Screening to Prevent Osteoporotic Fractures

Viswanathan, Meera; Reddy, Shivani M.; Berkman, Nancy D; Cullen, Katie; Middleton, Jennifer Cook; Nicholson, Wanda K; Kahwati, Leila C.

doi:10.1001/jama.2018.6537

Cited by 166 publications

(149 citation statements)

References 114 publications

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“…None of these are validated AI-treated women with breast cancer. One of the strongest risk factors for AI-induced fractures is having osteopenia or osteoporosis at the time of starting AI [ 65 ]. The development of FRAX ® uses clinical risk factors (i.e., age, height, weight, sex, prior personal history of fracture, parental history of hip fracture, current smoking, glucocorticoids, secondary osteoporosis, alcohol greater than three drinks/day), with or without femoral neck BMD to estimate to the ten-year risks of a hip or non-hip fracture [ 66 ].…”

Section: Determining Fracture Riskmentioning

confidence: 99%

Osteoporosis: A Long-Term and Late-Effect of Breast Cancer Treatments

Shapiro

2020

Cancers

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Osteoporosis is both a long-term effect (occurs during treatment and extends after treatment) and a late-effect (occurs after treatment ends) of breast cancer treatments. The worldwide prevalence of osteoporosis is estimated to be some 200 million patients. About one in three postmenopausal women will experience an osteoporotic (or fragility) fracture of the hip, spine, or wrist. breast cancer treatments, including gonadotropin-releasing hormone (GnRH) agonists, chemotherapy-induced ovarian failure (CIOF), and aromatase inhibitors (AIs), cause bone loss and increase the risks of osteoporosis. Also, breast cancer is a disease of aging, and most of the “one in eight” lifetime risks of breast cancer are in women in their sixth, seventh, and eighth decades. The majority of women diagnosed with breast cancers today will be long-term survivors and experience personal cures. It is the coalescence of osteoporosis with breast cancer, two common and age-related conditions that make osteoporosis relevant in women with breast cancer throughout the continuum from diagnosis, treatment, and survivorship. It is critical to remember that women (and men) will lose bone after age thirty years. However, only certain women will lose bone of sufficient magnitude to merit treatment with anti-osteoporosis drugs. The narrative review is intended for medical, surgical, radiation oncologists, and other mid-level providers, and provides an overview of bone loss and the prevention and treatment of osteoporosis.

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Section: Determining Fracture Riskmentioning

confidence: 99%

Osteoporosis: A Long-Term and Late-Effect of Breast Cancer Treatments

Shapiro

2020

Cancers

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“…Firstly, the high level of genetic predisposition to OP, muscle status and OF: the heritability of BMD was estimated between 60% and 90% [ 616 , 617 , 618 ], the heritability of OFs was estimated between 9.5% [ 619 ] to 16–35% [ 620 , 621 , 622 ] and 53–70% [ 617 , 623 , 624 ] and the heritability of muscle-related traits was estimated between 30% and 50% [ 625 , 626 , 627 ]. Secondly, only in half of patients (between 30% and 50%) antiresorptive drugs are effective [ 628 , 629 , 630 , 631 , 632 ]. Thirdly, among lifestyle preventive measures, only muscle strengthening, balance and posture exercises are beneficial (level of evidence A), whereas reduced smoking (level of evidence C) and alcohol consumption (level of evidence D) demonstrate low relevance [ 633 , 634 ].…”

Section: Clinical Implications and Recommendationsmentioning

confidence: 99%

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Fisher

Smith

2020

JCM

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Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world’s population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI–OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.

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“…Within the field of osteoporosis, one potential answer lies with the FRAX tool itself. Many studies have examined its clinical utility since its launch in 2008; two systematic reviews have demonstrated the significant predictive ability of FRAX for future fractures, especially of the hip [ 22 , 23 ]. In general, the incorporation of a measurement of femoral neck BMD results in higher accuracy than without BMD, but the additional value of BMD in all is modest [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Global impact of COVID-19 on non-communicable disease management: descriptive analysis of access to FRAX fracture risk online tool for prevention of osteoporotic fractures

et al. 2020

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Summary The COVID-19 pandemic, and its management, is markedly impacting the management of osteoporosis as judged by access to online FRAX fracture risk assessments. Globally, access was 58% lower in April than in February 2020. Strategies to improve osteoporosis care, with greater use of fracture risk assessments, offer a partial solution. Introduction The COVID-19 pandemic is having a significant detrimental impact on the management of chronic diseases including osteoporosis. We have quantified the global impact by examining changes in the usage of online FRAX fracture risk assessments before and after the declaration of the pandemic (11 March 2020). Methods The study comprised a retrospective analysis using GoogleAnalytics data on daily sessions on the FRAX® website (www.sheffield.ac.uk/FRAX) from November 2019 to April 2020 (main analysis period February–April 2020), and the geographical source of that activity. Results Over February–April 2020, the FRAX website recorded 460,495 sessions from 184 countries, with 210,656 sessions in February alone. In March and April, the number of sessions fell by 23.1% and 58.3% respectively, a pattern not observed over the same period in 2019. There were smaller reductions in Asia than elsewhere, partly related to earlier and less-marked nadirs in some countries (China, Taiwan, Hong Kong, South Korea and Vietnam). In Europe, the majority of countries (24/31, 77.4%) reduced usage by at least 50% in April. Seven countries showed smaller reductions (range − 2.85 to − 44.1%) including Poland, Slovakia, Czech Republic, Germany, Norway, Sweden and Finland. There was no significant relationship between the reduction in FRAX usage and measures of disease burden such as COVID-attributed deaths per million of the population. Conclusion This study documents a marked global impact of the COVID-19 pandemic on the management of osteoporosis as reflected by FRAX online fracture risk assessments. The analysis suggests that impact may relate to the societal and healthcare measures taken to ameliorate the pandemic.

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Screening to Prevent Osteoporotic Fractures

Cited by 166 publications

References 114 publications

Osteoporosis: A Long-Term and Late-Effect of Breast Cancer Treatments

Osteoporosis: A Long-Term and Late-Effect of Breast Cancer Treatments

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Global impact of COVID-19 on non-communicable disease management: descriptive analysis of access to FRAX fracture risk online tool for prevention of osteoporotic fractures

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