Most Health Care Costs Associated With Osteoporotic Fractures Occur in First Year

MedicalResearch.com Interview with:

Kandice A. Kapinos, Ph.D. Economist Professor RAND Corporation Pardee RAND Graduate School 

Dr. Kapinos

Kandice A. Kapinos, Ph.D.
Economist
Professor
RAND Corporation
Pardee RAND Graduate School 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The economic burden of osteoporotic fractures is substantial with studies estimating the annual healthcare cost burden between $10 to 17 billion. Although estimates from individual studies vary, most studies assessing costs after a fracture only explore up to twelve months following a fracture. There is little investigation of how fracture patients’ costs evolve over a longer post-fracture period.

As osteoporotic fractures are one of the most common causes of disability among older adults and can translate into greater medical costs, we focused on studying Medicare beneficiaries. In fact, previous research has suggested that most of the increase in Medicare spending over time can be explained from costs associated with treating higher risk Medicare beneficiaries.

Our objective in this study was to compare health care costs over a 3-year period of those who experienced a fracture to those who did not among a sample of Medicare beneficiaries who were at an increased risk of having a fracture.

Consistent with previous studies, we found a significant increase in expenditures in the year immediately following a fracture relative to controls: almost $14,000 higher for fractures relative to controls. However, at 2 and 3-years post-fracture, there were no significant differences in the change in expenditures between fracture cases and controls. We note that these findings may be different for beneficiaries living in skilled nursing facilities or other non-community-based settings.

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Zoledronate (Reclast, Zometa) Reduced Fractures in Older Women with Osteopenia

MedicalResearch.com Interview with:

Prof Ian Reid Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand 

Prof. Reid

Prof Ian Reid
Faculty of Medical and Health Sciences
University of Auckland
Auckland New Zealand 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Bisphosphonates prevent fractures in patients with osteoporosis, but their efficacy in women with less marked bone loss (referred to as osteopenia) is unknown.

Most fractures in postmenopausal women occur in osteopenic patients, so therapies with efficacy in osteopenia are needed.

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Genetic Testing Could Identify Individuals At Risk of Osteoporosis

MedicalResearch.com Interview with:

Stuart Kim - PhD Professor of Developmental Biology, Emeritus Bio-X Affiliated Faculty James H. Clark Center Stanford University

Dr. Kim

Stuart Kim PhD
Professor of Developmental Biology, Emeritus
Bio-X Affiliated Faculty
James H. Clark Center
Stanford University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Osteoporosis is caused by a reduction in bone mass, and leads to a high incidence of bone fracture because the weakened bone is less able to withstand the stress of slips and falls. Osteoporosis affects millions of elderly, is responsible for as many as 50% of fractures in women and 25% of fractures in men over the age of 50, and accounts for $19 billion in annual health care costs in the US. Identification of people with an increased genetic risk for osteoporosis could reduce the incidence of bone fracture. Low BMD is also a risk factor for stress fractures. For athletes and military personnel undergoing harsh rigors of training, stress fractures are common injuries that limit playing time, military effectiveness and competitive success.

Using data from UK Biobank, a genome-wide association study identified 1,362 independent SNPs that clustered into 899 loci of which 613 are new. These data were used to train a genetic algorithm using 22,886 SNPs as well as height, age, weight and sex as predictors. Individuals with low genetic scores (about 2% of those tested) showed a 17-fold increase in risk for osteoporosis and about a 2-fold increase in risk of fractures. Continue reading

USPSTF: Women 65 and Older Should Be Screened for Osteoporosis to Prevent Fractures

MedicalResearch.com Interview with:

Chien-Wen Tseng, M.D., M.P.H., M.S.E.E. Hawaii Medical Service Association Endowed Chair in health services and quality research Associate professor, and the Associate research director Department of Family Medicine and Community Health University of Hawaii John A. Burns School of Medicine

Dr. Chien-Wen Tseng

Chien-Wen Tseng, M.D., M.P.H., M.S.E.E.
Hawaii Medical Service Association Endowed Chair in health services and quality research
Associate professor, and the Associate research director
Department of Family Medicine and Community Health
University of Hawaii John A. Burns School of Medicine 

MedicalResearch.com: What is the background for this recommendation statement? What are the main findings and recommendations?

Response: Osteoporosis is a condition where bones become weak and can break or fracture more easily. These fractures can happen at the spine, hip, and other locations, and can have serious health consequences such as pain, limited mobility, or even death. By 2020, more than 12 million Americans over the age of 50 are expected to have osteoporosis and two million fractures occur yearly.

Since people often may not know they have osteoporosis until they have a fracture, the U.S. Preventive Services Task Force looked at the evidence to see if screening for osteoporosis can help to prevent fractures. We found that screening for and treating osteoporosis can prevent fractures in women ages 65 and older and in younger women who have been through menopause and have additional factors that put them at increased risk for osteoporosis.

In men, more research is needed to know if routine screening and treatment for osteoporosis can prevent fractures. Continue reading

Atopic Dermatitis (Eczema) Patients Have Higher Likelihood of Osteoporosis

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois

MedicalResearch.com: What is the background for this study?

Response: Persons with atopic dermatitis have a number of risk factors for osteopenia and osteoporosis, including systemic atopy and inflammation, being less physically active and using a lot of topical and/or systemic corticosteroids. We aimed to determine whether adults with atopic dermatitis in fact have higher rates of physician-diagnosed osteopenia and osteoporosis.

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Drug Holidays From Osteoporosis Meds Linked to More Broken Bones

MedicalResearch.com Interview with:
“Just a hairline fracture...” by Gloria Bell is licensed under CC BY 2.0Brittany Bindon, MD

Department of Internal Medicine
University of Chicago
Chicago, Illinois

MedicalResearch.com: What is the background for this study?

Response: Bisphosphonates are commonly used in the treatment of osteoporosis, however, they have been associated with rare, severe side effects such as osteonecrosis of the jaw and atypical femoral fractures.

As a result, bisphosphonate drug holidays have become common in clinical practice though currently, there are minimal data on the safe duration of these drug holidays. We sought to further characterize the clinical and laboratory parameters associated with increased fracture risk in patients on bisphosphonate drug holiday.

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Osteoporosis Drug Has Potential To Fight Triple Negative Breast Cancer

MedicalResearch.com Interview with:
Chenfang Dong, Ph.D & M.D.
Professor
Department of Pathology and Pathophysiology
Zhejiang University School of Medicine, 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Basal-like breast cancer (BLBC), which generally falls into the triple-negative breast cancer subtype, is associated with a poor clinical outcome due to few treatment options and poor therapeutic response; thus there is a pressing need to elucidate the determinants of aggressiveness in BLBC and identify potential therapeutic targets for this challenging disease.

By analyzing gene expression profiles of breast cancer in multiple publicly available datasets that contain over 5000 cases, we have identified that UDP-galactose ceramide galactosyltransferase (UGT8), a key enzyme in the sulfatide biosynthetic pathway, promotes BLBC progression by activating sulfatide-αVβ5 axis.

Importantly, we identify that zoledronic acid (ZA), a marketed drug for treating osteoporosis and bone metastasis, is a direct inhibitor of UGT8, which has the potential to become a valuable targeted drug for treating Basal-like breast cancer.  Continue reading

Later Puberty Linked To Lower Adult Bone Density

MedicalResearch.com Interview with:

Dr. Cousminer

Dr. Cousminer

Diana L. Cousminer, PhD
Division of Human Genetics
Children’s Hospital of Philadelphia
Philadelphia, PA 19104

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Osteoporosis is a significant public health burden, with origins early in life. Later puberty and lower adolescent bone mineral density are both risk factors for osteoporosis.

Geneticists have identified hundreds of genetic variants across the genome that impact pubertal timing, and we found that collectively this variation also plays a role in bone mineralization during adolescence. Additionally, we found that later puberty caused lower adult bone density.

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Exercise, Vision Testing and Osteoporosis Evaluation Are Keys To Fall Prevention

MedicalResearch.com Interview with:

Andrea C. Tricco PhD, MSc Scientist and Lead of the Knowledge Synthesis Team Associate Professor Dalla Lana School of Public Health, University of Toronto Associate Editor Journal of Clinical Epidemiology, BMC Medical Research Methodology, Systematic Reviews

Dr. Tricco

Andrea C. Tricco PhD, MSc
Scientist and Lead of the Knowledge Synthesis Team
Associate Professor Dalla Lana School of Public Health, University of Toronto
Associate Editor Journal of Clinical Epidemiology, BMC Medical Research Methodology, Systematic Reviews

MedicalResearch.com: What is the background for this study?

Response: Falls are the leading cause of injury among older adults and account for $2 billion in direct health-care costs annually ($31 billion in costs to Medicare in the United States in 2012). We aimed to determine which types of fall-prevention programs may be effective for reducing falls in older people.

MedicalResearch.com: What are the main findings?

Response: Exercise, along with vision assessment and treatment, as well as an assessment and possible modification of a person’s living environment, reduced the risk of injurious falls by 23% compared to usual care.

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New Approach Could Lead To Osteoporosis Drugs With Fewer Side Effects

MedicalResearch.com Interview with:

Dieter Bromme, Ph.D. Professor and Canada Research Chair The University of British Columbia Faculty of Dentistry  Vancouver, BC

Dr. Bromme

Dieter Bromme, Ph.D.
Professor and Canada Research Chair
The University of British Columbia Faculty of Dentistry
Vancouver, BC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Every three seconds somebody will fracture a bone because of osteoporosis. Several treatments are available to slow down bone loss but all of them have shortcomings ranging from poor bone quality to various side effects. Thus new treatment strategies and novel drug targets are needed that promise efficacy without significant adverse reactions.

One of the novel promising targets was cathepsin K, a protease solely responsible for the degradation of our organic bone matrix. Major efforts and funds were spent by the pharmaceutical industry to develop potent and selective cathepsin K inhibitors. These inhibitors were highly effective in preserving bone in clinical trials. Despite the good news, cathepsin K inhibitors were never approved because of various non-skeletal side effects. We hypothesized that these side effects are not caused by off-target effects (drugs react with undesired targets) but by on-target effects. Most drugs that target enzymes are active site-directed compounds and thus will stop the entire activity of the target enzyme. If the target is a multifunctional enzyme, safety problems are preprogrammed. Based on our studies to understand the molecular mechanism of collagen degradation by cathepsin K, we developed the concept of ectosteric enzyme inhibition, which allowed us to identify highly selective collagenase inhibitors of this protease.

In our study, we used a red sage-derived small molecule that selectively blocked the collagenase activity of cathepsin K and thus consequently bone degradation in an osteoporosis mouse model without affecting other known functions of the protease. The crucial difference might be that the red sage inhibitor did not block the cathepsin K-mediated degradation of TGF-ß1, a growth factor involved in fibrotic pathologies described in the clinical trials. TGF-ß1 degradation is blocked by these inhibitors and thus accumulates in tissues, causing fibrosis.

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Pharmaceutical Grade Chondroitin Sulfate As First-Line Treatment of Osteoarthritis

MedicalResearch.com Interview with:

Jean-Yves Reginster M.D.,PH.D. Professor of Epidemiology, Public Health and Health Economics Head of the Bone and Cartilage Metabolism Unit University of Liège

Dr. Reginster

Jean-Yves Reginster M.D.,PH.D.
Professor of Epidemiology, Public Health and Health Economics
Head of the Bone and Cartilage Metabolism Unit
University of Liège

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Whereas several recommendations, issued by scientific societies, recommend to use Symptom-Modifying Slow Acting Drugs (SYSADOAs) for the symptomatic and structural management of osteoarthritis, no medication is currently registered, in this particular indication, by the European Medicines Agency (EMA) or by the Food and Drug Administration (FDA).

This study is the first study, conducted, with a SYSADOA which fully complies with the requirements of the EMA for the assessment of drugs to be used in the treatment of osteoarthritis, i.e. a six-month duration, two co-primary endpoints (pain and function) and a three-arm design, with a placebo and an active comparator. The main findings are that pharmaceutical grade chondroitin sulfate provides an improvement in pain and function, which is greater than placebo and not distinguishable from celecoxib, a non-steroidal anti-inflammatory drug currently licensed for the symptomatic management of osteoarthritis.

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Dabigatran is Associated With a Lower Risk of Osteoporotic Fractures Compared to Warfarin

MedicalResearch.com Interview with:
Wallis CY Lau BSc

Centre for Safe Medication Practice and Research
Department of Pharmacology and Pharmacy
Li Ka Shing Faculty of Medicine
The University of Hong Kong

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Warfarin is a vitamin K antagonist (VKA) oral anticoagulant used for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF), a common heart rhythm disorder. It works by interfering with vitamin K-dependent reactions in the process of blood clot formation. As these reactions also play a role in bone mineralization, there is concern that warfarin use may be linked with osteoporotic fracture. Despite the concerns for fracture risk, warfarin had been an inevitable treatment choice for over 50 years as there were no other alternatives available.

Dabigatran is the first non-VKA oral anticoagulant (NOAC) approved for use in patients with NVAF. Recently, an animal study reported that use of dabigatran is associated with a better bone safety profile compared to warfarin in rats, suggesting a potential for a lower risk of osteoporotic fractures over warfarin. However, the actual risk of osteoporotic fractures with dabigatran use in human remains unclear. Therefore, we conducted a population-based cohort study to compare the risk of osteoporotic fractures in patients with NVAF treated with dabigatran and warfarin.

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Regular, Long-term Resistance Training or Jump-Training Increases Bone Mass

MedicalResearch.com Interview with:

Pamela S. Hinton, Ph.D. Associate Professor & Director of Graduate Studies Department of Nutrition and Exercise Physiology Columbia MO 65211

Dr. Hinton

Pamela S. Hinton, Ph.D.
Associate Professor & Director of Graduate Studies
Department of Nutrition and Exercise Physiology
Columbia MO 65211

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study builds on our previous work showing that weight-bearing, high-impact physical activity throughout the lifespan is associated with greater bone mass in men.  We previously conducted a 12-month randomized trial of the effectiveness of resistance training versus jump training to increase bone mass in men with low bone density of the hip or lumbar spine.

The current study is a follow up study investigating how exercise might work to increase bone mass.

The main findings are that exercise reduced circulating levels of a bone protein that inhibits bone formation (sclerostin) and increased levels of insulin-like growth factor-I (IGF-I), a hormone with osteogenic effects.

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Testosterone Therapy Improves Bone Mineral Density In Men With Low T

MedicalResearch.com Interview with:

Tony M. Keaveny, Ph.D. Professor, Departments of Mechanical Engineering and Bioengineering; Co-Director, Berkeley BioMechanics Laboratory University of California Berkeley, CA 94720-1740

Dr. Tony Keaveny

Tony M. Keaveny, Ph.D.
Professor, Departments of Mechanical Engineering and Bioengineering;
Co-Director, Berkeley BioMechanics Laboratory
University of California
Berkeley, CA 94720-1740

MedicalResearch.com: What is the background for this study?

Response: As men age, they experience decreased serum testosterone concentrations, decreased bone mineral density (BMD) and increased risk of fracture. While prior studies have been performed to determine the effect of testosterone treatment on bone in older men, for various reasons those studies have been inconclusive.

The goal of this study was to overcome past limitations in study design and determine if testosterone treatment — versus a placebo — in older men with low testosterone would improve the bone. Specifically, we used 3D quantitative CT scanning to measure changes in BMD and engineering “finite element analysis” to measure changes in the estimated bone strength, both at the spine and hip. The study was performed on over 200 older men (> age 65) who had confirmed low levels of serum testosterone.

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Compared To Other Blood Pressure Medications Diuretics Have Bone Protective Effect

MedicalResearch.com Interview with:

Joshua I. Barzilay, MD Kaiser Permanente of Georgia Duluth, GA 30096

Dr. Joshua I. Barzilay

Joshua I. Barzilay, MD
Kaiser Permanente of Georgia
Duluth, GA 30096

MedicalResearch.com: What is the background for this study?

Response: Hypertension (HTN) and osteoporosis (OP) are age-related disorders. Both increase rapidly in prevalence after age 65 years. Prior retrospective, post hoc studies have suggested that thiazide diuretics may decrease the risk of osteoporosis. These studies, by their nature, are open to bias. Moreover, these studies have not examined the effects of other anti HTN medications on osteoporosis.

Here we used a prospective blood pressure study of ~5 years duration to examine the effects of a thiazide diuretic, a calcium channel blocker and an ACE inhibitor on hip and pelvic fractures. We chose these fractures since they are almost always associated with hospitalization and thus their occurrence can be verified.

After the conclusion of the study we added another several years of follow up by querying medicare data sets for hip and pelvic fractures in those participants with medicare coverage after the study conclusion.

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Menopausal Hormone Therapy Benefits Bone Health For Several Years After Discontinuation

MedicalResearch.com Interview with:

Dr Georgios Papadakis FMH, Médecin InternenMédecin assistant Service d'endocrinologie, diabétologie et métabolisme Lausanne

Dr Georgios Papadakis

Dr Georgios Papadakis
FMH, Médecin InternenMédecin assistant
Service d’endocrinologie, diabétologie et métabolisme
Lausanne

MedicalResearch.com: What is the background for this study?

Response: This study was mainly motivated by the absence of available data on the effect of menopausal hormone therapy (MHT) on bone microarchitecture, as well as contradictory results of previous trials regarding the persistence of a residual effect after MHT withdrawal.

We performed a cross-sectional analysis of 1279 postmenopausal women aged 50-80 years participating in OsteoLaus cohort of Lausanne University Hospital. Participants had bone mineral density (BMD) measurement by dual X-ray absorptiometry (DXA) at lumbar spine, femoral neck and total hip, as well as assessment of trabecular bone score (TBS), a textural index that evaluates pixel grey-level variations in the lumbar spine DXA image, providing an indirect index of trabecular microarchitecture.

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Clinical Practice Guidelines For Diagnosis and Treatment of Postmenopausal Osteoporosis

MedicalResearch.com Interview with:

Pauline Camacho, MD, FACE Professor, Endocrinology Director, Loyola University Osteoporosis and Metabolic Bone Disease Center, Fellowship Program Director, Endocrinology, Medical Director, Osteoporosis Center

Dr. Pauline Camacho

Pauline Camacho, MD, FACE
Professor, Endocrinology
Director, Loyola University Osteoporosis and Metabolic Bone Disease Center, Fellowship Program Director, Endocrinology, Medical Director, Osteoporosis Center

MedicalResearch.com: What is the background for this report? What is the prevalence and significance of osteoporosis in US women?

Response: Osteoporosis is widely prevalent and is increasing in prevalence not only in the US but also around the world. 10.2 million Americans have osteoporosis and that an additional 43.4 million have low bone mass. More than 2 million osteoporosis-related fractures occur annually in the US, more than 70% of these occur in women ( from National Osteoporosis Foundation (NOF) estimates).

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Romosozumab Has Potential To Reduce New Vertebral Fractures at 12 Months

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Felicia Cosman, M.D.

Dr. Felicia Cosman

Felicia Cosman, M.D.
Medical Director of the Clinical Research Center
Helen Hayes Hospital
Professor of Medicine
Columbia University College of Physician and Surgeons
New York
Editor-in-Chief, Osteoporosis International

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Amgen and UCB presented detailed data from the Phase 3 FRAME study in an oral session at ASBMR 2016, and the data were also published in the New England Journal of Medicine. Additionally, the FRAME abstract has been awarded the 2016 ASBMR Most Outstanding Clinical Abstract Award. The FRAME data show significant reductions in both new vertebral and clinical fractures in postmenopausal women with osteoporosis.

Patients receiving a monthly subcutaneous 210 mg dose of romosozumab experienced a statistically significant 73 percent reduction in the relative risk of a vertebral (spine) fracture through 12 months, the co-primary endpoint, compared to those receiving placebo (fracture incidence 0.5 percent vs. 1.8 percent, respectively [p<0.001]). By six months, new vertebral fractures occurred in 14 romosozumab and 26 placebo patients; between six to 12 months, fractures occurred in two versus 33 additional patients in each group, respectively.

Patients receiving romosozumab experienced a statistically significant 36 percent reduction in the relative risk of a clinical fracture, a secondary endpoint, through 12 months compared to those receiving placebo (fracture incidence 1.6 percent vs. 2.5 percent, respectively [p=0.008]).

In patients who received romosozumab in year one, fracture risk reduction continued through month 24 after both groups transitioned to denosumab treatment through the second year of the study: there was a statistically significant 75 percent reduction in the risk of vertebral fracture at month 24 (the other co-primary endpoint) in patients who received romosozumab followed by denosumab vs. placebo followed by denosumab (fracture incidence 0.6 percent vs. 2.5 percent, respectively [p<0.001]).

Clinical fractures encompass all symptomatic fractures (both non-vertebral and painful vertebral fractures; all clinical fractures assessed in the FRAME study were symptomatic fragility fractures. A 33 percent reduction in relative risk of clinical fracture was observed through 24 months after patients transitioned from romosozumab to denosumab compared to patients transitioning from placebo to denosumab (nominal p=0.002, adjusted p=0.096).

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Risk of Second Fracture Highest Immediately After First Fracture from Osteoporosis

MedicalResearch.com Interview with:

Professor Nicholas C W Harvey, MA MB BChir PhD FRCP Professor of Rheumatology and Clinical Epidemiology Honorary Consultant Rheumatologist MRC Lifecourse Epidemiology Unit University of Southampton Southampton General Hospital Southampton UK

Prof. Harvey

Professor Nicholas C W Harvey, MA MB BChir PhD FRCP
Professor of Rheumatology and Clinical Epidemiology
Honorary Consultant Rheumatologist
MRC Lifecourse Epidemiology Unit
University of Southampton
Southampton General Hospital
Southampton UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Prof. Harvey:  It is well established that fracture risk is substantially increased by having had a previous fracture. A previous study suggested that fracture risk soon after a spine fracture might be greater than the risk later on, and if the risk varies with time, it would be sensible to identify the time at greatest risk, so intervention can be given.

The risk of a second osteoporotic fracture was greatest immediately after the first fracture and thereafter decreased with time though remained higher than the population risk throughout follow up. For example, 1 year after the first fracture the risk of a second fracture was three times higher than the population risk. After 10 years it was two times higher.

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Normal Bone Density in Men Does Not Prevent Fractures—Fall Prevention Still Needed

Margaret L. Gourlay, MD, MPH Assistant Professor UNC Department of Family Medicine Chapel Hill, NC 27599-7595

Dr. Margaret Gourlay

MedicalResearch.com Interview with:
Margaret L. Gourlay, MD, MPH
Assistant Professor
UNC Department of Family Medicine
Chapel Hill, NC 27599-7595

Medical Research: What is the background for this study? What are the main findings?

Dr. Gourlay: While clinical practice guidelines universally recommend bone density screening for fracture prevention in women aged 65 years and older, minimal data exist to guide bone density screening in older men. We studied how often bone density screening tests should be ordered in men, using data from the Osteoporotic Fractures in Men (MrOS) Study. MrOS is the largest and longest-running (since 2000) US study of bone density and fracture in men aged 65 and older.

After peak bone mass is reached in young adulthood, both men and women lose bone density as they get older. Based on our earlier findings in older women, we expected that men aged 65 and older with higher bone density T-score measurements (T-score >-1.50) on a first (baseline) bone density test would have a substantially longer estimated time to develop the lowest level of bone density (osteoporosis) than men with better baseline measurements. Clinicians want to know the time to osteoporosis because they prescribe osteoporosis treatments to prevent future fractures in elderly patients.

As expected, we found that the men with higher baseline bone density had a much slower transition to osteoporosis compared to men with lower bone density. In fact, only nine out of 4203 (0.2%) of men with higher baseline bone density developed osteoporosis after an average of 8.7 years of bone density follow-up. That was much lower than we expected and is good news for men who have favorable scores on their first bone density test. Men who had lower baseline bone density measurements developed osteoporosis faster.

Unfortunately, maintaining bone density above the osteoporosis range did not guarantee that men remained fracture-free.   Most of the major osteoporotic fractures (broken hip, spine, wrist or upper arm/shoulder) occurred in men who did not have osteoporosis. This might be because they had accidents or injuries that broke their bones despite their bone density being above the thinnest range.

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Black Tea Linked To Lower Fractures in Elderly Women

MedicalResearch.com Interview with:
Prof. Jonathan M. Hodgson
School of Medicine and Pharmacology
Royal Perth Hospital
University of Western Australia
Perth, Australia

MedicalResearch What is the background for this study? What are the main findings?

Prof. Hodgson: Flavonoids are a class of phytochemicals present at high levels in tea. Observational studies have found that higher tea and flavonoid intakes are associated with higher bone mineral density. However, the relationships of tea and flavonoid intakes with fracture risk are not clear. We therefore examined the relationship of black tea drinking and flavonoid intake with fracture risk in a population of women aged over 75 years followed for 10 years. We found that a higher intake of black tea and particular classes of flavonoids, some of which are derived primarily from tea, were associated with lower risk of fracture-related hospitalizations in these elderly women.

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Vitamin D Did Not Improve Bone or Muscle Health in Post-Menopausal Women

MedicalResearch.com Interview with:
Karen E. Hansen, M.D., M.S.
Associate Professor of Medicine
University of Wisconsin School of Medicine and Public Health
Madison, WI 53705-2281

Medical Research: What is the background for this study?

Dr. Hansen: The USPTF says to older community dwelling adults, “don’t bother taking vitamin D”, the Endocrine Society says “take 2,000-4,000 IU daily” and the Institute of Medicine gave an RDA of 600-800 IU daily. The Endocrine Society argues that optimal vitamin D levels are 30 ng/mL and higher, while the Institute of Medicine concludes that 20 ng/mL and higher indicates optimal vitamin D status. The disagreement between experts prompted my study.

Medical Research: What are the main findings?

Dr. Hansen: Among postmenopausal women whose vitamin D level was ~21 ng/mL at baseline, there was no benefit of high-dose or low-dose vitamin D, compared to placebo, on spine/hip/total body bone mineral density, muscle fitness by 5 sit to stand test or Timed Up and Go, or falls. We did see a small 1% increase in calcium absorption in the high-dose vitamin arm, but this small increase did not translate into clinically meaningful changes in bone density or muscle tests.

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No Association Between Kidney Stones and Osteoporosis or Fractures in Women

Monique Bethel, MD Subspecialty Service, Department of Veterans Affairs Medical Center, Department of Medicine, Section of Rheumatology Georgia Regents University Augusta, GAMedicalResearch.com Interview with:
Monique Bethel, MD
Subspecialty Service, Department of Veterans Affairs Medical Center,
Department of Medicine, Section of Rheumatology
Georgia Regents University
Augusta, GA

MedicalResearch: What is the background for this study?

Dr. Bethel: Osteoporosis and kidney stones share several risk factors, including elevated calcium in the urine (hypercalciuria), low potassium intake, and possibly, diets high in sodium. Accordingly, several studies have shown a significant relationship between kidney stones and osteoporosis in men. However, it is unclear if this relationship is also true for women. Previous studies examining this association have been small and inconclusive.   With the Women’s Health Initiative, we had data available from approximately 150,000 postmenopausal women in the US. Using this database, we were able to study the relationship between kidney stones and changes in bone mineral density and fractures.

MedicalResearch: What are the main findings?

Dr. Bethel: We found no association between the presence of kidney stones and changes in bone mineral density over time at the hip, lumbar spine, or the whole body. Also, there was no association between the presence of kidney stones and fractures. We also found that 14% of women who had a history of kidney stones upon entering the studies had another one occur during the course of the study (approximately 8 years).

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More Screen Time Linked To Lower Bone Mass In Boys

Anne Winther Msc Department of Health and Care Sciences, UiT The Arctic University of Norway Division of Rehabilitation Services, University Hospital of North Norway, Tromsø, NorwayMedicalResearch.com Interview with:
Anne Winther Msc

Department of Health and Care Sciences, UiT The Arctic University of Norway
Division of Rehabilitation Services, University Hospital of North Norway, Tromsø, Norway

Medical Research: What is the background for this study? What are the main findings?

Response: Norway has one of the highest reported incidences of osteoporotic fractures in the world. Research on fracture risk has primarily focused on bone mass in the elderly. However, there is a growing awareness of the importance of bone mass during growth as a compensation for the inevitable bone loss and prevention of fractures in the elderly . A recent study on Norwegian adolescents´ lifestyle and bone health concluded  that peak bone mass seem to be modifiable by lifestyle factors as higher physical activity levels were strongly associated with bone mass. The other way around; low levels of physical activity may have considerable negative effects on bone health, and increasing sedentary behavior in place of sports and play during growth is worrying. In this study we explored the associations between self-reported hours spent in front of television/computers during weekends along with self reported hours spent on leisure time physical activities and bone mass density (BMD) levels at the hip. This population based study, Fit Futures 1 consisting of 388 girls and 359 boys 15-17 years old was conducted in 2010/2011, and repeated two years later including 66% of the original cohort (Fit Futures 2; 312 girls and 231 boys).

Boys spent more time in front of computers and television than girls; approximately 5 and 4 hours, compared with 4 and 3 hours daily in weekends and weekdays, respectively.

Physical activity levels were adversely related to leisure time computer use at weekends. However, 20 % of the girls and 25 % of the boys balanced 2-4 hours in front of the screen daily with more than 4 hours of sports and hard training per week.

Screen time at weekends was negatively associated with bone mass density levels in boys and positively in girls, after adjustments of several confounders known to affect bone, including age, puberty, physical activity levels and weekday screen time.

Moreover; these contrasting patterns persisted two years later.

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Are Bisphosphonates Underutilized In Men on Androgen Deprivation Therapy?

MedicalResearch.com Interview with:
Shabbir M. H. Alibhai, MD, MSc and
Husayn Gulamhusein, BHSc
Department of Medicine, University Health Network
Toronto, Ontario, Canada

Medical Research: What is the background for this study? What are the main findings?

MedicalResearch: In 2009, we published a research letter in JAMA which examined the rate of bone mineral density (BMD) testing in men starting androgen deprivation therapy (ADT) in the province of Ontario, Canada, between 1995 and 2008. Despite being recommended as a tool to better characterize fracture risk and optimize bone health, use of bone mineral density testing was low throughout the study period. This current study focuses on another aspect of bone health, which is the use of bisphosphonates among men undergoing androgen deprivation therapy for prostate cancer. Bisphosphonates are generally safe and effective medications that can reduce fracture risk particularly in those at higher risk of future fracture. Throughout the 17-year study period, we found that rates of new prescriptions for bisphosphonates remained low. Even when focusing on those men who should be receiving bisphosphonates as per Canadian guidelines due to their high risk for future fracture, i.e. those with a prior fragility fracture or prior diagnosis of osteoporosis, prescription rates remained low. Moreover, in all three groups, new bisphosphonate prescriptions dipped between the 2007-09 and 2010-12 time periods. This may be partly due to recent negative media attention regarding the association of bisphosphonates with rare but serious side effects (i.e. osteonecrosis of the jaw and atypical femoral fracture).
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