OBJECTIVE: To analyze the clinical features of overweight and obese rheumatoid arthritis (RA)patients, and the relationship between body mass index (BMI) and disease characteristics. METHODS: The demographic data, extra-articular manifestations, comorbidities, and disease activity of RA patients admitted to the Rheumatology and Immunology Department of Peking University Third Hospital from January 2015 to December 2020 were collected, and the above characteristics of overweight and obese RA patients were retrospectively analyzed. According to the WHO, BMI≥30 kg/m² referred to obese individuals, 25≤BMI < 30 kg/m² referred to overweight individuals, 18.5≤BMI < 25 kg/m² referred to normal individuals, BMI < 18.5 kg/m² referred to reduced body mass individuals. t test was used for the quantitative data in accordance with normal distribution. Wilcoxon rank sum test was used for the quantitative data of non-normal distribution. The qualitative data were analyzed by chi square test. But while 1≤theoretical frequency < 5, Chi square test of corrected four grid table was used. And Fisher exact probability method was used when theoretical frequency < 1. Analyzing whether overweight or obesity was associated with comorbidities using Logistic regression adjusted confounding factors. RESULTS: A total of 481 RA patients were included in this study, with an average BMI value of (23.28±3.75) kg/m².Of the patients, 31 cases (6.5%) were with BMI < 18.5 kg/m², 309 cases (64.2%) with 18.5≤ BMI < 25 kg/m², amounting to 340 cases (70.7%). There were 119 overweight individuals (25≤ BMI < 30 kg/m², 24.7%) and 22 obese individuals (BMI≥30 kg/m², 4.6%), totaling 141 (29.3%).The proportion of the overweight and obese RA patients suffering from hypertension (57.4% vs. 39.1%, P < 0.001), diabetes (25.5% vs. 15.0%, P=0.006), hyperlipidemia (22.7% vs. 10.9%, P=0.001), fatty liver (28.4% vs. 7.4%, P < 0.001), osteoarthritis (39.0% vs. 29.4%, P=0.040) was significantly higher, and the proportion of the patients with osteoporosis(59.6% vs. 70.9%, P=0.016) and anemia (36.2% vs. 55.6%, P < 0.001) was significantly lower. However, there was no difference between the two groups in coronary heart disease (5.7% vs. 7.6%, P=0.442), cerebrovascular disease (6.4% vs. 8.8%, P=0.372) and peripheral atherosclerosis (9.2% vs. 7.6%, P=0.565).The median C-reactive protein (CRP, 1.52 mg/dL vs. 2.35 mg/dL, P=0.008), median erythrocyte sedimentation rate (ESR, 34.0 mm/h vs. 50.0 mm/h, P=0.003), pain visual simulation score (VAS) (3.66±3.08 vs. 4.40±2.85, P=0.011), and 28 joint disease activity scores (DAS-28, 5.05±1.60 vs. 5.45±1.52, P=0.010) in the overweight and obese RA group were all lower than those in the normal and reduced weight groups. Multivariate regression analysis showed that overweight and obesity was an independent risk factor for hypertension, diabetes, hyperlipidemia and fatty liver, and had protective effects on osteoporosis and anemia. CONCLUSION In RA patients, RA disease activity is lower in overweight and obesity patients. Overweight and obesity is associated with hypertension, diabetes and hyperlipidemia, but not with cardiovascular and cerebrovascular diseases.
Humans ; Body Mass Index ; Overweight/epidemiology* ; Retrospective Studies ; Arthritis, Rheumatoid/epidemiology* ; Obesity/epidemiology* ; Diabetes Mellitus ; Hypertension/complications* ; Fatty Liver/complications* ; Hyperlipidemias/complications* ; Osteoporosis/complications* ; Anemia

Osteoporosis is charactered by body bone mass reduce and bone microstructure degration. With the improvement of biology-psychology-social medical model, it have found a certain relation between osteoporosis and psychology. Psychology have an influence on BMD, contents of bone transition index, bone cytokine consistency and fragility fracture rate. Meantime, life of quality of the patients have been affected by osteoporosis, leading to their psychology situation have an according changes.
Bone Density ; Fractures, Bone ; epidemiology ; Humans ; Mental Disorders ; complications ; metabolism ; Osteoporosis ; etiology ; psychology ; Quality of Life

The fracture risk of patients with diabetes is higher than those of patients without diabetes due to hyperglycemia, usage of diabetes drugs, changes in insulin levels, and excretion, and this risk begins as early as adolescence. Many factors including demographic data (such as age, height, weight, and gender), medical history (such as smoking, drinking, and menopause), and examination (such as bone mineral density, blood routine, and urine routine) may be related to bone metabolism in patients with diabetes. However, most of the existing methods are qualitative assessments and do not consider the interactions of the physiological factors of humans. In addition, the fracture risk of patients with diabetes and osteoporosis has not been further studied previously. In this paper, a hybrid model combining XGBoost with deep neural network is used to predict the fracture risk of patients with diabetes and osteoporosis, and investigate the effect of patients' physiological factors on fracture risk. A total of 147 raw input features are considered in our model. The presented model is compared with several benchmarks based on various metrics to prove its effectiveness. Moreover, the top 18 influencing factors of fracture risks of patients with diabetes are determined.
Bone Density ; Deep Learning ; Diabetes Mellitus/epidemiology* ; Female ; Fractures, Bone/etiology* ; Humans ; Osteoporosis/complications* ; Risk Factors

BACKGROUND: The purpose of this study was to evaluate whether physicians' practice was adequate for the diagnosis and treatment of osteoporosis in patients with proximal humeral fracture over the age of 50 years, which is one of major osteoporotic fractures. METHODS: A retrospective nation-wide cohort study was performed using data collected in 2010 by the Korean Health Insurance Review Agency. The incidences of fractures around the hip, spine, and proximal humerus in patients more than 50 years of age, the frequencies of diagnostic bone density scan for osteoporosis, and the prescription for the osteoporosis medication were analyzed and compared. RESULTS: A search of database identified 48,351 hip fractures, 141,208 spine fractures, and 11,609 proximal humeral fractures in patients more than 50 years of age in 2010. Among these patients, 12,097 (25.0%) of hip fractures, 41,962 (29.7%) of spine fractures, and 1,458 (12.6%) of proximal humeral fractures underwent diagnostic bone density scan (p < 0.001); 4,773 (9.9%) of hip fractures, 27,261 (19.3%) of spine fractures, and 639 (5.5%) of proximal humeral fractures were managed with at least one medication approved for the treatment of osteoporosis (p < 0.001). Furthermore, 1,217 (2.5%) of hip fractures, 7,271 (5.2%) of spine fractures, and 188 (1.6%) of proximal humeral fractures received diagnostic bone density scans as well as osteoporosis medications (p < 0.001). Younger patients (50–69 years of age) were less likely to be evaluated and managed for osteoporosis relative to older patients (≥ 70 years of age) (p < 0.001); and men were less likely to be evaluated and managed for osteoporosis relative to women (p < 0.001). CONCLUSIONS: Current physicians' practice pattern may be inadequate for the diagnosis and treatment of osteoporosis in patients of proximal humeral fractures over the age of 50 years. Additional study and educational programs are necessary to improve this care gap, beginning with physicians who are responsible for the fracture treatment and shoulder diseases.
Aged ; Bone Density ; Bone Density Conservation Agents/therapeutic use ; Female ; Humans ; Male ; Middle Aged ; *Osteoporosis/complications/diagnosis/drug therapy/epidemiology ; Retrospective Studies ; Shoulder Fractures/*complications/*epidemiology

OBJECTIVES: People who have chronic diseases, as well as gait imbalance or psychiatric drug use, may be susceptible to injuries from falls and slips. The purpose of this study was to evaluate the effect of musculoskeletal diseases on incidental fall-related injuries among adults in Korea. METHODS: We analyzed data from the 4th Korea National Health and Nutrition Examination Survey (2007-2009), which are national data obtained by a rolling survey sampling method. The 1-year incidence of fall-related injuries was defined by health service utilization within the last year due to injury occurring after a slip and fall, and musculoskeletal diseases included osteoarthritis, rheumatoid arthritis, osteoporosis, and back pain. To evaluate the effects of preexisting musculoskeletal diseases, adults diagnosed before the last year were considered the exposed group, and adults who had never been diagnosed were the unexposed group. RESULTS: The weighted lifetime prevalence of musculoskeletal disease was 32 540 per 100 000 persons. Musculoskeletal diseases were associated with a higher risk of fall-related injury after adjustment for sex, age, residence, household income, education, occupation, visual disturbance, paralysis due to stroke, and medication for depression (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.03 to 1.93). As the number of comorbid musculoskeletal diseases increased, the risk of fall-induced injuries increased (p-value for trend <0.001). In particular, patients who had any musculoskeletal condition were at much higher risk of recurrent fall-related injuries (OR, 6.20; 95% CI, 1.06 to 36.08). CONCLUSIONS: One must take into account the risk of fall-related injuries and provide prevention strategies among adults who have musculoskeletal diseases.
Accidental Falls/*statistics & numerical data ; Adolescent ; Adult ; Age Factors ; Aged ; Arthritis, Rheumatoid/complications/epidemiology ; Back Pain/complications/epidemiology ; Female ; Health Surveys ; Humans ; Incidence ; Male ; Middle Aged ; Musculoskeletal Diseases/*complications ; Osteoarthritis/complications/epidemiology ; Osteoporosis/complications/epidemiology ; Republic of Korea/epidemiology ; Risk Factors ; Sex Factors ; Socioeconomic Factors ; Young Adult

BACKGROUND/AIMS: Osteoporotic fractures are an important comorbidity with rheumatoid arthritis (RA). We determined the overall fracture risk as assessed by the World Health Organization (WHO)'s FRAX(R) tool in Korean patients with seropositive RA. Additionally, we compared treatment eligibility according to the criteria of the Korean Health Insurance Review Agency (HIRA), FRAX, and the National Osteoporosis Foundation (NOF). METHODS: Postmenopausal women and men > or = 50 years of age with seropositive RA were recruited from one rheumatism center in Korea. The FRAX score was estimated using the Japanese model. Patients were classified as eligible for treatment using the HIRA, NOF, and FRAX thresholds for intervention. RESULTS: The study of 234 patients included 40 men (17%). The mean age was 60 +/- 9 years, and 121 (52%) patients had osteoporosis according to the WHO criteria. The overall median 10-year fracture risk was 13% for major osteoporotic fractures and 3.5% for hip fractures. HIRA guidelines identified 130 patients (56%) eligible for treatment, FRAX included 126 patients (54%), and 151 patients (65%) were included according to NOF guidelines. Older patients with a greater number of risk factors were included by FRAX compared to HIRA. The overall concordance between HIRA and FRAX, expressed as the kappa index, was 0.67, but was as low as 0.44 when limited to patients > or = 60 years of age. CONCLUSIONS: One-half of the patients had osteoporosis requiring treatment. RA patients have a high risk of fracture, and the adoption of a risk-scoring system should be considered.
Aged ; Arthritis, Rheumatoid/*complications ; Bone Density ; Cross-Sectional Studies ; Female ; Hip Fractures/epidemiology ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Osteoporosis/epidemiology/*therapy ; Osteoporotic Fractures/epidemiology ; Practice Guidelines as Topic ; Prevalence

OBJECTIVETo retrospectively investigate the clinical characteristics of sternal insufficiency fractures (SIFs) of post-menopausal women.

METHODSFindings on the clinical presentation, associated diseases, and imaging of SIFs in 17 postmenopausal women admitted to our hospital between February 1999 and January 2009 were reported.

RESULTSTwelve patients complained of severe pain in their anterior chest. Other symptoms included cough (5 cases), dyspnoea (3 cases), breathlessness (3 cases), and wheeze (2 cases). Four patients had no discomfort. The sternums of 11 cases were tender to palpation. Seventeen patients had osteoporosis. Other associated diseases were chronic obstructive pulmonary disease (7 cases), rheumatoid arthritis (3 cases), systemic lupus erythematosus (1 case), asthma (1 case), and thoracic vertebral fracture (13 cases). Nine patients had received glucocorticoid treatment. The fractures were located in the body of the sternum in 15 patients, in the manubrium in 1 patient, and in the manubriosternal junction in 1 patient. Displaced fracture was present in 13 cases. Lateral radiography of the sternum showed a fracture line in 14 patients. In the remaining 3 cases, other imaging examinations such as bone scan, computed tomography or magnetic resonance imaging demonstrated the presence of a fracture.

CONCLUSIONSOsteoporosis, glucocorticoid therapy, chronic obstructive pulmonary disease, and rheumatoid arthritis might be risk factors for SIFs. SIFs should be considered in the differential diagnosis of chest pain.

Aged ; Aged, 80 and over ; Arthritis, Rheumatoid ; complications ; epidemiology ; Cohort Studies ; Female ; Fractures, Bone ; diagnosis ; epidemiology ; etiology ; Fractures, Stress ; diagnosis ; epidemiology ; etiology ; Glucocorticoids ; adverse effects ; therapeutic use ; Humans ; Middle Aged ; Osteoporosis, Postmenopausal ; chemically induced ; complications ; epidemiology ; Postmenopause ; physiology ; Pulmonary Disease, Chronic Obstructive ; complications ; epidemiology ; Retrospective Studies ; Risk Factors ; Sternum ; injuries ; pathology

INTRODUCTIONThis study assessed the presence of osteoporosis/osteopenia in patients with severe lithogenic activity and compared their metabolisms with those in patients without lithiasis or with mild lithogenic activity.

METHODSFrom a sample of 182 patients, those with osteopenia/osteoporosis at the hip and lumbar spine were studied separately in a two-pronged study. 66 patients with bone mineral densities (BMDs) < -1 standard deviation (SD) on a T-score scale at the hip were divided into three groups: group A1 without lithiasis (n = 15); group A2 with lithiasis and mild lithogenic activity (n = 22); and group A3 with lithiasis and severe lithogenic activity (n = 29). Similarly, 86 patients with BMDs < -1 SD on a T-score scale at the lumbar spine were divided into three groups: group B1 without lithiasis (n = 15); group B2 with lithiasis and mild lithogenic activity (n = 29); and group B3 with lithiasis and severe lithogenic activity (n = 42).

RESULTSPatients from group A3 exhibited significantly higher levels of bone remodelling markers as compared to groups A1 and A2. Urinalysis also revealed higher excretion of calcium in 24-hour assessments in this group. Patients from group B3 differed from groups B1 and B2 mainly in bone remodelling markers and 24-hour urinary calcium excretion, which were significantly elevated in patients from group B3.

CONCLUSIONPatients with calcium lithiasis and severe lithogenic activity in addition to osteopenia/osteoporosis present with higher levels of hypercalciuria and negative osseous balance, which possibly perpetuate and favour lithiasic activity.

Absorptiometry, Photon ; Adult ; Bone Density ; Bone Remodeling ; Calcium ; urine ; Cross-Sectional Studies ; Female ; Humans ; Hypercalciuria ; complications ; metabolism ; Incidence ; Lumbar Vertebrae ; diagnostic imaging ; Male ; Middle Aged ; Nephrolithiasis ; complications ; metabolism ; Osteoporosis ; epidemiology ; etiology ; metabolism ; Risk Factors ; Severity of Illness Index ; Spain ; epidemiology

We investigated which of the three FRAX fracture risk assessment tool models is most applicable to Korean women. For 306 postmenopausal women (mean age, 77 yr) with a hip fracture, fracture probabilities were calculated using FRAX models from Japan, Turkey and China. Data on bone mineral density (BMD) at the femoral neck were available for 103 patients. Significant differences existed among the models, independent of the inclusion of BMD in the calculation of fracture probabilities. The probabilities of both major osteoporotic fractures and hip fractures were significantly higher in the Japanese model than in the Turkish or Chinese models. In all of the models, the probabilities of a major osteoporotic fracture, but not of a hip fracture, decreased significantly if calculated without BMD values. By applying the Japanese model, the ten-year probabilities for major osteoporotic and hip fractures increased significantly with age. Our results suggest that the Japanese FRAX model might be the most appropriate for Korean women.
Aged ; Aged, 80 and over ; Bone Density/physiology ; Female ; Fractures, Bone/*epidemiology/ethnology/prevention & control ; Hip Fractures/epidemiology/ethnology/prevention & control ; Humans ; Middle Aged ; *Models, Statistical ; Osteoporosis, Postmenopausal/complications ; Republic of Korea/epidemiology ; Risk Assessment

OBJECTIVETo study the distribution of Chinese syndrome type in patients with primary osteoporosis (POP) and its relationship with bone fracture.

METHODSMaterials of 180 POP patients who visited Xiyuan Hospital were investigated, their incidence of bone fracture observed and Chinese syndrome types differentiated. And the outcomes were analyzed statistically using SPSS 13.0.

RESULTSThe morbidity of POP in female was higher than that in male, the sex ratio (M/F) being 1:3 (41 cases vs 139 cases). Chinese syndrome type distribution in the POP patients was: Shen-deficiency syndrome (SDS) type in 7.8% patients (14 cases), Pi-Shen deficiency syndrome (PSDS) type in 21.7% (39 cases), Pi-Shen deficiency and blood-stasis syndrome (PBS) type in 70.6% (127 cases), the difference of partition between types was significant (P < 0.05). Bone fracture had occurred in 12.78% (23 cases) of patients, the occurrence in patients with different types was 4.34%, 17.39%, and 78.26%, respectively. Incidence of bone fracture was also different in patients of various age section, being 5.3% in 50-59 years section, up to 15.0% in 60-69 years section (P < 0.05), and down to 12.24% in 70-80 years Section.

CONCLUSIONThe risk of bone fracture in POP patients of PBS type is higher than that in those with SDS or PSDS type, and 60-69 years is the high risk age section of bone fracture in POP patients.

Age Distribution ; Aged ; Aged, 80 and over ; Bone Density ; Female ; Fractures, Bone ; epidemiology ; Humans ; Incidence ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Osteoporosis ; complications ; diagnosis ; Sex Distribution