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Summary This observational study prospectively assessed direct and indirect costs related to patient management over 18 months following hip, clinical vertebral, humeral, or distal forearm fracture events in France. It appears that their levels were much higher than the previous estimates, raising the burden of osteoporosis-related fractures on public health expenditures. Introduction This prospective observational study assessed the costs related to patient management over the 18-month period following the event of a hip, clinical vertebral, humeral, or distal forearm fracture in France. Methods Individuals aged ≥ 50 years old with the diagnosis of a fragility fracture in six French University Hospitals were enrolled in the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS). All resources used over the defined period and related to fracture and the underlying osteoporosis management were collected by questionnaires at baseline, 4 months, 12 months, and 18 months. Information was collected by direct or phone contact completed by patients’ records and interviews of partner, family, and general practitioners. Costs were estimated from a societal perspective, including direct and indirect costs. We implemented recursive partitioning analysis (RPA), a statistical learning algorithm to identify predictors of costs. Results Four hundred thirty-one patients (mean age 72.5 years; 84.6% women) were evaluated. Among them, 17.6% had a prior fracture in the last 5 years. Approximately half of the whole group lived alone in the community, and 56.8% were from a low- or middle-income category. Over the 18-month period of evaluation, total costs (including initial fracture-related and follow-up ones) were 23 926 €, 14 561 €, and 6 905 € for the hip, clinical vertebral, and distal forearm fracture, respectively. Over a year, costs related to a humeral fracture were 10 319 €. The RPA identified mobility impairment prior to fracture as a predictor of increase in costs related to fracture. Conclusions Our study for the first time prospectively assessed total costs related to the four main osteoporotic fractures in France. It appears that their levels were much higher than previous estimates, raising the burden of osteoporosis-related fractures on public health expenditures.

International audience; Introduction: This article presents the initial recommendations of the French Rheumatology Society (Société Française de Rhumatologie - SFR) and the Osteoporosis Research and Information Group (Groupe de Recherche et d'Informations sur les Ostéoporoses - GRIO) on the role of diet in the prevention and treatment of osteoporosis.Methods: The recommendations were produced by a working group composed of rheumatologists, physician nutrition specialists and a geriatrician. Fifteen (15) questions pertaining to "daily practices" were preselected by the working group. For the literature review, the working group focussed mainly on the effects of diet on bone mineral density (BMD) and fractures, and primarily on meta-analyses of longitudinal studies and dietary intervention studies.Results: A Mediterranean-type diet and the daily consumption of 2 to 3 dairy products are recommended. Together, these provide the calcium and "high quality" protein required to maintain a normal calcium-phosphorus balance and bone metabolism, and are associated with lower fracture risk. Conversely, unbalanced Western diets, vegan diets, weight-loss diets in non-overweight individuals, alcohol consumption and daily consumption of sodas are advised against. In terms of the beneficial effects on bone mineral density and fracture risk, current scientific data are either insufficient or too divergent to recommend increasing or restricting the consumption of tea or coffee, vitamins other than vitamin D, vitamin D-enriched or phytoestrogen-rich foods, calcium-enriched plant-based beverages, oral nutritional supplements, or dietary sources of prebiotics and probiotics.Conclusions: These are the first set of recommendations addressing the role of diet in the prevention and treatment of osteoporosis. More research is necessary to direct and support guidelines.

International audience; Background: In response to the gradual decline in the number of prescriptions for anti-osteoporosis medication (AOM) following fragility fractures, Fracture Liaison Services (FLSs) have been set up around the world with the aim of filling this treatment gap. Several studies have already reported the benefits of such organizations, particularly in reducing fracture risk, mortality rates and health-care costs, and literature on FLSs has increased at a steady pace over time.Methods: A narrative review was conducted on the latest available findings on the effectiveness of FLSs. Various approaches to implementing an effective FLS program are discussed.Results: FLS programs have enhanced the management of osteoporosis-related fractures. However, several studies have highlighted that not all FLSs are necessarily effective in reducing subsequent fracture risk and mortality. Long-term AOM persistence and monitoring are another critical issue in FLS programs. A few studies have reported that FLSs are associated with an improvement in AOM persistence, regardless of the type of AOM. Practitioners in the FLS setting need to be aware of the impact of recency of fracture and fracture recurrence rates, and the need for timely interventions. The administration of zoledronic acid in an in-patient setting may improve AOM treatment rates in patients, who often encounter obstacles to out-patient follow-up. Introducing 'vertebral fracture identification services' in FLS programs is also an option. However, doing so leads to an increase in workload and this would need to be considered by any FLS that is considering introducing such a service. Evidence suggests that digital technologies can support (i) multidisciplinary teams in providing the best possible patient care based on current evidence, and (ii) patient self-management. However, as the methodological quality of many of the studies evaluating these technologies was poor, their validity of their results is limited.Conclusion: Further research should focus on the optimal implementation of post-fracture care using automated systems, and standardized reporting of patient's characteristics and outcome measures using key performance indicators.

International audience; With intermittent vitamin D supplementation, serum 25-hydroxyvitamin D (25OHD) levels may remain stable only if the dosing interval is shorter than 3 months, the ideal perhaps being about 1 month. Recent data support moderate daily vitamin D doses instead of high intermittent doses, notably in elderly patients prone to falls. The level of evidence is low, however, with no head-to-head comparisons of clinical outcomes such as fractures and falls in groups given identical dosages daily versus intermittently. A challenge to daily vitamin D supplementation in France is the absence of a suitable pharmaceutical formulation. In addition, daily dosing carries a high risk of poor adherence. Until suitable vitamin D3 formulations such as tablets or soft capsules each containing 1000 or 1500 IU become available, we suggest intermittent supplementation according to 2011 GRIO guidelines. Among the available dosages, the lowest should be preferred, with the shortest possible interval, e.g., 50,000 IU monthly rather than 100,000 every two months.

International audience; The use of anti-osteoporosis treatment following a diagnosis of osteoporosis with fracture or a relevant fragility fracture remains low in France. Initiating an anti-resorptive may reduce the incidence of a subsequent fracture by 60%. Purpose To describe real-world osteoporosis treatment patterns in individuals with a fragility fracture in France and to explore the impact of initiating treatment on the risk of subsequent fracture. Methods A retrospective cohort study, using the national French Health Insurance claims database. Males and females 50 years and over, with a hospital discharge diagnosis of osteoporosis with fracture or a relevant fragility fracture between 2011 and 2014, were included and followed until death or the end of 2016, whichever came first. The primary outcome was the proportion of patients receiving anti-osteoporosis treatments prior to and post-index fracture. Change in fracture rates before and after treatment initiation was assessed in an exploratory analysis. Results A total of 574,133 patients (138,567 males, 435,566 females) had a qualifying index fracture. The proportion of patients receiving any anti-osteoporosis treatment increased pre-index fracture to post-index fracture from 2.2 to 5.6% among males, and from 11.8 to 18.2% among females. Oral bisphosphonates were the most prescribed anti-osteoporosis treatment for both males and females among post-index fractures (60.6% and 68.8% of patients initiating treatment). Following initiation of anti-resorptives, the incidence of subsequent fracture was reduced by 60% (rate ratio (RR): 0.40, 95% confidence interval [CI]: 0.34-0.45). Conclusion Anti-osteoporosis treatment following an index fracture in France remains low. Improved identification and pharmacologic management of patients at risk of fragility fractures are necessary to reduce the risk of subsequent fractures.

Background: Drug persistence reflects an agent’s efficacy and safety in routine practice. This study was undertaken to compare the 2-year persistence rates of three biologic disease-modifying antirheumatic drugs (bDMARDs) used to treat rheumatoid arthritis (RA) and to describe their efficacy and safety profiles. Methods: This retrospective, observational, single-center study included RA patients who had received at least one intravenous dose of infliximab, abatacept, and/or tocilizumab. Two-year drug persistence was estimated using the Kaplan–Meier method. Efficacy profiles were assessed as changes of Disease-Activity Score-28 (DAS28)-based EULAR-criteria responses. Results: The infliximab, abatacept, and tocilizumab groups included 40, 72, and 93 patients, respectively. Their respective 2-year persistence rates were similar: 55.0%, 45.8%, and 62.4%. Tocilizumab recipients benefited from greater improvement than those given infliximab (p = 0.0005) or abatacept (p < 0.0001). For all groups combined, 93.1% of patients obtained good or moderate EULAR responses. Conclusions: Even if this retrospective work includes different biases (lack of data, recruitment bias, etc.), it highlights that the 2-year persistence rates for infliximab, abatacept, and tocilizumab in daily practice did not differ significantly, thereby confirming the long-term efficacies of these three bDMARDs. However, tocilizumab was associated with more significant DAS28 improvement at 2 years than infliximab and abatacept.

International audience; The purpose of this multicentric study was to evaluate the prevalence and causes of Elevated Bone Mass (EBM) in patients who underwent DXA scanning over a 10-year period. The prevalence of EBM was 1 in 100. The main causes of EBM were degenerative spine disorders and renal osteodystrophy. Introduction Reports of elevated bone mass (EBM) on routine dual energy X-Ray absorptiometry (DXA) scanning are not infrequent. However, epidemiological studies of EBM are few and definition thresholds are variable. The purpose of this French multicentric study was to evaluate the prevalence and causes of EBM in adult patients who underwent DXA scanning over a 10-year period. Methods This multicentric, retrospective study was conducted in six French regional bone centres. DXA databases were initially searched for individuals with a bone mineral density (BMD) Z-score >= +4 at any site in the lumbar spine or hip from April 1st, 2008 to April 30st, 2018. Results In all, 72,225 patients with at least one DXA scan were identified. Of these, 909 (322 men and 587 women) had a Z-score >= + 4, i.e. a prevalence of 1.26% [1.18-1.34%]. The DXA scan reports and imagery and medical records of the 909 EBM patients were reviewed and 936 causes were found. In 42 patients (4%), no cause could be determined due to unavailability of data. Artefactual causes of EBM were found in 752 patients (80%), in whom the predominant cause was degenerative disease of the spine (613 patients, 65%). Acquired causes of focal EBM-including Paget's disease (n = 7)-were found in 12 patients (1%), and acquired causes of generalized EBM-including renal osteodystrophy (n = 32), haematological disorders (n = 20) and hypoparathyroidism (n = 15)-in 84 patients (9%). Other causes were rare hereditary diseases and unknown EBM in 19 (2%) and 27 (3%) cases respectively. Conclusions The prevalence of EBM was approximately 1 in 100. These findings suggest that degenerative disease of the spine is the main cause of EBM, but that acquired or hereditary diseases are also causal factors.

Osteoporosis-related fragility fractures increase the risk of subsequent fractures and are associated with substantial morbidity and mortality. Emphasis should be placed on the prevention of recurrent fractures, which will decrease both the clinical burden on patients and the economic burden on the health system. Fragility fractures are associated with increased morbidity and mortality. Quantifying the clinical and economic burden of subsequent fractures following an initial osteoporosis-related fracture is a key to informing public health policies. A retrospective cohort study, using the national French health insurance claims database. Males and females ≥ 50 years, with a hospital discharge diagnosis of osteoporosis with fracture or a relevant fragility fracture (hip, vertebrae, femur, pelvis, wrist/hand, forearm, humerus/clavicle) between 2011 and 2014, were included and followed until death or end of 2016, whichever came first. Index fracture was the first qualifying hospitalization; subsequent fractures were defined as those occurring either at a different site from the index fracture or at the same site ≥ 90 days apart. Costs abstracted included hospitalization, external consultation, outpatient visits, and treatment. A total of 544,426 participants (132,148 [24.3%] males and 412,278 [75.7%] females), of whom 16,110 (12.2%) males and 73,538 (17.8%) females had at least one subsequent fracture during follow-up, were included. Incidence of subsequent fracture was highest in the first year following index fracture. During follow-up, 161,179 patients died; mortality was highest among those with a hip fracture at index (29,971 (51.6%) males and 65,254 (39.6%) females). Total mean costs per patient in the year following index fracture were highest for males and females with a hip fracture (€18,585 and €15,754, respectively). Subsequent fractures among osteoporotic participants with an initial fracture result in increased clinical mortality and high healthcare resource use. Emphasis should be placed on the prevention of recurrent fractures.

Resume Les infiltrations epidurales de corticosteroides constituent un traitement classique des lomboradiculalgies. La description d’evenements neurologiques grave par la Food and Drug Administration (FDA) conduit a se poser la question du benefice-risque de cette pratique. Cas clinique : une femme caucasienne, âgee de 55 ans, est hospitalisee pour la prise en charge d’une lombosciatique de trajet S1 droite. Au cours de l’hospitalisation sont realisees a 48 heures d’intervalle, 2 infiltrations epidurales par voie interepineuse sous reperage anatomique a l’aide d’une aiguille spinale de dimension 20 gauge 0,90 × 88 mm. Un corticoide particulaire est utilise, a savoir une ampoule de 5 mL d’acetate d’hydrocortisone pour chaque geste infiltratif. A j5 de la sortie d’hospitalisation, la patiente presente des cephalees accompagnees de vertiges se majorant a la position orthostatique. Un scanner cerebral sans injection est effectue. Celui-ci retrouve un hematome sous dural subaigu de localisation fronto-parietale gauche s’etendant a la tente du cervelet gauche, d’environ 4 mm d’epaisseur. Il n’est pas retenu d’indication neurochirurgicale devant l’absence de signe de focalisation et la stabilite de l’hematome. La symptomatologie s’ameliore apres 48 h d’hydratation IV et le respect du decubitus strict. Conclusion : une surveillance rapprochee est necessaire dans les suites d’une infiltration epidurale. La presence de cephalees persistantes secondairement a une infiltration epidurale exige un examen neurologique approfondi. Une imagerie cerebrale doit parfois etre envisagee afin de ne pas meconnaitre une etiologie intracerebrale potentiellement fatale. Nous recommandons un repos strict au lit dans les suites immediates d’une infiltration epidurale.

Resume Introduction Les fractures sont la consequence clinique la plus grave de l’osteoporose en termes de morbidite, de mortalite et de depenses de sante. Cette etude analyse l’evolution du nombre de fractures ainsi que la consommation de traitements anti-osteoporotiques entre 2014 et 2016 chez les personnes de 50 ans et plus en France. Methodes Cette etude, basee sur les donnees du programme de medicalisation des systemes d’information en medecine, chirurgie et obstetrique, a identifie l’ensemble des personnes âgees d’au moins 50 ans hospitalisees en France entre 2014 et 2016 pour une fracture assimilable a une fracture osteoporotique. Les taux bruts d’incidence annuelle pour 100 000 habitants ont ete calcules a partir des estimations nationales de population publiees par l’INSEE. Parallelement, ont ete recueillies les ventes de traitements specifiques de l’osteoporose sur la meme periode (donnees Xponent d’IMS Health). Les resultats sont exprimes pour la France entiere et par region. Resultats Entre 2014 et 2016, entre 158 878 et 170 328 personnes ont ete hospitalisees, en majorite des femmes (76 %) qui avaient plus de 70 ans (71 a 72 %). L’incidence des fractures a augmente de 4 %, tandis que la vente de traitements specifiques de l’osteoporose a chute de 13 %. L’augmentation du taux d’incidence des fractures variait en fonction de l’âge et des regions. Conclusions Le nombre et l’incidence des fractures osteoporotiques ne cessent de croitre alors que les ventes de traitements anti-osteoporotiques diminuent. Une analyse approfondie des causes des deficits de prise en charge permettrait la mise au point de mesures correctrices.

French authorities have approved the reimbursement of denosumab as a second-line therapy after bisphosphonates (BPs) in women presenting with postmenopausal osteoporosis (PMO) at high risk of fracture. By using a nationally representative claims database, we analyzed the pattern of denosumab use. The objectives of this study were to describe the profile of women initiated with denosumab over the 14-month period after launch and to check as far back as possible for the appropriateness of its use regarding the restrictions brought by French health authorities. A retrospective study using a national representative claims database, i.e., the “Echantillon Generaliste des Beneficiaires” (EGB), was performed. The population was composed of women aged ≥ 40 years old who had an initiation of a PMO treatment in 2013 or 2014. The denosumab women's profiles were compared with those of women that started any other PMO treatment (except denosumab) over the same period. In 2013 and 2014, we identified 256 women who initiated denosumab. Denosumab was primarily prescribed by specialists (75%) compared with the other PMO treatments (37.6%). Patients on denosumab were significantly older, 73.2 versus 69.1 years old, and they more frequently had a history of fractures (20.7% versus 17.4%, NS) and chronic uptake of high-dose steroids (25% versus 22.8%, NS). Of the women initiated with denosumab, 93.8% had undergone a previous PMO treatment (during the 2005–2014 period). In 92.9% of cases, it was a BP alone or in association. This study suggests satisfactory compliance of prescribers concerning the restriction of the reimbursed indication of denosumab in second line after bisphosphonates with 6.2% possible inappropriate prescriptions. Amgen.

This observational study prospectively assessed direct and indirect costs related to patient management over 18 months following hip, clinical vertebral, humeral, or distal forearm fracture events in France. It appears that their levels were much higher than the previous estimates, raising the burden of osteoporosis-related fractures on public health expenditures.This prospective observational study assessed the costs related to patient management over the 18-month period following the event of a hip, clinical vertebral, humeral, or distal forearm fracture in France.Individuals aged ≥ 50 years old with the diagnosis of a fragility fracture in six French University Hospitals were enrolled in the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS). All resources used over the defined period and related to fracture and the underlying osteoporosis management were collected by questionnaires at baseline, 4 months, 12 months, and 18 months. Information was collected by direct or phone contact completed by patients' records and interviews of partner, family, and general practitioners. Costs were estimated from a societal perspective, including direct and indirect costs. We implemented recursive partitioning analysis (RPA), a statistical learning algorithm to identify predictors of costs.Four hundred thirty-one patients (mean age 72.5 years; 84.6% women) were evaluated. Among them, 17.6% had a prior fracture in the last 5 years. Approximately half of the whole group lived alone in the community, and 56.8% were from a low- or middle-income category. Over the 18-month period of evaluation, total costs (including initial fracture-related and follow-up ones) were 23 926 €, 14 561 €, and 6 905 € for the hip, clinical vertebral, and distal forearm fracture, respectively. Over a year, costs related to a humeral fracture were 10 319 €. The RPA identified mobility impairment prior to fracture as a predictor of increase in costs related to fracture.Our study for the first time prospectively assessed total costs related to the four main osteoporotic fractures in France. It appears that their levels were much higher than previous estimates, raising the burden of osteoporosis-related fractures on public health expenditures.

International audience; Several drugs are able to reduce fracture risk in osteoporotic patients. Incident fractures occur despite good adherence to treatment. Inadequate response has been found related to high serum bone biomarkers of bone turnover. We here aimed to analyze bone microarchitecture and cellular profiles of inadequate responders. We retrospectively analyzed bone biopsies from patients with major fractures despite long-term treatment (inadequate responder [IR] n = 31) in comparison to patients with untreated osteoporosis (U-OP, n = 31) and controls without osteoporosis (Ctrl, n = 16). Bone samples were analyzed by histomorphometry and micro-computed tomography. Clinical and bone turnover markers and bone mineral density were assessed. As compared with U-OP patients, IRs were older (mean age 69.7 +/- 8.8 vs 63.3 +/- 9.3 years, p = 0.007) and had lower mean hip bone mineral density (0.685 +/- 0.116 vs 0.786 +/- 0.093 g/cm(2)), p = 0.019 and T-score ( 2.3 +/- 0.769 vs 1.6 +/- 0.900, p = 0.032). BV/TV was lower for IRs than U-OP patients and Ctrls (13.9 +/- 3.8% vs 15.2 +/- 5.1 and 17.6 +/- 5.2%, p = 0.044) as was trabecular thickness (145.6 +/- 23.1 vs 160.5 +/- 22.7 and 153.7 +/- 21.4 mu m, p = 0.033). Mean structure model index was lower for IRs than U-OP patients (1.9 +/- 0.806 vs 2.4 +/- 0.687, p = 0.042) and osteoclast number was higher for IRs than U-OP patients and Ctrls (0.721 +/- 0.611 vs 0.394 +/- 0.393 and 0.199 +/- 0.071 mm(-2), p < 0.001). The mean Obl.S/BS was lower for IRs than U-OP patients and Ctrls (1.2 +/- 1.3 vs 1.9 +/- 1.4 and 3.0 +/- 0.638 mm(-2), p < 0.0001), and the mean number of labelled surfaces was lower for IRs than U-OP patients (51.6% vs 87%, p = 0.002). Cortical parameters did not significantly differ. We show an imbalance of bone remodeling in favor of bone resorption in IRs. The persistence of high bone resorption suggests insufficient inhibition of bone resorption that could explain the incident fractures with anti-osteoporotic drug use. Adaptation to treatment should be considered to inhibit bone resorption and prevent further fractures.

Osteoporosis diagnosis and screening. In fact, there are several definitions of osteoporosis according the purpose we have: pathophysiological, diagnosis, therapeutic, but also because of progress in technology. The first definition is based on histology of iliac crest bone biopsy showing the loss of trabecular bone and microarchitectural abnormalities. More useful, a definition based on biphotonic osteodensitometry X (DXA) proposes the threshold of -2.5 T-score as a clinical definition of osteoporosis. A global definition is proposed by NIH, osteoporosis being a general disease of the skeleton associating bone loss and microarchitectural defects leading to an increased risk of fractures. But none of these definitions allows the practitioner to initiate a specific treatment. That is why a diagnosis of osteoporosis can also be established when the risk of fracture is high considering a personal history of fracture and BMD or more precisely calculated using the FRAX tool.Diagnostic et dépistage de l'ostéoporose. Il existe de fait plusieurs définitions de l’ostéoporose en fonction du but que l’on se propose, explication physiopathologique, utilité diagnostique ou thérapeutique, et aussi du fait de l’évolution des technologies. La définition la plus ancienne est celle de l’histologiste obtenue par ponction-biopsie osseuse autorisant une analyse histomorphométrique, qui permet de quantifier visuellement la diminution du volume trabéculaire osseux et d’observer directement les altérations de la microarchitecture osseuse. Plus clinique et opérationnelle, l’ostéodensitométrie biphotonique par rayons X (DXA) propose le seuil de T-score de -2,5 comme définition densitométrique de l’ostéoporose. Une définition plus générique de la maladie énonce que l’ostéoporose est une maladie généralisée du squelette associant une diminution de la masse osseuse à des altérations de la microarchitecture conduisant à un risque augmenté de fractures. Cependant, cette définition ne permet pas au praticien de prendre une décision thérapeutique car elle ne propose pas de seuil décisionnel. C’est pourquoi le diagnostic d’ostéoporose peut aussi être retenu quand il y a une indication à traiter du fait de l’importance du risque fracturaire qui sera évalué en tenant compte des antécédents de fractures et de la masse osseuse ou calculé plus précisément à partir d’autres facteurs de risque indépendants en utilisant l’outil numérique FRAX.

Osteoporosis-related fragility fractures increase the risk of subsequent fractures and are associated with substantial morbidity and mortality. Emphasis should be placed on the prevention of recurrent fractures, which will decrease both the clinical burden on patients and the economic burden on the health system.Fragility fractures are associated with increased morbidity and mortality. Quantifying the clinical and economic burden of subsequent fractures following an initial osteoporosis-related fracture is a key to informing public health policies.A retrospective cohort study, using the national French health insurance claims database. Males and females ≥ 50 years, with a hospital discharge diagnosis of osteoporosis with fracture or a relevant fragility fracture (hip, vertebrae, femur, pelvis, wrist/hand, forearm, humerus/clavicle) between 2011 and 2014, were included and followed until death or end of 2016, whichever came first. Index fracture was the first qualifying hospitalization; subsequent fractures were defined as those occurring either at a different site from the index fracture or at the same site ≥ 90 days apart. Costs abstracted included hospitalization, external consultation, outpatient visits, and treatment.A total of 544,426 participants (132,148 [24.3%] males and 412,278 [75.7%] females), of whom 16,110 (12.2%) males and 73,538 (17.8%) females had at least one subsequent fracture during follow-up, were included. Incidence of subsequent fracture was highest in the first year following index fracture. During follow-up, 161,179 patients died; mortality was highest among those with a hip fracture at index (29,971 (51.6%) males and 65,254 (39.6%) females). Total mean costs per patient in the year following index fracture were highest for males and females with a hip fracture (€18,585 and €15,754, respectively).Subsequent fractures among osteoporotic participants with an initial fracture result in increased clinical mortality and high healthcare resource use. Emphasis should be placed on the prevention of recurrent fractures.

Rheumatoid arthritis (RA) is often characterized by bone loss and fragility fractures and is a frequent comorbidity. Compared with a matched population, RA patients with fractures have more common risk factors of osteoporosis and fragility fractures but also risk factors resulting from the disease itself such as duration, intensity of the inflammation and disability, and cachexia. The inflammatory reaction in the synovium results in the production of numerous cytokines (interleukin-1, interleukin-6, tumor necrosis factor) that activate osteoclasts and mediate cartilage and bone destruction of the joints, but also have a systemic effect leading to generalized bone loss. Regular bone mineral density (BMD) measurement, fracture risk assessment using tools such as the FRAX algorithm, and vertebral fracture assessment (VFA) should be performed for early detection of osteoporosis and accurate treatment in RA patients.

Background: Janus kinase inhibitors (JAKis) represent a new alternative to treat rheumatoid arthritis (RA). The objective of this study was to evaluate the effectiveness, tolerance profile, and maintenance of these treatments (tofacitinib and baricitinib) in real life. Methods: All patients in the rheumatology department of Amiens University Hospital treated by JAKis for RA were included from 1 October 2017 to 20 May 2020. Clinical and biological data were provided retrospectively in this observational and single-center study. We aimed to study the JAKi maintenance rate at 12 months and their clinical and biological safety profiles. Results: Fifty-five patients were included. Drug maintenance at 12 months was 67.6%. Factors associated with poorer maintenance were a higher Charlson comorbidity index (HR 1.311 (1.089&ndash, 1.579), p = 0.0042), a higher age (HR 1.055 (1.015&ndash, 1.096), p = 0.0067), and corticosteroids therapy at initiation (HR 2.722 (1.006&ndash, 7.365), p = 0.0487). The clinical and biological safety profile was generally good. Conclusions: Our study found that a higher Charlson index, age, and corticosteroids appeared to be associated with the earlier discontinuation of treatment. JAKis had a response and tolerance profile in real life at least equivalent to that of biological disease-modifying antirheumatic drugs (bDMARDs).

Objectif : identifier les facteurs predictifs de nouvelles fractures vertebrales (FV) dans une cohorte de patients ayant beneficie de vertebroplastie pour le traitement de fractures osteoporotiques. Patients et methodes : il s’agissait d’une etude ambispective, observationnelle, monocentrique realisee au CHU d’Amiens. Les patients ayant ete hospitalises pour la realisation de vertebroplastie pour des FV osteoporotiques entre janvier 2012 et mars 2015 ont ete selectionnes a partir des donnees du DIM. L’ensemble des patients a ete contacte afin de beneficier d’une consultation en 2017/2018 avec realisation d’une radiographie du rachis et d’une osteodensitometrie. Resultats : 51 patients ont ete inclus. Parmi ces patients, 15 (29.4%) ont presente au moins une nouvelle FV. Les facteurs predictifs de nouvelle FV retrouves etaient le faible poids (p=0.02), l’IMC (p=0.04), avoir plus de 2 FV initiales (p=0.01), le T-score au col femoral (p=0.03) et le grade total de Genant (p=0.03). En analyse multivariee, ces resultats etaient confirmes pour ceux qui presentaient initialement plus de 2 FV avec un RR 2.9 (IC: 1.09-7.81) et pour l’IMC. Nous n’avons pas constate d’augmentation du risque de FV adjacente a la vertebroplastie. Conclusion : aucun facteur predictif de nouvelle FV apres une vertebroplastie n’est lie directement a la vertebroplastie (fuite de ciment intra discal, nombre de vertebre traite par vertebroplastie). Les facteurs predictifs de nouvelle FV apres une vertebroplastie sont la maigreur et la severite de l’osteoporose. Les seuls facteurs predictifs de nouvelle FV qui sont modifiables sont la maigreur et le T-score.

Objectives The aim of this study was to investigate the clinical value of sVE and anti-vascular endothelial-cadherin antibodies (AAVE) in RA treated with etanercept or adalimumab combined with methotrexate. Methods This was an 18-month prospective multicenter study in which patients had active RA, requiring TNF antagonist. sVE rates and AAVE titers were measured respectively by dot blot and ELISA. The relationship of these biomarkers with parameters reflecting articular or systemic disease activity, progression of structural damage, and response or remission to treatment was analyzed. Results Forty-eight patients received TNF blocking agents. Variation of sVE rates were significantly correlated with that of C-reactive protein (CRP) levels at weeks 6, 12, 26 and 52. A significant decrease in sVE levels was observed in the group of patients exhibiting a decrease in CRP levels as compared to the patient group with unmodified CRP. AAVE at baseline were correlated with rheumatoid factor. Kinetics analysis of sVE levels and AAVE titers showed that their level were not associated with disease activity score and to methotrexate/adalimumab or etanercept response. Conclusions sVE is a biomarker associated with systemic RA activity under anti-TNF. AAVE are related to autoantibodies usually associated to RA.

Resume Objectif Notre objectif a ete de comparer l’apport de l’association d’un cliche du genou de face en charge en extension et d’un cliche en semi-flexion (dit en schuss) (le gold standard actuel) versus un cliche en schuss seul dans le diagnostic de gonarthrose femorotibiale. Methodes Des sujets âges de 40 a 75 ans, atteints d’arthrose symptomatique de la hanche et/ou du genou (de stade ≥ 2 selon la classification de Kellgren/Lawrence [KL]) ont ete recrutes par l’intermediaire d’une enquete de prevalence multiregionale realisee en France. Des cliches de face en extension et en schuss ont ete realises, puis lus, deux ans plus tard, par le meme examinateur, en insu des resultats de la premiere lecture, a une seconde lecture des incidences en schuss a ete realisee. La comparaison a porte sur les scores de KL de chaque genou mais aussi de facon independante sur les osteophytes, pincement de l’interligne articulaire (JSN). L’influence de l’obesite a ete etudiee. Resultats L’analyse a porte sur 350 participants atteints d’arthrose a differents stades. La comparaison des deux lectures a revele une proportion plus elevee de patients de stade KL ≥ 2 lorsque les deux cliches etaient associes (genou droit : p Conclusion Notre etude montre que le cliche en schuss est suffisant a lui seul pour detecter la presence d’osteophytes et d’un pincement articulaire. L’utilisation d’un seul cliche radiographique permettrait de repondre a deux problematiques d’actualite que sont l’economie de la sante et la radioprotection. Le recours a deux cliches semble preferable dans le cadre d’etudes epidemiologiques.

Introduction Lors de l’evaluation de la densite minerale osseuse (DMO) basee sur l’absorptiometrie biphotonique a rayons X (DXA), la decouverte d’une hyperdensite osseuse est inhabituelle. La frequence et les etiologies des hyperdensites osseuses restent largement meconnues. L’objectif de cette etude multicentrique etait d’evaluer la frequence et les etiologies des hyperdensites osseuses parmi des patients adultes ayant beneficie d’une mesure de la DMO sur une periode de 10 ans. Patients et methodes Il s’agit d’une etude observationnelle, retrospective et multicentrique, portant sur l’ensemble des patients ≥ 18 ans ayant beneficie d’une DMO par DXA sur une machine Hologic® entre avril 2008 et avril 2018 dans 6 centres de reference des pathologies osseuses. L’hyperdensite osseuse etait definie par un Z-score ≥ +4 sur au moins 1 site de mesure (rachis lombaire, col femoral, hanche totale). Les donnees ont ete reinterpretees selon les courbes de reference, a la hanche NHANES pour les 2 sexes, au rachis IOG pour les femmes et BMDCS pour les hommes. Les frequences des hyperdensites osseuses et des differentes etiologies ont ete estimees avec un intervalle de confiance a 95 % (methode exacte de Clopper-Pearson, intervalle asymetrique). Resultats Parmi les 72 225 patients ayant eu une DXA, 909 avaient un Z-score ≥ + 4 sur au moins l’un des sites de mesure, soit une frequence de 1,26 % [1,18 %-1,34 %]. Une hyperdensite osseuse etait plus frequemment retrouvee chez les hommes : 1,83 % [1,63 %-2,04 %]) que chez les femmes : 1,08 % [0,99 %-1,17 %]), p Conclusion Dans cette premiere etude multicentrique Francaise ayant porte sur plus de 72 000 patients, la prevalence de l’hyperdensite osseuse est de l’ordre de 1 % environ dont 80 % de causes artefactuelles essentiellement arthrosiques, suivies par les causes acquises locales et generalisees (osteodystrophies renales, myelofibroses, hypoparathyroidie…) et quelques rares causes genetiques.

Introduction Etude retrospective comparant a court terme l’efficacite sur la douleur des infiltrations peridurales de corticoides par la voie du hiatus sacrococcygien echo-guidee contre interepineuse chez des patients hospitalises pour radiculalgies lombaires dans un service de rhumatologie francais. Patients et methodes Soixante-dix patients ont ete inclus dans cette etude, ayant tous une lomboradiculalgie sur conflit disco-radiculaire ou canal lombaire retreci, 44 ayant recu 2 a 3 infiltrations epidurales par voie interepineuse et 26 ayant beneficie d’une infiltration echo-guidee par le hiatus sacrococcygien. Tous les patients ont ete hospitalises en service conventionnel, avec un repos relatif de 2 heures et une nuit de surveillance apres la realisation du geste. Les patients ont beneficie d’une reevaluation precoce a un mois, avec comme critere principal d’evaluation la douleur radiculaire evaluee par une echelle numerique. Resultats Nous retrouvons une diminution moyenne de la douleur radiculaire d’environ 50 % dans les deux groupes. Nous avons retrouve une reduction de la douleur dans le groupe interepineuses plus importante de maniere significative uniquement chez les femmes. Nous n’avons pas retrouve de difference significative en fonction des comorbidites, de la topographie de la radiculalgie ou du mecanisme de la radiculalgie (conflit disco-radiculaire ou stenose rachidienne). Le seul facteur predictif de moins bonne reponse aux infiltrations epidurales retrouve est le tabac, de maniere significative uniquement dans le groupe infiltration epidurale par voie interepineuse. Discussion Cette etude est a notre connaissance la premiere comparant les infiltrations epidurales posterieures, considerees comme gold standard et les infiltrations echo-guidees par le hiatus sacrococcygien. Cette etude a de nombreuses limites. En effet, il s’agit d’une etude retrospective avec de nombreux biais dont celui evident de randomisation, ne permettant pas de tirer de conclusion. L’efficacite des deux types d’infiltrations a court terme est comparable aux donnees retrouvees dans la litterature. Une diminution de la prise d’antalgique, signe indirect d’efficacite a ete constate dans les deux groupes. Il serait necessaire, dans une etude ulterieure, d’avoir un suivi a plus long terme pour verifier si l’amelioration obtenue apres une infiltration se prolonge dans le temps, et s’il existe une difference entre ces deux types d’infiltrations sur la duree de l’amelioration. On note egalement une duree d’hospitalisation plus longue dans le groupe interepineuse, alors que la plupart des services de rhumatologie en France s’oriente vers une prise en charge ambulatoire de ce type de pathologie. Conclusion Il n’a pas ete mis en evidence de difference significative en termes d’efficacite sur la douleur a court terme en comparant de maniere retrospective les deux types d’infiltrations. Cette etude pourrait deboucher sur d’autres travaux, avec une methodologie plus stricte, qui permettraient de comparer de maniere efficace ces deux types d’infiltration.

Background: This preliminary study was undertaken to assess and compare the psychological profiles of patients with chronic inflammatory rheumatisms (CIRs), rheumatoid arthritis (RA) or spondyloarthritis (SpA), to try to identify a particular emotional profile compared to patients without CIRs. Emotional repression, i.e., a tendency to inhibit the expression of negative feelings and/or unpleasant thoughts, has been the most studied. Methods: This monocenter observational pilot study included patients followed in a university rheumatology department who underwent systematic assessment of different psychological parameters by an experienced psychiatrist. The clinical and biological characteristics of their rheumatisms were collected. Comparisons were performed used Chi 2 or Fisher’s exact tests. Results: Fifty-nine patients were assessed: 47 with CIRs (27 RA and 20 SpA) and 12 non-CIR controls (nine osteoarthritis, and one each viral disease, osteoporosis or osteomalacia). The rates of severe emotional repression, and the rates of severe early life events, were higher in the group of CIR patients than in the control group (respectively P = 0.02, P = 0.02). In contrast, the rates of severe psychological and somatic complaints were significantly higher than in the control group (respectively, P

Background: Odanacatib, a cathepsin K inhibitor, reduces bone resorption while maintaining bone formation. Previous work has shown that odanacatib increases bone mineral density in postmenopausal women with low bone mass. We aimed to investigate the efficacy and safety of odanacatib to reduce fracture risk in postmenopausal women with osteoporosis. Methods: The Long-term Odanacatib Fracture Trial (LOFT) was a multicentre, randomised, double-blind, placebo-controlled, event-driven study at 388 outpatient clinics in 40 countries. Eligible participants were women aged at least 65 years who were postmenopausal for 5 years or more, with a femoral neck or total hip bone mineral density T-score between −2·5 and −4·0 if no previous radiographic vertebral fracture, or between −1·5 and −4·0 with a previous vertebral fracture. Women with a previous hip fracture, more than one vertebral fracture, or a T-score of less than −4·0 at the total hip or femoral neck were not eligible unless they were unable or unwilling to use approved osteoporosis treatment. Participants were randomly assigned (1:1) to either oral odanacatib (50 mg once per week) or matching placebo. Randomisation was done using an interactive voice recognition system after stratification for previous radiographic vertebral fracture, and treatment was masked to study participants, investigators and their staff, and sponsor personnel. If the study completed before 5 years of double-blind treatment, consenting participants could enrol in a double-blind extension study (LOFT Extension), continuing their original treatment assignment for up to 5 years from randomisation. Primary endpoints were incidence of vertebral fractures as assessed using radiographs collected at baseline, 6 and 12 months, yearly, and at final study visit in participants for whom evaluable radiograph images were available at baseline and at least one other timepoint, and hip and non-vertebral fractures adjudicated as being a result of osteoporosis as assessed by clinical history and radiograph. Safety was assessed in participants who received at least one dose of study drug. The adjudicated cardiovascular safety endpoints were a composite of cardiovascular death, myocardial infarction, or stroke, and new-onset atrial fibrillation or flutter. Individual cardiovascular endpoints and death were also assessed. LOFT and LOFT Extension are registered with ClinicalTrials.gov (number NCT00529373) and the European Clinical Trials Database (EudraCT number 2007-002693-66). Findings: Between Sept 14, 2007, and Nov 17, 2009, we randomly assigned 16 071 evaluable patients to treatment: 8043 to odanacatib and 8028 to placebo. After a median follow-up of 36·5 months (IQR 34·43–40·15) 4297 women assigned to odanacatib and 3960 assigned to placebo enrolled in LOFT Extension (total median follow-up 47·6 months, IQR 35·45–60·06). In LOFT, cumulative incidence of primary outcomes for odanacatib versus placebo were: radiographic vertebral fractures 3·7% (251/6770) versus 7·8% (542/6910), hazard ratio (HR) 0·46, 95% CI 0·40–0·53; hip fractures 0·8% (65/8043) versus 1·6% (125/8028), 0·53, 0·39–0·71; non-vertebral fractures 5·1% (412/8043) versus 6·7% (541/8028), 0·77, 0·68–0·87; all p

Current therapeutic modalities for fibromyalgia (FM) do not provide satisfactory results and new approaches have to be explored.To assess efficacy and safety of adding a phytotherapy treatment (Fib-19-01) to the current therapeutic regimen in patients with FM.Double-blind controlled trial: women with active FM (Fibromyalgia Index Questionnaire FIQ40) were randomised to receive Fib-19-01 or a food supplement (FS) undistinguishable from Fib-19-01 or no supplementary treatment (NoST). All continued the conventional therapy throughout the 6 month follow-up. Primary endpoint: change in FIQ between Day 0 and month 6 (M6). Secondary Criteria: variation over time FIQ ( repeated measurements), change in Pichot fatigue scale, Pittsburgh Sleep Quality Index (PSQI), SF-12 and Hospital Anxiety and Depression (HAD) scales.100 patients (Intent-To-Treat population) were analyzed. FIQ decreased significantly only in the Fib-19-01 group (P.001) at both week 12 and 24. Improvement was higher for Fib-19-01 (-13.4 ± 18.9) than in the 2 other groups (-5.5 ± 15.6 and -5.6 ± 11.3) despite there was no statistical between-group difference at week 24 in FIQ score (P = .08 and P = .09 respectively). Analysis of variance in repeated measurements of FIQ showed a significant difference between Fib-19-01 and FS throughout the follow-up period (P = .03). Fib-19-01 was superior to both FS and NoST for Pichot scale decrease over time: -4.6 (range -6.9; -2.28), -0.29 (-2.7; 2.1) and -0.72 (-3.1; 1.66) (P = .013 and 0.023 respectively), mental and social SF12 [+8.1 (range 3.5; 12.6), -0.27(range -5.3; 4.8 ) and -0.02 (range -5.0; 4.9 ) P = .02 and 0.018)],HAD depression [-2.0 (range -3.3; -0.7), +0.5 (range -0.9; 1.9 ) and +0.71 (range -0.7; 2.1) P = .013 and 0.007]. No significant difference was found between FS and NoST groups for any outcome. All treatments were well and similarly tolerated.In patients with FM taking conventional therapy, Fib-19-01 has a therapeutic effect on fatigue, emotion and social life, and depression associated with the disease.

International audience; Il a été récemment suggéré que la stabilité de la concentration de 25-hydroxyvitamine D (25OHD) ne peut être obtenue lors d’une supplémentation intermittente que si l’espacement entre les prises est inférieur à 3 mois et plutôt de l’ordre d’un mois. Quelques données récentes suggèrent, par ailleurs, que l’utilisation de doses journalières modérées de vitamine D plutôt que de fortes doses administrées de manière intermittentes serait à privilégier, en particulier chez les sujets âgés chuteurs. Le niveau de preuve qu’on peut attribuer à cette suggestion reste toutefois faible avec, en particulier, une absence d’étude ayant comparé directement l’effet de doses journalières et de doses intermittentes équivalentes sur des événements cliniques tels que fractures ou chutes. La prescription d’une prise quotidienne de vitamine D est aujourd’hui difficile, sans forme galénique bien adaptée disponible en France, avec un risque certainement élevé de mauvaise observance. À cette date, et en attendant l’éventuelle disponibilité de formes pharmaceutiques de vitamine D3 adaptées à une prise journalière comme des comprimés ou capsules molles dosées à 1000 ou 1500 UI, nous suggérons de maintenir une administration intermittente telle que préconisée dans les recommandations du GRIO publiées en 2011, mais en choisissant les posologies les moins élevées parmi celles disponibles et les intervalles les plus courts possibles, par exemple 50 000 UI de vitamine D3 tous les mois plutôt que 100 000 UI tous les deux mois.

Vitamin D deficiency is frequent in the general population and both subjects and health professionals could benefit from a broader range of vitamin D3 formulations. We conducted a single-dose, open-label, parallel-group, randomized bioequivalence study to compare a single dose of a newly developed vitamin D3 100,000 IU in a soft capsule (Group 1) with the reference drug vitamin D3 100,000 IU oral solution in ampoule (Group 2) in healthy volunteers over a four-month period. The primary endpoint was the area under the curve (AUC) of serum 25-hydroxyvitamin-D (25(OH)D) concentrations on Day 112. This study was conducted in France from February to June 2014 in 53 young adults with a mean age of 26.9 years. At baseline, low mean serum 25(OH)D levels were observed in both groups (10.6 ng/mL in Group 1 and 9.0 ng/mL in Group 2). On Day 112, the AUC of serum 25(OH)D concentration was 2499.4 &plusmn, 463.8 nmol/mL (7.8 &plusmn, 0.2 for LogAUC) for Group 1 and 2152.3 &plusmn, 479.8 nmol/mL (7.6 &plusmn, 0.2 for LogAUC) for Group 2. Bioequivalence of the two treatments was not demonstrated. Superiority of vitamin D3 100,000 IU soft capsule was observed with p = 0.029 for AUC and p = 0.03 for LogAUC using a non-parametric Wilcoxon test. The profile of the serum 25(OH)D concentration showed a significant difference in favor of Group 1 on Days 1, 3, 7, 14 and 90. Mean serum 25(OH)D concentrations in Group 1 were between 20 and 30 ng/mL during the four-month period and under 20 ng/mL throughout the study in Group 2, except on Day 112. Mean Cmax for Group 1 was significantly higher (p = 0.002). Fourteen days were needed to reach Tmax by more than half the subjects in Group 1 compared to 45 days in Group 2. Both treatments were well tolerated, with no severe or related adverse events reported. In conclusion, the pharmacokinetic profile of the new formulation of vitamin D3 100,000 IU soft capsule is superior to that of the oral solution in ampoule. The new formulation increased serum 25(OH)D levels to above 20 ng/mL and maintained levels from 20 ng/mL to 30 ng/mL for four months in late winter and spring.

Milk is a major source of high bioavailable calcium in most developed countries with an average calcium content of 1150 mg/L, providing a ready means of meeting the daily requirements. Its content in other minerals, phosphorus, vitamins, iodine, proteins, potassium and various nutrients is supposed to be beneficial for skeleton growth and bone strength. Studies on the effects of milk or whey extracts in animal trials and on surrogate markers in humanlike bone remodeling markers or bone mineral density and many observational studies in large cohorts show positive effects on bone health or risk of hip fracture. Nevertheless, a few contradictory epidemiological studies showed an increased risk of hip fractures in subjects drinking higher quantities of milk. These conflicting results may be due to the large number of confounders and methodological issues as recall bias. Most of the experts state that there are no proven effect of milk consumption on the risk of hip fractures in a way or the other. Of a scientific point of view, there is no reason to remove from the diet of large populations an aliment rich in calcium and other interesting nutrients.

The recommended intake of vitamin D-fortified dairy products can substantially decrease the burden of osteoporotic fractures and seems an economically beneficial strategy in the general French population aged over 60 years.This study aims to assess the public health and economic impact of vitamin D-fortified dairy products in the general French population aged over 60 years.We estimated the lifetime health impacts expressed in number of fractures prevented, life years gained, and quality-adjusted life years (QALY) gained of the recommended intake of dairy products in the general French population over 60 years for 1 year (2015). A validated microsimulation model was used to simulate three age cohorts for both women and men (60-69, 70-79, and > 80 years). The incremental cost per QALY gained of vitamin D-fortified dairy products compared to the absence of appropriate intake was estimated in different populations, assuming the cost of two dairy products per day in base case.The total lifetime number of fractures decreased by 64,932 for the recommended intake of dairy products in the general population over 60 years, of which 46,472 and 18,460 occurred in women and men, respectively. In particular, 15,087 and 4413 hip fractures could be prevented in women and men. Vitamin D-fortified dairy products also resulted in 32,569 QALYs and 29,169 life years gained. The cost per QALY gained of appropriate dairy intake was estimated at a,notsign58,244 and fall below a threshold of a,notsign30,000 per QALY gained in women over 70 years and in men over 80 years.Vitamin D-fortified dairy products have the potential to substantially reduce the burden of osteoporotic fractures in France and seem an economically beneficial strategy, especially in the general population aged above 70 years.

Resume Le lait de vache fait regulierement l’objet d’attaques repetees l’accusant d’etre la cause de tres nombreux problemes de sante parmi lesquels on retrouve un risque augmente de fractures. Lorsqu’on examine attentivement la litterature scientifique concernant le lait et la sante osseuse, on est frappe par la discordance qui existe entre les etudes experimentales portant sur des criteres intermediaires : marqueurs du remodelage osseux, densite minerale osseuse (DMO), qui donnent la plupart du temps des resultats favorables a la consommation de lait de vache alors que les etudes epidemiologiques offrent des resultats contradictoires et destabilisants. A tous les âges de la vie, notamment chez l’enfant et la femme menopausee, la consommation de lait de vache ou la supplementation de l’alimentation habituelle en poudre de lait ou bien encore en proteines du petit-lait reduit le remodelage osseux et ameliore ou protege la DMO. Ces effets benefiques sont d’autant plus importants qu’ils se produisent au sein de populations carencees en calcium comme les populations asiatiques. Il n’y a pas d’etudes d’intervention evaluant le risque fracturaire lie a la consommation de lait de vache, mais seulement des etudes epidemiologiques, observationnelles. Les resultats de ces dernieres montrent des resultats contradictoires ne permettant pas de conclure : tantot protection contre les fractures, ou bien absence d’effet ou encore augmentation du risque fracturaire. Les auteurs de ces publications mettent en avant plusieurs mecanismes possibles : effet nocif du d -galactose, intolerance au lactose, augmentation de la charge acide, entre autres. Les etudes epidemiologiques rencontrent des difficultes pour mettre en evidence des effets d’un seul composant alimentaire en raison du grand nombre d’interactions nutritionnelles, des difficultes a recueillir sur de longues periodes les habitudes alimentaires des sujets, parfois tres anterieures au recueil des donnees fracturaires, ce qui est a l’origine de nombreux biais, pas toujours identifies, au sein de populations qui ne sont pas forcement carencees en apports calciques. En l’etat actuel de nos connaissances scientifiques, il n’existe pas d’argument incontestable justifiant qu’on se passe d’un aliment aussi largement consomme que le lait de vache.

Resume Le score de l’os trabeculaire (TBS) est un indice relativement nouveau obtenu au rachis lombaire en meme temps que la densite minerale osseuse globale. Il a ete developpe pour rendre compte la microarchitecture osseuse. Ce score a ete propose pour etre facilement utilisable dans la pratique quotidienne pour rendre compte de la solidite des os. Notre objectif a ete d’examiner (1) les points techniques tels que les correlations entre le TBS et les parametres microarchitecturaux de l’os, le score de l’os trabeculaire et la solidite des os, les effets de la resolution spatiale des images d’absorptiometrie biphotonique a rayons X, l’âge, la macroarchitecture, l’indice de masse corporelle et l’arthrose sur le TBS, et (2) les elements en faveur de l’utilisation du TBS trabeculaire pour differencier les sujets ayant des fractures de fragilite des temoins, la prediction des fractures de fragilite et le suivi longitudinal des modifications liees aux traitements. Les correlations entre le TBS et les parametres microarchitecturaux osseux varient considerablement selon les sites osseux, les parametres microarchitecturaux et la conception des etudes. In vivo, le TBS rend peu compte de la variance des parametres microarchitecturaux trabeculaires. Nous soulignons qu’il s’agit d’un parametre de texture. Le TBS est reduit chez les patients qui ont des fractures de fragilite. Plusieurs etudes retrospectives et prospectives ont montre sa capacite discriminatoire pour le risque de fracture en combinant la densite minerale osseuse de surface et le TBS Ce dernier reste un facteur predictif de fracture contrairement a la densite minerale osseuse surfacique. Cependant, dans des etudes prospectives, le meilleur facteur predictif de fracture reste pour la hanche la densite minerale osseuse surfacique. En raison de l’absence de preuves, nous recommandons de ne pas utiliser le TBS pour le suivi des patients traites par des medicaments anti-osteoporotiques.

International audience

International audience