An update on the diagnosis of osteoporosis

Kanis, John А.

doi:10.1007/s11926-996-0070-y

Cited by 44 publications

(35 citation statements)

References 33 publications

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“…These reference data provided by the manufacturer have a good concordance with data derived from a previously described German control population [22] . Furthermore, osteopenia and osteoporosis were defined as BMD measurements between 1 and 2.5 (-2.5≤T≤1) and more than 2.5 (T≤-2.5) standard deviations below the mean bone density for young adults, respectively, consistent with the World Health Organization criteria [23] . Care was taken not to measure collapsed lumbar vertebrae to avoid false BMD readings.…”

Section: Bone Mineral Density Measurementsmentioning

confidence: 99%

Reduced bone mineral density and altered bone turnover markers in patients with non-cirrhotic chronic hepatitis B or C infection

Schiefke

Fach²,

Wiedmann³

et al. 2005

WJG

139

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AIM: Previous studies suggest that loss of bone mineral density (BMD) frequently occurs in patients with chronic viral liver disease, presenting with histologically proven liver cirrhosis. However, little is known about the occurrence of bone disease in non-cirrhotic patients with chronic hepatitis B or C. Therefore, it was the aim of this study to evaluate this particular population for BMD and bone turnover markers. METHODS:Biochemical markers of bone turnover and BMD were measured in 43 consecutive patients with HCV (n = 30) or HBV (n = 13) infection without histological evidence for liver cirrhosis. Mean age was 49 years (range 26-77 years). BMD was measured by dual X-ray absorptiometry in the femoral neck (FN) and the lumbar spine (LS) region. In addition, bone metabolism markers were measured. RESULTS:BMD was lowered in 25 (58%) of the patients with chronic hepatitis B or C (FN: 0.76 (0.53-0.99); LS: 0.96 (0.62-1.23) g/cm²). Eight (32%) osteopenic patients were diagnosed with osteoporosis. Bone-specific alkaline phosphatase (P = 0.005) and intact parathyroid hormone (iPTH) (P = 0.001) were significantly elevated in the more advanced stages of fibrosis. Mean T-score value was lower in patients with chronic hepatitis C as compared to patients suffering from chronic hepatitis B; however, the difference was not statistically significant (P = 0.09). CONCLUSION:There was a significantly reduced BMD in non-cirrhotic patients with chronic hepatitis B or C infection. Alterations of bone metabolism already occurred in advanced liver fibrosis without cirrhosis. According to our results, these secondary effects of chronic viral hepatitis should be further investigated.

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Section: Bone Mineral Density Measurementsmentioning

confidence: 99%

Reduced bone mineral density and altered bone turnover markers in patients with non-cirrhotic chronic hepatitis B or C infection

Schiefke

Fach²,

Wiedmann³

et al. 2005

WJG

139

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“…One in 3 women and 1 in 5 men over 50 years of age will experience osteoporotic fractures, and about 20% of women and 40% of men die within 1 year after a hip fracture [2,3]. In the United States, osteoporosis accounts for more than 1.5 million fractures annually with direct expenditures of USD 18 billion per year [4].…”

Section: Introductionmentioning

confidence: 99%

Association between Lean and Fat Mass and Indicators of Bone Health in Prepubertal Caucasian Children

Rousseau²,

Lambert³

et al. 2013

Horm Res Paediatr

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Background/Aims: Childhood and adolescence are critical periods for bone growth. The independent association between lean and fat mass and indicators of bone health in children is not yet known. We aim to examine the association between each of lean and fat mass and indicators of bone health in 8- to 10-year-old prepubertal Caucasian children. Methods: We present a cross-sectional analysis of baseline data from the QUebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort which study the natural history of obesity. Study participants (n = 483) included prepubertal children aged 8-10 years and their biological parents. Whole-body bone mineral content (BMC, g), bone area (cm²), bone mineral density (BMD, g/cm²), lean mass (kg), and fat mass (kg) were measured by dual-energy X-ray absorptiometry. Data analyses include multiple linear regressions adjusted for potential confounding variables. Results: A 1-kg increase in lean mass was associated with 28.42 g, 19.88 cm², and 0.007 g/cm² increase in whole-body BMC, bone area and BMD respectively. A 1-kg increase in fat mass was associated with 9.32 g, 8.02 cm², and 0.002 g/cm² increase in whole-body BMC, bone area and BMD, respectively. Conclusion: Increasing lean mass in children may help optimize bone acquisition and prevent future osteoporosis.

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“…1 These criteria were established based on dual-energy X-ray absorptiometry (DXA) as the technique to quantify bone mass. 2 Given that the diagnostic cut-point for osteoporosis (more than 2·5 standard deviations below the young average value) is based on a statistical distribution, the absolute BMD values for osteoporosis diagnosed in this way differ according to the site measured, technique, equipment, and reference population.…”

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confidence: 99%

Diagnostic criteria for osteoporosis should be expanded

Παπαϊωάννου

Kennedy

2015

The Lancet Diabetes & Endocrinology

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As a relatively newly classified chronic disease, scientific enquiry about pathophysiology, diagnosis, and treatment for osteoporosis has rapidly increased in the past three decades. Under the direction of the National Bone Health Alliance, a working group has proposed expansion of the diagnostic criteria for osteoporosis in men and postmenopausal women aged 50 years and older to include individuals with any of the following: a hip fracture (with or without bone mineral density [BMD] testing); low bone mass as determined by BMD and a vertebral, proximal humeral, pelvic, or, in some cases, distal forearm fracture; or raised fracture risk based on the WHO fracture risk algorithm, FRAX. We propose that this is a prudent approach and that it reflects the present understanding of bone fragility and fracturerisk prediction.With the emergence of bone densitometry as a reliable measure, in 1994 WHO proposed the first operational definition of osteoporosis based on BMD T-scores. 1 These criteria were established based on dual-energy X-ray absorptiometry (DXA) as the technique to quantify bone mass. 2 Given that the diagnostic cut-point for osteoporosis (more than 2·5 standard deviations below the young average value) is based on a statistical distribution, the absolute BMD values for osteoporosis diagnosed in this way differ according to the site measured, technique, equipment, and reference population.In the past decade, there have been at least two paradigm shifts in the diagnosis and management of osteoporosis. The first major shift was the incorporation of clinical risk factors into fracture risk prediction. The FRAX tool developed by WHO, which can be used to predict fracture risk with or without BMD values, has been validated worldwide. Since 2010, Canadian osteoporosis guidelines have incorporated clinical risk factors for diagnosis of osteoporosis in addition to BMD, 3 similar to other countries. 4 Individuals at high risk of fractures are those with previous fracture of the hip or spine, more than one previous nonvertebral fracture (excluding hands, feet, and ankles), or those who have recently used glucocorticoids and have had one previous fracture. Numbers needed to treat to prevent further fractures are low and intervention is cost-effective in these high-risk individuals. 3 The second shift has been recognition of the importance of bone quality, in addition to density, as a key component of bone strength. Bone quality can be thought of as a complex set of interdependent factors that affect bone strength, including structural (eg, geometry and CIHR Author ManuscriptCIHR Author Manuscript CIHR Author Manuscript microarchitecture) and material (eg, mineral crystal size, quality of collagen, and microdamage or microfracture) properties of bone. 5 Although the use of bone quality measures in clinical diagnosis of osteoporosis is still being investigated, several techniques can be used to estimate bone quality.These shifts are based on the concept that BMD alone does not adequately predict fracture risk. Relative...

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An update on the diagnosis of osteoporosis

Cited by 44 publications

References 33 publications

Reduced bone mineral density and altered bone turnover markers in patients with non-cirrhotic chronic hepatitis B or C infection

Reduced bone mineral density and altered bone turnover markers in patients with non-cirrhotic chronic hepatitis B or C infection

Association between Lean and Fat Mass and Indicators of Bone Health in Prepubertal Caucasian Children

Diagnostic criteria for osteoporosis should be expanded

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