Sign Up For Our Newsletter We'll email you a 10% discount code to use once on your next orderVolume 2, Issue 1, March 2016, Pages 1–12 AimThis Clinical Guidance is aimed to help practitioners assess, diagnose and manage their patients with osteoporosis (OP), using the best available evidence.MethodsA literature search using PubMed (MEDLINE) and The Cochrane Library identified all relevant articles on OP and its assessment, diagnosis and treatment, from 2011, to update from the 2012 edition. The studies were assessed and the level of evidence assigned. For each statement, studies with the highest level of evidence were used to frame the recommendation.ResultsThis article summarizes the diagnostic and treatment pathways for postmenopausal and male OP, while addressing the risk-benefit ratio for OP treatment. Recognising the limitation of only depending on bone mineral density in assessing fracture risk, a move to assess 10 year fracture risk using tools such as FRAX, is recommended as a guide to decision-making on when to start treatment.
A re-evaluation was done of the position of calcium supplementation and on the importance of vitamin D. There has been concern about the potential adverse effects of the long-term usage of bisphosphonates, which have been discussed fully. Algorithms for the management of postmenopausal and male OP have been updated.ConclusionsAdequate intake of calcium (1000 mg from both diet and supplements) and vitamin D (800 IU) daily remain important adjuncts in the treatment of OP. However, in confirmed OP, pharmacological therapy with anti-resorptives is the mainstay of treatment in both men and postmenopausal women. Patients need to be regularly assessed while on medication and treatment adjusted as appropriate.Osteoporosis (OP) is a systemic skeletal disease characterised by low bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture [1]. Epidemiological studies have estimated that there would be an exponential increase in the incidence of osteoporotic fractures in Asia, so that by 2050, 50% of all hip fractures would occur in this region [2].
In Malaysia, in 1997, the incidence of hip fracture among individuals above 50 years of age was 90 per 100,000 population [3]. The incidence increased with age; in the 50–54 year olds, the incidence was 10 per 100,000, rising to 510 per 100,000 in those over 75 years old [3]. Malaysia still has a predominantly young population, with only 5.5% (∼1.6 million) of its estimated 30 million populace above the age of 65 years. However, the life expectancy of Malaysians is increasing; it is 77.4 years for women and 72.5 years for men. With this ageing population, the burden of OP is expected to continue to rise in Malaysia.The Malaysian Osteoporosis Society (MOS) had previously published Clinical Practice Guidelines in the Management of OP in 2001, 2006 and 2012, which aimed at providing a framework to assist doctors in the diagnosis and management of osteoporosis without restricting the physician's individual judgement. Following the 2012 edition, there were further data and studies, in the controversial area of calcium supplementation, bisphosphonate side effects (atypical femoral fractures and osteonecrosis of the jaw), and the place of hormone replacement therapy and strontium in the OP therapeutic armamentarium.
Although other guidelines are available, this guidance was written in the context of a developing country such as Malaysia, taking into account the healthcare resources available locally. This guidance provides a review of the therapeutic agents available for the treatment of osteoporosis, with the aim of reducing fracture, and its accompanying morbidity and mortality.The previous Clinical Practice Guidelines published in 2012 was used as the baseline. To update the document, a systematic review and literature search by the members of the Working Group, using PubMed (MEDLINE) and The Cochrane Library, identified all relevant articles on OP and its assessment, diagnosis and treatment, from 2011 to 2015. The date 2011 rather than 2012 was chosen so that all studies published just before and after the last guidelines would be reviewed and none inadvertently overlooked. The studies were assessed and graded with the levels of evidence as used by the National Guideline Clearinghouse, Agency for Healthcare Research and Quality, U.S. Department of Health & Human Services, USA [4] (Appendix 1).
For each statement, studies with the highest levels of evidence were used to frame the statements. The grade of recommendation was taken from the Scottish Intercollegiate Guidelines Network grading system [5] (Appendix 1).The traditional risk factors, as shown in Table 1 (adapted from Ref. [6]), are still useful in identifying subjects at risk of OP and fracture (case finding) (Grade C, Level IV). The Osteoporosis Self-Assessment Tool for Asians (OSTA) is a simple table based on age and weight that can identify women who may be at high risk of OP who then may require a bone mineral density (BMD) measurement [7](Grade B, Level III). The best method of assessing BMD is using dual-energy x-ray absorptiometry (DXA) at the lumbar spine and hip. General screening of the population is not recommended; the exceptions being women over the age of 65 and men over the age of 70 [8](Grade C, Level IV). Table 2 shows the indications for BMD measurement.Ethnic group (Oriental & Caucasian)3.Female gender4.
Premature menopause (<45 years)including surgical menopause5.Family history of osteoporosis or fracturein first degree relative6.Personal history of fracture as an adultModifiable1.Low calcium and/or vitamin D intake2.Alcohol intake of more than 3 units daily5.Caffeine intake of more than 330 mg daily (more than 3 cups daily)6.Low body weight (BMI < 19 kg/m2)7.Estrogen deficiency8.Next Article in Journal The Omega-3 Fatty Acid Docosahexaenoic Acid Attenuates Organic Dust-Induced Airway Inflammation Next Article in Special Issue The Protective Effect of Rhizoma Dioscoreae Extract against Alveolar Bone Loss in Ovariectomized Rats via Regulating Wnt and p38 MAPK Signaling Previous Article in Journal Reduced Anxiety in Forensic Inpatients after a Long-Term Intervention with Atlantic Salmon Previous Article in Special Issue Annatto Tocotrienol Improves Indices of Bone Static Histomorphometry in Osteoporosis Due to Testosterone Deficiency in Rats Choose your preferred view mode
Volume 6, Issue 12 Create a SciFeed alert for new publications Wan Zurinah Wan Ngah One email with all search results One email for each search Nutrients 2014, 6(12), 5419-5433; Vitamin D Status in Malaysian Men and Its Associated Factors (This article belongs to the Special Issue Nutrition and Bone Health) Abstract Vitamin D insufficiency is a global health problem. The data on vitamin D status in Malaysian men is insufficient. This study aimed to investigate vitamin D status among Chinese and Malay men in Malaysia and its associating factors. A cross-sectional study was conducted on 383 men aged 20 years and above, residing in Klang Valley, Malaysia. Their age, ethnicity, body anthropometry and calcaneal speed of sound (SOS) were recorded. Their fasting blood was collected for serum 25-hydroxyvitamin D (25(OH)D), intact parathyroid (PTH), total calcium and inorganic phosphate assays. Vitamin D deficiency was defined as a serum 25(OH)D level <30 nmol/L and insufficiency as a serum 25(OH)D level between 30 and 50 nmol/L.
The overall prevalence of vitamin D deficiency was 0.5%, and insufficiency was 22.7%. Vitamin D deficiency and insufficiency were more prevalent in the Malays compared to the Chinese. Being Chinese, older in age, having lower body mass index (BMI) and a high physical activity status were associated significantly with a higher serum 25(OH)D level (p < 0.05). The serum PTH level was inversely associated with the serum 25(OH)D level (p < 0.05). As a conclusion, a significant proportion of Malaysian men have vitamin D insufficiency, although deficiency is uncommon. Steps should be taken to correct the vitamin D status of these men. This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Scifeed alert for new publications Never miss any articles matching your research from any publisher Get alerts for new papers matching your research