Showing papers in "Archives of Osteoporosis in 2020"

Fragility fractures in Europe: burden, management and opportunities

Abstract: This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five countries of the European Union plus Sweden (EU6). In 2017, new fragility fractures in the EU6 are estimated at 2.7 million with an associated annual cost of €37.5 billion and a loss of 1.0 million quality-adjusted life years. Osteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fractures, which in turn, represent the main consequence of the disease. This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five EU countries and Sweden (designated the EU6). A series of metrics describing the burden and management of fragility fractures were defined by a scientific steering committee. A working group performed the data collection and analysis. Data were collected from current literature, available retrospective data and public sources. Different methods were applied (e.g. standard statistics and health economic modelling), where appropriate, to perform the analysis for each metric. Total fragility fractures in the EU6 are estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; a 23% increase. The resulting annual fracture-related costs (€37.5 billion in 2017) are expected to increase by 27%. An estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures. The current disability-adjusted life years (DALYs) per 1000 individuals age 50 years or more were estimated at 21 years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. The treatment gap (percentage of eligible individuals not receiving treatment with osteoporosis drugs) in the EU6 is estimated to be 73% for women and 63% for men; an increase of 17% since 2010. If all patients who fracture in the EU6 were enrolled into fracture liaison services, at least 19,000 fractures every year might be avoided. Fracture-related burden is expected to increase over the coming decades. Given the substantial treatment gap and proven cost-effectiveness of fracture prevention schemes such as fracture liaison services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are appropriately assessed and treated.

The impact of lockdown during the COVID-19 pandemic on osteoporotic fragility fractures: an observational study

Abstract: We investigated whether osteoporotic fractures declined during lockdown, among adults aged 50 years and older. We showed that fewer outpatients attended the Fracture Clinic, for non-hip fractures, during lockdown; in contrast, no change in admissions for hip fractures was observed. This could be due to fewer outdoors falls, during lockdown. Many countries implemented a lockdown to control the spread of the COVID-19 pandemic. We explored whether outpatient attendances to the Fracture Clinic for non-hip fragility fracture and inpatient admissions for hip fracture declined during lockdown, among adults aged 50 years and older, in a large secondary care hospital. In our observational study, we analysed the records of 6681 outpatients attending the Fracture Clinic, for non-hip fragility fractures, and those of 1752 inpatients, admitted for hip fracture, during the time frames of interest. These were weeks 1st to 12th in 2020 (“prior to lockdown”), weeks 13th to 19th in 2020 (“lockdown”) and corresponding periods over 2015 to 2019. We tested for differences in mean numbers (standard deviation (SD)) of outpatients and inpatients, respectively, per week, during the time frames of interest, across the years. Prior to lockdown, in 2020, 63.1 (SD 12.6) outpatients per week attended the Fracture Clinic, similar to previous years (p value 0.338). During lockdown, 26.0 (SD 7.3) outpatients per week attended the Fracture Clinic, fewer than previous years (p value < 0.001); similar findings were observed in both sexes and age groups (all p values < 0.001). During lockdown, 16.1 (SD 5.6) inpatients per week were admitted for hip fracture, similar to previous years (p value 0.776). During lockdown, fewer outpatients attended the Fracture Clinic, for non-hip fragility fractures, while no change in inpatient admissions for hip fracture was observed. This could reflect fewer non-hip fractures and may inform allocation of resources during pandemic.

Application of machine learning approaches for osteoporosis risk prediction in postmenopausal women

Abstract: Many predictive tools have been reported for assessing osteoporosis risk. The development and validation of osteoporosis risk prediction models were supported by machine learning. Osteoporosis is a silent disease until it results in fragility fractures. However, early diagnosis of osteoporosis provides an opportunity to detect and prevent fractures. We aimed to develop machine learning approaches to achieve high predictive ability for osteoporosis risk that could help primary care providers identify which women are at increased risk of osteoporosis and should therefore undergo further testing with bone densitometry. We included all postmenopausal Korean women from the Korea National Health and Nutrition Examination Surveys (KNHANES V-1, V-2) conducted in 2010 and 2011. Machine learning models using methods such as the k-nearest neighbors (KNN), decision tree (DT), random forest (RF), gradient boosting machine (GBM), support vector machine (SVM), artificial neural networks (ANN), and logistic regression (LR) were developed to predict osteoporosis risk. We analyzed the effect of applying the machine learning algorithms to the raw data and featuring the selected data only where the statistically significant variables were included as model inputs. The accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were used to evaluate performance among the seven models. A total of 1792 patients were included in this study, of which 613 had osteoporosis. The raw data consisted of 19 variables and achieved performances (in terms of AUROCs) of 0.712, 0.684, 0.727, 0.652, 0.724, 0.741, and 0.726 for KNN, DT, RF, GBM, SVM, ANN, and LR with fivefold cross-validation, respectively. The feature selected data consisted of nine variables and achieved performances (in terms of AUROCs) of 0.713, 0.685, 0.734, 0.728, 0.728, 0.743, and 0.727 for KNN, DT, RF, GBM, SVM, ANN, and LR with fivefold cross-validation, respectively. In this study, we developed and compared seven machine learning models to accurately predict osteoporosis risk. The ANN model performed best when compared to the other models, having the highest AUROC value. Applying the ANN model in the clinical environment could help primary care providers stratify osteoporosis patients and improve the prevention, detection, and early treatment of osteoporosis.

Association between grip strength and bone mineral density in general US population of NHANES 2013-2014.

Abstract: Association between strength of nonadjacent muscles and bone mineral density is unclear. We used data from the National Health and Nutrition Examination Survey to convince the effect of grip strength on femoral neck and lumbar spine mineral density in the general US population. This research can broaden the area of muscle-bone interaction. Grip test measures the maximum isotonic strength of hand and forearm and is often used as an indicator of general muscle strength. Muscle has been shown to exert positive effects on bone health, and studies are needed to test whether grip strength can be associated with bone mineral density of nonadjacent bones. The aim of this study is to assess whether grip strength is an independent predictor for bone mineral density (BMD) of femoral neck and total lumbar spine in the general US population. We used the data from the National Health and Nutrition Examination Survey (NHANES) 2013–2014, and 1850 participants aged from 40 to 80 years old were included in the analysis. Grip strength was recorded as the largest reading of three efforts of one’s dominant hand using a handgrip dynamometer. Femoral neck and lumbar spine BMDs were measured through Dual-energy X-ray absorptiometry (DXA) scan. Univariate and multivariate linear regression analyses were done to examine the association between grip strength and BMDs. After adjusting for age, ethnicity, body mass index (BMI), use of female hormones, smoking habit, drinking habit, family history of osteoporosis, use of calcium and vitamin D supplements, physical activity, serum calcium, and phosphorus levels, grip strength is associated with increased femoral neck and total lumbar spine BMDs in men (P < 0.001, P = 0.005), premenopausal women (P = 0.040, P = 0.014), and postmenopausal women (P = 0.016, P = 0.012). Our results suggest that (1) grip strength can be associated with BMD of nonadjacent bones, and (2) grip strength of dominant hand can be an indicator of BMD in the general US population across genders and menopausal status.

Estimation and projection about the standardized prevalence of osteoporosis in mainland China

Abstract: We performed a systematic analysis of the standardized prevalence of osteoporosis in mainland China from 1990 to 2050. Osteoporosis is the most common bone disease. We aimed to investigate the standardized prevalence of osteoporosis in mainland China at the national and regional levels, with projections until 2050. A comprehensive literature search was performed in PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and CBM-SinoMed. We constructed resample sets to calculate the standardized prevalence in each study. Multilevel mixed-effects logistic regression was used to estimate the age-specific and sex-specific prevalence. The United Nations Population Division (UNPD) data and regional population data from the fifth and sixth censuses in mainland China were used to estimate and project the national and regional prevalence of osteoporosis. The standardized prevalence of osteoporosis ranged from 5.04% (2.12~11.34%) to 7.46% (3.13~16.32%) in males aged ≥ 50 years and from 26.28% (15.38~40.40%) to 39.19% (25.74~53.95%) in females aged ≥ 50 years from 1990 to 2050. Moreover, we did not find a significant difference in the standardized prevalence among three geographic regions (Central China, West China, and East China). We found that osteoporosis is a serious public health challenge in mainland China. The findings in our study add insight into the epidemiology of osteoporosis and would be beneficial for the prevention and treatment of osteoporosis in mainland China.

Diagnosis and management of vitamin D deficiency in the Gulf Cooperative Council (GCC) countries: an expert consensus summary statement from the GCC vitamin D advisory board

Abstract: A summary of recommendations is given within the Gulf Cooperation Council (GCC) setting on the assessment and management of vitamin D deficiency in the region. An assembly of 11 regional experts gathered to formulate an all-inclusive approach to vitamin D deficiency within GCC. Several gaps were identified before regional guidelines could be developed. These include adequacy and standardization of vitamin D testing, frequency of repeated testing and reference ranges, distinguishing prevention from the treatment of vitamin D deficiency, quality assurance of vitamin D products sold within GCC including contents and origins of products, and cut-points for vitamin D levels in local populations. A platform is created that can be further developed for overall regional implementation.

A meta-analysis of secondary osteoporosis in systemic lupus erythematosus: prevalence and risk factors

Abstract: This study aimed to evaluate the prevalence and risk factors of secondary osteoporosis (OP) in patients with systemic lupus erythematosus (SLE) and provide a theoretical basis for clinical prevention and treatment of SLE. Take systematic review and meta-analysis of relevant studies. Data sources are CINAHL databases, PubMed, Embase, Wan Fang, Weipu, and CNKI databases. Eligibility criteria are cross-sectional or case–control studies which analyzed the prevalence and risk factors of OP in SLE. Two authors independently screened all studies; a third author verified and identify controversial studies. The quality of the included articles was evaluated. Stata 11 and Rev-Man 5.2 software were used for data processing. Thirty-one articles were included, with a total sample size of 3089 SLE, including 529 OP cases and 2560 non-OP cases. Meta-analysis showed that the prevalence of OP among SLE was 16% (95% CI (0.12, 0.19)). The risk of OP in SLE cases compared with controls was significantly greater with OR of 2.03 (95% CI 1.33–3.10, P = 0.001). Age, disease duration, cumulative glucocorticoid dose, duration of glucocorticoid therapy, SLICC, and menopause had significant differences between two groups. No statistical differences of daily glucocorticoid dose, SLEDAI, and BMI were found between OP and non-OP cases. Our study found a statistically significant increased risk of OP in SLE patients compared with controls. SLE patients should be actively screened for OP and its consequences. Larger longitudinal studies are needed to confirm this possible association. The prevalence of OP in SLE was 16%. Compared with controls, the risk of OP in SLE was 2.03. There were significant differences of age, disease duration, cumulative glucocorticoid dose, time of glucocorticoid, SLICC, and menopause, while daily glucocorticoid dose, SLEDAI, and BMI had no statistical differences between OP and non-OP cases.

Diagnosis and management of osteoporosis in postmenopausal women in Gulf Cooperation Council (GCC) countries: consensus statement of the GCC countries’ osteoporosis societies under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)

Abstract: A consensus platform is provided by the experts of the Gulf Cooperation Council (GCC) countries’ respective osteoporosis societies, on which specific guidelines can be developed further for regional use on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis. Guidance is provided in a Gulf Cooperation Council (GCC) country setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis, which is an adaptation of the European guidance by Kanis et al., jointly published by the International Osteoporosis Foundation and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). The respective osteoporosis societies of the Gulf Cooperation Council (GCC) countries assembled for a unifying consensus on the diagnosis and management of osteoporosis in postmenopausal women for the region. The Chair for Biomarkers of Chronic Diseases (CBCD) in King Saud University (KSU), Riyadh, Kingdom of Saudi Arabia (KSA), in cooperation with the Saudi Osteoporosis Society (SOS), hosted regional experts and respective leaders from different GCC osteoporosis societies, together with an adviser from the ESCEO. An assembly of experts representing the different osteoporosis societies from Saudi Arabia, the UAE, Bahrain, Oman, and Kuwait gathered on February 15–16, 2019 in Riyadh, KSA for the formulation of a general osteoporosis consensus for the region. The following areas were covered: diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; and hip fractures, vitamin D, recommendation on which FRAX tool to follow, and the importance of country-specific FRAX® and fracture liaison services for secondary fracture prevention. A platform is provided on which specific guidelines can be developed for regional use in GCC.

Burden of illness of hip fractures in elderly Dutch patients

Abstract: Summary: Patients with hip fractures experience reduced health-related quality of life and have a reduced life expectancy. Patients’ utilization of healthcare leads to costs to society. The results of the study can be used in future economic evaluations of treatments for hip fractures. Purpose: Hip fractures are associated with high mortality, reduced quality of life, and increased healthcare utilization, leading to an economic burden to society. The purpose of this study is to determine the burden of illness of hip fractures in elderly Dutch patients for specific time periods after surgery. Methods: Patients with a hip fracture above the age of 65 were included in the study. In the 1-year period after surgery, patients were asked to complete a set of questionnaires pre-injury (retrospectively), and 1 week, 1 month, 3 months, 6 months and 12 months after surgery. The set of questionnaires included the Euroqol 5D (EQ-5D-3L), the iMTA Medical Consumption Questionnaire (iMCQ) and iMTA Productivity Cost Questionnaire (iPCQ). Health-related quality of life was calculated using Dutch tariffs. Costs were calculated using the methodology described in the Dutch costing manual. Results: Approximately 20% of patients with a hip fracture died within 1 year. Health-related quality of life was significantly reduced compared to pre-injury values, and patients did not recover to their pre-injury values within 1 year. Total costs in the first year after injury were €27,573, of which 10% were due to costs of the procedure (€2706). Total follow-up costs (€24,876) were predominantly consisting of healthcare costs. Monthly costs decreased over time. Conclusions: Hip fractures lead to a burden to patients, resulting from mortality and health-related quality of life reductions, and to society, due to (healthcare) costs. The results of this study can be used in future economic evaluations.

Correlation of bone mineral density with MRI T2* values in quantitative analysis of lumbar osteoporosis

Abstract: We found that the MRI T2* value is moderately negatively correlated with the bone mineral density assessed with quantitative computed tomography in evaluating osteoporosis in postmenopausal women and may have some potential in assessing severity of lumbar osteoporosis for scientific research. To investigate the T2* quantitative measurement in magnetic resonance imaging (MRI) and its correlation with the bone mineral density (BMD) values evaluated with quantitative computed tomography (QCT) in women with postmenopausal lumbar vertebrae osteoporosis. Eighty-seven postmenopausal women were enrolled who had MRI scanning with T1WI, T2WI, and T2* mapping sequences and QCT evaluation of BMD. The T2* value and the BMD were assessed in lumbar vertebral bodies 2–4. Based on the BMD values, the patients were divided into three groups: normal, osteopenia, and osteoporosis. The inter- and intra-observer intraclass correlation coefficients (ICCs) for T2* were 0.91 (0.87–0.94, 95% CI) and 0.93 (0.88–0.95, 95% CI), respectively. The inter- and intra-observer ICCs for the BMD value were 0.89 (0.83–0.92, 95% CI) and 0.91 (0.86–0.93, 95% CI), respectively. The differences of the T2* values and BMD among the three groups were statistically significant (P < 0.05). The BMD value was greater in the normal group (145.02 ± 18.94 mg/cm3) than the other two groups (97.90 ± 16.18 mg/cm3 for osteopenia and 59.09 ± 18.71 mg/cm3 for osteoporosis). The normal group had a significantly (P < 0.05) smaller T2* value than the other two groups (8.39 ± 4.17 ms in the normal group versus 12.25 ± 3.36 ms in the osteopenia or 15.54 ± 4.9 ms in the osteoporosis). A significant (P < 0.05) difference also existed in the T2* value between the osteopenia and the osteoporosis groups. The correlations of the T2* values with BMD values were significantly (P < 0.05) negative after adjusting for age (r = − 0.33, − 0.45, and − 0.51 for normal, osteopenia, and osteoporosis, respectively). The MRI T2*value is moderately negatively correlated with the bone mineral density assessed with quantitative computed tomography in evaluating osteoporosis in postmenopausal women and may have some potential in assessing severity of lumbar osteoporosis for scientific research.

Epidemiology of osteoporotic fracture in Kazakhstan and development of a country specific FRAX model

Abstract: Retrospective and prospective population-based survey in a region of the Republic of Kazakhstan determined the incidence of fractures at the hip, proximal humerus and distal forearm. The hip fracture rates were used to create a FRAX® model to enhance fracture risk assessment in Kazakhstan. This paper describes the epidemiology of osteoporotic fractures in the Republic of Kazakhstan that was used to develop a country specific FRAX® tool for fracture prediction. We carried out a retrospective population-based survey in Taldykorgan in the Republic of Kazakhstan representing approximately 1% of the country’s population. Hip, forearm and humerus fractures were identified retrospectively in 2015 and 2016 from hospital registers and the trauma centre. Hip fractures were prospectively identified in 2017 from the same sources and additionally from primary care data. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Kazakhstan. Fracture probabilities were compared with those from neighbouring countries having FRAX models. The difference in hip fracture incidence between the retrospective and prospective survey indicated that approximately 25% of hip fracture cases did not come to hospital attention. The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 11,690 and is predicted to increase by 140% to 28,000 in 2050. Hip fracture incidence was a good predictor of forearm and humeral fractures in men but not in women. The FRAX model should enhance accuracy of determining fracture probability among the Kazakh population and help guide decisions about treatment.

Prevalence of vitamin D deficiency and its predictors in the Portuguese population: a nationwide population-based study

Abstract: Vitamin D deficiency is prevalent worldwide, but its prevalence is unknown in adult Portuguese population. In Portugal, 66% of adults present Vitamin D insufficiency/deficiency. Winter, living in Azores, older age, and obesity were the most important risk factors. It highlights the need of strategies to prevent vitamin D deficiency in Portugal. To estimate the prevalence and risk factors of vitamin D deficiency in the adult Portuguese population. Adults (≥ 18 years old) from the EpiReumaPt Study (2011–2013) were included. Standardized questionnaires on socio-demographic and lifestyle features were obtained. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were evaluated using ADVIA Centaur VitD competitive immunoassay (Siemens Healthineers) in 2015–2017 as 25 (OH)D Level 0: ≤ 10 ng/mL; Level 1: 11–19 ng/mL; Level 2: 20–29 ng/mL, and Level 3: ≥ 30 ng/mL. Weighted multinomial regression analysis was conducted to evaluate the association between socio-demographic and lifestyle variables and vitamin D status. Based on weighted analysis, the estimated prevalence of levels of 25(OH)D ≤ 10, 60% of all Portuguese adults, with strong geographical and seasonal variation. This study highlights the need to critically assess the relevance of vitamin D deficiency as a public health problem and the urgent need for a wide and scientifically robust debate about the most appropriate interventions at the individual and societal levels.

Effects of age and sex on osteocalcin and bone-specific alkaline phosphatase—reference intervals and confounders for two bone formation markers

Abstract: Bone formation markers bone-specific alkaline phosphatase and osteocalcin are used in many clinical situations. Therefore, we calculated reference intervals for the two markers and investigated how they are influenced by several factors including sex and age. Furthermore, we established clinically relevant reference intervals for the two markers. The bone turnover markers (BTMs), bone-specific alkaline phosphatase (bone ALP), and osteocalcin (OC), are frequently measured formation markers. The purpose of this study was to establish reference intervals (RIs) for the two BTMs in a general adult Danish population. Bone ALP and OC were measured on the iSYS (IDS Plc) automatic analyzer in samples from the Danish Health2006 5-year follow-up study on serum from 2308 participants (54% women, age range 24–76). Participants with self-reported diagnosis of osteoporosis or receiving hormonal replacement were excluded from analyses while participants on hormonal contraceptives were included. The geometric mean and 95%RI for bone ALP were 13.9 μg/L (7.6–25.6) for men and 13.8 μg/L (7.0–27.4) for women, while for OC 16.0 μg/L (7.5–34.4) for men and 18.6 μg/L (8.1–42.9) for women. Levels of bone ALP increased with increasing age (β 1.004, p < 0.001), while female sex had no effect. OC levels decreased with increasing age (β 0.998, p = 0.009) and increased with female sex (β 1.104, p < 0.001). Based on our findings, we propose for bone ALP and OC three clinical RIs for men based on age and three clinical RI for women based on age and menopausal status. The RI for bone ALP and OC varies with age and sex and the BTMs are influenced differently by the two factors. Consequently, the need for establishing valid RIs is of great importance before the full potential of BTM can be used in clinical practice.

Predictors of imminent risk of fracture in Medicare-enrolled men and women

Abstract: Advancing age, female sex, recent prior fracture and falls, and specific comorbidities and medications contribute to imminent (within 1–2 years) risk of fracture in Medicare enrollees. Clinician awareness of these risk factors and their dynamic nature may lead to improved osteoporosis care for elderly patients. The burden of osteoporotic fracture disproportionately affects the elderly. Growing awareness that fracture risk can change substantially over time underscores the need to understand risk factors for imminent (within 1–2 years) fracture. This study assessed predictors of imminent risk of fracture in the US Medicare population. Administrative claims data from a random sample of Medicare beneficiaries were analyzed for patients aged ≥ 67 years on January 1, 2011 (index date), with continuous coverage between January 1, 2009 and March 31, 2011, excluding patients with non-melanoma cancer or Paget’s disease. Incident osteoporotic fractures were identified during 12 and 24 months post-index. Potential predictors were age, sex, race, history of fracture, history of falls, presence of osteoporosis, cardiovascular diseases, chronic obstructive pulmonary disorder (COPD), mood/anxiety disorders, polyinflammatory conditions, difficulty walking, use of durable medical equipment, ambulance/life support, and pre-index use of osteoporosis medications, steroids, or central nervous system medications. Cox proportional hazards models were used to evaluate predictors of fracture risk in the two follow-up intervals. Among 1,780,451 individuals included (mean age 77.7 years, 66% female), 8.3% had prior fracture and 6.1% had a history of falls. During the 12- and 24-month follow-up periods, 3.0% and 5.4% of patients had an incident osteoporotic fracture, respectively. Imminent risk of fracture increased with older age (double/triple), female sex (> 80%), recent prior fracture (> double) and falls, and specific comorbidities and medications. Demographics and factors including fall/fracture history, comorbidities, and medications contribute to imminent risk of fracture in elderly patients.

The top 100 highly cited articles on osteoporosis from 1990 to 2019: a bibliometric and visualized analysis

Abstract: Research on osteoporosis is a well-developed and promising research field. The top 100 literature included 73 articles and 27 reviews. The average citation number was 747 (range 370 to 2970). Researchers and institutions from the USA, the UK, and France contributed the most to the top high-cited articles. To provide a bibliometric and visualized analysis of the top 100 highly cited articles on osteoporosis indexed by the Web of Science (WoS) from 1990 to 2019. Data were obtained from the WoS Core Collection on Jan 10, 2020. Qualitative and quantitative analysis was conducted based on WoS. Collaboration analysis and keywords analysis were performed using VosView software. A total of 12,863 references were obtained. The top 100 highly cited literature included 73 articles and 27 reviews. The average citation number of the 100 articles was 747 (range 370 to 2970). The fund sources mostly came from the USA. A total of 29 journals published the top 100 highly cited literature. The New England Journal of Medicine had the largest number of papers and the highest total cited times. The USA published 72 articles. The University of California San Francisco published 17 articles, followed by University of Sheffield and Mayo Clinic and Mayo Foundation. Cooper C had the most publications (n = 12) and Genant HK had the largest total citation (n = 11,055). Considering only the first author and corresponding author, Kanis JA had published the most articles. Researchers and institutions from the USA, the UK, and France contributed the most to the top high-cited articles. Research on osteoporosis is a well-developed and promising research field. The top 100 articles have been cited widely and actively. New England Journal of Medicine was the most popular journal. The most productive country was the USA. The University of California San Francisco, University of Sheffield, and Mayo Clinic and Mayo Foundation were the most productive institutions. Cooper C, Kanis JA, and Genant HK were the most prolific and influential authors. Researchers and institutions from North America and Europe contributed the most.

Plain vitamin D or active vitamin D in the treatment of osteoporosis: where do we stand today?

Abstract: Osteoporosis is a major cause of morbidity and mortality worldwide and its prevention in order to avert fractures was considered of great importance in maintaining well-being and independence among the elderly. Strategies for osteoporosis prevention are well delineated, but research shows that the treatment options offered today could still be improved. The role of plain vitamin D (cholecalciferol) in bone health and the prevention of osteoporosis are well documented; however, as a treatment for osteoporosis, either with or without calcium, it has been shown to be ineffective. This is due in part to the strong negative feedback mechanisms in place in vitamin D-replete patients. However, other factors linked directly to ageing such as oestrogen depletion, reduced kidney or liver function may also be involved in reducing the body's capability to activate plain vitamin efficiently. This is why active vitamin D analogues such as alfacalcidol, 1-α-(OH)D3, are of clinical interest. Alfacalcidol requires only one hydroxylation reaction to become active 1,25-(OH)2-vitamin D3, and the 25-hydroxylase catalyzing this reaction is found in the liver and also interestingly in osteoblasts suggesting a local effect. Registered for use in postmenopausal osteoporosis, in most countries worldwide, alfacalcidol has also shown efficacy in glucocorticoid-induced and male osteoporosis. The present review provides compelling evidence for the efficacy of this compound in the treatment of osteoporosis and prevention of fractures both in monotherapy and when combined with other osteoporotic drugs where additive effects are clear. The safety profile of alfacalcidol is shown to be highly acceptable and it is considered less likely to induce hypercalcaemia than another more widely used analogue, calcitriol. Therefore, it remains unclear as to why alfacalcidol is not more widely used in clinical practice.

Elderly men have much lower vertebral fracture risk than elderly women even at advanced age: the MrOS and MsOS (Hong Kong) year 14 follow-up radiology results

Abstract: MrOS MsOS (Hong Kong) studies year 14 follow-up shows for subjects without baseline osteoporotic vertebral deformity, women’s incident vertebral fracture (VF) rate was twice that of men. For subjects with vertebral deformity of baseline ≥ 20% height loss, counting subject, women’s incident VF rate was three times higher than that of men. For MrOS MsOS (Hong Kong) baseline (BL) studies, 2000 men and 2000 women ≥ 65 years were recruited during 2001 to 2003. This study presents the year 14 follow-up (FU). Whole spine MRI was performed in 271 males (mean, 82.8 ± 3.6 years) and 150 females (mean, 82.0 ± 4.29 years). Osteoporotic vertebral deformity (OVD) classification included no OVD (grade 0), and OVDs with 25%~1/3, > 1/3~40%, > 40%~2/3, and > 2/3 height loss (grade 1~6). With an existing VD, a further height loss of ≥ 15% was a VD progression. A new incident VD was a change from grade 0 to ≥ grade 2 or to grade 1 with ≥ 10% height loss. OVD progression and new incident OVD were considered incident VF. The proportion of osteoporotic subjects only slightly increased during FU for men but doubled for women. Groupwise, OVD was not associated with back pain in men; but OVD with > 1/3 height loss was associated with back pain in women. For subjects without BL OVD, 7.9% of men and 14.6% of women had incident VF. For subjects with BL OVD of ≥ 20% height loss, men’s and women’s incident VF were 17.6% and 52.6%, respectively, counting subject and 1.68% and 7.89%, respectively, counting vertebra. Elderly men with or without existing osteoporotic VD have much lower future VF risk than elderly women.

Hip fractures in South Africa: mortality outcomes over 12 months post-fracture

Abstract: With increased urbanisation and longevity in sub-Saharan Africa, the burden of osteoporosis and resultant hip fractures (HF) has increased. This study shows that 1 in 3 subjects dies post-HF, and that there are significant delays and barriers to surgery, reflecting the need to prioritise HF care in South Africa. The outcomes following hip fractures are unknown in sub-Saharan Africa. This study aimed to quantify the mortality rate (MR) following hip fractures and to identify predictors of mortality over 1 year. In this cohort study, demographic, clinical, and biochemical characteristics of consecutive patients with low trauma hip fractures, admitted to the five public sector hospitals in eThekwini (formerly Durban), were recorded. Cox regression analyses identified predictors of mortality at 30 days and 1 year. In the 200 hip fracture patients studied, the mean age was 74.3 years (SD ± 8.8) and 72% were female. Hospital presentation was often delayed, only 15.5% presented on the day of fracture. At admission, 69.5% were anaemic, 42% had hyponatraemia, 34.5% raised creatinine, and 58.5% hypoalbuminaemia. All received skin traction before 173 (86.5%) underwent surgical fixation. Median time from admission to surgery was 19.0 days (IQR 12.3–25.0). Median hospital stay was 9.0 days (IQR 12.3–25.0). Mortality rates were 13% and 33.5% at 30 and 365 days, respectively. Over 1 year, African patients were more likely to die than Indian patients (40.9 versus 30%, HR 11.5 [95% CI 1.51, 2.57]; p = 0.012); delays to surgery predicted death (HR 1.02 [95% CI (1.00, 1.04)]; p = 0.022). In multivariate analyses, death at 1 year was most strongly predicted by an elevated serum creatinine (HR 2.43, 95% CI (1.02, 5.76), p = 0.044]. Hip fractures are associated with high MRs, in part explained by insufficient surgical capacity, highlighting the need for national efforts to improve hip fracture service provision.

Effects of dairy products on bone mineral density in healthy postmenopausal women: a systematic review and meta-analysis of randomized controlled trials

Abstract: To investigate the effects of dairy products on bone mineral density (BMD) in healthy postmenopausal women. The EMBASE, Cochrane Library, Medline, and Web of Science databases were systematically searched for relevant studies. The pooled standardized mean difference (SMD) with its 95% confidence interval (CI) was used as the effect size. Subgroup analysis and Begg’s test were conducted. Six studies with a total of 618 participants were included in the meta-analysis. Milk was the main dairy product used in the trials. There was a significant association between dairy product consumption and BMD of the lumbar spine (SMD 0.21, 95% CI 0.05–0.37, P = 0.009), femoral neck (SMD 0.36, 95% CI 0.19–0.53, P < 0.001), total hip (SMD 0.37, 95% CI 0.20–0.55, P < 0.001), and total body (SMD 0.58, 95% CI 0.39–0.77, P < 0.001). Subgroup analysis suggested that there was a positive effect of dairy product consumption on the BMD of the total hip starting from 12 months and the femoral neck starting from 18 months. There was also a positive association with the BMD in the four sites in people living in low-calcium intake countries. This meta-analysis provides evidence that dairy products can increase BMD in healthy postmenopausal women. Dairy product consumption should be considered an effective public health measure to prevent osteoporosis in postmenopausal women.

Vertebral fracture assessment by dual-energy X-ray absorptiometry along with bone mineral density in the evaluation of postmenopausal osteoporosis.

Abstract: This is a cross-sectional study to look at the utility of DXA-VFA in addition to bone mineral density (BMD) in the evaluation of postmenopausal osteoporosis. Vertebral fracture (VF) was detected in more than two-thirds of postmenopausal women referred for DXA-BMD. Addition of DXA-VFA detected additional 27% with VF whose BMD were in the non-osteoporotic range. VFs are the hallmark of osteoporotic fractures. Prevalent vertebral fractures are an independent risk factor for future fragility fractures. This study was conducted to look at the prevalence of VF by DXA–vertebral fracture assessment (VFA) and to study the utility of DXA-VFA in addition to bone mineral density (BMD) in the evaluation of osteoporosis. A cross-sectional study of the postmenopausal women above the age of 50 years who were referred for BMD assessment by DXA. All subjects underwent VFA and BMD assessment by Hologic DXA. Four hundred postmenopausal women with a mean age of 62.7 ± 6.2 years underwent BMD and VFA assessment by DXA. Prevalent VF was seen in 261 (65.2%) subjects, of which 114 (28.5%) subjects, 135 (33.7%) subjects, and 12 (3%) subjects had mild, moderate, and severe VF, respectively. Among subjects with VF, 136 (52.1%) and 90 (34.5%) had BMD-defined osteoporosis at the spine and femur neck, respectively. Overall, 59% with VF had osteoporosis at either the spine or femur neck. Forty-one-percent subjects with VF had BMD in non-osteoporotic range at both sites, of which 20% had moderate-to-severe VF. Addition of DXA-VFA to BMD assessment detected additional 27% with VF whose BMD was in the non-osteoporotic range. VF was seen in more than two-thirds of the postmenopausal women referred for osteoporosis evaluation. VFA identified additional patients with VF whose BMD was not in the osteoporotic range. Incorporation of VFA to BMD will assist in documenting prevalent vertebral fracture which is an independent risk factor for incident fragility fracture irrespective of the BMD.

Basketball players possess a higher bone mineral density than matched non-athletes, swimming, soccer, and volleyball athletes: a systematic review and meta-analysis

Abstract: Basketball athletes possess a higher bone mineral density (BMD) than matched non-athletes and swimming, soccer, and volleyball athletes. Differences appear to be exacerbated with continued training and competition beyond adolescence. The greater BMD in basketball athletes compared to non-athletes, swimming, and soccer athletes is more pronounced in males than females. The aim of this study was to examine differences in total and regional bone mineral density (BMD) between basketball athletes, non-athletes, and athletes competing in swimming, soccer, and volleyball, considering age and sex. PubMed, MEDLINE, ERIC, Google Scholar, and Science Direct were searched. Included studies consisted of basketball players and at least one group of non-athletes, swimming, soccer, or volleyball athletes. BMD data were meta-analyzed. Cohen’s d effect sizes [95% confidence intervals (CI)] were interpreted as: trivial ≤ 0.20, small = 0.20–0.59, moderate = 0.60–1.19, large = 1.20–1.99, and very large ≥ 2.00. Basketball athletes exhibited significantly (p < 0.05) higher BMD compared to non-athletes (small-moderate effect in total-body: d = 1.06, CI 0.55, 1.56; spine: d = 0.67, CI 0.40, 0.93; lumbar spine: d = 0.96, CI 0.57, 1.35; upper limbs: d = 0.70, CI 0.29, 1.10; lower limbs: d = 1.14, CI 0.60, 1.68; pelvis: d = 1.16, CI 0.05, 2.26; trunk: d = 1.00, CI 0.65, 1.35; and femoral neck: d = 0.57, CI 0.16, 0.99), swimming athletes (moderate-very large effect in total-body: d = 1.33, CI 0.59, 2.08; spine: d = 1.04, CI 0.60, 1.48; upper limbs: d = 1.19, CI 0.16, 2.22; lower limbs: d = 2.76, CI 1.45, 4.06; pelvis d = 1.72, CI 0.63, 2.81; and trunk: d = 1.61, CI 1.19, 2.04), soccer athletes (small effect in total-body: d = 0.58, CI 0.18, 0.97), and volleyball athletes (small effect in total-body: d = 0.32, CI 0.00, 0.65; and pelvis: d = 0.48, CI 0.07, 0.88). Differences in total and regional BMD between groups increased with age and appeared greater in males than in females. Basketball athletes exhibit a greater BMD compared to non-athletes, as well as athletes involved in swimming, soccer, and volleyball.

Loss in DXA-estimated total body lean mass but not fat mass predicts incident major osteoporotic fracture and hip fracture independently from FRAX: a registry-based cohort study

Abstract: During median follow-up 60 years in 9622 individuals, prior loss in estimated total body lean mass (TBLM), but not total body fat mass loss (TBFM), was associated with increased fracture risk, particularly for hip fracture Weight loss, and especially muscle loss, adversely affects skeletal health The FRAX® tool considers baseline body mass index, but not body composition nor changes in its components over time Our aim was to compare the independent associations between prior loss in DXA-estimated TBLM and TBFM and subsequent fracture risk We identified women and men age 40 years or older with two DXA assessments at least 1 year apart (median interval 33 years) TBLM and TBFM were estimated from weight, sex, and DXA of the spine and hip Incident fractures and deaths were ascertained from linked population-based health service data after the date of the second DXA Hazard ratios (HRs) from Cox regression models were used to study time to fracture from prior loss in TBLM and TBFM adjusted for FRAX-related covariates The study population consisted of 9622 individuals (mean age 67 [SD 10] years, 95% female) We identified 692 subjects with incident major osteoporotic fracture [MOF] and 194 with hip fracture Mean TBLM loss was significantly greater in those with incident MOF and hip fracture (P < 0001) while TBFM loss was only significantly greater in those with incident hip fracture (P < 0001) Each SD greater TBLM loss was associated with 10–13% increased MOF risk and 29–38% increased hip fracture risk, adjusted for TBFM loss and other covariates Prior TBFM loss was not associated with fractures when adjusted for TBLM loss Prior loss in total body lean mass, but not in fat mass, is associated with increased fracture risk, particularly hip fracture, independent of other risk factors This is consistent with the hypothesis that muscle loss (sarcopenia) adversely impacts skeletal health and fracture risk

Undertreatment of osteoporosis following hip fracture: a retrospective, observational study in Singapore.

Abstract: Undertreatment of osteoporosis after hip fracture increases the risk of death, disability, recurrent osteoporotic fractures, and financial burden. Only half were compliant with osteoporosis medications. Elderly patients were less persistent and compliant to treatment. Denosumab was associated with a higher proportion of days covered by osteoporosis medications than oral bisphosphonates. The aim of this study was to identify factors that contributed to the initiation of osteoporosis medications following hip fracture as well as the compliance and persistence to osteoporosis medications. Clinical data of 532 patients older than 50 years old admitted for surgical fixation of hip fractures were reviewed. Three hundred forty-seven had sufficient data for analysis after excluding patients with non-fragility fractures. Prescription for any osteoporosis medication in the year following hip fracture as well as compliance to treatment was evaluated. Only 40.3% of patients were prescribed with osteoporosis medication within 1 year post-hip fracture. Females (p = 0.020) performing dual-energy x-ray absorptiometry scan (p < 0.001) and 25 hydroxyvitamin D levels testing post-hip fracture (p < 0.027) were independent determinants of increased likelihood of being prescribed with osteoporosis medication. Patients with proportion of days covered (PDC) ≥ 0.8 (or 80% of days covered in a year) were defined as compliant. Overall, only 49.7% of the patients were compliant with osteoporosis medications. Elderly patients aged 70–79 years (p = 0.002) and males (p = 0.017) were less persistent with osteoporosis treatment when compared with patients aged < 69 years and females. The compliance was poorer in patients aged 70–79 years (p = 0.026) as compared with those under 69 years of age. Statistically significant difference (p = 0.032) was observed between mean PDC of oral bisphosphonates (0.66) and denosumab (0.83). Only 39.3% of patients were persistent with treatment at 1 year. Our findings demonstrate the urgent need to increase awareness through a structured protocol of osteoporosis treatment. A multi-disciplinary Fracture Liaison Service should be set up to ensure compliance to osteoporosis medication post-hip fracture.

Public priorities for osteoporosis and fracture research: results from a focus group study.

Abstract: Four focus groups were conducted with members of the public to identify important areas for future osteoporosis research. Participants identified priorities to increase public awareness of osteoporosis, reduce delays in diagnosis, improve communication between healthcare providers and to improve follow-up and information provision about causes of osteoporosis, medication harms and prognosis. Patients and the public must be involved in setting research agendas to ensure relevant and impactful questions are prioritised. This study aimed to understand what people living with osteoporosis and fragility fractures felt was important to research, to inform the content of a national survey on research priorities in this area. Focus groups were conducted with members of the public with experience of osteoporosis or fragility fractures. The topic guide was co-developed with a patient and public involvement research user group, and explored participants’ experiences of osteoporosis including diagnosis, management and effect upon their lives, what aspects of their ongoing care was most important to them and what about their care or condition could be improved. Focus groups were audio-recorded, transcribed and analysed thematically. A total of twenty-three participants were recruited to four focus groups. Analysis identified two main themes: challenges in living with osteoporosis and healthcare services for osteoporosis. Information needs was a further cross-cutting theme. Participants called for increased public awareness of osteoporosis and wanted healthcare services to address conflicting messages about diet, exercise and medication. Participants described long delays in diagnosis, poor communication between primary and secondary care and the need for structured follow-up as important areas for future research to address. The findings from this study provide an understanding of research priorities from the perspective of patients and the public, have informed the content of a national survey and have implications for patient education, health services research and policy.

Second rebound-associated vertebral fractures after denosumab discontinuation

Abstract: Here, we report the case of a 69-year-old female who discontinued denosumab to undergo dental treatment. She subsequently suffered rebound-associated vertebral fractures (RVFs) twice. Denosumab is approved in several countries for osteoporosis treatment. Its discontinuation can result in bone turnover rebound increase and rapid bone mineral density loss. Rebound-associated vertebral fractures (RVFs) after discontinuing denosumab have been widely reported. We previously reported the case of a patient who suffered RVFs after discontinuing denosumab to undergo dental treatment. A 69-year-old female suffered five acute VFs 10 months after the last denosumab injection. The current report identifies the risks associated with denosumab discontinuation to undergo dental treatment. The patient described in this report also underwent an additional clinical course after the first RVFs. Next month after the first RVFs, she developed severe back pain when she changed her posture. Magnetic resonance imaging showed new RVFs at T9 and T12 levels. This case indicates that RVFs may occur more than once. In addition, it suggests that additional denosumab injections do not completely eliminate the risk of RVFs.

Does quality of care in hip fracture vary by day of admission

Abstract: This study investigates if the day of the week a person is admitted with a hip fracture influences the quality of care they receive. We found those admitted Thursday and Friday were likely to obtain poorer postoperative care, indicating a need to optimize services ensuring equality for all. We sought to investigate how the day of admission affects the quality of care provided to hip fracture patients according to national standards (The Scottish Standards of Care for Hip Fracture Patients [SSCHFP]). Retrospective analysis of national cohort data. Data were collected by the Scottish Hip Fracture Audit (SHFA) local audit co-ordinators (LACs) at participating Scottish hospitals on behalf of NHS Scotland and the Scottish Government. Adherence to the SSCHFP included assessment of both individual and cumulative standard attainment as a marker for quality of patient care. From January 2014 to April 2018, 15,351 admissions for hip fracture were recorded. Compared with Monday admission (reference day), patients admitted on a Thursday or Friday had a significantly lower likelihood of achieving the postoperative standards of prompt mobilization (OR 1.77; p < 0.001 & OR 1.48; p < 0.001, respectively); prompt physiotherapy assessment (OR 8.61; p < 0.001 & OR 3.47; p < 0.001, respectively); and prompt comprehensive geriatric assessment (OR 1.88; p < 0.001 & OR 1.41; p < 0.001, respectively). Patients admitted on a Friday or Saturday were less likely to receive the preoperative standards of no delay prior to theatre (OR 1.24; p = 0.001 & OR 1.23; p = 0.002, respectively) and avoidance of repeat fasting (OR 1.22; p = 0.009 & OR 1.22; p = 0.01, respectively). Patients admitted on Thursday or Friday were significantly more likely to not receive postoperative care standards than patients admitted on the reference day (Monday). This appears to be related to inequalities in service provision for Saturday and Sunday compared with the rest of the week.

Adjustment of DXA BMD measurements for anthropometric factors and its impact on the diagnosis of osteoporosis.

Abstract: We compared the effect of anthropometric factors on osteoporosis diagnosis by quantitative computed tomography (QCT) and dual energy X-ray absorptiometry (DXA) and found QCT spine volumetric bone mineral density (vBMD) was not associated with body weight, body mass index (BMI) or DXA anteroposterior spine thickness. In contrast, DXA spine and hip areal bone mineral density (aBMD) were strongly associated with all three factors. Adjustment of DXA aBMD measurements improved consistency with QCT vBMD. Although the diagnosis of osteoporosis using DXA T scores preferentially targets patients with BMI, there is evidence that obesity is not protective against fractures. The aim of this study was to compare the effect of anthropometric factors on osteoporosis diagnosis by QCT and DXA and investigate whether adjustment of DXA aBMD can achieve a more even distribution of diagnoses between slimmer and heavier individuals consistent with QCT. The participants were 964 men and 682 women referred for low-dose chest CT and DXA examinations as part of their employers’ health check-up programs. QCT vBMD was measured in the L1–L2 vertebrae and DXA aBMD in the spine and hip. The prevalence of osteoporosis in each tertile of BMI in participants aged > 50 years was evaluated based on their QCT and DXA findings, and then re-evaluated after adjustment to the mean BMI in each sex. Similar investigations were performed for body weight and DXA anteroposterior (AP) spine thickness. The effect of the adjustment of DXA aBMD for anthropometric factors on the correlation with QCT vBMD was also examined. For spine QCT, correlations of age adjusted vBMD residuals against BMI were not statistically significant in men (P = 0.44) or women (P = 0.32). In contrast, slopes for aBMD residuals were all highly statistically significant (P < 0.001). There were similar findings for weight and AP spine thickness. Adjustment of DXA aBMD for anthropometric factors resulted in a more equal spread of diagnoses of osteoporosis and greater consistency with QCT. Our study highlights differences between DXA and QCT in their correlation with anthropometric factors and its effect on the diagnosis of osteoporosis. Adjustment of DXA T scores for anthropometric factors gave greater consistency with QCT vBMD. Further studies are required into whether adjusting DXA aBMD for anthropometric factors has a beneficial impact on the discriminative or predictive power for vertebral fracture.

FRAX: re-adjust or re-think.

Abstract: Since its development in 2008, FRAX has booked its place in the standard day to day management of osteoporosis. The FRAX tool has been appreciated for its simplicity and applicability for use in primary care, but criticised for the same reason, as it does not take into account exposure response. To address some of these limitations, relatively simple arithmetic procedures have been proposed to be applied to the conventional FRAX estimates of hip and major fracture probabilities aiming at adjustment of the probability assessment. However, as the list of these adjustments got longer, this has reflected on its implementation in the standard practice and gave FRAX a patchy look. Consequently, raises the need to re-think of the current FRAX and whether a second generation of the tool is required to address the perceived limitations of the original FRAX. This article will discuss both point of views of re-adjustment and re-thinking.

Differences in fracture prevalence and in bone mineral density between Chinese and White Canadians: the Canadian Multicentre Osteoporosis Study (CaMos).

Abstract: Fracture determinants differ between Canadians of Chinese and White descent, the former constituting the second largest visible minority group in Canada. The results of this study support the importance of characterizing bone health predictors in Canadians of different ethnicity to improve population-specific fracture prevention and treatment strategies. We aimed to compare clinical risk factors, bone mineral density, prevalence of osteoporosis, and fractures between Chinese and White Canadians to identify ethnicity-specific risks. We studied 236 Chinese and 8945 White Canadians aged 25+ years from the Canadian Multicentre Osteoporosis Study (CaMos). The prevalence of osteoporosis using ethnicity-specific peak bone mass (PBM), and of prior and incident low trauma fractures were assessed and compared between groups. Linear regressions, adjusting for age and anthropometric measures, were used to examine the association between baseline and 5-year changes in BMD and ethnicity. Chinese participants had shorter stature, lower BMI, and lower rate of falls than White participants. Adjusted models showed no significant differences in baseline BMD between ethnic groups except in younger men where total hip BMD was 0.059 g/cm2 (0.009; 0.108) lower in Chinese. Adjusted 5-year BMD change at lumbar spine was higher in older Chinese women and men compared with Whites. When using Chinese-specific PBM, the prevalence of osteoporosis in Chinese women was 2-fold lower than when using that of White women The prevalence of fractures was higher in White women compared with Chinese with differences up to 14.5% (95% CI 9.2; 19.7) and 10.5% (95% CI 4.5–16.4) in older White men. Incident fractures were rare in young Chinese compared with White participants and not different in the older groups. Our results support the importance of characterizing bone strength predictors in Chinese Canadians and the development of ethnicity-specific fracture prediction and prevention strategies.

Bone mineral density in young adults: the influence of vitamin D status, biochemical indicators, physical activity and body composition.

Abstract: The aim of the study was to assess the associations of bone mineral density and bone mass with physical activity levels, vitamin D, phosphorus, magnesium, total cholesterol and triglyceride concentration and body composition in young women and men. Physical activity has the most significant effect on bone status especially in men. The aim of the study was to assess the associations of bone mineral density and bone mass with physical activity levels, vitamin D, phosphorus, magnesium, total cholesterol and triglyceride concentration and body composition in young women and men. One hundred subjects aged 19–24 years were included. Bone mineral density (BMD) in distal and proximal parts was evaluated by forearm densitometry. Body composition was analysed with the use of JAWON-Medical-x-scan. The following biochemical indicators were analysed: 25(OH) D and 1,25(OH)2D, magnesium, phosphorus, total cholesterol and triglycerides. Physical activity levels were assessed by interview. Significant correlations between BMD and physical activity, skeletal muscle mass and body fat percentage were revealed in men. Among women, considerably weaker correlations of BMD with body composition and physical activity were noted than in men. BMD in the distal part correlated only with lean body mass, soft lean mass and body fat percentage. The strongest relationship between physical activity and bone mineral status parameters was noted for BMD in men. In women, physical activity did not affect BMD. Physical activity has the most significant effect on bone status especially in men.