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See detailAn indirect comparison of the efficacies of vitamin D and its hydroxylated analogs in postmenopausal and corticosteroid-induced osteoporosis
Richy, Florent; Schacht, E.; Bruyère, Olivier ULg et al

in Osteoporosis International (2005, March), 16(Suppl.3), 29

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See detailVitamin D analogs versus native vitamin D in preventing bone loss and osteoporosis-related fractures: A comparative meta-analysis
Richy, F.; Schacht, E.; Bruyère, Olivier ULg et al

in Calcified Tissue International (2005), 76(3), 176-186

It has been suggested that early postmenopausal women and patients treated with steroids should receive preventive therapy (calcium, vitamin D, vitamin D analogs, estrogens, or bisphosphonates) to ... [more ▼]

It has been suggested that early postmenopausal women and patients treated with steroids should receive preventive therapy (calcium, vitamin D, vitamin D analogs, estrogens, or bisphosphonates) to preserve their bone mineral density (BMD) and to avoid fragility fractures. We designed the present study to compare the effects of native vitamin D to its hydroxylated analogs alfacalcidol 1-alpha(OH)D and calcitriol 1,25(OH)(2)D. All randomized, controlled, double-blinded trials comparing oral native vitamin D and its analogs, alfacalcidol or calcitriol, to placebo or head-to-head trials in primary or corticosteroids-induced osteoporosis were included in the meta-analysis. Sources included the Cochrane Controlled Trials Register, EMBASE, MEDLINE, and a hand search of abstracts and references lists. The study period January 1985 to January 2003. Data were abstracted by two investigators, and methodological quality was assessed in a similar manner. Heterogeneity was extensively investigated. Results were expressed as effect-size (ES) for bone loss and as rate difference (RD) for fracture while allocated to active treatment or control. Publication bias was investigated. Fourteen studies of native vitamin D, nine of alfacalcidol, and ten of calcitriol fit the inclusion criteria. The two vitamin D analogs appeared to exert a higher preventive effect on bone loss and fracture rates in patients not exposed to glucocorticoids. With respect to BMD, vitamin D analogs versus placebo studies had an ES of 0.36 (P < 0.0001), whereas native vitamin D versus placebo had an ES of 0.17 (P = 0.0005), the interclass difference being highly significant (ANOVA-1, P < 0.05). When restricted to the lumbar spine, this intertreatment difference remained significant: ES = 0.43 (P = 0.0002) for vitamin D analogs and ES = 0.21 (P = 0.001) for native vitamin D (analysis of variance [ANOVA-1], P = 0.047). There were no significant differences regarding their efficacies on other measurement sites (ANOVA-1, P = 0.36). When comparing the adjusted global relative risks for fracture when allocated to vitamin D analogs or native vitamin D, alfacalcidol and calcitriol provided a more marked preventive efficacy against fractures: RD = 10% (95% Confidence interval [CI-2] to 17) compared to RD = 2% (95% CI, 1 to 2), respectively. The analysis of the spinal and nonspinal showed that fracture rates differed between the two classes, thereby confirming the benefits of vitamin D analogs, with significant 13.4% (95% CI 7.7 to 19.8) and. 6% (95% CI 1 to 12) lower fracture rates for vitamin D analogs, respectively. In patients receiving corticosteroid therapy, both treatments provided similar global ESs for BMD: ES = 0.38 for vitamin D analogs and ES = 0.41 for native vitamin D (ANOVA-1, P = 0.88). When restriced to spinal BMD, D analogs provided significant effects, whereas native vitamin D did not: ES = 0.43 (P < 0.0001) and ES = 0.33 (P = 0.21), respectively. The intertreatment difference was nonsignificant (ANOVA-1, P = 0.52). Neither D analogs for native vitamin D significantly prevented fractures in this subcategory of patients: RD = 2.6 (95%CI, -9.5 to 4.3) and RD = 6.4 (95%CI, -2.3 to 10), respectively. In head-to-head studies comparing D analogs and native vitamin D in patients receiving corticosteroids, significant effects favoring D analogs were found for femoral neck BMD: ES = 0.31 at P = 0.02 and spinal fractures: RD = 15% (95%CI, 6.5 to 25). Publication bias was not significant. Our analysis demonstrates a superiority of the D analogs atfacalcidol and calcitriol in preventing bone loss and spinal fractures in primary osteoporosis, including postmenopausal women. In corticosteroid-induced osteoporosis, the efficacy of D analogs differed depending on the comparative approach: indirect comparisons led to nonsignificant differences, whereas direct comparison did provide significant differences. In this setting, D analogs seem to prevent spinal fractures to a greater extent than do native vitamin D, but this assumption should be confirmed on a comprehensive basis in multiarm studies including an inactive comparator. [less ▲]

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See detailControlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents
Bruyère, Olivier ULg; Wuidart, M. A.; Di Palma, E. et al

in Archives of Physical Medicine & Rehabilitation (2005), 86(2), 303-307

Objective: To investigate the effects of whole body vibration in the elderly. Design: Randomized controlled trial. Setting: Nursing home. Participants: Forty-two elderly volunteers. Interventions: Six ... [more ▼]

Objective: To investigate the effects of whole body vibration in the elderly. Design: Randomized controlled trial. Setting: Nursing home. Participants: Forty-two elderly volunteers. Interventions: Six-week vibration intervention plus physical therapy (PT) (n=22) or PT alone (n=20). Main Outcome Measures: We assessed gait and body balance using the Tinetti test (maximum scores of 12 for gait, 16 for body balance, 28 for global score), motor capacity using the Timed Up & Go (TUG) test, and health-related quality of life (HRQOL) using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results: After 6 weeks, the vibration intervention group improved by a mean +/- standard deviation of 2.4 +/- 2.3 points on the gait score compared with no score change in the control group (P<.001). The intervention group improved by 3.5 +/- 2.1 points on the body balance score compared with a decrease of 03 +/- 1.2 points in the control group (P<.001). TUG test time decreased by 11.0 +/- 8.6 seconds in the treated group compared with an increase of 2.6 +/- 8.8 seconds in the control group (P<.001). The intervention group had significantly greater improvements from baseline on 8 of 9 items on the SF-36 compared with the control group. Conclusions: Controlled whole body vibration can improve elements of fall risk and HRQOL in elderly patients. [less ▲]

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See detailRisk assessment tools for osteoporosis: scope and limits
Richy, Florent; Gourlay, M.; Ross, P. et al

in Osteoporosis International (2004, May), 15(Suppl.1), 11

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See detailBMD in men: which normative data?
Richy, Florent; Gourlay, M.; Ethgen, Olivier ULg et al

in Osteoporosis International (2004, May), 15(Suppl.1), 54

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See detailValidation and comparative evaluation of the osteoporosis self-assessment tool (OST) in a Caucasian population from Belgium
Richy, F.; Gourlay, M.; Ross, P. D. et al

in QJM : Monthly Journal of the Association of Physicians (2004), 97(1), 39-46

BACKGROUND: Risk indices have been developed to identify women at risk of low bone mineral density (BMD) who should undergo BMD testing. Aim: To compare the performance of four risk indices in White ... [more ▼]

BACKGROUND: Risk indices have been developed to identify women at risk of low bone mineral density (BMD) who should undergo BMD testing. Aim: To compare the performance of four risk indices in White ambulatory women in Belgium. DESIGN: Epidemiological cross-sectional study. METHODS: Records were analysed for 4035 postmenopausal White women without Paget's disease or advanced osteoarthritis, seen at an out-patient osteoporosis centre between January 1996 and September 1999. Osteoporosis risk index scores were compared to bone density T-scores. The ability of each risk index to identify women with low BMD (T-score < -2.0) or osteoporosis (T < -2.5) was evaluated. RESULTS: Using an Osteoporosis Self-Assessment Tool (OST) score <2 to recommend DXA referral, sensitivity ranged from 85% at the lumbar spine to 97% at the total hip to detect BMD T-scores of <or= -2.5, and specificity ranged from 34% at the total hip to 37% at the femoral neck and lumbar spine. The negative predictive value was high at all skeletal sites (89-99%), demonstrating the usefulness of the OST to identify patients who have normal BMD and should not receive DXA testing. All risk indices performed similarly, although the OST had somewhat better sensitivity and somewhat lower specificity than the other indices at the cut-offs evaluated. Among the 11-12% of women who were classified as highest risk using OST or the Osteoporosis Index of Risk (OSIRIS), 81-85% had low bone mass and 68-74% had osteoporosis. DISCUSSION: The performance of these risk indices among women in Belgium was similar to that reported earlier for other samples in Asian countries, the US, and the Netherlands. The OST and other risk indices are effective and efficient tools to help target high-risk women for DXA testing. [less ▲]

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See detailRisk assessment tools for osteoporosis: scope and limits
Richy, Florent; Gourlay, M.; Ross, P. D. et al

in Osteoporosis International (2003, November), 14(Suppl. 7), 68-69

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See detailRational to use OSIRIS® (osteoporosis index of risk) to prescreen for osteoporosis in the general population
Richy, Florent; Gourlay, M.; Ethgen, Olivier ULg et al

in Osteoporosis International (2003, November), 14(Suppl. 7), 67-68

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See detailBMD in men: which normative data?
Richy, Florent; Gourlay, M.; Ethgen, Olivier ULg et al

in Osteoporosis International (2003, November), 14(Suppl. 7), 66-67

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See detailBone mineral density and vertebral fractures in women who have discontinued hormone replacement therapy: a retrospective population-based study
Richy, Florent; Gourlay, M.; Neuprez, Audrey ULg et al

in Osteoporosis International (2003, November), 14(Suppl. 7), 67

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See detailControlled whole body vibration to decrease fall risk and improve health related quality of life in elderly patients
Bruyère, Olivier ULg; Wuidart, M. A.; di Palma, E. et al

in Osteoporosis International (2003, November), 14(Suppl. 7), 63

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See detailEvaluation of a campaign for osteoporosis screening in the general population: what is the follow-up given by general practitioners to a positive screening result?
Richy, Florent; Pire, G.; Maassen, P. et al

in Osteoporosis International (2003, November), 14(Suppl. 7), 67

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See detailEvaluation of an osteoporosis screening campaign in the general population: does misclassification by screening test impact on the perception of the campaign?
Richy, Florent; Pire, G.; Maassen, P. et al

in Osteoporosis International (2003, November), 14(Suppl. 7), 68

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See detailStrategies for the prevention of hip fracture
Gourlay, M.; Richy, F.; Reginster, Jean-Yves ULg

in American Journal of Medicine (2003), 115(4), 309-317

Hip fractures are associated with 10% to 20% excess mortality in the first year and cause functional disability in most survivors. An estimated 17% of white women in the United States will sustain a hip ... [more ▼]

Hip fractures are associated with 10% to 20% excess mortality in the first year and cause functional disability in most survivors. An estimated 17% of white women in the United States will sustain a hip fracture after the age of 50 years. Despite the availability of evidence-based guidelines for hip fracture prevention, routine screening and preventive measures have not been incorporated into standard primary care practice. Many physicians lack adequate knowledge to initiate bone mineral density testing and treatment with preventive medications to decrease the incidence of osteoporosis and fractures. Furthermore, patients are less likely to request information about bone health than about diseases for which systematic screening and prevention protocols have been established. This review describes preventive measures to decrease hip fracture in postmenopausal women, including screening by bone mineral density testing, risk factor assessment, and chemoprevention. Existing guidelines are summarized, and dilemmas regarding their implementation are discussed. (C) 2003 by Excerpta Medica Inc. [less ▲]

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