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Real-world effectiveness of osteoporosis treatment in the oldest old


  • 影响因子:3.48
  • DOI:10.1007/s00198-020-05380-6
  • 作者列表:"Ström, O.","Lauppe, R.","Ljunggren, Ö.","Spångéus, A.","Ortsäter, G.","O’Kelly, J.","Åkesson, K.
  • 发表时间:2020-03-30

Summary We studied effectiveness of osteoporosis treatment in women older than 80 years, who often are not included in clinical trials. Treatments were as effective on bone density and fractures as in younger women. Introduction To study real-world effectiveness of osteoporosis treatment on BMD and fractures in the oldest old women (≥ 80 years) compared with women (60–79 years) in the clinical setting using Swedish health register data. Methods National registers and data from DXA machines were used to study effectiveness of all available osteoporosis treatments in women 60–79 and ≥ 80 years using three approaches: (1) Total Hip BMD change up to 8 years after treatment start; (2) fracture incidence where patients served as their own controls, comparing the first 3 months after treatment start with the subsequent 12 months; and (3) comparison of fracture incidence post-fracture in women ≥ 80 years treated with osteoporosis treatment or calcium/vitamin D. Results Analysis 1: Total Hip BMD increased by up to 6.7% and 7.7% in women 60–79 and ≥ 80 years old, respectively. The mean increase in BMD was 1.1%-units per year in both age groups. Analysis 2: Relative to the 3-month baseline, fracture incidence decreased during the subsequent 12 months of treatment. Incidence rate ratios were estimated at 0.65, 0.74, 0.29, and 0.81 for any, hip, vertebral, and non-hip-non-vertebral fracture, respectively. Analysis 3: A 24-month incidence of any fracture in women ≥ 80 years given post-fracture osteoporosis treatment was lower (HR = 0.78) than in women given calcium/vitamin D, but treatment allocation was not random, with lower mortality (HR = 0.51) in patients receiving OP treatment. Conclusions Osteoporosis medication in women > 80 years in clinical practice likely works, and the magnitude of effect is similar to what was estimated in younger women. The choice between osteoporosis treatment and calcium/vitamin D after fracture in women ≥ 80 years is not random but appears associated with the patient’s health status and presence of vertebral fractures, rather than the known risk profile of sustaining a fracture at a high age.


摘要: 我们研究了 80 岁以上女性骨质疏松症治疗的有效性,这些女性经常不被纳入临床试验。治疗对骨密度和骨折的效果与年轻女性一样。老年女性 (≥ 80 岁) 与女性 (60-79 岁) 相比,骨质疏松治疗对 BMD 和骨折的真实世界有效性研究简介在使用瑞典健康注册数据的临床环境中。方法使用国家注册和 DXA 机器的数据,使用三种方法研究 60-79 岁和 ≥ 80 岁女性所有可用骨质疏松症治疗的有效性: (1) 治疗开始后 8 年内全髋关节 BMD 变化; (2) 患者作为自身对照的骨折发生率,比较治疗开始后的前 3 个月与随后的 12 个月; (3) 接受骨质疏松治疗或钙/维生素d 治疗的 ≥ 80 岁女性骨折后骨折发生率的比较。结果分析 1: 60 ~ 79 岁和 ≥ 80 岁的女性髋部骨密度分别增加 6.7% 和 7.7%。两个年龄组的 BMD 平均每年增加 1.1% 单位。分析 2: 相对于 3 个月的基线,在随后的 12 个月的治疗中骨折发生率下降。发病率比率估计为 0.65,0.74,0.29 和 0.81 的任何,髋关节,椎体,和非髋关节非椎体骨折,分别。分析 3: 接受 ≥ 80 岁骨折后骨质疏松治疗的女性 24 个月内任何骨折发生率低于接受钙/维生素d 治疗的女性 (hr = 0.78),但治疗分配不是随机的,接受 OP 治疗的患者死亡率较低 (hr = 0.51)。结论在临床实践中,> 80 岁女性的骨质疏松药物可能有效,其影响程度与年轻女性的估计值相似。≥ 80 岁女性骨折后骨质疏松症治疗和钙/维生素d 之间的选择不是随机的,而是与患者的健康状况和椎体骨折的存在相关,而不是已知的高年龄骨折的风险特征。



来源期刊:Food & function
作者列表:["Galán MG","Weisstaub A","Zuleta A","Drago SR"]

METHODS::Apparent calcium absorption, total bone mineral content and density, and mineral contents of the right femur were studied using a growing rat model. Twenty-four male Wistar rats were fed with diets based on extruded whole grain red (RSD) or white sorghum (WSD), and control diet (CD) up to 60 days. The animals fed with sorghum diets consumed less and gained less weight compared to those fed with CD, but the efficiency of all diets was similar. Calcium intake was lower in animals fed with sorghum diets, related to the lower total intake of these animals. Apparent calcium absorption in animals fed with RSD was lower than in those fed with CD (CD: 72.7%, RSD: 51.0%, WSD: 64.8%). No significant differences in bone mineral density of total body, spin, femur, distal femur, tibia and proximal tibia were observed among the groups. However, Ca and P contents in the right femur of the rats consuming RSD were lower, indicating a certain imbalance in the metabolism of these minerals.

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来源期刊:Skeletal radiology
作者列表:["Schaffler-Schaden D","Kneidinger C","Schweighofer-Zwink G","Flamm M","Iglseder B","Pirich C"]

METHODS:OBJECTIVE:Controversy exists about the impact of bone mineral density (BMD) and fracture risk in newly diagnosed patients with breast cancer (BC). It is presumed that there are differences in BMD between women with BC and healthy controls. BMD is therefore considered as a potential marker to predict BC risk. This study was conducted to investigate the association of BMD, trabecular bone score (TBS) and fracture risk in younger postmenopausal women with hormone responsive BC. METHODS:Overall, 343 women were examined. Women with BC were matched to a control group of the general population. Forty-nine women and fifty-nine controls were included in the final analysis. All subjects underwent dual energy x-ray absorptiometry (DXA) of the lumbar spine, femoral neck, and the total hip to evaluate bone mineral density. The 10-year fracture risk for a major osteoporotic fracture was assessed using the FRAX-score and the TBS-adjusted FRAX-Score, respectively. RESULTS:Lumbar and femoral neck BMD were similar in BC patients and controls. No difference was found for TBS of the spine (1.38 ± 0.1 vs.1.36 ± 0.09) in the BC and the control group, respectively (p = 0.19). The 10- year probability for a major osteoporotic fracture (MoF) or femoral neck (FN) fracture was 6.1 (± 2.6%) and 0.9 (± 1.2%) in the BC group vs. 6.7 (± 3.5%) (p = 0.33) and 0.9 (± 1.1%) (p = 0.73) in the control group. CONCLUSION:Postmenopausal women younger than 60 years with breast cancer do not show any differences in baseline BMD, TBS, or TBS adjusted FRAX in comparison to controls.

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作者列表:["Gurumurthy B","Tucci MA","Fan LW","Benghuzzi HA","Pal P","Bidwell GL","Salazar Marocho SM","Cason Z","Gordy D","Janorkar AV"]

METHODS::The goals of this study are to evaluate the ability of the multicomponent collagen-elastin-like polypeptide (ELP)-Bioglass scaffolds to support osteogenesis of rat mesenchymal stem cells (rMSCs), demonstrate in vivo biocompatibility by subcutaneous implantation in Sprague-Dawley rats, monitor degradation noninvasively, and finally assess the scaffold's ability in healing critical-sized cranial bone defects. The collagen-ELP-Bioglass scaffold supports the in vitro osteogenic differentiation of rMSCs over a 3 week culture period. The cellular (rMSC-containing) or acellular scaffolds implanted in the subcutaneous pockets of rats do not cause any local or systemic toxic effects or tumors. The real-time monitoring of the fluorescently labeled scaffolds by IVIS reveals that the scaffolds remain at the site of implantation for up to three weeks, during which they degrade gradually. Micro-CT analysis shows that the bilateral cranial critical-sized defects created in rats lead to greater bone regeneration when filled with cellular scaffolds. Bone mineral density and bone microarchitectural parameters are comparable among different scaffold groups, but the histological analysis reveals increased formation of high-quality mature bone in the cellular group, while the acellular group has immature bone and organized connective tissue. These results suggest that the rMSC-seeded collagen-ELP-Bioglass composite scaffolds can aid in better bone healing process.

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