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Journal ArticleDOI

Diagnosis of Osteoporosis

01 Jun 2011-The Journal of the Korean Hip Society (The Korean Hip Society)-Vol. 23, Iss: 2, pp 108-115

TL;DR: WHO recently developed FRAX, a novel method the authors can use to more conveniently evaluate osteoporotic fracture risk, and dual energy X-ray absorptiometry (DXA), one of the measurement tools for BMD, is particularly regarded as the appropriate tool applicable to WHO criteria.

AbstractOsteoporosis is defined as a skeletal disorder characterized by compromised bone strength, predisposing an individual to increased fracture risk. Many factors can lead to the development of osteoporosis. It is usually asymptomatic unless osteoporotic fracture and secondary changes of bone structure occur. Early radiographs show normal findings; however, osteopenic appearance, fracture, cortical bone thinning, and roughening of bone trabeculae can be found according to severity of osteoporosis. These symptoms are most frequently found in the spine and proximal femur. Bone mineral density (BMD) is the standard method used to diagnose osteoporosis, and dual energy X-ray absorptiometry (DXA), one of the measurement tools for BMD, is particularly regarded as the appropriate tool applicable to WHO criteria, which defines osteoporosis as a T-score of less than 2.5 SDs below the mean of young adult women. Peripheral densitometry is less useful in predicting the risk of fractures of the spine and proximal femur, and it is not enough to diagnose and treat osteoporosis. Biochemical bone markers have demonstrated utility in clinical research and trials; however, they cannot replace BMD as a diagnostic tool. WHO recently developed FRAX, a novel method we can use to more conveniently evaluate osteoporotic fracture risk.

Topics: Osteoporosis (64%), FRAX (63%), Skeletal disorder (55%), Bone mineral (55%), Cortical bone (54%)

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Journal ArticleDOI
TL;DR: FO was not properly restored in 23% of subjects receiving bipolar hemiarthroplasty due to femoral neck fracture and independently predicted fair MBI after the surgery.
Abstract: Background Restoring preoperative horizontal femoral offset (FO) promised good functional outcome in patients receiving total hip arthroplasty. However, relatively little was known regarding the clinical relevance of restoring the offset in patients with bipolar hemiarthroplasty to treat displaced femoral neck fracture. Therefore, the objective of this study was to evaluate postoperative FO accurately and verify its relation with functional outcome. Methods One hundred elderly patients who received bipolar hemiarthroplasty to treat displaced femoral neck fracture were identified. Preoperative CT scanning of contralateral hip joint and reconstruction of images led to rotation-free FO. By referencing postoperative implant specification and comparing to measured values in Picture Archive and Communication System, rotation-free postoperative FO and the amount of change were acquired. Postoperative Harris Hip Score (HHS) and Modified Barthel Index (MBI) were evaluated to measure functional outcome at 12-month after the surgery. Patients with significant FO change were identified. Multiple regression analysis was conducted to determine if the FO change might independently affect the outcome regardless of confounding factors. Results The mean preoperative offset was 37.4 ± 2.5 increased by 12.7 ± 9.6% after the surgery. Only 25.0% of postoperative offset after hemiarthroplasty was changed within ±5% of preoperative offset. A total of 45.0% of postoperative offset changed within ±10% while 77.0% of postoperative offset changed within ±20%. 23% of patients whose FO changed more than 20% showed significantly worse outcome score than the patients whose FO change remained within ±20% of initial value. Mean MBI and HHS were negatively correlated with FO change. After adjusting for confounding factors, significant correlation remained between modification of FO and MBI, but not between FO change and HHS ( B = 4.576; β = 0.235; 95% confidence interval of B: 0.534 to 8.135). Conclusions FO was not properly restored in 23% of subjects receiving bipolar hemiarthroplasty due to femoral neck fracture. FO restoration independently predicted fair MBI after the surgery. Therefore, surgeons should pay attention to restoring FO with meticulous templating.

8 citations


Journal ArticleDOI
TL;DR: Engaging in the outdoor exercise program, including aerobic and resistance exercises, for 20 weeks improved bone mineral density and inhibited bone loss in old women and had a positive influence on vitamin D levels, thereby potentially lowering the risk of osteoporosis.
Abstract: The purpose of this study is to investigate the effects of indoor and outdoor exercise environments on bone mineral density and body composition in old women. A total of 26 old women were randomly divided into two groups: an indoor exercise group (IE, n=13) and an outdoor exercise group (OE, n=13). The exercise groups performed moderate exercise (HR max 50~70%; RPE 11-15) three times a week for 60 minutes over 20 weeks. After exercise training, bone mineral density was significantly improved in the OE group as compared with the IE group. Body fat mass was significantly decreased in the IE group. Weight, lean body mass, and body fat mass were significantly decreased in the OE group. Body mass index was significantly decreased in the outdoor exercise group as compared to the IE group. Our findings show that a 20-week program of outdoor exercise training improves bone mineral density and body composition in old women. As mentioned above, it has been found that engaging in an outdoor exercise program for 20 weeks has a positive effect on bone mineral density and body composition in old women. In conclusion, engaging in the outdoor exercise program, including aerobic and resistance exercises, for 20 weeks improved bone mineral density and inhibited bone loss in old women and had a positive influence on vitamin D levels, thereby potentially lowering the risk of osteoporosis.

4 citations


Journal ArticleDOI
TL;DR: Dietary factors, such as higher vegetable intake, seem to affect the changes in bone mineral density in more favorable way, and efforts are needed to enhance the access to nutritional care for rural elderly postmenopausal women.
Abstract: This study was conducted to investigate dietary factors, bone status, and bone loss in postmenopausal women in rural areas. A total of 189 women participated in the follow-up study after two years. Radius, Tibia, and Phalanx SOS (Speed of Sound) was measured on two occasions 2 years apart by ultra-sonic-metry, and % body fat was measured by bioelectrical impedance analysis at the baseline and after 2years. Dietary intake data were collected 4 times at different season by 24-hour recall method, and then calculated as average. Bone density of radius decreased by 4.2% during the two year period. When the subjects were divided into three groups, by bone decline level during two years, the lowest bone loss group had higher potassium and vegetable intake than other groups. Age and calcium intakes showed significant correlation with bone decline rate at tibia. In multiple regressions, the baseline SOS, vitamin A, vegetables and eggs intakes were found to be significant factors for tibia bone decline. In conclusion, dietary factors, such as higher vegetable intake, seem to affect the changes in bone mineral density in more favorable way. Therefore, efforts are needed to enhance the access to nutritional care for rural elderly postmenopausal women. (Korean J Nutr 2012; 45(5): 470 ~ 478)

3 citations


References
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Journal ArticleDOI
14 Feb 2001-JAMA
TL;DR: Though prevalent in white postmenopausal women, osteoporosis occurs in all populations and at all ages and has significant physical, psychosocial, and financial consequences.
Abstract: OBJECTIVES To clarify the factors associated with prevention, diagnosis, and treatment of osteoporosis, and to present the most recent information available in these areas. PARTICIPANTS From March 27-29, 2000, a nonfederal, nonadvocate, 13-member panel was convened, representing the fields of internal medicine, family and community medicine, endocrinology, epidemiology, orthopedic surgery, gerontology, rheumatology, obstetrics and gynecology, preventive medicine, and cell biology. Thirty-two experts from these fields presented data to the panel and an audience of 699. Primary sponsors were the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institutes of Health Office of Medical Applications of Research. EVIDENCE MEDLINE was searched for January 1995 through December 1999, and a bibliography of 2449 references provided to the panel. Experts prepared abstracts for presentations with relevant literature citations. Scientific evidence was given precedence over anecdotal experience. CONSENSUS PROCESS The panel, answering predefined questions, developed conclusions based on evidence presented in open forum and the literature. The panel composed a draft statement, which was read and circulated to the experts and the audience for public discussion. The panel resolved conflicts and released a revised statement at the end of the conference. The draft statement was posted on the Web on March 30, 2000, and updated with the panel's final revisions within a few weeks. CONCLUSIONS Though prevalent in white postmenopausal women, osteoporosis occurs in all populations and at all ages and has significant physical, psychosocial, and financial consequences. Risks for osteoporosis (reflected by low bone mineral density [BMD]) and for fracture overlap but are not identical. More attention should be paid to skeletal health in persons with conditions associated with secondary osteoporosis. Clinical risk factors have an important but poorly validated role in determining who should have BMD measurement, in assessing fracture risk, and in determining who should be treated. Adequate calcium and vitamin D intake is crucial to develop optimal peak bone mass and to preserve bone mass throughout life. Supplementation with these 2 nutrients may be necessary in persons not achieving recommended dietary intake. Gonadal steroids are important determinants of peak and lifetime bone mass in men, women, and children. Regular exercise, especially resistance and high-impact activities, contributes to development of high peak bone mass and may reduce risk of falls in older persons. Assessment of bone mass, identification of fracture risk, and determination of who should be treated are the optimal goals when evaluating patients for osteoporosis. Fracture prevention is the primary treatment goal for patients with osteoporosis. Several treatments have been shown to reduce the risk of osteoporotic fractures, including those that enhance bone mass and reduce the risk or consequences of falls. Adults with vertebral, rib, hip, or distal forearm fractures should be evaluated for osteoporosis and given appropriate therapy.

4,197 citations


Journal ArticleDOI
TL;DR: This paper summarizes issues and proposes diagnostic criteria for osteoporosis for practical use and addresses a number of problems which need to be addressed in adapting a conceptual definition for clinical use.
Abstract: VER THE YEARS many definitions of osteoporosis have been 0 offered to describe variously the outcome events (fragility fractures), the process giving rise to porous bones, or the resultant diminution of bone mass. More consistency has been achieved in recent years by the development of definitions that cover the spectrum of its manifestations. from the reduced amount of bone present to some of the consequences of bone loss. A consensus development conference statement defined osteoporosis as "a disease characterized by low bonc mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk."'" The definition has survived the rigors of the most recent consensus development confcrence."' There are, however, a number of problems which need to be addressed in adapting a conceptual definition for clinical use. Some of these problems were recently discussed by an expert panel of the World Health Organization."' This paper summarizes these issues and proposes diagnostic criteria for osteoporosis for practical use.

3,169 citations


01 Jan 1994
TL;DR: There is little evidence that osteoporosis can usefully be tackled by a public health policy to influence risk factors such as smoking, exercise and nutrition, so the selective use of screening techniques will improve the cost-benefit ratio of intervention.

2,840 citations



Journal ArticleDOI
TL;DR: The models provide a framework which enhances the assessment of fracture risk in both men and women by the integration of clinical risk factors alone and/or in combination with BMD.
Abstract: Summary A fracture risk assessment tool (FRAX™) is developed based on the use of clinical risk factors with or without bone mineral density tests applied to the UK.

1,887 citations