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Vitamin D Deficiency Is Highly Concomitant but Not Strong Risk Factor for Mortality in Patients Aged 50 Year and Older with Hip Fracture.

Gyeong Hak LEE ; Jung Won LIM ; Yong Gum PARK ; Yong Chan HA

Journal of Bone Metabolism.2015;22(4):205-209. doi:10.11005/jbm.2015.22.4.205

BACKGROUND: The purpose of this study was to ascertain the prevalence of vitamin D deficiency and risk factors associated with mortality in patients > or =50-year-of-age with hip fractures. METHODS: A total of 489 patients > or =50-year-of-age who sustained a hip fracture from January 2010 to October 2014 were followed-up for a minimum of 1 year. Clinical and radiological outcomes were evaluated including prevalence of vitamin D deficiency. Crude mortality rates were calculated, and the effects of different risk factors on mortality were assessed. RESULTS: Vitamin D deficiency was present in 76.5% of cases (n=237). The prevalence of vitamin D insufficiency was 12.3%, and only 11.2% of patients had normal vitamin D levels. Accumulated mortality was 11% (54 patients) at 1 year. A univariate analysis showed that vitamin D deficiency (P=0.012), age (P<0.001), BMI (P<0.001), type of management (P<0.001), American Society of Anesthesiologists (ASA) score (P=0.009), pre-fracture ambulatory status (P<0.001), and osteoporosis (P<0.001) were associated with mortality. A multivariate analysis performed using a Cox proportional hazards model demonstrated that ASA score (P=0.001) and pre-fracture ambulatory status (P=0.011) were independently associated with mortality after hip fracture. CONCLUSIONS: We did not find a relationship between serum 25-hydroxy-vitamin D levels and mortality after hip fracture, although we observed a high prevalence of vitamin D deficiency and a significant association with mortality in the univariate analysis.
Hip Fractures ; Hip* ; Humans ; Mortality* ; Multivariate Analysis ; Osteoporosis ; Prevalence ; Proportional Hazards Models ; Risk Factors* ; Vitamin D Deficiency* ; Vitamin D* ; Vitamins*

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Relationship between Bone Mineral Density and Spinal Muscle Area in Magnetic Resonance Imaging.

Dae Young LEE ; Jae Ho YANG ; Chul Hyun KI ; Min Seok KO ; Kyung Soo SUK ; Hak Sun KIM ; Hwan Mo LEE ; Seong Hwan MOON

Journal of Bone Metabolism.2015;22(4):197-204. doi:10.11005/jbm.2015.22.4.197

BACKGROUND: Bone mineral density (BMD) is known to have a positive correlation with lean body mass. Several studies have also reported the positive correlation between muscle power and BMD. From this point of view, we hypothesized BMD of lumbar spine to have a positive correlation with muscle mass. METHODS: Seventy-nine female patients aged between 60 and 75 years old and who underwent magnetic resonance imaging (MRI) and BMD studies were included. Muscle mass in spine MRI was defined by the sum of the average muscle area of three axial images for each disc level. Lumbosacral muscle is the sum of paraspinal muscle and psoas muscle. RESULTS: In correlation analysis, paraspinal muscle mass showed positive correlation with BMD of lumbar spine. Lumbosacral muscle mass showed positive correlation with BMD of trochanteric area of the femur. However, BMD of other area showed no significant correlation with muscle mass. CONCLUSIONS: Therefore, postmenopausal women older than 60 years with a well developed spine muscle mass, have a high BMD.
Bone Density* ; Female ; Femur ; Humans ; Magnetic Resonance Imaging* ; Osteoporosis ; Paraspinal Muscles ; Postmenopause ; Psoas Muscles ; Spine

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Prevalence of Sarcopenia in Healthy Korean Elderly Women.

Eun Sil LEE ; Hyoung Moo PARK

Journal of Bone Metabolism.2015;22(4):191-195. doi:10.11005/jbm.2015.22.4.191

BACKGROUND: We evaluated the prevalence of sarcopenia, presarcopenia, and severe sarcopenia in healthy Korean elderly women. METHODS: We measured the muscle mass and muscle function of 196 ambulatory women over the age of 65 years who visited the University Hospital Menopause Clinic. Appendicular skeletal muscle mass was measured by dual energy X-ray absorptiometry to measure skeletal muscle mass index (SMI). Assessment of hand grip strength (HGS) of the dominant hand was performed to measure the muscle strength, and 4-m straight on-way path was used to measure gait speed for physical performance. The values used to define the presarcopenia, sarcopenia, and severe sarcopenia were based on the cutoff values proposed by the Asian Working Group for Sarcopenia (AWGS). RESULTS: The mean age of women was 71.2 years, and the mean SMI in 196 women was 5.94 kg/m2. The average HGS was 20.3 kg, and the mean gait speed was 1.08 m/sec. In 41 out of the 196 women (20.9%), the SMI was reduced to less than 5.4 kg/m2. Fifty-nine women (30.1%) had HGS of less than 18 kg, and gait speed was less than 0.8 m/sec in 12 women (6.1%). Twenty-six women (13.3%) were classified into the presarcopenia stage, and 15 women (7.6%) were classified into the sarcopenia stage. There was no case of severe sarcopenia. CONCLUSIONS: One out of five relatively healthy women aged more than 65 years showed a decrease in muscle mass, and 7.6% of women showed a decrease in muscle mass and strength. The sarcopenia stage was also intensified with aging.
Absorptiometry, Photon ; Aged* ; Aging ; Asian Continental Ancestry Group ; Female ; Gait ; Hand ; Hand Strength ; Humans ; Menopause ; Muscle Strength ; Muscle, Skeletal ; Prevalence* ; Sarcopenia*

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Effect of Teriparatide on Healing of Atypical Femoral Fractures: A Systemic Review.

Gun Il IM ; Seong Hyun LEE

Journal of Bone Metabolism.2015;22(4):183-189. doi:10.11005/jbm.2015.22.4.183

BACKGROUND: Bisphosphonates (BPs) are the most commonly used anti-osteoporotic drugs, which have been proven to reduce the risk of osteoporotic fractures. However, use of BPs, particularly for long periods of time, is associated with an increased risk of atypical femoral fracture (AFF). Healing of BP-associated AFF is usually delayed because of suppressed bone turnover. Teriparatide (TPTD), a recombinant form of parathyroid hormone (PTH), enhances bone healing in patients with delayed healing or non-union. METHODS: In this study, we summarized and performed a systemic review of the published literature on treatment of AFF using TPTD. RESULTS: Although there is a lack of level 1 studies on the evidence of TPTD in promoting bone union in AFFs, this systemic review of the available literature revealed that TPTD works positively in AFFs, and we put together the evidence that TPTD is a viable treatment option for enhancing fracture healing in AFFs. CONCLUSIONS: While anecdotal evidence of beneficial effects of TPTD on fracture healing offer limited guidance for clinical decision making, a better understanding of the role of TPTD in fracture healing may be elucidated with future prospective trials.
Decision Making ; Diphosphonates ; Femoral Fractures* ; Fracture Healing ; Humans ; Osteoporotic Fractures ; Parathyroid Hormone ; Prospective Studies ; Teriparatide*

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Osteoporotic Fracture: 2015 Position Statement of the Korean Society for Bone and Mineral Research.

Je Hyun YOO ; Seong Hwan MOON ; Yong Chan HA ; Dong Yeon LEE ; Hyun Sik GONG ; Si Young PARK ; Kyu Hyun YANG

Journal of Bone Metabolism.2015;22(4):175-181. doi:10.11005/jbm.2015.22.4.175

Osteoporotic fractures are one of the most common causes of disability and a major contributor to medical care costs worldwide. Prior osteoporotic fracture at any site is one of the strongest risk factors for a new fracture, which occurs very soon after the first fracture. Bone mineral density (BMD) scan, a conventional diagnostic tool for osteoporosis, has clear limitations in diagnosing osteoporotic fractures and identifying the risk of subsequent fractures. Therefore, early and accurate diagnosis of osteoporotic fractures using the clinical definition which is applicable practically and independent of BMD, is essential for preventing subsequent fractures and reducing the socioeconomic burden of these fractures. Fractures caused by low-level trauma equivalent to a fall from a standing height or less at major (hip, spine, distal radius, and proximal humerus) or minor (pelvis, sacrum, ribs, distal femur and humerus, and ankle) sites in adults over age 50, should be first regarded as osteoporotic. In addition, if osteoporotic fractures are strongly suspected on history and physical examination even though there are no positive findings on conventional X-rays, more advanced imaging techniques such as computed tomography, bone scan, and magnetic resonance imaging are necessary as soon as possible.
Adult ; Bone Density ; Diagnosis ; Femur ; Health Care Costs ; Humans ; Humerus ; Magnetic Resonance Imaging ; Osteoporosis ; Osteoporotic Fractures* ; Physical Examination ; Practice Guidelines as Topic ; Radius ; Ribs ; Risk Factors ; Sacrum ; Spine

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Position Statement: Drug Holiday in Osteoporosis Treatment with Bisphosphonates in South Korea.

Seung Hun LEE ; Hyun Sik GONG ; Tae Hee KIM ; Si Young PARK ; Jung Ho SHIN ; Sun Wook CHO ; Dong Won BYUN

Journal of Bone Metabolism.2015;22(4):167-174. doi:10.11005/jbm.2015.22.4.167

Bisphosphonates have been widely used in the treatment of osteoporosis with robust data from many placebo-controlled trials demonstrating its efficacy in fracture risk reduction over 3 to 5 years of treatment. Although bisphosphonates are generally safe and well tolerated, concerns have emerged about the adverse effects related to its long-term use, including osteonecrosis of the jaw and atypical femur fractures. Because bisphosphonates are incorporated into the skeleton and continue to exert an anti-resorptive effect for a period of time after the discontinuation of drugs, the concept of a "drug holiday" has emerged, whereby the risk of adverse effects might be decreased while the patient still benefits from anti-fracture efficacy. As randomized clinical trial evidence is not yet available on who may qualify for a drug holiday, there is considerable controversy regarding the selection of candidates for the drug holiday and monitoring during a drug holiday, both of which should be based on individual assessments of risk and benefit. This statement will provide suggestions for clinicians in South Korea on the identification of possible candidates and monitoring during a bisphosphonate drug holiday.
Diphosphonates* ; Femur ; Holidays* ; Humans ; Jaw ; Korea* ; Osteonecrosis ; Osteoporosis* ; Risk Reduction Behavior ; Skeleton

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Kyoung Min KIM ; Yumie RHEE ; Yong Dae KWON ; Tae Geon KWON ; Jeong Keun LEE ; Deog Yoon KIM

Journal of Bone Metabolism.2015;22(4):151-165. doi:10.11005/jbm.2015.22.4.151

Bisphosphonates are the most widely prescribed drugs for the treatment of osteoporosis, and are also used in malignant bone metastases, multiple myeloma, and Paget's disease, and provide therapeutic efficacy on those diseases. However, it was reported that occurrence of osteonecrosis of the jaw (ONJ) could be related with bisphosphonate exposures, and there have been many cases regarding this issue. Therefore, a clearer definition and treatment guidelines were needed for this disease. The American Society for Bone and Mineral Research (ASBMR) and American Association of Oral and Maxillofacial Surgeons (AAOMS) reported statements on bisphosphonate-related ONJ (BRONJ), and a revised version was recently presented. In the revised edition, the diagnosis BRONJ was changed to medication-related ONJ (MRONJ), which reflects a consideration of the fact that ONJ also occurs for denosumab, a bone resorption inhibitor of the receptor activator of nuclear factor-kappa B ligand (RANKL) antibody family, and bevacizumab, an anti-angiogenesis inhibitor. In 2009, a statement on ONJ was also reported locally by a relevant organization, which has served as basis for clinical treatment in Korea. In addition to the new official stance of the AAOMS and ASBMR, with an increasing pool of ONJ clinical experience, a revised version of the 2009 local statement is needed. As such, the Korean Society for Bone and Mineral Research (KSBMR) and the Korean Association of Oral and Maxillofacial Surgeons (KAOMS) have collectively formed a committee for the preparation of an official statement on MRONJ, and have reviewed recent local and international data to propose guidelines customized for the local Korean situation.
Bisphosphonate-Associated Osteonecrosis of the Jaw ; Bevacizumab ; Bone Resorption ; Denosumab ; Diagnosis ; Diphosphonates ; Humans ; Jaw* ; Korea ; Multiple Myeloma ; Neoplasm Metastasis ; Osteonecrosis* ; Osteoporosis ; RANK Ligand

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Calcium and Vitamin D Supplementations: 2015 Position Statement of the Korean Society for Bone and Mineral Research.

Kyoung Min KIM ; Han Seok CHOI ; Mi Ja CHOI ; Ho Yeon CHUNG

Journal of Bone Metabolism.2015;22(4):143-149. doi:10.11005/jbm.2015.22.4.143

Calcium and vitamin D are essential components for bone health, thus calcium and vitamin D supplementation is an important strategy in the management of osteoporosis. However, the benefit of calcium and vitamin D supplementation on bone health is still controversial. Moreover, potentially harmful effects of excessive calcium supplementation on cardiovascular health are recently suggested. Too high a level of vitamin D has been also reported to have several, possibly related, harmful events. Korea is well known for low dietary calcium intake and vitamin D deficiency in its population. This position statement developed the following recommendation for adequate levels of calcium and vitamin D intake in Korean, postmenopausal women and men older than 50 years: Adequate calcium intake and optimal vitamin D level are essential for preventing and treating osteoporosis in postmenopausal women and men older than 50 years. We recommend a daily calcium intake of 800 to 1,000 mg/day. Food remains the best source of calcium; however calcium supplements should be considered when dietary intake of calcium is inadequate. We recommend dietary vitamin D intake of more than 800 IU per day, a level which appears to reduce the risk of fractures. When vitamin D deficiency is suspected, serum 25-hydroxy-vitamin D (25-[OH]D) level should be tested. We suggest that a serum 25-(OH)D level greater than 20 ng/mL is generally appropriate for prevention of osteoporosis. However, a serum 25-(OH)D level greater than 30 ng/mL is probably helpful for management of osteoporosis and prevention of fractures.
Calcium* ; Calcium, Dietary ; Cardiovascular Diseases ; Female ; Humans ; Korea ; Male ; Osteoporosis ; Vitamin D Deficiency ; Vitamin D* ; Vitamins*

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Insufficiency Fracture of Ipsilateral Femur Neck in Patient Treated with Long Term Bisphosphonate Treatment: A Case Report.

Do Hoon KIM ; Eui Chul LEE ; Seok Kwon KANG

Journal of Bone Metabolism.2012;19(2):159-162. doi:10.11005/jbm.2012.19.2.159

Bisphosphonate is notable for the treatment of osteoporosis in the world. But recently if Bisphosphonate is taken for a long time, it causes an insufficiency fracture by suppression of bone turn-over and it is reported rarely on femur neck. Here we report a case of insufficiency fracture on ipsilateral femur neck in woman treated with long term Bisphosphonate therapy.
Female ; Femur ; Femur Neck ; Fractures, Stress ; Humans ; Osteoporosis

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A Case of Cushing Syndrome Diagnosed by Recurrent Pathologic Fractures in a Young Woman.

Ju Young HAN ; Jungjin LEE ; Gyung Eun KIM ; Jin Yeob YEO ; So Hun KIM ; Moonsuk NAM ; Yong Seong KIM ; Seongbin HONG

Journal of Bone Metabolism.2012;19(2):153-158. doi:10.11005/jbm.2012.19.2.153

Cushing's syndrome is characterized by central obesity, fatigability, weakness, amenorrhea, hirsutism, edema, hypertension, impaired glucose tolerance, and osteoporosis due to excessive production of steroids. Cushing's syndrome is an important cause of secondary osteoporosis. Patients with Cushing's syndrome have a high incidence of osteoporotic fractures. At least, 30-50% of patients with Cushing's syndrome experience fractures, particularly in the vertebral body. And it is consistent with the 50% prevalence of osteoporosis in patients with Cushing's syndrome. However, reports of multiple pathological fractures in young patients with Cushing's syndrome are rare. Thus, we describe the case of a 26-year-old woman with Cushing's syndrome accompanied with recurrent multiple osteoporotic fractures and being treated by parathyroid hormone. Careful consideration for the possibility of Cushing's syndrome will be necessary in case of young patients with a spontaneous multiple compression fractures in spine.
Adult ; Amenorrhea ; Cushing Syndrome ; Edema ; Female ; Fractures, Compression ; Fractures, Spontaneous ; Glucose ; Hirsutism ; Humans ; Hypertension ; Incidence ; Obesity, Abdominal ; Osteoporosis ; Osteoporotic Fractures ; Parathyroid Hormone ; Prevalence ; Spine ; Steroids

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