Despite the sexual dimorphism of bone, hip fracture risk is very similar in men and women at the same absolute bone mineral density (BMD). A recent study was conducted with the objective of elucidating the main structural properties of bone that underlie the measured BMD and that ultimately determine the risk of hip fracture in elderly men and women [1]. This study is part of the Rotterdam Study (a large prospective population-based cohort) and included 147 incident hip fracture cases in 4806 participants with DXA-derived hip structural analysis (mean follow-up, 8.6 y).
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Early diagnosis of onset osteoporosis is essential for the delivery of effective therapy. Biochemical markers of bone turnover provide a means of evaluating skeletal dynamics that complements static measurements of bone mineral density (BMD) by dual energy X-ray absorptiometry. Conventional clinical measurements of bone turnover, primarily the estimation of collagen and its breakdown products in the blood or urine, lack both sensitivity and specificity as a reliable diagnostic tool. In this study [1], the serum proteome of 58 postmenopausal women with high or low/normal bone turnover (training set) was analyzed by surface-enhanced laser-desorption/ionization time-of-flight (SELDI-TOF) mass spectrometry, and a diagnostic fingerprint was identified using a variety of statistical and machine-learning tools. The diagnostic fingerprint was validated in a separate test set, consisting of serum samples from an additional 59 postmenopausal women obtained from the same Mayo cohort, with a gap of 2 y.

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Osteoporosis is defined as a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Although the diagnosis of the disease relies on the quantitative assessment of bone mineral density (BMD), which is a major determinant of bone strength, the clinical significance of osteoporosis lies in the fractures that arise.

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A recent study [1] aimed to develop a hip screening tool combining relevant clinical risk factors (CRFs) and quantitative ultrasound at the heel in order to determine the 10-y probability of hip fractures in elderly women. This study used the EPISEM database, totaling 13 000 women aged 70 or more. All women had baseline data on CRFs and a baseline measurement of the stiffness index derived from quantitative ultrasound at the heel. Women were followed prospectively to identify incident fractures. Multivariate analysis was performed to determine the CRFs that contributed significantly to hip fracture risk, and these were used to generate a CRF score.

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The International Osteoporosis Foundation (IOF) has welcomed the launch of the World Health Organization (WHO) technical report “Assessment of osteoporosis at the primary health care level” and the FRAX^TM Web site, as major steps towards helping health professionals worldwide to identify more easily patients at high risk of fracture for treatment.

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As the population ages, the number of fractures is projected to increase dramatically, and hip fractures in particular are expected to increase almost 4-fold by 2050 if effective prevention strategies are not implemented. The criteria used to define osteoporotic fractures warrant further investigation. By the current definition, fractures are recognized as osteoporotic if they are associated with low bone mineral density (BMD), and if they increase the risk of subsequent fracture. It remains unclear whether degree of trauma should be included in the definition of osteoporotic fractures. The objective of a recent study [1] was to examine the association between BMD and high-trauma fracture and between high-trauma fracture and subsequent fracture in older women and men.

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The inflammation of aging hypothesis purports that aging is the accumulation of damage, which results, in part, from chronic activation of the inflammatory process. This process is believed to play an important role in deterioration of the cardiovascular system and skeleton. Cytokines play major roles in regulating bone remodeling in the bone microenvironment, but their relationship to fractures is uncertain.

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The 2000 NIH Consensus Development Conference on Osteoporosis Prevention, Diagnosis, and Therapy identified bone mineral accretion during childhood as a critical determinant of osteoporosis risk later in life. Consequently, there is interest in monitoring the impact of behavioral modifications for maximizing bone mineral content (BMC) and density (BMD) during childhood and adolescence with the aim of preventing osteoporosis later in life. For children with chronic disorders, identifying ways to increase bone mineral accrual is of particular importance because many have been found to have low BMC and BMD.
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Hip fractures are common causes of morbidity and mortality in older adults, with a lifetime cost for hip fractures which is a major burden in public health. Two of the most important proximal factors leading to hip fracture are low bone density (osteopenia or osteoporosis) and falls. Alcohol consumption may influence each of these factors. Although alcohol use has been associated with an increased risk for falls, leading to injury or death in a variety of populations, this relation among older adults has not been established.

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The lifetime risk for fragility fractures due to osteoporosis after the age of 50 years is about 50% in women and 20% in men. The resultant high morbidity, mortality, and economic costs for elderly people have stimulated the development of effective interventions to reduce fracture risk. Despite these advances, however, the question remains as to whether patients take their treatment as prescribed (compliance) and for the recommended duration (persistence) [1].

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