Higher rates of osteoporosis treatment initiation and persistence in patients with newly diagnosed vertebral fracture when introduced in inpatients than later in outpatients.

Whether in-hospital management of patients with newly identified vertebral fractures leads to a higher rate of osteoporosis medication than delayed outpatient management remains unknown. Our study showed that early osteoporosis therapy initiation in a fracture liaison service during hospital stay was a more efficacious strategy for secondary fracture prevention. INTRODUCTION: Fracture liaison services are standard care for secondary fracture prevention. A higher rate of osteoporosis treatment initiation may be considered when introduced in the hospital rather than an outpatient recommendation to a primary care physician (PCP). Whether this applies to patients with newly detected vertebral fractures in a general internal medicine ward remains unknown. We prospectively investigated whether in-hospital management of newly identified vertebral fractures led to a higher rate of osteoporosis medication initiation and persistence at 3 and 6 months than delayed outpatient management by a PCP. METHODS: We conducted a prospective study including hospitalized patients > 60 years systematically searched for asymptomatic vertebral fractures on lateral chest and/or abdominal radiographs. Patients were included either in phase 1 (outpatient care recommendations on osteoporosis management to a PCP) or in phase 2 (inpatient care management initiated during hospitalization). The percentage of patients under osteoporosis treatment was evaluated by telephone interview at 3 and 6 months. RESULTS: Outpatients' (84 with fracture/407 assessed (21%); 75.7 ± 7.7 years) and inpatients' (100/524 (19%); 77.8 ± 9.4 years) characteristics were similar. Osteoporosis medication was more often prescribed in inpatients at 3 (67% vs. 19%, respectively; p < 0.001) and 6 months (69 vs. 27%, respectively; p < 0.001). The percentage under treatment was also higher in inpatients than in outpatients at 3 (52 vs. 19%, p < 0.001) and 6 months (54 vs. 22%, p < 0.001). Length of stay and destination post-discharge were not different between groups. CONCLUSIONS: Early patient management after a newly detected vertebral fracture during hospitalization was a more efficacious strategy of secondary fracture prevention than delayed outpatient management following discharge.

Impact of level of expertise versus the statistical tool on vertebral fracture assessment (VFA) readings in cohort studies.

The present study tested if the accuracy of the VFA reading reproducibility is more affected by the statistical tool used or by the reader's level of expertise in 50 VFA from a population-based cohort, the OstéoLaus study. We found that uniform kappa and instruction reading with the ISCD/IOF VFA reading course both increased the accuracy of the reproducibility. INTRODUCTION: Vertebral fractures (VF) due to osteoporosis are under diagnosed. Screening osteoporosis in the general population allows improving management of fragility fracture. It consists to perform a dual X-ray absorptiometry and a spine X-ray to look at a VF. To reduce the dosage of radiation, prevalent or incident VF could be detected by DXA image. The aim of the present study was to test the reproducibility of vertebral fracture assessment (VFA) readings in a population-based cohort and to explore if the accuracy of the reproducibility is more affected by the statistical tool used or by the reader's level of expertise. METHODS: We calculated the reproducibility of VFA reading by uniform and Cohen's kappa, comparing one expert and one non-expert, before and after an instructional on-line International Society of Clinical Densitometry (ISCD) /International Osteoporosis Foundation (IOF) course on VFA reading. We performed the analysis on 50 VFA from a population-based cohort, the OstéoLaus study. RESULTS: Before the VFA reading course, reproducibility with Cohen's kappa was moderate to poor (0 to 0.520), good with the uniform kappa (0.796 to 0.958). After the course, both Cohen's kappa and uniform kappa statistically increased, ranging from 0.524 to 1.000. CONCLUSIONS: For female population-based cohort studies, we recommend using the uniform kappa and instructing a non-expert reader using the ISCD/IOF VFA reading course to correctly read and evaluate the reproducibility of the VFA reading.

[Calcinosis cutis associated with connective tissue diseases]. / Calcinose cutanée associée aux connectivites.

Calcinosis cutis is characterized by calcified deposits in the skin and in subcutaneous tissues. The potential complications are ulceration, infection, functional limitation. According to serum calcium/phosphate levels, calcinosis cutis is classified in 4 subtypes: dystrophic, metastatic, iatrogenic, idiopathic. In dystrophic calcinosis, calcium/phosphate serum levels are within range. Dystrophic calcinosis occurs in damaged tissues and is associated with several connective tissue diseases (mainly systemic sclerosis and dermatopolymyositis). Its physiopathology remains unclear. Despite different therapeutic modalities in the litterature, there is no standard therapy for calcinosis. Thus, larger controlled studies are necessary.

[Connective tissue diseases: news in therapy, role of biologics agents]. / Les connectivites: progrès thérapeutiques et place de la biothérapie.

Systemic lupus erythematosus and primary Sjögren's syndrom are the two major connective tissue diseases. A better knowledge of their physiopathology allows us today to propose an adapted therapy. Moreover progress concerns the oldest treatment, hydroxychloroquine, and biotherapy. Hydroxychloroquine is still an actual treatment for lupus, its positive effects are better understood today. Nevertheless it does not seem to be efficient to treat primitive Sjögren. Biotherapy targeting B lymphocytes seems efficient in these two connective tissue diseases. Anti TNF therapy is not recommended and seems to induce connective tissue diseases. The real news is the recent approval and reimbursement in Switzerland of the new drug belimumab (Benlysta) in case of moderate lupus.

[Canakinumab: a promising treatment in rheumatology]. / Rhumatologie. Canakinumab: un traitement prometteur.

In auto-inflammatory diseases, the role of the inflammasome and the interleukine IL-1beta has recently been shown. Thus, the physiopathology of rare diseases as Cryopyrin-associated periodic syndrome (CAPS) is better understood. In the era of biologics, new treatments targeting IL-1 have been developped. Canakinumab is a fully humanized monoclonal antibody inhibiting specifically IL-1beta Clinical studies have shown its efficacy on clinical symptoms and on inflammatory markers in patients with rare diseases such as CAPS or idiopathic juvenile arthritis, but also in more common rheumatic conditions like gout. Canakinumab has been approved in Switzerland only for the treatment of CAPS. Studies evaluating its effect on cardiovascular diseases are ongoing.