Postmenopausal Osteoporosis: Diagnosis, FRAX® and Management

@#Osteoporosis-related fractures are increasing at a rapid rate, especially in Asia due to the ageing population. This would result in increased morbidity and mortality of the seniors as well as creating a strain on the healthcare system. Efforts should be made to prevent osteoporosis, screen for osteoporosis early and timely treatment to reduce the risk of fractures. As falls are a major risk factor for fracture in osteoporotic patients, management of osteoporosis should include efforts to reduce falls. Using a population-wide strategy for women 65 years old couple with high-risk population screening using a combination of tools such as FRAX® and OSTA as well as clinical risk factors for women below 65 years old can detect osteoporosis early for intervention. Treatment options for osteoporosis include bisphosphonates, denosumab, teriparatide, raloxifene, menopausal hormone therapy and tibolone. Drug choices should be individualised to the patient, balancing the risk/benefit ratio.

APPROACH AND ASSESSMENT OF OSTEOPOROSIS: IDENTIFYING AND MANAGING RISK

With an ageing population, the incidence of osteoporoticfractures leading to deaths and impairment in quality oflife. However, despite the availability of effectivetreatments, osteoporosis is often under-diagnosed andunder-treated. Primary fracture prevention meansdetection of osteoporosis early with timely appropriatetreatment to improve the bone and lifestyle andenvironment optimisation to reduce falls. We propose apopulation-based combined with high-risk prescreeningfor measurement of bone mineral density (BMD) toreduce the incidence of fractures in the population.

A survey of bone mineral density in 9 158 urban residents in Chongqing / 实用医学杂志

Objective To study retrospectively the changes of bone mineral density,the prevalence of osteopenia/osteoporosis and risk factors in urban residents in Chongqing.Methods The data of radial bone mineral density of 9,158 healthy Han people (4 577 males and 4 581 females) who received health examination in the Health Management Center of Southwest China University were collected,from September 2012 to December 2016.Osteoporosis was judged according to T-value and the detection rate,BMI and OSTA indexes were calculated respectively.Results The total detection rate of osteoporosis in this group was 15.6％ (9.5％ in males and 21.6％in females,respectively).Among all the vocational groups,the detection rate of osteoporosis of teachers was the highest,while that of workers was the lowest.The detection rate of osteoporosis in the fcmales was higher than those in male,which in the emaciation group was much higher than those in the overweight/obesity group,among all the BMI status.The male over 70 years and female over 50 years belonged to the intermediate-risk group,which were also the focus for osteoporosis prevention and treatment.Conclusions The detection rate of osteoporosis in the urban residents in Chongqing is higher than those in other regions of China.Hence,Chongqing has a high-prevalence area of osteoporosis.Meanwhile,risk assessment using indexes such as vocation,BMI and OSTA and systematic intervention of osteopenia/osteoporosis for the urban residents are critical for the prevention and control of osteoporosis incidences.

Analysis on the effects of group medical visits on high-risk elder people suffering senile osteoporosis / 上海预防医学

Objective To explore the therapeutic effect of group medical visits on high-risk elder people suffering senile osteoporosis.Methods A total of 86 high-risk elder people aged over 65, suffering senile osteoporosis and with the OSTA index below-4 were randomly selected, and were separated into an intervention group and a control group, with 43 patients belonging to each group.The dual-energy X-ray absorptiometry(DXA) was used to measure the left femoral neck bone mineral density (LFN BMD), and relevant biochemical indexes thereof and biochemical indicators of bone metabolism thereof were measured at the same time.The osteoporotic knowledge test(OKT) and the osteoporotic self-efficiency scheme(OSES) were used to make relevant evaluations.Group interventions included the following four items: health edutaion and individual technical guidance, state of illness monitoring, group activities and prescription of medicines.At one year after the intervention, the above-mentioned items were to be evaluated again for the two groups.Results After the intervention, the blood calcium(Ca2+), phosphorus(P3+) and LFN BMD of the two groups had no statistical difference(P>0.05);the OKT and OSES scores as well as the level of 25(OH)VitD3 of the intervention group were all higher than those of the control group as well as those of the intervention group before the intervention(P<0.05).After intervention, the PTH, PINP and β-CTX levels of the intervention group were lower than those of the control group as well as those of the intervention group before the intervention(P<0.05).Conclusion The group medical visit is an effective community-based management intervention mode suitable for high-risk patients suffering osteoporosis.

Association of OSTA index with bone mineral density (BMD) and its comparison with calcaneal quantitative ultrasound for the prediction of low BMD in peri-menopausal Indian women.

Background: Osteoporosis is characterized by low bone mineral density (BMD) and an increased risk of fractures with advancing age in postmenopausal women. BMD measurements with dual energy X-ray absorptiometry (DEXA) are costly and not widely available The Osteoporosis Self-Assessment Tool for Asians (OSTA) index is a simple tool based on age and body weight to predict low BMD and identify women at risk of osteoporosis. The objective was to study the association of OSTA index with BMD (T-score) and to validate OSTA index in comparison with calcaneal Quantitative Ultrasound (QUS) for the prediction of low BMD in peri-menopausal Indian women. Methods: This was a prospective, cross-sectional, descriptive study carried out in department of physiology of a tertiary care teaching hospital (Navi Mumbai). Seventy two peri-menopausal women between 40 to 55 years with no previous diagnosis of osteoporosis were included. Participants’ socio-demographic detail, anthropometric measurements, OSTA index and QUS-based BMD was recorded. Pearson’s correlation test was used. Sensitivity, specificity, positive and negative predictive value was calculated. Results: OSTA index did not correlate with BMD in the entire samples. On subgroup analysis, OSTA index significantly correlated in a positive direction with BMD (T-score) in women in the age group of 50-55 years. OSTA index had a sensitivity of 70 %, and specificity of 84.62 % at T-score cutoff value of < -1. Conclusions: OSTA index is a simple risk assessment tool that can be used to identify women with low BMD in the age group of 50-55 years.

Performance of Osteoporosis Self-assessment Tool for Asian (OSTA) for Primary Osteoporosis in Post-menopausal Malay Women

The Osteoporosis Self-Assessment Tool for Asians (OSTA) score has been developed to identify women at risk of osteoporosis. It can be used as a screening tool for patients at risk who would benefit from bone mineral density measurement and treatment. It was developed based on data from eight countries including Malaysia. However, most subjects were of Chinese (59%). This study evaluated the performance of OSTA among 152 post-menopausal Malay women. OSTA score calculation and DEXA scan were performed. Our results showed that the OSTA score is a good predictor of patients at risk of osteoporosis based on BMD measurements at the proximal femur. Instrument sensitivity was 87.5%, specificity was 95.8%, positive predictive value (PPV) was 0.538, negative predictive value (NPV) was 0.993, and the area under the receiver operating characteristic curve (ROC) was 0.895. We conclude that use of the OSTA score in postmenopausal Malay women is effective and has adequate sensitivity and specificity.

Efectos de la cópula y el tamaño del macho sobre el comportamiento de ovipostura en la mosca estercolera Archisepsis diversiformis (Diptera: Sepsidae) / Effects of copulation and male size on the oviposition behavior of the manure fly Archisepsis diversiformis (Diptera: Sepsidae)

Effects of copulation and male size on the oviposition behavior of the manure fly Archisepsis diversiformis (Diptera: Sepsidae). I evaluated the effect of copulation as a stimulation factor for oviposition of Archisepsis diversiformis by using two different age groups of females. In addition, I tested the effect of copulation on female longevity and progeny sex ratio, taking into account female and male size, and oocyte development in relation to female age. A delay in copulation leads to a delay in oviposition. Females of both age groups started to oviposit between four and five days after copulation. The number of eggs that were laid during the first ten days after copulation, the average number of ovipositions (number of eggs laid per day) during the female’s life, and the average time between ovipositions were all similar. I found further evidence for the effect of copulation on oviposition: when females copulate, they oviposited faster than virgin females. In addition, these females laid a lower number of eggs after the age of 13 days, while females of the same age (that have copulated before, when they were two or six days old) laid a higher number of eggs (an average of 75 eggs). Oocytes in virgin females became larger with age; 57 % of the variation in the number of eggs laid by females depends on female’s longevity. As in other studies, female size had an effect on the total number of eggs laid. However, male size significantly affected the oviposition rate (total number of eggs/female longevity). Females tended to have a higher oviposition rate after copulating with larger males. These data suggest that for this fly species, sexual selection through female choice might be occurring. Rev. Biol. Trop. 57 (Suppl. 1): 239-250. Epub 2009 November 30.

Se evaluó el efecto de la cópula como factor esti­mulante de la oviposición en Archisepsis diversiformis utilizando hembras de dos edades, y en la longevidad de la hembra y en la proporción sexual de la progenie, tomando en cuenta el tamaño de hembra y macho, y el desarrollo de los ovocitos en relación a la edad de la hembra. Se demostró que una demora en copular indujo una demora en oviponer. También hubo similitud en el número de huevos puestos en los diez primeros días después de la cópula, en el número promedio de posturas (grupo de huevos puestos por día) durante toda la vida de una hembra, y en el tiempo promedio transcurrido entre posturas. Otra evidencia del efecto de la cópula en la ovipostura, fue que las hembras que copularon ovipositaron más rápido que las vírgenes. Además, éstas colocaron un número muy bajo (en prome­dio 14) de huevos a partir de los 13 días de edad, mientras que hembras de esta misma edad (que previamente habían copulado a los dos o seis días de edad) colocaron un mayor número (en promedio 75) de huevos. Como en otros estu­dios, el tamaño de la hembra tuvo un efecto significativo sobre el número total de huevos puestos. Sin embargo, el tamaño del macho afectó significativamente la tasa (Nº total de huevos/duración de la vida de la hembra) de ovipostura. Estos datos sugieren la posibilidad de que la selección sexual por elección femenina actúe en hembras de esta especie de mosca.

Clinical and Radiologic Assessment for Anterior Cervical Interbody Fusion with Synthetic Cages

OBJECTIVE: This purpose of this study was to determine the clinical efficiency and applicability, and to analyze the radiologic findings of the anterior cervical approach using two synthetic cages for interbody fusion. METHODS: A total of 41 patients with cervical diseases underwent anterior discectomy and interbody fusion with the PEEK Solis(TM) cage in 21 patients and the carbon composite Osta-Pek(TM) cage in 20 patients. Outcome assessment was done using Odom's criteria. Radiological assessment was performed with respect to subsidence, bony fusion and lordosis. The mean follow-up period was 13 months. RESULTS: There were 34 (92.9%) successful cases. The average height of the disc space 12 months after surgery compared to the height before surgery was increased in 28 cases. The height of the disc space 12 months after surgery compared to the height just after surgery was decreased over 3mm in 4 cases, indicating severe subsidence. The use of these synthetic cages have provided the increase in postoperative cervical lordosis. CONCLUSION: There were no significant differences between the Solis(TM) and Osta-Pek(TM) cages on clinical and radiologic outcomes. Both Solis(TM) and Osta-Pek(TM) cages showed low subsidences and complications associated with hardware with good clinical outcomes, high fusion rates, restored disc heights, and restored cervical lordosis.

The Evaluation of OSTA on Screening of Osteoporosis in Post-menopausal Women in Mainland China / 中国慢性病预防与控制

Objective To evaluate the screening effect of OSTA in Chinese post-menopausal women, to provide suggestions for the further development of OP screening in mainland China. Methods With the data from Chinese Database of Bone Mineral Density of Chinese women aged 50 years old and above, each subject was calculated a OSTA score by the formula of OSTA and classified into three risk levels (the normal, the osteopenia and the osteoporosis) or two groups (the low and the high risk) by the original cutoffs, and compared with results by T-score. A series of screening indexes, such as sensitivity, specificity, kappa value and ROC etc., were employed to compare and analyze the diagnosis results of OSTA with T-score from the femoral neck bone density. Results According to the 3 levels by original cutoffs, the Kappa value was 0.357 (P

Anterior Cervical Interbody Fusion with the Carbon Composite Osta-Pek Frame Cage in Degenerative Cervical Diseases

OBJECTIVE: Different types of interbody fusion cages are available for use in the surgical treatment of degenerative cervical diseases. The purpose of this study is to assess the technical feasibility, clinical efficacy and radiological results of intervertebral fusion with a carbon composite Osta-Pek frame cage (Co-Ligne AG, Switzerland) following anterior cervical discectomy. METHODS: 41patients (25males and 16females) with minimum 6months follow-up were included in the study. Disc height, cervical lordotic angle, segmental angle, and fusion rate were assessed by lateral radiographs. In this retrospective analysis, clinical outcome was assessed as evaluated according to Odom's criteria. RESULTS: Fifty-four cages were implanted in 30 single-level, 9 two-level, and 2 three-level procedures. The mean disc height, cervical lordosis angle, segmental angle were 4.2+/-1.8mm, 23.5+/-7.2degrees, 2.3+/-3.3degrees pre-operatively and 5.3+/-2.1mm, 24.2+/-8.3degrees, 3.8+/-3.5degrees at 6months after the surgery. Six months after surgery, there was radiographic evidence of fusion in 92.7% (38/41) of the patients. According to Odom's criteria, 37 of 41 (90.2%) patients experienced good to excellent functional recovery. CONCLUSION: These clinical and radiological results suggest that the carbon composite Osta-Pek frame cages are safe and effective alternative to autologous bone graft after anterior cervical discectomy for treatment of degenerative cervical disease.

The Validational study of OSTA (Osteoporosis Self Assessment Tool for Asian) for Prediction of Osteoporosis in Korean Post- and Perimenopausal Women / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the performance of OSTA (Osteoporosis Self assessment Tool for Asian) in Korean peri- and postmenopausal women. DESIGN AND METHODS: Total 1488 peri- and postmenopausal women over 45 years were included from Menopause Clinic in Chung-Ang University Hospital. Femoral neck BMD was measured by using DEXA (Lunar DPXIQ #7055). Three categories of bone status were defined by BMD based on the WHO definition. OSTA index values were calculated by using only 2 components such as age and weight. Three risk categories (high, medium, low) were classified according to index values. RESULTS: Seven hundred thirty women tested comprising 49.1% of all subject had low BMD (10.6% osteoporosis, 38.5% osteopenia respectively). The combined medium and high risk groups had a high prevalence (447/557=80.3%) of low bone mass. The medium and high risk groups had 85.5% of a high specificity, and 61.2% of a good sensitivity for identifying low bone mass. The medium and high risk groups also had 87.9% of a high sensitivity, and 68.5% of a good specificity for identifying osteoporosis. CONCLUSION: OSTA is a simple tool and easy to use, because it requires only age and weight. The OSTA risk tool performed well for identifying low bone mass, especially osteoporosis in Korean peri- and postmenopausal women.