1.Osteoporosis in East Asia: Current issues in assessment and management.
Elaine YN CHEUNG ; Kathryn CB TAN ; Ching Lung CHEUNG ; Annie WC KUNG
Osteoporosis and Sarcopenia 2016;2(3):118-133
The greatest burden of hip fractures around the world is expected to occur in East Asia, especially China. However, there is a relative paucity of information on the epidemiology and burden of fractures in East Asia. Osteoporosis is greatly under-diagnosed and under-treated, even among the highest-risk subjects who have already suffered fractures. The accessibility to bone densitometry, the awareness of the disease by professionals and the public, and the use and reimbursement of drugs are some of the areas which need improvement especially. Cost-effective analysis on screening strategy and intervention thresholds based on local epidemiology data and economic status are available only in Japan. In addition, clinical risk factor models for the assessment of fracture probability may be ethnic specific. Further research is needed to develop a cost-effective risk assessment strategy to identify high-risk individuals for screening and treatment based on local data. Moreover, inadequate calcium and vitamin D intake is still an issue faced by this region.
Asia
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Calcium
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China
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Densitometry
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Epidemiology
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Far East*
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Hip Fractures
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Japan
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Mass Screening
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Osteoporosis*
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Risk Assessment
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Risk Factors
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Vitamin D
2.Development and validation of the Chinese osteoporosis screening algorithm (COSA) in identification of people with high risk of osteoporosis
Ching-Lung CHEUNG ; Gloria HY. LI ; Hang-Long LI ; Constance MAK ; Kathryn CB. TAN ; Annie WC. KUNG
Osteoporosis and Sarcopenia 2023;9(1):8-13
Objectives:
To enhance the public awareness and facilitate diagnosis of osteoporosis, we aim to develop a new Chinese Osteoporosis Screening Algorithm (COSA) to identify people at high risk of osteoporosis.
Methods:
A total of 4747 postmenopausal women and men aged ! 50 from the Hong Kong Osteoporosis Study were randomly split into a development (N ¼ 2373) and an internal validation cohort (N ¼ 2374). An external validation cohort comprising 1876 community-dwelling subjects was used to evaluate the positive predictive value (PPV).
Results:
Among 11 predictors included, age, sex, weight, and history of fracture were significantly associated with osteoporosis after correction for multiple testing. Age- and sex-stratified models were developed due to the presence of significant sex and age interactions. The area under the curve of the COSA in the internal validation cohort was 0.761 (95% CI, 0.711e0.811), 0.822 (95% CI, 0.792e0.851), and 0.946 (95% CI, 0.908e0.984) for women aged < 65, women aged ! 65, and men, respectively. The COSA demonstrated improved reclassification performance when compared to Osteoporosis Self-Assessment Tool for Asians. In the external validation cohort, the PPV of COSA was 40.6%, 59.4%, and 19.4% forwomen aged < 65, women aged ! 65, and men, respectively. In addition, COSA > 0 was associated with an increased 10-year risk of hip fracture in women ! 65 (OR, 4.65; 95% CI, 2.24e9.65) and men (OR, 11.51; 95% CI, 4.16e31.81).
Conclusions
We have developed and validated a new osteoporosis screening algorithm, COSA, specific for Hong Kong Chinese.
3.Comparison of Serum Ketone Levels and Cardiometabolic Efficacy of Dapagliflozin versus Sitagliptin among Insulin-Treated Chinese Patients with Type 2 Diabetes Mellitus
Chi-Ho LEE ; Mei-Zhen WU ; David Tak-Wai LUI ; Darren Shing-Hei CHAN ; Carol Ho-Yi FONG ; Sammy Wing-Ming SHIU ; Ying WONG ; Alan Chun-Hong LEE ; Joanne King-Yan LAM ; Yu-Cho WOO ; Karen Siu-Ling LAM ; Kelvin Kai-Hang YIU ; Kathryn Choon-Beng TAN
Diabetes & Metabolism Journal 2022;46(6):843-854
Background:
Insulin-treated patients with long duration of type 2 diabetes mellitus (T2DM) are at increased risk of ketoacidosis related to sodium-glucose co-transporter 2 inhibitor (SGLT2i). The extent of circulating ketone elevation in these patients remains unknown. We conducted this study to compare the serum ketone response between dapagliflozin, an SGLT2i, and sitagliptin, a dipeptidyl peptidase-4 inhibitor, among insulin-treated T2DM patients.
Methods:
This was a randomized, open-label, active comparator-controlled study involving 60 insulin-treated T2DM patients. Participants were randomized 1:1 for 24-week of dapagliflozin 10 mg daily or sitagliptin 100 mg daily. Serum β-hydroxybutyrate (BHB) levels were measured at baseline, 12 and 24 weeks after intervention. Comprehensive cardiometabolic assessments were performed with measurements of high-density lipoprotein cholesterol (HDL-C) cholesterol efflux capacity (CEC), vibration-controlled transient elastography and echocardiography.
Results:
Among these 60 insulin-treated participants (mean age 58.8 years, diabetes duration 18.2 years, glycosylated hemoglobin 8.87%), as compared with sitagliptin, serum BHB levels increased significantly after 24 weeks of dapagliflozin (P=0.045), with a median of 27% increase from baseline. Change in serum BHB levels correlated significantly with change in free fatty acid levels. Despite similar glucose lowering, dapagliflozin led to significant improvements in body weight (P=0.006), waist circumference (P=0.028), HDL-C (P=0.041), CEC (P=0.045), controlled attenuation parameter (P=0.007), and liver stiffness (P=0.022). Average E/e’, an echocardiographic index of left ventricular diastolic dysfunction, was also significantly lower at 24 weeks in participants treated with dapagliflozin (P=0.037).
Conclusion
Among insulin-treated T2DM patients with long diabetes duration, compared to sitagliptin, dapagliflozin modestly increased ketone levels and was associated with cardiometabolic benefits.
4.Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors
David Tak Wai LUI ; Chi Ho LEE ; Wing Sun CHOW ; Alan Chun Hong LEE ; Anthony Raymond TAM ; Carol Ho Yi FONG ; Chun Yiu LAW ; Eunice Ka Hong LEUNG ; Kelvin Kai Wang TO ; Kathryn Choon Beng TAN ; Yu Cho WOO ; Ching Wan LAM ; Ivan Fan Ngai HUNG ; Karen Siu Ling LAM
Endocrinology and Metabolism 2021;36(3):582-589
Background:
The occurrence of Graves’ disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors.
Methods:
We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months.
Results:
In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer.
Conclusion
Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.
5.Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors
David Tak Wai LUI ; Chi Ho LEE ; Wing Sun CHOW ; Alan Chun Hong LEE ; Anthony Raymond TAM ; Carol Ho Yi FONG ; Chun Yiu LAW ; Eunice Ka Hong LEUNG ; Kelvin Kai Wang TO ; Kathryn Choon Beng TAN ; Yu Cho WOO ; Ching Wan LAM ; Ivan Fan Ngai HUNG ; Karen Siu Ling LAM
Endocrinology and Metabolism 2021;36(3):582-589
Background:
The occurrence of Graves’ disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors.
Methods:
We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months.
Results:
In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer.
Conclusion
Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.
6.Illicit drug use is associated with lower bone mineral density and bone strength
Suhas KRISHNAMOORTHY ; Gloria Hoi-Yee LI ; Kelvin Shun-Cheong HO ; Yin-Pan CHAU ; Constance MAK ; Donna NG ; Albert Kar-Kin CHUNG ; Jody Kwok-Pui CHU ; Kathryn Choon-Beng TAN ; Ruby Lai-Chong HOO ; Ching-Lung CHEUNG
Osteoporosis and Sarcopenia 2023;9(3):88-93
Objectives:
To evaluate the association of illicit drug use with bone mineral density (BMD) and hip geometric parameters at the narrow neck.
Methods:
This is a cross-sectional matched cohort study conducted in the Hong Kong Chinese population. Associations with illicit drug use were estimated using linear regression for BMD (lumbar spine and femoral neck) and hip geometrical parameters (cross-sectional area [CSA], cross-sectional moment of inertia [CSMI], section modulus [SM], average cortical thickness [ACT] and BMD at the narrow neck) after adjusting for age, body mass index (BMI), smoking status, drinking status, physical activity, and history of antipsychotic and antidepressant use. Mean difference and 95% confidence intervals (95% CI) were calculated between 108 illicit drug users and 108 controls using an adjusted linear model and cluster-robust standard errors after matching by age and sex. The false discovery rate was used to correct for multiple testing.
Results:
Illicit drug users had a significantly lower BMD (g/cm2 ) at the lumbar spine (mean difference: -0.062; 95% CI: -0.108 to − 0.015), and femoral neck (mean difference: -0.058; 95% CI: -0.106 to − 0.010) in the fully adjusted model. Illicit drug users also had a significantly lower CSA (mean difference: -0.238 cm2 ; 95% CI: -0.462 to − 0.013), ACT (mean difference: -0.018 cm; 95% CI: -0.030 to − 0.006) and BMD (mean difference: -0.070 g/ cm2 ; 95% CI: -0.128 to − 0.012) at the narrow neck.
Conclusions
Illicit drug use is associated with lower BMD and bone strength. Future studies evaluating the risk of illicit drug use with fragility fracture are warranted.
7.Hip fracture is associated with a reduced risk of type 2 diabetes: A retrospective cohort study
Suhas KRISHNAMOORTHY ; Casey Tze-Lam TANG ; Warrington Wen-Qiang HSU ; Gloria Hoi-Yee LI ; Chor-Wing SING ; Xiaowen ZHANG ; Kathryn Choon-Beng TAN ; Bernard Man-Yung CHEUNG ; Ian Chi-Kei WONG ; Annie Wai-Chee KUNG ; Ching-Lung CHEUNG
Osteoporosis and Sarcopenia 2024;10(2):60-65
Objectives:
Type 2 diabetes mellitus (T2DM) shares a complex relationship with bone metabolism and few studies investigated the effect of impaired bone health on the risk of T2DM. This study was conducted to investigate the association between hip fractures and the risk of incident T2DM.
Methods:
This is a retrospective cohort study using data from the real-world hip fracture cohort. Hong Kong Chinese patients aged ≥ 65 years without T2DM who were admitted to public hospitals due to a fall between 2008 and 2015 were included in the study. Patients who sustained falls with and without hip fractures were matched by propensity score (PS) at a 1:1 ratio. Competing risk regression was used to evaluate the association between hip fracture and incident T2DM, with death being the competing event.
Results:
A total of 23,314 hip fracture cases were matched to 23,314 controls. The median follow-up time was 5.09 years. The incidence rate of T2DM was 11.947 and 14.505 per 1000 person-years for the hip fracture and control group respectively. After accounting for the competing risk of death, the hip fracture group had a significantly lower risk of developing T2DM (HR: 0.771, 95% CI: 0.719–0.827). Similar results were observed in all subgroups after stratification by age and sex.
Conclusions
Hip fracture was found to be associated with a reduced risk of T2DM. These findings provide insight into the topic of bone and glucose metabolism and prompt further research in evaluating the role of bone health in the management of T2DM.
8.A consensus of key opinion leaders on the management of pre-diabetes in the Asia-Pacific region.
Roberto MIRASOL ; Ah Chuan THAI ; Aftab Ahmad SALAHUDDIN ; Kathryn TAN ; Chaicharn DEEROCHANAWONG ; Mafauzy MOHAMED ; Made Ratna SARASWATI ; Bipin Kumar SETHI ; Sanjiv SHAH ; Nanny Natalia SOETEDJO ; Swangjit SURAAMORNKUL ; Rima TAN ; Farid UDDIN
Journal of the ASEAN Federation of Endocrine Societies 2017;32(1):6-12
The Asia-Pacific region carries a high disease burden, with over half of the global diabetic population residing in this region. Increasing evidence shows that without targeted intervention, the progression from impaired glucose tolerance (IGT) to type 2 diabetes occurs more frequently in Asians compared with Caucasians. Furthermore, IGT is independently associated with an increased risk of cardiovascular disease, and should be managed as early as possible. Because diabetes is now a major public health issue, strategies aimed at prevention and treatment are urgently required. Lifestyle modification, including weight loss, dietary changes and increased physical activity, play a major role in controlling the disease. Significant evidence also supports the effectiveness of a combination of lifestyle modification and pharmacologic therapy, such as metformin, in delaying the onset of diabetes. Although the importance of lifestyle interventions is well recognized throughout Asia, many countries do not have formal recommendations to guide the diagnosis and management of individuals at risk of progression to diabetes. At a recent regional meeting, experts from the Asian region convened to develop consensus recommendations to guide clinicians in the management of Asian patients with pre-diabetes. These consensus recommendations provide a clear and concise approach to the management of individuals with IGT based on the available evidence and current best clinical practice.
Human ; Male ; Female ; Adult ; Prediabetic State ; Asia
9.A consensus of key opinion leaders on the management of pre-diabetes in the Asia-Pacific Region
Roberto Mirasol ; Ah Chuan Thai ; Aftab Ahmad Salahuddin ; Kathryn Tan ; Chaicharn Deerochanawong ; Mafauzy Mohamed ; Made Ratna Saraswati ; Bipin Kumar Sethi ; Sanjiv Shah ; Nanny Natalia Soetedjo ; Swangjit Suraamornkul ; Rima Tan ; Farid Uddin
Journal of the ASEAN Federation of Endocrine Societies 2016;31(11):6-12
The Asia-Pacific region carries a high disease burden, with over half of the global diabetic population residing in thisregion. Increasing evidence shows that without targeted intervention, the progression from impaired glucose tolerance(IGT) to type 2 diabetes occurs more frequently in Asians compared with Caucasians. Furthermore, IGT is independently associated with an increased risk of cardiovascular disease, and should be managed as early as possible. Because diabetes is now a major public health issue, strategies aimed at prevention and treatment areurgently required. Lifestyle modification, including weight loss, dietary changes and increased physical activity, play a major role in controlling the disease. Significant evidence also supports the effectiveness of a combination of lifestylemodification and pharmacologic therapy, such as metformin, in delaying the onset of diabetes. Although the importanceof lifestyle interventions is well recognized throughout Asia, many countries do not have formal recommendations to guide the diagnosis and management of individuals at risk of progression to diabetes. At a recent regional meeting,experts from the Asian region convened to develop consensus recommendations to guide clinicians in themanagement of Asian patientswith pre-diabetes. These consensus recommendations provide a clear and conciseapproach to the management of individuals with IGT based on the available evidence and current best clinical practice.
Glucose Intolerance
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Asia