Trends in osteoporosis and mean bone density among type 2 diabetes patients in the US from 2005 to 2014.
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ABSTRACT:
SUBMITTER: Xu Y
PROVIDER: S-EPMC7881186 | biostudies-literature | 2021 Feb
REPOSITORIES: biostudies-literature
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Trends in osteoporosis and mean bone density among type 2 diabetes patients in the US from 2005 to 2014.
Scientific reports 20210212 1
This study aimed to examine how bone health changed among T2DM patients in the past decade. Continuous National Health and Nutrition Examination Survey (NHANES) data from 2005-2006 to 2013-2014 were analyzed to examine the trends of bone mineral density (BMD) and the prevalence trends of osteoporosis osteopenia among T2DM patients and non-diabetic people aged 40 years and older. The age- and BMI-adjusted mean BMD of the femur neck for the four NHANES cycles decreased linearly in both T2DM patien ...[more]
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Project description:This study examined trends in osteoporosis and low bone mass in older US adults between 2005 and 2014 using bone mineral density (BMD) data from the National Health and Nutrition Examination Survey (NHANES). Osteoporosis and low bone mass appear to have increased at the femur neck but not at the lumbar spine during this period.IntroductionRecent preliminary data from Medicare suggest that the decline in hip fracture incidence among older US adults may have plateaued in 2013-2014, but comparable data on BMD trends for this time period are currently lacking. This study examined trends in the prevalence of osteoporosis and low bone mass since 2005 using BMD data from NHANES. The present study also updated prevalence estimates to 2013-2014 and included estimates for non-Hispanic Asians.MethodsFemur neck and lumbar spine BMD by DXA were available for 7954 adults aged 50 years and older from four NHANES survey cycles between 2005-2006 and 2013-2014.ResultsSignificant trends (quadratic or linear) were observed for the femur neck (mean T-score and osteoporosis in both sexes; low bone mass in women) but not for the lumbar spine. The trend in femur neck status was somewhat U-shaped, with prevalences being most consistently significantly higher (by 1.1-6.6 percentage points) in 2013-2014 than 2007-2008. Adjusting for changes in body mass index, smoking, milk intake, and physician's diagnosis of osteoporosis between surveys did not change femur neck trends. In 2013-2014, the percent of older adults with osteoporosis was 6% at the femur neck, 8% at the lumbar spine, and 11% at either site.ConclusionsThere was some evidence of a decline in femur neck BMD between 2005-2006 and 2013-2014, but not in lumbar spine BMD. Changes in the risk factors that could be examined did not explain the femur neck BMD trends.
| S-EPMC7891684 | biostudies-literature
Project description:Studies examining recent bone mineral density (BMD) trends in the US population are limited. In our study, we found that age-adjusted mean BMD among US men and women was stable from 2005 to 2010, but then declined in 2013-2014. We also explored factors associated with decreasing BMD in recent years. INTRODUCTION:Osteoporosis prevalence in the USA declined between 1988 and 2006, while the declining trend in hip fracture may have plateaued in 2013-2014. We aimed to examine whether there has been a corresponding change in BMD trajectory for the US population. METHODS:Continuous National Health and Nutrition Examination Survey (NHANES) data from 2005-2006 to 2013-2014 were analyzed to examine BMD trends among US men and women aged 30 years and older and among different race/ethnicity subgroups. ANOVA and Bonferroni adjustments were used to examine the differences in mean BMD, and multiple linear regressions adjusting for potential confounding effects were employed to examine BMD trends. RESULTS:After age standardization, the mean BMD of the femur neck for the first three NHANES cycles was stable (all p?>?0.1) in both men and women, but significantly decreased in 2013-2014, from 0.864 g/cm2 to 0.846 g/cm2 (p?=?0.0025) in men and from 0.789 to 0.771 g/cm2 (p?=?0.03) in women. The overall mean femur neck BMD in 2013-2014 was significantly lower than that in earlier survey cycles in both men and women, even after adjusting for multiple covariates, including age, race, physical activity, previous fracture, BMI, and other variables. Similar results were observed in subgroup analyses of race and sensitivity analyses. CONCLUSIONS:Age-adjusted mean BMD decreased in 2013-2014 in both men and women, and this significant decrease was also observed in sensitivity and subgroup analyses. The decreased BMD in 2013-2014 still remained significant even after being adjusted for multiple potentially confounding effects.
| S-EPMC6192842 | biostudies-literature
Project description:BackgroundA review of data from large clinical trials reported more than 90% of subjects significantly improved their bone mineral density (BMD) at the lumbar spine (LS) with teriparatide (TPTD) (bone 39:1268-1275, 1). However, our clinical experience suggests that many patients may be non-responders, raising questions as to the true efficacy of TPTD in improving BMD in osteoporotic patients.Questions/purposesThe purpose of the study is to determine the rate of improvement in BMD following 18-24 months of teriparatide (TPTD) in patients with osteoporosis within an orthopedic hospital setting.MethodsThis is a retrospective chart review of patients with osteoporosis who completed 18-24 months of TPTD therapy. The primary endpoint was the change in BMD at lumbar spine (LS) and hip-femoral neck (FN) and total hip (TH) following treatment. Secondary endpoints included the effect of prior bisphosphonate therapy, age, body mass index (BMI) and family history of fracture on BMD response, and the changes in bone-specific markers during active treatment.ResultsSeventy-eight women and men with mean T-scores at the LS?=?-2.63 met the inclusion criteria. The overall group showed a 10.7% increase in LS-BMD after 24 months of TPTD. Eighty-three percent were considered responders defined as ?3.0% increase in LS-BMD. Non-responders (16.7%) had mean LS-BMD change?=?-1.41%. No difference in baseline vitamin D, calcium, creatinine, BMI, age, gender, prior fracture history, or bisphosphonate use was observed between responders and non-responders. No consistent pattern of change in measures of bone markers was noted between responders and non-responders.ConclusionEighty-three percent of patients with osteoporosis showed a >3% increase in BMD after TPTD treatment. Baseline parameters, prior bisphosphonate therapy, and the changes in bone markers showed no correlation with final BMD outcome.
| S-EPMC5481259 | biostudies-literature
Project description:Canagliflozin is a sodium glucose cotransporter 2 inhibitor developed to treat type 2 diabetes mellitus (T2DM).Our objective is to describe the effects of canagliflozin on bone mineral density (BMD) and bone biomarkers in patients with T2DM.This was a randomized study, consisting of a 26-week, double-blind, placebo-controlled period and a 78-week, double-blind, placebo-controlled extension.This study was undertaken in 90 centers in 17 countries.Patients were aged 55-80 years (N = 716) and whose T2DM was inadequately controlled on a stable antihyperglycemic regimen.Canagliflozin 100 or 300 mg or placebo were administered once daily.BMD was assessed using dual-energy x-ray absorptiometry at weeks 26, 52, and 104. Bone strength was assessed using quantitative computed tomography and finite element analysis at week 52. Serum collagen type 1 ?-carboxy-telopeptide, osteocalcin, and estradiol were assessed at weeks 26 and 52.Canagliflozin doses of 100 and 300 mg were associated with a decrease in total hip BMD over 104 weeks, (placebo-subtracted changes: -0.9% and -1.2%, respectively), but not at other sites measured (femoral neck, lumbar spine, or distal forearm). No meaningful changes in bone strength were observed. At week 52, canagliflozin was associated with an increase in collagen type 1 ?-carboxy-telopeptide that was significantly correlated with a reduction in body weight, an increase in osteocalcin, and, in women, a decrease in estradiol.In older patients with T2DM, canagliflozin showed small but significant reductions in total hip BMD and increases in bone formation and resorption biomarkers, due at least in part to weight loss.
| S-EPMC4701848 | biostudies-literature
Project description:OBJECTIVE:To evaluate trends in the utilization, clinical characteristics, and inpatient outcomes among persons with knee osteoarthritis undergoing bariatric surgery. METHOD:We used the National Inpatient Sample (NIS) to examine trends of bariatric surgeries performed on adults with clinically documented knee osteoarthritis between 2005 and 2014. We abstracted hospital setting, procedure, demographic and clinical characteristics, and inpatient surgical outcomes from each discharge. We examined temporal trends using linear regression and Cochran-Armitage test for trend. RESULTS:The utilization of bariatric surgery among persons with knee osteoarthritis from 2005 to 2014 remained consistent, with an annual total of about 3,300 procedures performed nationally. The most common procedure type changed from laparoscopic Roux-en-Y (65%) in 2005-2006 to laparoscopic sleeve gastrectomy (58%) in 2013-2014. The median age, proportion on Medicare, and age- and sex-adjusted prevalence of diabetes increased from 46 to 51 years, 7-23%, and 28-32%, respectively. From 2005 to 2014, the median adjusted costs, in 2017 USD, for laparoscopic and open Roux-en-Y surgeries decreased from $15,100 to $13,300 (p < 0.01) and $14,100 to $10,100 (p = 0.0001), respectively, whereas the costs of laparoscopic sleeve gastrectomy and laparoscopic banding did not change significantly. In-hospital mortality remained at 0.0-0.1% from 2005 to 2014. CONCLUSION:Although growing evidence suggests that bariatric surgery is associated with improvements in osteoarthritis pain and functional status, the utilization of bariatric surgery among morbidly obese persons with knee osteoarthritis remained consistent from 2005 to 2014. Bariatric surgery in persons with knee osteoarthritis is generally safe, as inpatient complication and mortality rates remained low despite an increase in age and number of comorbidities.
| S-EPMC6293464 | biostudies-literature
Project description:Without antiresorptive therapy, postmenopausal women lose bone mass after teriparatide (TPTD) discontinuation; estrogen treatment prevents bone loss in this setting. It is not known whether premenopausal women with regular menses lose bone mass after teriparatide discontinuation.This study aimed to test the hypothesis that normally menstruating premenopausal women with idiopathic osteoporosis (IOP) will maintain teriparatide-associated bone mineral density (BMD) gains after medication cessation.Twenty-one premenopausal IOP women previously enrolled in an open-label pilot study of teriparatide (20 mcg for 18-24 mo), had substantial BMD increases at the lumbar spine (LS; 10.8 ± 8.3%), total hip (TH; 6.2 ± 5.6%), and femoral neck (7.6 ± 3.4%). For this study, BMD was remeasured 2.0 ± 0.6 years after teriparatide cessation.Fifteen women, who had gained 11.1 ± 7.2% at LS and 6.1 ± 6.5% at TH and were premenopausal at teriparatide completion, were followed without antiresorptive treatment.Two years after completing teriparatide, BMD declined by 4.8 ± 4.3% (P = .0007) at the LS. In contrast, BMD remained stable at the femoral neck (-1.5 ± 4.2%) and TH (-1.1 ± 3.7%). Those who sustained LS bone loss >3% (-7.3 ± 2.9%; n = 10), did not differ from those with stable LS BMD (0.1 ± 1.1%; n=5) with regard to baseline body mass index, BMD at any site, or duration of followup, but were significantly older at re-evaluation (46 ± 3 vs 38 ± 7; P = .046), had larger increases in LS BMD during teriparatide treatment and higher cancellous bone remodeling on transiliac biopsy at baseline and completion of teriparatide treatment. Serum bone turnover markers did not differ at baseline or teriparatide completion, but tended to be higher at the re-evaluation timepoint in those with post-teriparatide bone loss.These findings lead us to conclude that premenopausal women with IOP, particularly those over 40, may require antiresorptive treatment to prevent bone loss after teriparatide.
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Project description:IntroductionStudies show trabecular bone score (TBS) may provide information regarding bone quality independent of bone mineral density (BMD) in type 2 diabetes (DM2) patients. We analyzed our Southeast Asian severe osteoporotic hip fracture patients to study these differences.MethodsWe conducted a retrospective cross-sectional analysis of subjects admitted to Changi General Hospital, Singapore with severe osteoporotic hip fractures from 2014-2017 who had BMD performed. Electronic records were reviewed and subjects were classified as having diabetes according to the WHO 2019 criteria. DM2 patients were classified according to their HbA1c into well controlled (HbA1c < 7%) and poorly controlled (HbA1c ≥ 7%) DM2.ResultsElderly patients with hip fractures present with average femur neck T scores at the osteoporotic range, however those with DM2 had higher BMD and TBS values compared to non DM2 patients. These differences were statistically significant in elderly women-poorly controlled elderly DM2 women with hip fracture had the highest total hip T-score (-2.57 ± 0.86) vs (-2.76 ± 0.96) in well controlled DM2 and (-3.09 ± 1.01) in non DM2 women with hip fracture, p < 0.001. In contrast, TBS scores were lower in poorly controlled DM2 women with hip fracture compared to well controlled DM2 women with hip fracture (1.22 ± 0.11) vs (1.24 ± 0.09), but these were still significantly higher compared to non DM2 women with hip fracture (1.19 ± 0.10), p < 0.001. In elderly men with hip fractures, univariate analysis showed no statistically significant differences in TBS or hip or LS BMD between those with poorly controlled DM2, well controlled DM2 and non DM2. The differences in TBS and BMD remained significant in all DM2 women with hip fractures even after adjustments for potential confounders. Differences in TBS and BMD in poorly controlled DM2 men with hip fractures only became significant after accounting for potential confounders. However, upon inclusion of LS BMD into the multivariate model these differences were attenuated and remained significant only between elderly women with well controlled DM2 and non DM2 women with hip fractures.ConclusionsElderly patients with DM2 and severe osteoporosis present with hip fractures at a higher BMD and TBS values compared to non DM2 patients. These differences were significant after adjustment for confounders in all DM2 women and poorly controlled DM2 men with hip fractures, TBS differences were attenuated with the inclusion LS BMD. Further studies are needed to ascertain differences in BMD and TBS in older Southeast Asian DM2 patients with variable glycemic control and severe osteoporosis.
| S-EPMC7676677 | biostudies-literature
Project description:BackgroundThe American Diabetes Association (ADA) recommends that treatment with metformin be considered for prevention of type 2 diabetes in persons with prediabetes. However, metformin use outside the setting of diagnosed diabetes in US adults is not well characterized.ObjectiveTo examine trends in self-reported prediabetes and treatment with metformin. We also compared characteristics of adults self-reported prediabetes who were vs. were not taking metformin.DesignCross-sectional analysis.ParticipantsAdults ? 20 years of age who participated in the 2005-2014 National Health and Nutrition and Examination Survey (NHANES), n = 28,461.ApproachWe characterized trends in self-reported prediabetes and metformin use in this population. We used multiple logistic regression models to identify predictors of metformin use among adults with self-reported prediabetes. All analyses accounted for the weighted complex survey design to generate nationally representative estimates.Key resultsThe prevalence of self-reported prediabetes increased from 5.1% in 2005-2006 to 7.4% in 2013-2014 (P-for-trend < 0.001). In persons with self-reported prediabetes, metformin use increased, from 2.4 to 8.3% (P-for-trend = 0.013). Adults who were taking metformin were more likely to be obese and to report trying to lose weight in the past year.ConclusionsSelf-reported prediabetes has increased in the past decade. Metformin use in the setting of prediabetes has also increased but remains relatively uncommon at 8% in adults who self-report prediabetes, despite current clinical recommendations.
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Project description:BackgroundED overutilization is a leading cause of increased healthcare costs and a key target for healthcare reform. ED utilization patterns following common operative procedures are unknown.MethodsUsing the SPARCS New York (NY) statewide longitudinal administrative database, a longitudinal analysis on 746,633 patients who underwent cholecystectomy (n = 355,368), appendectomy (n = 142,797) or inguinal hernia repair (n = 248,468) from 2005 to 2014 was performed. ED revisits were identified via unique patient identifiers which allow for patient tracking across hospitals in NY State.ResultsIn total, 59,255 (7.9%) patients presented to the ED within 30-days of their operation of which 21,638 (36.5%) were admitted. The aggregated rate of ED utilization and admission from the ED were as follows: cholecystectomy (9.5%, 40%), appendectomy (9.1%, 33.1%), and inguinal hernia repair (5.1%, 26.2%), respectively. A longitudinal analysis demonstrated a relative slowing of the rate of increase in hospital readmissions for cholecystectomy and inguinal hernia repair but no change in the number of ED revisits for inguinal hernia repair.ConclusionsNearly 1 in 10 patients undergoing cholecystectomy and appendectomy, and 1 in 20 patients undergoing inguinal hernia repair will present to the ED following surgery. The majority of ED visits do not result in admission, calling their necessity into question. These data suggest possible overutilization of the ED following common operations and support the consideration of ED utilization as a quality indicator.
| S-EPMC6954989 | biostudies-literature
Project description:Objectives: To assess the effect of vitamin D supplementation on bone mineral density (BMD) in rheumatoid arthritis (RA) patients with osteoporosis and determine whether supplementation of more than 800 IU/day, which is the currently recommended dose, is beneficial. Methods: RA patients with osteoporosis who received bisphosphonate were included. Patients were classified into four groups according to the dose of vitamin D supplementation (0, 400, 800, and ≥1,000 IU/day). Multivariable linear regression models were performed to evaluate the effect of each dose of vitamin D supplementation on 1-year% change of BMD. Results: In total, 187 RA patients with osteoporosis were included. In the multivariate model adjusted for potential confounders, patients receiving vitamin D supplementation had a significantly higher increase in 1-year % change in lumbar spine BMD (400 IU/day: β = 2.51 [95% CI: 0.04-4.99], 800 IU/day: β = 2.90 [95% CI: 0.47-5.33], and ≥1,000 IU/day: β = 6.01 [95% CI: 3.71-8.32]) and femoral neck BMD (400 IU/day: β = 3.88 [95% CI: 1.83-5.94], 800 IU/day: β =4.30 [95% CI: 2.25-6.35], and ≥1,000 IU/day: β = 6.79 [95% CI: 4.87-8.71]) than those not receiving the supplementation. Notably, the ≥1,000-IU/day group had a significantly higher increase in 1-year % change in lumbar spine BMD (β = 3.11 [95% CI: 0.86-5.37]) and femoral neck BMD (β = 2.50 [95% CI: 0.63-4.36]) than the 800-IU/day group. Conclusion: In RA patients with osteoporosis receiving bisphosphonates, vitamin D supplementation was associated with a higher increase in BMD. This effect was higher in the vitamin D supplementation dose of ≥1,000 IU/day than in 800 IU/day.
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