Screening To Prevent Osteoporotic Fractures
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Screening To Prevent Osteoporotic Fractures
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Author : Meera Viswanathan
language : en
Publisher:
Release Date : 2018
Screening To Prevent Osteoporotic Fractures written by Meera Viswanathan and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2018 with categories.
PURPOSE: To review evidence about screening to prevent osteoporotic fractures for the U.S. Preventive Services Task Force (USPSTF). DATA SOURCES: PubMed, the Cochrane Library, Embase, and trial registries from November 1, 2009, through October 1, 2016, and surveillance of the literature through March 23, 2018; bibliographies from retrieved articles. STUDY SELECTION: Two investigators independently selected studies using a priori inclusion and exclusion criteria. We selected studies with a majority of adults age 40 years or older conducted in countries with a very high human development index. For screening studies, we required that studies include a majority of participants without prevalent low-trauma fractures. For treatment studies, we required that studies include a majority of participants with increased fracture risk. We selected studies of screening tests (fracture risk prediction instruments, bone measurement testing, or a combination of fracture risk prediction instruments and bone measurement testing) that were feasible for primary care settings and available in the United States. We selected studies of treatment approved by the U.S. Food and Drug Administration for synthesis of benefits and harms. We excluded studies of poor quality and of fracture risk prediction instruments without external validation. DATA EXTRACTION: One investigator extracted data and a second checked accuracy. Two reviewers independently rated quality for included studies using predefined criteria. DATA SYNTHESIS: One fair-quality trial demonstrated reduction in hip fractures when comparing screening with no screening (2.6% v 3.5%, Hazard rate [HR] 0.72; 95% confidence interval [CI], 0.59 to 0.89). The study reported no other statistically significant benefits (osteoporotic or clinical fractures, mortality) or harms (anxiety, quality of life). We included 168 articles of fair or good quality; 105 articles assessed screening accuracy and 65 articles assessed benefits and harms of treatment. Using centrally measured dual-energy X-ray absorptiometry (DXA) as the reference standard for identifying osteoporosis, the pooled estimate of accuracy as measured by the area under the curve (AUC) for clinical risk assessment instruments for women ranges from 0.65 to 0.76 and for men from 0.76 to 0.80. AUCs for the accuracy of calcaneal quantitative ultrasound in identifying central DXA--measured osteoporosis for women is 0.77 (95% CI, 0.72 to 0.82, 7 studies) and for men is 0.80 (95% CI, 0.67 to 0.94, 3 studies). The AUCs of machine-based tests, including centrally measured DXA (areal bone mineral density and trabecular bone score) and calcaneal quantitative ultrasound, for predicting fractures ranged from 0.59 to 0.86 (21 studies). The AUCs for instruments predicting fractures, some of which incorporate machine-based tests, have similar accuracy (pooled AUC range for the Fracture Risk Assessment Tool: 0.62 to 0.79; 24 studies). Available but limited evidence in studies including participants with a wide spectrum of baseline bone mineral density from normal to osteoporosis suggests no benefit from repeating a bone measurement test between 4 and 8 years after the initial screen. Evidence from placebo-controlled trials demonstrates the following benefits. For women, the risk of vertebral fractures can be reduced by bisphosphonates, parathyroid hormone, raloxifene, and denosumab by 36 percent to 68 percent. Relative risks (RRs) range from 0.32 (parathyroid hormone or denosumab) to 0.64 (raloxifene). The risk of nonvertebral fractures can be reduced by 16 percent to 20 percent by bisphosphonates and denosumab (RR, 0.84 and 0.80, respectively). The risk of hip fractures can be reduced by 40 percent by denosumab (RR, 0.60). Evidence from bisphosphonates does not demonstrate benefit for hip fractures. Evidence is very limited for men. The risk of morphometric vertebral fractures can be reduced by 67 percent by zoledronic acid (RR, 0.33). No studies demonstrate reductions in risk of clinical vertebral fractures or hip fractures for men. Evidence on variations in effectiveness for subgroups is also limited; a single trial each for five drugs suggests no differences in effectiveness by age, baseline bone mineral density, prior fractures, or a combination of risk factors. Bisphosphonates are not consistently associated with discontinuations, serious adverse events, gastrointestinal events, or cardiovascular events. No included studies reported cases of osteonecrosis of the jaw or atypical femur fracture, although evidence from excluded studies (including active comparisons, case series, and secondary prevention populations) suggests an increased but rare risk of these outcomes. Raloxifene increases the risk of deep vein thrombosis (0.7% vs. 0.3%, RR, 2.14; 95% CI, 0.99 to 4.66; I2=0%, 3 studies, N=5,839) and hot flashes (11.2% vs. 7.6%, RR, 1.42; 95% CI, 1.22 to 1.66; I2=0%, 5 trials; N=6,249) when compared with placebo. LIMITATIONS: The evidence is limited on the direct question of the benefits and harms of screening for elevated osteoporotic fracture risk. The indirect evidence pathway rests on studies evaluating (1) the accuracy of screening approaches in identifying osteoporosis and predicting fractures and (2) the benefits of treatment among those with osteoporosis or at high risk for fractures. Other limitations of the evidence base relate to underlying heterogeneity in baseline risk, prior fractures, prior treatment, and duration of followup. CONCLUSIONS: Evidence from one trial of screening to prevent osteoporotic fractures suggests a reduction in hip fractures. The accuracy of clinical risk assessment tools for identifying osteoporosis or predicting fractures generally ranges from very poor (0.50) to good (0.90). Treatments reduce the risk of vertebral and nonvertebral fractures. Studies do not consistently demonstrate an increased risk of harms for drugs, although studies of raloxifene suggest a trend toward higher risk of deep vein thrombosis. Rare harms, such as osteonecrosis of the jaw and atypical femur fractures were not reported in this body of evidence but they may occur. The evidence is limited for subpopulations characterized by age, sex, baseline bone mineral density, and baseline fracture risk.
Screening For Postmenopausal Osteoporosis
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Author : Heidi D. Nelson
language : en
Publisher:
Release Date : 2002
Screening For Postmenopausal Osteoporosis written by Heidi D. Nelson and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2002 with categories.
CONTEXT: The incidence of osteoporotic fractures increases with age and is associated with a significant health burden. OBJECTIVE: To examine evidence on the benefits and harms of screening asymptomatic postmenopausal women for osteoporosis. DATA SOURCES: MEDLINE (1966 to May 2001), HealthSTAR (1975 to May 2001), and Cochrane databases, reference lists of systematic reviews, and experts. STUDY SELECTION: We included English-language abstracts with original data about postmenopausal women and osteoporosis that addressed the effectiveness of risk factor assessment, bone measurement tests, or treatment. Two reviewers read each abstract to determine its eligibility. DATA EXTRACTION: We extracted selected information about the patient population, interventions, clinical endpoints, and study design, and applied a set of criteria to evaluate study quality. DATA SYNTHESIS: Although many studies have been published about osteoporosis in postmenopausal women, there have been no trials of screening and, therefore, no direct evidence that screening improves outcomes. Instruments developed to assess clinical risk factors for low bone density or fractures generally have moderate-to-high sensitivity and low specificity, many have not been validated, and none have been widely tested in a practice setting. Among different bone density tests measured at various sites, bone density measured at the femoral neck by dual-energy x-ray absorptiometry is the best predictor of hip fracture and is comparable to forearm measurements for predicting fractures at other sites. Women with low bone density have a 40% to 50% reduction in fracture risk when treated with raloxifene (vertebral fractures) or bisphosphonates (both vertebral and nonvertebral fractures). Trials of estrogen are inconclusive because of methodologic limitations. CONCLUSIONS: Although there is no direct evidence that screening prevents fractures, there is evidence that the prevalences of osteoporosis and fractures increase with age, that the short-term risk of fracture can be estimated by bone measurement tests and risk factor assessment, and that treatment may reduce fracture risk among women with low bone density.
Osteoporosis
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Author : Sics Editore
language : en
Publisher: SICS Editore
Release Date : 2014-10-01
Osteoporosis written by Sics Editore and has been published by SICS Editore this book supported file pdf, txt, epub, kindle and other format this book has been release on 2014-10-01 with Medical categories.
The aim in the prevention and treatment of osteoporosis is to prevent fractures.In prevention of osteoporosis on the population level it is essential to ensure sufficient intake of calcium and vitamin D and to advise proper exercise habits as well as cessation of smoking. Diagnosis of osteoporosis is the responsibility of primary care. Bone density measurements should be targeted at risk groups (see table ). General, non-targeted DXA-screening is not indicated . Bone density measurements targeted at persons with increased risk are cost-effective and should be a part of the public health care. The treatment yields most benefit for those patients who already have a history of a low energy fracture, usually after a fall on flat ground. Patients who have experienced such a fracture should be referred to bone density measurement or directly to treatment. They have a 2–4-fold risk of refracture. Causes of secondary osteoporosis should be identified and treated accordingly (e.g. hyperparathyroidism, hyperthyroidism, Cushing's syndrome, hypogonadism, uraemia, coeliac disease, myeloma, glucocorticoid therapy, rheumatoid arthritis). Bisphosphonates are the first line drugs in the treatment and prevention. Oestrogen therapy is suitable also in the prevention and treatment of osteoporosis in women who have postmenopausal symptoms that require treatment and who have no arterial disease. The success of pharmacological treatment is assessed by bone density measurements and, on the population level, by the decrease in complications.
Screening For Osteoporosis Systematic Review To Update The 2002 U S Preventive Services Task Force Recommendation
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Author : U. S. Department of Health and Human Services
language : en
Publisher: Createspace Independent Pub
Release Date : 2013-05-01
Screening For Osteoporosis Systematic Review To Update The 2002 U S Preventive Services Task Force Recommendation written by U. S. Department of Health and Human Services and has been published by Createspace Independent Pub this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-05-01 with Medical categories.
Osteoporosis is a systemic skeletal condition characterized by low bone mass and microarchitectural deterioration of bone tissue that increases bone fragility and risk for fractures. Osteoporosis may occur without a known cause, or secondary to another condition. These include corticosteroid therapy, excessive alcohol use, primary or secondary hypogonadism, low calcium intake, vitamin D deficiency, smoking, antiepileptic drug use, thyrotoxicosis, primary hyperparathyroidism, chronic liver or kidney disease, rheumatoid arthritis, diabetes, human immunodeficiency virus, organ transplantation, multiple myeloma, and others. Osteoporosis is diagnosed in individuals on the basis of presence of a fragility fracture or by bone mass measurement criteria. A fragility fracture results from forces that would not normally cause a fracture, such as a hip or wrist fracture from falling from standing height or a vertebral compression fracture. Although specific fracture sites have been considered more characteristic of osteoporosis, fractures occurring at nearly every anatomical site have been associated with osteoporosis. This systematic evidence review is an update for the U.S. Preventive Services Task Force (USPSTF) recommendation on screening for osteoporosis. In 2002, based on results of a previous review, the USPSTF recommended bone density screening for women age greater than or equal to 65 years and women age 60–64 years at increased risk for osteoporotic fractures. They made no recommendations for or against screening postmenopausal women age less than 60 years or women age 60–64 years without increased risk. Men were not considered in the prior recommendation. This update focuses on new studies and evidence gaps that were unresolved at the time of the 2002 recommendation. These include the effectiveness and harms of osteoporosis screening in reducing fractures and fracture-related health outcomes for men as well as postmenopausal women without known previous fractures; the performance of risk-assessment instruments and bone measurement tests in identifying individuals with osteoporosis; optimal screening intervals; and efficacy and harms of medications to reduce primary fractures in a screening-detected population. Based on evidence gaps identified from the previous review and using the methods of the USPSTF, the USPSTF and Agency for Healthcare Research and Quality (AHRQ) developed Key Questions for this review. Investigators created an analytic framework incorporating the Key Questions and outlining the patient populations, interventions, outcomes, and harms of the screening process. The target populations include postmenopausal women and men age greater than 50 years without known previous osteoporosis-related fragility fractures or secondary causes of osteoporosis. Key Questions include: 1. Does screening for osteoporosis and low bone density reduce osteoporosis-related fractures and/or fracture-related morbidity and mortality in the target populations? These include postmenopausal women (age less than 60 years, 60–64 years at increased risk for osteoporotic fractures, 60–64 years not at increased risk for osteoporotic fractures, and greater than or equal to65 years) and men less than 50 years. 2. What valid and reliable risk-assessment instruments stratify women and men into risk categories for osteoporosis or fractures? 3. A. How well does DXA predict fractures in men? B. How well do peripheral bone measurement tests predict fractures? C. What is the evidence to determine screening intervals for osteoporosis and low bone density? 4. What are the harms associated with osteoporosis screening? 5. Do medications for osteoporosis and low bone density reduce osteoporosis-related fracture rates and/or fracture-related morbidity and mortality in the target populations? 6. What are the harms associated with medications for osteoporosis and low bone density?
Screening For Osteoporosis
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Author :
language : en
Publisher:
Release Date : 2010
Screening For Osteoporosis written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2010 with Osteoporosis categories.
BACKGROUND: Osteoporosis and related fractures are common in older individuals and lead to premature mortality, loss of function and independence, reduced quality of life, and high costs. Despite its importance, osteoporosis is under detected in the United States. This review updates evidence since the 2002 U.S. Preventive Services Task Force recommendation on osteoporosis screening. PURPOSE: To determine the effectiveness and harms of osteoporosis screening in reducing fractures for men and postmenopausal women without known previous fractures; the performance of risk-assessment instruments and bone measurement tests in identifying persons with osteoporosis; optimal screening intervals; and efficacy and harms of medications to reduce primary fractures. DATA SOURCES: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the 4th Quarter of 2009), MEDLINE (January 2001 to December 2009), reference lists, and Web of Science searches. STUDY SELECTION: Randomized, controlled trials of screening or medications with fracture outcomes published in English; performance studies of validated risk-assessment instruments; and systematic reviews and population-based studies of bone measurement tests or medication harms. DATA EXTRACTION: Data on patient populations, study design, analysis, follow-up, and results were abstracted; study quality was rated by using criteria developed by the USPSTF. DATA SYNTHESIS: Risk-assessment instruments are modest predictors of low bone density (area under the curve, 0.13 to 0.87; 14 instruments) and fractures (area under the curve, 0.48 to 0.89; 11 instruments); simple and complex instruments perform similarly. Dual-energy x-ray absorptiometry predicts fractures similarly for men and women; calcaneal quantitative ultrasonography also predicts fractures, but correlation with dual-energy x-ray absorptiometry is low. Repeating a bone density measurement up to 8 years after an initial measurement does not significantly improve predictive performance for fracture outcomes. For postmenopausal women, bisphosphonates, parathyroid hormone, raloxifene, and estrogen reduce primary vertebral fractures; bisphosphonates reduce primary nonvertebral fractures in sensitivity analysis. Medications are effective for bone density T-scores of 2.5 or less for women without previous known fractures. Primary prevention trials are lacking for men. Bisphosphonates are not consistently associated with serious adverse events; raloxifene and estrogen increase thromboembolic events; estrogen increases stroke; and estrogen with progestin increases coronary heart disease and breast cancer. LIMITATIONS: Trials of screening with fracture outcomes, screening intervals, and medications to reduce primary fractures, particularly enrolling men, are lacking. CONCLUSIONS: Although methods to identify risk for osteoporotic fractures are available and mediations to reduce fractures are effective, no trials directly evaluate screening effectiveness, harms, and intervals.
Preventing Osteoporotic Fractures In Men Living With Hiv
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Author : Michelle Letchumanan
language : en
Publisher:
Release Date : 2021
Preventing Osteoporotic Fractures In Men Living With Hiv written by Michelle Letchumanan and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2021 with categories.
I aimed to provide Ontario's public healthcare payers with an economic evaluation of fracture prevention strategies for HIV-positive men who take antiretroviral therapy (ART). When developing microsimulations models for this purpose, calibration is critical and computationally expensive. Studies that explore efficient calibration methods for microsimulation models are limited. As such, I sought to determine whether simulated annealing or Nelder-Mead is the best-performing parameter search algorithm to calibrate a microsimulation model in project one; determine whether a discrete-event simulation model of fractures leads to more efficient calibrations than a patient-level, discrete-time simulation model in project two; and, estimate the cost-effectiveness of osteoporosis screening and treatment strategies in ART-treated men over a lifetime horizon in project three. For projects one and two, I constructed a Markov microsimulation model that tracked bone loss and incident fractures. All calibrations were based on 4 calibration targets, 12 calibration inputs, a binomial log-likelihood goodness-of fit measure, and first-order searches in a simulated sample of 1000. I assessed calibration performance according to differences in the goodness-of-fit and the time to identifying a good parameter set. In project one, both algorithms produced good sets that had similar fit, but simulated annealing identified the sets two times faster than Nelder-Mead. In project two, both model structures generated similarly accurate good sets, while the discrete-event simulation generated these three times as quickly as the discrete-time simulation. In project three, I evaluated 13 strategies for initiating osteoporosis treatment based on Fracture Risk Assessment Tool (FRAX) scores, with and without bone mineral density (BMD). The base-case included 50-year-old, HIV-positive men who took ART for ≥3 years and did not have a history of fractures or osteoporosis treatment. I incorporated the calibrated results from projects 1 and 2 in project 3's probabilistic analysis. I discounted outcomes annually by 1.5%. At a willingness-to-pay threshold of $50,000/QALY, it is most cost-effective to assess FRAX without BMD, offer treatment if FRAX is ≥10%, and re-screen annually. Collectively, these studies suggest using simulated annealing and discrete-event simulation as efficient calibration methods; as well as that the payer should not pay for BMD screening in older HIV-positive men.
Osteoporosis In Men
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Author : Eric S. Orwoll
language : en
Publisher: Academic Press
Release Date : 2009-11-30
Osteoporosis In Men written by Eric S. Orwoll and has been published by Academic Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009-11-30 with Medical categories.
Since the publication of the first edition, the U.S. Surgeon General released the first-ever report on bone health and osteoporosis in October 2004. This report focuses even more attention on the devastating impact osteoporosis has on millions of lives. According to the National Osteoporosis Foundation, 2 million American men have osteoporosis, and another 12 million are at risk for this disease. Yet despite the large number of men affected, the lack of awareness by doctors and their patients puts men at a higher risk that the condition may go undiagnosed and untreated. It is estimated that one-fifth to one-third of all hip fractures occur in men. This second edition brings on board John Bilezikian and Dirk Vanderschueren as editors with Eric Orwoll. The table of contents is more than doubling with 58 planned chapters. The format is larger – 8.5 x 11. This edition of Osteoporosis in Men brings together even more eminent investigators and clinicians to interpret developments in this growing field, and describe state-of-the-art research as well as practical approaches to diagnosis, prevention and therapy. Brings together more eminent investigators and clinicians to interpret developments in this growing field Describes state-of-the-art research as well as practical approaches to diagnosis, prevention and therapy There is no book on the market that covers osteoporosis in men as comprehensively as this book
Assessment Of Fracture Risk And Its Application To Screening For Postmenopausal Osteoporosis
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Author : WHO Study Group on Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis
language : en
Publisher:
Release Date : 1994
Assessment Of Fracture Risk And Its Application To Screening For Postmenopausal Osteoporosis written by WHO Study Group on Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1994 with Medical categories.
Osteoporosis In Hong Kong
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Author : Yun-Ning Elaine Cheung
language : en
Publisher: Open Dissertation Press
Release Date : 2017-01-26
Osteoporosis In Hong Kong written by Yun-Ning Elaine Cheung and has been published by Open Dissertation Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017-01-26 with Medical categories.
This dissertation, "Osteoporosis in Hong Kong: Important Issues in Prevention, Assessment and Treatment" by Yun-ning, Elaine, Cheung, 張欣寧, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: The overall objective of the present study is to find out effective measures to prevent fractures among postmenopausal women in the Hong Kong population. Fracture prevention can be accomplished by preventing bone loss within the general community, especially over menopausal transition, and identifying high risk subjects for treatment. There is relative paucity of data regarding bone loss across menopausal transition among Chinese women. 160 women between 45 to 55 years old were followed up longitudinally for four years for bone mineral density measurement. Data on menstrual status, lifestyle and dietary habits were collected. Biochemical and hormonal assay were carried out. The time of onset, rate and determinants of peri-menopausal bone loss were investigated. No significant bone loss was detected at both spine and hip in premenopausal women. Maximal bone loss was noted at the peri-menopausal stage (STRAW stage -1/-2) and bone loss attenuated after final menopausal period. Subjects tended to experience more rapid bone loss if they were older, had an early menopause, weighed less or had a higher FSH level at baseline. The second part of the study aimed to investigate means by which to identify high risk postmenopausal women for treatment to prevent fracture. This part consisted of three studies utilizing the same cohort of 2266 local postmenopausal Chinese women. First, the discriminative values of various models for fracture prediction were compared. Second, the clinical utility in fracture prevention was evaluated when different international guidelines were applied to this cohort. Third, the effectiveness in fracture prevention using different intervention strategies was assessed. The discriminative value for major osteoporotic fracture prediction was found in our study to be better for an ethnic specific clinical risk factors model with T-score than the WHO Fracture Risk Assessment (FRAX) while the performance for hip fracture was similar. The former model has a 10% higher sensitivity than FRAX at specificity of 0.8 or above. The clinical utility of various international guidelines including NOF, National Osteoporosis Guideline Group (NOGG) and Taiwanese guidelines to direct BMD screening and treatment strategies for fracture prevention was compared and found to be low as reflected by the poor clinical utility index. Finally, different treatment strategies which include treating women with prior fractures, women with age-specific FRAX probability corresponding to those with prior fractures, women with osteoporosis as well as women with FRAX probability above a fixed cut-off based on optimizing sensitivity and specificity on the ROC curve were compared. All strategies had negative predictive value of >90%. Using a fixed cut-off of 9.95% (major osteoporotic fractures, with BMD, determined by finding the optimal threshold point from the ROC curve) had the highest sensitivity but lowest specificity and positive predictive value. The above findings may help to design effective public health measures to prevent osteoporosis and provide an important step in the development of treatment guidelines specific to the Hong Kong population. Subjects: Osteoporosis - China - Hong Kong
Osteoporosis
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Author : Morris Notelovitz
language : en
Publisher: Professional Communications
Release Date : 2008
Osteoporosis written by Morris Notelovitz and has been published by Professional Communications this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008 with Medical categories.
This handbook reviews pathophysiologic basis of osteoporosis and how to evaluate patients and develop a practical approach to prevention and management. Diagnosing and screening, including bone densitometry and qualitative bone ultrasound, are discussed. Exercise, nutritional supplements, and dietary regimens are included. Postmenopausal hormone therapy and drug therapies for the prevention and treatment of osteoporosis are reviewed in detail. The importance of individualized treatment is stressed.