Osteoporosis in East Asia: Current issues in assessment and management

Cheung, Eric F.C.; Tan, K. C. B.; Cheung, Ching‐Lung; Kung, A. W. C.

doi:10.1016/j.afos.2016.07.001

Cited by 55 publications

(47 citation statements)

References 150 publications

(214 reference statements)

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“…It has been estimated that one in three women and one in five men aged over 50 years will experience osteoporotic fractures worldwide, making the identification of risk factors of fracture an important public health issue. Such issue is particularly of concern in East Asia as the population aged over 60 years has an exponential increase in recent years, leading to a projection of high annual incidence of fractures in near future . The use of various classes of medication has been identified as a risk factor for fracture.…”

Section: Introductionmentioning

confidence: 99%

“…Such issue is particularly of concern in East Asia as the population aged over 60 years has an exponential increase in recent years, leading to a projection of high annual incidence of fractures in near future. 3 The use of various classes of medication has been identified as a risk factor for fracture. Using large databases, a number of pharmacoepidemiology studies showed that medications, such as antidiabetic 4 and antihypertensive 5 drugs, are associated with fracture risk, demonstrating the importance of utilizing databases in pharmacoepidemiology study of fracture.…”

Section: Introductionmentioning

confidence: 99%

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Validity of major osteoporotic fracture diagnosis codes in the Clinical Data Analysis and Reporting System in Hong Kong

Sing

Woo

Lee

et al. 2017

Pharmacoepidemiology and Drug

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Validity of major osteoporotic fracture diagnosis codes in the Clinical Data Analysis and Reporting System in Hong Kong

Sing

Woo

Lee

et al. 2017

Pharmacoepidemiology and Drug

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“…Oral bisphosphonates, particularly alendronate, are the most commonly prescribed anti-osteoporosis medication in the region [14][15][16]; however, two out of three patients in Asia are non-adherent to oral bisphosphonates within 3-12 months of prescription [17][18][19]. As a result of the high burden and proportion of patients with imminent risk of fracture in the region, there is a strong need for more potent medications that can impact outcomes early in the course of the disease [20,21].…”

Section: Introductionmentioning

confidence: 99%

Romosozumab or alendronate for fracture prevention in East Asian patients: a subanalysis of the phase III, randomized ARCH study

Lau¹,

Dinavahi

Woo

et al. 2020

Osteoporos Int

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Romosozumab, a sclerostin antibody, exerts dual effect to increase bone formation and decrease bone resorption. Among high-risk postmenopausal East Asian women, romosozumab followed by alendronate was associated with lower incidences of fractures vs alendronate alone. Romosozumab demonstrates potential to address an unmet need in osteoporosis management in Asia. Introduction Romosozumab, a sclerostin antibody, exerts dual effect to increase bone formation and decrease bone resorption. The global ARCH study demonstrated superiority of romosozumab followed by alendronate in reducing fracture risk in high-risk postmenopausal osteoporotic women vs alendronate alone. We report outcomes among ARCH East Asian patients. Methods In ARCH, 4093 postmenopausal osteoporotic women with fragility fracture were randomized 1:1 to monthly romosozumab 210 mg or weekly alendronate 70 mg for 12 months, both followed by open-label alendronate. Primary endpoints were incidence of new vertebral fracture (VF) at 24 months and clinical fracture at primary analysis (confirmed fractures in ≥ 330 patients and all patients had opportunity to attend month 24 visit). This post hoc analysis was not powered to detect fracture-rate differences. Results This analysis included 275 patients from Hong Kong, Korea, and Taiwan. Romosozumab followed by alendronate reduced risk of new VFs at 24 months by 60% (P = 0.11) and clinical fractures at primary analysis by 44% (P = 0.15) vs alendronate alone. Romosozumab followed by alendronate significantly increased mean bone mineral density at 24 months from baseline by a further 9.0%, 3.3%, and 3.0% at the lumbar spine, total hip, and femoral neck vs alendronate alone. Adverse event (AE) rates, including positively adjudicated serious cardiovascular AEs (1.6% vs 1.4% at 12 months for romosozumab vs alendronate), were similar across treatment groups. Conclusions Consistent with the global analysis, romosozumab followed by alendronate was associated with lower incidences of new vertebral, clinical, non-vertebral, and hip fractures vs alendronate alone among East Asian patients.

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“…The USA experienced two million osteoporotic fractures in 2005 and this figure is projected to reach three million in 2025 [4,5]. Elderly population in Asia is rapidly expanding and in 2050, 50% of total hip fractures would be seen in the Asian region [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Performance of Sri Lankan FRAX algorithm without bone mineral density and with Quantitative Ultrasound data input

et al. 2019

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Introduction Fracture risk assessment algorithm (FRAX) is the most validated method available to predict fracture risk. Its use is restricted due to limited availability of Dual Energy X-ray Absorptiometry (DXA). FRAX has the option of assessing fracture risk without bone mineral density (BMD) data. Objectives To assess the ability of Sri Lankan FRAX algorithm without BMD input in evaluating fracture risk. The possibility of replacing the BMD input with Quantitative Ultrasound (QUS) data of radius in calculating fracture risk also assessed. Methods Data of clinical risk factors associated with fractures were collected from community dwelling postmenopausal women (n=339). DXA scans were performed in all subjects and QUS scans (in radius) were performed in a randomly selected sample (n=207). Ten-year risks of major osteoporotic fracture (MOFR) and hip fracture (HFR) were calculated with BMD, without BMD (FRAX-FN 0) and with QUS T score instead of BMD (FRAX-UST). Results and conclusion Nearly 35.7% had high risk of fractures. FRAX-FN 0 had 79.2% sensitivity, 80.1% specificity, 68.8% positive predictive value (PPV) and 87.4% negative predictive value (NPV). FRAX-UST showed 78.4% sensitivity, 70% specificity, 59.8% PPV and 85% NPV. ROC AUCs were above 0.80 in both FRAX-FN 0 and FRAX-UST. The standard errors of estimate (SEE) were less in FRAX-FN 0 (3.96 and 2.76 for MOFR-FN 0 and HFR-FN 0 respectively) compared to FRAX-UST (6.13 and 4.83 for MOFR-UST and HFR-UST, respectively). In conclusion, Sri Lankan FRAX without BMD is an acceptable alternative in areas with restricted DXA facility. Radial QUS data cannot be used as a substitute to FN-BMD in Sri Lankan FRAX.

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Osteoporosis in East Asia: Current issues in assessment and management

Cited by 55 publications

References 150 publications

Validity of major osteoporotic fracture diagnosis codes in the Clinical Data Analysis and Reporting System in Hong Kong

Validity of major osteoporotic fracture diagnosis codes in the Clinical Data Analysis and Reporting System in Hong Kong

Romosozumab or alendronate for fracture prevention in East Asian patients: a subanalysis of the phase III, randomized ARCH study

Performance of Sri Lankan FRAX algorithm without bone mineral density and with Quantitative Ultrasound data input

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