Osteoporosis: Grazio S

Curković B, Grazio S, Babić-Naglić D, Anić B, Vlak T, Hanih M, Anonymous00020. · Hrvatsko reumatolosko drustvo HLZ-a, Subićeva 9, 10000 Zagreb. · Reumatizam. · Pubmed #19024267 No free full text.

Abstract: Osteoporosis is a disease characterized by loss of bone mass and the structural deterioration of bone tissue leading to increased bone fragility and fractures. Preventive measures for osteoporosis and osteoporotic fractures include adequate calcium and vitamine D intake, adequate physical activity and reduction of the risk factors can be influenced. Currently, measurement of bone mineral density using dual energy x-ray absorptiometry (DXA) is still the gold standard for the diagnosis of osteoporosis. Non-pharmacological therapy is the integral part of the management ofosteoporosis. Nitrogen-containing bisphosphonates in weekly or more prolonged (monthly) dosing intervals are now the firstline osteoporosis therapy. Oral bisphosphonates show, generally, similar efficacy on vertebral fractures risk reduction. There, might be some differences among bisphosphonates, regarding risk reduction of non-vertebral, hip and glucocortiocoid related fratures. On behalf of Croatian Society of Rheumatology of Croatian Medical Association we propose recommendations for the prevention, diagnosis and management ofpostmenopausal osteoporosis.

Korsić M, Grazio S. · University Hospital Centre Zagreb, Zagreb, Croatia. · Arh Hig Rada Toksikol. · Pubmed #18407871 No free full text.

Abstract: Fractures are the most serious consequence of osteoporosis. Non-vertebral and non-hip fractures are seldom recognised as important, even though they account for the majority of all fractures. The most prevalent localisations are distal radius, proximal humerus, ribs, clavicle, and the pelvis. According to the results from large phase III clinical trials for placebo groups, their incidence ranges from 4.9 % to 12.0 %. Hospital morbidity data in Croatia in 2006 show that peripheral non-hip fractures ranked among the leading fifteen injuries, accounting for 23.7 % of all injuries in patients aged 60 years and above. Risk factors for non-hip and non-vertebral fractures are similar to other osteoporotic fractures, and the main are low bone mineral density and earlier fractures. Quality of life is considerably affected by these fractures, and medical costs are very high, soaring as high as 36.9% of all national medical costs in the USA. Non-vertebral non-hip fractures need more attention, which was also recognised by the European regulatory bodies that approve use of anti-osteoporotic drugs.

Grazio S, Morović-Vergles J. · Klinika za reumatologiju, fizikalnu medicinu i rehabilitaciju, Klinicka bolnica "Sestre milosrdnice", Vinogradska 29, 10000 Zagreb. · Reumatizam. · Pubmed #18351154 No free full text.

Abstract: Persistence and adherence are major determinants of optimal results in the treatment of osteoporosis. In order to improve the efficacy of antiresorptive drugs, fewer demands on patients and better adherence were obtained with less frequent dosing schedule. Once-weekly and once-monthly oral bisphophonates showed equivalency with once daily medications. Comparison of persistence and adherence between weekly and monthly bisphosphonate regimens revealed conflicting results. In Croatia, persistence and adherence of weekly alendronate seem to be better than in other countries. In the light of compliance problems there is a need to assure adequate intake of vitamin D, because it is essential for prevention and treatment of osteoporosis and osteoporotic fractures. Vitamin D has other beneficial effects, particularly on neuromuscular performances. A high prevalence of vitamin D inadequacy was seen across all geographic regions. Weekly alendronate and vitamin D in one tablet provides proven fracture prevention at the spine and hip, and assure that patients receive a weekly dose of vitamin D.

Babić-Naglic D, Grazio S. · Klinika za reumatske bolesti i rehabilitaciju, Klinicki bolnicki centar Zagreb, Kispatićeva 12, 10000 Zagreb. · Reumatizam. · Pubmed #17580559 No free full text.

Abstract: Osteoporosis is chronic bone disorder that require persistent treatment. Bone fracture is the final outcome of OP and early diagnosis, active prevention, treatment and improvement of the patient adherence to treatment are needed. Ibandronate is a potent, nitrogen-containing bisphosphonate specifically developed for once-monthly oral and three-monthly administration with the same anti-resorptive efficacy. Ibandronate reduce vertebral fracture risk 50-60%, increase spine and hip BMD, 6% and 3%, significantly decrease biochemical markers of bone turn-over without histomorphometric changes of bone. There is strong patient preference for once-monthly regimen and the favourable impact on therapeutic adherence. Intravenous ibandronate formulation is indicated for all patients who are unable to take oral medicine. Adverse events are infrequent, short duration and reversibile.

Anić B, Grazio S. · Zavod za klinicku imunologiju i reumatologiju, Klinika za unutarnje bolesti, Klinicki bolnicki centar Zagreb, Kispatićeva 12, 10000 Zagreb. · Reumatizam. · Pubmed #17580557 No free full text.

Abstract: Recently, many studies showed need to administer vitamin D in treatment of osteoporosis. Vitamin D deficiency was proved in postmenopausal women with osteoporosis. Effects of vitamin D resulted in lower risk of fractures and falls, as well as improvement of neuromuscular performances. In more than ten years of practice and several short- and long-term clinical studies alendronate lowered the risk of vertebral and extravertebral fractures, improved BMD of all measured sites in postmenopausal women and men with osteoporosis. Positive results of alendronate were demonstrated in different entities like persons of various ages and grades of lower BMD or patients with glucocorticoid-induced osteoporosis. Combination of vitamin D with efficacious antiresorptive drug alendronate maintains all pharmacological features and proves clinical effects of lx weekly alendronate, partly eliminating need for vitamin D supplementation.

Grazio S. · Klinika za reumatologiju, fizikalnu medicinu i rehabilitaciju, Klinicka bolnica Sestre milosrdnice, Vinogradska 29, 10000 Zagreb. · Reumatizam. · Pubmed #17580550 No free full text.

Abstract: Osteoporosis represents a major and increasing public health problem with the aging of population. Major clinical consequences and economic burden of the disease are fractures. Many risk factors are associated with the fractures including low bone mass, hormonal disorders, personal and family history of fractures, low body weight, use of certain drugs (e.g. glucocorticoids), cigarette smoking, elevated intake of alchohol, low physical activity, insufficient level of vitamin D and low intake of calcium. This epidemiological review describes frequency, importance of risk factors and impact of osteoporosis and osteoporotic fractures. Objective measures of bone mineral density along with clinical assessment of risk factors can help identify patients who will benefit from prevention and intervention efforts and eventually reduce the morbidity and mortality associated with osteoporosis-related fractures.

Grazio S, Korsić M, Anić B, Vitezić-Misjak M, Grubisić F. · Klinika za reumatologiju, fizikalnu medicinu i rehabilitaciju Medicinskog fakulteta SveuMilista u Zagrebu, KB Sestre milosrdnice, Zagreb. · Lijec Vjesn. · Pubmed #16145872 No free full text.

Abstract: Glucocorticoids are the most frequent cause of secondary osteoporosis. They are responsible for both inadequate quantitative and qualitative effects on bone, primarily on osteoblasts (decreased activity and apoptosis). Studies have shown that patients taking glucocorticoids have decreased bone mineral density and increased risk for fractures, especially for postmenopausal women. Prevention of glucocorticoid-induced osteoporosis includes use of the lowest effective glucocorticoid dose possible, calcium and vitamin D supplementation, hormone replacement therapy and adequate physical activity. Prevention of fractures also includes all those factors that can influence the balance (e.g. muscle strenghtening, walking aids, architectonic barriers). Antiresorptive drugs should be started in all the patients with increased risk for osteoporosis, and among them bisphosphonates are the first drugs of choice.

Grazio S, Korsić M, Jajić I. · University Department of Rheumatology, Physical Medicine and Rehabilitation, Sestre milosrdnice University Hospital, Zagreb, Croatia. · Wien Klin Wochenschr. · Pubmed #15986590 No free full text.

Abstract: AIM OF THE STUDY: To establish the prevalence of vertebral fractures according to age groups, sex and vertebral level in a sample of a Croatian urban population aged > or =50. We also tried to establish how many people had been diagnosed with osteoporosis by their family physician. PARTICIPANTS AND METHODS: Lateral thoracic and lumbar spinal radiographs were obtained in 425 ambulatory people (156 men and 269 women) aged > or =50 and living in the community as a random sample of the City of Zagreb (Croatia) population. An interviewer-administered questionnaire was used to obtain information on prior traumatic vertebral fractures and whether the person had been diagnosed with osteoporosis. Vertebral fractures in the population sample were defined using the morphometric method proposed by McCloskey et al., and normal values of the ratios of dimensions in nonfractured vertebrae with the iterative algorithm described by Melton et al. RESULTS: The prevalence of individuals with vertebral fractures was 11.8% (15.8% of men and 9.7% of women), ranking Zagreb mid-scale among other European cities. The prevalence of individuals with vertebral fractures rose with age. Sixty-nine (1.24%) of 5525 analysed vertebrae had been fractured. The most common fractures were those of lower thoracic and upper lumbar vertebrae. The elderly tend to sustain multiple fractures. Forty-one (9.6%) people had been previously diagnosed as having osteoporosis. Extrapolation to the Croatian population implies that approximately 90,000 men and 77,000 women aged > or =50 have vertebral fractures. CONCLUSION: Vertebral osteoporotic fractures are common in the Croatian population aged > or =50; however, awareness of osteoporosis appears to be low.

Grazio S, Babic-Naglic D, Kehler T, Curkovic B. · Department of Rheumatology, Physical Medicine and Rehabilitation, Sisters of Mercy University Hospital, Zagreb, Croatia. · Clin Rheumatol. · Pubmed #18197449 No free full text.

Abstract: Long-term treatment of osteoporosis is required for optimal efficacy, but adherence to therapy is suboptimal with daily and weekly oral bisphosphonates. The aim of this study was to assess real-world persistence (long-term adherence) with weekly alendronate. Persistence data were collected according to World Health Organization criteria for the prior month and year for 102 consecutive patients with osteoporosis at three outpatient clinics in Croatia. Persistence was assessed using medication possession ratios (MPR). Adequate persistence was defined as sufficient medication supply to ensure antifracture efficacy (MPR >or=80%). Self-reported persistence data were compared with resupply prescription data from primary care physicians (PCPs). The effect of patient age, co-therapy, co-morbidity, and time since osteoporosis was diagnosed were evaluated. A diagnosis of osteoporosis was established 3.21+/-1.83 years prior for the 96 women and six men enrolled (mean age 66.92+/-8.05 years). During the previous year, 86.3% patients reported not missing any tablets. Age correlated with the number of missed tablets, with older patients missing more tablets (p=0.038). Patients with co-therapy (p=0.042) missed more tablets. PCPs reported that 65.7% of the patients were issued prescriptions for 52 tablets. A total of 68.7% had MPR >80%. Patients with rheumatoid arthritis did not impact MPR (p=0.936). Previous fractures or number of fractures were not associated with persistence (p>0.05). In Croatia, persistence was superior with weekly-administered alendronate than has been reported elsewhere, perhaps due to socio-cultural factors. Larger, longitudinal studies are needed to confirm these results.

Cvijetić S, Grazio S, Kastelan D, Korsić M. · Institut za medicinska istrazivanja i medicinu rada, Klinika za fizikalnu medicinu i reumatologiju KB Sestre Milosrdnice, Zagreb, Hrvatska. · Arh Hig Rada Toksikol. · Pubmed #17424780 No free full text.

Abstract: In many countries, including Croatia, there is no disease registry for osteoporosis and osteoporotic fractures. Epidemiological data show that the prevalence of osteoporosis is much higher in Asian people than in white European or North American populations, where the prevalence ranges between 10% and 15%. Epidemiological characteristics of osteoporosis in Croatia are similar to other European countries, though the incidence of osteoporotic fractures is somewhat higher. According to the annual report of registered diseases, the number of patients with osteoporosis and osteoporotic fractures increased during the last 10 years. In 2004, 0.70 % of all registered diseases in Croatia referred to osteoporosis and osteomalacia. The most important risk factors for osteoporosis are age, heredity, lifestyle, chronic diseases, hormonal abnormalities and physical characteristics of bone. Like in other chronic diseases, prevention measures are most important for disease control.

Cvijetić S, Grazio S, Kastelan D, Korsić M. · Institut za medicinska istralivanja i medicinu rada, Zagreb. · Lijec Vjesn. · Pubmed #17128662 No free full text.

Abstract: There is no disease registry for osteoporosis and osteoporotic fractures in Croatia. According to the annual report of registered diseases, the number of patients with osteoporosis and osteoporotic fractures increased during the last 10 years. In 2004, 0.70% of all registered diseases in Croatia referred to osteoporosis and osteomalacia. Epidemiological data show that the prevalence of osteoporosis in Croatia is similar to other European countries, while the prevalence and incidence of osteoporotic fractures is somewhat higher. It is estimated that 90 000 men and 77 000 women in Croatia older than 50 years have vertebral fractures. The prevalence is more frequent in older age and in women, although the great number of men (16.2%) were diagnosed as having osteoporosis using ultrasound densitometry. Calcium intake is found to be a dominant risk factor for building-up and maintenance of bone density.

Grazio S, Korsić M, Jajić I, Janjić I. · Department of Rheumatology, Physical Medicine and Rehabilitation, University Hospital "Sestre milosrdnice", Zagreb, Croatia. · Coll Antropol. · Pubmed #16417162 No free full text.

Abstract: The aim of the study was to assess the role of smoking and alcohol consumption as possible risk factors for vertebral deformities in an elderly Croatian population sample. Data on smoking habit, alcohol consumption, body mass index, and overall life activity were collected in 425 randomly chosen community dwelling subjects. Radiographic morphometric method was used to assess vertebral deformities of thoracic and lumbar spine. Men smoked and drank significantly more than women. There was no association of either smoking status or number of cigarettes, or frequency of alcohol intake with prevalent vertebral deformities. There was a tendency of an increased risk of vertebral deformities in heavy drinkers (OR = 1.69; 95% CI = 0.98-2.91), and a reduced risk of these deformities in female regular drinkers (OR = 0.72; 95% CI = 0.14-3.66). Further studies in the Croatian population are needed to establish the association of smoking and alcohol consumption with vertebral deformities.

Grazio S. · Klinika za reumatologiju, fizikalnu medicinu i rehabilitaciju, Referentni centar za upalne reumatske bolesti Ministarstva zdravstva RH Klinicka bolnica Sestre milosrdnice, Vinogradska c. 29, 10000 Zagreb. · Reumatizam. · Pubmed #12476748 No free full text.

Abstract: Physical activity is associated with increased bone mass and reduced risk of hip fracture. However, scarce are data from population samples concerning the effect of level of physical and sport activity on the risk of osteoporotic vertebral deformity. The aim of the study was to determine the amount of physical and sport activity and to relate it to occurrence of vertebral deformity in older population. In total 425 subjects (269 women and 156 men) age 50 and above, were recruited from a population frame sample, as a random sample of city of Zagreb. An interviewer-administered questionnaire was used to get information about level of physical and sport activity in three different age periods (15-24 years, 25-49 years and 50 years and above), and the amount of time spent walking or cycling each day. Lateral thoracolumbar radiographs were taken using standardised procedure. Radiographs were evaluated morphometrically and the presence of vertebral deformity was defined according to method of McCloskey and al., with an alternative approach for defining normal values using iterative algorithm described by Melton and al. Vertebral deformities were found in 50 (11.8%) subjects. Men were more involved in sports activities in all three life periods, and had heavier overall physical activity from 15-24 years. Although results suggest possible decreased risk for vertebral deformity with stronger physical activity in the first life period, no significant association was found between physical or sport activity and vertebral deformities, even when possible confounding factors were taken in account. Current walking or cycling, adjusted for possible confounders, did not change the risk for vertebral deformities, too. Various confounding factor, different from those taken in account for this study or inadequately large sample for sport activity could have influence the results. We conclude that men are more physically active in younger age, and overall do more sports. Warning is the fact that appreciable proportion of men and women do not do any sport activity. We could not confirm that level of physical or sport activity, as well as regular walking or cycling was significantly important for occurrence of vertebral deformities. Prospective studies are needed in order to understand better the epidemiology and the role of possible risk factors of osteoporotic vertebral deformities in our population, which can help us in planning programs of prevention.

Vergnaud P, Lunt M, Scheidt-Nave C, Poor G, Gennari C, Hoszowski K, Vaz AL, Reid DM, Benevolenskaya L, Grazio S, Weber K, Miazgowski T, Stepan JJ, Masaryk P, Galan F, Armas JB, Lorenc R, Havelka S, Perez Cano R, Seibel M, Armbrecht G, Kaptoge S, O'Neill TW, Silman AJ, Felsenberg D, Reeve J, Delmas PD. · U. INSERM 403, Lyon, France. · Clin Chim Acta. · Pubmed #12104091 No free full text.

Abstract: BACKGROUND: In the European Prospective Osteoporosis Study (EPOS), a past spine fracture increased risk of an incident fracture 3.6 - 12-fold even after adjusting for BMD. We examined the possibility that biochemical marker levels were associated with this unexplained BMD-independent element of fracture risk. METHODS: Each of 182 cases in EPOS of spine or non-spine fracture that occurred in 3.8 years of follow-up was matched by age, sex and study centre with two randomly assigned never-fractured controls and one case of past fracture. Analytes measured blind were: osteocalcin, bone-specific alkaline phosphatase, total alkaline phosphatase, serum creatinine, calcium, phosphate and albumin, together with the collagen cross-links degradation products serum CTS and urine CTX. Most subjects also had bone density measured by DXA. RESULTS: Cases who had recent fractures did not differ in marker levels from cases who had their last fracture more than 3 years previously. No statistically significant effect of recent fracture was found for any marker except osteocalcin, which was 17.6% lower in recent peripheral cases compared to unfractured controls (p<0.05) and this was independent of BMD. CONCLUSION: Past fracture as a risk indicator for future fracture is not strongly mediated through increased bone turnover.

Crabtree NJ, Kroger H, Martin A, Pols HA, Lorenc R, Nijs J, Stepan JJ, Falch JA, Miazgowski T, Grazio S, Raptou P, Adams J, Collings A, Khaw KT, Rushton N, Lunt M, Dixon AK, Reeve J. · University Department of Medicine, University of Cambridge, UK. · Osteoporos Int. · Pubmed #11883408 No free full text.

Abstract: Hip geometry and bone mineral density (BMD) have previously been shown to relate independently to hip fracture risk. Our objective was to determine by how much hip geometric data improved the identification of hip fracture. Lunar pencil beam scans of the proximal femur were obtained. Geometric and densitometric values from 800 female controls aged 60 years or more (from population samples which were participants in the European Prospective Osteoporosis Study, EPOS) were compared with data from 68 female hip fracture patients aged over 60 years who were scanned within 4 weeks of a contralateral hip fracture. We used Lunar DPX 'beta' versions of hip strength analysis (HSA) and hip axis length (HAL) applied to DPX(L) data. Compressive stress (Cstress), calculated by the HSA software to occur as a result of a typical fall on the greater trochanter, HAL, body mass index (BMI: weight/(height)2) and age were considered alongside femoral neck BMD (FN-BMD, g/cm2) as potential predictors of fracture. Logistic regression was used to generate predictors of fracture initially from FN-BMD. Next age, Cstress (as the most discriminating HSA-derived parameter), HAL and BMI were added to the model as potentially independent predictors. It was not necessary to include both HAL and Cstress in the logistic models, so the entire data set was examined without excluding the subjects missing HAL measurements. Cstress combined with age and BMI provided significantly better prediction of fracture than FN-BMD used alone as is current practice, judged by comparing areas under receiver operating characteristic (ROC) curves (p<0.001, deLong's test). At a specificity of 80%, sensitivity in identification was improved from 66% to 81%. Identifying women at high risk of hip fracture is thus likely to be substantially enhanced by combining bone density with age, simple anthropometry and data on the structural geometry of the hip. HSA might prove to be a valuable enhancement of DXA densitometry in clinical practice and its use could justify a more proactive approach to identifying women at high risk of hip fracture in the community.

Crabtree N, Lunt M, Holt G, Kröger H, Burger H, Grazio S, Khaw KT, Lorenc RS, Nijs J, Stepan J, Falch JA, Miazgowski T, Raptou P, Pols HA, Dequeker J, Havelka S, Hoszowski K, Jajic I, Czekalski S, Lyritis G, Silman AJ, Reeve J. · University Department of Medicine, Addenbrooke's Hospital, Cambridge, UK. · Bone. · Pubmed #10865223 No free full text.

Abstract: Hip geometry and bone mineral density (BMD) have been shown previously to relate, independently of each other, to risk of hip fracture. We used Lunar DPX "beta" versions of hip strength analysis (HSA) and hip axis length (HAL) software to analyze scans from ten representative age-stratified population samples in the European Prospective Osteoporosis Study (EPOS). All 1617 subjects were >50 years of age, and 1033 were women. The data were modeled with gender and center as categorical variables. The bone mineral density of the upper half of the femoral neck declined at a faster rate with age than that in the lower half. Femoral neck cross-sectional moment of inertia (CSMI), a measure of resistance to bending, showed no significant age reduction in either gender. However, height and weight effects on CSMI were significantly more beneficial in men than in women (0.002 < p < 0.012) and the weight effect appeared to be mediated by bone mineral content (BMC). Compressive stress (Cstress), defined as the stress in the femoral neck at its weakest cross section arising from a standardized fall, was higher in women. Although Cstress increased with body weight when BMC was held constant, in practice it fell through the association and statistical interaction of rising body weight with rising BMC. HAL, as expected, was strongly positively associated with male gender and also height (p < 0.0001). Hip strength-related indices were markedly center-dependent. Significant differences (p < 0.0001) were noted between the centers for all the variables investigated that related to hip geometry. Adjustment for femoral neck bone mineral content (totBMC) showed these center differences to account for >50% of center variation in hip strength, which remained highly significant (p < 0.0001). We conclude that there are substantial geographical differences in femoral neck geometry as well as in BMD. These geometric variations may contribute to the large variations in hip fracture risk across Europe. The effects of aging on hip strength need to be explored in longitudinal studies.