Summary of the Thai Osteoporosis Foundation (TOPF) Clinical Practice Guideline on the diagnosis and management of osteoporosis 2021

Objectives@#The Thai Osteoporosis Foundation (TOPF) is an academic organization that consists of a multidisciplinary group of healthcare professionals managing osteoporosis. The first clinical practice guideline for diagnosing and managing osteoporosis in Thailand was published by the TOPF in 2010, then updated in 2016 and 2021. This paper presents important updates of the guideline for the diagnosis and management of osteoporosis in Thailand. @*Methods@#A panel of experts in the field of osteoporosis was recruited by the TOPF to review and update the TOPF position statement from 2016. Evidence was searched using the MEDLINE database through PubMed. Primary writers submitted their first drafts, which were reviewed, discussed, and integrated into the final document. Recommendations are based on reviews of the clinical evidence and experts' opinions. The recommendations are classified using the Grading of Recommendations, Assessment, Development, and Evaluation classification system. @*Results@#The updated guideline comprises 90 recommendations divided into 12 main topics. This paper summarizes the recommendations focused on 4 main topics: the diagnosis and evaluation of osteoporosis, fracture risk assessment and indications for bone mineral density measurement, fracture risk categorization, management according to fracture risk, and pharmacological management of osteoporosis. @*Conclusions@#This updated clinical practice guideline is a practical tool to assist healthcare professionals in diagnosing, evaluating, and managing osteoporosis in Thailand.

Back pain in patients with severe osteoporosis on teriparatide or antiresorptives: a prospective observational study in a multiethnic population

<p><b>INTRODUCTION</b>We evaluated reduced back pain in a multiethnic population treated with teriparatide and/or antiresorptives in real-life clinical settings over 12 months.</p><p><b>METHODS</b>This prospective observational study comprised 562 men and postmenopausal women (mean age 68.8 years) receiving either teriparatide (n = 230), antiresorptives (raloxifene or bisphosphonates; n = 322), or both (n = 10) for severe osteoporosis. The primary endpoint was the relative risk of new/worsening back pain at six months.</p><p><b>RESULTS</b>At baseline, a higher proportion of teriparatide-treated than antiresorptive-treated patients had severe back pain (30.9% vs. 17.7%), extreme pain/discomfort (25.3% vs. 16.8%), extreme anxiety/depression (16.6% vs. 7.8%) and were confined to bed (10.0% vs. 5.3%). Teriparatide-treated patients had higher visual analog scale (VAS) scores for pain (5.8 ± 2.42 vs. 5.1 ± 2.58) and lower mean European Quality of Life-5 Dimensions (EQ-5D) scores (37.7 ± 29.15 vs. 45.5 ± 31.42) than antiresorptive-treated patients. The incidence of new/worsening back pain at six months for patients on teriparatide and antiresorptives was 9.8% and 10.3% (relative risk 0.99, 95% confidence interval 0.80-1.23), respectively. The incidence of severe back pain at 12 months was 1.3% and 1.6% in the teriparatide and antiresorptive treatment groups, respectively. Teriparatide-treated patients had lower mean VAS (2.71 ± 2.21 vs. 3.30 ± 2.37) and EQ‑5D (46.1 ± 33.18 vs. 55.4 ± 32.65) scores at 12 months. More teriparatide-treated patients felt better (82.7% vs. 71.0%) and were very satisfied with treatment (49.4% vs. 36.8%) compared to antiresorptive-treated patients.</p><p><b>CONCLUSION</b>Patients treated with either teriparatide or antiresorptives had similar risk of new/worsening back pain at six months.</p>

Bone mineral density measured by calcaneal quantitative ultrasound and bone stress fracture in Thai army recruits

Background: Stress fracture of army recruits usually occur during basic military training. The symptoms of stress fracture are local tenderness and inability to run. Currently, no methods of risk identification are available in spite of many stress fractures. If bone mineral density (BMD), measured by calcaneal quantitative ultrasound (QUS), is related to stress fractures, QUS may be a tool for identifying army recruits at risk.Objectives: To evaluate the relationship between bone mineral density and stress fractures, and to study the incidence of stress fracture and risk factors among Thai army recruits during basic military training.Material and methods: One-thousand two-hundred sixty-three new army recruits were enrolled from different 10 battalions of Thai army in Bangkok. Before the 10-week basic military training, their heels were measured by calcaneal QUS and a risk factor questionnaire was administered. During training, their musculoskeletal injuries were monitored, especially stress fracture. Radiographic examination or a bone scintigraphy was performed in suspect of stress fracture. At the end of the training, they filled-out another questionnaire.Results: The cumulative incidence of stress fracture was 6.57% (95%CI: 5.27, 8.08) and the incidence rate was 1.22 per 1,000 person-days (95%CI: 0.97, 1.51). The Cox proportional hazards model showed that the BMD, measured by calcaneal QUS, had a significant relationship to stress fracture. The lowest quartile (Q₁) of speed of sound (SOS) was significantly related to stress fracture (Hazard ratio (HR) = 3.42; 95%CI: 1.74, 6.75; p-value \< 0.001), history of fracture (HR=2.20; 95%CI: 1.15, 4.21; p-value=0.017), and heavy smoking (HR=2.08; 95%CI: 1.23, 3.50; p-value=0.006). The area under the ROC curve of SOS was 61.1% (95%CI: 54.70, 67.39).Conclusion: The bone mineral density, measured by calcaneal QUS, was significantly related to stress fracture. In the lowest group of SOS measurement, heavy smokers, and recruits with a history of fracture had high risk of stress fracture. The incidence of stress fracture might be some what reduced by the application of adapted basic military training for high-risk recruits.