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The importance of morphometric radiographic vertebral assessment for the detection of patients who need pharmacological treatment of osteoporosis among postmenopausal diabetic Korean women

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Abstract

Summary

Many diabetic patients with vertebral fractures remain undiagnosed and untreated. We found that more than two-thirds of osteoporotic diabetic women could not be identified for pharmacological treatment according to the NOF guidelines if without radiographic vertebral assessment. This study shows the importance of radiographic vertebral assessment for identifying patients who need treatment for osteoporosis in diabetic women.

Introduction

Diagnosis of vertebral fracture (VF) is important for identifying patients who need pharmacologic therapy for osteoporosis. However, many patients with vertebral fractures remain undiagnosed and untreated. This study evaluated the number of patients with VFs who would be unrecognized as candidates for osteoporosis treatments according to the National Osteoporosis Foundation (NOF) Clinician’s Guidelines to the Treatment of Osteoporosis, among postmenopausal diabetic Korean women without spinal imaging.

Methods

A total of 873 postmenopausal diabetic women were enrolled. Lateral plain radiographs of the thoracolumbar spine and total hip BMD were obtained. The Fracture Risk Assessment Tool (FRAX®) probability was computed using the algorithm available online at http://www.shef.ac.uk/FRAX (South Korea version). The subjects with and without VFs were classified into candidates for osteoporosis treatment [Tx + by NOF] and not candidates for osteoporosis treatment [Tx − by NOF] according to the NOF pharmacologic treatment guidelines, regardless of the presence of VFs.

Results

Forty-six percent of postmenopausal diabetic women had morphometric VFs. Among the subjects with morphometric VFs, only 2% of the patients had previously diagnosed VFs by medical doctors. In addition, 73.6% of the patients with VFs were not included in the [Tx + by NOF] group, given the assumption of no radiographic diagnosis of VFs.

Conclusions

With regard to increased risk of VFs in postmenopausal Korean women with type 2 diabetes mellitus, radiographic vertebral assessment would be useful for the clinical identification of osteoporosis and fractures.

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References

  1. OECD (2007) OECD economic survey Korea. OECD, Paris. 107–8

  2. The Korea Institute for Health and Social Affairs and the Korea Centers for Disease Control and Prevention (2008) The fourth Korea National Health and Nutrition Examination Survey (KNHANES)

  3. Melton LJ III, Kan SH, Frye MA et al (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129:1000–1011

    PubMed  Google Scholar 

  4. Meunier PJ, Delmas PD, Eastell R et al (1999) Diagnosis and management of osteoporosis in postmenopausal women: clinical guidelines. International Committee for Osteoporosis Clinical Guidelines. Clin Ther 21:1025–1044

    Article  PubMed  CAS  Google Scholar 

  5. Black DM, Arden NK, Palermo L et al (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–828

    Article  PubMed  CAS  Google Scholar 

  6. The Korean Society of the Bone Metabolism (2008) Physician’s guide for diagnosis & treatment of osteoporosis. The Korean Society of the Bone Metabolism, Seoul

    Google Scholar 

  7. National Osteoporosis Foundation (2010) Clinician’s guide to prevent and treatment of osteoporosis. National Osteoporosis Foundation, Washington, DC

    Google Scholar 

  8. Greenspan SL, von Stetten E, Emond SK, Jones L, Parker RA (2001) Instant vertebral assessment: a noninvasive DXA technique to avoid misclassification and clinical mismanagement of osteoporosis. J Clin Densitom 4:373–80

    Article  PubMed  CAS  Google Scholar 

  9. Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561

    Article  PubMed  CAS  Google Scholar 

  10. Gold DT (1996) The clinical impact of vertebral fractures: quality of life in women with osteoporosis. Bone 18(Suppl 3):185S–189S

    Article  PubMed  CAS  Google Scholar 

  11. Link TM, Guglielmi G, van Kuijk C, Adams JE (2005) Radiologic assessment of osteoporotic vertebral fractures: diagnostic and prognostic implications. Eur Radiol 15:1521–1532

    Article  PubMed  Google Scholar 

  12. Lewiecki EM, Laster AJ (2006) Clinical review: clinical applications of vertebral fracture assessment by dual-energy x-ray absorptiometry. J Clin Endocrinol Metab 91:4215–4222

    Article  PubMed  CAS  Google Scholar 

  13. Middleton ET, Steel SA (2008) Routine versus targeted vertebral fracture assessment for the detection of vertebral fractures. Osteoporos Int 19:1167–1173

    Article  PubMed  CAS  Google Scholar 

  14. Fink HA, Milavetz DL, Palermo L et al (2005) What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J Bone Miner Res 20:1216–1222

    Article  PubMed  Google Scholar 

  15. Vokes TJ, Dixon LB, Favus MJ (2003) Clinical utility of dual-energy vertebral assessment (DVA). Osteoporos Int 14:871–878

    Article  PubMed  Google Scholar 

  16. Choi YJ, Kim HC, Kim HM et al (2009) Prevalence and management of diabetes in Korean adults: Korea national health and nutrition examination surveys. 1998–2005. Diabetes Care 32:2016–2020

    Article  PubMed  Google Scholar 

  17. Vestergaard P (2007) Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes: a meta-analysis. Osteoporos Int 18:427–444

    Article  PubMed  CAS  Google Scholar 

  18. Janghorbani M, Van Dam RM, Willett WC, Hu FB (2007) Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 166:495–505

    Article  PubMed  Google Scholar 

  19. Yamamoto M, Yamaguchi T, Yamauchi M, Kaji H, Sugimoto T (2009) Diabetic patients have an increased risk of vertebral fractures independent of BMD or diabetic complications. J Bone Miner Res 24:702–709

    Article  PubMed  CAS  Google Scholar 

  20. Mehta JS, Reed MR, McVie JL, Sanderson PL (2004) Weight-bearing radiographs in thoracolumbar fractures: do they influence management? Spine (Phila Pa 1976) 29:564–7

    Article  CAS  Google Scholar 

  21. Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148

    Article  PubMed  CAS  Google Scholar 

  22. World Health Organization (2008) FRAX WHO fracture risk assessment tool. World Health Organization, Geneva

    Google Scholar 

  23. Gerdhem P, Isaksson A, Akesson K, Obrant KJ (2005) Increased bone density and decreased bone turnover, but no evident alteration of fracture susceptibility in elderly women with diabetes mellitus. Osteoporos Int 16:1506–1512

    Article  PubMed  CAS  Google Scholar 

  24. Schuit SCE, van der Klift M, Weel AEAM, de Laet CEDH, Burger H, Seeman E, Hofman A, Uitterlinden AG, van Leeuwen JPTM, Pols HAP (2004) Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone 34:195–202

    Article  PubMed  CAS  Google Scholar 

  25. Schwartz AV, Vittinghoff E, Bauer DC et al (2011) Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. JAMA 305:2184–2192

    Article  PubMed  CAS  Google Scholar 

  26. Donaldson MG, Cawthon PM, Lui LY et al (2009) Estimates of the proportion of older white women who would be recommended for pharmacologic treatment by the new U.S. National Osteoporosis Foundation Guidelines. J Bone Miner Res 24:675–80

    Article  PubMed  Google Scholar 

  27. Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E, Adachi JD (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33:522–532

    Article  PubMed  CAS  Google Scholar 

  28. Schousboe JT, Vokes T, Broy SB et al (2008) Vertebral fracture assessment: the 2007 ISCD official positions. J Clin Densitom 11:92–108

    Article  PubMed  Google Scholar 

  29. Mithal A, Dhingra V, Lau E (2009) The Asian epidemiology, costs and burden of osteoporosis in Asia. International Osteoporosis Foundation, Nyon

    Google Scholar 

  30. Jiang G, Eastell R, Barrington NA, Ferrar L (2004) Comparison of methods for the visual identification of prevalent vertebral fracture in osteoporosis. Osteoporos Int 15:887–896

    Article  PubMed  CAS  Google Scholar 

  31. Hurxthal LM (1968) Measurement of anterior vertebral compressions and biconcave vertebrae. Am J Roentgenol Radium Ther Nucl Med 103:635–644

    PubMed  CAS  Google Scholar 

  32. Hospers IC, van der Laan JG et al (2009) Vertebral fracture assessment in supine position: comparison by using conventional semiquantitative radiography and visual radiography. Radiology 251:822–828

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank all the participants and research staffs in this multi-center study. We also thank Yoo Mee Kim (Mizmedi Hospital, Seoul, Korea) for the advice on quantitative morphometry. We acknowledge the data management support of the C&R research in the preparation of this manuscript. This work was supported by the Sanofi-Aventis Korea.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea

    Y. J. Choi & Y.-S. Chung

  2. Department of Radiology and Radiologic Science, Asia Cancer Center, Busan, South Korea

    S.-O. Yang

  3. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    C. S. Shin

Authors
  1. Y. J. Choi
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  2. S.-O. Yang
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  3. C. S. Shin
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  4. Y.-S. Chung
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Correspondence to Y.-S. Chung.

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Choi, Y.J., Yang, SO., Shin, C.S. et al. The importance of morphometric radiographic vertebral assessment for the detection of patients who need pharmacological treatment of osteoporosis among postmenopausal diabetic Korean women. Osteoporos Int 23, 2099–2105 (2012). https://doi.org/10.1007/s00198-011-1803-y

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  • DOI: https://doi.org/10.1007/s00198-011-1803-y

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