ObjectiveTo preliminarily explore the effect of Osteoporosis Self-assessment Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX) on predicting osteoporosis and osteoporosis fracture in postmenopausal patients with maintenance hemodialysis (MHD).MethodsThirty-six postmenopausal patients undergoing MHD from August 2017 to October 2018 in Hemodialysis Center of Nephrology Department, West China Hospital of Sichuan University were selected. Relevant data such as age, height, and weight were collected. OSTA index and the 10-year probability of major osteoporotic fractures and 10-year probability of hip fractures of FRAX score were calculated. Bone mineral densities (BMD) of the hip and lumbar spine were measured by dual energy X-ray absorptiometry (DXA) at the same time. The value of OSTA index and FRAX scale in evaluating the risk of osteoporosis predicated on T value ≤−2.5 determined by DXA BMD and fracture in postmenopausal patients with MHD were analyzed.ResultsThe DXA BMD of the 36 patients showed that 50.0% (18/36) had a T value≤−2.5, and 30.6% (11/36) had a fracture history. BMD in postmenopausal patients with MHD was negatively correlated with FRAX score (model without BMD values), and positively correlated with OSTA index. The sensitivity and specificity of OSTA in the prediction of osteoporosis were 94.4% and 61.1%, respectively; and the sensitivity and specificity of FRAX (the model without BMD values) in the prediction of osteoporosis were 88.9% and 50.0%, respectively. The FRAX score with or without BMD had the same clinical value in predicting osteoporosis.ConclusionsPostmenopausal MHD patients have a higher risk of osteoporosis and fracture. Both OSTA index and FRAX scale can predict osteoporosis risk among postmenopausal MHD patients, and the FRAX scale with or without BMD has the same clinical value in predicting osteoporosis risk. In clinical work, for primary hospitals and dialysis centers lacking DXA, preliminary screening of osteoporosis in MHD patients can be performed with OSTA and FRAX scales.
Objective To evaluate the effect of remote controlled injection manipulator system (RCIM) assisted percutaneous kyphoplasty (PKP) for the treatment of rupture of posterior vertebral osteoporotic vertebral fracture by comparing with intermittent hand bolus injection of bone cement during operation. Methods Between September 2010 and January 2016, a retrospective analysis was made on the clinical data of 48 senile patients with single segment rupture of the posterior vertebral osteoporotic thoracolumbar fracture undergoing PKP who accorded with the inclusion criteria. Of 48 patients, 22 received intermittent hand bolus injection of bone cement in the control group, and 26 received RCIM assisted bone cement perfusion in the trial group. There was no significant difference in age, gender, duration of disease, causes of injury, implicated vertebral bodies, bone mineral density T value, pain duration, preoperative visual analogue scale (VAS), relative vertebral body height in the anterior part, and posterior convex Cobb angle between groups (P>0.05). The bone cement perfusion time, the radiation dose of both doctors and patients, and the amount of bone cement injection were recorded; treatment effects were evaluated based on VAS score, posterior convex Cobb angle, relative ver-tebral body height in the anterior part, ratios of bone cement diffusion area and bone cement leakage rate. Results The patients were followed up for 6 months; no complications of toxic effect of bone cement, spinal cord or nerve root injuries, infection and vascular embolization occurred during follow-up period. There was no significant difference in bone cement injection amount and radiation dose of doctors between groups (P>0.05), but bone cement perfusion time, ratios of bone cement diffusion area, and radiation dose of patients were significantly lower in the trial group than the control group (P<0.05). Bone cement leakage was observed in 6 cases of the control group (27.27%) and 2 cases of the trial group (7.69%), showing significant difference between groups (χ2=4.850,P=0.029); no cement leakage into the spinal canal was found in both groups. VAS score, relative vertebral body height in the anterior part, and posterior convex Cobb angle were significantly improved at 3 days and 6 months after operation when compared with preoperative ones (P<0.05), but no significant difference was observed in the above indexes between groups at 3 days and 6 months after operation (P>0.05). Conclusion Satisfactory effectiveness can be achieved by applying RCIM assisted PKP for the treatment of rupture of posterior vertebral osteoporotic vertebral fracture. RCIM can shorten perfusion time, reduce radiation dose, and decrease incidence of bone cement leakage.
ObjectiveTo evaluate the efficacy and safety of bisphosphonates in preventing and treating glucocorticoid induced osteoporosis. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2016), CNKI, WanFang Data and VIP were searched to collect randomized controlled trials (RCTs) related bisphosphonates for the prevention and treatment of glucocorticoid induced osteoporosis from inception to January 2016. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 20 RCTs were included, which involved 2 330 patients. The results of meta-analysis showed that, compared with the placebo group, the bisphosphonates group could significantly increase the bone mineral density (BMD) at lumbar and femoral neck (MD=3.70, 95%CI 2.65 to 4.75, P<0.000 01; MD=2.18, 95%CI 1.30 to 3.06, P<0.000 01), but the bisphosphonates group could not decrease the incidence rates of vertebral fracture or non-vertebral fracture (OR=0.66, 95%CI 0.38 to 1.16, P=0.15; OR=0.73, 95%CI 0.42 to 1.28, P=0.28). There were no significant differences in the incidence rates of total adverse reactions and total severe adverse reactions between the two groups (OR=0.89, 95%CI 0.62 to 1.28, P=0.53; OR=0.93, 95%CI 0.62 to 1.39, P=0.72). ConclusionCurrent evidence shows that, compared with placebo, bisphosphonates canld effectively prevent and treat the decrease of bone mineral density of glucocorticoid induced osteoporosis, not decrease the incidence of fracture, but not increase the incidence of adverse reactions.
Objective To explore the effectiveness of unilateral percutaneous vertebroplasty (PVP) through mild side and severe side approaches in the treatment of elderly osteoporotic vertebral compression fracture (OVCF). Methods The clinical data of 100 patients with OVCF with symptoms on one side who were admitted between June 2020 and June 2021 and met the selection criteria were retrospectively analyzed. The patients were divided into the severe side approach group (group A) and the mild side approach group (group B) according to the cement puncture access during PVP, with 50 cases in each group. There was no significant difference between the two groups in terms of general information such as gender composition, age, body mass index, bone density, damaged segments, disease duration, and chronic comorbidities (P>0.05). The lateral margin height of the vertebral body on the operated side in group B was significantly higher than that of group A (P<0.001). The pain level and spinal motor function were evaluated using the pain visual analogue scale (VAS) score and Oswestry disability index (ODI) before operation, at 1 day, 1 month, 3 months, and 12 months after operation in both groups, respectively. Results No intraoperative or postoperative complications such as bone cement allergy, fever, incision infection, and transient hypotension occurred in both groups. Four cases of bone cement leakage occurred in group A (3 cases of intervertebral leakage and 1 case of paravertebral leakage), and 6 cases of bone cement leakage occurred in group B (4 cases of intervertebral leakage, 1 case of paravertebral leakage, and 1 case of spinal canal leakage), and none of them had neurological symptoms. Patients in both groups were followed up 12-16 months, with a mean of 13.3 months. All fractures healed and the healing time ranged from 2 to 4 months, with a mean of 2.9 months. The patients had no complication related to infection, adjacent vertebral fracture, or vascular embolism during follow-up. At 3 months postoperatively, the lateral margin height of the vertebral body on the operated side in groups A and B were improved when compared with preoperative ones, and the difference between pre- and post-operative lateral margin height of the vertebral body in group A was higher than that in group B, all showing significant differences (P<0.001). The VAS scores and ODI in both groups improved significantly at all postoperative time points when compared with those before operation, and further improved with time after operation (P<0.05). The differences in VAS scores and ODI between the two groups before operation were not significant (P>0.05); VAS scores and ODI in group A were significantly better than those in group B at 1 day, 1 month, and 3 months after operation (P<0.05), but no significant difference was found between the two groups at 12 months after operation (P>0.05). Conclusion Patients with OVCF have more severe compression on the more symptomatic side of the vertebral body, and patients with PVP have better pain relief and better functional recovery when cement is injected through the severe symptomatic side.
Objective To summarize the advances in MRI-based bone quality scoring systems and their clinical applications. Methods A comprehensive literature review was conducted on recent studies related to the MRI-based bone quality scoring system, focusing on measurement methods, influencing factors, and clinical significance. Results Osteoporosis has a high incidence in China, significantly impacting patients’ quality of life and the postoperative outcomes of related orthopedic surgeries. Early identification of osteoporosis holds important clinical significance. In recent years, both domestic and international research has enriched the MRI-based bone quality scoring systems, which includes vertebral bone quality scoring, endplate bone quality scoring, and pedicle bone quality scoring. Compared to the “gold standard” of bone density measurement, dual-energy X-ray absorptiometry, the bone quality scoring systems demonstrate good efficacy in identifying abnormal bone mass and predicting postoperative complications, while being less influenced by degenerative changes in the lumbar spine, indicating its important clinical application value. ConclusionThe MRI-based bone quality scoring systems have good value in clinical applications. However, current studies are mostly retrospective cohort and case-control studies, which carry a risk of bias. The clinical application value needs further clarification through meta-analysis and large-scale prospective studies.
Osteosarcopenia (OS), which has become a global public health problem, is a geriatric syndrome in which sarcopenia and osteoporosis co-exist, leading to falls, fractures, and even varying degrees of disability in the elderly. The Dietary Inflammatory Index (DII) is a tool to measure the overall level of dietary inflammation in an individual, and the DII score is closely associated with the development of OS. This article reviews the basic concepts of DII and OS and their interrelationships, focusing on the associations between diet, inflammation, DII and OS, with the aim of providing a reference for dietary interventions in the prevention and control of OS patients.
Objective Secondary osteoporosis is very common in patients with primary osteoporosis. Diabetes is a known cause of secondary osteoporosis. While type I diabetes has been clearly linked with diabetic osteoporosis, the effect of type II diabetes on bone health is controversial.Methods In the present study, we investigated the associations between type II diabetes and osteoporosis as well as fractures at different skeletal sites in Women’s Health Initiative participants.Results Common risk factors such as age, race, BMI, HRT use, and the history of fractures were significantly associated with osteoporosis and fractures in this study population. Diabetic women appeared to have a decreased risk of osteoporosis although it no longer remained significant after adjusting for other risk factors (crude HR=0.78, 95%CI 0.61 to 0.99; adjusted HR=0.93, 95%CI 0.73 to 1.19). The impact of diabetes on fractures varied at different body sites. There was a significant increase of risk of hip fracture (HR=2.54, 95%CI 1.14 to 5.66), but not spine fracture (HR=1.71, 95%CI 0.81 to 3.60) and arm fracture (HR=0.92, 95%CI 0.48 to 1.76) among the women with diabetes. Although the overall risk of fractures in diabetic women did not differ significantly from non-diabetic women (HR=1.37, 95%CI 0.89 to 2.09), the difference had a two-fold increase and was statistically significant after 2,000 days (HR=2.01, 95%CI 1.21 to 3.35), indicating a different hazard at different stages of diabetes.Conclusion Our findings suggest that type II diabetes may not be clearly associated with osteoporosis, it increases a site-specific fracture risk at least in the hip. In addition, the overall fracture risk appears to increase in a time-dependent manner.
Objective To explore the correlation of risk factors affecting the L2-4BMD level in patients with post-menopausal osteoporosis. Methods Ninety-two patients with post-menopausal osteoporosis were surveyed with a retrospective questionnaire. We used the findings to set up a multiple stepwise regression model and perform correlation analysis with L2-4BMD levels as the dependent variable and risk factors as the independent variables. Results Assuming that age has a definite effect on the L2-4BMD level of menopausal women, menopausal age limit, history of milk drinking, menopausal age, menarche age, fracture history and bend-back entered into the multiple stepwise regression equation. Conclusions Menopausal age limit, history of milk drinking, menopausal age, menarche age, fracture history, and bend-back influence patients with menopausal osteoporosis.The menopausal age limit is especially important. Awareness of the risk factors of osteoporosis should be raised.