Development and use of FRAX in osteoporosis.

WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
Osteoporosis International (Impact Factor: 4.04). 06/2010; 21 Suppl 2:S407-13. DOI: 10.1007/s00198-010-1253-y
Source: PubMed

ABSTRACT This paper reviews briefly the development and clinical use of FRAX in the development of assessment guidelines for osteoporosis.Fractures are the clinical consequence of osteoporosis and are a major cause of morbidity and mortality worldwide. Several treatments are available that have been shown to decrease the risk of fracture, but problems arise in identifying individuals at high fracture risk so that treatments can be effectively targeted. Case finding can be enhanced by the consideration of clinical risk factors that provide information on fracture risk over and above that provided by bone mineral density measurements. The FRAX tool integrates information on fracture risk from clinical risk factors with or without the use of BMD and can be used to improve the targeting of individuals at high fracture risk.

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    ABSTRACT: Background People with schizophrenia experience increased rates of osteoporosis and may be at heightened risk of fractures. We conducted a systematic review and meta-analysis to investigate fractures among people with schizophrenia compared to people without mental illness. Method We systematically searched major electronic databases from inception till 10/2014. Articles were included that reported the number of fractures in people with schizophrenia and a control group. Two independent authors conducted searches, completed methodological assessment and extracted data. Data was narratively synthesised and a random effects incidence rate ratio (IRR) meta-analysis was performed. Results Eight studies were included encompassing 48,384 people with schizophrenia (49.9 -75.2 years, 41-100% female) and 3,945,783 controls. The pooled adjusted rate of fractures per 1000 person years was 5.54 (95% CI 4.92-5.57) in people with schizophrenia and 3.48 (95% CI 3.39-3.64) in control participants. The comparative meta-analysis showed that people with schizophrenia experience an increased rate of fractures compared to control participants (IRR 1.72, 95% CI = 1.24 to 2.39, I2= 49%; n = 168,914). There was insufficient data to conduct a robust moderator analysis, but the narrative review consistently highlighted antipsychotic medication was an important risk factor for fractures. Conclusion People with schizophrenia are at significantly increased risk of fractures. Future research is required to understand the mechanisms and should seek to validate fracture prediction algorithms used in the general population. Importantly there is a need to develop preventative strategies to improve bone health and reduce fracture risk involving the wider multidisciplinary team and incorporating falls prevention strategies.
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    ABSTRACT: Secure fixation of fractured osteoporotic bone is a serious clinical challenge mainly because the reduced mechanical quality of low-density bone hampers proper implant fixation. Recent experimental findings have shown strong evidence for a rather complex bone-implant interface contact behavior, with frictional and non-linear mechanical properties. Furthermore, the bone microarchitecture is highly diverse even within the same anatomical site of a specific individual. Due to this intrinsic variability experimental studies that could analyze in detail the contributions of screw designs and thread geometry would require a very large amount of bone specimens; this hampers finding potential improvements for implant fixation. As a complementary approach, computational methods may overcome this limitation, since the same specimen can be tested repeatedly in numerous configurations and under various loading conditions. Recent advances in imaging techniques combined with parallel computing methods have enabled the creation of high-resolution finite-element models that are able to represent bone-implant systems in great detail. Yet, the predictive power of the mechanical competence of bone-implant systems is still limited, both on the apparent level and on the local microstructural level. The current strategy in high-resolution FE models to model the bone-implant interface, employing fully bonded cube-like elements, needs to be reconsidered, refined and validated, such that it mimics more closely the actual non-linear mechanical behavior as observed in vitro in order to exploit the full potential of numeric models as an effective, complementary research method to physical in vitro models.
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    ABSTRACT: Introduction. Secondary osteoporosis occurs in many diseases. Celiac disease-induced osteoporosis is the consequence of secondary hyperparathyroidism. Biochemical bone markers show predominance of bone resorption, thus making the bisphosphonates the first line therapy option. Intestinal mucosal changes are reversible on gluten-free diet. Osteoporosis reversibility is also possible, provided postmenopausal osteoporosis risk factors independent from celiac disease are not present. Case report. We presented a postmenopausal woman with at least a 10-year history of celiac disease prior to diagnosis, which had overt secondary hyperparathyroidism with insufficient status of vitamin D and a significant bone mass reduction. At the time of diagnosis of celiac disease the patient was receiving 250 jig of levothyroxine daily without achieving optimal substitution. Three years after the initiation of gluten-free diet the patient was without any signs and symptoms of the disease. All laboratory findings were within normal range. It was decided to treat the underlying disease and to supplement calcium and vitamin D without the initiation of bisphosponate therapy. Conclusion. Osteoporosis regression justified this therapeutic approach. The presence of primary autoimmune hypothyroidism makes this case specific, since the inability for optimal substitution therapy with a high daily dose of levothyroxine provoked the suspicion of celiac disease.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 01/2015; 72(1):72-76. DOI:10.2298/VSP1501072K · 0.27 Impact Factor

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