Summary
This pilot audit explored how bone health is assessed patients with diabetes in diverse centres across Asia. Only 343 of 1092 (31%) audited patients had a bone health assessment, 27% of whom ...were diagnosed with osteoporosis. Quality improvement strategies are needed to address gaps in patient care in this area.
Purpose
The Asia Pacific Consortium on Osteoporosis (APCO) Framework outlines clinical standards for assessing and managing osteoporosis. A pilot audit evaluated adherence to clinical standard 4, which states that bone health should be assessed in patients with conditions associated with bone loss and/or increased fracture risk; this report summarises the audit findings in patients with diabetes. A secondary aim was to assess the practicality and real-world use of the APCO bone health audit tool kit.
Methods
Eight centres across Asia participated in the pilot audit, selecting diabetes as the target group. Participants reviewed their practice records for at least 20 consecutively treated patients with the target condition. Questions covered routine investigations, bone health assessment, osteoporosis diagnosis, and patient referral pathways. Data were summarised descriptively.
Results
The participants represented public hospitals, university medical centres, and private clinics from India, Malaysia, Pakistan, Singapore, Taiwan, and Vietnam that see an estimated total of 95,000 patients with diabetes per year. Overall, only 343 of 1092 audited patients (31%) had a bone health assessment. Osteoporosis was subsequently diagnosed in 92 of 343 (27%) patients.
Conclusion
Bone health was not assessed in most patients with diabetes. The results provide insight into current practices across diverse Asian centres and demonstrate the practical value of the audit tool kit. Participant feedback has been used to improve the tool kit. Results of this pilot audit are being used in the respective centres to inform quality improvement projects needed to overcome the gap in patient care.
This study assessed the accuracy of a selected formula used to estimate the appendicular muscle mass (AMM) which is linked with many clinical outcomes. A group of community-dwelling adult women ...(n=80) had their AMM measured using dual energy x-ray absorptiometry (DXA). The same was estimated using a formula already published {Skeletal muscle mass = (0.244 × BW in kg) + (7.80 × Ht in meters) + (6.6 × Sex) - (0.098 × Age) + race - 3.3} (sex=0 for female and 1 for male, race =-1.2 for Asian, 1.4 for African American and 0 for White and Hispanic).The two datasets were compared for accuracy and precision. Mean AMM measured by DXA and estimated by the formula were very close (14.8 and 14.5 kg) and the difference ranged from -1.2 to 3.6 kg. Correlation between the two datasets was high (r=0.92) and the Bland-Altman plot showed an acceptable measurement agreement between the two methods. Results were independent of age and BMI. The formula used in this analysis gave an accurate estimation of the absolute AMM in women included in this study.
Introduction Chronic kidney disease (CKD) is a risk factor for cardiovascular disease (CVD). It is evident that traditional risk factors as well as uraemia related non-traditional risk factors are ...responsible for the increased CVD risk in CKD patients. Objective The objective of this study was to compare the prevalence of selected cardiovascular risk factors among patients with end stage renal disease with controls. Methods and Materials Fifty (men=38) consecutive patients with ESRD, awaiting kidney transplant at Teaching Hospitals, Karapitiya and Kandy were included in the study. The control group included fifty (50) age and sex-matched healthy individuals. Data were collected using a questionnaire followed by anthropometric and blood pressure measurements. Fasting plasma glucose (FPG) serum total cholesterol (TCh), triglyceride (TG), high–density lipoprotein cholesterol (HDL-Ch), phosphorous (SPho), corrected calcium (SCCa), creatinine (SCr), albumin (SAl), high-sensitivity C-reactive protein (Hs-CRP), interleukin-6 (IL-6), vitamin D (vit.D) concentrations and blood glycated haemoglobin HbA1c were estimated. Results The mean age of the patient group was 44(10) years. Compared to controls, mean TCh (p
To find out the proportion of patients who qualifies to receive prophylactic therapy for glucocorticoid-induced osteoporosis.
Retrospective record review. Participants Current users of oral ...glucocorticoids referred for bone mineral density estimation to assess their fracture risk (n=134).
Clinical history and bone mineral density of the spine and proximal femur.
Based on the current U.K. guidelines published by the College of Physicians of London in 2002, 22 of 57 (probability of 0.39) patients under 20 years, 19 of 38 (probability of 0.5) between 20-49 years, 22 of 28 (probability of 0.79) between 50-64 years and 10 of 11 (probability of 0.9) above 64 years, qualified for the diagnosis of glucocorticoid-induced osteoporosis and prophylactic therapy was indicated for them. The prevalence of glucocorticoid-induced osteoporosis was not different between men and women in any age group.
Due to the restricted availability of DXA scan facility, initiation of prophylactic therapy without baseline bone mineral density appears rational in current users of oral glucocorticoids older than 50 years as 80-90% of them would qualify for such therapy. However, only 40-50% of current glucocorticoids users younger than 50 years would require such therapy and simultaneous prescribing of prophylaxis appears unnecessary in 50-60% of them. Attempts should be made to estimate baseline bone mineral density in this group of patients.
Summary
Potential FRAX®-based major osteoporotic fracture (MOF) and hip fracture (HF) intervention thresholds (ITs) for postmenopausal Singaporean women were explored. Age-dependent ethnic-specific ...and weighted mean ITs progressively increased with increasing age. Fixed ITs were derived via discriminatory value analysis. MOF and HF ITs with highest the Youden index were chosen as optimal.
Introduction
We aimed to explore FRAX®-based intervention thresholds (ITs) to potentially guide osteoporosis treatment in Singapore, a multi-ethnic nation.
Method
One thousand and one Singaporean postmenopausal community-dwelling women belonging to Chinese, Malay and Indian ethnicities underwent clinical risk factor (CRF) and BMD assessment. FRAX® major osteoporotic fracture (MOF) and hip fracture (HF) probabilities were calculated using ethnic-specific models. We employed the translational logic adopted by NOGG (UK), whereby osteoporosis treatment is recommended to any postmenopausal woman whose fracture probability based on other CRFs is similar to or exceeds that of an age-matched woman with a fracture. Using the same logic, ethnic-specific and mean weighted age-dependent ITs were computed. Employing these age-dependent ITs as a reference, the performance of fixed (age-independent) ITs were examined using ROC curves and discriminatory analysis, with the highest Youden index (YI) (sensitivity + specificity − 1) used to identify the optimal MOF and HF ITs.
Results
The mean age was 58.9 (6.9) years. Seven hundred and eighty-nine (79%) women were Chinese, 136 (13.5%) Indian and 76 (7.5%) Malay. Age-dependent MOF ITs ranged from 3.1 to 33%, 2.5 to 17% and 2.5 to 16% whilst HF ITs ranged from 0.7 to 17%, 0.4 to 6% and 0.4 to 6.3% in Chinese, Malay and Indian women, respectively, between the ages of 50 and 90 years. The weighted age-dependent MOF and HF ITs ranged from 2.9% and 0.6%, respectively, at the age of 50, to 28% and 14% at 90 years of age. Fixed MOF/HF ITs of 5.5%/1%, 2.5%/1% and 2.5%/0.25% were identified as the most optimal by the highest YI in Chinese, Malay and Indian women, respectively. Fixed MOFP and HF ITs of 4% and 1%, respectively, were found to be most optimal on the weighted means analysis.
Conclusion
The ITs for osteoporosis treatment in Singapore show marked variations across ethnicities. Weighted mean thresholds may overcome the dilemma of intervening at different thresholds for different ethnicities. Choosing fixed ITs may have to involve trade-offs between sensitivity and specificity. FRAX®-based age-dependent or the fixed intervention thresholds suggested as an alternative to be considered for use in Singapore though further studies on the societal and health economic impacts of choosing these thresholds in Singapore are needed.
Studies on body composition and its determinants among SLE patients are limited. Estimation of body composition, analysis of determinants and associations of different body compartments are important ...in planning long-term care of these patients. The aim of the study was to identify the changes in body composition among SLE patients and assess the effect of corticosteroid use, patient and disease-related variables on body composition. We compared lean mass, fat mass, bone mineral density (BMD), and bone mineral content (BMC) determined by dual-energy x-ray absorptiometry technology, in a group of premenopausal women with SLE (n = 27) and an age-matched healthy group of women (n = 27). The median (IQR) duration of SLE was 3 (2-5) years while median (IQR) duration and dose of prednisolone therapy were 108 (88 − 172) weeks and 9730 (6160−15360) mg, respectively. No significant difference was observed in body mass index (BMI) or total fat mass between the two groups. SLE patients, however, had significantly lower lean mass (p < 0.001), BMD (p < 0.001) and BMC (p < 0.005) than healthy controls. Among cases, compared with lean mass, total body fat content showed stronger associations with total body BMD (r = 0.49, p < 0.01) and total body BMC (r = 0.63, p < 0.01). When a stepwise regression model was fitted, lean mass among controls and total fat mass among cases emerged as the best predictors of BMC/BMD. No significant correlations were found between the disease duration or cumulative glucocorticosteroid dose and total body BMD, total body BMC, lean mass or total fat content in SLE patients.
BMI, hip and waist circumferences (HC and WC) are being used as clinical surrogates of obesity. Unceratinities exist regarding the cut-off values, which are recommonded for Western countries.
We ...conducted a study to determine cut-off values for Sri Lankan women.
Healthy premenopausal women (n=128) aged 25 to 50 years were selected randomly, from local MOH area and stratified into four groups (32 in each) according to their BMI. Those who were pregnant, breast feeding, or on long-term medications were excluded. Body weight and height, hip circumference (HC) and waist circumference (WC) were measured, using standard protocols. Lean and fat mass, were measured by DXA and percentage FM (%FM) was calculated (FM/body weight x100). Women with %FM> 30% were considered obese.
BMI moderately correlated (r = 0.41) with %FM and BMI accounted for only 16% (r2 = 0.16) of %FM variation. Regression equations were used to estimate the cut-off values that corresponded to %FM of 30. Those cut-off values for BMI, WC, and HC were 24.4 Kg/m2, 92 cm, and 78 cm, respectively.
BMI, WC and HC values of 24 kg/m2, 92 cm and 78 cm can be considered appropriate cut-off values when detecting central obesity in premenopausal women.
Barthel index consisting 10 items is used to estimate physical dependence of elderly and physically disabled. A shorter version with 5 items has been developed and it is more suitable as a rapid ...screening tool of physical dependence.
To assess the measurement agreement between 10-item Barthel index and 5-item shorter version.
The 10-item Barthel index was translated to Sinhala, adhering to the standard protocols and validated among 286 patients with varying degree of physical disability selected by stratified quota system. From the same data sheets, scores given for bathing, transfer, toileting, walking and climbing steps were used to make the shorter version.
The 5-item Barthel index showed a high internal consistency (global Cronbach's alpha = 0.93). The 10-item version also showed a similar internal consistency (global Cronbach's alpha = 0.92) while its item-total correlations varied between 0.64- 0.90 for all items except for the urinary and bladder functions. In the factor analysis, urinary and bowel functions factored together and independent to other items and these two factors accounted for 73% variation of the score. The total scores of the 10-item and 5-item versions showed a high correlation (r = 0.9, p<0.001). In the Bland-Altman plot, more than 95% of data points were within the +/- 1.96 SD tolerance limits.
This analysis illustrates the reliability and validity of the Sinhala version of 10-item Barthel index in estimating physical activities of daily living and the high measurement concordance between the standard 10-item and 5-item shorter versions.
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