Summary
This study in 8 countries across Europe found that about 75% of elderly women seen in primary care who were at high risk of osteoporosis-related fractures were not receiving appropriate ...medication. Lack of osteoporosis diagnosis appeared to be an important contributing factor.
Introduction
Treatment rates in osteoporosis are documented to be low. We wished to assess the osteoporosis treatment gap in women ≥ 70 years in routine primary care across Europe.
Methods
This cross-sectional observational study in 8 European countries collected data from women 70 years or older visiting their general practitioner. The primary outcome was treatment gap: the proportion who were not receiving any osteoporosis medication among those at increased risk of fragility fracture (using history of fracture, 10-year probability of fracture above country-specific Fracture Risk Assessment Tool FRAX thresholds, T-score ≤ − 2.5).
Results
Median 10-year probability of fracture (without bone mineral density BMD) for the 3798 enrolled patients was 7.2% (hip) and 16.6% (major osteoporotic). Overall, 2077 women (55%) met one or more definitions for increased risk of fragility fracture: 1200 had a prior fracture, 1814 exceeded the FRAX threshold, and 318 had a T-score ≤ − 2.5 (only 944 received a dual-energy x-ray absorptiometry DXA scan). In those at increased fracture risk, the median 10-year probability of hip and major osteoporotic fracture was 11.2% and 22.8%, vs 4.1% and 11.5% in those deemed not at risk. An osteoporosis diagnosis was recorded in 804 patients (21.2%); most (79.7%) of these were at increased fracture risk. The treatment gap was 74.6%, varying from 53% in Ireland to 91% in Germany. Patients with an osteoporosis diagnosis were found to have a lower treatment gap than those without a diagnosis, with an absolute reduction of 63%.
Conclusions
There is a large treatment gap in women aged ≥ 70 years at increased risk of fragility fracture in routine primary care across Europe. The gap appears to be related to a low rate of osteoporosis diagnosis.
The newly constructed Jagiellonian Positron Emission Tomograph (J-PET) is the first tomograph built from plastic scintillators. As a detector optimized for the registration of photons from the ...electron-positron annihilations, it also capable to tests discrete symmetries in decays of positronium atoms via the determination of the expectation values of the discrete-symmetries-odd operators, which may be constructed from the spin of ortho-positronium atom and the momenta and polarization vectors of photons originating from its annihilation.
In this paper we summarize the recent experimental results from KLOE-2 on the dark photon search in the e+e−→Uγ, U→π+π−, measurement of Branching Ratio and Transition Form Factor of ϕ→π0e+e− decay, ...Dalitz plot analysis of η→π+π−π0 process and CPT symmetry and Lorentz invariance test with entangled K mesons. Additionally a discussion about ongoing test of CPT symmetry via measurement of KS charge asymmetry is included together with description of the KLOE-2 detection system.
The European League Against Rheumatism (EULAR) and the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) have recognised the importance of optimal acute care for ...the patients aged 50 years and over with a recent fragility fracture and the prevention of subsequent fractures in high-risk patients, which can be facilitated by close collaboration between orthopaedic surgeons and rheumatologists or other metabolic bone experts. Therefore, the aim was to establish for the first time collaborative recommendations for these patients. According to the EULAR standard operating procedures for the elaboration and implementation of evidence-based recommendations, 7 rheumatologists, a geriatrician and 10 orthopaedic surgeons met twice under the leadership of 2 convenors, a senior advisor, a clinical epidemiologist and 3 research fellows. After defining the content and procedures of the task force, 10 research questions were formulated, a comprehensive and systematic literature search was performed and the results were presented to the entire committee. 10 recommendations were formulated based on evidence from the literature and after discussion and consensus building in the group. The recommendations included appropriate medical and surgical perioperative care, which requires, especially in the elderly, a multidisciplinary approach including orthogeriatric care. A coordinator should setup a process for the systematic investigations for future fracture risk in all elderly patients with a recent fracture. High-risk patients should have appropriate non-pharmacological and pharmacological treatment to decrease the risk of subsequent fracture.
Context:
Denosumab and zoledronic acid (ZOL) are parenteral treatments for patients with osteoporosis.
Objective:
The objective of the study was to compare the effect of transitioning from oral ...bisphosphonates to denosumab or ZOL on bone mineral density (BMD) and bone turnover.
Design and Setting:
This was an international, multicenter, randomized, double-blind trial.
Participants:
A total of 643 postmenopausal women with osteoporosis previously treated with oral bisphosphonates participated in the study.
Interventions:
Subjects were randomized 1:1 to sc denosumab 60 mg every 6 months plus iv placebo once or ZOL 5 mg iv once plus sc placebo every 6 months for 12 months.
Main Outcome Measures:
Changes in BMD and bone turnover markers were measured.
Results:
BMD change from baseline at month 12 was significantly greater with denosumab compared with ZOL at the lumbar spine (primary end point; 3.2% vs 1.1%; P < .0001), total hip (1.9% vs 0.6%; P < .0001), femoral neck (1.2% vs −0.1%; P < .0001), and one-third radius (0.6% vs 0.0%; P < .05). The median decrease from baseline was greater with denosumab than ZOL for serum C-telopeptide of type 1 collagen at all time points after day 10 and for serum procollagen type 1 N-terminal propeptide at month 1 and at all time points after month 3 (all P < .05). Median percentage changes from baseline in serum intact PTH were significantly greater at months 3 and 9 with denosumab compared with ZOL (all P < .05). Adverse events were similar between groups. Three events consistent with the definition of atypical femoral fracture were observed (two denosumab and one ZOL).
Conclusions:
In postmenopausal women with osteoporosis previously treated with oral bisphosphonates, denosumab was associated with greater BMD increases at all measured skeletal sites and greater inhibition of bone remodeling compared with ZOL.
Postmenopausal women with osteoporosis transitioned from oral bisphosphonates had greater BMD increases and greater inhibition of bone turnover with denosumab compared with zoledronic acid.
This article reports the influence of cosmic radiation interaction while testing the T-symmetry in metastable triplet states of positronium with the Jagiellonian-Positron Emission Tomograph (J-PET) ...detector. The J-PET detector developed at Jagiellonian University in Krakow, Poland is one of its kind being based on organic scintillators. J-PET is an axially symmetric and high acceptance scanner that can be used as a multi-purpose detector system. It is well suited to pursue tests of discrete symmetries in decays of positronium in addition to medical imaging. Cosmic rays have been considered as a well known source of background while performing test measurements with the J-PET detector. It is important to estimate and reject the significant contribution of the cosmic ray interactions within the J-PET detector in order to improve the sensitivity while testing T-symmetry violation. Therefore, the results of cosmic radiation uniquely being separated due to their large energy deposits in plastic scintillator detectors are shown in this article.
The place of calcium supplementation, with or without concomitant vitamin D supplementation, has been much debated in terms of both efficacy and safety. There have been numerous trials and ...meta-analyses of supplementation for fracture reduction, and associations with risk of myocardial infarction have been suggested in recent years. In this report, the product of an expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF), we review the evidence for the value of calcium supplementation, with or without vitamin D supplementation, for healthy musculoskeletal ageing. We conclude that (1) calcium and vitamin D supplementation leads to a modest reduction in fracture risk, although population-level intervention has not been shown to be an effective public health strategy; (2) supplementation with calcium alone for fracture reduction is not supported by the literature; (3) side effects of calcium supplementation include renal stones and gastrointestinal symptoms; (4) vitamin D supplementation, rather than calcium supplementation, may reduce falls risk; and (5) assertions of increased cardiovascular risk consequent to calcium supplementation are not convincingly supported by current evidence. In conclusion, we recommend, on the basis of the current evidence, that calcium supplementation, with concomitant vitamin D supplementation, is supported for patients at high risk of calcium and vitamin D insufficiency, and in those who are receiving treatment for osteoporosis.
Recent KLOE results on kaon physics Czerwiński, E.
Nuclear and particle physics proceedings,
April-June 2016, 2016-04-00, Letnik:
273-275
Journal Article
Recenzirano
Odprti dostop
A short review of two measurements recently published by KLOE/KLOE-2 collaborations is presented. Namely the most stringent limits of the CPT-violating parameters Δaμ for neutral kaons, and the ...absolute branching ratio of K+→π+π−π+(γ) decay. In addition a discussion of starting KLOE-2 project is performed.
The place of calcium supplementation, with or without concomitant vitamin D supplementation, has been much debated in terms of both efficacy and safety. There have been numerous trials and ...meta-analyses of supplementation for fracture reduction, and associations with risk of myocardial infarction have been suggested in recent years. In this report, the product of an expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF), we review the evidence for the value of calcium supplementation, with or without vitamin D supplementation, for healthy musculoskeletal ageing. We conclude that (1) calcium and vitamin D supplementation leads to a modest reduction in fracture risk, although population-level intervention has not been shown to be an effective public health strategy; (2) supplementation with calcium alone for fracture reduction is not supported by the literature; (3) side effects of calcium supplementation include renal stones and gastrointestinal symptoms; (4) vitamin D supplementation, rather than calcium supplementation, may reduce falls risk; and (5) assertions of increased cardiovascular risk consequent to calcium supplementation are not convincingly supported by current evidence. In conclusion, we recommend, on the basis of the current evidence, that calcium supplementation, with concomitant vitamin D supplementation, is supported for patients at high risk of calcium and vitamin D insufficiency, and in those who are receiving treatment for osteoporosis.
A novel approach to tomographic data processing has been developed and evaluated using the Jagiellonian positron emission tomography scanner as an example. We propose a system in which there is no ...need for powerful, local to the scanner processing facility, capable to reconstruct images on the fly. Instead, we introduce a field programmable gate array system-on-chip platform connected directly to data streams coming from the scanner, which can perform event building, filtering, coincidence search, and region-of-response reconstruction by the programmable logic and visualization by the integrated processors. The platform significantly reduces data volume converting raw data to a list-mode representation, while generating visualization on the fly.
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