Absolute 10-y fracture risk based on multiple factors is the preferred method for risk assessment. A simplified risk assessment system from sex, age, DXA, and two clinical risk factors (CRFs) prior fracture and systemic corticosteroid (CS) use has been used in Canada since 2005. This study [1] was undertaken to evaluate this system in the Canadian female population. A total of 16205 women >50 y of age at the time of baseline BMD (1998–2002) were identified in a database containing all clinical DXA test results for the Province of Manitoba, Canada. Basal 10-yr fracture risk from age and minimum T-score (lumbar spine, femur neck, trochanter, total hip) was categorized as low (<10%), moderate (10–20%), or high (>20%).
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Although patients with type 2 diabetes have an increased risk of hip fracture, risk of vertebral fracture (VF) and its association with BMD are still unclear. A recent study [1] examined Japanese type 2 diabetic patients (161 men >50 y and 137 postmenopausal women) and nondiabetic controls (76 and 622, respectively) by lateral spine radiography and DXA at the lumbar spine (L), femoral neck (FN), and radius (R).
The development and maintenance of the mammalian skeleton are controlled by actions of morphogens and growth factors on bone cells. Skeletal growth factors such as insulin-like growth factor-1 (IGF-1) affect bone formation and induce osteoblast proliferation and lifespan by activating antiapoptotic pathways, increasing cell proliferation, and influencing differentiation. A key control point in many antiapoptotic pathways is a kinase named phosphatidylinositol (PI) 3-kinase (PI3K), which is activated in response to various extracellular signals and leads to generation to lipidic second messengers. A key downstream target of this pathway is another kinase named Akt. When activated, Akt promotes cell growth and cell survival by regulating numerous downstream pathways.
A simple risk score for the assessment of absolute fracture risk in general practice
02/02/2010 in DiagnosisThe aim of this prospective study [1] was to develop a risk score, based on putative risk factors in current guidelines, which can be used to identify women at high risk of fractures in general practice. The study sample included 4157 women >60 y of age (mean ± SD: 74.1 ± 9.1 yr), with a median follow-up of 8.9 y of the Rotterdam Study (ERGO), and 762 women >65 y of age (mean ± SD: 76.0 ± 6.7.y), with a median follow-up of 6.0 y of the Longitudinal Aging Study Amsterdam (LASA). Potential risk factors were those proposed in risk scores of three recent guidelines on osteoporosis: age, family history of fractures, prior fracture, low body weight/body mass index (BMI), serious immobility, rheumatoid arthritis, current smoking, alcohol consumption >2 units daily, prevalent vertebral fracture, and systemic corticosteroid use.
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