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Osteoporosis in Africa—where are we now
Abstract
Africa is experiencing an exponential increase in the number of older persons. The number of persons surviving with human immunodeficiency virus is simultaneously increasing due to improved availability of anti-retroviral therapy. The burden of non-communicable diseases, in particular, osteoporosis and its consequent fragility fractures, is also predicted to increase. Osteoporosis, however, remains a neglected disease and there are no age-standardized reference data available to accurately screen and diagnose individuals with osteoporosis. Epidemiological studies reporting the incidence of hip fracture or vertebral fractures are limited from Africa, especially Sub-Saharan Africa. The studies are usually limited as they are based on a retrospective data and small study numbers and often from a single study site. However, compared with early initial studies, the more recent studies show that osteoporosis and fractures are increasing across the continent. The overall incidence rates for osteoporosis and fractures still vary greatly between different regions in Africa and ethnic groups. Predisposing factors are similar with those in developed countries, but awareness of osteoporosis is sorely lacking. There is a lack of awareness among the population as well as health authorities, making it extremely difficult to quantify the burden of disease. There is great potential for research into the need and availability of preventive strategies. The FRAX® tool needs to be developed for African populations and may circumvent the shortage of bone densitometry.
... e prevalence of osteoporosis among South African men is poorly studied despite many osteoporosis risk factors occurring in South Africa [1]. Awareness of osteoporosis is sorely lacking among men, the population at large as well as health authorities, making it extremely difficult to quantify the burden of the disease [1]. ...
... e prevalence of osteoporosis among South African men is poorly studied despite many osteoporosis risk factors occurring in South Africa [1]. Awareness of osteoporosis is sorely lacking among men, the population at large as well as health authorities, making it extremely difficult to quantify the burden of the disease [1]. Osteoporosis is defined as a skeletal disorder that is characterized by compromised bone strength, ultimately predisposing a person to an increased risk for fracture [2]. ...
... Several alternative imaging tools are available to measure volumetric BMD, including quantitative computed tomography (QCT) [1]. QCT is a feasible option in resourcelimited settings [1]. ...
Developing countries are predicted to bear the burden of osteoporosis in the coming decades. The prevalence of osteoporosis in South African men is unknown, but is thought to be rare. Opportunistic screening for osteoporosis can be performed using quantitative computed tomography (CT) obtained for various clinical indications. We assessed the frequency of osteoporosis in male patients using quantitative computed tomography (CT) obtained for various clinical indications. Data were collected from abdominal and spinal CT scans performed at the radiology department of a provincial tertiary hospital between January 2019 and January 2021. The CT examinations were derived from 507 male patients (mean age, 45±15 years; 83% Black, 0.8% Coloured, 4.1% Indian and 11.2% White). In the CT scans, the region of interest was placed manually at the axial cross-sections of L1 and L3 vertebrae. Using densitometry, we calculated average bone mass density and T and Z scores. We diagnosed osteoporosis in 18.5% (n = 94) of our patients. Only 7.9% of patients younger than 50 had osteoporosis, while 35.9% of patients older than 50 years showed signs of osteoporosis. Osteoporosis was more common amongst White male patients (45.6%) and least common in Black male patients (14.4%). Indian patients had the highest prevalence of osteopenia (42.9%). We successfully used CT scans, obtained for various conditions, to identify large numbers of patients with low bone mineral density (BMD). The prevalence of osteoporosis in this sample is similar to rates reported elsewhere in Africa. Asymptomatic patients at risk of developing insufficiency fractures can be diagnosed and managed early using CT scans, thus preventing unnecessary admissions and reducing osteoporosis-related morbidity and mortality.
... In this study, the prevalence of osteoporosis in the world was 18.3%, which is calculated based on reports of the prevalence of osteoporosis from 86 studies across five continents. Although the number of reported epidemiological studies on osteoporosis in Africa is limited, recent studies have shown that osteoporosis and related fractures increase across the continent [93]. Therefore, based on the results of this study, it was revealed that the prevalence of osteoporosis in Africa is much worse than that in other continents. ...
... Health policymakers can also help prevent and reduce osteoporosis in the community through a variety of means, such as moderate physical activity, an appropriate intake of calcium and vitamin D, cessation of smoking, and pharmaceutical intervention in high-risk groups. Also, effective dissemination of findings from research should be used to increase the awareness of osteoporosis, both among the general population and in the health services, to increase early detection of risk factors and to motivate preventive measures [90][91][92][93][94][95][96][97][98][99][100][101][102]. ...
Background
Osteoporosis affects all sections of society, including families with people affected by osteoporosis, government agencies and medical institutes in various fields. For example, it involves the patient and his/her family members, and government agencies in terms of the cost of treatment and medical care. Providing a comprehensive picture of the prevalence of osteoporosis globally is important for health policymakers to make appropriate decisions. Therefore, this study was conducted to investigate the prevalence of osteoporosis worldwide.
Methods
A systematic review and meta-analysis were conducted in accordance with the PRISMA criteria. The PubMed, Science Direct, Web of Science, Scopus, Magiran, and Google Scholar databases were searched with no lower time limit up till 26 August 2020. The heterogeneity of the studies was measured using the I ² test, and the publication bias was assessed by the Begg and Mazumdar’s test at the significance level of 0.1.
Results
After following the systematic review processes, 86 studies were selected for meta-analysis. The sample size of the study was 103,334,579 people in the age range of 15–105 years. Using meta-analysis, the prevalence of osteoporosis in the world was reported to be 18.3 (95% CI 16.2–20.7). Based on 70 studies and sample size of 800,457 women, and heterogenicity I ² : 99.8, the prevalence of osteoporosis in women of the world was reported to be 23.1 (95% CI 19.8–26.9), while the prevalence of osteoporosis among men of the world was found to be 11.7 (95% CI 9.6–14.1 which was based on 40 studies and sample size of 453,964 men.). The highest prevalence of osteoporosis was reported in Africa with 39.5% (95% CI 22.3–59.7) and a sample size of 2989 people with the age range 18–95 years.
Conclusion
According to the medical, economic, and social burden of osteoporosis, providing a robust and comprehensive estimate of the prevalence of osteoporosis in the world can facilitate decisions in health system planning and policymaking, including an overview of the current and outlook for the future; provide the necessary facilities for the treatment of people with osteoporosis; reduce the severe risks that lead to death by preventing fractures; and, finally, monitor the overall state of osteoporosis in the world. This study is the first to report a structured review and meta-analysis of the prevalence of osteoporosis worldwide.
... Osteoporosis has a high prevalence rate in Africa. In Egypt, for example, about one-fifth of men and one-third of women are affected [4]. ...
Postmenopausal osteoporosis is a critical issue for female health worldwide. This current study was designed to evaluate the role of nanopowder eggshell (NPES) in healthy and ovariectomy-induced osteoporosis rats. Fifty-six female rats were divided into healthy rats (35) and ovariectomized rats (21). The healthy rats were subdivided into five groups (G1–G5) and received one of the following treatments: saline, 20 or 40 mg/kg of calcium carbonate, and 20 or 40 mg/kg of NPES. The 21 ovariectomized rats were divided into three groups (G6–G8) and received either saline, 40 mg/kg of calcium carbonate, or 40 mg/kg of NPES. Biochemical and histopathological assessments of bone formation and resorption were performed. Biomarkers of bone formation (calcium and osteocalcin (OCN)) and calcium content in left femur ashes were significantly higher in healthy rats given 40-mg/kg NPES than in healthy control rats and healthy rats given 40-mg/kg calcium carbonate. The ovariectomized groups had significantly lower levels of vitamin D3, OCN, and osteoprotegerin (OPG) than the healthy control. Alanine transaminase (ALT), alkaline phosphatase (ALP), and receptor activator of nuclear factor-κB ligand (RANKL) were significantly increased in the ovariectomized group than in the healthy control group. Treatment with NPES and calcium carbonate reduced liver enzymes in ovariectomized rats. NPES treatment significantly increased Vit D3, OCN, OPG, and bone ash mineral content (calcium, magnesium, zinc, and phosphorus) in ovariectomized rats. NPES also increased femur cortical thickness, osteoblast number, and collagen fiber. The current study suggests that NPES can modulate bone turnover biomarkers and increase bone trace elements. Moreover, NPES alleviates bone resorption in ovariectomy-induced osteoporosis.
... Osteoporosis is a geriatric condition characterised by bone mass and microarchitecture deterioration. This often neglected disease carries high morbidity and healthcare cost in developing nations experiencing rapid population ageing [1,2]. For instance, hip fracture incidence in Malaysia is projected to increase from 5880 cases in 2018 to 20,893 cases by 2050, representing the highest increase in Asia [3]. ...
Background:
Osteoporosis is an emerging geriatric condition with high morbidity and healthcare cost in developing nations experiencing rapid population ageing. Thus, identifying strategies to prevent osteoporosis is critical in safeguarding skeletal health. This study aimed to evaluate the effects of a bone health screening and education programme on knowledge, beliefs, and practice regarding osteoporosis among Malaysians aged 40 years and above.
Methods:
A longitudinal study was conducted from April 2018 to August 2019. During the first phase of the study, 400 Malaysians (190 men, 210 women) aged ≥ 40 years were recruited in Klang Valley, Malaysia. Information on subjects' demography, medical history, knowledge, and beliefs regarding osteoporosis, physical activity status, and dietary and lifestyle practices were obtained. Subjects also underwent body anthropometry measurement and bone mineral density scan (hip and lumbar spine) using a dual-energy X-ray absorptiometry device. Six months after the first screening, similar investigations were carried out on the subjects.
Results:
During the follow-up session, 72 subjects were lost to follow up. Most of them were younger subjects with a lower awareness of healthy practices. A significant increase in knowledge, beliefs (p < 0.05), calcium supplement intake (p < 0.001), and dietary calcium intake (p = 0.036) and a reduction in coffee intake (p < 0.001) were found among subjects who attended the follow-up. In this study, the percentage of successful referrals was 41.86%. Subjects with osteoporosis were mostly prescribed alendronate plus vitamin D3 by medical doctors, and they followed the prescribed treatment accordingly.
Conclusions:
The bone health screening and education programmes in this study are effective in changing knowledge, beliefs, and practice regarding osteoporosis. The information is pertinent to policymakers in planning strategies to prevent osteoporosis and its associated problems among the middle-aged and elderly population in Malaysia. Nevertheless, a more comprehensive bone health education program that includes long-term monitoring and consultation is needed to halt the progression of bone loss.
... The prevalence of osteoporosis in Egypt is estimated to be 21.9% in men and 28.4% in postmenopausal women, while 53.9% of woman as having osteopenia. A recent study has concluded a higher prevalence (47.8%) of osteoporosis among rural postmenopausal women [16]. A recently published systematic review included 71 studies, representative of many different populations of the globe has revealed that occupation is regarded as a major factor contributing to suboptimal vitamin D levels, and indoor workers are at a higher risk of osteoporosis compared with outdoor ones, where 78% of indoor workers were vitamin D deficient compared with 48% of outdoor peers [1,17]. ...
... This has been linked to several reasons. Firstly, health authorities have been overwhelmed by the burden of communicable diseases such as tuberculosis and human immunodeficiency virus (HIV) [7]. Secondly, tools to assess the BMD and consequently diagnose osteoporosis such as dual X-ray absorptiometry (DXA) are not widely available, hindering early diagnosis and treatment of the disease. ...
The objective of this consensus statement is to inform the clinical practice communities, research centres and policymakers across Africa of the results of the recommendations for osteoporosis prevention, diagnosis and management. The developed guideline provides state-of-the-art information and presents the conclusions and recommendations of the consensus panel regarding these issues.
Purpose:
To reach an African expert consensus on a treat-to-target strategy, based on current evidence for best practice, for the management of osteoporosis and prevention of fractures.
Method:
A 3-round Delphi process was conducted with 17 osteoporosis experts from different African countries. All rounds were conducted online. In round 1, experts reviewed a list of 21 key clinical questions. In rounds 2 and 3, they rated the statements stratified under each domain for its fit (on a scale of 1-9). After each round, statements were retired, modified or added in view of the experts' suggestions and the percent agreement was calculated. Statements receiving rates of 7-9 by more than 75% of experts' votes were considered as achieving consensus.
Results:
The developed guidelines adopted a fracture risk-centric approach. Results of round 1 revealed that of the 21 proposed domains, 10 were accepted whereas 11 were amended. In round 2, 32 statements were presented: 2 statements were retired for similarity, 9 statements reached consensus, whereas modifications were suggested for 21 statements. After the 3rd round of rating, the experts came to consensus on the 32 statements. Frequency of high-rate recommendation ranged from 83.33 to 100%. The response rate of the experts was 100%. An algorithm for the osteoporosis management osteoporosis was suggested.
Conclusion:
This study is an important step in setting up a standardised osteoporosis service across the continent. Building a single model that can be applied in standard practice across Africa will enable the clinicians to face the key challenges of managing osteoporosis; furthermore, it highlights the unmet needs for the policymakers responsible for providing bone health care together with and positive outcomes of patients' care.
Hyponatraemia and Vitamin D deficiency are common conditions in older adults. Both conditions cause bone fragility and gait abnormalities, which are risk factors for falls and poor health outcomes in older adults. Vitamin D deficiency is a risk factor for osteoporosis and increases the risk for fragility fractures. Hyponatraemia, the commonest electrolyte abnormality, causes bone resorption and contributes to falls by impairing cognition and by causing gait abnormalities. Sodium homeostasis is complex and the syndrome of inappropriate antidiuretic hormone secretion (SIADH), a diagnosis of exclusion, is one of the most common causes of hyponatraemia. Instability is a feared geriatric syndrome, as falls can have devastating consequences for the older adult, leading to significant morbidity and mortality. Previous studies have shown that patients with hyponatraemia had a higher rate of vitamin D deficiency and, conversely, those with vitamin D deficiency had a higher rate of hyponatraemia. The exact pathophysiological mechanism behind this correlation is unclear but may involve bone derived hormone fibroblast growth factor 23 and the renin–angiotensin–aldosterone system. A case of an 83-year-old Asian female, who presented with an osteoporotic intertrochanteric femoral fracture following a fall, is presented. She was found to have chronic hyponatraemia and was subsequently diagnosed with SIADH due to vitamin D deficiency.
This study assesses BMSCs’ effect on bone strength and osteoblast activity in rats with osteoporosis. 40 SD female rats were assigned into normal (A) group, model (B) group, puerarin (C) group, and BMSCs (D) group followed by analysis of bone strength by small animal bone strength analyzer and the expression of ROCK1 protein in tibia by immunohistochemistry. The bone strength of group B was lower than group A ( P < 0.05), and higher in groups C and D than group B ( P < 0.05) with further higher in group D than group C ( P < 0.05). Group A showed obvious mesh cancellous bone trabecular bone and continuity, compact structure, and group B cells appeared loose and irregular distribution, parts cancellous bone trabeculae decrease and part of the fracture, and arranged in sparse irregular distribution. The decrease of trabecular bone in group C and D is not more obvious than group B and the morphology in group D got better improved than in group C. Group B showed lower proliferation of osteoblasts and ALP activity than group A ( P < 0.05) and the proliferation and ALP activity in groups C and D was increased significantly compared with group B ( P < 0.05). ROCK1 expression was significantly lower in group B than group A ( P < 0.05) higher in groups C and D than group B ( P < 0.05). Bone marrow mesenchymal stem cells (BMSCs) can effectively increase the bone strength and activity of osteoblasts in rats with osteoporosis, and promote the activation of ROCK signal.
This systematic review and meta-analysis estimated the global, regional prevalence, and risk factors of osteoporosis. Prevalence varied greatly according to countries (from 4.1% in Netherlands to 52.0% in Turkey) and continents (from 8.0% in Oceania to 26.9% in Africa). Osteoporosis is a common metabolic bone disorder in the elderly, usually resulting in bone pain and an increased risk of fragility fracture, but few summarized studies have guided global strategies for the disease. Therefore, we pooled the epidemiologic data to estimate the global, regional prevalence, and potential risk factors of osteoporosis. We conducted a comprehensive literature search through PubMed, EMBASE, Web of Science, and Scopus, to identify population-based studies that reported the prevalence of osteoporosis based on the World Health Organization (WHO) criteria. Meta-regression and subgroup analyses were used to explore the sources of heterogeneity. The study was registered in the PROSPERO database (CRD42021285555). Of the 57,933 citations evaluated, 108 individual studies containing 343,704 subjects were included. The global prevalence of osteoporosis and osteopenia was 19.7% (95%CI, 18.0%–21.4%) and 40.4% (95%CI, 36.9%–43.8%). Prevalence varied greatly according to countries (from 4.1% in Netherlands to 52.0% in Turkey) and continents (from Oceania 8.0% to 26.9% in Africa). The prevalence was higher in developing countries (22.1%, 95%CI, 20.1%–24.1%) than in developed countries (14.5%, 95%CI, 11.5%–17.7%). Our study indicates a considerable prevalence of osteoporosis among the general population based on WHO criteria, and the prevalence varies substantially between countries and regions. Future studies with robust evidence are required to explore risk factors to provide effective preventive strategies for the disease.
IntroductionUse of tenofovir based anti-retroviral therapy (ART) in HIV patients is associated with low bone mineral density (BMD). Low BMD predisposes people living with HIV (PLWHIV) to fractures thereby increasing morbidity and mortality. Since the introduction of tenofovir based ARV regimens in 2011, information on the prevalence of low BMD in PLWHIV and receiving ART is still scarce in Malawi. This study aimed to determine the prevalence and associated factors of low BMD among adults living with HIV and receiving ART in Blantyre, Malawi.MethodologyThis was a cross sectional study involving 282 HIV-positive adults of whom 102 (36%) were males. The participants aged 18-45 years were recruited from three primary and one tertiary health care facilities. Patients with no other comorbidities or conditions associated with low BMD and on ART >12 months were included. Data on BMD (femoral neck and lumbar spine) were collected using Dual-Energy X-ray Absorptiometry (DEXA). The International Physical Activity Questionnaire (IPAQ) was used to assess the physical activity (PA) levels. Participants' body weight (kg) and height (m) were also measured. Descriptive statistics, Chi-Square test and multivariable logistic regression were used to analyse data.ResultsMean age of participants was 37(± 6.4) years, mean duration on ART was 5(± 3.5) years and mean body mass index (BMI) was 23(± 4.5) kg/m2. Twenty percent (55) had reduced BMD. More males (28%) had reduced BMD than females (14%) (p = 0.04). There was a significant association between lumbar BMD and femoral neck BMD (r = 0.66,p
Background:
Vitamin D deficiency is associated with non-communicable and infectious diseases, but the vitamin D status of African populations is not well characterised. We aimed to estimate the prevalence of vitamin D deficiency in children and adults living in Africa.
Methods:
For this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, African Journals Online, and African Index Medicus for studies on vitamin D prevalence, published from database inception to Aug 6, 2019, without language restrictions. We included all studies with measured serum 25-hydroxyvitamin D (25[OH]D) concentrations from healthy participants residing in Africa. We excluded case reports and case series, studies that measured 25(OH)D only after a clinical intervention, and studies with only a meeting abstract or unpublished material available. We used a standardised data extraction form to collect information from eligible studies; if the required information was not available in the published report, we requested raw data from the authors. We did a random-effects meta-analysis to obtain the pooled prevalence of vitamin D deficiency in African populations, with use of established cutoffs and mean 25(OH)D concentrations. We stratified meta-analyses by participant age group, geographical region, and residence in rural or urban areas. The study is registered with PROSPERO, number CRD42018112030.
Findings:
Our search identified 1692 studies, of which 129 studies with 21 474 participants from 23 African countries were included in the systematic review and 119 studies were included in the meta-analyses. The pooled prevalence of low vitamin D status was 18·46% (95% CI 10·66-27·78) with a cutoff of serum 25(OH)D concentration less than 30 nmol/L; 34·22% (26·22-43·68) for a cutoff of less than 50 nmol/L; and 59·54% (51·32-67·50) for a cutoff of less than 75 nmol/L. The overall mean 25(OH)D concentration was 67·78 nmol/L (95% CI 64·50-71·06). There was no evidence of publication bias, although heterogeneity was high (I2 ranged from 98·26% to 99·82%). Mean serum 25(OH)D concentrations were lower in populations living in northern African countries or South Africa compared with sub-Saharan Africa, in urban areas compared with rural areas, in women compared with men, and in newborn babies compared with their mothers.
Interpretation:
The prevalence of vitamin D deficiency is high in African populations. Public health strategies in Africa should include efforts to prevent, detect, and treat vitamin D deficiency, especially in newborn babies, women, and urban populations.
Funding:
Wellcome Trust and the DELTAS Africa Initiative.
Background:
Osteoporosis is a global health problem, and its prevalence is rapidly increasing worldwide.
Aim:
The aim was to assess the awareness concerning some nutritional and socio-economic variables causes the disease in a sample of Egyptian women.
Methods:
This study was done among 116 female volunteers. They were divided into two groups, pre and post-menopausal, with a mean age of 42.05 ± 8.25 & 51.13 ± 5.82 years and mean body mass index (BMI) of 30.83 ± 8.18 & 34.24 ± 8.80 kg/m2. A standardised questionnaire, socioeconomic and food frequency chart were used to assess osteoporosis and food intake awareness. Bone mineral density was measured by dual-energy X-ray absorptiometry (DEXA). Statistical analyses were done using simple percentage and Chi-square test.
Results:
Data revealed that a low percentage of pre and post-menopausal women were aware of osteoporosis and fracture (16.67% & 12.96% and 30.65% & 19.35%). They had incomplete knowledge about the sources and the beneficial effects of consumption of calcium and vitamin D rich diet. Non-osteoporotic women showed more awareness. Odds ratio predict occupations and educations levels as risk factors for osteoporosis.
Conclusion:
Awareness about osteoporosis and consumption healthy diet were low among Egyptian women, so it is important to implement special osteoporosis prevention program.
Background: Vitamin D plays an important role in many physiological and pathological processes, including bone metabolism. Vitamin D deficiency is common worldwide, but there are few data in older South Africans.
Objectives: This study aimed to determine vitamin D status in older adults with and without hip fractures and the effect of demography, body mass index (BMI) and functional status on vitamin D levels.
Methodology: In a secondary analysis, the association between 25(OH) vitamin D levels, obtained from 327 subjects (151 with fractures and 176 controls), and age, gender, ethnicity, BMI and functional status, was explored using Student’s t-test, a chi-square test, regression analysis and ANOVA.
Results: In the total cohort, vitamin D deficiency and insufficiency was present in 27% and 38%, respectively. While vitamin D levels decreased with age, this was not significant (p = 0.082). There was a significant association between vitamin D and BMI (p = 0.023), the physical maintenance scale (p = 0.002) and independent activities of daily living (p = 0.001). Mean vitamin D levels in fracture subjects was significantly lower than controls (39.4 ± 23.1 nmol/l vs. 50.1 ± 23.3 nmol/l, p = 0.00) and vitamin D deficiency and/or insufficiency was significantly more common in the fracture group compared with controls (75.5% vs. 56.8%, p = 0.00). There was no association with gender or ethnicity.
Conclusions: Vitamin D deficiency is common in this population, especially in those with hip fractures. Contrary to other studies, increasing BMI was associated with higher vitamin D levels. This suggests that poor health status as indicated by a low BMI and poorer functional status is associated with lower vitamin D levels. The high prevalence of vitamin D deficiency and/or insufficiency in the cohort strongly argues for universal vitamin D supplementation in older adults, especially those at risk for osteoporotic fractures.
BACKGROUND: Limited studies are available documenting the demographics and mortality of hip fractures following surgery in South Africa and in Africa. The aim of this study was to evaluate short- and long-term mortality following displaced intracapsular femur neck fractures managed in the elderly with cemented hemiarthroplasty surgery at our institution METHODS: Data was collected from 561 patients who were treated from 1 May 2001 to 30 April 2014. Mortality was confirmed with the National Population Register RESULTS: The mean age was 77.96 years (SD=9.76) with more female (69.2%) compared to male (30.8%) patients. Male patients presented at a younger age (mean=74.6) than female patients (mean=79.4; p
We explored the role of iron overload, deficiency of vitamin C and alcohol abuse in the aetiology of cervical and intertrochanteric fractures of the neck of the femur as a result of minor trauma. We studied prospectively 72 patients (45 men, 27 women). Levels of serum iron markers, vitamin C and alcohol markers were measured. Consumption of alcohol was estimated using questionnaires. The findings were compared with those of an age- and gender-matched control group. The mean age of the men was 59.5 years and of the women 66.9 years, with a male predominance. In the men, iron overload, as shown by high levels of serum ferritin (p < 0.001) and deficiency of vitamin C (p < 0.03), as well as abuse of both Western and the traditional type of alcohol, appear to be important aetiological factors. In women, alcohol abuse was also common, but iron markers and levels of vitamin C did not differ significantly from the control group.
The Gambian Bone and Muscle Ageing Study is a prospective observational study investigating bone and muscle ageing in men and women from a poor, subsistence farming community of The Gambia, West Africa. Musculoskeletal diseases, including osteoporosis and sarcopenia, form a major part of the current global non-communicable disease burden. By 2050, the vast majority of the world’s ageing population will live in low- and middle-income countries with an estimated two-fold rise in osteoporotic fracture. The study design was to characterise change in bone and muscle outcomes and to identify possible preventative strategies for fracture and sarcopenia in the increasing ageing population. Men and women aged ≥40 years from the Kiang West region of The Gambia were recruited with stratified sampling by sex and age. Baseline measurements were completed in 488 participants in 2012 who were randomly assigned to follow-up between 1.5 and 2 years later. Follow-up measurements were performed on 465 participants approximately 1.7 years after baseline measurements. The data set comprises a wide range of measurements on bone, muscle strength, anthropometry, biochemistry, and dietary intake. Questionnaires were used to obtain information on health, lifestyle, musculoskeletal pain, and reproductive status. Baseline cross-sectional data show preliminary evidence for bone mineral density and muscle loss with age. Men had greater negative differences in total body lean mass with age than women following adjustments for body size. From peripheral quantitative computed tomography scans, greater negative associations between bone outcomes and age at the radius and tibia were shown in women than in men. Ultimately, the findings from The Gambian Bone and Muscle Ageing Study will contribute to the understanding of musculoskeletal health in a transitioning population and better characterise fracture and sarcopenia incidence in The Gambia with an aim to the development of preventative strategies against both.
Bone health status is largely absent in South Africa, the main reasons being the absence and cost-effectiveness of specific screening equipment for assessing bone mineral density (BMD). Various risk factors seem to play a role, some of which can be modified to change bone health status. Urbanisation is also a public health concern. Changing nutritional, as well as social behaviour, play integral roles in the prevalence and incidence of decreased BMD. Furthermore, human immunodeficiency virus (HIV) specifically, has a negative impact on BMD and although highly active antiretroviral therapy increases the prognosis for HIV-infected individuals, BMD still seem to decrease further. Dual energy X-ray absorptiometry is considered the gold standard for BMD assessment; however, recent developments have provided more cost-effective screening methods, among which heel quantitative ultrasound appears to be the most widely used in resource limited countries such as South Africa.
Background: Osteoporosis is a silent disabling clinical condition often attributed to ageing. It is of public health importance because of its complications and attendant morbidity and mortality.
Methods: A cross-sectional study was undertaken of 2401 older patients (60 years and above) at the Geriatric Centre, University College Hospital, Ibadan. Candidate variables such as socio-demographic characteristics, anthropometric indices, physical and lifestyle habits were assessed. Bivariate and multivariate analyses were carried out using SPSS 17®.
Results: The point prevalence of osteoporosis was 56.9% (males = 43.7% and females = 65.8%). The most significant factors associated with osteoporosis on logistics regression analyses were increasing age, female sex, lack of formal education, lack of engagement in occupational activities and living with relatives/friends. Receiving social support from relatives/friends, non-participation in sporting activities at younger ages, prolonged use of medications for peptic ulcer disease, hospitalisation on or after the age of 60 years and asthenic build were also found to be significant. Yearly increase in age shows a 6.9% (95% CI 5.4–8.4%) increase in the odds of having osteoporosis.
Conclusion: The high prevalence of osteoporosis among older persons in this study calls for concerted efforts by the healthcare workers to prevent osteoporosis among older patients.
Osteoporosis, a public health problem is able to
occur severe fractures and its prevalence increases in developing countries.
Several factors involved in its pathogenesis. These factors are: Heredity,
elderly, race, ethnicity, hormones, physical inactivity, sunlight exposure, vitamin
D deficiency and certain drugs. In Africa, few data are available and the
disease prevalence is maybe underestimated. In Senegal, measure of bone mineral
density is recent. In this study, our objective was to determine DEXA patients
profile and epidemiological, clinical characteristics of patients for
densitometry examination. Thus, 43 cases were collected; lumbar and femoral
sites were evaluated. Median lumbar T-score was 0.91 and the femoral T-score
was 0.16. Osteopenia was found in 35% of patients and osteoporosis in 26%. Bone
Mineral Density was abnormal in 60% of cases. This study is another proof of
documented reality of osteoporosis in Senegal. It determines frequency in a
population at risk. For the future, it opens way for further larger studies to
get better profile of the patients and prevalence osteoporosis in Senegal.
This ecological correlation study explores the marked differential in osteoporosis susceptibility between East and West Africans. African tsetse belt populations are lactase non-persistent (lactose intolerant) and possess none of the genetic polymorphisms carried by lactase persistent (lactose tolerant) ethnic populations. What appears paradoxical, however, is the fact that Niger-Kordofanian (NK) West African ethnicities are also at minimal risk of osteoporosis. Although East Africans share a genetic affinity with NK West Africans, they display susceptibility rates of the bone disorder closer to those found in Europe. Similar to Europeans, they also carry alleles conferring the lactase persistence genetic traits. Hip fracture rates of African populations are juxtaposed with a global model to determine whether it is the unique ecology of the tsetse-infested zone or other variables that may be at work. This project uses MINITAB 17 software for regression analyses. The research data are found on AJOL (African Journals Online), PUBMED and JSTOR (Scholarly Journal Archive). Data showing the risk of osteoporosis to be 80 times higher among East Africans with higher levels of lactase persistence than lactase non-persistence West Africans are compared with global statistics. Hip fracture rates in 40 countries exhibit a high Pearson's correlation of r=0.851, with P-value=0.000 in relation to dairy consumption. Lower correlations are seen for hip fracture incidence vis-à-vis lactase persistence, per capita income and animal protein consumption. Ethnic populations who lack lactase persistence single-nucleotide polymorphisms may be at low risk of developing osteoporosis.
Introduction:
Despite abundant sunshine, hypovitaminosis D is common in the Middle East. The aim of this study was to determine the prevalence of hypovitaminosis D and related correlates among patients with hip fracture in Assiut University Hospitals in Upper Egypt.
Materials and methods:
A cross-sectional study was carried out in 133 patients with hip fracture, aged 50 years and older, admitted to Trauma Unit of Assiut University Hospitals, from January through December 2014. Patients were selected by systematic random sampling. Serum 25-hydroxy vitamin D level was measured by enzyme-linked immunosorbent assay; bone mineral density (BMD) by dual-energy X-ray absorptiometry. Weight and height measurements were used for body mass index (BMI) calculation.
Results:
Patients' median age was 70 years (range: 50-99); 51.9% were females. Osteoporosis (femoral neck T score: <-2.5 standard deviation) prevalence was 72.2%. Of all patients, 60.9% had vitamin D deficiency (<20 ng/mL); 15.8% reported vitamin D inadequacy (from 20 to 29 ng/mL) and vitamin D levels were normal in 23.3% (>30 ng/mL). According to univariate analysis, vitamin D deficiency was significantly associated with obesity (P = .012) and low T scores of the femoral neck (P = .001), L2 (P = .021), L3 (P = .031), L4 (P = .012), and the greater trochanter (P < .001). In a multivariable logistic regression model, high BMI and low BMD of the femoral neck and greater trochanter were associated with hypovitaminosis D.
Conclusion:
Prevalence of hypovitaminosis D is high among patients with hip fracture and associated with low BMD and high BMI. Increasing awareness about prevention as well as detection and treatment of vitamin D deficiency is recommended.
The aim of this study was to describe bone density characteristics in elderly Black Zimbabwean men aged at least 50 years and above attendingParirenyatwa Hospital. An exploratory study was donein the x-ray department, excluding men who had a history of a disease known to affect bone density. Convenience sampling was used to recruit 51 men within one month period. Data was collected by using a questionnaire and DXA scans of the left hip joint and lumbar spine.Microsoft excel and SPSS version 16.0 were used for data capture and analysis.Thebone mineral density measurements ranged from 0.620g/cm2 to 1.222g/cm2- with an average of 0.954g/cm2for the hip and from 0.625 to 1.208g/cm2- with an average of 0.952g/cm2for the lumbar spine. There was no evidence of an association between age and bone mineral density for both the total hip and the lumbar spine even after adjusting for weight or body mass index (BMI). There was evidence of association between age and bone mineral density for the femur neck before (p value = 0.025) and after adjusting for BMI (p value = 0.047). Both weight and BMI had a strong positive correlation with bone mineral density with p-values less than 0.001. The conclusion wasthat weight and BMI both had a significant association with bone mineral density and that there was a higher prevalence of osteoporosis with the lumbar spine as compared to the proximal femur for the men in this study. We recommend a further study, with a greater sample size from which more conclusions can be drawn.
Background
It is well established that weight is an important determinant of bone health. Whereas obesity is associated with increased mortality and morbidity from diabetes and cardiovascular diseases, high body weight is widely believed to be associated to hypovitaminosis D and protective against the development of osteoporosis and fracture risk. The objective of the study was to evaluate the effect of BMI on vitamin D status and on densitometric vertebral fractures (VFs) in a large series of asymptomatic women aged over 50 who had a VFA examination during their bone mineral density (BMD) testing.
Methods
We enrolled 429 postmenopausal women (mean age, weight and BMI of 59.5 ± 8.3 (50 to 83) years, 75.8 ± 13.3 (35 to 165) kgs and 29.9 ± 5.2 (14.6 to 50.8) kg/m2, respectively. Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a Lunar Prodigy densitometer. VFs were defined using the Genant semiquantitative (SQ) approach. Clinical risk factors of osteoporosis were collected and 25-hydroxivitamin D was measured using electrochimiluminescence (Roche).
Results
Prevalence of osteoporosis and hypovitaminosis D (<20 ng/ml) was 21.0 % and 78.1 % respectively. VFs grade 2/3were identified in 76 (17.7 %). Comparison between women according to their BMI showed that obese women had a higher BMD and less proportion of women with osteoporosis and VFs grade 2/3 than lean and overweight women. The prevalence of VFs globally increased with age and as BMI and BMD declined. Stepwise regression analysis showed that the presence of osteoporosis was independently related to BMI and history of fractures while the presence of grade 2/3 VFs was independently related to age, hypovitaminosis D and years of menopause.
Conclusion
Obese women had a higher BMD and lower prevalence of VFs. VFs were significantly related to age, hypovitaminosis D and years since menopause. However, among obese women, prevalence of VFs was increased in osteoporotic women.
Objectives To identify and synthesise the best available evidence on the accuracy of the currently available tools for predicting fracture risk.
Methods We systematically searched PubMed MEDLINE, Embase and Cochrane databases to 2014. Two reviewers independently selected articles, collected data from studies, and carried out a hand search of the references of the included studies. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) checklist was used, and the primary outcome was the area under the curve (AUC) and 95% CIs, obtained from receiver operating characteristic (ROC) analyses. We excluded tools if they had not been externally validated or were designed for specific disease populations. Random effects meta-analyses were performed with the selected tools.
Results Forty-five studies met inclusion criteria, corresponding to 13 different tools. Only three tools had been tested more than once in a population-based setting: FRAX (26 studies in 9 countries), GARVAN (6 studies in 3 countries) and QFracture (3 studies in the UK, 1 also including Irish participants). Twenty studies with these three tools were included in a total of 17 meta-analyses (for hip or major osteoporotic fractures; men or women; with or without bone mineral density). Conclusions Most of the 13 tools are feasible in clinical practice. FRAX has the largest number of externally validated and independent studies. The overall accuracy of the different tools is satisfactory (>0.70), with QFracture reaching 0.89 (95% CI 0.88 to 0.89). Significant methodological limitations were observed in many studies, suggesting caution when comparing tools based solely on the AUC.
Aim of the work: The current study was conducted in order to assess knowledge about osteoporosis (OP) among women aged more than 40. years in Alexandria of Egypt as well as identifying its relation with other variables. Patients and methods: A cross sectional survey included 532 women aged at or more than 40. years who lived in Alexandria governorate in Egypt was conducted using a self-administered questionnaire as well as the Facts on Osteoporosis Quiz (FOOQ). Results: The mean age of studied women was 49.92. ±. 7.75. years. The majority of them (95.1%) reported that they are familiar with OP and 77.1% perceive it as a serious disease and mass media was the main source of information regarding OP (54.2%) among them. The mean total score of the FOOQ was 11.3. ±. 3.6. It was significantly associated with the level of education and employment status (P = 0.001 and 0.021 respectively). Regarding the total knowledge percent score, nearly one half of studied females (51.5%) achieved a percent score ranging from 50% to less than 75% and 18.8% of them obtained a score of 75% or higher. Conclusions: The knowledge of OP among Alexandrian women could be considered moderate as regards its risk factors, preventive measures and consequences. Controlling the quality of health information provided through the mass media as well as motivating health care providers to play a role in providing information regarding OP is recommended.
Hip fracture is the most common serious injury of older people. The UK National Hip Fracture Database (NHFD) was launched in 2007 as a national collaborative, clinician-led audit initiative to improve the quality of hip fracture care, but has not yet been externally evaluated.
We used routinely collected data on 471,590 older people (aged 60 years and older) admitted with a hip fracture to National Health Service (NHS) hospitals in England between 2003 and 2011. The main variables of interest were the use of early surgery (on day of admission, or day after) and mortality at 30 days from admission. We compared time trends in the periods 2003-2007 and 2007-2011 (before and after the launch of the NHFD), using Poisson regression models to adjust for demographic changes.
The number of hospitals participating in the NHFD increased from 11 in 2007 to 175 in 2011. From 2007 to 2011, the rate of early surgery increased from 54.5% to 71.3%, whereas the rate had remained stable over the period 2003-2007. Thirty-day mortality fell from 10.9% to 8.5%, compared with a small reduction from 11.5% to 10.9% previously. The annual relative reduction in adjusted 30-day mortality was 1.8% per year in the period 2003-2007, compared with 7.6% per year over 2007-2011 (P<0.001 for the difference).
The launch of a national clinician-led audit initiative was associated with substantial improvements in care and survival of older people with hip fracture in England.
There have been reports of high rate of abnormal bone mineral densities (BMD) among people living with HIV. Following the introduction of combination antiretroviral therapy (CART) into Nigeria, the country is now home to increasing population of HIV positive patients. There is paucity of data about osteoporosis/osteopaenia and bone mineral density in this population.
The aim of the study was to determine the prevalence and determinants of osteopaenia/osteoporosis in a cohort of HIV-positive patients in Nigeria.
The BMD of a group of patients attending the outpatient clinic of the University of Ibadan, Nigeria was assessed using a DXA machine. The relationship of bone mineral density to body weight, CART status, protease inhibitor use, and gender was investigated. Their CD4 counts and viral load were also estimated.
A total of 1005 patients participated with a mean age of 41.3 ± 10 years. There were 724 females (72.0%) and 29.7% were single. The median length of diagnosis was 2 years (Range 1-18 years). The Median CD4 count was 371cells/ml and Median viral load was 200 copies/ml. Of this sample, 785 (78.1%) were on CART with 99 (12.6%) on protease inhibitor. The mean body mass index (BMI) was 23.7±4.7 with 9.2% underweight and 10% obese. The prevalence of osteopaenia and osteoporosis were 46.6% and 31.9% respectively, while 19.6% had normal bone mineral density (BMD). Osteoporosis was significantly higher in those aged above 40 years (p= 0.00001), the females (p= 0.022), the single (p=0.028) and the underweight (p=0.0001). There was no significant difference in BMD of those with or without protease inhibitor containing medications as well as treatment naïve patients.
A high prevalence of abnormal bone mineral density was found in HIV positive patients in Nigeria. Patient age above 40 years and a body mass index class of underweight were significant associated factors. Routine bone mineral density assessment is recommended as an adjunct in the evaluation of HIV positive patients in Nigeria.
There are differences in bone health between ethnic groups in both men and in women. Variations in body size and composition are likely to contribute to reported differences. Most studies report ethnic differences in areal bone mineral density (aBMD), which do not consistently parallel ethnic patterns in fracture rates. This suggests that other parameters beside aBMD should be considered when determining fracture risk between and within populations, including other aspects of bone strength: bone structure and microarchitecture, as well as muscle strength (mass, force generation, anatomy) and fat mass. We review what is known about differences in bone-densitometry-derived outcomes between ethnic groups and the extent to which they account for the differences in fracture risk. Studies are included that were published primarily between 1994 and 2014. A "one size fits all approach" should definitely not be used to understand better ethnic differences in fracture risk.
The Global Burden of Disease Study 2010 estimated the worldwide health burden of 291 diseases and injuries and 67 risk factors by calculating disability-adjusted life years (DALYs). Osteoporosis was not considered as a disease, and bone mineral density (BMD) was analysed as a risk factor for fractures, which formed part of the health burden due to falls.
To calculate (1) the global distribution of BMD, (2) its population attributable fraction (PAF) for fractures and subsequently for falls, and (3) the number of DALYs due to BMD.
A systematic review was performed seeking population-based studies in which BMD was measured by dual-energy X-ray absorptiometry at the femoral neck in people aged 50 years and over. Age- and sex-specific mean ± SD BMD values (g/cm(2)) were extracted from eligible studies. Comparative risk assessment methodology was used to calculate PAFs of BMD for fractures. The theoretical minimum risk exposure distribution was estimated as the age- and sex-specific 90th centile from the Third National Health and Nutrition Examination Survey (NHANES III). Relative risks of fractures were obtained from a previous meta-analysis. Hospital data were used to calculate the fraction of the health burden of falls that was due to fractures.
Global deaths and DALYs attributable to low BMD increased from 103 000 and 3 125 000 in 1990 to 188 000 and 5 216 000 in 2010, respectively. The percentage of low BMD in the total global burden almost doubled from 1990 (0.12%) to 2010 (0.21%). Around one-third of falls-related deaths were attributable to low BMD.
Low BMD is responsible for a growing global health burden, only partially representative of the real burden of osteoporosis.
Tenofovir-emtricitabine (TDF-FTC) pre-exposure prophylaxis (PrEP) has been found to be effective for prevention of HIV infection in several clinical trials. Two studies of TDF PrEP among men who have sex with men showed slight bone mineral density (BMD) loss. We investigated the effect of TDF and the interaction of TDF and hormonal contraception on BMD among HIV-uninfected African men and women.
We evaluated the effects on BMD of using daily oral TDF-FTC compared to placebo among heterosexual men and women aged 18-29 years enrolled in the Botswana TDF2 PrEP study. Participants had BMD measurements at baseline and thereafter at 6-month intervals with dual-energy X-ray absorptiometry (DXA) scans at the hip, spine, and forearm.
A total of 220 participants (108 TDF-FTC, 112 placebo) had baseline DXA BMD measurements at three anatomic sites. Fifteen (6.8%) participants had low baseline BMD (z-score of <-2.0 at any anatomic site), including 3/114 women (2.6%) and 12/106 men (11.3%) (p = 0.02). Low baseline BMD was associated with being underweight (p = 0.02), having high blood urea nitrogen (p = 0.02) or high alkaline phosphatase (p = 0.03), and low creatinine clearance (p = 0.04). BMD losses of >3.0% at any anatomic site at any time after baseline were significantly greater for the TDF-FTC treatment group [34/68 (50.0%) TDF-FTC vs. 26/79 (32.9%) placebo; p = 0.04]. There was a small but significant difference in the mean percent change in BMD from baseline for TDF-FTC versus placebo at all three sites at month 30 [forearm -0.84% (p = 0.01), spine -1.62% (p = 0.0002), hip -1.51% (p = 0.003)].
Use of TDF-FTC was associated with a small but statistically significant decrease in BMD at the forearm, hip and lumbar spine. A high percentage (6.8%) of healthy Batswana young adults had abnormal baseline BMD Further evaluation is needed of the longer-term use of TDF in HIV-uninfected persons.
ClinicalTrials.gov NCT00448669.
Osteoporotic fractures are devastating public health problems due to significant morbidity, mortality, and the socioeconomic burden. h2 Ethiopia, the weight of such fractures is often underestimated due to lack of epidemiological data.
To assess the magnitude and pattern of osteoporotic fractures among adults admitted to zonal hospitals in Tigrai, North Ethiopia.
Two years retrospective hospital based medical-record review was employed. All fractures that occurred from September, 01, 2009 to August, 31, 2011 where the source population and osteoporosis related fracture cases were extracted. A total of 1173 charts was retrieved for further characterization of the cases with osteoporotic fractures. The sample size was proportionally distributed to the six hospitals, the cards were selected using a systematic random sampling technique and descriptive analysis was done using SPSS version 19.0.
A total of 24.672 (15.402 males and 9,270 females) fractures of all types were extracted from medical records of the six zonal hospitals in the region (September 2009-August 2011), among which 2,294 (1,465 males and 829 females) were cases with osteoporotic fractures. The overall prevalence of osteoporotic fractures was 9.3 % and the sex specific prevalence rate was 9.5 and 8.9% for males and females respectively. Characterization in terms of the fracture site, cause, residence, age, and gender was done for 1173 patient charts with osteoporotic fracture. Eight hundred twenty nine (70.9%) of the cases were males. The mean age was 50 (+/- 12) with median age of 45 years. The highest proportion 441 (37.7%) of osteoporotic fractures were of the proximal femur; with higher proportion among males than females. The majority of the fractures, 688 (58.9%) were observed between the age group 40-49.
Osteoporotic fractures are not infrequent in Tigrai, Ethiopia. Clinicians and other health care providers should be more aware of osteoporosis as the predominant underlying cause of fragility fractures in the region.
This is the first report examining vitamin D status and bone mass in African women with HIV infection using dual-energy X-ray absorptiometry (DXA) with an appropriate HIV-negative control group. Unlike previous publications, it demonstrates no difference in bone mineral density (BMD) or vitamin D status in HIV-positive patients, at different disease stages, vs. HIV-negative subjects.
Introduction
Low bone mass and poor vitamin D status have been reported among HIV-positive patients; suggesting HIV or its treatment may increase the risk of osteoporosis, a particular concern for women in countries with high HIV prevalence such as South Africa. We describe bone mass and vitamin D status in urban premenopausal South African women, who were HIV positive but not on antiretroviral therapy (ARV).
Methods
This study is a cross-sectional measurement of BMD and body composition by DXA and vitamin D status by serum 25-hydroxyvitamin D (25(OH)D) concentration. Subjects were recruited into three groups: HIV negative (n = 98) and HIV positive with preserved CD4 cell count (non-ARV; n = 74) or low CD4 cell counts prior to ARV initiation (pre-ARV; n = 75).
Results
The mean (standard deviation (SD)) age of women was 32.1 (7.2) years. Mean CD4 (SD) counts (×106/l) were 412 (91) and 161 (69) in non-ARV and pre-ARV groups (p < 0.0001). Pre-ARV women were significantly lighter and had lower mean BMI than the other two groups (p < 0.002). The pre-ARV group also had significantly less fat and lean mass compared with non-ARV and HIV-negative subjects (p ≤ 0.05). After full adjustment, there were no significant differences in BMD at any site (p > 0.05) between the groups, nor was vitamin D status significantly different between groups (p > 0.05); the mean (SD) cohort 25(OH)D being 60 (18) nmol/l.
Conclusion
Contrary to previous studies, these HIV-positive women did not have lower BMD or 25(OH)D concentrations than HIV-negative controls, despite the pre-ARV group being lighter with lower BMI.
Though inconsistent, a number of studies have shown an association between vitamin D (25(OH)D) status, parathyroid hormone (PTH) and the metabolic syndrome (Met S). These have largely been carried out in Caucasians or black subjects living in high income countries. There no data on the relationship of 25(OH)D and PTH status with Met S in populations resident in Africa. The aims of this study were to evaluate if there was an association of 25(OH)D or PTH with Met S in non-Caucasian populations in South Africa, and whether these molecules explained ethnic differences in the prevalence of Met S and its individual components.
We measured anthropometry, serum 25(OH)D and PTH levels and the components of Met S, plus related metabolic variables, in 374 African and 350 Asian Indian healthy adults from the greater Johannesburg metropolitan area.
Met S was diagnosed in 29% of the African and 46% of the Asian Indian subjects (p<0.0001). Subjects with Met S had higher PTH than those without Met S, (p<0.0001), whilst 25(OH)D levels were not significantly different (p = 0.50). In multivariate analysis, 25(OH)D was not associated with any components of the Met S however PTH was shown to be positively associated with systolic (p = 0.018) and diastolic (p = 0.005) blood pressures and waist circumference (p<0.0001) and negatively associated with HOMA (p = 0.0008) levels. Logistic regression analysis showed that Asian Indian ethnicity (OR 2.24; 95% CIs 1.57, 3.18; p<0.0001) and raised PTH (OR 2.48; 95% CIs 1.01, 6.08; p = 0.04; adjusted for 25(OH)D) produced an increased risk of Met S but 25(OH)D did not (OR 1.25; 95% CI 0.67, 2.24; p = 0.48).
Plasma PTH but not 25(OH)D is an independent predictor of the Met S in African and Asian Indians in South Africa.
This document is an update of the clinical guideline published by the National Osteoporosis Foundation of South Africa (NOFSA) in 2000, which aims to improve the overall efficacy of the diagnosis and management of patients with, or at risk for, osteoporosis. The guideline is not limited to any particular patient group and targets all health care workers. This is a detailed summary, which is cross-referenced to the full guideline and is available on the NOFSA (www.osteoporosis.org.za) and JEMDSA (www.
jemdsa.co.za) websites.
Unlabelled:
This study, characterizing the incidence of hip fracture in the province of Rabat, showed that age- and sex-specific rates remained stable between 2006 and 2009. The demographic projections estimated for Morocco indicate that between 2010 and 2030, the expected annual number of hip fractures would increase about twofold.
Introduction:
No data on hip fracture incidence trends exist from Africa. The aim of the study was to determine time trends in hip fracture rates for the province of Rabat and to forecast the number of hip fractures expected in Morocco up to 2030.
Methods:
All hip fracture cases registered during the years 2006-2009 were collected at all the public hospitals and private clinics with a trauma unit and/or a permanent orthopedic surgeon across the province.
Results:
Over the 4-year period, 723 (54.3%) hip fractures were recorded in women and 607 (45.6%) in men. The age- and gender-specific incidence of hip fracture rose steeply with advancing age. Hip fractures occurred later in women 75.0 (10.7) years than in men 73.3 (11.0) years (p=0.014), and its incidence was higher in women than in men [85.9 (95% CI 79.7-92.2) per 100,000 person-years vs. 72.7 (95% CI 66.9-78.5)]. The incidence remained globally stable over the period study, and the linear regression analysis showed no significant statistical difference. For the year 2010, there were 4,327 hip fractures estimated in Morocco (53.3% in women). Assuming no change in the age- and sex-specific incidence of hip fracture from 2010 to 2030, the number of hip fractures in men is expected to increase progressively from 2,019 to 3,961 and from 2,308 to 4,259 in women.
Conclusion:
The age-specific incidence of hip fracture between the years 2006 and 2009 remained stable in Morocco, and the number of expected hip fractures would double between 2010 and 2030.
KeywordspQCT–BMD–Children–Adults–Black–White
We examined ethnic differences in bone mineral density (BMD) and the contribution of body composition, lifestyle and socioeconomic factors in South African women. Femoral neck and total hip BMD were higher, but lumbar spine BMD was lower in black women, with body composition, lifestyle and socioeconomic status (SES) factors contributing differently in ethnic groups.
There is a paucity of data on the relative contribution of body composition, lifestyle factors and SES, unique to different ethnic groups in South Africa, to BMD. We examined differences in femoral neck (FN), total hip (TH) and lumbar spine (LS) BMD between black and white premenopausal South African women and the associations between BMD and body composition, lifestyle factors and SES in these two ethnic groups.
BMD and body composition were measured in 240 black (27 ± 7; 18-45 years) and 187 white (31 ± 8; 18-45 years) women using dual-energy X-ray absorptiometry. Questionnaires were administered to examine SES, physical activity and dietary intake.
After co-varying for age, FN and TH were higher in black than white women (FN 0.882 ± 0.128 vs. 0.827 ± 0.116 g/cm(2), P < 0.001; TH 0.970 ± 0.130 vs. 0.943 ± 0.124 g/cm(2), P = 0.018). When adjusting for ethnic differences in body composition, LS was higher in white than black women. In black women, fat-free soft tissue mass, SES and injectable contraceptive use explained 33-42% of the variance in BMD at the hip sites and 22% at the LS. In white women, fat-free soft tissue mass and leisure activity explained 24-30% of the variance in BMD at the hip sites, whereas fat mass, leisure activity and oral contraceptive use explained 11% of the variance at the LS.
FN and TH BMD were higher, but LS BMD was lower in black than white South African women with body composition, lifestyle and SES factors contributing differently to BMD in these women.
Abacavir-lamivudine and tenofovir DF-emtricitabine fixed-dose combinations are commonly used as first-line antiretroviral therapies. However, few studies have comprehensively compared their relative safety profiles.
In this European, multicenter, open-label, 96-week study, antiretroviral-naive adult subjects with human immunodeficiency virus (HIV) infection were randomized to receive either abacavir-lamivudine or tenofovir-emtricitabine with efavirenz. Primary analyses were conducted after 48 weeks of treatment. Bone mineral density (BMD), a powered secondary end point, was assessed by dual energy x-ray absorptiometry. Bone turnover markers (osteocalcin, procollagen 1 N-terminal propeptide, bone specific alkaline phosphatase, and type 1 collagen cross-linked C telopeptide [CTx]) were assessed in an exploratory analysis.
A total of 385 subjects were enrolled in the study. BMD loss was observed in both treatment groups, with a significant difference in the change from baseline in both total hip (abacavir-lamivudine group, -1.9%; tenofovir-emtricitabine group, -3.6%; P < .001) and lumbar spine (abacavir-lamivudine group, -1.6%; tenofovir-emtricitabine group, -2.4%; P = .036). BMD loss of >or=6% was more common in the tenofovir-emtricitabine group (13% of the tenofovir-emtricitabine group vs 3% of the abacavir-lamivudine group had a loss of >or=6% in the hip; 15% vs 5% had a loss of >or=6% in the spine). Bone turnover markers increased in both treatment groups over the first 24 weeks, stabilizing or decreasing thereafter. Increases in all markers were significantly greater in the tenofovir-emtricitabine treatment group than in the abacavir-lamivudine group at week 24. All but CTx remained significantly different at week 48 (eg, osteocalcin: abacavir-lamivudine group, +8.07 mg/L; tenofovir-emtricitabine group, +11.92 mg/L; P < .001).
This study demonstrated the impact of first-line treatment regimens on bone. Greater increases in bone turnover and decreases in BMD were observed in subjects treated with tenofovir-emtricitabine than were observed in subjects treated with abacavir-lamivudine.
Background
The hip fracture is the most serious complication of osteoporosis. It is a public health issue in elderly because of its frequency, severity and economic impact. We report the result of an 18 months investigation.
Objectives
The aim of this study was to determine the frequency of osteoporotic hip fractures and identify the risk factors of osteoporosis and falls leading to these fractures.
Methods
Cross-sectional, prospective, descriptive study. Were included patients with spontaneous or secondary low trauma hip fractures during 18 months, who consulted at trauma unit, Mohamed Lamine Debaghine hospital. Have been collected: patient characteristics, risk factors for osteoporosis and falls, type of treatment and length of hospital stay.
Results
115 cases of hip fractures were recorded out of a total of 486 fractures, with a frequency of 16.8%, from all the fractures operated, it represents 22.7%. We noted a female predominance (62.6%) with a sex ratio of 0.60, the average age is 76.44 +/- 11.71 years. The associated comorbidities are: cardiovascular (55.7%), diabetes (33%), dysthyroidism (11.4%), asthma (10.4%), chronic renal failure (5.2%) prostate adenoma (4.5%). The fracture mechanism is dominated by the fall (92%), it is most often a domestic accident: slipping (30%), stumbling (26%), ablution (11%), falling on the stairs (7%).%). The risk factors for osteoporosis identified are: age more than 70 years (72.8%), female sex (62.6%), low BMI (18%), sedentary lifestyle (15.3%), corticosteroid therapy 7.2%, smoking (6.3%), history of rheumatoid arthritis in 3.4% and early menopause in 2.1% of patients. The risk factors of fracture: visual disturbances (40%) neuromuscular disorders in 11, 9%, poor health (more than 3 chronic diseases) in 9% of patients, mother’s history of hip fracture (1.7%). A personal history of osteoporotic fracture was noted in 17.4%, 7 patients presented a contralateral hip fracture. The average duration of hospitalization is 5.2 +/- 2.5 days. The treatment is surgical in 81.6% (40.8% prostheses).
Conclusion
Through this study, we found that osteoporotic hip fracture is frequent. The osteoporosis risk factors identified were female sex, advanced age, corticosteroid therapy and sedentary lifestyle. Fall risk factors were dominated by visual disturbances and neuromuscular disorders.
References
[1] Charles M. Court-Brown, Ben Caesar. Epidemiology of adult fractures: A review. Injury 2006. [2] Desmond Curran. épidémiologie des fractures liées à l’ostéoporose en France : revue de la littérature. Revue du rhumatisme77 (2010) 579–585.
[3] Denise Grolimund Berset. Traumatologie de la personne âgée: une urgence nutritionnelle? Nutrition clinique et métabolisme 23 (2009) 129–132
[4] Margaret stevens.preventing falls in older peoples: impact of an interventionto reduce environmental hazards in home. J Am Geratr Soc2001; 49: 1442-7.
Disclosure of Interests
None declared
We aimed to compare the performance of seven risk screening tools for detecting elderly Egyptian women with osteoporosis and to modify the tool with the best performance to increase the efficiency of referral for bone mineral density (BMD) testing. There are few studies about the epidemiology of osteoporosis in Egypt, in addition, there was no study done before to evaluate the performance of these seven screening tools in a large sample size. This aims to help clinicians restrict the use of DXA scan for those patients defined as “high risk” for osteoporosis which can substantially reduce the cost for the community and the patients, especially in developing countries. We conducted a cross-sectional study on 681 elderly women for measurement of BMD using DXA scans. The performance of the Simple Calculated Osteoporosis Risk Estimation (SCORE) was superior to other indices with the highest sensitivity and specificity. The newly modified SCORE tool at cutoff point ≥1 is a simple easy tool and shows good sensitivity (up to 94%) and acceptable specificity (up to 46.7%) in detecting osteoporosis in elderly women with fewer items and easier calculation.
Osteoporotic hip fractures are thought to be rare in Blacks however, this study from South Africa shows a significant increase in the number of hip fracture in Blacks. With the expected increase in older people, osteoporotic fractures will pose a major health problem and screening guidelines needed to be implemented. IntroductionDeveloping countries are predicted to bear the burden of osteoporosis in the coming decades. This study was undertaken to review earlier reports that osteoporotic hip fractures are rare in Black Africans. Methods
In an observational study, the incidence rates and relative risk ratios (RRR) of osteoporotic hip fractures were calculated in the Black population, aged 60 years and older, residing in the eThekwini region of South Africa. All Black subjects, presenting with a minimal trauma hip fracture to five public hospitals in the region, entered the study. Descriptive statistics were applied to show differences in age and sex. ResultsEighty-seven subjects were enrolled in the study with a mean age of 76.5 ± 10.5 years and the sex ratio of women to men was 2.5:1. Although men were younger than women, this was not significant (74.2 ± 12.3 vs. 77.4 ± 9.6 years, p = 0.189). The age-adjusted rate was 69.2 per 100,000 p.a. for women and 73.1 per 100,000 p.a. for men. There was a significant increase in the relative risk ratios for hip fractures after the age of 75 years in the total cohort and in women and men. Except for the 65–69-year age group, there was no significant difference in the age-adjusted RRR between women and men. Conclusion
This study represents the largest number of hip fractures recorded in Black Africans. Although the incidence rate is approximately tenfold higher than previously recorded, it remains amongst the lowest globally. A national registry inclusive of private and public sector is required to establish the true incidence rate of hip fractures in Black Africans.
Introduction:
Osteoporosis is a bone disease in which the bone becomes porous, brittle, and more susceptible to fracture. It is the most common metabolic bone disease worldwide. Increased prevalence of disease is attributed to low awareness of disease among general population referred to as a 'silent disease.' There is paucity of evidence of osteoporosis awareness in Africa while level of knowledge in Nigeria is also minimal.
Methods:
The study was carried out in a Polytechnic in Enugu, South East Nigeria, as one of the phases of ongoing awareness exercise on osteoporosis. Study design was descriptive cross-sectional study using stratified random sampling method for selection. The study made use of a structured, self-administered questionnaire using English language. Statistical analyses were carried out with SPSS version 22 software, using Chi square and Fischer exact tests of significance and alpha level set at p = 0.05.
Results:
Out of a total number of 500 respondents, 187 (37.4%) had heard about osteoporosis, however, only 34 (18.2%) of those who have heard about osteoporosis knew the correct meaning of osteoporosis. Overall, only 34 (6.8%) out of 500 knew the correct meaning of osteoporosis. Osteoporosis awareness was highest among age group ≥51 years (33.3%) and least in age group ≤20 years (6.3%) (p = 0.006). Awareness was also highest among civil servants (17.9%) and least among unemployed respondents (0.0%) (p < 0.001). There was no gender preponderance in awareness level while marital status and level of education were not significantly associated with level of awareness.
Conclusion:
While there was low knowledge of osteoporosis in the study area, awareness of osteoporosis was associated with age and occupation but not gender, marital status, or level of education. There is need for educational interventions to improve awareness of osteoporosis.
This study examined hip fractures during a 5-year period at Kilimanjaro Christian Medical Center (KCMC). There was a general increase in proportions of fragility hip fractures during this period. PurposeFragility hip fractures are expected to increase in low-resource countries. This study examined hip fractures in the osteoporotic age group during a 5-year period at the Kilimanjaro Christian Medical Center (KCMC), which is located in Moshi, Tanzania. Methods
We conducted a retrospective study of all hip fracture patients above the age of 50 who were admitted to KCMC between January 1, 2011 and December 31, 2015. Objective measures including patient demographics, mechanism of injury, and X-ray evaluation were used to differentiate high- and low-energy fractures. Low-energy hip fractures with no other suspected pathological processes on X-ray were labelled as fragility fractures. ResultsThree hundred forty patients were admitted in the study period and 222 patients met the inclusion criteria. Males contributed to 59.5% of hip fractures. Falls from standing height constituted the majority of fractures (76%) followed by injury from road traffic crashes (14%). Regardless of high- or low-energy aetiology, intertrochanteric fracture dominated representing 54.5% of all hip fractures. 75.6% (n = 168) of the analysed patients had fragility fractures. The fragility fractures were 55.8% (n = 96) intertrochanteric, 28.5% (n = 49) cervical, 9.9% (n = 17) subtrochanteric, and 5.8% (n = 10) mixed subtrochanteric with intertrochanteric. We noted a 2.34% per year increase in the proportions of fragility fractures among all included hip fractures over 5 years. Conclusion
We concluded that men and women contributed almost equally to the fragility hip fracture burden. The dominant cause of hip fractures overall was low-energy injuries. There was an increase in proportions of fragility hip fractures in the period of January 2011 to December 2015.
Background In Algeria, no epidemiological data on postmenopausal osteoporosis is available which justified this study of prevalence of postmenopausal osteoporosis in our country
Objectives To determine the prevalence of densitometric osteoporosis in postmenopausal women aged 45 and over, living in Douera (Algiers). Look factors to the occurrence of osteoporosis and determine the frequency of fragility fractures
Methods A prospective epidemiological cross-sectional study in which women were selected on the basis of the method of cluster sampling of the first degree in locality of Douera (Algiers)
Results 546 postmenopausal women 45 years and older were included in the study with an average age of 62±9.42 years (range: 45-89 years), personal and family history of documented fractures were found respectively in 21% and 11% of the population
Osteoporosis was found in 41.7% (CI: 35% - 48%) of postmenopausal women.
The adjusted prevalence of osteoporosis in the Algerian population of women aged 45 years and older was 35.8%.
Among the risk factors sought those related to the occurrence of osteoporosis in varied plain analysis and after adjustment, respectively, I'IMC <26 kg/m2 (OR: 4.32 (1.54 to 12.10) p<0.005), weight <60 kg (OR: 3.28 (1.18 to 9.14) p<0.023), the duration of menopause >15 years (OR: 3.46 (1.41 to 8 50) p<0.007), personal history of fractures (OR: 3.77 (1.58 to 8.9), p<0.003) and the low level of education (OR: 2.34 (1.18 - 4.62) p<0.014).
Conclusions postmenopausal osteoporosis seems common in our study, a number of potential risk factors was determined and who deserves to be validated by a larger study on a representative sample of the Algerian population
Disclosure of Interest None declared
DOI 10.1136/annrheumdis-2014-eular.2980
Objective: To determine the types of fractures encountered in osteoporotic patients and assess the functional outcome of these fractures. Also suggest change of their management and to suggest preventive interventions.
Design: A retrospective analytical 10 years study between 1998 and 2007.
Setting: The patients were treated at three private hospitals in Nairobi, Kenya.
Patients and methods: Consecutive files of traceable patients who were treated for osteoporotic fractures from January 1998 to December 2007. The demographic data, investigations, management methods and functional outcomes of the treatment were determined. The data collected was analysed using SPSS 17.0 windows.
Results: Sixty patients were available for review. Forty five were females while 15 were males, giving a F:M ration of 3:1. There were 14 vertebral fractures, 15 hip fractures (5 neck fractures intra-capsular) and 10 extra capsular)., 5 fractures of the distal wrist and 8 humeral fractures, 4 rib fractures, 6 pelvic fractures, 2 sternal fractures and 6 tibial fractures. Twenty six (40%) of the above fractures namely the vertebral, ribs, pelvis and sternum were treated conservatively while 34 fractures (60%) were treated by various methods of internal fixation. All were old patients aged 60 to 101 years (Mean 75 years.) The overall results of the surgery was unsatisfactory in 13(38%) due to metal pull out, screw loosening, periprosthetic fractures, none union seen in patients of hip, humerus, tibia fractures. Twenty one patients (62%) had good outcome.
Conclusion: Osteoporotic fractures are a challenge to orthopaedic and trauma surgeons due to unpredictable results of surgery in the elderly patients.
Recommendations: It is suggested to make awareness among health workers especially the orthopaedic and trauma surgeons, nurses and physiotherapists so as to put preventive measures in place. As regards operative management careful planning as team work and use of newer techniques, pharmaceuticals like diphosphonates to assist in fracture healing and use of augmentation techniques is worthwhile considering. Kenya Orthopaedic Association (K.O.A) formulate a policy for management of osteoporotic fractures in our local set up.
East African Orthopaedic Journal, Vol. 4: March 2010
Unlabelled:
There is a paucity of normative bone mineral density (BMD) data in healthy African women. Baseline total hip and lumbar spine BMD was measured in premenopausal women. BMD distribution was comparable to that of a reference population and was impacted by several factors including contraception and duration of lactation.
Introduction:
Normative data on bone mineral density (BMD) and the cumulative impact of lactation, contraceptive use, and other factors on BMD in healthy African women have not been well studied.
Objectives:
The objective of this study was to determine the factors associated with BMD in healthy premenopausal women in Uganda and Zimbabwe.
Methods:
Baseline total hip (TH) and lumbar spine (LS) BMD was measured by dual x-ray absorptiometry in 518 healthy, premenopausal black women enrolling in VOICE, an HIV-1 chemoprevention trial, at sites in Uganda and Zimbabwe. Contraceptive and lactation histories, physical activity assessment, calcium intake, and serum vitamin D levels were assessed. Independent factors associated with BMD were identified using an analysis of covariance model.
Results:
The study enrolled 331 women from Zimbabwe and 187 women from Uganda. Median age was 29 years (IQR 25, 32) and median body mass index (BMI) was 24.8 kg/m(2) (IQR 22.2, 28.6). In univariate analyses, lower TH BMD values were associated with residence in Uganda (p < 0.001), lower BMI (p < 0.001), and any use of and duration of depot-medroxyprogresterone acetate. Use of oral contraceptives, progestin-only implants, and higher physical activity levels were protective against reduced BMD. Similarly, lower LS BMD values were associated with these same factors but also higher parity and history of breastfeeding. In a multivariable analysis, lower TH and LS BMD values were associated with enrollment in Uganda, lower BMI, and lower physical activity level; contraceptive use was associated with lower spine BMD, and breastfeeding contributed to lower total hip BMD.
Conclusions:
Among healthy premenopausal women, TH and LS BMD was higher in Zimbabwe than Uganda. Additional factors independently associated with BMD included BMI, physical activity level, contraceptive use, and lactation.
Black women are generally regarded as being less prone to the development of osteoporosis. This study reports a similar prevalence of morphometric vertebral fractures in black (9.1 %) and white (5.0 %) South African women. Clinical risk factors and bone strength parameters contributed differently to fracture risk in the two ethnic cohorts.
Vertebral fracture represents one of the most common osteoporotic fractures and is a significant cause of morbidity and mortality. Little is known regarding the prevalence of vertebral fractures on the African continent. We therefore prospectively examined the prevalence of vertebral fracture on radiographs of the thoraco-lumbar spine in otherwise healthy community-dwelling older black and white South African women.
Radiographs of the spine (T4-L5) were obtained randomly in 189 women (47 % black), aged 40 years or older, for the analysis of vertebral fracture. Radiographs were evaluated by a single radiologist, blinded to clinical data, using Genant's semi-quantitative method. Clinical risk factors for osteoporosis, risk factors for falls (fall history, quadriceps strength, lateral sway and reaction time), areal and volumetric bone mineral density of the spine and hip, calcaneal ultrasonography (QUS) and vertebral macro-geometry were assessed in the two ethnic groups and the association with prevalent vertebral fractures examined.
Vertebral fracture prevalence in older South African black and white women was similar (9.1 % in black and 5.0 % in white women). In black women, lower body weight and lower areal and volumetric bone mineral density (BMD) at all sites could serve as markers of increased fracture risk. Older age, physical inactivity, lower muscle strength and lower femoral BMD were associated with vertebral fracture risk in whites.
Our findings are noteworthy and the first attempt to compare vertebral fracture risk in women of different ethnicities on the African continent. A similar vertebral fracture risk between black and white women in South Africa must be considered at present to ensure appropriate evaluation in all subjects who present with clinical risk factors for osteoporosis, regardless of ethnicity.
Ethnic differences in bone mineral density (BMD) between healthy adult black and white South African women were studied. Higher BMD was only noted at the femoral sites in black women. Body weight significantly impacted these findings. A lower fracture risk at all skeletal sites cannot be assumed in black South African (SA) women.
Purpose
Bone mineral density (BMD) varies amongst women of different ethnicities. African-Americans have higher BMD at all skeletal sites compared with whites. On the African continent, bone density studies suggest site-specific ethnic differences in BMD. To examine the contribution of body weight and lifestyle characteristics to ethnic differences in BMD between adult black and white South African women, we assessed lumbar spine (SBMD), femoral neck (FNBMD) and total femoral BMD (FTBMD) by dual-energy X-ray absorptiometry (DXA) in 184 black and 143 white women aged between 23 and 82 years.
Methods
BMDs were compared amongst pre- and postmenopausal blacks and whites before and after adjustment for covariates with significant univariate association with BMD. Volumetric bone mineral apparent density (BMAD) of the spine and femoral neck was also calculated to account for ethnic differences in bone size.
Results
Before adjustment, SBMD was lower (p
AIM: To review the mortality rate of patients admitted with intertrochanteric fractures within a period of three years. Intertrochanteric fractures are common in elderly patients and result in a high morbidity and mortality rate. This article retrospectively reviewed 57 patients (65 years of age and older) admitted with intertrochanteric fractures. Descriptive statistics using the frequency / proportion method was used to interpret the results. The mortality rate in hospital was 14%, in the first year 32%, in the second year 39% and insignificant in the third year.
Osteoporotic fractures are a major worldwide epidemic. Here, we review global variability, ethnic differences and secular changes in osteoporotic fractures. Worldwide, age-standardized incidence rates of hip fracture vary >200-fold in women and >140-fold in men when comparing the country in which incidence rates are the highest with that in which they are the lowest. Median age-standardized rates are highest in North America and Europe, followed by Asia, Middle East, Oceania, Latin America and Africa. Globally, rates of hip fracture are greater in women than in men, with an average ratio of ∼2:1. The incidence of radiographic vertebral fractures is much higher than that of hip fractures, whereas the incidence rates of clinical vertebral fractures mirror hip fracture rates in most countries. Methodological challenges of defining and ascertaining vertebral fractures limit the interpretation of these data. Secular declines in hip fracture rates have been reported in populations from North America, Europe and Oceania. These declines are especially notable in women, suggesting that reproductive factors might contribute to this reduction. By contrast, hip fracture rates are increasing in parts of Asia and Latin America. Global indicators of health, education and socioeconomic status are positively correlated with fracture rates suggesting that lifestyles in developed countries might contribute to hip fracture. Improvements in fracture assessment, in particular for nonhip fractures, and identification of factors that contribute to this variability might substantially influence our understanding of osteoporotic fracture aetiology and provide new avenues for prevention.
Compared with white women, Asian women have about a 40%–50% and blacks a 50%–60% lower risk of hip fracture, but the reason for this racial difference is not known. Women with a shorter hip axis have a lower risk of hip fracture. To test the hypothesis that a shorter hip axis length could account for the lower risk of hip fracture among Asian and black women, we measured hip axis length in 135 Caucasian, 74 Asian and 50 black women. The mean hip axis lengths of Asian and black women were significantly shorter (1.2 and 0.7 standard deviations, respectively) than that of the whites (p
Purpose of the studyOsteoporotic fractures are an important public health problem due to significant morbidity and mortality and the socioeconomic burden. In Tunisia, the impact of such fractures is often underestimated due to lack of epidemiological data. We eva-luated the prevalence of these fractures in a sample population at risk in order to better ascertain the amplitude of this problem in our country.Material and methodsThis prospective study involved 2 000 menopaused women aged 50 years or more. The sample was randomly selected among the population of Manouba, an urban administrative district of the capital of Tunisia. One thousand three hundred eleven women agreed to participate in this survey. Women with a risk of secondary osteoporosis were excluded. We retained for study fractures related to primary osteoporosis. History taking recorded anthropometric data and medical history, particularly gyn-ob history. All fractures occurring after minor trauma, in women aged 50 years or more, and involving the femoral neck, the wrist, or the proximal humerus were noted. Lateral x-rays of the thoracolumbar spine were studied to search for unrecognized vertebral fractures.ResultsThe study population included 1 311 women, mean age 64.07 ± 9.31 years, menopaused at mean 48.29 ± 3.84 years. Among these women, 212 (16.2%) had presented a fracture at one of the localizations retained for study. Vertebral wedge fractures accounted for 59.83% of all fractures, wrist fractures 31.96%, proximal femoral fractures 4.51% and proximal humeral fractures 3.69%.DiscussionOsteoporotic fractures are not uncommon in women in Tunisia. Increasing life expectancy in our country suggests this public health problem will grow in the years to come, pointing out the importance of better management of osteoporosis to prevent fractures.
This study focuses on the controversy surrounding selective approaches to screen for osteoporosis. Seven screening approaches were compared in terms of cost-effectiveness and incremental cost-effectiveness ratios in a sample of 4035 postmenopausal women. Our results show that certain prescreening strategies are more efficient than DXA-based approaches. These results are of considerable value for health policy decision-makers and the scientific community.
There is no general consensus on the most efficient strategy to use bone densitometry for osteoporosis screening. Two distinct approaches have progressively emerged: mass screening using DXA and prescreening strategies using user-friendly risk indices. This study was designed to compare the efficiency of these approaches.
A database of 4035 medical records from postmenopausal women above 45 years was analyzed. In the first scenario, women were systematically referred to DXA if above 45, 50, or 65 years of age. The second scenario involved the validated prescreening tools SCORE, ORAI, OST, and OSIRIS and assessed two separate ways of handling their results (theoretical and pragmatic). The cost of a DXA test was set as the median Belgian value: 40.14 Euros. All strategies were compared in terms of cost exposed per osteoporotic patient detected and in terms of incremental cost-effectiveness ratios.
In the systematic DXA strategies, the cost per patient detected ranged from 123 Euros when measuring all women >45 years of age to 91 Euros when focusing on women >65 years of age. The corresponding percentage of cases detected ranged from 100% (age > 45 years) to 50% (age > 65 years). When considering prescreening under the theoretical and pragmatic scenarios, the OSIRIS index provided the best efficiency, with costs of 74 Euros (theoretical) to 85 Euros (pragmatic) per case detected, followed by ORAI (75 Euros and 96 Euros), OST (84 Euros and 94 Euros), and SCORE (96 Euros and 103 Euros). The corresponding percentage of cases detected ranged from 89% (SCORE) to 75% (OSIRIS). The cost-effectiveness analysis showed that mass screening strategies over 50 and 65 years of age and using ORAI were best.
Our study sets the grounds for considering, in a health economics perspective, prescreening tools as valuable, cost-effective, approaches to significantly reduce the economic burden of osteoporosis screening.