Yield and cost-effectiveness of laboratory testing to identify metabolic contributors to falls and fractures in older persons

Johnson, Kate; Suriyaarachchi, Pushpa; Kakkat, Mohammed; Boersma, Derek; Gunawardene, Piumali; Demontiero, Oddom; Tannenbaum, Cara; Duque, Gustavo

doi:10.1007/s11657-015-0226-3

Cited by 21 publications

(9 citation statements)

References 32 publications

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“…Targeted investigations addressing modifiable risk factors identified in the history and physical assessment may be required based on clinician suspicion. Most secondary causes of pathology leading to the increased risk of falls and fractures can be detected by testing the serum for 25(OH) vitamin D, calcium, parathyroid hormone, and serum testosterone (in men) . However, certain investigations are required for osteosarcopenia to make the diagnosis and inform management decisions.…”

Section: Epidemiologymentioning

confidence: 99%

“…Most secondary causes of pathology leading to the increased risk of falls and fractures can be detected by testing the serum for 25(OH) vitamin D, calcium, parathyroid hormone, and serum testosterone (in men). 34 However, certain investigations are required for osteosarcopenia to make the diagnosis and inform management decisions. Muscle mass, quantity or quality, and BMD are the focus of investigations in the workup of osteosarcopenia.…”

Section: Investigationsmentioning

confidence: 99%

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Osteosarcopenia: epidemiology, diagnosis, and treatment—facts and numbers

Kirk

Zanker

Duque

2020

J cachexia sarcopenia muscle

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Background Osteosarcopenia, the presence of osteopenia/osteoporosis and sarcopenia, is an emerging geriatric giant, which poses a serious global health burden. Methods and results The prevalence of osteosarcopenia ranges in community‐dwelling older adults [5–37% (≥65 years)] with the highest rates observed in those with fractures (low‐trauma fracture: ~46%; hip fracture: 17.1–96.3%). Among 2353 community‐dwelling adults, risk factors associated with osteosarcopenia include older age [men: 14.3% (60–64 years) to 59.4% (≥75 years); women: 20.3% (60–64 years) to 48.3% (≥75 years), P < 0.05], physical inactivity [inverse relationship: 0.64, 95% confidence interval (CI) 0.46–0.88 (sexes combined)], low body mass index (inverse relationship: men: 0.84, 95% CI 0.81–0.88; women: 0.77, 95% CI 0.74–0.80), and higher fat mass (men: 1.46, 95% CI 1.11–1.92; women: 2.25, 95% CI 1.71–2.95). Among 148 geriatric inpatients, osteosarcopenic individuals demonstrate poorer nutritional status (mini‐nutritional assessment scores: 8.50 ± 2.52 points, P < 0.001) vs. osteoporosis or sarcopenia alone, while among 253 older Australians, osteosarcopenia is associated with impaired balance and functional capacity [odds ratios (ORs): 2.56–7.19; P < 0.05] vs. non‐osteosarcopenia. Osteosarcopenia also associates with falls (ORs: 2.83–3.63; P < 0.05), fractures (ORs: 3.86–4.38; P < 0.05), and earlier death [hazard ratio (1‐year follow‐up): 1.84, 95% CI; 0.69–4.92, P = 0.023] vs. non‐osteosarcopenia. Conclusions This syndrome is expected to grow in age‐related and disease‐related states, a likely consequence of immunosenescence coinciding with increased sedentarism, obesity, and fat infiltration of muscle and bone. Evidence suggests the pathophysiology of osteosarcopenia includes genetic polymorphisms, reduced mechanical loading, and impaired endocrine functioning, as well as altered crosstalk between muscle, bone, and fat cells. Clinicians should screen for osteosarcopenia via imaging methods (i.e. dual‐energy X‐ray absorptiometry) to quantify muscle and bone mass, in addition to assessing muscle strength (i.e. grip strength) and functional capacity (i.e. gait speed). A comprehensive geriatric assessment, including medical history and risk factors, must also be undertaken. Treatment of this syndrome should include osteoporotic drugs [bone anabolics/antiresorptives (i.e. teriparatide, denosumab, bisphosphates)] where indicated, and progressive resistance and balance exercises (at least 2‐3 times/week). To maximize musculoskeletal health, nutritional recommendations [protein (1.2–1.5 g/kg/day), vitamin D (800–1000 IU/day), calcium (1300 mg/day), and creatine (3–5 g/day)] must also be met. It is anticipated that diagnosis and treatment for osteosarcopenia will become part of routine healthcare in the future. However, further work is required to identify biomarkers, which, in turn, may increase diagnosis, risk stratification, and targeted treatments to improve health outcomes.

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Section: Epidemiologymentioning

confidence: 99%

Section: Investigationsmentioning

confidence: 99%

Osteosarcopenia: epidemiology, diagnosis, and treatment—facts and numbers

Kirk

Zanker

Duque

2020

J cachexia sarcopenia muscle

Self Cite

256

245

View full text Add to dashboard Cite

show abstract

“…Male osteoporosis that results from specific, well-defined clinical disorders or medical treatment is classified as secondary osteoporosis. Although the prevalence of secondary osteoporosis is widely debated (34,35,36,37,38,39,40), it is generally assumed that up to 40% of postmenopausal women and 60% of men have factors contributing to osteoporosis when evaluated for underlying causes of the disease (4). Indeed, the relative percentage of primary and secondary forms depends on the clinical approach and depth of diagnostic work up.…”

Section: Box 1: Physiological Roles Of Sex Steroids In Bone Metabolismmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Male osteoporosis: diagnosis and management - should the treatment and the target be the same as for female osteoporosis?

Porcelli

Maffezzoni

Pezzaioli

et al. 2020

European Journal of Endocrinology

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Male osteoporosis has been neglected for too long time and there is need for a change. This condition is clearly under-estimated, under-diagnosed and under-treated. The diagnosis is often made late in the natural history of the pathology or even after a fracture event. Guidelines on screening politics do not agree whether and when men should be considered, and clinical trials are far less performed in men with respect to women. Actually, most of our knowledge on male osteoporosis, especially regarding treatment, is extrapolate from the female counterpart. Male osteoporosis is frequently secondary to other conditions and often associated with comorbidities. Therefore, identification of specific causes of male osteoporosis is essential to drive a correct and personalized treatment. Moreover, men have more osteoporosis-related complications and higher mortality rate associated with fractures. Furthermore, not only fewer men receive a correct and timely diagnosis, but also fewer men receive adequate treatment, and adherence to therapy is far less in men than in women. Of note, very few studies assessed the effect of anti-osteoporotic treatments in men and most of them considered only bone density as primary endpoint. This review focuses on the areas that are still nebulous in male osteoporosis field, from identification of subjects who need to be evaluated for osteoporosis and screening programs dealing with primary prevention, to diagnostic procedures for good estimates of bone quantity and quality and precise calculation of fracture risk, and personalized treatment that take into account the pathophysiology of osteoporosis.

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“…However, absence of established biomarkers may limit the estimated prevalence of osteosarcopenia, as opposed to osteoporosis and sarcopenia independently. Diagnostic rate versus cost per diagnosis of alternative screening strategies to identify and treat metabolic contributors of falls and fractures to achieve a diagnostic rate over 90%, most cost-effective way, while obtaining valuable information in terms of treatment decision making is the following: incorporating 25-ΟΗ vitamin D, calcium, parathyroid hormone, testosterone (in males), thyroid-stimulating hormone (TSH), and creatinine/estimated glomerular filtration rate (eGFR) in clinical practice, which may be potent markers of enhanced falls and fracture risk assessment in vulnerable groups[ 39 ].…”

Section: Diagnosis Of Osteosarcopeniamentioning

confidence: 99%

Osteosarcopenia School

Dionyssiotis¹,

Prokopidis²,

Vorniotakis³

et al. 2021

JFSF

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Osteosarcopenia has been proposed as a syndrome in a subset of frail individuals at higher risk of falls, fractures and institutionalization. In this paper, we will go over the translational aspects of sarcopenia and osteoporosis research and highlight outcomes from different interventions. In addition, preventative measures and therapeutic interventions that can benefit both muscle and bone simultaneously will be analysed also. A new holistic concept called Osteosarcopenia School will be presented. This new concept is based on counselling and education of patients as part of a rehabilitation program, aiming to reduce the risk of social isolation, falls and fractures, and subsequent disability through muscle strengthening and balance training. In this patient group, the combination of pharmaceutical treatments and specific exercise programmes are essential to counteract the consequences of osteosarcopenia. Finally, educational programmes targeting patient functionality through social reintegration may have a substantial impact on their daily living activities and overall quality of life.

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Yield and cost-effectiveness of laboratory testing to identify metabolic contributors to falls and fractures in older persons

Abstract: The minimum cost-effective battery for occult metabolic disorders in older adults at risk of falls and fractures should include serum vitamin D, PTH, TSH, creatinine/eGFR, testosterone (in men), and calcium.

Cited by 21 publications

References 32 publications

Osteosarcopenia: epidemiology, diagnosis, and treatment—facts and numbers

Osteosarcopenia: epidemiology, diagnosis, and treatment—facts and numbers

MANAGEMENT OF ENDOCRINE DISEASE: Male osteoporosis: diagnosis and management - should the treatment and the target be the same as for female osteoporosis?

Osteosarcopenia School

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