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Current Role and Application of Teriparatide in Fracture Healing of Osteoporotic Patients: A Systematic Review.

Sang Min KIM ; Kyung Chung KANG ; Ji Wan KIM ; Seung Jae LIM ; Myung Hoon HAHN

Journal of Bone Metabolism.2017;24(1):65-73. doi:10.11005/jbm.2017.24.1.65

BACKGROUND: The use of osteoanabolic agents to facilitate fracture healing has been of heightened interest to the field of orthopaedic trauma. This study aimed to evaluate the evidence of teriparatide for fracture healing and functional recovery in osteoporotic patients. METHODS: We performed a literature search in PubMed, EMBASE, Web of Science, and the Cochrane Library using terms including “Fracture” [tiab] AND “Teriparatide [tiab] OR “PTH” [tiab]. RESULTS: This systematic review included 6 randomized clinical trials, 4 well-controlled retrospective studies, and 1 retrospective post hoc subgroup analysis. Fracture location was 2 in pelvis, 3 in proximal femur, 1 in distal femur, 1 in shoulder, 2 in wrist and 2 in spine. The use of teriparatide yielded positive effects on radiographic bone healing in 6 studies, but was not associated with better radiographic outcome in 3. In terms of functional recovery, teriparatide injection was related with decrease in pain or shorter time to mobilization in 6 studies, but not related with pain numerical scale and mobility in 3. CONCLUSIONS: Our findings suggest that teriparatide provide selective advantages to fracture healing or functional recovery in the management of osteoporotic fractures. A better understanding of the role of teriparatide on osteoporotic fractures requires greater evidences from large volume prospective trials.
Femur ; Fracture Healing* ; Humans ; Osteoporosis ; Osteoporotic Fractures ; Parathyroid Hormone ; Pelvis ; Prospective Studies ; Retrospective Studies ; Shoulder ; Spine ; Teriparatide* ; Wrist

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Characteristics of Patients Diagnosed with Osteoporosis in South Korea: Results from the National Claim Registry.

Hyun Koo YOON ; Young Kyun LEE ; Yong Chan HA

Journal of Bone Metabolism.2017;24(1):59-63. doi:10.11005/jbm.2017.24.1.59

BACKGROUND: Although osteoporosis is increasing medical issue in the elderly population, attempts to analyze the characteristics of patients diagnosed with osteoporosis are rare in South Korea. We investigated the characteristics of patients diagnosed with osteoporosis using Korea's National Health Insurance claims data, which includes almost Korean population. METHODS: We evaluated the patients who were diagnosed and treated with osteoporosis in medical institute in South Korea, using the national database by the Health Insurance Review & Assessment Service (HIRA). We evaluated the characteristic of patients and state of medical service utilization in 2010. RESULTS: The number of patients who were diagnosed with osteoporosis were 1,733,685, and almost of them (91.1%) were females. Fourteen point three percent of the patients had experienced osteoporosis-related fracture. The most commonly used type of institute and department was hospital and orthopedic surgery. CONCLUSIONS: Considering increasing age population, basic information including characteristic of patients and current state of medical service utilization could be useful to perform appropriate management and treatment for osteoporosis patients in South Korea, using the National Health Insurance claims data.
Aged ; Female ; Humans ; Insurance, Health ; Korea* ; National Health Programs ; Orthopedics ; Osteoporosis* ; Osteoporotic Fractures ; Republic of Korea

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Association of Serum 25-hydroxy-vitamin D Concentration and Arterial Stiffness among Korean Adults in Single Center.

Jung Hae LEE ; Heuy Sun SUH

Journal of Bone Metabolism.2017;24(1):51-58. doi:10.11005/jbm.2017.24.1.51

BACKGROUND: There are growing concerns about the role of vitamin D deficiency in cardiovascular diseases. Therefore, we investigated the correlation between serum 25-hydroxy-vitamin D (25[OH]D) and arterial stiffness among Korean adults. METHODS: We retrospectively reviewed the medical charts of 302 people (115 women and 187 men) who visited a tertiary hospital from January 2015 to December 2016. Serum 25(OH)D was measured using the radioimmunoassay technique, and brachial-ankle pulse wave velocity (baPWV) was measured using an automatic wave analyzer. We obtained the doctor's report on the medical history of the participants, their alcohol consumption and smoking habits, and their exercise status. Metabolic syndrome was diagnosed based on guidelines from the National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATP III) and the International Diabetes Federation (IDF). Results of basic blood tests and physical assessment were also collected. RESULTS: In the Pearson correlation analysis, serum 25(OH)D and baPWV showed a statistically significant inverse relationship (r=-0.279, P<0.001). Using multiple regression analysis, and after adjusting for possible confounders, serum 25(OH)D concentration was found to be significantly associated with baPWV (β=-0.121, P=0.011). CONCLUSIONS: We observed an association between serum 25(OH)D concentration and arterial stiffness. Further studies involving larger sample sizes will be needed to confirm this associations.
Adult* ; Alcohol Drinking ; Calcifediol ; Cardiovascular Diseases ; Cholesterol ; Education ; Female ; Hematologic Tests ; Humans ; Pulse Wave Analysis ; Radioimmunoassay ; Retrospective Studies ; Sample Size ; Smoke ; Smoking ; Tertiary Care Centers ; Vascular Stiffness* ; Vitamin D Deficiency

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The Efficacy of Bisphosphonates for Prevention of Osteoporotic Fracture: An Update Meta-analysis.

Ji Hye BYUN ; Sunmee JANG ; Sumin LEE ; Suyeon PARK ; Hyun Koo YOON ; Byung Ho YOON ; Yong Chan HA

Journal of Bone Metabolism.2017;24(1):37-49. doi:10.11005/jbm.2017.24.1.37

BACKGROUND: The efficacy of bisphosphonates for osteoporotic fracture has been consistently reported in recent randomized controlled trials (RCTs) enrolling hundreds of patients. The objective of this study was to update knowledge on the efficacy of available bisphosphonates in the prevention of vertebral and non-vertebral fractures. METHODS: An approach “using systematic reviews” on PubMed and Cochrane Library was taken. Twenty-four RCTs investigating the effects of bisphosphonates for the prevention of osteoporotic fracture were included in final analysis. A pairwise meta-analysis was conducted with a random effects model. Subgroup analysis was performed according to the type of bisphosphonate. RESULTS: The use of bisphosphonate decrease the risk of overall osteoporotic fracture (odds ratio [OR] 0.62; P<0.001), vertebral fracture (OR 0.55; P<0.001) and non-vertebral fracture (OR 0.73; P<0.001). Subgroup analysis indicated that zoledronic acid showed the lowest risk reduction (OR 0.61; P<0.001) for overall osteoporotic fractures but no significance was observed for etidronate (OR 0.34; P=0.127). CONCLUSIONS: This update meta-analysis re-confirmed that bisphosphonate use can effectively reduce the risk of osteoporotic fracture. However, there is a lack of evidence regarding etidronate for the prevention of osteoporotic fracture.
Diphosphonates* ; Etidronic Acid ; Humans ; Meta-Analysis as Topic ; Osteoporosis ; Osteoporotic Fractures* ; Risk Reduction Behavior

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The Association between Dehydroepiandrosterone Sulfate (DHEA-S) and Bone Mineral Density in Korean Men and Women.

Seung Gun PARK ; Sena HWANG ; Jong Suk KIM ; Kyung Chae PARK ; Yuri KWON ; Kyong Chol KIM

Journal of Bone Metabolism.2017;24(1):31-36. doi:10.11005/jbm.2017.24.1.31

BACKGROUND: The relationship between dehydroepiandrosterone sulfate (DHEA-S) and bone mineral density (BMD) is controversial. And findings of most studies that have investigated this relationship are restricted to postmenopausal women. In this study, we investigated the relationship between serum DHEA-S and BMD in both men and women. METHODS: This cross-sectional study evaluated a total of 294 healthy Korean participants through a medical examination program. And a subgroup of 154 participants was subjected to a longitudinal analysis. We measured BMD by dual energy X-ray absorptiometry and assayed DHEA-S by a chemiluminescent immunoassay. RESULTS: We evaluated the association between serum DHEA-S concentration and BMD at the femur trochanter after adjusting for cofounders such as age, body mass index, lifestyle factors, serum cortisol level, serum insulin-like growth factor 1 (IGF-1) level, and sex. Through our longitudinal study, we found that the changes in BMD at the total spine, at the femur neck, and at the femur trochanter were all smaller in the ΔDHEA-S <0 group than in the ΔDHEA-S >0 group. CONCLUSIONS: We found that there was a positive correlation between serum DHEA-S and femur BMD, which suggests that controlling serum DHEA-S levels may retard age-related BMD reduction in Koreans.
Absorptiometry, Photon ; Aging ; Body Mass Index ; Bone Density* ; Cross-Sectional Studies ; Dehydroepiandrosterone Sulfate* ; Dehydroepiandrosterone* ; Female ; Femur ; Femur Neck ; Humans ; Hydrocortisone ; Immunoassay ; Life Style ; Longitudinal Studies ; Male ; Osteoporosis ; Spine

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Effects of Escherichia Coli-derived Recombinant Human Bone Morphogenetic Protein-2 Loaded Porous Hydroxyaptite-based Ceramics on Calvarial Defect in Rabbits.

Shin Young KIM ; Youngkyun LEE ; Seung Jun SEO ; Jae Hong LIM ; Yong Gun KIM

Journal of Bone Metabolism.2017;24(1):23-30. doi:10.11005/jbm.2017.24.1.23

BACKGROUND: Recombinant human bone morphogenetic proteins (rhBMPs) have been widely used in regenerative therapies to promote bone formation. The production of rhBMPs using bacterial systems such as Escherichia coli (E. coli) is estimated to facilitate clinical applications by lowering the cost without compromising biological activity. In clinical practice, rhBMP-2 and osteoconductive carriers (e.g., hydroxyapatite [HA] and bovine bone xenograft) are used together. This study examined the effect of E. coli-derived rhBMP-2 combined with porous HA-based ceramics on calvarial defect in rabbits. METHODS: Six adult male New Zealand white rabbits were used in this study. The experimental groups were divided into the following 4 groups: untreated (NC), bovine bone graft (BO), porous HA (HA) and porous HA with rhBMP-2 (HA-BMP). Four transosseous defects of 8 mm in diameter were prepared using stainless steel trephine bur in the frontal and parietal bones. Histological and histomorphometric analyses at 4 weeks after surgery revealed significant new bone formation by porous HA alone. RESULTS: HA-BMP showed significantly higher degree of bone formation compared with BO and HA group (P<0.05). The average new bone formation % (new bone area per total defect area) of NC, BO, HA, and HA-BMP at 4-week after surgery were 12.65±5.89%, 29.63±6.99%, 28.86±6.17% and 49.56±8.23%, respectively. However, there was no statistical difference in the bone formation between HA and BO groups. CONCLUSIONS: HA-BMP promoted more bone formation than NC, BO and HA alone. Thus, using E. coli-derived rhBMP-2 combined with porous HA-based ceramics can promote new bone formation.
Adult ; Bone Morphogenetic Proteins ; Ceramics* ; Durapatite ; Escherichia coli ; Escherichia* ; Humans* ; Hydroxyapatites ; Male ; Osteogenesis ; Parietal Bone ; Rabbits* ; Stainless Steel ; Transplants

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Coronary Artery Calcium Score and Bone Metabolism: A Pilot Study in Postmenopausal Women.

Pooneh SALARI ; Abbasali KESHTKAR ; Shapour SHIRANI ; Leila MOUNESAN

Journal of Bone Metabolism.2017;24(1):15-21. doi:10.11005/jbm.2017.24.1.15

BACKGROUND: Since 1991 many studies evaluated the link between cardiovascular diseases and osteoporosis, two age-related conditions, but the main common pathologic pathway has not been determined yet. The histological similarity between arterial calcified plaque and bone matrix and involvement of similar cells and mediators provide a special field of research. Therefore in the present study, we aimed to evaluate the relationship between coronary artery calcium score (CACS) as a surrogate marker of atherosclerosis and bone mediators and parameters in postmenopausal women. METHODS: Eleven postmenopausal women who had CACS higher than 80 were enrolled into the study and underwent bone densitometry. In addition, their serum and urine samples were taken for measuring osteoprotegerin, osteocalcin, and β cross laps. Patients' 10-year probability of fracture was calculated by the World Health Organization fracture-risk assessment tool (FRAX). RESULTS: The regression analysis of our results showed the association between CACS and OC (std β=0.66, 95% confidence interval [CI] 5.47-72.27, P=0.027), femoral bone density (std β=−0.6, 95% CI -6864.34-14.27, P=0.05) and T-score (std β=−0.6, 95% CI −773.08-1.28, P=0.05) which remained significant after adjustment for age, weight, years since menopause and body mass index. No association was found between CACS and osteoprotegerin, spinal bone density and FRAX score. CONCLUSIONS: In conclusion, this pilot study with small sample size showed the potential association between CACS and osteocalcin, femoral bone density and T-score. However, the relationship between CACS and osteoprotegerin, receptor activator of nuclear factor-kappa B ligand, FRAX score and other bone parameters remain to be clarified in larger sample size studies.
Atherosclerosis ; Biomarkers ; Body Mass Index ; Bone Density ; Bone Matrix ; Calcium* ; Cardiovascular Diseases ; Coronary Artery Disease ; Coronary Vessels* ; Densitometry ; Female ; Humans ; Menopause ; Metabolism* ; Osteocalcin ; Osteoporosis ; Osteoprotegerin ; Pilot Projects* ; RANK Ligand ; Sample Size ; World Health Organization

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Association between Sarcopenic Obesity and Metabolic Syndrome in Postmenopausal Women: A Cross-sectional Study Based on the Korean National Health and Nutritional Examination Surveys from 2008 to 2011.

Sun Young KANG ; Gyeong Eun LIM ; Yang Keun KIM ; Hye Won KIM ; Kayoung LEE ; Tae Jin PARK ; Jinseung KIM

Journal of Bone Metabolism.2017;24(1):9-14. doi:10.11005/jbm.2017.24.1.9

BACKGROUND: Menopause contributes to an increase in visceral fat mass and a decrease in muscle protein synthesis. Therefore, we performed this study to examine their relationship how effect the changes of body composition as obesity and sarcopenia on metabolic syndrome (MS) as a predictor of cardiovascular disease in postmenopausal women. METHODS: Using data from the Korean National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011, we estimated that 4,183 postmenopausal women underwent dual energy X-ray absorptiometry scans. Sarcopenia was defined as an appendicular skeletal muscle mass divided by body weight that was less than 1 standard deviation below the sex specific mean for the young reference group. After classification into four groups, the results were adjusted with menopausal age and hormonal treatment. The relationship between sarcopenic obesity (SO) and MS in postmenopausal women was analyzed by logistic regression analysis in a complex sampling. RESULTS: In an unadjusted model, the odds ratio (OR) of MS for sarcopenia was 1.94 (95% confidence interval [CI], 1.52-2.49); the obesity group had an OR of 4.55 (95% CI, 3.63-5.71); and distinctly, the SO group had an OR of 6.26 (95% CI, 5.10-7.70). Even though there was controlling for variable adjustment, no definite difference was seen in the results. CONCLUSIONS: Sarcopenia and obesity were associated with MS independent of other metabolic impairment risk factors in both early menopausal and postmenopausal women. The results showed that, in particular, the prevalence of MS has increased more in postmenopausal women compared with previous research.
Absorptiometry, Photon ; Body Composition ; Body Weight ; Cardiovascular Diseases ; Classification ; Cross-Sectional Studies* ; Female ; Humans ; Intra-Abdominal Fat ; Logistic Models ; Menopause ; Metabolic Syndrome X ; Muscle Proteins ; Muscle, Skeletal ; Nutrition Surveys ; Obesity* ; Odds Ratio ; Prevalence ; Risk Factors ; Sarcopenia

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Role of the Cytokine-like Hormone Leptin in Muscle-bone Crosstalk with Aging.

Mark W HAMRICK

Journal of Bone Metabolism.2017;24(1):1-8. doi:10.11005/jbm.2017.24.1.1

The cytokine-like hormone leptin is a classic adipokine that is secreted by adipocytes, increases with weight gain, and decreases with weight loss. Additional studies have, however, shown that leptin is also produced by skeletal muscle, and leptin receptors are abundant in both skeletal muscle and bone-derived mesenchymal (stromal) stem cells. These findings suggest that leptin may play an important role in muscle-bone crosstalk. Leptin treatment in vitro increases the expression of myogenic genes in primary myoblasts, and leptin treatment in vivo increases the expression of microRNAs involved in myogenesis. Bone marrow adipogenesis is associated with low bone mass in humans and rodents, and leptin can reduce marrow adipogenesis centrally through its receptors in the hypothalamus as well as directly via its receptors in bone marrow stem cells. Yet, central leptin resistance can increase with age, and low circulating levels of leptin have been observed among the frail elderly. Thus, aging appears to significantly alter leptin-mediated crosstalk among various organs and tissues. Aging is associated with bone loss and muscle atrophy, contributing to frailty, postural instability, and the incidence of falls. Therapeutic interventions such as protein and amino acid supplementation that can increase muscle mass and muscle-derived leptin may have multiple benefits for the elderly that can potentially reduce the incidence of falls and fractures.
Accidental Falls ; Adipocytes ; Adipogenesis ; Adipokines ; Aged ; Aging* ; Bone Marrow ; Frail Elderly ; Humans ; Hypothalamus ; In Vitro Techniques ; Incidence ; Insulin-Like Growth Factor I ; Leptin* ; Mesenchymal Stromal Cells ; MicroRNAs ; Muscle Development ; Muscle, Skeletal ; Muscular Atrophy ; Myoblasts ; Osteoporosis ; Receptors, Leptin ; Rodentia ; Sarcopenia ; Stem Cells ; Weight Gain ; Weight Loss

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Atypical Femoral Fracture Combined with Osteonecrosis of Jaw During Osteoporosis Treatment with Bisphosphonate.

Yougun WON ; Joon Ryul LIM ; Young Hwan KIM ; Hyung Keun SONG ; Kyu Hyun YANG

Journal of Bone Metabolism.2014;21(2):155-159. doi:10.11005/jbm.2014.21.2.155

Bisphosphonate, a potent anti-resorptive agent, is generally accepted as a safe, effective, well tolerated treatment for postmenopausal osteoporosis. Atypical femoral fracture (AFF) and bisphosphonate related osteonecrosis of jaw (BRONJ) are the increasing morbidities in patients treated with long term bisphosphonate. Pathogenic mechanisms of AFF and BRONJ are not fully identified and not identical. We report a case of BRONJ followed by AFF and its nonunion in a 67-year-old woman patient receiving an oral bisphosphonate during 7 years for the treatment of osteoporosis.
Aged ; Female ; Femoral Fractures* ; Humans ; Jaw* ; Osteonecrosis* ; Osteoporosis* ; Osteoporosis, Postmenopausal

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