The clinical impact of vertebral fractures: Quality of life in women with osteoporosis

Gold, Deborah T.

doi:10.1016/8756-3282(95)00500-5

Cited by 330 publications

(173 citation statements)

References 25 publications

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“…(5,7) In addition to health care costs, osteoporotic fractures significantly impact mortality and patient quality of life by inducing pain, physical limitations, and psychological symptoms, including depression and loss of self-esteem, resulting in institutionalization and long-term care. (2,4,(8)(9)(10)(11)(12)(13)(14) Pharmacotherapies currently available for the prevention and treatment of osteoporosis include oral bisphosphonates (OBP), calcitonin, estrogen/hormone therapy, the estrogen agonist/ antagonist raloxifene, and the recombinant parathyroid hormone teriparatide. Among these, bisphosphonates are the most commonly used treatment for established osteoporosis with a market share of 35% in the US.…”

Section: Introductionmentioning

confidence: 99%

Long-term impact of adherence to oral bisphosphonates on osteoporotic fracture incidence

Sampalis

Adachi

Rampakakis

et al. 2011

Journal of Bone and Mineral Research

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Adherence to osteoporosis treatments is a critical parameter resulting in suboptimal effectiveness in real-life practice. The long-term effect of adherence on fracture risk has not been assessed. This was a retrospective study using provincial health insurance claims databases to assess the association between adherence to oral bisphosphonates (OBP) and incidence of osteoporotic fractures in all Ontario patients with osteoporosis between April 1996 and December 2009. Multivariate logistic regression models were used to assess the association between OBP adherence and fracture risk. Treatment duration was classified into 2-year intervals. Compliance was estimated with the medication possession ratio (MPR), and persistence was defined as the length of continuous therapy without a gap in refills >30 days. The study cohort was composed of 636,114 patients, among whom 36.1% were prescribed OBPs for 0 to 2 years, 19.7% for 2 to 4 years, 15.1% for 4 to 6 years, 12% for 6 to 8 years, 9.1% for 8 to 10 years, 6.1% for 10to 12 years, and 1.9% for 12 to 14 years. Overall, the mean (SD) compliance for the cohort was 0.72 (0.30) with 53.5% of the patients having compliance >80% and 24.6% being persistent with treatment during the 14-year follow-up period. Significant associations between high adherence and reduced fracture risk over the entire 14-year period were observed; the overall odds ratio for categorical compliance (MPR >80% or MPR 80%), continuous compliance, and persistence were 0.909 (95% confidence interval [CI] 0.893-0.925), 0.918 (95% CI 0.893-0.944), and 0.804 (95% CI 0.787-0.821), respectively. In conclusion, adherence to OBP in osteoporosis management is suboptimal in a real-life setting. A significant positive association exists between poor adherence and increased risk of osteoporotic fractures, which becomes augmented with longer treatment duration. ß

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Section: Introductionmentioning

confidence: 99%

Long-term impact of adherence to oral bisphosphonates on osteoporotic fracture incidence

Sampalis

Adachi

Rampakakis

et al. 2011

Journal of Bone and Mineral Research

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“…However, it is important to distinguish the pain caused by a fracture from other causes of back pain. Patients requiring a percutaneous cement augmentation procedure are usually very fragile with multiple medical co-morbid factors [3,4,7,9,[18][19][20][21]. Thus, the differential diagnosis should include not only osteoporosis, but also malignant tumor, benign tumor endocrinopathy, autoimmune disease, blood dyscrasias, and infection [1,22,23].…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 700,000 VCFs occur in the US each year and approximately one-third of them are causing chronic pain [1]. In addition to the debilitating symptoms of pain that VCFs can cause, progressive loss of sagittal posture can have a tremendous impact on quality of life [2][3][4][5][6][7][8][9][10]. New minimal invasive techniques like percutaneous vertebroplasty and percutaneous kyphoplasty proved to be an effective treatment for treating the pain and preventing further collapse at the fracture level [11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Routine needle biopsy during vertebral augmentation procedures. Is it necessary?

et al. 2010

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Vertebral augmentation procedures are currently widely performed to treat vertebral compression fractures. The purpose of this study was to determine the frequency of underlying previously unrecognized etiology in a consecutive series of patients undergoing kyphoplasty to treat vertebral compression fractures. A prospective histological evaluation of vertebral body biopsy specimens from presumed osteoporotic vertebral compression fractures were performed in order to identify aforementioned causes. Over a 2-year period, vertebral body biopsies from 154 vertebral levels were performed in 75 patients undergoing kyphoplasty for vertebral compression fractures. All patients received a preoperative workup that included plain radiographs, MRI, whole body bone scan, and laboratory examinations. Bone specimens were obtained from affected vertebral bodies and submitted for histologic evaluation to identify the prevalence of an underlying cause. All specimens demonstrated fragmented bone with variable amounts of unmineralised bone, signs of bone-remodeling and/or fracture-healing. In 11 patients underlying pathology other than osteoporosis was identified (prostate cancer, 1; pancreatic cancer, 1; colon cancer, 1; breast cancer, 2; multiple myeloma, 3; leukemia, 1; and lung cancer, 2). In all but one patient the results of the biopsy confirmed the diagnosis suspected from the preoperative workup. For the last patient, namely the one with pancreatic cancer, the workup did not identify the origin of the primary tumor, although the patient was considered to have a compression fracture secondary to metastatic disease of unknown origin, the vertebral biopsy suggested the presence of adenocarcinoma which eventually was proven to be pancreatic cancer. In augmentation procedures for vertebral compression fractures, bone biopsy should be reserved for the patients where the preoperative evaluation raises the suspicion of a non-osteoporotic etiology.

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“…Osteoporotic fractures impose severe physical, psychosocial, and financial burden both to the patient and the society. They may be accompanied by pain, bone deformities, fear, distress, difficulty in per forming daily activities, loss of independence, and insti tutionalization (3). More important, fragility fractures are associated with high mortality rates that can exceed 20% in the first year after the fracture (4,5).…”

Section: Introductionmentioning

confidence: 99%

The burden of osteoporosis in Brazil

Marinho

Guerra

Drummond³

et al. 2014

Arq Bras Endocrinol Metab

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Osteoporotic fractures impose severe physical, psychosocial, and financial burden both to the patient and the society. Studies on the prevalence of osteoporosis and fragility fractures in Brazil show a wide variation, due to differences in sample size, the population studied, and methodologies. Few studies have been conducted in Brazil about the cost-effectiveness analyses of different intervention options aimed at the diagnosis and treatment of osteoporosis. Investigation and treatment strategies based on cost-effectiveness and scientific evidence are essential in the preparation of public health policies with the ultimate goal of reducing the incidence of fractures and, consequently, the direct and indirect costs associated with them. This article reviews the Brazilian burden of osteoporosis in terms of the prevalence and fractures attributable to the disease, the costs related to the investigation and management, as well as the impact of osteoporosis on the population as a whole and on affected individuals. Arq Bras Endocrinol Metab. 2014;58(5):434-43Keywords Expenses; osteoporosis; Brazil RESUMOFraturas osteoporóticas impõem graves entraves físicos, psicossociais e financeiros, tanto para o paciente quanto para a sociedade. Estudos sobre a prevalência de osteoporose e fraturas por fragilidade no Brasil mostram uma grande variação, em decorrência das diferenças no tamanho das amostras, da população estudada e da metodologia empregada. Poucos estudos têm sido realizados no Brasil sobre a análise de custo-efetividade das diferentes opções de intervenção que visam ao diagnóstico e ao tratamento da osteoporose. Estratégias de investigação e de tratamento com base na relação custo-eficácia e evidências científicas são essenciais para a elaboração de políticas de saúde pública, com o objetivo final de reduzir a incidência de fraturas e, consequentemente, os custos diretos e indiretos associados a elas. Este artigo faz uma revisão sobre o ônus da osteoporose no Brasil em termos de prevalência e fraturas atribuí-veis à doença, de custos relacionados com a investigação, tratamento da osteoporose, bem como seu impacto na população como um todo e em indivíduos afetados. Arq Bras Endocrinol Metab.

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The clinical impact of vertebral fractures: Quality of life in women with osteoporosis

Cited by 330 publications

References 25 publications

Long-term impact of adherence to oral bisphosphonates on osteoporotic fracture incidence

Long-term impact of adherence to oral bisphosphonates on osteoporotic fracture incidence

Routine needle biopsy during vertebral augmentation procedures. Is it necessary?

The burden of osteoporosis in Brazil

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