Hellenic Osteoporosis Foundation

Objectives:To investigate the impact of the body mass index (BMI) change on risk of falling in postmenopausal women with osteopenia or osteoporosis. Also, we aimed to evaluate and associate the individuals’ functionality, mobility and balance with the risk of falling.Methods:This one-year prospective observational study assessed 498 postmenopausal Greek women over the 50th year of age suffering from either osteoporosis or osteopenia. Parameters such as the height, weight and BMI were documented. Furthermore, the subjects were asked whether they experienced a fall the preceding year. Balance was evaluated using the Berg Balance Scale, the Timed-Up-And-Go test, and the 30 Seconds Sit-to-Stand test. Hand-grip strength was assessed with the Jamar Hydraulic Hand Dynamometer.Results:The observed one-year BMI change was associated with falls in postmenopausal osteopenic and osteoporotic women over the age of 70. Additionally, there were statistically significant changes in the BBS, TUG, 30CST and the hand-grip strength on both hands at the one-year follow-up but there were not associated with an increased fall risk.Conclusion:The one-year change in BMI was associated with the risk of falling in postmenopausal osteopenic and osteoporotic women over the 70th year of age. Whereas, the one-year change in balance, mobility and grip strength were not linked to an increased risk of falling.

Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post-fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). © 2019 American Society for Bone and Mineral Research.

Objective:A study to retrospectively assess the decision to implement treatment for osteoporosis based on Greek version of FRAX tool.Methods:The study population was 1000 postmenopausal women aged 45 or above, excluding those with medical conditions demanding specific osteoporosis management. Data were collected regarding their medical history and additionally, risk factors incorporated in FRAX questionnaire. FRAX score was estimated at the time of the anti-osteoporotic treatment initiation.Results:The mean age of the study sample was 58.5±8.79 years. 46.8% of the participating osteopenic women had initiated treatment for osteoporosis at their first consultation while the 80.6% met the current national intervention threshold of FRAX tool.Conclusion:Stemming from our results there is an indication that women who are borderline eligible for treatment and seek consultation for osteoporosis are likely to be given treatment regardless of the potential benefit. One cannot ignore the fact that a clinician’s good clinical judgment is of the utmost importance and under no circumstances can be replaced by any prognostic assessment tool.

The purpose of this study was to evaluate the first implementation of a fracture liaison service (FLS) in Greece, at the 251 Hellenic Air Force and VA General Hospital, Athens. Single-center, prospective study from May 1, 2013 to April 30, 2015 (first year-second year follow-up) was conducted. Patients of both genders aged 40-90years old, with a history of a low trauma fracture and willing to participate, were included after identification by an FLS nurse. Following recruitment, osteoporosis risk factors were assessed, FRAX score was calculated for treatment-naïve patients, bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA), and osteoporosis treatment was suggested where applicable. The rate of participation, the indication of osteoporosis treatment, and the difficulties met were evaluated. Of the eligible 213 patients, 97 (45.5%) were reluctant to participate for personal reasons. From the 116 initially recruited patients (mean age 74.8±12years), 77 (66.4%) discontinued their participation at some point for various reasons and 39 patients concluded the study. All 116 patients were assessed for osteoporosis risk factors and given a tailor-made exercise and education program, while FRAX score was assessed in all treatment-naïve patients (74 patients, 63.8%). Osteoporosis medication was suggested or reviewed in 74 patients; however, an adherence rate of 100% is only available for the 24 who concluded the study. We report the first implementation of FLS in the Greek healthcare setting. The participation rate is moderate and definitely needs improvement.

Anorexia nervosa is a serious psychiatric disorder accompanied by high morbidity and mortality. It is characterized by emaciation due to self-starvation and displays a unique hormonal profile. Alterations in gonadal axis, growth hormone resistance with low insulin-like growth factor I levels, hypercortisolemia and low triiodothyronine levels are almost universally present and constitute an adaptive response to malnutrition. Bone metabolism is likewise affected resulting in low bone mineral density, reduced bone accrual and increased fracture risk. Skeletal deficits often persist even after recovery from the disease with serious implications for future skeletal health. The pathogenetic mechanisms underlying bone disease are quite complicated and treatment is a particularly challenging task.

We report a case of a 55 year-old morbidly obese woman 150 kg (BMI 56) who underwent a biliopancreatic diversion (BPD) surgery in April 2008. Her past medical history includes hypothyroidism, diabetes mellitus and hypertension. BPD consists of a distal gastrectomy, a 250 cm alimentary channel, and a 50 cm common channel. Digestion and absorption of macronutrients and micronutrients are limited mostly to this 50-cm “common channel”. Lipid status and glycemic control are improved in patients with dyslipidemia and diabetes following BPD. However, BPD may be associated with a variety of nutrient deficiencies and metabolic derangements, such as iron deficiency, anemia, deficiencies of the fat-soluble vitamins (A, D, E, K), and metabolic bone disease. After BPD, the patient lost 65 kg (BMI 31) but exhibited deterioration of her general condition with back pain, progressive leg weakness, diffuse musculoskeletal pain and peripheral neuropathy associated with severe difficulty in climbing stairs and standing up from a sitting position. On clinical examination (twelve months after BPD) she was unable to rise from a chair without assistance. She needed to push off with both hands in order to stand from a chair and she had a broadbased “waddling“ gait. Her daily activities were compromised by severe weakness and musculoskeletal pain. Because of the diffuse and severe musculoskeletal pain the patient was under analgesics and nonsteroidal anti-inflammatory drugs at a daily basis. Osteomalacic myopathy was diagnosed on the basis of her biochemical profile (increased ALP levels, hypocalcemia, hypophosphatemia, undetectable 25OHD, increased iPTH level) which was attributed to severe malabsorption after BPD. Femoral and lumbarspine BMD were consistent with osteoporosis. Τ-score of lumbar spine BMD was -3.6 and of total hip -3.8 (Hologic QDR-4000). The patient was treated with 400.000 IU ergocalciferol intramuscularly every month for 2 consecutive months. She also received dietary calcium supplementation (1,5 grams), cholecalciferol (1200 iu) and oral multivitamin supplements daily. J Musculoskelet Neuronal Interact 2010; 10(4):287-289