Outcome of osteoporosis evaluation, treatment, and follow-up in patients referred to a specialized outpatient clinic compared to patients in care of general practitioners.

In Denmark, osteoporosis treatment is either handled by general practitioners or at more resource demanding specialist clinics. We evaluated the treatment adherence and persistence in the two settings, which were overall similar. The type of medical support did, however, differ and was provided to two very different patient populations. PURPOSE: The study aimed to investigate the effect of patient care by general practitioners (GPs) or specialists on treatment adherence among osteoporosis patients initiating treatment with oral bisphosphonates (OB). METHODS: Dual-energy X-ray absorption (DXA)-scanning data from 2005 to 2013 were extracted. Treatment naïve patients with a T-score ≤ - 2.5 (spine or hip) were included. Information on medical treatment, comorbidities, and socio-economic status was extracted from Danish registries. Scanning results were evaluated by a specialist. Subsequent treatment initiation and follow-up was either handled by GPs or specialists: GP population (GPP) vs. specialist population (SP). Primary adherence was defined as treatment initiating within 12 months from diagnosis and secondary adherence as days with medicine possession rates (MPR) > 80%. RESULTS: Of 11,201 DXA-scanned patients, 3685 met the inclusion criteria (GPP = 2177, SP = 1508). The GPP consisted of relatively more men, was older, had shorter education, lower income, and more comorbidities. There was no difference in baseline T-score or prior incidence of major osteoporotic fractures (MOFs). The GPP was primarily treated with OB and had better primary adherence (adjusted ORGPP/SP = 1.52 [1.31-1.75], p < 0.0001) than the SP that to a higher degree received another treatment. Secondary adherence was similar (adjusted ORGPP/SP: OR12 months = 1.02 [0.83-1.26]; OR24 months = 0.90 [0.73-1.10]; OR4 years = 0.88 [0.71-1.07]; OR5 years = 0.91 [0.74-1.13]. CONCLUSION: Patients in care of specialists were most likely to receive a treatment other than OB. Primary adherence was highest in the GPP, whereas short- and long-term persistence was similar for up to 5 years whether treated by a specialist or a GP.

Incidence, Risk Factors and Evaluation of Osteoporosis in Patients With Inflammatory Bowel Disease: A Danish Population-Based Inception Cohort With 10 Years of Follow-Up.

BACKGROUND: Patients with inflammatory bowel disease [IBD] including Crohn's disease [CD] and ulcerative colitis [UC] are at risk of developing metabolic bone disease. The aims here were to investigate the screening strategy, incidence and risk factors of osteoporosis in a prospective population-based inception cohort. METHOD: Between 2003 and 2004 all incident patients diagnosed with CD and UC in a well-defined Copenhagen area were included and followed until 2015. Data were compared with a control population [at a ratio of 1:20]. Regression models were performed with several covariates. The sensitivity of the Danish registries for osteoporosis was also assessed. RESULTS: A total of 513 patients were included [213 CD, 300 UC]. Overall, 338 (66%, CD: 164 [77%], UC: 174 [58%], p < 0.001] patients received ≥ 500 mg corticosteroid within a year, resulting in 781 patient-years at risk of osteoporosis. Of those, only 83 [10.6%] patient-years were followed by a dual-energy X-ray absorptiometry scan within the same or the following 2 years.Overall, 73 [14.2%] IBD patients (CD: 31 [14.6%], UC: 42 [14%]) and 680 [6.6%, p < 0.001] controls were diagnosed with osteoporosis during follow-up. The risk of osteoporosis was increased compared to the control population (odds ratio: CD: 2.9 [95% confidence interval: 2.0-4.1], UC: 2.8 [2.1-3.9]). CONCLUSION: In this population-based inception cohort, the incidence of osteoporosis was significantly higher compared to a control population. Measurement of bone mineral density is infrequent, especially in patients at high risk of developing osteoporosis. These results demonstrate the need of further awareness of the risk of osteoporosis among IBD patients, and prospective population-based studies are warranted.

Fracture risk in women with type II diabetes. Results from a historical cohort with fracture follow-up.

PURPOSE: To examine the independent association between type II diabetes and fracture risk in a population of predominantly postmenopausal women referred to a specialist clinic for osteoporosis evaluation. METHODS: Type II diabetes associated fracture risk were evaluated among to 229 patients with type II diabetes in a cohort of 6285 women followed on average (until major osteoporotic fracture (MOF), death or end of study) for 5.8 years. Information of fracture risk factors was obtained from a clinical database and from national registries. RESULTS: An elevated fracture risk was present. Prevalent fractures (43.7 vs. 33.2%, p = 0.0010) and prevalent MOF (26.2 vs. 20.5% p = 0.038) were more common among patients with type II diabetes. The unadjusted incident fracture risk was increased with a higher relative risk of 42%. An elevated MOF hazard ratio was present (HR = 1.726, p = 0.0006). Adjustment for prevalent osteoporosis and other possible confounders did not change this finding (HR = 1.558, p = 0.0207). CONCLUSIONS: An association between type II diabetes and an increased risk of MOF primarily driven by an increased hip fracture risk was documented. This finding was independent of the presence of osteoporosis. Clinicians need to be aware of and adjust for these findings when evaluating patients with diabetes. Additional research examining pathophysiological mechanisms are needed.

[Hyponatraemia is a risk factor for osteoporosis and bone fracture].

There is increasing evidence that mild hyponatraemia is associated with fractures. This association seems to be partially mediated by a reduced bone mass and an in-creased risk of falling. Large population studies have shown that other factors such as bone quality may be important. Hyponatraemia should not be considered a benign and asymptomatic condition, and an increased awareness, especially in the elderly patients with chronic hypona-traemia, is warranted. Sodium status should be evaluated in patients who experience falls, fractures or are at increased risk of having osteoporosis.

Time trends in osteoporosis risk factor profiles: a comparative analysis of risk factors, comorbidities, and medications over twelve years.

The aim of this article was to identify prevalent osteoporosis risk factors, medications and comorbidities associated with bone mineral density (BMD). Furthermore to evaluate changes in risk factor profiles over 12 years. 6285 women consecutively referred to an osteoporosis specialist clinic were included. Information of potential risk factors was obtained by questionnaire and clinical examination. Additional information on medication use, comorbidities and fractures were obtained from national registries. An association (<0.05) between well-known risk factors negatively influencing bone health was established in a real-life setting. The prevalence of osteoporosis and proportion of patient's having comorbidity's associated with osteoporosis were increasing during the inclusion period (start 23.8 %, end 29.7 %). Increasing age (OR = 1.05), current smoking (OR = 1.18), estrogen deficiency (OR = 1.7), hyperthyroidism (OR = 1.5), previous major osteoporotic fracture (OR = 1.7), former osteoporosis treatment (OR = 3.5), higher BMI (OR = 0.87), use of calcium supplementation (OR = 1.2), high exercise level (OR = 0.7), and use of thiazide diuretics (OR = 0.7) were identified as predictors of osteoporosis by DXA. Rheumatoid arthritis (OR = 2.4) and chronic pulmonary disease (OR = 1.5) was associated with site-specific osteoporosis by DXA at the total hip. Current use of loop diuretics (OR = 1.7) and glucocorticoid use (OR = 1.04-1.06) were associated with both total hip and femoral neck T-score <-2.5. Our data confirms an independent negative association with BMD of many established risk factors, certain comorbidities, and medications. Exercise level, use of loop diuretics, and prevalent chronic pulmonary disease, risk factors not included in fracture risk calculators were associated with osteoporosis by DXA. Time trends indicate risk profile is dynamic, with increasing focus on secondary osteoporosis.