Low dietary calcium in European postmenopausal osteoporotic women.

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).

Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women.

Unlabelled: Adherence is now one of the major issues in the management of osteoporosis and several papers have suggested that vertebral fractures might be increased in patients who do not follow appropriately their prescriptions. This paper relates the strong relationship existing between adherence to anti-osteoporosis treatment and the risk of subsequent hip fracture.

Introduction: A study was performed to investigate adherence to bisphosphonate (BP) therapy and the impact of adherence on the risk of hip fracture (Fx).

Prevalence and impact of osteoarthritis and osteoporosis on health-related quality of life among active subjects.

Background And Aims: To assess the prevalence and impact of osteoarthritis (OA) and osteoporosis (OP) on health-related quality of life (HRQOL) among active subjects employed in the public workforce in Belgium.

Methods: A cohort of 3440 subjects employed by the Liège City Council was prospectively followed for 6 months. The employees were asked to fill in a monthly log in a health record book, of data regarding their healthcare consumption due to OA and OP.

Longitudinal study of magnetic resonance imaging and standard X-rays to assess disease progression in osteoarthritis.

Objective: To investigate, over 1-year, the relationship between X-ray and magnetic resonance imaging (MRI) findings in patients with knee osteoarthritis (OA).

Methods: Sixty-two osteoarthritic patients (46 women) were followed for 1 year. At baseline and after 1 year, volume and thickness of cartilage of the medial tibia, the lateral tibia and the femur were assessed by MRI.

Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents.

Objective: To investigate the effects of whole body vibration in the elderly.

Design: Randomized controlled trial.

Setting: Nursing home.

Evaluation of proposals of Belgian Social Security Institute for reimbursement of bone densitometry tests. Toward a cost-effective strategy for osteoporosis screening?

Background And Aims: The Belgian Social Security Institute (hereafter INAMI) proposes a list of conditions to be considered as a prerequisite for reimbursement of Bone Mineral Density (BMD) measurements. The aim of this paper was to evaluate the diagnostic accuracy of the proposed criteria for identifying osteoporosis, and to gauge how useful they are for more rational application of densitometry tests.

Methods: 3748 Caucasian women aged at least 50 years old were recruited consecutively from an outpatient university center, from the database of which all relevant data corresponding to the INAMI list of clinical factors, as well as patients' age, weight and height, were collected.

Age- and sex-stratified prevalence of physical disabilities and handicap in the general population.

Background And Aims: Our aim was to provide age- and sex-stratified prevalence estimates of physical disabilities and handicap in the general Belgian population.

Methods: A cross-sectional and demographically representative health interview survey was conducted nationwide in Belgium in 1997. The 8836 persons aged 15 years and over who answered the health interview were included in this study.

Social support and health-related quality of life in hip and knee osteoarthritis.

Objective: To document the association between social support and health-related quality of life (HRQoL) in hip and knee osteoarthritis (OA).

Methods: A prospective survey including the SF-36 and the Social Support questionnaire (SSQ) was administered to 108 hip and knee OA patients attending an outpatient physical rehabilitation and rheumatology clinic. Multiple regression analysis were performed to study the relation between social support and each dimension of the SF-36, controlling for age, sex, body mass index, number of comorbid conditions, socioeconomic status, site of survey completion and severity of OA which was gauged with the pain dimension of the WOMAC, an OA-specific health status instrument.

Efficacy of alphacalcidol and calcitriol in primary and corticosteroid-induced osteoporosis: a meta-analysis of their effects on bone mineral density and fracture rate.

Vitamin D metabolites alphacalcidol and calcitriol (D-hormones) have been investigated for two decades, but few and conflicting results are available from high-quality randomized controlled trials. Our objectives were to provide an evidence-based update quantitatively summarizing their efficacy on bone mineral density (BMD) and fracture rate. We performed a systematic research of any randomized controlled trial containing relevant data, peer review, data extraction and quality scoring blinded for authors and data sources, and comprehensive meta-analyses of the relevant data.

Do utility values and willingness to pay suitably reflect health outcome in hip and knee osteoarthritis? A comparative analysis with the WOMAC Index.

Objective: To establish whether health utility (time trade-off, TTO) and willingness to pay (WTP) values reflect clinical health outcome as evaluated by the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) in hip and knee osteoarthritis (OA).

Methods: One hundred twenty-eight patients with OA attending a specialized arthritis clinic were interviewed about their socioeconomic characteristics and administered the TTO technique and the WOMAC. Their WTP for 2 hypothetical anti-osteoarthritic drugs was also investigated: the first drug was said to provide a significant improvement in WOMAC dimensions and the second a complete cure of the disease.

Impact of the joint space width measurement method on the design of knee osteoarthritis studies.

Background And Aims: Recent guidelines recommend measurement of articular loss over several years, determined by conventional X-rays, as the principal outcome measure in clinical trials of potential structure-modifying drugs in osteoarthritis (OA). The aim of this study was to assess the impact of the joint space width measurement method on sample size calculation in knee OA studies.

Methods: Standard knee X-rays were taken in 212 patients with knee OA at baseline and after 3 years of follow-up.

Health-related quality of life and cost of ambulatory care in osteoporosis: how may such outcome measures be valuable information to health decision makers and payers?

The objective was to quantify the outcome of osteoporosis (OP) in terms of health-related quality of life (HR-QOL) and cost of ambulatory care and to look at the association between these two outcomes variables. A cross-sectional health survey of 4800 Belgian individuals over the age of 45 years was used. Individuals having reported OP were retrieved and for each of them, at least two matched individuals for age, sex, residency location, and health insurance status were identified.

Inhaled corticosteroids effects on bone in asthmatic and COPD patients: a quantitative systematic review.

Deleterious effect of oral corticosteroids on bone has been well documented, whereas this remains debated for inhaled ones (ICS). Our objectives were to analyze the effects of ICS on bone mineral density, fracture risk and bone markers. We performed an exhaustive systematic research of all controlled trials potentially containing pertinent data, peer-reviewed by a dedicated WHO expert group, and comprehensive meta-analyses of the data.

Interest of a prescreening questionnaire to reduce the cost of bone densitometry.

Bone mineral density (BMD) measurement is widely recognized as the best single tool to identify patients with a high lifetime risk of developing an osteoporosis-related fracture. However, the cost/benefit value of screening the whole population has been repeatedly challenged and demonstrated to be rather poor. In many countries, BMD scan is not or no longer reimbursed because of lack of validated criteria to identify patients who should benefit from this procedure.

Bone resorption in post-menopausal women with normal and low BMD assessed with biochemical markers specific for telopeptide derived degradation products of collagen type I.

Biochemical markers of bone resorption can be used clinically to predict the risk of osteoporosis-related fractures (prognostic tool) and to assess the response of an osteoporotic patient to an antiresorptive therapy (monitoring tool). Our aim was to assess the ability of four currently marketed biochemical markers of bone resorption, based on the measurement of degradation products from collage type I telopeptides to monitor the elevated resorption associated with menopause. Women (846) were stratified for menopause, age, and bone mineral density and the following markers were measured: urinary cross-linked N-telopeptides of type I collagen (NTx), the levels of breakdown products of type I collagen C-telopeptides in serum (S-CTx), and in urine, by ELISA (U-CTx-E), and RIA (U-CTx-R).

Intermittent cyclic tiludronate in the treatment of osteoporosis.

The objective of the study was to determine the efficacy and safety of tiludronate in the treatment of postmenopausal osteoporosis. Two placebo-controlled, randomized, double-masked, multicenter, cyclical, intermittent, dose-ranging studies including 1805 women with low vertebral bone mineral density and prevalent vertebral fractures and 488 women with low bone mineral density and no prevalent fracture were conducted. Patients were randomized to either tiludronate 50 mg/day, tiludronate 200 mg/day or placebo, given orally for the first 7 days of each month.

Intensive and prolonged health promotion strategy may increase awareness of osteoporosis among postmenopausal women.

The aim of the study was to measure the results of a 15-year health promotion strategy towards osteoporosis, in an urban community of subjects over 45 years old, in terms of osteoporosis awareness and handling. To this end an ancillary study to a large survey of the Belgian population's self-perceived health status was carried out. A rectangular sample of 4800 individuals over 45 years old was randomly selected in two Belgian cities, among the affiliates of the two main health insurance providers.

On conducting burden-of-osteoporosis studies: a review of the core concepts and practical issues. A study carried out under the auspices of a WHO Collaborating Center.

Osteoporosis is a problem that is relevant to public health from the clinical, economic and social viewpoints. Except in a handful of industrialized countries, there is a considerable void in our knowledge of the magnitude of the problem. By exploring both the epidemiological and the economic impact of osteoporosis and the fractures associated with it in a particular country, studies of the 'burden of illness' (BOI) can fill that void.

Depressive vulnerability is not an independent risk factor for osteoporosis in postmenopausal women.

Major depression has been repeatedly but not consistently reported to be associated with low bone mineral density (BMD) and to an increased risk for fracture in women. We have investigated, in healthy postmenopausal women, whether depressive symptomatology, assessed by the General Health Questionnaire (GHQ), was associated to a significant decrease in BMD, hence supporting the hypothesis of an independent pathogenetic link between the two disorders. We investigated 121 postmenopausal women, aged 48-77 years, spontaneously attending a screening visit for osteoporosis in an outpatient facility.

Promising new agents in osteoporosis.

Currently marketed inhibitors of bone resorption or stimulators of bone formation have significantly contributed to a better preventive and therapeutic approach to postmenopausal and senile osteoporosis. However, none of the available compounds has unequivocally demonstrated an ability to fully prevent the occurrence of new vertebral or peripheral osteoporotic fractures once the disease is established. Therefore, several new medications are being developed, with the aim of providing a better risk-benefit profile and/or a more favourable cost-utility assessment than available drugs.

Direct costs of hip fractures in patients over 60 years of age in Belgium.

Objective: Osteoporosis-related costs are now considered a major burden for health authorities in most developed countries. An accurate and exhaustive evaluation of these costs would be a major contribution to health economic studies evaluating the efficiency of screening and prevention strategies. Osteoporosis is the most frequent underlying cause of femoral neck fractures in the elderly; these fractures weigh heavily on healthcare budgets.