FRAX-based osteoporosis treatment guidelines for resource-poor settings in India

Nagendra, Lakshmi; Bhavani, Nisha; Menon, Vishnu; Pavithran, Praveen V; Menon, Arun S; Abraham, Nithya; Nair, Vasantha; Kumar, Harish

doi:10.1007/s11657-021-00931-8

Cited by 7 publications

(3 citation statements)

References 16 publications

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“…In the current healthcare climate, there is mounting pressure for clinicians to rationalize their treatment decisions, and the decision to initiate bisphosphonate treatment is highly dependent on the attended clients. Factors such as previous fractures, steroid usage, and other disease-specific factors will likely influence the decision, but the BMDs result is likely the primary factor [ 20 - 21 ].…”

Section: Discussionmentioning

confidence: 99%

Best Bisphosphonate Threshold for 10-Year Vertebral and Non-vertebral Fracture Mitigation

Alboun,

Khreisat,

Alawneh

et al. 2024

Cureus

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Aims: This study was aimed to determine the ideal thresholds for bone mineral densities in our tested Jordanian cohort to initiate bisphosphonate pharmacotherapeutics in order to establish a national protocol for prescribing bisphosphonates that is tailored to the local population, rather than relying on global T and Z scores standards.Methods: This retrospective study analyzed the entire population of adult patients at Prince Rashid bin Al-Hussein Hospital Rehabilitation and Rheumatology Center between August and October 2023 for the purpose of screening, monitoring, diagnosing, and treating osteoporosis. The study included 328 clients suspected to have osteoporosis, selected based on criteria such as primary osteoporosis or potential secondary osteoporosis. The study used two fracture risk assessment tools (FRAX) dichotomized states: <3% (negative state) and ≥3% (positive state), as well as <20% (negative state) and ≥20% (positive state). Binary logistic regression analysis, receiver-operating characteristic, and sensitivity analysis tests were performed sequentially to analyze the performance of prognosticators and sensitivity indices to evaluate their sensitivity, specificity, and accuracy indexes.Results: The study involved 328 clients at a rehabilitation clinic, with 82.62% (271) females and 17.38% (57) males. The majority were aged between 60 and 69 years, with a slightly higher obesity rate in females. The study found that initiation of bisphosphonates in Jordanian cohorts with optimal bone mineral density thresholds of 0.775 g/cm 2 may significantly reduce the risk of hip osteoporosis over 10 years, with sensitivity, specificity, and accuracy indexes of 78.6%, 88.46%, and 50.61%, respectively, with a performance utility of 0.896±0.026 (p-value<0.001), 95% CI (0.846-0.946).Conclusion: Due to ethnicity differences, exploring regional or national specific bone mineral density thresholds for bisphosphonates initiation may be a better optional choice than adopting global T-score standards.

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Section: Discussionmentioning

confidence: 99%

Best Bisphosphonate Threshold for 10-Year Vertebral and Non-vertebral Fracture Mitigation

Alboun,

Khreisat,

Alawneh

et al. 2024

Cureus

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“…In Malaysia, primary care doctors identified inability to access bone mineral densitometry as the leading barrier to osteoporosis screening and management (90.6%) [ 26 ]. Applying country-specific FRAX® intervention thresholds has the potential to optimise DXA referrals and guide treatment initiation in areas with resource constraints [ 27 , 28 ]. In Thailand, guidelines recommend using the Thai-specific FRAX® tool, whilst noting the paucity of data on major non-hip fractures and the need to establish appropriate intervention thresholds [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluating compliance with the care standard of proactively assessing bone health in patients with diabetes: a pilot audit of practice across Asia by the Asia Pacific Consortium on Osteoporosis (APCO)

Chandran,

Aftab,

Amin

et al. 2024

Arch Osteoporos

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Summary This pilot audit explored how bone health is assessed patients with diabetes in diverse centres across Asia. Only 343 of 1092 (31%) audited patients had a bone health assessment, 27% of whom were diagnosed with osteoporosis. Quality improvement strategies are needed to address gaps in patient care in this area. Purpose The Asia Pacific Consortium on Osteoporosis (APCO) Framework outlines clinical standards for assessing and managing osteoporosis. A pilot audit evaluated adherence to clinical standard 4, which states that bone health should be assessed in patients with conditions associated with bone loss and/or increased fracture risk; this report summarises the audit findings in patients with diabetes. A secondary aim was to assess the practicality and real-world use of the APCO bone health audit tool kit. Methods Eight centres across Asia participated in the pilot audit, selecting diabetes as the target group. Participants reviewed their practice records for at least 20 consecutively treated patients with the target condition. Questions covered routine investigations, bone health assessment, osteoporosis diagnosis, and patient referral pathways. Data were summarised descriptively. Results The participants represented public hospitals, university medical centres, and private clinics from India, Malaysia, Pakistan, Singapore, Taiwan, and Vietnam that see an estimated total of 95,000 patients with diabetes per year. Overall, only 343 of 1092 audited patients (31%) had a bone health assessment. Osteoporosis was subsequently diagnosed in 92 of 343 (27%) patients. Conclusion Bone health was not assessed in most patients with diabetes. The results provide insight into current practices across diverse Asian centres and demonstrate the practical value of the audit tool kit. Participant feedback has been used to improve the tool kit. Results of this pilot audit are being used in the respective centres to inform quality improvement projects needed to overcome the gap in patient care.

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“…I was fortunate to have been chosen for this award for my work on Fracture Risk Assessment Tool (FRAX)-based osteoporosis treatment thresholds for resource-poor settings in India. [ 2 ] I truly believe that this award gave me that initial push very early in my career to pursue research alongside clinical work. This also inspired me to set up a full-fledged osteoporosis clinic at my institution.…”

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confidence: 99%

The View from Here: A Woman Early Career Endocrinologist in India

Nagendra¹

2023

Indian Journal of Endocrinology and Metabolism

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Being a young female endocrinologist and a new mother brings its own challenges. As much as an understanding family helped me deal with the myriad of things at home, equally understanding colleagues and the huge network of endocrine fraternity provided me the much-needed support professionally. From helping me juggle my responsibilities, to answering all my questions about complex endocrine disorders, the close-knit endocrine fraternity in India has been my greatest source of strength. I am sure my story and experiences will inspire many more women to be part of this wonderful fraternity.

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FRAX-based osteoporosis treatment guidelines for resource-poor settings in India

Cited by 7 publications

References 16 publications

Best Bisphosphonate Threshold for 10-Year Vertebral and Non-vertebral Fracture Mitigation

Best Bisphosphonate Threshold for 10-Year Vertebral and Non-vertebral Fracture Mitigation

Evaluating compliance with the care standard of proactively assessing bone health in patients with diabetes: a pilot audit of practice across Asia by the Asia Pacific Consortium on Osteoporosis (APCO)

The View from Here: A Woman Early Career Endocrinologist in India

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