Identification of asymptomatic frailty vertebral fractures in post-menopausal women

Pizzato, S.; Trevisan, Caterina; Lucato, Paola; Girotti, G.; Mazzochin, Mattia; Zanforlini, Bruno Micael; Bano, Gabriele; Piovesan, Francesca; Bertocco, Anna; Zoccarato, Francesca; Dianin, Marta; Manzato, Enzo; Sergi, Giuseppe

doi:10.1016/j.bone.2018.05.007

Cited by 14 publications

(8 citation statements)

References 21 publications

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“…This is in line with previous larger observational studies which showed that loss of BMD during the off-treatment period is not only localized at the spine, but that hip BMD loss is equal to or even greater than the gain achieved during treatment [3]. Our finding might be also explained by the fact that vertebral fractures, in contrast to hip ones, are more often clinically silent and might remain undiagnosed if spinal X-rays are not performed [38].…”

Section: Discussionsupporting

confidence: 92%

COVID-19 lockdown negatively impacted on adherence to denosumab therapy: incidence of non-traumatic fractures and role of telemedicine

Vincentis

Domenici

Ansaloni

et al. 2022

J Endocrinol Invest

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Purpose Coronavirus disease (COVID-19) lockdowns have impacted on management of osteoporosis and the use of telemedicine is increasingly widespread albeit supported by little evidence so far. The aim of the study is to assess adherence to denosumab and incidence of non-traumatic fractures during the lockdown compared to the pre-COVID-19 year and to explore the effectiveness of telemedicine in the management of osteoporotic patients. Methods Retrospective, longitudinal, single-center study on patients receiving subcutaneous denosumab therapy every 6 months. Each patient was scheduled to undergo 2 visits: one during the pre-COVID-19 period (March 2019-March 2020) and another visit during the lockdown period (March 2020-March 2021). Data on new fractures, adherence, risk factors for osteoporosis and the modality of visit (telemedicine or face-to-face) were collected. ResultsThe prevalence of non-adherent patients was higher during the lockdown (35 of 269 patients, 13.0%) than the pre-COVID-19 period (9 of 276 patients, 3.3%) (p < 0.0001). During the lockdown, the number of new non-traumatic fractures was higher than the pre-COVID-19 year (p < 0.0001): 10 patients out of 269 (3.7%) experienced a fragility fracture and 2 patients (0.7%) a probable rebound fracture during the lockdown period, whereas no patient had fragility/rebound fractures during the pre-COVID-19 period. No difference was found in the prevalence of non-adherence and new non-traumatic fractures comparing patients evaluated with tele-medicine to those evaluated with face-to-face visit. Conclusion Non-adherent patients and new non-traumatic fractures (including rebound fractures) were more prevalent during the lockdown in comparison to the pre-COVID-19 period, regardless of the modality of medical evaluation.

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Section: Discussionsupporting

confidence: 92%

COVID-19 lockdown negatively impacted on adherence to denosumab therapy: incidence of non-traumatic fractures and role of telemedicine

Vincentis

Domenici

Ansaloni

et al. 2022

J Endocrinol Invest

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“…The presence of vertebral fractures was investigated by reading thoracic and lumbar spine X-ray pictures, performed in anterior-posterior and lateral view within 12 months from the outpatient visit.The presence of a vertebral fracture was evaluated by measuring the anterior, middle and posterior heights of each vertebra with the aid of a caliper. It was defined as a reduction ≥20% in vertebral anterior, middle or posterior height, or as a loss in vertebral body height in relation to normal-looking adjacent vertebra according to the criteria proposed by Genant[29,30]. The assessment of vertebral fractures took into account deformities linked to spinal curvatures with parallax distortion of vertebral borders, osteoarthritis, degenerative diskA C C E P T E D M A N U S C R I P Tdisease or Schmorl's nodes.…”

mentioning

confidence: 99%

The Impact of Smoking on Bone Metabolism, Bone Mineral Density and Vertebral Fractures in Postmenopausal Women

Trevisan

Alessi

Girotti

et al. 2020

Journal of Clinical Densitometry

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“…However, under-recognition of VFs is well recognised for both incidental and clinical fractures [1,13]. Affected individuals may not seek medical attention as around two-thirds of individuals may be unaware of the presence of VF, ranging up to 82% being asymptomatic in one European series [14]. There is often a lack of recognition of the clinical significance of VFs by clinicians and radiologists leading to delayed diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Detection of vertebral fracture in an acute hospital setting: an intervention to reduce future fracture risk through fracture liaison service intervention?

Toal¹,

McLoughlin²,

Pierce³

et al. 2020

Arch Osteoporos

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Summary We introduced a standardised reporting system in the radiology department to highlight vertebral fractures and to signpost fracture prevention services. Our quality improvement project achieved improved fracture reporting, access to the FLS service, bone density assessment and anti-fracture treatment. Purpose Identification of vertebral fragility fractures (VF) provides an opportunity to identify individuals at high risk who might benefit from secondary fracture prevention. We sought to standardise VF reporting and to signpost fracture prevention services. Our aim was to improve rates of VF detection and access to our fracture liaison service (FLS). Methods We introduced a standardised reporting tool within the radiology department to flag VFs with signposting for referral for bone densitometry (DXA) and osteoporosis assessment in line with Royal Osteoporosis Society guidelines. We monitored uptake of VF reporting during a quality improvement phase and case identification within the FLS service. Results Recruitment of individuals with VF to the FLS service increased from a baseline of 63 cases in 2017 (6%) to 95 (8%) in 2018 and 157 (8%) in 2019 and to 102 (12%) in the first 6 months of 2020 (p = 0.001). One hundred fifty-three patients with VFs were identified during the QI period (56 males; 97 females). Use of the terminology ‘fracture’ increased to 100% (mean age 70 years; SD 13) in computed tomography (n = 110), plain X-ray (n = 37) or magnetic resonance imaging (n = 6) reports within the cohort. Signposting to DXA and osteoporosis assessment was included in all reports (100%). DXA was arranged for 103/153; 12 failed to attend. Diagnostic categories were osteoporosis (31%), osteopenia (36%) or normal bone density (33%). A new prescription for bone protection therapy was issued in 63/153. Twelve of the series died during follow-up. Conclusions Standardisation of radiology reporting systems facilitates reporting of prevalent vertebral fractures and supports secondary fracture prevention strategies.

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Identification of asymptomatic frailty vertebral fractures in post-menopausal women

Cited by 14 publications

References 21 publications

COVID-19 lockdown negatively impacted on adherence to denosumab therapy: incidence of non-traumatic fractures and role of telemedicine

COVID-19 lockdown negatively impacted on adherence to denosumab therapy: incidence of non-traumatic fractures and role of telemedicine

The Impact of Smoking on Bone Metabolism, Bone Mineral Density and Vertebral Fractures in Postmenopausal Women

Detection of vertebral fracture in an acute hospital setting: an intervention to reduce future fracture risk through fracture liaison service intervention?

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