Summary of meta-analyses of therapies for postmenopausal osteoporosis and the relationship between bone density and fractures

Guyatt, Gordon; Cranney, Ann; Griffith, Lauren; Walter, Stephen D.; Krolicki, N; Favus, Murray J.; Rosen, Clifford J.

doi:10.1016/s0889-8529(02)00024-5

Cited by 76 publications

(44 citation statements)

References 25 publications

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“…This benefit may show a clinically significant reduction in the number of fractures. (37) In this study, we also indicated that any isoflavone intake, walking exercise, and combined intervention decreased body fat mass in postmenopausal women. We noticed that isoflavone intake significantly reduced fat mass in the trunk region but not in the other regions.…”

Section: Discussionsupporting

confidence: 60%

Effects of Isoflavone and Exercise on BMD and Fat Mass in Postmenopausal Japanese Women: A 1-Year Randomized Placebo-Controlled Trial

Oka

Tabata

et al. 2006

Journal of Bone and Mineral Research

121

116

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The combined intervention of isoflavone intake and walking exercise over 1 year in postmenopausal Japanese women exhibited a trend for a greater effect on prevention of bone loss at the total hip and Ward's triangle regions. Introduction:The additive effects of isoflavones and exercise on bone and lipid metabolism have been shown in estrogen-deficient animals. In this study, we determined the effects of isoflavone intake, walking exercise, and their interaction on bone, fat mass, and lipid metabolism over 1 year in postmenopausal Japanese women. Materials and Methods: A total of 136 postmenopausal women at <5 years after the onset of menopause were randomly assigned to four groups: (1) placebo, (2) walking (45 minutes/day, 3 days/week) with placebo, (3) isoflavone intake (75 mg of isoflavone conjugates/day), and (4) combination of isoflavone plus walking. BMD, fat mass, serum lipid, and serum and urinary isoflavone concentrations were assessed. Results: A significant main effect of isoflavone on the reduction in trunk fat mass was obtained at 12 months. Significant main effects of walking on the reduction in fat mass in the whole body and the trunk were observed at 3, 6, and 12 months and that in the legs and arms at 6 and 12 months. Serum high-density lipoprotein (HDL)-cholesterol concentration significantly increased by 12 months after the walking and the combined intervention. After 12 months, a significant main effect of isoflavone on BMD was observed only at Ward's triangle. Walking prevented bone loss at the total hip and the Ward's triangle to significant degrees. The effect of the combined intervention on BMD at total hip and Ward's triangle regions was greater than that of either alone. No significant interaction was observed between isoflavone and walking in any measurements recorded during the study. Conclusions: Our study suggest that combined intervention of 75 mg/day of isoflavone intake and walking exercise 3 times/week for 1 year showed a trend for a greater effect on BMD at total hip and Ward's triangle regions than either alone. Intervention with isoflavone in postmenopausal Japanese women showed a modest effect on BMD compared with those in Westerners. Further studies over longer treatment duration that include assessment of BMD at various regions are necessary to ascertain the clinical significance of the combined intervention of isoflavone plus walking in postmenopausal women.

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Section: Discussionsupporting

confidence: 60%

Effects of Isoflavone and Exercise on BMD and Fat Mass in Postmenopausal Japanese Women: A 1-Year Randomized Placebo-Controlled Trial

Oka

Tabata

et al. 2006

Journal of Bone and Mineral Research

121

116

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“…[50][51][52][53] Hospitalists have the opportunity to start medications that can reduce the risk for subsequent fracture by nearly 50%. [54][55][56][57][58] A total calcium intake of 1200 to 1500 mg per day and vitamin D of 400 to 800 IU per day are recommended for all postmenopausal women. Patients who smoke should receive smoking cessation counseling and be considered for pharmacologic treatment for tobacco dependence.…”

Section: Long Termmentioning

confidence: 99%

“…Alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva) have been shown in randomized trials to increase bone density and reduce the risk of osteoporotic fractures. 55,56,59 Daily, weekly, and monthly preparations of bisphosphonates now exist. Pill-induced esophagitis is a potential adverse effect of bisphosphonate therapy, but is extremely rare if proper precautions are taken.…”

Section: Long Termmentioning

confidence: 99%

Acute vertebral fracture

Agulnek¹,

O’Leary²,

Edwards

2009

Journal of Hospital Medicine

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Vertebral fractures resulting from osteoporosis are a significant cause of morbidity and mortality in the aging population and are commonly seen in the hospital setting. Appropriately assessing and treating these conditions continues to be a challenge. This article is an evidence-based clinical update on the evaluation and management options of acute vertebral fractures, ranging from conservative treatment to surgical intervention. Hospitalists can play an influential role in the management of osteoporosis.

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“…As reviewed by the ORAG group (25), if the forearm was used for monitoring treatment, only the treatment with Hormonal Therapy and Alendronate for 2 to 4 years could be adequately monitored. Peripheral densitometry seems to be inadequate for antiresorptive treatment monitoring.…”

Section: Potential Application #4: Monitoring Changes Over Timementioning

confidence: 99%

Peripheral bone densitometry: clinical applications

Eis¹,

Lewiecki

2006

Arq Bras Endocrinol Metab

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Technologies for the measurement of bone mineral density and other parameters of bone strength at peripheral skeletal sites have been studied since the 1960s. Single-energy Photon Absorptiometry (SPA), Radiographic Absorptiometry (RA), Radiogrametry (RG), Single-energy X-ray Absorptiometry (SXA), Peripheral Dual-energy X-ray Absorptiometry (pDXA), and Quantitative Ultrasonometry (QUS) have been successively evaluated. These technologies and their clinical applications are discussed in this article. The available scientific evidence supports the clinical use of these technologies at peripheral skeletal for assessment of fracture risk. Peripheral measurements other than the 33% (one-third) radius by DXA cannot be used to diagnose osteoporosis according to current standards. Peripheral skeletal sites are not clinically useful for monitoring changes in BMD with natural evolution of the disease and its treatment. Peripheral BMD measurement can theoretically be used to screen patients for selection to central DXA testing, although device-specific cut-points should be developed before this is implemented. When central DXA testing is not available, peripheral BMD testing may be considered to identify individuals who might benefit from pharmacological intervention. RESUMODensitometria Periférica: Aplicabilidade Clínica e Uso Atual. Tecnologias para medidas de densidade (DMO) e outros parâmetros determinantes da resistência óssea no esqueleto periférico vêm sendo estudados desde os anos 60. Absorciometria Fotônica de Energia Única (SPA), Absorciometria Radiográfica (AR), Radiogrametria (RG), Absorciometria por Raios-X de Energia Única (SXA), Absorciometria por Raios-X de Dupla Energia (pDXA), e Ultrassonometria Quantitativa (QUS) têm sido sucessivamente avaliados. Tais tecnologias e suas aplicabilidades clínicas são discutidas neste artigo. As evidências científicas disponíveis apóiam o emprego clínico dessas tecnologias em sítios esqueléticos periféricos para avaliação prognóstica do risco de fraturas. Medidas periféricas além do radio 33% (um terço) medido por DXA não podem ser utilizadas para diagnóstico da osteoporose de acordo com os padrões atuais. Sítios esqueléticos não são úteis clinicamente para o monitoramento de mudanças na DMO com a evolução natural da doença e seu tratamento. Medidas de DMO periféri-ca podem, teoricamente, ser utilizadas no rastreio de pacientes, para seleção daqueles que necessitem realizar exames DXA centrais, embora critérios de corte específicos para cada um desses equipamentos necessitem ainda ser desenvolvidos antes que isso seja incorporado à prática clínica. Em locais onde exames DXA centrais não sejam disponíveis, avaliações de DMO do esqueleto periférico podem ser consideradas para identificar indivíduos que poderão se beneficiar de intervenções farmacológi-cas.

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Summary of meta-analyses of therapies for postmenopausal osteoporosis and the relationship between bone density and fractures

Cited by 76 publications

References 25 publications

Effects of Isoflavone and Exercise on BMD and Fat Mass in Postmenopausal Japanese Women: A 1-Year Randomized Placebo-Controlled Trial

Effects of Isoflavone and Exercise on BMD and Fat Mass in Postmenopausal Japanese Women: A 1-Year Randomized Placebo-Controlled Trial

Acute vertebral fracture

Peripheral bone densitometry: clinical applications

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