Type 2 diabetes (T2D) and glucocorticoid treatment both increase risk of bone fractures. We found that glucocorticoid use increases fracture risk similarly regardless of T2D status. Findings were consistent over time and across subgroups. Care should be taken when prescribing glucocorticoids to individuals with T2D already at increased fracture risk. Type 2 diabetes (T2D) is associated with increased risk of bone fractures, which may be caused by suppressed bone formation. Similarly, glucocorticoid (GC) treatment leads to suppressed bone formation, in addition to increased resorption. It is unknown whether GC treatment alters fracture risk equally in subjects with and subjects without T2D. We performed a nationwide registry-based cohort study with a within-subject pre-treatment reference period to investigate whether T2D status modified the effects of systemic GCs on risk of first major osteoporotic fractures (MOFs)—defined as fractures of the hips, vertebrae, humerus, or forearm—within each observation period. Individuals with or without T2D receiving systemic GC treatment (≥ 1 redeemed prescription) between 2000 and 2018 were identified and followed during treatment. The reference period for GC treatment consisted of the 2-year period immediately prior to treatment in any given individual. For confounding control, we used standardized morbidity ratio (SMR) weighting. Each group (with/without T2D and during/before GC) was reweighted to resemble the T2D group in the GC treatment period. Incidence rate ratios (IRR) were estimated using a zero-inflated negative binomial model with predictors being T2D, GC treatment, and a product term between the two. A product term estimate > 1 represents a larger effect of GC among the T2D group than in the non-T2D group. We included 477,605 individuals (27,942 with T2D) with a total follow-up time of 1,358,739 person-years. A total of 21,581 MOFs were observed. Median follow-up time was 35 days (with a mean of 212 days) during GC treatment and 731 days in the pre-treatment period. After weighting, GC treatment was associated with an IRR of 1.70 [1.55–1.85], with no evidence of effect modification by T2D (product term IRR 1.01 [0.871.17]). These results were similar across subgroup and sensitivity analyses; when stratifying by sex (males vs. females) or age (< 65 years, 6574 years, and ≥ 75 years), when counting recurring fractures during treatment, when allowing the effects of GC treatment to vary smoothly as a function of time-since-initiation, when accounting for differences in daily dosage with different durations of treatment, and under alternative modeling specifications. We found that systemic GC use increases fracture risk to a similar degree in individuals with and individuals without T2D. While no potentiating effect was observed, individuals with T2D receiving GC treatment experience increased risk through multiple paths, and care should be taken when prescribing GCs in this population.
Evidence on the effects of romosozumab mainly concerns axial aBMD. In 28 postmenopausal women, we found that spine and hip aBMD (DXA) significantly increased, while volumetric BMD, microarchitecture, and strength at the radius and tibia (HR-pQCT) remained unchanged or deteriorated. Most HR-pQCT changes did not differ from those in age-matched women on bisphosphonate treatment. We assessed the effects of ROMO treatment on the axial skeleton using dual-energy X-ray absorptiometry (DXA) and on the peripheral skeleton using high-resolution peripheral quantitative CT (HR-pQCT) in real-world data of postmenopausal women at high fracture risk and compared HR-pQCT changes with those during bisphosphonate (BP) treatment. As part of regular care in our hospital, DXA (lumbar spine, hip) and HR-pQCT (distal radius, distal tibia) were performed before the start (T0) and after 12 months (T1) of ROMO treatment. HR-pQCT results were compared with those in 55 age-matched women receiving BP treatment after a recent fracture. ROMO data were available of 28 women (72.4 ± 7.6 years, 67.9
Monoclonal gammopathy of undetermined significance (MGUS) is a frequent hematological condition that occurs in later life. MGUS is associated with increased fragility fractures that mix individual osteoporotic risk factors, MGUS-related comorbidities, and direct MGUS bone impact such as senescence of plasma cells. This International Osteoporosis Foundation (IOF) position statement aims at evaluating the potential relationship between MGUS and fracture risk, as well as methods for evaluating bone involvement in MGUS. Finally, we propose the first bone clinical guidance for patients with MGUS to improve their bone health. Monoclonal gammopathy of undetermined significance is a prevalent hematological condition in adults, characterized by the presence of an abnormal monoclonal protein in the blood without concomitant symptoms or malignancy. MGUS is of considerable bone significance and contributes to fragility fractures in adults. In this review, data pertaining to bone fragility were collected, including epidemiological fracture data in patients with MGUS, bone mineral density (BMD), bone microarchitecture, bone turnover marker, and bone histomorphometry data. Collectively, these findings suggest an elevated risk of fractures, especially in presence of osteoporotic risk factors or comorbidities, and a diminished BMD due to augmented bone resorption. Studies focusing on the treatment of this condition are limited. Based on this analysis, we present the International Osteoporosis Foundation (IOF) position statement for bone evaluation and management of these patients. We recommend a risk-adapted treatment strategy. A proposal of bone clinical guidance dedicated to patients with MGUS is presented, suggesting bisphosphonates as the preferred treatment option.
This study assessed variation of automated CT-based L1 trabecular attenuation for opportunistic CT screening across multiple U.S.-based healthcare systems. L1 HU measurements demonstrated similar behavior among the five sites, including relative relationships according to age, sex, race, and CT scanner, and < 100 HU was generalizable for practical opportunistic CT screening and diagnosis. To assess variability of automated population-based L1 trabecular attenuation (HU) measurement at abdominal CT among five US-based medical systems and consider a practical 100 HU threshold for opportunistic CT-based osteoporosis screening and diagnosis. Heterogeneous adult patient cohorts undergoing abdominal CT evaluation for any indication at five US medical systems were included for L1 vertebral body trabecular attenuation (L1 HU) assessment using a validated AI pipeline that places a fully automated ROI. Exclusion criteria included IV contrast, non-120 kVp setting, and non-physiologic outliers. All results were normalized to White patient ranges after age and sex matching. Thresholds of 100 HU and 120 HU were considered. The final multi-center cohort included 123,001 adults (51.1
Among 606,449 adults aged 60–74 years, the claims-based frailty index categories predicted hospitalisation for hip fractures: beneficiaries classified as pre-frail or frail were at higher risk (hazard ratios, 2.17 and 3.50, respectively). The CFI can help identify individuals who can benefit from targeted interventions to prevent hip fractures. Although the claims-based frailty index (CFI) may aid early identification of older adults at high risk of hip fractures, little is known about the association between the CFI and the incidence of hip fractures. The aim of this study was to examine the association between the CFI and hospitalisation for hip fractures among adults aged 60–74 years in Tokyo, Japan. This retrospective cohort study used linked health checkup and medical claims data in Tokyo between April 2015 and March 2023. Beneficiaries of the National Health Insurance aged 60–74 years who underwent an annual health checkup between April 2017 and March 2018 were identified. Beneficiaries were followed up for hospitalisation for hip fractures through March 2023. Cox proportional hazards models, adjusted for Fracture Risk Assessment Tool (FRAX)-related variables, osteoporosis, and self-reported health status and habits, were used to examine the association between the CFI and hospitalisation for hip fractures. Harrell’s C-statistics were compared between models with and without the CFI to assess the CFI's discriminative ability. Among 606,449 beneficiaries, 553,747 (91.3
