BACKGROUND: Impaired physical performance and muscle strength are recognized risk factors for fragility fractures, frequently associated with osteoporosis and sarcopenia. However, the integration of muscle strength and physical performance in the comprehensive assessment of fracture risk is still debated. Therefore, this cross-sectional study aimed to assess the potential role of hand grip strength (HGS) and short physical performance battery (SPPB) for predicting fragility fractures and their correlation with Fracture Risk Assessment Tool (FRAX) with a machine learning approach. METHODS: In this cross-sectional study, a group of postmenopausal women underwent assessment of their strength, with the outcome measured using the HSG, their physical performance evaluated using the SPPB, and the predictive algorithm for fragility fractures known as FRAX. The statistical analysis included correlation analysis using Pearson's r and a decision tree model to compare different variables and their relationship with the FRAX Index. This machine learning approach allowed to create a visual decision boundaries plot, providing a dynamic representation of variables interactions in predicting fracture risk. RESULTS: Thirty-four patients (mean age 63.8±10.7 years) were included. Both HGS and SPPB negatively correlate with FRAX major (r=-0.381, P=0.034; and r=-0.407, P=0.023 respectively), whereas only SPPB significantly correlated with an inverse proportionality to FRAX hip (r=-0.492, P=0.001). According to a machine learning approach, FRAX major ≥20 and/or hip ≥3 might be reported for an SPPB<6. Concurrently, HGS<17.5 kg correlated with FRAX major ≥20 and/or hip ≥3. CONCLUSIONS: In light of the major findings, this cross-sectional study using a machine learning model related SPPB and HGS to FRAX. Therefore, a precise assessment including muscle strength and physical performance might be considered in the multidisciplinary assessment of fracture risk in post-menopausal women.

• MeSH
• hodnocení rizik MeSH
• kostní denzita * fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteoporotické fraktury * epidemiologie   etiologie   MeSH
• postmenopauza MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• síla ruky MeSH
• tělesná a funkční výkonnost MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Snížení výskytu osteoporotických zlomenin je dosahováno léčbou, která ovliňuje proces kostní remodelace. Široce dostupná je antiresorpční (antiremodelační) léčba (estrogeny, raloxifen, bisfosfonáty, denosumab). Pro pacienty v nejvyšším riziku zlomeniny, kteří zároveň splňují indikační kritéria, je dostupný i osteoanabolický teriparatid. V Evropské unii byl nedávno k léčbě postmenopauzálních žen s osteoporózou ve vysokém riziku zlomenin registrován inhibitor sklerostinu romosozumab. Snížení incidence osteoporotických zlomenin jak ve srovnání s placebem, tak ve srovnání s antiresorpčním alendronátem je dosaženo unikátním mechanismem účinku, jímž je 12 měsíců trvající stimulace kostní novotvorby a suprese kostní resorpce. Přestože v klinické praxi osteoanabolické léčbě zpravidla předchází podávání antiresorpčního léku, preferovanou sekvencí léčby je aplikace osteoanabolika před antiresorpční terapií. V klinické praxi se uplatňuje dvanáctiměsíční aplikace romosozumabu následovaná antiresorptivem.

The reduction of osteoporotic fractures is achieved by influencing the process of bone remodelling. Antiresorptive (antiremodelling) therapy (estrogens, raloxifene, bisphosphonates, denosumab) is widely available. The osteoanabolic drug teriparatide is also available for patients at highest risk of fracture who meet the indication criteria. In the European Union, the sclerostin inhibitor romosozumab has recently been registered for the treatment of postmenopausal women with osteoporosis at high risk of fracture. The reduction in the incidence of osteoporotic fractures, both compared to placebo and to the antiresorptive alendronate, is achieved by a unique mechanism of action, which is a 12-month stimulation of bone remodelling with concomitant mild suppression of bone resorption. Although in clinical practice osteoanabolic treatment is usually preceded by administration of an antiresorptive agent, the preferred sequence of treatment is osteoanabolic administration before the antiresorptive agent. Twelve months of romosozumab followed by an antiresorptive is used in clinical practice.

• Klíčová slova
• romosozumab,
• MeSH
• inhibitory kostní resorpce * aplikace a dávkování   farmakologie   škodlivé účinky   MeSH
• klinické zkoušky jako téma MeSH
• lidé MeSH
• monoklonální protilátky aplikace a dávkování   farmakologie   škodlivé účinky   MeSH
• osteoporotické fraktury epidemiologie   prevence a kontrola   MeSH
• osteoporóza * farmakoterapie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH

FRAX® calculates the 10-year probability of major osteoporotic fractures (MOF), which are considered to have a greater clinical impact than other fractures. Our results suggest that, in postmenopausal women with severe osteoporosis, those treated with teriparatide had a 60% lower risk of FRAX®-defined MOF compared with those treated with risedronate. INTRODUCTION: The VERO trial was an active-controlled fracture endpoint clinical trial that enrolled postmenopausal women with severe osteoporosis. After 24 months, a 52% reduction in the hazard ratio (HR) of clinical fractures was reported in patients randomized to teriparatide compared with risedronate. We examined fracture results restricted to FRAX®-defined major osteoporotic fractures (MOF), which include clinical vertebral, hip, humerus, and forearm fractures. METHODS: In total, 1360 postmenopausal women (mean age 72.1 years) were randomized to receive subcutaneous daily teriparatide (20 μg) or oral weekly risedronate (35 mg). Patient cumulative incidence of ≥ 1 FRAX®-defined MOF and of all clinical fractures were estimated by Kaplan-Meier analyses, and the comparison between treatments was based on the stratified log-rank test. Additionally, an extended Cox model was used to estimate HRs at different time points. Incidence fracture rates were estimated at each 6-month interval. RESULTS: After 24 months, 16 (2.6%) patients in the teriparatide group had ≥ 1 low trauma FRAX®-defined MOF compared with 40 patients (6.4%) in the risedronate group (HR 0.40; 95% CI 0.23-0.68; p = 0.001). Clinical vertebral and radius fractures were the most frequent FRAX®-defined MOF sites. The largest difference in incidence rates of both FRAX®-defined MOF and all clinical fractures between treatments occurred during the 6- to 12-month period. There was a statistically significant reduction in fractures between groups as early as 7 months for both categories of clinical fractures analyzed. CONCLUSION: In postmenopausal women with severe osteoporosis, treatment with teriparatide was more efficacious than risedronate, with a 60% lower risk of FRAX®-defined MOF during the 24-month treatment period. Fracture risk was statistically significantly reduced at 7 months of treatment. CLINICAL TRIAL INFORMATION: ClinicalTrials.gov Identifier: NCT01709110 EudraCT Number: 2012-000123-41.

• MeSH
• dvojitá slepá metoda MeSH
• inhibitory kostní resorpce * terapeutické užití   MeSH
• kostní denzita MeSH
• kyselina risedronová terapeutické užití   MeSH
• lidé MeSH
• osteoporotické fraktury * epidemiologie   etiologie   prevence a kontrola   MeSH
• postmenopauzální osteoporóza * farmakoterapie   MeSH
• senioři MeSH
• teriparatid terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• antirevmatika farmakologie   škodlivé účinky   MeSH
• autoimunitní nemoci MeSH
• diabetes mellitus diagnóza   epidemiologie   farmakoterapie   MeSH
• hyperglykemie farmakoterapie   MeSH
• hypoglykemika farmakologie   MeSH
• lidé MeSH
• osteoporotické fraktury epidemiologie   chirurgie   prevence a kontrola   MeSH
• revmatoidní artritida epidemiologie   farmakoterapie   MeSH
• senioři MeSH
• stárnutí * MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• novinové články MeSH

Od 1. dubna 2020 došlo v České republice změnou úhradové vyhlášky k posunutí denosumabu do první linie léčby osteoporózy u pacientů starších 70 let. Při rozhodování o optimálním typu léčby osteoporózy v první linii a volbě mezi denosumabem a bisfosfonáty je třeba zvážit specifické kontraindikace a toleranci léčby zásadně ovlivňující adherenci (riziko fraktur i mortalitu). V předkládaném textu jsou všechny tyto faktory diskutovány. Zároveň je porovnána účinnost obou těchto léčebných strategií na denzitu kostního minerálu, riziko fraktur, riziko závažných nežádoucích účinků, srovnávána je rovněž adherence k léčbě a zmíněny faktory, které adherenci a perzistenci ovlivňují. V závěru je uvedeno současné doporučení stran délky léčby a naznačeny možné denzitometrické terapeutické cíle.

In the Czech Republic, denosumab has been approved as the first‑line anti‑osteoporotic treatment in patients older than 70 years since April 1, 2020. While choosing optimal anti‑osteoporotic treatment in the first line (denosumab or bisphosphonates), it is essential to consider specific contraindications and tolerance (with great impact on adherence, thus the fracture and even mortality risk). All these factors are discussed, as well as the comparison of efficacy (BMD increase, reduction of fracture risk, risk of serious adverse events), adherence and persistence to treatment are provided. At the end, current expert recommendation is commented and possible densitometry therapeutic goals are suggested.

• Klíčová slova
• Prolia (denosumab),
• MeSH
• adherence a compliance při léčbě MeSH
• biologická terapie MeSH
• bisfosfonátová osteonekróza čelistí epidemiologie   MeSH
• bisfosfonáty aplikace a dávkování   škodlivé účinky   MeSH
• denosumab aplikace a dávkování   škodlivé účinky   MeSH
• denzitometrie MeSH
• hodnocení rizik MeSH
• inhibitory kostní resorpce MeSH
• lidé středního věku MeSH
• lidé MeSH
• ligand RANK antagonisté a inhibitory   MeSH
• osteoporotické fraktury epidemiologie   prevence a kontrola   MeSH
• osteoporóza farmakoterapie   MeSH
• postmenopauzální osteoporóza farmakoterapie   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

PURPOSE OF THE STUDY The pilot study deals with the current situation in proximal femoral fractures in culturally diverse regions, namely in Afghanistan (AFG) and in the Czech Republic (CZ). The study aimed to find out whether there are any differences in proximal femoral fractures in dependence on the selected criteria between the two culturally diverse areas. The study used the data of patients who underwent surgery for proximal femoral fracture at the Department of Orthopaedics of the 1 s t Medical Faculty of the Charles University and the Military University Hospital and at the Military Base Hospital Kabul. MATERIAL AND METHODS The study included patients aged 21 years or older who sustained a proximal femoral fracture in the period from October 2013 to February 2014. For the period concerned, the evaluation comprised 44 patients with a proximal femoral fracture from the Military Base Hospital Kabul, of whom 25 women and 19 men, and a total of 71 patients with a proximal femoral fracture from the Department of Orthopaedics of the 1st Medical Faculty of the Charles University and the Military University Hospital, of whom 43 women and 28 men. Based on the medical documentation, the following evaluation parameters were selected: age, sex, type of fracture. The data was processed using descriptive statistics, one-way and multifactorial analysis (ANOVA) and the POST-HOC test (Fisher LSD test, confidence interval = 95%) RESULTS The mean age of all the patients who suffered a fracture of proximal femur in AFG (58 years) was considerably lower (p < 0.001) than in patients in CZ (81 years). Similarly, a significant difference (p <0.001) was identified in the age of men and women treated for a proximal femoral fracture in both the countries. In AFG there was a statistically significant difference (p = 0.002) between the age of men and women, where women sustaining fractures were younger (54 years) compared to men (63 years). In CZ no significant age difference was reported (83 years vs 78 years). In AFG, the observed fractures occurred generally in their 6th and 7th decade, whereas in CZ only in their 9th decade. The incidence of proximal femoral fractures in Afghan women is the highest in their 5th and 6th decade. Pertrochanteric fractures and intracapsular fractures prevailed in both countries. The lowest age in both types of the fracture was reported in Afghan women (52 years in femoral neck fracture, p <0.001, 54 years in trochanteric fracture, p = 0.039). DISCUSSION Significant differences between the patients in AFG and CZ concern several factors. Afghanistan is a country with the lowest average life expectancy. In the Afghan population a major Vitamin D deficiency was confirmed. This is related to the conservative dress code, especially in women, when the Vitamin D synthesis is suppressed. That can cause the occurrence of osteoporosis in women at a considerably younger age than in the population in the Czech Republic, which is subsequently accompanied by an increased incidence of proximal femoral fractures. Similar results, however, were also obtained in men. One of the risk factors of osteoporosis development is also low physical activity throughout the lifetime. This risk factor is significant primarily in female population in the Muslim world. Afghanistan also faces serious malnutrition. All of that is reflected in low life expectancy in the given country, incidence of osteoporosis and injuries in this region. There is reasonable evidence that the mortality in a causal relationship with proximal femoral fracture is substantially higher in this region than in Western Europe. CONCLUSIONS The results of the pilot study showed that there are significant differences in age and frequency of fractures in dependence on sex and country. The obtained results can be considered valuable since there are virtually no scientific or professional studies on osteoporosis and fractures in the given area that would help physicians get ready for significant differences. These results may become a source of valuable information not only for medical practitioners coming to Afghanistan to help as volunteers in the framework of developmental assistance from all over the world, but also for physicians from Europe, with respect to the wave of migrants coming from this area. Key words: proximal femur, fracture, gender, age, Afghanistan, Czech Republic.

• MeSH
• fraktury femuru epidemiologie   etiologie   MeSH
• fraktury krčku femuru epidemiologie   etiologie   MeSH
• fraktury kyčle epidemiologie   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteoporotické fraktury epidemiologie   etiologie   MeSH
• pilotní projekty MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sexuální faktory MeSH
• věkové faktory MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Afghánistán MeSH
• Česká republika MeSH

PURPOSE OF THE STUDY Osteoporotic hip fractures commonly associated with comorbid diseases and use of multiple drugs. Polypharmacy status and the comorbidity-polypharmacy score (CPS) are the most common two grading system to predict mortality risk for the trauma patients older than 45 years. The purpose of the study was to determine whether the CPS or polypharmacy can predict the mortality risk in the older patients had a surgery due to an osteoporotic hip fracture. MATERIAL AND METHODS Consecutive patients aged > 65 years had an osteoporotic hip fracture due to a simple trauma were enrolled in the study. Detailed data were collected included comorbid conditions, medications, T-scores and additional fractures. Patients were divided into four groups according to CPS classification and polypharmacy status was indicated in case of using five or more drugs before admission. Overall mortality was assessed using Kaplan-Meier survival testing. Factors influencing 1-year, 2-year and 5-year mortality were evaluated using a multivariate logistic regression model with adjusted odds ratios (AORs) and a threshold significance at p < 0.05. RESULTS A total of 109 patients (65% women) with a mean age 80 ± 8.06 were included in the study. The mean time to death from the surgery was 42.06 ± 34.9 months. The Kaplan-Meier survival curves showed a significant difference in mortality among CPS groups. (Log-Rank test < 0.001). CPS presented a significant prediction in 1-year (AOR: 4.2; p < 0.05) and 2-year mortality (AOR: 2.9; p < 0.05) after adjustment for several covariates (including age, gender, surgical procedure) whereas 5-year mortality did not reveal a significant prediction (p = 0.46) Polypharmacy existence did not independently predict both overall or year-based mortality (p > 0.05) . CONCLUSIONS CPS is a better predictor for mortality risk than polypharmacy existence in the first two years in the patients underwent surgery for an osteoporotic hip fracture. Key words:osteoporotic hip fracture, mortality, polypharmacy, comorbidity.

• MeSH
• fraktury kyčle epidemiologie   etiologie   mortalita   MeSH
• komorbidita MeSH
• lidé MeSH
• osteoporotické fraktury epidemiologie   etiologie   mortalita   MeSH
• polypharmacy * MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ukazatele zdravotního stavu MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• estradiol * genetika   krev   MeSH
• hodnocení rizik MeSH
• jednonukleotidový polymorfismus MeSH
• kostní denzita * genetika   MeSH
• lidé MeSH
• osteoporotické fraktury * epidemiologie   genetika   krev   MeSH
• testosteron genetika   krev   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• komentáře MeSH
• souhrny MeSH

INTRODUCTION: Osteoporosis is characterized by low bone mineral density (BMD) and an increased risk of fracture. In randomized controlled trials, denosumab has been shown to significantly reduce the fracture risk in women with osteoporosis. However, little is known about the real-world management of women who are prescribed denosumab. METHODS: This multicenter, prospective, observational real-world study in the Czech Republic and Slovakia evaluated the baseline characteristics and clinical management of women with postmenopausal osteoporosis prescribed denosumab for 24 months. RESULTS: A total of 600 women were included (300 in each country). In the Czech Republic and Slovakia, respectively, mean age at enrollment was 69.0 and 64.3 years, 67.7% and 30.0% of patients had a previous osteoporotic fracture, and 85.0% and 48.7% had previously received osteoporosis medication. In both countries, 'low BMD T score' and 'a history of osteoporotic fracture' were the main reasons for prescribing denosumab. Most patients received all four post-baseline denosumab injections (Czech Republic, 82.0%; Slovakia, 81.0%), and more than 98% of patients in both countries received all injections at the prescribing center. At 24 months, most patients experienced an increase in BMD T score for the lumbar spine, total hip, or femoral neck (Czech Republic, 69.7-91.7%; Slovakia, 67.1-92.9%). Adverse drug reactions were consistent with the known safety profile of denosumab. CONCLUSION: Baseline characteristics of patients receiving denosumab in the Czech Republic and Slovakia reflect the reimbursement criteria for this agent in each country. The findings of our study in patients who are at high risk for fracture are consistent with the growing body of evidence demonstrating the effectiveness of denosumab in real-world clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT01652690. FUNDING: Amgen Inc.

• MeSH
• denosumab * aplikace a dávkování   škodlivé účinky   MeSH
• hodnocení rizik MeSH
• hodnocení výsledků zdravotní péče MeSH
• inhibitory kostní resorpce aplikace a dávkování   škodlivé účinky   MeSH
• kostní denzita účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteoporotické fraktury * epidemiologie   etiologie   prevence a kontrola   MeSH
• postmenopauzální osteoporóza * komplikace   farmakoterapie   epidemiologie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• služby preventivní péče metody   statistika a číselné údaje   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Slovenská republika MeSH

Context: Patients with Turner syndrome (TS) are at risk for osteoporotic fractures. Objective: The aims of this study were to assess the incidence of clinically important fractures in girls with TS and prospectively describe the development of volumetric bone mineral density (BMD). Design: Peripheral quantitative computerized tomography (pQCT) of the radius every other year over the 6 years of observation. Setting: Government-funded university referral center. Participants: Thirty-two girls with TS, aged 6 to 16 years, were included in the analyses. Fracture incidence was compared with the data in the general population. Bone density and strength were compared with data from 185 healthy girls. Outcomes: The main clinical outcome was the fracture occurrence. The secondary outcomes were the changes in Z-scores of the bone parameters. Results: Three girls with TS sustained four fractures during 6 years of observation. The fracture rate in TS was not substantially higher than the downward-biased fracture-rate estimate from age-matched, healthy controls (P = 0.48). Whereas the trabecular BMD Z-score decreased with age (β estimate -0.21 ± 0.04, P < 0.001), total bone cross-sectional area correspondingly increased (+0.16 ± 0.04, P < 0.001), which led to normal bone strength. A positive history of incident fractures was not significantly associated with any of the pQCT-derived bone parameters. Conclusions: Current pediatric TS patients that are treated with growth hormone and estrogens are not at risk for osteoporotic fractures. Low BMD in TS may be counterweighted by enlarged bone radius, which leads to normal bone strength at the appendicular skeleton.

• MeSH
• časové faktory MeSH
• dítě MeSH
• estrogeny terapeutické užití   MeSH
• incidence MeSH
• kostní denzita účinky léků   MeSH
• lidé MeSH
• mladiství MeSH
• následné studie MeSH
• osteoporotické fraktury epidemiologie   etiologie   MeSH
• počítačová rentgenová tomografie metody   MeSH
• radius diagnostické zobrazování   MeSH
• rizikové faktory MeSH
• růstový hormon terapeutické užití   MeSH
• Turnerův syndrom komplikace   farmakoterapie   patofyziologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH