Bone Mineral Density Measurement and Treatment for Osteoporosis in Older Individuals With Fractures

Feldstein, Adrianne C.; Elmer, Patricia J.; Orwoll, Eric; Herson, Michael; Hillier, Teresa A.

doi:10.1001/archinte.163.18.2165

Cited by 202 publications

(124 citation statements)

References 39 publications

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“…Despite the prevalence of fracture(s), few had been referred for BMD measurement and only 57 (14%) of 400 subjects with fracture who had responded to the invitation had in fact been treated for osteoporosis. This finding is in accordance with other reports (Freedman et al 2000, Andrade et al 2003, Feldstein et al 2003.…”

Section: Discussionsupporting

confidence: 94%

Women with low-energy fracture should be investigated for osteoporosis

et al. 2007

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Introduction Treatment of osteoporosis is becoming more effective, but methods to identify patients who are most suitable for investigation and treatment are still being debated. Should any type of fracture have higher priority for investigation of osteoporosis than any other? Is the number of previous fractures useful information?Material and methods We investigated 303 consecutive women patients between 55 and 75 years of age who had a newly diagnosed low-energy fracture. They answered a questionnaire on previous fractures which also dealt with risk factors. Bone mineral density (BMD) was measured at the hip, lumbar spine, and forearm.Results The distribution of fracture location was: distal forearm 56%, proximal humerus 12%, vertebra 18%, and hip 13%, all with similar age. Half of the subjects had had at least one previous fracture before the index fracture, 19% had had two previous fractures, and 6% had had three or more previous fractures. Patients with vertebral or hip fracture had lower BMD and had had more previous fractures than patients with forearm or humerus fractures. There was an inverse correlation between number of fractures and BMD. Osteoporosis was present in one-third of patients with forearm fracture, in one-half of those with hip or humerus fracture, and in two-thirds of those with vertebral fracture.Interpretation Vertebral fractures were the strongest marker of low BMD and forearm fractures the weakest. The number of previous fractures is helpful information for finding the most osteoporotic patient in terms of severity. Investigation of osteoporosis therefore seems

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Section: Discussionsupporting

confidence: 94%

Women with low-energy fracture should be investigated for osteoporosis

et al. 2007

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“…The demographic data of this disease have shown that hip fractures throughout globe will rise from 1.66 million in 1990 to 6.26 million by 2050 (Dhanwal et al, 2011). It is characterized by low bone mass and micro architectural deterioration of bone tissue, finally increasing the susceptibility of bone fracture with a low energy trauma (Feldstein et al, 2003). National Institute of Health consensus statement defines OP as ''a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture'' (NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy, 2001).…”

Section: Introductionmentioning

confidence: 99%

Bisphosphonates: therapeutics potential and recent advances in drug delivery

et al. 2014

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Context: Bisphosphonates (BPs) are widely used for prevention and treatment of osteoporosis. BPs are known as gold standard for osteoporosis (OP) treatment due to their positive results in clinical studies. But some serious side effects are associated with BPs like gastrointestinal adverse effect i.e. esophagitis and ulcer of esophagus. Oral bioavailability (BA) of BPs ranges from 0.6 to 1% due to poor absorption through gastrointestinal tract (GIT). Objective: The main objective of this review is to explore the role of novel drug delivery systems (DDSs) for the delivering of BPs and minimizing the drawbacks associated with them. Methods: The current review is focusing on classification, mechanism of action, and limitations of BPs, and is also dwelling on the use of novel DDSs like nanoparticles, liposomes, topical, transdermal systems, implants, bisphosphonate osteotropic DDS (BP-ODDS), microspheres, and calcium phosphate cements (CPCs) for BPs. This review also gives a critically reviewed compilation of the various in vitro and in vivo studies conducted till date. Conclusion: On the basis of the exhaustive literature, it has been found that the novel DDS minimizes the side effects associated with BPs and enhances the BA. The advance drug delivery has a greater impact on reducing the undesirable effects and increasing the BA of BPs.

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“…The guidelines do not tell us how to integrate multiple clinical risk factors or how to integrate clinical risk factors and BMD. The plethora of variable treatment guidelines may sometimes serve to confuse more than enlighten (20) and contribute to their underutilization in clinical practice (21). Population-based strategies identify more patients at high fracture risk for treatment than do case-based strategies, but require more healthcare resources (e.g., BMD testing devices, trained personnel), generate greater costs, and may result in some patients at low risk for fracture being treated.…”

Section: Intervention Thresholdsmentioning

confidence: 99%

Redefining osteoporosis treatment: who to treat and how long to treat

Lewiecki

Silverman

2006

Arq Bras Endocrinol Metab

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Osteoporosis is a common disease that is associated with increased risk of fractures and serious clinical consequences. Bone mineral density (BMD) testing is used to diagnose osteoporosis, estimate the risk of fracture, and monitor changes in BMD over time. Combining clinical risk factors for fracture with BMD is a better predictor of fracture risk than BMD or clinical risk factors alone. Methodologies are being developed to use BMD and validated risk factors to estimate the 10-year probability of fracture, and then combine fracture probability with country-specific economic assumptions to determine cost-effective intervention thresholds. The decision to treat is based on factors that also include availability of therapy, patient preferences, and co-morbidities. All patients benefit from nonpharmacological lifestyle treatments such a weight-bearing exercise, adequate intake of calcium and vitamin D, fall prevention, avoidance of cigarette smoking and bone-toxic drugs, and moderation of alcohol intake. Patients at high risk for fracture should be considered for pharmacological therapy, which can reduce fracture risk by about 50%. Osteoporose é uma doença comum, que está associada a um aumento do risco de fraturas e de importantes conseqüências clínicas. A densidade mineral óssea (DMO) é o método usado para o diagnóstico da osteoporose, estimando o risco de fratura e monitorando as alterações da DMO durante o tempo. A combinação de fatores de risco para fraturas com a densidade mineral óssea é melhor preditor do risco de fratura do que um deles isoladamente. Metodologias estão sendo desenvolvidas para usar a DMO e fatores de risco validados para estimar o risco de fraturas em 10 anos. A decisão de tratar também está baseada em fatores que incluem terapia disponível, preferência do paciente e co-morbidades. Todos os pacientes se beneficiam de medidas não farmacológicas tais como uma ingesta adequada de cálcio e vitamina D, prevenção de queda, evitar tabagismo e drogas de efeito tóxico ao osso. Pacientes de alto risco de fraturas devem ser considerados para o tratamento farmacológico, os quais podem reduzir este risco em 50%.

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Bone Mineral Density Measurement and Treatment for Osteoporosis in Older Individuals With Fractures

Abstract: Evaluation and treatment rates for osteoporosis in older individuals with fractures fall far below national recommendations, especially for men. Intervention strategies should be developed and evaluated to prevent refracture in older individuals with fractures.

Cited by 202 publications

References 39 publications

Women with low-energy fracture should be investigated for osteoporosis

Women with low-energy fracture should be investigated for osteoporosis

Bisphosphonates: therapeutics potential and recent advances in drug delivery

Redefining osteoporosis treatment: who to treat and how long to treat

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