diez-Perez, A., Dufour, A. B., Eisman, J. A., Elders, P. J. M., Ferrari, S., Fujita, Y., Fujiwara, S., Glüer, C. -C, Goldshtein, I., Goltzman, D., Gudnason, V., Hall, J., Hans, D., Hoff, M., Hollick, R. J., Huisman, M., Iki, M., Ish-Shalom, S., Jones, G., Karlsson, M. K., Khosla, S., Kiel, D. P., Koh, W. -P, Koromani, F., Kotowicz, M. A., Kröger, H., Kwok, T., Lamy, O., Langhammer, A., Larijani, B., Lippuner, K., McGuigan, F. E. A., Mellström, D., Merlijn, T., Nguyen, T. V., Nordström, Anna, Nordström, P., O’Neill, T. W., Obermayer-Pietsch, B., Ohlsson, C., Orwoll, E. S., Pasco, J. A., Rivadeneira, F., Schott, A. -M, Shiroma, E. J., Siggeirsdottir, K., Simonsick, E. M., Sornay-Rendu, E., Sund, R., Swart, K. M. A., Szulc, P., Tamaki, J., Torgerson, D. J., van Schoor, N. M., van Staa, T. P., Vila, J., Wareham, N. J., Wright, N. C., Yoshimura, N., Zillikens, M. C., Zwart, M., Harvey, N. C., Lorentzon, M., Leslie, W. D., Kanis, J. A., Vandenput, L., Johansson, H., McCloskey, E. V., Liu, E., Schini, M., Åkesson, K.E., Anderson, F. A., Azagra, R., Bager, C. L., Beaudart, C., Bischoff-Ferrari, H. A., Biver, E., Bruyère, O., Cauley, J. A., Center, J. R., Chapurlat, R., Christiansen, C., Cooper, C., Crandall, C. J., Cummings, S. R., da Silva, J. A. P., Dawson-Hughes, B., Diez-Perez, A., Dufour, A. B., Eisman, J. A., Elders, P. J. M., Ferrari, S., Fujita, Y., Fujiwara, S., Glüer, C. -C, Goldshtein, I., Goltzman, D., Gudnason, V., Hall, J., Hans, D., Hoff, M., Hollick, R. J., Huisman, M., Iki, M., Ish-Shalom, S., Jones, G., Karlsson, M. K., Khosla, S., Kiel, D. P., Koh, W. -P, Koromani, F., Kotowicz, M. A., Kröger, H., Kwok, T., Lamy, O., Langhammer, A., Larijani, B., Lippuner, K., McGuigan, F. E. A., Mellström, D., Merlijn, T., Nguyen, T. V., Nordström, Anna, Nordström, P., O’Neill, T. W., Obermayer-Pietsch, B., Ohlsson, C., Orwoll, E. S., Pasco, J. A., Rivadeneira, F., Schott, A. -M, Shiroma, E. J., Siggeirsdottir, K., Simonsick, E. M., Sornay-Rendu, E., Sund, R., Swart, K. M. A., Szulc, P., Tamaki, J., Torgerson, D. J., van Schoor, N. M., van Staa, T. P., Vila, J., Wareham, N. J., Wright, N. C., Yoshimura, N., Zillikens, M. C., Zwart, M., Harvey, N. C., Lorentzon, M., Leslie, W. D., and Kanis, J. A.
- Abstract
Summary: The relationship between self-reported falls and fracture risk was estimated in an international meta-analysis of individual-level data from 46 prospective cohorts. Previous falls were associated with an increased fracture risk in women and men and should be considered as an additional risk factor in the FRAX® algorithm. Introduction: Previous falls are a well-documented risk factor for subsequent fracture but have not yet been incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between previous falls and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD). Methods: The resource comprised 906,359 women and men (66.9% female) from 46 prospective cohorts. Previous falls were uniformly defined as any fall occurring during the previous year in 43 cohorts; the remaining three cohorts had a different question construct. The association between previous falls and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture, and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients. Results: Falls in the past year were reported in 21.4% of individuals. During a follow-up of 9,102,207 person-years, 87,352 fractures occurred of which 19,509 were hip fractures. A previous fall was associated with a significantly increased risk of any clinical fracture both in women (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.33–1.51) and men (HR 1.53, 95% CI 1.41–1.67). The HRs were of similar magnitude for osteoporotic, major osteoporotic fracture, and hip fracture. Sex significantly modified the association between previous fall and fracture risk, with predictive values being higher in men than in women (e.g., for major osteoporotic fracture, HR 1.53 (95% CI 1.27–1.84) in men vs. HR 1.32
- Published
- 2024
- Full Text
- View/download PDF
14. Use of an electronic medical record dashboard to identify gaps in osteoporosis care
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Papaioannou, A., McCloskey, E., Bell, A., Ngui, D., Mehan, U., Tan, M., Goldin, L., and Langer, A.
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- 2021
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15. A surrogate FRAX model for Pakistan
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Naureen, G., Johansson, H., Iqbal, R., Jafri, L., Khan, A. H., Umer, M., Liu, E., Vandenput, L., Lorentzon, M., Harvey, N. C., McCloskey, E. V., and Kanis, J. A.
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- 2021
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16. A country-specific FRAX model for Botswana
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Kebaetse, M., Nkhwa, S., Mogodi, M., Masunge, J., Gureja, Y. P., Ramabu, M., Mmopelwa, T., Sharif, I., Orford, A., Harvey, N. C., McCloskey, E. V., Cauley, J. A., Kanis, J. A., and Johansson, H.
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- 2021
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17. Epidemiology of hip fracture in Botswana
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Kebaetse, M., Nkhwa, S., Mogodi, M., Masunge, J., Gureja, Y. P., Ramabu, M., Mmopelwa, T., Sharif, I., Orford, A., Johansson, H., Harvey, N. C., McCloskey, E. V., Cauley, J. A., and Kanis, J. A.
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- 2021
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18. An overview of the use of the fracture risk assessment tool (FRAX) in osteoporosis
- Author
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Schini, M., primary, Johansson, H., additional, Harvey, N. C., additional, Lorentzon, M., additional, Kanis, J. A., additional, and McCloskey, E. V., additional
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- 2023
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19. An experience- and preference-based EQ-5D-3L value set derived using 18 months of longitudinal data in patients who sustained a fracture: results from the ICUROS.
- Author
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Svedbom, A, Borgstöm, F, Hernlund, E, Alekna, V, Bianchi, ML, Clark, P, Diaz-Curiel, M, Dimai, HP, Jürisson, M, Lesnyak, O, McCloskey, E, Sanders, KM, Silverman, S, Tamulaitiene, M, Thomas, T, Tosteson, ANA, Jönsson, B, Kanis, JA, Svedbom, A, Borgstöm, F, Hernlund, E, Alekna, V, Bianchi, ML, Clark, P, Diaz-Curiel, M, Dimai, HP, Jürisson, M, Lesnyak, O, McCloskey, E, Sanders, KM, Silverman, S, Tamulaitiene, M, Thomas, T, Tosteson, ANA, Jönsson, B, and Kanis, JA
- Abstract
INTRODUCTION: EQ-5D-3L preference-based value sets are predominately based on hypothetical health states and derived in cross-sectional settings. Therefore, we derived an experience-based value set from a prospective observational study. METHODS: The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) was a multinational study on fragility fractures, prospectively collecting EQ-5D-3L and Time trade-off (TTO) within two weeks after fracture (including pre-fracture recall), and at 4, 12, and 18 months thereafter. We derived an EQ-5D-3L value set by regressing the TTO values on the ten impairment levels in the EQ-5D-3L. We explored the potential for response shift and whether preferences for domains vary systematically with prior impairment in that domain. Finally, we compared the value set to 25 other EQ-5D-3L preference-based value sets. RESULTS: TTO data were available for 12,954 EQ-5D-3L health states in 4683 patients. All coefficients in the value set had the expected sign, were statistically significant, and increased monotonically with severity of impairment. We found evidence for response shift in mobility, self-care, and usual activities. The value set had good agreement with the only other experience- and preference-based value set, but poor agreement with all hypothetical value sets. CONCLUSIONS: We present an experience- and preference-based value set with high face validity. The study indicates that response shift may be important to account for when deriving value sets. Furthermore, the study suggests that perspective (experienced versus hypothetical) is more important than country setting or demographics for valuation of EQ-5D-3L health states.
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- 2023
20. Prevalence of FRAX risk factors and the osteoporosis treatment gap among women >= 70 years of age in routine primary care across 8 countries in Europe
- Author
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McCloskey, E., Rathi, J., Heijmans, S., Blagden, M., Cortet, B., Czerwinski, E., Hadji, P., Payer, J., Palmer, K., Stad, R., O’Kelly, J., and Papapoulos, S.
- Subjects
Primary Health Care ,Treatment gap ,Fragility fracture ,Risk Assessment ,Europe ,Fracture Risk Assessment Tool (FRAX) ,Risk factors ,Bone Density ,Observational study ,Prevalence ,Humans ,Osteoporosis ,Orthopedics and Sports Medicine ,Female ,Original Article ,Osteoporotic Fractures ,Aged - Abstract
Summary We studied whether elderly women at risk for fractures receive primary care treatment to prevent fracture. We found that across Europe, women at risk are often not identified, and less than half of such women receive appropriate treatment. Finally, women diagnosed with osteoporosis are much more likely to receive treatment. Purpose To examine the relationship between risk factors for fragility fracture (FF) and osteoporosis (OP) treatment gap in elderly women across Europe, and compare the prevalence of risk factors between countries. Methods Demographic and clinical information was collected from women ≥ 70 years visiting primary care physicians in Belgium, France, Germany, Ireland, Poland, Slovakia, Switzerland, and the UK. Increased risk of FF was defined by the presence of 1 or more criteria (history of fracture, 10-year fracture probability, or T-score ≤ − 2.5). Results There were 3798 women in total. Treatment gap (proportion at increased risk of FF not receiving treatment for OP) varied from 53.1 to 90.8% across countries, and the proportion of patients at increased risk of FF varied from 41.2 to 76.1%. Across countries, less than 50% of patients with increased risk of FF had a diagnosis of OP. Previous fracture was the most common risk factor, with similar prevalence across most countries; other risk factors varied widely. The treatment gap was reduced in patients with an OP diagnosis in all countries, but this reduction varied from 36.5 to 79.4%. The countries with the lowest rates of bone densitometry scans (Poland, France, and Germany; 8.3–12.3%) also had the highest treatment gap (82.2 to 90.8%). Conclusions This study highlights differences across Europe in clinical risk factors for fracture, rates of densitometry scanning, and the rates of OP diagnosis. More emphasis is needed on risk assessment to improve the identification and treatment of elderly women at risk for fracture.
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- 2022
21. Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan
- Author
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Vandenput, L, Johansson, H, McCloskey, E V, Liu, E, et al, Bischoff-Ferrari, H A, and University of Zurich
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Diabetes and Metabolism ,2712 Endocrinology, Diabetes and Metabolism ,Endocrinology ,11221 Department of Aging Medicine ,610 Medicine & health - Published
- 2022
22. Update of the fracture risk prediction tool FRAX:a systematic review of potential cohorts and analysis plan
- Author
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Vandenput, L, Johansson, H, McCloskey, E V, Liu, E, Åkesson, K E, Anderson, F A, Azagra, R, Bager, C L, Beaudart, C, Bischoff-Ferrari, H A, Biver, E, Bruyère, O, Cauley, J A, Center, J R, Chapurlat, R, Christiansen, C, Cooper, C, Crandall, C J, Cummings, S R, da Silva, J A P, Dawson-Hughes, B, Diez-Perez, A, Dufour, A B, Eisman, J A, Elders, P J M, Ferrari, S, Fujita, Y, Fujiwara, S, Glüer, C-C, Goldshtein, I, Goltzman, D, Gudnason, V, Hall, J, Hans, D, Hoff, M, Hollick, R J, Huisman, M, Iki, M, Ish-Shalom, S, Jones, G, Karlsson, M K, Khosla, S, Kiel, D P, Koh, W-P, Koromani, F, Kotowicz, M A, Kröger, H, Kwok, T, Lamy, O, Langhammer, A, Larijani, B, Lippuner, K, Mellström, D, Merlijn, T, Nordström, A, Nordström, P, O'Neill, T W, Obermayer-Pietsch, B, Ohlsson, C, Orwoll, E S, Pasco, J A, Rivadeneira, F, Schei, B, Schott, A-M, Shiroma, E J, Siggeirsdottir, K, Simonsick, E M, Sornay-Rendu, E, Sund, R, Swart, K M A, Szulc, P, Tamaki, J, Torgerson, D J, van Schoor, N M, van Staa, T P, Vila, J, Wareham, N J, Wright, N C, Yoshimura, N, Zillikens, M C, Zwart, M, Harvey, N C, Lorentzon, M, Leslie, W D, and Kanis, J A
- Subjects
SDG 3 - Good Health and Well-being ,Bone Density ,Hip Fractures ,Risk Factors ,Endocrinology, Diabetes and Metabolism ,Humans ,Osteoporosis ,Prospective Studies ,610 Medicine & health ,Risk Assessment ,Osteoporotic Fractures - Abstract
We describe the collection of cohorts together with the analysis plan for an update of the fracture risk prediction tool FRAX with respect to current and novel risk factors. The resource comprises 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. INTRODUCTION The availability of the fracture risk assessment tool FRAX® has substantially enhanced the targeting of treatment to those at high risk of fracture with FRAX now incorporated into more than 100 clinical osteoporosis guidelines worldwide. The aim of this study is to determine whether the current algorithms can be further optimised with respect to current and novel risk factors. METHODS A computerised literature search was performed in PubMed from inception until May 17, 2019, to identify eligible cohorts for updating the FRAX coefficients. Additionally, we searched the abstracts of conference proceedings of the American Society for Bone and Mineral Research, European Calcified Tissue Society and World Congress of Osteoporosis. Prospective cohort studies with data on baseline clinical risk factors and incident fractures were eligible. RESULTS Of the 836 records retrieved, 53 were selected for full-text assessment after screening on title and abstract. Twelve cohorts were deemed eligible and of these, 4 novel cohorts were identified. These cohorts, together with 60 previously identified cohorts, will provide the resource for constructing an updated version of FRAX comprising 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. For each known and candidate risk factor, multivariate hazard functions for hip fracture, major osteoporotic fracture and death will be tested using extended Poisson regression. Sex- and/or ethnicity-specific differences in the weights of the risk factors will be investigated. After meta-analyses of the cohort-specific beta coefficients for each risk factor, models comprising 10-year probability of hip and major osteoporotic fracture, with or without femoral neck bone mineral density, will be computed. CONCLUSIONS These assembled cohorts and described models will provide the framework for an updated FRAX tool enabling enhanced assessment of fracture risk (PROSPERO (CRD42021227266)).
- Published
- 2022
23. Quantitating age-related BMD textural variation from DXA region-free-analysis: a study of hip fracture prediction in three cohorts
- Author
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Farzi, M., Pozo, J.M., McCloskey, E., Eastell, R., Harvey, N.C., Frangi, A.F., and Wilkinson, J.M.
- Abstract
The risk of osteoporotic fracture is inversely related to bone mineral density (BMD), but how spatial BMD pattern influences fracture risk remains incompletely understood. This study used a pixel-level spatiotemporal atlas of proximal femoral BMD in 13,338 white European women (age 20–97 years) to quantitate age-related texture variation in BMD maps and generate a “reference” map of bone aging. We introduce a new index, called Densitometric Bone Age (DBA), as the age at which an individual site-specific BMD map (the proximal femur is studied here) best matches the median aging trajectory at that site in terms of the root mean squared error (RMSE). The ability of DBA to predict incident hip fracture and hip fracture pattern over 5 years following baseline BMD was compared against conventional region-based BMD analysis in a subset of 11,899 women (age 45–97 years), for which follow-up fracture records exist. There were 208 subsequent incident hip fractures in the study populations (138 femoral necks [FNs], 52 trochanteric [TR], 18 sites unspecified). DBA had modestly better performance compared to the conventional FN-BMD, TR-BMD, and total hip (TOT)-BMD in identifying hip fractures measured as the area under the curve (AUC) using receiver operating characteristics (ROC) curve analysis by 2% (95% confidence interval [CI], −0.5% to 3.5%), 3% (95% CI, 1.0% to 4.0%), and 1% (95% CI, 0.4% to 1.6%), respectively. Compared to FN-BMD T-score, DBA improved the ROC-AUC for predicting TR fractures by ~5% (95% CI, 1.1% to 9.8%) with similar performance in identifying FN fractures. Compared to TR-BMD T-score, DBA improved the ROC-AUC for the prediction of FN fractures by ~3% (95% CI, 1.1% to 4.9%), with similar performance in identifying TR fractures. Our findings suggest that DBA may provide a spatially sensitive measure of proximal femoral fragility that is not captured by FN-BMD or TR-BMD alone.
- Published
- 2022
24. Update of the fracture risk prediction tool FRAX: A systematic review of potential cohorts and analysis plan
- Author
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Vandenput, Lisbeth, Johansson, H., McCloskey, E. V., Liu, E., Akesson, Kristina E., Anderson, F.A., Azagra, R., Bager, C.L., Beaudart, Charlotte, Bischoff-Ferrari, H.A., Biver, E., Bruyère, Olivier, Cauley, J.A., Center, J.R., Chapulat, R., Christiansen, C., Cooper, Cyrus, Crandall, Carolyn J., Cummings, Steven, da Silva, J.A.P., Dawson-Hughes, Bess, Diez-Pérez, A., Dufour, Alyssa B., Eisman, J.A., Elders, Petra J.M., Ferrari, S., Fujita, Y., Fujiwara, S., Glüer, C.C., Goldstein, I., Goltzman, D., Gudnason, V., Hall, J., Hans, D., Hoff, M., Hollick, Rosemary J., Huisman, Martijn, Iki, M., Ish-Shalom, S., Jones, G., Karlsson, M.K., Khosla, Sundeep, Kiel, D.P., Koh, W-P, Koromani, F., Kotowicz, M.A., Kroger, H., Kwok, T., Lamy, Olivier, Langhammer, Arnulf, Larijani, Bagher, Lippuner, Kurt, Mellström, D, Merlijn, Thomas, Nordstrom, A., Nordstrom, P., O'Neill, T.W., Obermayer-Piestch, B., Harvey, Nicholas, Kanis, J A., Ohlsson, C., Orwoll, E.S., Pasco, J.A., Rivadeneira, F., Schei, B., Schott, A.M., Shiroma, E.J., Siggeirsdottir, K., Simonsick, E.M., Sornay-Rendu, E., Sund, R., Swart, K.M.A., Szulc, P., Tamaki, J., Torgerson, D.J., Van Schoor, N.M., van Staa, T.P., Vilas, J.C., Wareham, N.J, Wright, N.C., Yoshimura, N., Zillikens, M.C., Zwart, M., Lorentzon, M., and Leslie, W.D.
- Abstract
Summary: We describe the collection of cohorts together with the analysis plan for an update of the fracture risk prediction tool FRAX with respect to current and novel risk factors. The resource comprises 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. Introduction: The availability of the fracture risk assessment tool FRAX® has substantially enhanced the targeting of treatment to those at high risk of fracture with FRAX now incorporated into more than 100 clinical osteoporosis guidelines worldwide. The aim of this study is to determine whether the current algorithms can be further optimised with respect to current and novel risk factors. Methods: A computerised literature search was performed in PubMed from inception until May 17, 2019, to identify eligible cohorts for updating the FRAX coefficients. Additionally, we searched the abstracts of conference proceedings of the American Society for Bone and Mineral Research, European Calcified Tissue Society and World Congress of Osteoporosis. Prospective cohort studies with data on baseline clinical risk factors and incident fractures were eligible. Results: Of the 836 records retrieved, 53 were selected for full-text assessment after screening on title and abstract. Twelve cohorts were deemed eligible and of these, 4 novel cohorts were identified. These cohorts, together with 60 previously identified cohorts, will provide the resource for constructing an updated version of FRAX comprising 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. For each known and candidate risk factor, multivariate hazard functions for hip fracture, major osteoporotic fracture and death will be tested using extended Poisson regression. Sex- and/or ethnicity-specific differences in the weights of the risk factors will be investigated. After meta-analyses of the cohort-specific beta coefficients for each risk factor, models comprising 10-year probability of hip and major osteoporotic fracture, with or without femoral neck bone mineral density, will be computed. Conclusions: These assembled cohorts and described models will provide the framework for an updated FRAX tool enabling enhanced assessment of fracture risk (PROSPERO (CRD42021227266)).
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- 2022
25. Dynapenic abdominal obesity as a risk factor for falls
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Dowling, L., McCloskey, E., Cuthbertson, D.J., and Walsh, J.S.
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General Medicine - Abstract
Background\ud \ud Obesity and low muscle strength (dynapenia) are independently associated with greater falls risk. It remains unclear whether dynapenia and obesity have an additive effect on falls risk, greater than either phenotype alone. Objectives: To determine whether a combination of abdominal obesity with dynapenia, dynapenic abdominal obesity (DAO), confers a greater risk of falls than either obesity or dynapenia alone in both men and women.\ud \ud \ud \ud Design\ud \ud An observational cohort study was conducted. Setting and Participants: Data from English adults (n=4239, 60–87 years) who took part in the English Longitudinal Study of Ageing were included.\ud \ud \ud \ud Measurements\ud \ud Dynapenia, was defined as hand-grip strength 88cm (female), >102cm (male). Data on falls and fall-related injuries over a 2-year follow-up were collected. Multiple logistic regression analyses were performed adjusting for age and sex, with results expressed as odds ratios (OR) and areas under the receiver operating characteristic curve (AUC).\ud \ud \ud \ud Results\ud \ud Falls occurred in 1049 participants, with 284 reporting a related injury during follow-up. DAO was associated with greater OR of falls in men (OR 2.1, 95% Confidence Intervals (CI) 1.3–3.2). Dynapenia rather than obesity was associated with falls in women, with greatest OR observed in those with low hand-grip strength (OR 1.4, 95% CI 1.1–1.7). Individual discrimination was low for measures of obesity or dynapenia either alone or in combination (AUC 0.51–0.58). There was no relationship between fall-related injuries and obesity or dynapenia.\ud \ud \ud \ud Conclusion\ud \ud Our findings suggest a synergistic effect of obesity with dynapenia on falls risk in men but not women.
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- 2022
26. Digital health interventions for osteoporosis and post-fragility fracture care
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Gupta, A., Maslen, C., Vindlacheruvu, M., Abel, R.L., Bhattacharya, P., Bromiley, P.A., Clark, E.M., Compston, J.E., Crabtree, N., Gregory, J.S., Kariki, E.P., Harvey, N.C., McCloskey, E., Ward, K.A., and Poole, K.E.S.
- Abstract
The growing burden from osteoporosis and fragility fractures highlights a need to improve osteoporosis management across healthcare systems. Sub-optimal management of osteoporosis is an area suitable for digital health interventions. While fracture liaison services (FLSs) are proven to greatly improve care for people with osteoporosis, such services might benefit from technologies that enhance automation. The term ‘Digital Health’ covers a variety of different tools including clinical decision support systems, electronic medical record tools, patient decision aids, patient apps, education tools, and novel artificial intelligence (AI) algorithms. Within the scope of this review are AI solutions that use algorithms within health system registries to target interventions. Clinician-targeted, patient-targeted, or system-targeted digital health interventions could be used to improve management and prevent fragility fractures. This review was commissioned by The Royal Osteoporosis Society and Bone Research Academy during the production of the 2020 Research Roadmap (https://theros.org.uk), with the intention of identifying gaps where targeted research funding could lead to improved patient health. We explore potential uses of digital technology in the general management of osteoporosis. Evidence suggests that digital technologies can support multidisciplinary teams to provide the best possible patient care based on current evidence and to support patients in self-management. However, robust randomised controlled studies are still needed to assess the effectiveness and cost-effectiveness of these technologies.
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- 2022
27. Epidemiology and economic burden of osteoporosis in Greece
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Makras, P., Lyritis, G. P., Rizou, S., Drakopoulou, T., Trovas, G., Willers, C., Norton, N., Harvey, N. C., Jacobson, T., Johansson, H., Lorentzon, M., McCloskey, E. V., Borgström, F., and Kanis, J. A.
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treatment ,Greece ,fracture ,economic burden ,epidemiology ,European Union ,health technology assessment - Abstract
[Extract] The scorecard summarises key indicators of the burden of osteoporosis and its management in the 27 member states of the European Union, as well as the UK and Switzerland (termed EU27+2) [1]. This country-specific report summarises the principal results for Greece.
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- 2022
28. Dynapenic Abdominal Obesity as a Risk Factor for Falls
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Dowling, L., primary, McCloskey, E., additional, Cuthbertson, D.J., additional, and Walsh, J.S., additional
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- 2022
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29. 1768MO Incidence of fracture related hospitalisations in men with de novo high risk localised and metastatic hormone sensitive prostate cancer: Analysis of routinely collected healthcare data from the STAMPEDE docetaxel and zoledronic acid comparisons
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Jones, C., Dutey-Magni, P., Murphy, L.R., Murray, M., Brown, J.E., McCloskey, E., Parmar, M.K., James, N.D., Sydes, M.R., Brown, L.C., Clarke, N.W., and Sachdeva, A.
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- 2023
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30. Fracture risk assessment by the FRAX model.
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McCloskey, E. V., Harvey, N. C., Johansson, H., Lorentzon, M., Liu, E., Vandenput, L., Leslie, W. D., and Kanis, J. A.
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- *
BONE density , *RISK assessment , *CANCELLOUS bone , *TYPE 2 diabetes , *HIP fractures - Abstract
The introduction of the FRAX algorithms has facilitated the assessment of fracture risk on the basis of fracture probability. FRAX integrates the influence of several well-validated risk factors for fracture with or without the use of bone mineral density. Since age-specific rates of fracture and death differ across the world, FRAX models are calibrated with regard to the epidemiology of hip fracture (preferably from national sources) and mortality (usually United Nations sources). Models are currently available for 73 nations or territories covering more than 80% of the world population. FRAX has been incorporated into more than 80 guidelines worldwide, although the nature of this application has been heterogeneous. The limitations of FRAX have been extensively reviewed. Arithmetic procedures have been proposed in order to address some of these limitations, which can be applied to conventional FRAX estimates to accommodate knowledge of dose exposure to glucocorticoids, concurrent data on lumbar spine bone mineral density, information on trabecular bone score, hip axis length, falls history, type 2 diabetes, immigration status and recency of prior fracture. [ABSTRACT FROM AUTHOR]
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- 2022
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31. Osteoporosis and fractures in women: the burden of disease.
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Lorentzon, M., Johansson, H., Harvey, N. C., Liu, E., Vandenput, L., McCloskey, E. V., and Kanis, J. A.
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BONE fractures ,OSTEOPOROSIS in women ,BONE density - Abstract
Osteoporosis is a disease characterized by impaired bone microarchitecture and reduced bone mineral density (BMD) resulting in bone fragility and increased risk of fracture. In western societies, one in three women and one in five men will sustain an osteoporotic fracture in their remaining lifetime from the age of 50 years. Fragility fractures, especially of the spine and hip, commonly give rise to increased morbidity and mortality. In the five largest European countries and Sweden, fragility fractures were the cause of 2.6 million disability-adjusted life years in 2016 and the fracture-related costs increased from €29.6 billion in 2010 to €37.5 billion in 2017. In the European Union and the USA, only a small proportion of women eligible for pharmacological treatment are being prescribed osteoporosis medication. Secondary fracture prevention, using Fracture Liaison Services, can be used to increase the rates of fracture risk assessment, BMD testing and use of osteoporosis medication in order to reduce fracture numbers. Additionally, established primary prevention strategies, based on case-finding methods utilizing fracture prediction tools, such as FRAX, to identify women without fracture but with elevated risk, are recommended in order to further reduce fracture numbers. [ABSTRACT FROM AUTHOR]
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- 2022
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32. A0645 - Fracture-related hospitalisations in de novo advanced or metastatic hormone-sensitive prostate cancer: Secondary analysis of the STAMPEDE abiraterone acetate plus prednisone +/- enzalutamide and M1|RT phase 3 trials using health systems data.
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Jones, C., Dutey-Magni, P., Murphy, L., Murray, M., Brown, J., Mccloskey, E., Parmar, M.K.B., Parker, C., Attard, G., James, N.D., Sydes, M.R., Brown, L.C., Clarke, N.W., and Sachdeva, A.
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- *
CLINICAL trials , *ABIRATERONE acetate , *PROSTATE cancer , *SECONDARY analysis , *PREDNISONE , *RESPIRATORY therapists - Published
- 2024
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33. Cost-effectiveness intervention thresholds for romosozumab and teriparatide in the treatment of osteoporosis in the UK.
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Borgström F, Lorentzon M, Johansson H, Harvey NC, McCloskey E, Willems D, Knutsson D, and Kanis JA
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Sequential romosozumab-to-alendronate or sequential teriparatide-to-alendronate can be a cost-effective treatment option for postmenopausal women at very high risk of fracture., Purpose: To estimate the 10-year probability of a major osteoporotic fracture (MOF) at which sequential treatment with romosozumab or teriparatide followed by alendronate, compared with alendronate alone, becomes cost-effective in a UK setting., Methods: A microsimulation model with a Markov structure was used to simulate fractures, costs, and quality-adjusted life years (QALYs), in women receiving sequential treatment with either romosozumab or teriparatide followed by alendronate, compared with alendronate alone. Patients aged 50 to 90 years with a recent MOF, hip or spine fracture were followed from the start of a 5-year treatment until the age of 100 years or death. The analysis had a healthcare perspective. Efficacy of romosozumab, teriparatide and alendronate was derived from phase III randomised controlled trials. Resource use and unit costs were derived from the literature. Cost-effectiveness intervention threshold (CEIT), defined as the 10-year probability of a major osteoporotic fracture at which treatment becomes cost-effective, was compared with clinically appropriate intervention thresholds for bone-forming treatment in women with very high fracture risk as recommended by the UK National Osteoporosis Guideline Group (NOGG)., Results: The base case analysis showed that sequential romosozumab-to-alendronate treatment was cost-effective from a 10-year MOF probability of 18-35% and above depending on age and site of sentinel fracture at a willingness to pay (WTP) of £30,000. For teriparatide-to-alendronate, treatment was cost-effective at a 10-year MOF probability of 27-57%. The results were sensitive to pricing of the drugs but relatively insensitive to treatment duration, romosozumab persistence assumptions, and site of sentinel fracture. The CEITs for romosozumab-to-alendronate treatment were lower than the clinical thresholds from the age of 70 years meaning that treatment could be considered both cost-effective and aligned with the NOGG treatment guidelines. By contrast, for teriparatide-to-alendronate the CEITs were higher than the clinical thresholds irrespective of age. However, cost-effective scenarios were found in the presence of strong clinical risk factors in addition to a recent sentinel fracture., Conclusion: The results of this study indicate that sequential romosozumab-to-alendronate or teriparatide-to-alendronate treatment can be a cost-effective treatment option for postmenopausal women at very high risk of fracture., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)
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- 2024
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34. Risk of Fractures and Falls in Men with Advanced or Metastatic Prostate Cancer Receiving Androgen Deprivation Therapy and Treated with Novel Androgen Receptor Signalling Inhibitors: A Systematic Review and Meta-analysis of Randomised Controlled Trials.
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Jones C, Gray S, Brown M, Brown J, McCloskey E, Rai BP, Clarke N, and Sachdeva A
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- Humans, Male, Neoplasm Metastasis, Neoplasm Staging, Randomized Controlled Trials as Topic, Risk Assessment, Accidental Falls statistics & numerical data, Androgen Antagonists adverse effects, Androgen Antagonists therapeutic use, Androgen Receptor Antagonists therapeutic use, Androgen Receptor Antagonists adverse effects, Fractures, Bone epidemiology, Fractures, Bone chemically induced, Fractures, Bone etiology, Prostatic Neoplasms drug therapy, Prostatic Neoplasms pathology
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Context: The addition of androgen receptor signalling inhibitors (ARSIs) to standard androgen deprivation therapy (ADT) has improved survival outcomes in patients with advanced prostate cancer (PCa). Advanced PCa patients have a higher incidence of osteoporosis, compounded by rapid bone density loss upon commencement of ADT resulting in an increased fracture risk. The effect of treatment intensification with ARSIs on fall and fracture risk is unclear., Objective: To assess the risk of falls and fractures in men with PCa treated with ARSIs., Evidence Acquisition: A systematic review of EMBASE, MEDLINE, The Cochrane Library, and The Health Technology Assessment Database for randomised control trials between 1990 and June 2023 was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analyses guidance. Risk ratios were estimated for the incidence of fracture and fall events. Subgroup analyses by grade of event and disease state were conducted., Evidence Synthesis: Twenty-three studies were eligible for inclusion. Fracture outcomes were reported in 17 studies (N = 18 811) and fall outcomes in 16 studies (N = 16 537). A pooled analysis demonstrated that ARSIs increased the risk of fractures (relative risk [RR] 2.32, 95% confidence interval [CI] 2.00-2.71; p < 0.01) and falls (RR 2.22, 95% CI 1.81-2.72; p < 0.01) compared with control. A subgroup analysis demonstrated an increased risk of both fractures (RR 2.13, 95% CI 1.70-2.67; p < 0.01) and falls (RR 2.19, 95% CI 1.53-3.12; p < 0.0001) in metastatic hormone-sensitive PCa patients, and an increased risk of fractures in the nonmetastatic (RR 2.27, 95% CI 1.60-3.20; p < 0.00001) and metastatic castrate-resistant (RR 2.85, 95% CI 2.16-3.76; p < 0.00001) settings. The key limitations include an inability to distinguish fragility from pathological fractures and potential for a competing risk bias., Conclusions: Addition of an ARSI to standard ADT significantly increases the risk of fractures and falls in men with prostate cancer., Patient Summary: We found a significantly increased risk of both fractures and falls with a combination of novel androgen signalling inhibitors and traditional forms of hormone therapy., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
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- 2024
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35. Causes of Musculoskeletal Pain in Paget's Disease of Bone.
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Berg K, Dockrell D, Colvin L, Fraser WD, Tang JC, Aspray T, Dennison E, Divyateja H, Ghouri N, Hanison E, Keen R, McCloskey E, O'Neill TW, Rahman F, Siddiqi M, Tuck S, Turton J, and Ralston SH
- Abstract
Paget's disease of bone (PDB) is characterised by increased and disorganised bone remodelling leading to various complications, such as bone deformity, deafness, secondary osteoarthritis, and pathological fracture. Pain is the most common presenting symptom of PDB, but it is unclear to what extent this is due to increased metabolic activity of the disease, complications, or unrelated causes. We conducted a cross-sectional study of 168 people with PDB attending secondary care referral centres in the UK. We documented the presence of musculoskeletal pain and sought to determine its underlying causes. Musculoskeletal pain was reported by 122/168 (72.6%) individuals. The most common cause was osteoarthritis of joints distant from an affected PDB site in 54 (44.3%), followed by metabolically active PDB in 18 (14.7%); bone deformity in 14 (11.4%); osteoarthritis of a joint neighbouring an affected site in 11 (9.0%), neuropathic pain in 10 (8.2%), and various other causes in the remainder. Pain was more common in women (p<0.019) and in older individuals (p<0.001). Circulating concentrations of macrophage colony-stimulating factor (M-CSF) were significantly higher in those with pain (p = 0.008), but there was no difference between groups of patients with and without pain in concentrations of interleukin-6 (IL-6) or biochemical markers of bone turnover. Pain is a common symptom in PDB but is most often due to osteoarthritis at an unaffected site. The study illustrates the importance of fully evaluating people with PDB to determine the underlying cause of pain so that management can be tailored appropriately., (© 2024. The Author(s).)
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- 2024
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36. Extra-osseous Roles of the RANK-RANKL-OPG Axis with a Focus on Skeletal Muscle.
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Gostage J, Kostenuik P, Goljanek-Whysall K, Bellantuono I, McCloskey E, and Bonnet N
- Abstract
Purpose of Review: This review aims to consolidate recent observations regarding extra-osseous roles of the RANK-RANKL-OPG axis, primarily within skeletal muscle., Recent Findings: Preclinical efforts to decipher a common signalling pathway that links the synchronous decline in bone and muscle health in ageing and disease disclosed a potential role of the RANK-RANKL-OPG axis in skeletal muscle. Evidence suggests RANKL inhibition benefits skeletal muscle function, mass, fibre-type switching, calcium homeostasis and reduces fall incidence. However, there still exists ambiguity regarding the exact mechanistic actions and subsequent functional improvements. Other potential RANK-RANKL-OPG extra-osseous roles include regulation of neural-inflammation and glucose metabolism. Growing evidence suggests the RANK-RANKL-OPG axis may play a regulatory role in extra-osseous tissues, especially in skeletal muscle. Targeting RANKL may be a novel therapy in ameliorating loss of muscle mass and function. More research is warranted to determine the causality of the RANK-RANKL-OPG axis in extra-osseous tissues, especially those affected by aging., (© 2024. The Author(s).)
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- 2024
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37. Insulin resistance, bone health, and fracture risk.
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Armutcu F and McCloskey E
- Abstract
Insulin resistance, defined as an impaired biological response to insulin stimulation in target tissues, arises most frequently in the presence of central obesity. Although obesity is generally associated with increased bone mass, recent data challenge this view and, if complicated by T2DM, obese patients are at high risk for fragility fractures. IR may play a key role in this increased fracture risk through effects on bone quality rather than bone quantity. Further understanding of the mechanisms and approaches to prevent osteoporotic fractures in IR-related diseases is needed., Clinical Relevance: The dramatic increase in obesity and metabolic syndrome (MetS) over the last half-century has led to a worldwide epidemic of type 2 diabetes mellitus (T2DM) as well as in the incidence of insulin resistance (IR). IR is defined as an impaired biological response to insulin stimulation in target tissues and is primarily related to the liver, muscle, and adipose tissue. The most frequent underlying cause is central obesity, and it is known that excess abdominal adipose tissue secretes increased amounts of free fatty acids, which directly affects insulin signalling, reduces glucose uptake in muscle, and triggers excessive triglyceride synthesis and gluconeogenesis in the liver. When pancreatic β cells are unable to secrete the higher levels of insulin needed, T2DM, the main complication of IR, occurs., Observations: Although obesity is generally associated with increased bone mass, recent data challenge this view and highlight the multifaceted nature of the obesity-bone relationship. Patients with T2DM are at significant risk for well-known complications of diabetes, including retinopathy, nephropathy, macrovascular disease, and neuropathy, but it is clear that they are also at high risk for fragility fractures. Moreover, recent data provide strong evidence that IR may key role in the increased fracture risk observed in both obesity and T2DM., Conclusions: In this concise review article, the role of IR in increased risk of osteoporotic fractures in MetS, obesity, and T2DM is discussed and summarised, including consideration of the need for fracture risk assessment as a 'preventive measure', especially in patients with T2DM and chronic MetS with abdominal obesity. Personalised and targeted diagnostic and therapeutic approaches to prevent osteoporotic fractures in IR-related diseases are needed and could make significant contributions to health outcomes., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)
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- 2024
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38. Clinical utility of the fracture risk assessment tool (FRAX) in biopsy-confirmed coeliac disease.
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Green O, Raju SA, Shiha MG, Nandi N, Bayley M, McCloskey E, and Sanders DS
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- Humans, Female, Male, Middle Aged, Risk Assessment methods, Retrospective Studies, Adult, Biopsy, Risk Factors, Aged, Prevalence, Logistic Models, Sensitivity and Specificity, Incidence, Bone Density, Bone Diseases, Metabolic epidemiology, Bone Diseases, Metabolic diagnosis, GTP-Binding Proteins, Predictive Value of Tests, Celiac Disease complications, Absorptiometry, Photon, Osteoporotic Fractures epidemiology, Osteoporotic Fractures etiology, Osteoporotic Fractures diagnosis, Osteoporosis complications, Osteoporosis epidemiology
- Abstract
Background: People with coeliac disease (CD) are at increased risk of osteoporosis and fractures. Currently, baseline dual-energy X-ray absorptiometry (DXA) is recommended for all patients with newly diagnosed CD. We aimed to determine the prevalence of osteoporosis and the clinical utility of the Fracture Risk Assessment Tool (FRAX) in predicting major osteoporotic fractures (MOF) in patients with biopsy-proven CD., Methods: We retrospectively collected data for consecutive adult patients with biopsy-proven CD between 2001 and 2015 who underwent DXA scanning within 1 year of diagnosis and were followed up for a minimum of 7 years. Fracture risk was assessed using FRAX scores, and the incidence of major osteoporotic fractures during the follow-up period was analysed., Results: A total of 593 patients (median age 45.0 years, 68.5% female) were included. The prevalence of osteopenia and osteoporosis were 32.3% and 14.5%, respectively. Increasing age (OR 1.06, p < .0001), decreasing BMI (OR 0.90, p = .003), and higher baseline immunoglobulin A-tissue tissue transglutaminase titre (OR 1.04, p = .03) were significantly associated with increased risk of osteoporosis. The sensitivity, specificity, positive and negative predictive values of the FRAX tool to predict MOF were 21.2%, 91.3%, 16.3%, 93.5%, respectively. A higher risk of fractures was associated with ongoing gluten exposure (OR 1.86, p = .02), previous fractures (OR 2.69, p = .005), and older age (OR 1.03, p < .0001)., Conclusion: Osteoporosis is a common finding in patients with CD. The FRAX tool showed high specificity in predicting osteoporotic fractures and could be used to aid with patient selection for DXA scanning in some cases.
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- 2024
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39. Sarcopenia definitions and their association with injurious falls in older Swedish women from the Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone fractures (SUPERB) study.
- Author
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Gandham A, Gregori G, Johansson L, Larsson BAM, Johansson H, Harvey NC, Vandenput L, McCloskey E, Kanis JA, Litsne H, Axelsson K, and Lorentzon M
- Abstract
Associations between different sarcopenia definitions and the risk of injurious falls were investigated in 75-80-year-old women in the Swedish SUPERB cohort. Only sarcopenia according to the Sarcopenia Definitions and Outcomes Consortium (SDOC) definition was associated with incident injurious falls with and without fractures in older women., Purpose: To investigate the association between three commonly used sarcopenia definitions and the risk of injurious falls in a population of older Swedish women., Methods: A total of 2,883 75-80-year-old women with complete data on relevant sarcopenia definitions from the Swedish SUPERB cohort were studied. Sarcopenia was defined based on the Sarcopenia Definitions and Outcomes Consortium (SDOC: low handgrip strength and gait speed), revised European Working Group on Sarcopenia in Older People (EWGSOP2: low appendicular lean mass index (ALMI, dual-energy X-ray absorptiometry (DXA)-derived), appendicular lean mass (kg)/height (m
2 ), hand grip strength (kg), or low chair stand time (s)), and Asian Working Group for Sarcopenia (AWGS: low ALMI and hand grip strength (kg) or low gait speed (m/s)). Questionnaires captured the occurrence of falls in the past 12 months. Incident injurious falls were identified using national registers. Cox regression (hazard ratios (HR) and 95% confidence intervals (CI)) analyses were performed without adjustment and after adjustment for age, body mass index, previous falls, and the Charlson comorbidity index., Results: During a median (IQR) follow-up time of 7.06 (6.2-7.9) years, there were 491 injurious falls without fracture and 962 injurious falls when also including falls resulting in a fracture. Sarcopenia according to EWGSOP2 and AWGS was not associated with an increased risk of injurious falls. Individuals with sarcopenia defined by SDOC had a higher risk of injurious falls with and without fracture (HR 2.11; 95% CI, 1.63-2.73 and HR, 2.16; 95% CI, 1.55-3.02, respectively)., Conclusion: Sarcopenia definitions confined to muscle function and strength such as SDOC, rather than including DXA-determined ALMI (EWGSOP2 and AWGS), are associated with incident injurious falls with and without fractures in older women., (© 2024. The Author(s).)- Published
- 2024
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40. Update on fracture risk assessment in osteoporosis.
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McCloskey E, Tan ATH, and Schini M
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- Humans, Risk Assessment methods, Bone Density, Absorptiometry, Photon, Risk Factors, Female, Bone Density Conservation Agents therapeutic use, Osteoporotic Fractures epidemiology, Osteoporotic Fractures etiology, Osteoporotic Fractures prevention & control, Osteoporosis epidemiology
- Abstract
Purpose of Review: The assessment of fracture risk is playing an ever-increasing role in osteoporosis clinical management and informing international guidelines for osteoporosis. FRAX, a fracture risk calculator that provides individualized 10-year probabilities of hip and major osteoporotic fracture, has been widely used since 2008. In this review, we recap the development and limitations of intervention thresholds and the role of absolute fracture risk., Recent Findings: There is an increasing awareness of disparities and inequities in the setting of intervention thresholds in osteoporosis. The limitations of the simple use of prior fracture or the DXA-derived BMD T -score threshold are increasingly being discussed; one solution is to use fracture risk or probabilities in the setting of such thresholds. This approach also permits more objective assessment of high and very high fracture risk to enable physicians to make choices not just about the need to treat but what agents to use in individual patients., Summary: Like all clinical tools, FRAX has limitations that need to be considered, but the use of fracture risk in deciding who to treat, when to treat and what agent to use is a mechanism to target treatment equitably to those at an increased risk of fracture., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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41. HSV-1 ICP0 dimer domain adopts a novel β-barrel fold.
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McCloskey E, Kashipathy M, Cooper A, Gao P, Johnson DK, Battaile KP, Lovell S, and Davido DJ
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- Crystallography, X-Ray, Models, Molecular, Humans, Protein Domains, Protein Folding, Amino Acid Sequence, Protein Conformation, beta-Strand, Immediate-Early Proteins chemistry, Immediate-Early Proteins metabolism, Immediate-Early Proteins genetics, Herpesvirus 1, Human, Ubiquitin-Protein Ligases chemistry, Ubiquitin-Protein Ligases metabolism, Protein Multimerization
- Abstract
Infected cell protein 0 (ICP0) is an immediate-early regulatory protein of herpes simplex virus 1 (HSV-1) that possesses E3 ubiquitin ligase activity. ICP0 transactivates viral genes, in part, through its C-terminal dimer domain (residues 555-767). Deletion of this dimer domain results in reduced viral gene expression, lytic infection, and reactivation from latency. Since ICP0's dimer domain is associated with its transactivation activity and efficient viral replication, we wanted to determine the structure of this specific domain. The C-terminus of ICP0 was purified from bacteria and analyzed by X-ray crystallography to solve its structure. Each subunit or monomer in the ICP0 dimer is composed of nine β-strands and two α-helices. Interestingly, two adjacent β-strands from one monomer "reach" into the adjacent subunit during dimer formation, generating two β-barrel-like structures. Additionally, crystallographic analyses indicate a tetramer structure is formed from two β-strands of each dimer, creating a "stacking" of the β-barrels. The structural protein database searches indicate the fold or structure adopted by the ICP0 dimer is novel. The dimer is held together by an extensive network of hydrogen bonds. Computational analyses reveal that ICP0 can either form a dimer or bind to SUMO1 via its C-terminal SUMO-interacting motifs but not both. Understanding the structure of the dimer domain will provide insights into the activities of ICP0 and, ultimately, the HSV-1 life cycle., (© 2024 Wiley Periodicals LLC.)
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- 2024
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42. Predictive value of sarcopenia components for all-cause mortality: findings from population-based cohorts.
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Westbury LD, Harvey NC, Beaudart C, Bruyère O, Cauley JA, Cawthon P, Cruz-Jentoft AJ, Curtis EM, Ensrud K, Fielding RA, Johansson H, Kanis JA, Karlsson MK, Lane NE, Lengelé L, Lorentzon M, McCloskey E, Mellström D, Newman AB, Ohlsson C, Orwoll E, Reginster JY, Ribom E, Rosengren BE, Schousboe JT, Dennison EM, and Cooper C
- Subjects
- Humans, Male, Aged, Female, Cohort Studies, Risk Factors, Predictive Value of Tests, Aged, 80 and over, Mortality, Sarcopenia mortality, Sarcopenia physiopathology, Hand Strength physiology, Walking Speed physiology
- Abstract
Background: Low grip strength and gait speed are associated with mortality. However, investigation of the additional mortality risk explained by these measures, over and above other factors, is limited., Aim: We examined whether grip strength and gait speed improve discriminative capacity for mortality over and above more readily obtainable clinical risk factors., Methods: Participants from the Health, Aging and Body Composition Study, Osteoporotic Fractures in Men Study, and the Hertfordshire Cohort Study were analysed. Appendicular lean mass (ALM) was ascertained using DXA; muscle strength by grip dynamometry; and usual gait speed over 2.4-6 m. Verified deaths were recorded. Associations between sarcopenia components and mortality were examined using Cox regression with cohort as a random effect; discriminative capacity was assessed using Harrell's Concordance Index (C-index)., Results: Mean (SD) age of participants (n = 8362) was 73.8(5.1) years; 5231(62.6%) died during a median follow-up time of 13.3 years. Grip strength (hazard ratio (95% CI) per SD decrease: 1.14 (1.10,1.19)) and gait speed (1.21 (1.17,1.26)), but not ALM index (1.01 (0.95,1.06)), were associated with mortality in mutually-adjusted models after accounting for age, sex, BMI, smoking status, alcohol consumption, physical activity, ethnicity, education, history of fractures and falls, femoral neck bone mineral density (BMD), self-rated health, cognitive function and number of comorbidities. However, a model containing only age and sex as exposures gave a C-index (95% CI) of 0.65(0.64,0.66), which only increased to 0.67(0.67,0.68) after inclusion of grip strength and gait speed., Conclusions: Grip strength and gait speed may generate only modest adjunctive risk information for mortality compared with other more readily obtainable risk factors., (© 2024. The Author(s).)
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- 2024
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43. Sarcopenia definitions and their association with fracture risk in older Swedish women.
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Gandham A, Gregori G, Johansson L, Johansson H, Harvey NC, Vandenput L, McCloskey E, Kanis JA, Litsne H, Axelsson K, and Lorentzon M
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- Humans, Female, Sweden epidemiology, Aged, Risk Factors, Aged, 80 and over, Hand Strength, Risk Assessment, Fractures, Bone epidemiology, Sarcopenia epidemiology, Sarcopenia complications
- Abstract
The purpose of this study was to investigate the prevalence of three sarcopenia definitions and their associations with fracture risk in older Swedish women when adjusted for fracture risk assessment (FRAX)-based risk factors; 2,883 women with a mean age of 77.8 years were included. Sarcopenia was defined based on the Sarcopenia Definitions and Outcomes Consortium (SDOC; low handgrip strength [kg] and gait speed (m/s)), revised European Working Group on Sarcopenia in Older People (EWGSOP2; low appendicular lean mass index, appendicular lean mass [ALM]/height; kg/m2], and hand grip strength [kg]), and Asian Working Group for Sarcopenia (AWGS; low ALM (kg), and hand grip strength [kg]) definitions. Femoral neck T-score was obtained from dual-energy X-ray absorptiometry. All fractures, confirmed by X-ray or medical record review, were subsequently categorized as major osteoporotic fractures (MOFs) and hip fractures. Deaths were verified through regional registers. The total follow-up time was 6.4 ± 1.3 (mean ± SD) yr. Cox regression (hazard ratios [HR] and 95% CIs) analyses were performed with adjustment for age, FRAX variables, and femoral neck T-score. Sarcopenia prevalence was 4.5% (n = 129) according to SDOC, 12.5% (n = 360) for EWGSOP2, and 10.3% (n = 296) defined by AWGS. Individuals with sarcopenia defined by SDOC had a higher mortality risk than individuals without sarcopenia (HR: 3.41; 95% CI: 2.51, 4.62) after adjusting for age and FRAX variables. Sarcopenia according to EWGSOP2 and AWGS was not associated with an increased fracture risk after adjusting for age and FRAX variables. Individuals with sarcopenia defined by SDOC had a higher risk for any fractures (HR: 1.48; 95% CI: 1.10, 1.99) and MOF (HR: 1.42; 95% CI: 1.03, 1.98) compared with individuals without sarcopenia after adjusting for clinical risk factors used in FRAX. In conclusion, sarcopenia defined by SDOC, incorporating muscle function/strength, was the only sarcopenia definition associated with fracture risk in older women., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research.)
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- 2024
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44. Evidence-Based Guideline for the management of osteoporosis in men.
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Fuggle NR, Beaudart C, Bruyère O, Abrahamsen B, Al-Daghri N, Burlet N, Chandran M, Rosa MM, Cortet B, Demonceau C, Dere W, Halbout P, Hiligsmann M, Kanis JA, Kaufman JM, Kurth A, Lamy O, Laslop A, Maggi S, Matijevic R, McCloskey E, Mobasheri A, Prieto Yerro MC, Radermecker RP, Sabico S, Al-Saleh Y, Silverman S, Veronese N, Rizzoli R, Cooper C, Reginster JY, and Harvey NC
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- Male, Female, Humans, Bone Density, Osteoporosis diagnosis, Osteoporosis drug therapy, Fractures, Bone, Musculoskeletal Diseases, Osteoarthritis complications
- Abstract
Historically, osteoporosis has been viewed as a disease of women, with research, trials of interventions and guidelines predominantly focused as such. It is apparent, however, that this condition causes a substantial health burden in men also, and that its assessment and management must ultimately be addressed across both sexes. In this article, an international multidisciplinary working group of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases presents GRADE-assessed recommendations for the diagnosis, monitoring and treatment of osteoporosis in men. The recommendations are based on a comprehensive review of the latest research related to diagnostic and screening approaches for osteoporosis and its associated high fracture risk in men, covering disease burden, appropriate interpretation of bone densitometry (including the use of a female reference database for densitometric diagnosis in men) and absolute fracture risk, thresholds for treatment, and interventions that can be used therapeutically and their health economic evaluation. Future work should specifically address the efficacy of anti-osteoporosis medications, including denosumab and bone-forming therapies., (© 2024. Springer Nature Limited.)
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- 2024
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45. Prolonged bone health benefits for breast cancer patients following adjuvant bisphosphonate therapy: the BoHFAB study.
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Brown J, Paggiosi MA, Rathbone E, Gregory W, Bertelli G, Din O, McCloskey E, Dodwell D, Cameron D, Eastell R, and Coleman R
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- Humans, Female, Diphosphonates therapeutic use, Zoledronic Acid pharmacology, Bone Density, Imidazoles pharmacology, Neoplasm Recurrence, Local drug therapy, Lumbar Vertebrae, Bone Remodeling, Collagen, Bone Density Conservation Agents therapeutic use, Breast Neoplasms drug therapy
- Abstract
Adjuvant bisphosphonates are often recommended in postmenopausal women with early breast cancer at intermediate-to-high risk of disease recurrence, but the magnitude and duration of their effects on bone mineral density (BMD) and bone turnover markers (BTMs) are not well described. We evaluated the impact of adjuvant zoledronate on areal BMD and BTMs in a sub-group of patients who had completed the large 5-yr randomized Adjuvant Zoledronic Acid to Reduce Recurrence (AZURE) trial. About 224 women (recurrence free) who had completed the AZURE trial within the previous 3 mo were recruited from 20 UK AZURE trial sites. One hundred twenty had previously been randomized to zoledronate (19 doses of 4 mg over 5 yr) and 104 to the control arm. BMD and BTMs were assessed at sub-study entry, 6 (BTMs only), 12, 24, and 60 mo following the completion of AZURE. As expected, mean BMD, T-scores, and Z-scores at sub-study entry were higher in the zoledronate vs the control arm. At the lumbar spine, the mean (SD) standardized BMD (sBMD) was 1123 (201) and 985 (182) mg/cm2 in the zoledronate and control arms, respectively (P < .0001). The baseline differences in sBMD persisted at all assessed skeletal sites and throughout the 5-yr follow-up period. In patients completing zoledronate treatment, BTMs were significantly lower than those in the control arm (α- and β-urinary C-telopeptide of type-I collagen, both P < .00001; serum intact pro-collagen I N-propeptide, P < .00001 and serum tartrate-resistant acid phosphatase 5b, P = .0001). Some offset of bone turnover inhibition occurred in the 12 mo following the completion of zoledronate treatment. Thereafter, during the 60 mo of follow-up, all BTMs remained suppressed in the zoledronate arm relative to the control arm. In conclusion, in addition to the known anti-cancer benefits of adjuvant zoledronate, there are likely to be positive, lasting benefits in BMD and bone turnover., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2024
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46. Asia-Pacific consensus on long-term and sequential therapy for osteoporosis.
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Tai TW, Chen HY, Shih CA, Huang CF, McCloskey E, Lee JK, Yeap SS, Cheung CL, Charatcharoenwitthaya N, Jaisamrarn U, Kuptniratsaikul V, Yang RS, Lin SY, Taguchi A, Mori S, Li-Yu J, Ang SB, Chan DC, Chan WS, Ng H, Chen JF, Tu ST, Chuang HH, Chang YF, Chen FP, Tsai KS, Ebeling PR, Marin F, Nistal Rodríguez FJ, Shi H, Hwang KR, Kim KK, Chung YS, Reid IR, Chandran M, Ferrari S, Lewiecki EM, Hew FL, Ho-Pham LT, Nguyen TV, Nguyen VH, Lekamwasam S, Pandey D, Bhadada S, Chen CH, Hwang JS, and Wu CH
- Abstract
Objectives: This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition. The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach., Methods: A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and antiresorptive agents in sequential therapy approaches., Results: The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to antiresorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for individuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment., Conclusions: This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management., Competing Interests: The authors disclosed the following conflicts of interest.1.Ta-Wei Tai received honoraria for lectures, meetings, and/or travel from Amgen and Alvogen/Lotus.2.Swan Sim Yeap has received honoraria for lectures from Amgen.3.Natthinee Charatcharoenwitthaya received honoraria for lectures, meetings, and/or travel from Amgen, Alvogen, and Zuellig Pharma.4.Akira Taguchi has received lecture fees from Asahi Kasei Pharma Corp., Daiichi Sankyo Co. Ltd, Chugai Pharmaceutical Co. Ltd, and Teijin Pharma Ltd.5.Peter R Ebeling has received research funding from Amgen, Alexion and Sanofi, and honoraria from Amgen, Alexion and Kyowa Kirin.6.Fernando Marin has received honoraria for lectures from DKSH and Zuellig Pharma. He is a former employee of Eli Lilly and Company.7.Yoon-Sok Chung has received research funding from Samsung Bioepis and honoraria from Amgen, Alvogen, Celltrion, Daewoong, Hanlim, and Yuyu.8.Ian R Reid has received speaking fees from Amgen and Medison Pharma.9.Manju Chandran has received honoraria and travel sponsorships from Amgen, DKSH, and Kyowa Kirin.10.E. Michael Lewiecki - Amgen: investigator, consultant, speaker; Radius: investigator, consultant; Kyowa Kirin: consultant, speaker; Ultragenyx: investigator; Angitia: consultant; Ascendis: consultant.11.Fen Lee Hew has received honoraria from Amgen and DKSH.12.Tuan Van Nguyen has received a global competitive grant from Amgen and honoraria from Amgen, DKSH, and Bridge Health Care, for giving lectures and travelling to meetings.13.Chung-Hwan Chen received honoraria for lectures, attending meetings, and/or travel from Amgen, and Alvogen/Lotus.14.Chih-Hsing Wu received honoraria for lectures, attending meetings, and/or travel from Eli Lilly, Roche, Amgen, Merck, Servier laboratories, GE Lunar, Harvester, TCM Biotech, and Alvogen/Lotus.15.The other authors reported that they have nothing to declare for potential conflicts of interest., (© 2024 The Korean Society of Osteoporosis. Publishing services by Elsevier B.V.)
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- 2024
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47. Clinical Use of Trabecular Bone Score: The 2023 ISCD Official Positions.
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Goel H, Binkley N, Boggild M, Chan WP, Leslie WD, McCloskey E, Morgan SL, Silva BC, and Cheung AM
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- Humans, Cancellous Bone diagnostic imaging, Risk Assessment methods, Bone Density, Absorptiometry, Photon methods, Lumbar Vertebrae diagnostic imaging, Lumbar Vertebrae pathology, Osteoporotic Fractures diagnosis, Osteoporosis diagnostic imaging, Osteoporosis pathology
- Abstract
Osteoporosis can currently be diagnosed by applying the WHO classification to bone mineral density (BMD) assessed by dual-energy x-ray absorptiometry (DXA). However, skeletal factors other than BMD contribute to bone strength and fracture risk. Lumbar spine TBS, a grey-level texture measure which is derived from DXA images has been extensively studied, enhances fracture prediction independent of BMD and can be used to adjust fracture probability from FRAX® to improve risk stratification. The purpose of this International Society for Clinical Densitometry task force was to review the existing evidence and develop recommendations to assist clinicians regarding when and how to perform, report and utilize TBS. Our review concluded that TBS is most likely to alter clinical management in patients aged ≥ 40 years who are close to the pharmacologic intervention threshold by FRAX. The TBS value from L1-L4 vertebral levels, without vertebral exclusions, should be used to calculate adjusted FRAX probabilities. L1-L4 vertebral levels can be used in the presence of degenerative changes and lumbar compression fractures. It is recommended not to report TBS if extreme structural or pathological artifacts are present. Monitoring and reporting TBS change is unlikely to be helpful with the current version of the TBS algorithm. The next version of TBS software will include an adjustment based upon directly measured tissue thickness. This is expected to improve performance and address some of the technical factors that affect the current algorithm which may require modifications to these Official Positions as experience is acquired with this new algorithm., (Copyright © 2023 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.)
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- 2024
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48. Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX.
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Kanis JA, Johansson H, McCloskey EV, Liu E, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff-Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson-Hughes B, Diez-Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish-Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, Mellström D, Merlijn T, Nordström A, Nordström P, O'Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Vandenput L, Harvey NC, Lorentzon M, and Leslie WD
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- Male, Humans, Female, Bone Density, Risk Factors, Risk Assessment, Osteoporotic Fractures etiology, Osteoporotic Fractures complications, Osteoporosis complications, Hip Fractures etiology, Hip Fractures complications
- Abstract
A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX., Introduction: The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD)., Methods: We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted β-coefficients., Results: A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72-2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69-2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63-2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62-2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination., Conclusion: A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies., (© 2023. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)
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- 2023
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49. Hemoglobin Levels Improve Fracture Risk Prediction in Addition to FRAX Clinical Risk Factors and Bone Mineral Density.
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Jaiswal R, Johansson H, Axelsson KF, Magnusson P, Harvey NC, Vandenput L, McCloskey E, Kanis JA, Litsne H, Johansson L, and Lorentzon M
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- Humans, Female, Aged, Bone Density, Cohort Studies, Prospective Studies, Risk Assessment methods, Risk Factors, Absorptiometry, Photon, Osteoporotic Fractures epidemiology, Osteoporotic Fractures etiology, Hip Fractures etiology, Hip Fractures complications, Pelvic Bones, Anemia complications, Anemia epidemiology
- Abstract
Context: Anemia and decreasing levels of hemoglobin (Hb) have previously been linked to increased fracture risk, but the added value to FRAX, the most utilized fracture prediction tool worldwide, is unknown., Objective: To investigate the association between anemia, Hb levels, bone microstructure, and risk of incident fracture and to evaluate whether Hb levels improve fracture risk prediction in addition to FRAX clinical risk factors (CRFs)., Methods: A total of 2778 community-dwelling women, aged 75-80 years, and part of a prospective population-based cohort study in Sweden were included. At baseline, information on anthropometrics, CRFs, and falls was gathered, blood samples were collected, and skeletal characteristics were investigated using dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. At the end of follow-up, incident fractures were retrieved from a regional x-ray archive., Results: The median follow-up time was 6.4 years. Low Hb was associated with worse total hip and femoral neck bone mineral density (BMD), and lower tibia cortical and total volumetric BMD, and anemia was associated with increased risk of major osteoporotic fracture (MOF; hazard ratio 2.04; 95% CI 1.58-2.64). Similar results were obtained for hip fracture and any fracture, also when adjusting for CRFs. The ratio between 10-year fracture probabilities of MOF assessed in models with Hb levels included and not included ranged from 1.2 to 0.7 at the 10th and 90th percentile of Hb, respectively., Conclusion: Anemia and decreasing levels of Hb are associated with lower cortical BMD and incident fracture in older women. Considering Hb levels may improve the clinical evaluation of patients with osteoporosis and the assessment of fracture risk., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.)
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- 2023
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50. Estimating the future clinical and economic benefits of improving osteoporosis diagnosis and treatment among postmenopausal women across eight European countries.
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Yeh EJ, Gitlin M, Sorio F, and McCloskey E
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- Female, Humans, Cross-Sectional Studies, Postmenopause, Europe epidemiology, Health Care Costs, Osteoporotic Fractures epidemiology, Osteoporotic Fractures prevention & control, Osteoporosis diagnosis, Osteoporosis epidemiology, Osteoporosis therapy, Osteoporosis, Postmenopausal diagnosis, Osteoporosis, Postmenopausal epidemiology, Osteoporosis, Postmenopausal therapy
- Abstract
A population-level, cross-sectional model was developed to estimate the clinical and economic burden of osteoporosis among women (≥ 70 years) across eight European countries. Results demonstrated that interventions aimed at improving fracture risk assessment and adherence would save 15.2% of annual costs in 2040., Purpose: Osteoporosis is associated with significant clinical and economic burden, expected to further increase with an ageing population. This modelling analysis assessed clinical and economic outcomes under different hypothetical disease management interventions to reduce this burden., Methods: A population-level, cross-sectional cohort model was developed to estimate numbers of incident fractures and direct costs of care among women (≥ 70 years) in eight European countries under different hypothetical interventions: (1) an improvement in the risk assessment rate, (2) an improvement in the treatment adherence rate and (3) a combination of interventions 1 and 2. A 50% improvement from the status quo, based on existing disease management patterns, was evaluated in the main analysis; scenario analyses evaluated improvement of either 10 or 100%., Results: Based on existing disease management patterns, a 44% increase in the annual number of fractures and costs was predicted from 2020 to 2040: from 1.2 million fractures and €12.8 billion in 2020 to 1.8 million fractures and €18.4 billion in 2040. Intervention 3 provided the greatest fracture reduction and cost savings (a decrease of 17.9% and 15.2% in fractures and cost, respectively) in 2040 compared with intervention 1 (decreases of 8.7% and 7.0% in fractures and cost, respectively) and intervention 2 (10.0% and 8.8% reductions in fracture and cost, respectively). Scenario analyses showed similar patterns., Conclusion: These analyses suggest that interventions which improve fracture risk assessment and adherence to treatments would relieve the burden of osteoporosis, and that a combination strategy would achieve greatest benefits., (© 2023. The Author(s).)
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- 2023
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