Low dietary intake calcium in European postmenopausal osteoporotic women
Bruyère, Olivier ; ; et al
in Public Health Nutrition (2009), 12(1), 111-114
Objective The WHO recommends a daily Ca intake for postmenopausal women of 1300 mg. The objective of the present study was to assess the dietary Ca intake in European postmenopausal osteoporotic women ... [more ▼]
Objective The WHO recommends a daily Ca intake for postmenopausal women of 1300 mg. The objective of the present study was to assess the dietary Ca intake in European postmenopausal osteoporotic women. Design, setting and subjects Assessment of dietary Ca intake (food and supplements) was performed with a validated self-questionnaire in 8524 osteoporotic women from nine European countries (Belgium, Denmark, France, Germany, Hungary, Italy, Poland, Spain and the UK). Results Mean age of the patients was 74·2 (sd 7·1) years, mean BMI was 25·7 (sd 4·2) kg/m2. Of the study population, 37·2 % of the women took Ca supplements. The mean dietary intake of Ca was 930·7 (sd 422·9) mg/d. The lowest Ca intake was found in Hungary (586·7 (sd 319·1) mg/d) and the highest in Denmark (1145·6 (sd 463·0) mg/d). In the whole study population, only 19·1 % of the women had a dietary Ca intake >1300 mg/d. Only 17·1 % of women aged over 75 years achieved 1300 mg/d compared with 20·5 % of women aged less than 75 years (P = 0·0001 for the difference between the two groups). Conclusion Dietary intake of Ca is very low in European postmenopausal women. A greater awareness is needed to resolve this public health problem. [less ▲]Detailed reference viewed: 85 (30 ULg)
La gestione post-frattura del paziente con frattura di femore: Una visione prospettica
Bruyère, Olivier ; ; et al
in Clinical Cases in Mineral and Bone Metabolism (2009), 6(3), 270-279
[No abstract available]Detailed reference viewed: 21 (1 ULg)
Highest prevalence of vitamin D inadequacy in institutionalized women compared with noninstitutionalized women: a case-control study.
Bruyère, Olivier ; ; et al
in Women's Health (2009), 5(1), 49-54
The reduced capacity of older skin to synthesize vitamin D(3) under the influence of ultraviolet light makes older persons at risk of vitamin D deficiency. The risk could even be increased in ... [more ▼]
The reduced capacity of older skin to synthesize vitamin D(3) under the influence of ultraviolet light makes older persons at risk of vitamin D deficiency. The risk could even be increased in institutionalized persons owing to their lower sunshine exposure. It has been reported that an inadequate vitamin D level is associated with secondary hyperparathyroidism, increased bone turnover, and bone loss, which increase fracture risk. The objective of this study was to assess the prevalence of inadequate serum vitamin D levels in institutionalized, postmenopausal, osteoporotic women. Assessment of 25-hydroxyvitamin D [25(OH)D] was performed in 445 institutionalized, osteoporotic women from nine countries (Australia, Belgium, France, Germany, Hungary, Italy, Poland, Spain and UK). For each institutionalized woman, three age-matched, noninstitutionalized, osteoporotic controls were also included. Four cutoffs of 25(OH)D inadequacy were fixed: less than 80, less than 75, less than 50 and less than 30 nmol/l. Mean age was 79.7 years (standard deviation [SD] = 5.8) for the institutionalized women and 79.5 years (SD = 5.5) for the noninstitutionalized women (p = 0.45). Significantly fewer institutionalized women received vitamin D supplements (13.2 vs 24.0%; p < 0.0001). In women without vitamin D supplements, the level of 25(OH)D was significantly lower in institutionalized women (56.9 [SD = 23.9] nmol/l) compared with noninstitutionalized women (63.2 [SD = 22.0] nmol/l; p < 0.0001). In institutionalized women (without vitamin D supplements), the prevalence of 25(OH)D inadequacy was 10.4, 41.2, 80.3 and 84.2% when considering cutoffs of 80, 75, 50 and 30 nmol/l, respectively. In the control group, the prevalence was 2.7, 22.9, 74.4 and 81.7%, respectively. The prevalence of vitamin D inadequacy was significantly higher in institutionalized women when considering the 75, 50 and 30 nmol/l cutoffs but not when considering the 80 nmol/l cutoff. This study highlights a high prevalence of vitamin D inadequacy in institutionalized, osteoporotic women. Compared with age-matched osteoporotic controls, the prevalence of severe vitamin D inadequacy was substantially more important in institutionalized women. We believe that a greater awareness of the importance of vitamin D inadequacy is needed in order to address this public health problem. [less ▲]Detailed reference viewed: 59 (12 ULg)
Ibandronate in the management of postmenopausal osteoporosis
Reginster, Jean-Yves ; Hiligsmann, Mickaël ; Rabenda, Véronique et al
in Clinical Medicine. Therapeutics (2009), 1Detailed reference viewed: 48 (11 ULg)
Efficacite anti-fracturaire de l'ibandronate administre par voie intraveineuse: de la complexite des etudes epidemiologiques interventionnelles a la pratique quotidienne.
; Hiligsmann, Mickaël ; Bruyère, Olivier et al
in Revue Médicale de Liège (2009), 64(10), 525-9
Numerous epidemiological approaches are used to demonstrate the efficacy of a new chemical entity. In postmenopausal osteoporosis, anti-fracture efficacy can be assessed through prospective, randomized ... [more ▼]
Numerous epidemiological approaches are used to demonstrate the efficacy of a new chemical entity. In postmenopausal osteoporosis, anti-fracture efficacy can be assessed through prospective, randomized controlled trials, meta-analyses or real-life setting studies. Intravenous ibandronate was recently marketed, with the aim of optimizing drug absorption and adherence to treatment. Furthermore, this new formulation avoids gastrointestinal side effects and constrains linked to the oral intake of the medication. Spinal anti-fracture efficacy of IV ibandronate derives from a non-inferiority bridging study, using surrogate endpoints, i.e., bone mineral density and biochemical markers of bone turnover, compared to the oral daily formulation, previously registered for the treatment of osteoporosis in Europe. Coherent results from two separate meta-analyses have suggested that the non-vertebral anti-fracture efficacy of IV ibandronate is similar to that observed with oral, daily and weekly bisphosphonates. Similarly, a recent real-life setting study, based on claims from an US database, suggests that hip fractures are reduced, with IV ibandronate, to the same extend as they are with oral bisphosphonates. Notwithstanding, those results should probably be confirmed in an European setting, before being extrapolated, in daily practice, to the Belgian population. [less ▲]Detailed reference viewed: 36 (3 ULg)
Effets du sulfate de chondroitine sur les indices d'utilité de santé chez des sujets gonarthrosiques et analyses économiques préliminaires.
Bruyère, Olivier ; ; Neuprez, Audrey et al
in Revue du Rhumatisme (2009), 76Detailed reference viewed: 24 (5 ULg)
Rationalisation du remboursement des médicaments de l'ostéoporose : de la mesure isolée de la densité osseuse à l'intégration des facteurs cliniques de risque fracturaire. Validation de l'algorithme FRAX(r)
Neuprez, Audrey ; ; et al
in Revue du Rhumatisme (2009), 76Detailed reference viewed: 17 (5 ULg)
Analyses coût-efficacité du sulfate de glucosamine chez des patients gonarthrosiques : comparaison avec le paracétamol.
Bruyère, Olivier ; ; Neuprez, Audrey et al
in Revue du Rhumatisme (2009), 76Detailed reference viewed: 51 (3 ULg)
Relations entre les variations de densité minérale osseuse et l'incidence des fractures vertébrales: analyse des 3 dernières années d'un traitement de 8 ans sous ranélate de strontium.
Bruyère, Olivier ; Detilleux, Johann ; et al
in Revue du Rhumatisme (2009), 76Detailed reference viewed: 14 (1 ULg)
Management of osteoporosis in the elderly.
; Bruyère, Olivier ; et al
in Current Medical Research & Opinion (2009), 25(10), 2373-2387
ABSTRACT Background: Osteoporosis is predominantly a condition of the elderly, and the median age for hip fracture in women is approximately 83 years. Osteoporotic fracture risk is multifactorial, and ... [more ▼]
ABSTRACT Background: Osteoporosis is predominantly a condition of the elderly, and the median age for hip fracture in women is approximately 83 years. Osteoporotic fracture risk is multifactorial, and often involves the balance between bone strength and propensity for falling. Objective: To present an overview of the available evidence, located primarily by Medline searches up to April, 2009, for the different management strategies aimed at reducing the risk of falls and osteoporotic fractures in the elderly. Results: Frailty is an independent predictor of falls, hip fractures, hospitalisation, disability and death in the elderly that is receiving increasing attention. Non-pharmacological strategies to reduce fall risk can prevent osteoporotic fractures. Exercise programmes, especially those involving high doses of exercise and incorporating balance training, have been shown to be effective. Many older people, especially the very elderly and those living in care institutions, have vitamin D inadequacy. In appropriate patients and given in sufficient doses, vitamin D and calcium supplementation is effective in reducing both falls and osteoporotic fractures, including hip fractures. Specific anti-osteoporosis drugs are underused, even in those most at risk of osteoporotic fracture. The evidence base for the efficacy of most such drugs in the elderly is incomplete, particularly with regard to nonvertebral and hip fractures. The evidence base is perhaps most complete for the relatively recently introduced drug, strontium ranelate. Non-adherence to treatment is a substantial problem, and may be exacerbated by the requirements for safe oral administration of bisphosphonates. Conclusion: Evidence-based strategies are available for reducing osteoporotic fracture risk in the elderly, and include exercise training, vitamin D and calcium supplementation, and use of evidence-based anti-osteoporotic drugs. A positive and determined approach to optimising the use of such strategies could reduce the burden of osteoporotic fractures in this high-risk group. [less ▲]Detailed reference viewed: 87 (6 ULg)
Long-term treatment of postmenopausal osteoporosis with strontium ranelate: Results at 8 years.
Reginster, Jean-Yves ; Bruyère, Olivier ; et al
in BONE (2009), 45
OBJECTIVES: Strontium ranelate 2 g/day has proven efficacy against vertebral and nonvertebral fracture over 5 years in postmenopausal osteoporosis, though many women require longer-term treatment. This ... [more ▼]
OBJECTIVES: Strontium ranelate 2 g/day has proven efficacy against vertebral and nonvertebral fracture over 5 years in postmenopausal osteoporosis, though many women require longer-term treatment. This article describes the efficacy, safety, and tolerability of this agent over 8 years. METHODS: Postmenopausal osteoporotic women having participated in the 5-year efficacy trials SOTI and TROPOS were invited to enter a 3-year open-label extension study. The results presented here focus on patients who received strontium ranelate for 8 years. RESULTS: At the extension baseline, the population treated for 8 years (n=879; 79.1+/-5.6 years) had femoral neck T-score of -2.61+/-0.71. The cumulative incidences of new vertebral and nonvertebral fractures (13.7% and 12.0%, respectively) over years 6 to 8 were non-statistically different from the cumulative incidences in the first 3 years of the original studies (11.5% and 9.6%). Lumbar spine, femoral neck, and total hip bone mineral density (BMD) increased throughout the 8-year period. Annual relative change in BMD was significant at every visit, except the 8-year visit for femoral neck and total hip BMD. Strontium ranelate was safe and well tolerated over 8 years. CONCLUSIONS: Long-term treatment with strontium ranelate 2 g/day in postmenopausal osteoporotic women leads to continued increases in BMD at all sites. The data also provide some evidence for a sustained antifracture efficacy. [less ▲]Detailed reference viewed: 97 (31 ULg)
Impact of chondroitin sulphate on health utility in patients with knee osteoarthritis: towards economic analysis.
Bruyère, Olivier ; ; et al
in Journal of Medical Economics (2009), 12(4), 356-360
Abstract Objectives: The first objective was to assess the effect of the chondroitin 4 and 6 sulphate (CS) on health-related quality of life using utility values in patients with knee osteoarthritis (OA ... [more ▼]
Abstract Objectives: The first objective was to assess the effect of the chondroitin 4 and 6 sulphate (CS) on health-related quality of life using utility values in patients with knee osteoarthritis (OA) during a 24-month treatment course. The second objective was, using these data, to conduct economic analyses. Methods: Data from the STOPP study was used. This study was a randomised, double-blind, placebo (PL) -controlled trial of 2-year duration. In the STOPP study, authors assessed quality of life using the Western Ontario and McMaster Osteoarthritis Index (WOMAC). WOMAC scores were translated into Health Utility Index (HUI) scores using a specific formula. Incremental cost effectiveness ratio (ICER) was calculated taking into account the cost of CS and its effect on HUI scores, compared to PL. Results: At baseline, the mean (SD) HUI scores were 0.59 (0.17), and 0.59 (0.18) for the PL and CS groups, respectively (p=0.31 between the two groups). The mean (SD) HUI scores changes from baseline to 6 months were 0.02 (0.02), and 0.05 (0.01) for the PL and CS groups, respectively (p=0.03). After 24 months of follow-up, HUI score increases by 0.04 (0.02) in the PL group and by 0.05 (0.02) in the CS group (p=0.37). Using the price bracket of CS in Europe, ICER assessment always resulted in a cost below euro30,000 per QALY gained, after 6, 12 and 24 months of treatment. Conclusion: CS treatment increases health utilities in patients with knee OA compared to PL over the first 6 months of treatment. Economic evaluation based on these data suggests that CS treatment could be considered as cost-effective in patients with knee OA up to a period of 24 months. A limitation in this study is the absence of direct utility assessment as well as the absence of effective treatment as comparator. [less ▲]Detailed reference viewed: 65 (18 ULg)
Strontium ranelate: new data on fracture prevention and mechanisms of action.
Reginster, Jean-Yves ; Deroisy, Rita ; et al
in Current Osteoporosis Reports (2009), 7(3), 96-102
Osteoporosis treatments need to combine an unequivocally demonstrated reduction of fractures, at various skeletal sites, long-term safety, and a user-friendly profile that optimizes therapeutic adherence ... [more ▼]
Osteoporosis treatments need to combine an unequivocally demonstrated reduction of fractures, at various skeletal sites, long-term safety, and a user-friendly profile that optimizes therapeutic adherence. Strontium ranelate is the first compound to simultaneously decrease bone resorption and stimulate bone formation. Its anti-fracture efficacy at various skeletal sites has been established for as long as 5 years through studies of the highest methodological standards. Increases in bone mineral density observed after 1 year of treatment are predictive of the long-term fracture efficacy, suggesting for the first time in osteoporosis that bone densitometry can be used as a monitoring tool. Due to a positive risk/benefit ratio, strontium ranelate is now considered as a first-line treatment in the management of osteoporosis. [less ▲]Detailed reference viewed: 39 (2 ULg)
Loss of hip bone mineral density over time is associated with spine and hip fracture incidence in osteoporotic postmenopausal women.
Bruyère, Olivier ; ; et al
in European journal of epidemiology (2009), 24
The objective of the study assess the relationship between bone mineral density (BMD) loss over time and fracture incidence in postmenopausal women. This is a posthoc analysis that includes women from the ... [more ▼]
The objective of the study assess the relationship between bone mineral density (BMD) loss over time and fracture incidence in postmenopausal women. This is a posthoc analysis that includes women from the placebo group of two large randomized controlled trials having assessed the efficacy of a new anti-osteoporotic drug. BMD was assessed every 6 months during 3 years at the lumbar spine, the femoral neck and the total proximal femur. Vertebral fractures were assessed using a semiquantitative method. Hip fractures were based on written documentation. All patients received calcium and vitamin D. In the present study that included 1,775 patients (with complete data at baseline and after 3 years), the logistic regression analysis, adjusted for covariates, showed that 3-year change in lumbar BMD was not statistically associated with the new vertebral fractures after 3 years. However, femoral neck and total proximal femur BMD changes was statistically correlated with the incidence of new vertebral fractures (P < 0.001). When considering change in BMD after the first year of follow-up, a decrease in total proximal femur BMD was statistically associated with an increase in the incidence of new vertebral fractures during the last 2 years of follow-up (P = 0.048). The 3-year change in femoral neck and total proximal BMD was statistically correlated with the incidence of hip and fragility fracture after 3 years (all P < 0.001). In this elderly osteoporotic population receiving calcium and vitamin D, a decrease in hip BMD after 1 or 3 year of follow-up, is associated with an increased risk of fracture incidence. However, spine BMD changes do not influence vertebral fracture incidence. [less ▲]Detailed reference viewed: 41 (10 ULg)
Bone mineral density and health related quality of life: a 3-year follow-up study of osteoportic postmenopaul women
Bruyère, Olivier ; ; Deroisy, Rita et al
in The Open Geritric Medicine Journal (2009), 2
Objective: The objective of this study was to evaluate the relationship between change in bone mineral density (BMD) and change in health related quality of life (HRQoL) over a 3-year eriod, in patients ... [more ▼]
Objective: The objective of this study was to evaluate the relationship between change in bone mineral density (BMD) and change in health related quality of life (HRQoL) over a 3-year eriod, in patients without incident of osteoporotic fracture. Materials and Methods: Prior to the present study, two randomized controlled trials had been carried out to assess the efficacy of a new anti-osteoporotic drug. From the placebo group of those two trials, we selected for the present study 1838 osteoporotic postmenopausal women aged over 50 years, and followed their progress for a period of 3 years. BMD was measured at the lumbar spine and the proximal femur by dual-energy X-ray absorptiometry. Each patient received calcium and vitamin D supplements. HRQoL was assessed using 2 questionnaires: the generic tool Short Form 36 items (SF-36; including mental and physical components) and the specific Quality of Life Questionnaire in Osteoporosis (QUALIOST). Result: At baseline, after adjustment for body mass index (BMI), age, number of vertebral fractures and number of peripheral fractures, multivariate regression analysis showed a significant association between the lumbar BMD and the mental component of the SF-36 (p<0.001). However, the relationship was not significant with the global score of the QUALIOST (p=0.098) and the physical component of the SF-36 (p=0.051). Multivariate regressions did not show a significant relationship between HRQoL and proximal femur BMD at baseline. After 3 years of follow-up, multivariate regression analysis showed no significant association between change in lumbar BMD and the main HRQoL items (global score of the QUALIOST, physical and mental components of the SF-36; p between 0.437 and 0.942). No significant relationships were found between change in femoral BMD and change in the global score of the QUALIOST (p=0.088) or change in the mental component of the SF-36 (p=0.222). However, a significant positive association (p=0.031) appeared between change in the physical component of the SF-36 and femoral BMD change. Conclusion: In osteoporotic postmenopausal women receiving calcium and vitamin D, few relationships were found between BMD and HRQoL. However, these results were not strong enough to indicate a real clinically interesting relationship between HRQoL and BMD. Other studies would need to be performed to verify these results. [less ▲]Detailed reference viewed: 60 (4 ULg)
Development and Validation of a Markov Microsimulation Model for the Economic Evaluation of Treatments in Osteoporosis.
Hiligsmann, Mickaël ; Ethgen, Olivier ; Bruyère, Olivier et al
in Value in Health (2009), 12(5), 687-696
ABSTRACT Objective: Markov models are increasingly used in economic evaluations of treatments for osteoporosis. Most of the existing evaluations are cohort-based Markov models missing comprehensive memory ... [more ▼]
ABSTRACT Objective: Markov models are increasingly used in economic evaluations of treatments for osteoporosis. Most of the existing evaluations are cohort-based Markov models missing comprehensive memory management and versatility. In this article, we describe and validate an original Markov microsimulation model to accurately assess the cost-effectiveness of prevention and treatment of osteoporosis. Methods: We developed a Markov microsimulation model with a lifetime horizon and a direct health-care cost perspective. The patient history was recorded and was used in calculations of transition probabilities, utilities, and costs. To test the internal consistency of the model, we carried out an example calculation for alendronate therapy. Then, external consistency was investigated by comparing absolute lifetime risk of fracture estimates with epidemiologic data. Results: For women at age 70 years, with a twofold increase in the fracture risk of the average population, the costs per quality-adjusted life-year gained for alendronate therapy versus no treatment were estimated at Euro 9105 and Euro 15,325, respectively, under full and realistic adherence assumptions. All the sensitivity analyses in terms of model parameters and modeling assumptions were coherent with expected conclusions and absolute lifetime risk of fracture estimates were within the range of previous estimates, which confirmed both internal and external consistency of the model. Conclusion: Microsimulation models present some major advantages over cohort-based models, increasing the reliability of the results and being largely compatible with the existing state of the art, evidence-based literature. The developed model appears to be a valid model for use in economic evaluations in osteoporosis. [less ▲]Detailed reference viewed: 234 (35 ULg)
Assessment of determinants for osteoporosis in elderly men.
Scholtissen, Sophie ; ; Bruyère, Olivier et al
in Osteoporosis International (2009), 20(7), 1157-66
SUMMARY: The aim of this cross-sectional study was to determine and quantify some determinants associated to low bone mineral density (BMD) in elderly men. This study showed that ageing, a lower body mass ... [more ▼]
SUMMARY: The aim of this cross-sectional study was to determine and quantify some determinants associated to low bone mineral density (BMD) in elderly men. This study showed that ageing, a lower body mass index (BMI), a higher blood level of C-terminal cross-linking telopeptides of type I collagen (CTX-1), family history of osteoporosis, and/or fracture and prior fracture were associated with bone mineral density. INTRODUCTION: Our aims were to identify some determinants associated to low bone mineral density in men and to develop a simple algorithm to predict osteoporosis. METHODS: A sample of 1,004 men aged 60 years and older was recruited. Biometrical, serological, clinical, and lifestyle determinants were collected. Univariate, multivariate, and logistic regression analyses were performed. Receiver operating characteristic analysis was used to assess the discriminant performance of the algorithm. RESULTS: In the multiple regression analysis, only age, BMI, CTX-1, and family history of osteoporosis and/or fracture were able to predict the femoral neck T-score. When running the procedure with the total hip T-score, prior fracture also appeared to be significant. With the lumbar spine T-score, only age, BMI, and CTX-1 were retained. The best algorithm was based on age, BMI, family history, and CTX-1. A cut-off point of 0.25 yielded a sensibility of 78%, a specificity of 59% with an area under the curve of 0.73 in the development and validation cohorts. CONCLUSION: Ageing, a lower BMI, higher CTX-1, family history, and prior fracture were associated with T-score. Our algorithm is a simple approach to identify men at risk for osteoporosis. [less ▲]Detailed reference viewed: 81 (8 ULg)
Place de la densitométrie osseuse dans le diagnostic et le suivi des patients ostéoporotiques
Bruyère, Olivier ; Reginster, Jean-Yves
in Ortho-Rhumato (2009), 7Detailed reference viewed: 19 (6 ULg)
The need for economic evaluation in osteoarthritis
Bruyère, Olivier ; Reginster, Jean-Yves
in Aging Health (2009), 5(5), 591-594Detailed reference viewed: 40 (7 ULg)
Impact of medication non-compliance and non-persistence on pharmacoeconomic evaluations in osteoporosis
Hiligsmann, Mickaël ; Rabenda, Véronique ; Gathon, Henry-Jean et al
in Osteoporosis International (2008, December), 19(S2), 282Detailed reference viewed: 38 (13 ULg)