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Osteoporosis: HELP
Articles from Kentucky
Based on 40 articles published since 2008

These are the 40 published articles about Osteoporosis that originated from Kentucky during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline ACR Appropriateness Criteria 2017

Anonymous3730905 / Ward, Robert J / Roberts, Catherine C / Bencardino, Jenny T / Arnold, Erin / Baccei, Steven J / Cassidy, R Carter / Chang, Eric Y / Fox, Michael G / Greenspan, Bennett S / Gyftopoulos, Soterios / Hochman, Mary G / Mintz, Douglas N / Newman, Joel S / Reitman, Charles / Rosenberg, Zehava S / Shah, Nehal A / Small, Kirstin M / Weissman, Barbara N. ·Principal Author, Tufts Medical Center, Boston, Massachusetts. Electronic address: robwardmd@gmail.com. · Panel Chair, Mayo Clinic, Phoenix, Arizona. · Panel Vice-Chair, New York University School of Medicine, New York, New York. · Illinois Bone and Joint Institute, Morton Grove, Illinois; American College of Rheumatology. · UMass Memorial Medical Center, Worcester, Massachusetts. · UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons. · VA San Diego Healthcare System, San Diego, California. · University of Virginia Health System, Charlottesville, Virginia. · Medical College of Georgia at Augusta University, Augusta, Georgia. · New York University Medical Center, New York, New York. · Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Hospital for Special Surgery, New York, New York. · New England Baptist Hospital, Boston, Massachusetts. · Medical University of South Carolina, Charleston, South Carolina; North American Spine Society. · Hospital for Joint Diseases, New York, New York. · Brigham and Women's Hospital, Boston, Massachusetts. · Specialty Chair, Brigham and Women's Hospital, Boston, Massachusetts. ·J Am Coll Radiol · Pubmed #28473075.

ABSTRACT: Osteoporosis is a considerable public health risk, with 50% of women and 20% of men >50 years of age experiencing fracture, with mortality rates of 20% within the first year. Dual x-ray absorptiometry (DXA) is the primary diagnostic modality by which to screen women >65 years of age and men >70 years of age for osteoporosis. In postmenopausal women <65 years of age with additional risk factors for fracture, DXA is recommended. Some patients with bone mineral density above the threshold for treatment may qualify for treatment on the basis of vertebral body fractures detected through a vertebral fracture assessment scan, a lateral spine equivalent generated from a commercial DXA machine. Quantitative CT is useful in patients with advanced degenerative bony changes in their spines. New technologies such as trabecular bone score represent an emerging role for qualitative assessment of bone in clinical practice. It is critical that both radiologists and referring providers consider osteoporosis in their patients, thereby reducing substantial morbidity, mortality, and cost to the health care system. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

2 Editorial Gender dysphoria and transgender medicine in the year 2018. 2018

Koch, Christian A / Tangpricha, Vin. ·Medicover GmbH Germany, Berlin / Hannover, Germany. Christian.koch65@gmail.com. · Carl von Ossietzky University of Oldenburg, Oldenburg, Germany. Christian.koch65@gmail.com. · Technical University of Dresden, Dresden, Germany. Christian.koch65@gmail.com. · University of Louisville, Louisville, KY, USA. Christian.koch65@gmail.com. · Division of Endocrinology, Metabolism and Lipids at Emory University School of Medicine and the Atlanta VA Medical Center, Atlanta, GA, USA. ·Rev Endocr Metab Disord · Pubmed #30382492.


3 Editorial Strengthening the bones in primary biliary cirrhosis. 2013

Angulo, Paul. ·Division of Digestive Diseases and Nutrition, University of Kentucky Medical Center, Lexington, KY. ·Hepatology · Pubmed #23959535.

ABSTRACT: -- No abstract --

4 Review Female Athlete Triad. 2018

Daily, Jennifer P / Stumbo, Jessica R. ·KentuckyOne Health, University of Louisville, Louisville, KY, USA; Department of Family and Geriatric Medicine, Centers for Primary Care, University of Louisville, 215 Central Avenue, Suite 205, Louisville, KY 40208, USA. ·Prim Care · Pubmed #30401345.

ABSTRACT: The female athlete triad is a condition seen in physically active female athletes, consisting of low energy availability, menstrual dysfunction, and low bone mineral density. The condition should be viewed as a metabolic injury. It can have an impact on female athletes at any age or level. Activities at highest risk are those emphasizing leanness, aesthetics, and endurance. The cornerstone of treatment is improving mismatched energy balance. A multidisciplinary team, including health care providers, dieticians, and mental health professionals, is vital in caring for female athlete triad patients. Increased awareness and education are needed for medical as well as athletic communities.

5 Review Sex-based Differences in Common Sports Injuries. 2018

Carter, Cordelia W / Ireland, Mary Lloyd / Johnson, Anthony E / Levine, William N / Martin, Scott / Bedi, Asheesh / Matzkin, Elizabeth G. ·From the Department of Orthopaedic Surgery, Yale University, New Haven, CT (Dr. Carter), the Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY (Dr. Ireland), the Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX (Dr. Johnson), the Department of Orthopaedic Surgery, Columbia University, New York, NY (Dr. Levine), the Department of Orthopaedic Surgery, the Brigham & Women's Hospital, Boston, MA (Dr. Martin), the Department of Orthopaedic Surgery, the University of Michigan, Ann Arbor, MI (Dr. Bedi), and the Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA (Dr. Matzkin). ·J Am Acad Orthop Surg · Pubmed #29847420.

ABSTRACT: The patient's sex plays an important role in mediating the risk for, and experience of, disease. Injuries of the musculoskeletal system are no exception to this phenomenon. Increasing evidence shows that the incidence, clinical presentation, and treatment outcomes for male and female patients with common sports injuries may vary widely. Stress fracture, which is associated with the female athlete triad, is a sports injury with known sex-based differences. Other common sports-related injuries may also have distinct sex-based differences. Understanding these differences is important to optimize each patient's musculoskeletal care.

6 Review Female athlete triad. 2017

Loveless, Meredith B. ·Departments Ob/Gyn and Pediatrics, Norton Children's Hospital Louisville, Clinical Faculty University of Louisville, Louisville, Kentucky, USA. ·Curr Opin Obstet Gynecol · Pubmed #28737524.

ABSTRACT: PURPOSE OF REVIEW: The obstetrician/gynecologist (ob/gyn) may be the first provider to have the opportunity to recognize and diagnose female athlete triad. This review will help the ob/gyn to understand the female athlete triad and what is new on this topic, how to screen and diagnose the condition and the ob/gyn's role in treatment. RECENT FINDINGS: Female athlete triad, also known as relative energy deficiency in sports, involves an interrelationship among energy availability, menstrual function and low bone density. When these components are not balanced, the health of the athlete is at risk. By using menstrual cycle as a vital sign, a careful medical history may alert you to this condition. The mainstay of treatment is achieving optimal energy balance and resumption of menses. This may involve dietary invention by increasing caloric intake or activity modification by limiting or restricting participation in sports. A multidisciplinary team, including the ob/gyn, athlete, coach, parents, sport nutritionist and sometimes psychiatrist/psychologist, is optimal for management. Medication may supplement but not replace treating the underlying condition. SUMMARY: The female athlete triad is an important disorder to identify, as early diagnosis and intervention may prevent long-term consequences, some of which may not be reversible if not diagnosed and treated.

7 Review Homocysteine as a Pathological Biomarker for Bone Disease. 2017

Behera, Jyotirmaya / Bala, Jyoti / Nuru, Mohammed / Tyagi, Suresh C / Tyagi, Neetu. ·Department of Physiology, School of Medicine, University of Louisville, Louisville, Kentucky. ·J Cell Physiol · Pubmed #27859269.

ABSTRACT: In the last few decades, perturbation in methyl-group and homocysteine (Hcy) balance have emerged as independent risk factors in a number of pathological conditions including neurodegenerative disease, cardiovascular dysfunction, cancer development, autoimmune disease, and kidney disease. Recent studies report Hcy to be a newly recognized risk factor for osteoporosis. Elevated Hcy levels are known to modulate osteoclastgenesis by causing detrimental effects on bone via oxidative stress induced metalloproteinase-mediated extracellular matrix degradation and decrease in bone blood flow. Evidence from previous studies also suggests that the decreased chondrocytes mediated bone mineralization in chick limb-bud mesenchymal cells and during the gestational period of ossification in rat model. However, Hcy imbalance and its role in bone loss, regression in vascular invasion, and osteoporosis, are not clearly understood. More investigations are required to explore the complex interplay between Hcy imbalance and onset of bone disease progression. This article reviews the current body of knowledge on regulation of Hcy mediated oxidative stress and its role in bone remodeling, vascular blood flow and progression of bone disease. J. Cell. Physiol. 232: 2704-2709, 2017. © 2016 Wiley Periodicals, Inc.

8 Review Effects of Type 1 Diabetes on Osteoblasts, Osteocytes, and Osteoclasts. 2016

Kalaitzoglou, Evangelia / Popescu, Iuliana / Bunn, R Clay / Fowlkes, John L / Thrailkill, Kathryn M. ·UK Barnstable Brown Diabetes Center, University of Kentucky College of Medicine, 830 S. Limestone St., Lexington, KY, 40536, USA. evangelia.kalaitzoglou@uky.edu. · Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, 40536, USA. evangelia.kalaitzoglou@uky.edu. · UK Barnstable Brown Diabetes Center, University of Kentucky College of Medicine, 830 S. Limestone St., Lexington, KY, 40536, USA. · Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, 40536, USA. ·Curr Osteoporos Rep · Pubmed #27704393.

ABSTRACT: PURPOSE OF REVIEW: To describe the effects of type 1 diabetes on bone cells. RECENT FINDINGS: Type 1 diabetes (T1D) is associated with low bone mineral density, increased risk of fractures, and poor fracture healing. Its effects on the skeleton were primarily attributed to impaired bone formation, but recent data suggests that bone remodeling and resorption are also compromised. The hyperglycemic and inflammatory environment associated with T1D impacts osteoblasts, osteocytes, and osteoclasts. The mechanisms involved are complex; insulinopenia, pro-inflammatory cytokine production, and alterations in gene expression are a few of the contributing factors leading to poor osteoblast activity and survival and, therefore, poor bone formation. In addition, the observed sclerostin level increase accompanied by decreased osteocyte number and enhanced osteoclast activity in T1D results in uncoupling of bone remodeling. T1D negatively impacts osteoblasts and osteocytes, whereas its effects on osteoclasts are not well characterized, although the limited studies available indicate increased osteoclast activity, favoring bone resorption.

9 Review Advances in Controlled Drug Delivery for Treatment of Osteoporosis. 2016

Asafo-Adjei, T A / Chen, A J / Najarzadeh, A / Puleo, D A. ·Department of Biomedical Engineering, University of Kentucky, 522A Robotics and Manufacturing Building, Lexington, KY, 40506-0108, USA. · Department of Biomedical Engineering, University of Kentucky, 522A Robotics and Manufacturing Building, Lexington, KY, 40506-0108, USA. puleo@uky.edu. ·Curr Osteoporos Rep · Pubmed #27502334.

ABSTRACT: Osteoporosis, which is characterized by resorption of bone exceeding formation, remains a significant human health concern, and the impact of this condition will only increase with the "graying" of the worldwide population. This review focuses on current and emerging approaches for delivering therapeutic agents to restore bone remodeling homeostasis. Well-known antiresorptive and anabolic agents, such as estrogen, estrogen analogs, bisphosphonates, calcitonin, and parathyroid hormone, along with newer modulators and antibodies, are primarily administered orally, intravenously, or subcutaneously. Although these treatments can be effective, continuing problems include patient noncompliance and adverse systemic or remote-site effects. Controlled drug delivery via polymeric, targeted, and active release systems extends drug half-life by shielding against premature degradation and improves bioavailability while also providing prolonged, sustained, or intermittent release at therapeutic doses to more effectively treat osteoporosis and associated fracture risk.

10 Review The role of homocysteine in bone remodeling. 2013

Vacek, Thomas P / Kalani, Anuradha / Voor, Michael J / Tyagi, Suresh C / Tyagi, Neetu. ·Department of Physiology and Biophysics, University of Louisville School of Medicine Louisville, Louisville, KY 40202, USA. ·Clin Chem Lab Med · Pubmed #23449525.

ABSTRACT: Bone remodeling is a very complex process. Homocysteine (Hcy) is known to modulate this process via several known mechanisms such as increase in osteoclast activity, decrease in osteoblast activity and direct action of Hcy on bone matrix. Evidence from previous studies further support a detrimental effect on bone via decrease in bone blood flow and an increase in matrix metalloproteinases (MMPs) that degrade extracellular bone matrix. Hcy binds directly to extracellular matrix and reduces bone strength. There are several bone markers that can be used as parameters to determine how high levels of plasma Hcy (hyperhomocysteinemia, HHcy) affect bone such as: hydroxyproline, N-terminal collagen 1 telopeptides. Mitochondrion serves an important role in generating reactive oxygen species (ROS). Mitochondrial abnormalities have been identified during HHcy. The mechanism of Hcy-induced bone remodeling via the mitochondrial pathway is largely unknown. Therefore, we propose a mitochondrial mechanism by which Hcy can contribute to alter bone properties. This may occur both through generations of ROS that activate MMPs and could be extruded into matrix to degrade bone matrix. However, there are contrasting reports on whether Hcy affects bone density, with some reports in favour and others not. Earlier studies also found an alteration in bone biomechanical properties with deficiencies of vitamin B12, folate and HHcy conditions. Moreover, existing data opens speculation that folate and vitamin therapy act not only via Hcy-dependent pathways but also via Hcy-independent pathways. However, more studies are needed to clarify the mechanistic role of Hcy during bone diseases.

11 Review Bisphosphonates: focus on inflammation and bone loss. 2012

Iannitti, Tommaso / Rosini, Stefano / Lodi, Daniele / Frediani, Bruno / Rottigni, Valentina / Palmieri, Beniamino. ·Department of Physiology, School of Medicine, University of Kentucky Medical Center, Lexington, 40536-0298, USA. tommaso.iannitti@gmail.com ·Am J Ther · Pubmed #22549638.

ABSTRACT: Bisphosphonates are pharmacological compounds that have been used for the prevention and treatment of several pathological conditions including osteoporosis, primary hyperparathyroidism, osteogenesis imperfecta, and other conditions characterized by bone fragility. Many studies have been performed to date to analyze their effects on inflammation and bone remodelling and related pathologies. The aim of this review is, starting from a background on inflammatory processes and bone remodelling, to give an update on the use of bisphosphonates, outlining the possible side effects and proposing new trends for the future. Starting from a brief introduction on inflammation and bone remodelling, we collect and analyze studies involving the use of bisphosphonates for treatment of inflammatory conditions and pathologies characterized by bone loss. Selected articles, including reviews, published between 1976 and 2011, were chosen from Pubmed/Medline on the basis of their content. Bisphosphonates exert a selective activity on inflammation and bone remodelling and related pathologies, which are characterized by an excess in bone resorption. They improve not only skeletal defects, but also general symptoms. Bisphosphonates have found clinical application preventing and treating osteoporosis, osteitis deformans (Paget's disease of bone), bone metastasis (with or without hypercalcaemia), multiple myeloma, primary hyperparathyroidism, osteogenesis imperfecta, and other conditions that feature bone fragility. Further clinical studies involving larger cohorts are needed to optimize the dosage and length of therapy for each of these agents in each clinical field in order to be able to maximize their properties concerning modulation of inflammation and bone remodelling. In the near future, although "old" bisphosphonates will reach the end of their patent life, "new" bisphosphonates will be designed to specifically target a pathological condition.

12 Review Osseous deficits after anterior cruciate ligament injury and reconstruction: a systematic literature review with suggestions to improve osseous homeostasis. 2010

Nyland, John / Fisher, Brent / Brand, Emily / Krupp, Ryan / Caborn, David N M. ·Department of Orthopaedic Surgery, University of Louisville, Kentucky 40202, USA. john.nyland@louisville.edu ·Arthroscopy · Pubmed #20810081.

ABSTRACT: PURPOSE: This systematic review was performed to improve our understanding of the current evidence regarding the influence of anterior cruciate ligament (ACL) injury and reconstruction on involved lower extremity apparent bone mineral density, bone content, or bone area mass (bone integrity). METHODS: Two independent reviewers performed a Medline search from 1966 to January 2010 using the terms "anterior cruciate ligament" or "ACL" combined with "wound" or "injury" and "bone density" or "osteoporosis." Study inclusion criteria were English-language human studies. Reference sections of selected studies were also reviewed. RESULTS: Ten studies were identified that met our inclusion criteria. Eight studies performed ACL reconstruction with bone-patellar tendon-bone autografts and interference screw fixation. One study performed ACL reconstruction by use of Achilles tendon allografts with interference screw and staple fixation. Two ACL injury studies either did not involve ACL reconstruction or attempted primary repair with sutures. All studies reported varying levels of decreased bone mineral density, bone content, or bone area mass (bone integrity) at the involved lower extremity after ACL injury that did not return to premorbid levels even with ACL reconstruction and rehabilitation. Sites of reduced bone integrity included the proximal and distal femur, proximal tibia, patella, and calcaneus. Bone loss was increased with limited weight bearing and prolonged disuse or immobilization; however, significant improvements were not observed with accelerated rehabilitation. Some studies reported relations between Lysholm, Tegner, International Knee Documentation Committee survey, or function scores and bone integrity, whereas others reported no or poor relations. CONCLUSIONS: Involved lower extremity bone integrity is decreased after ACL injury. Current evidence suggests that premorbid bone integrity is not re-established after ACL reconstruction even when accelerated rehabilitation is performed. Recommendations to improve osseous homeostasis and bone health after ACL injury and reconstruction are provided.

13 Review Osteoporotic vertebral fractures and collapse with intravertebral vacuum sign (Kümmel's disease). 2008

Pappou, Ioannis P / Papadopoulos, Elias C / Swanson, Andrew N / Cammisa, Frank P / Girardi, Federico P. ·Department of Orthopedic Surgery, University of Kentucky, Lexington, Kentucky, USA. ·Orthopedics · Pubmed #18269169.

ABSTRACT: The intravertebral vacuum phenomenon was first described by Kümmel and is also known as delayed vertebral collapse or vertebral pseudarthrosis. Clinically, it occurs in approximately 10% of vertebral osteoporotic fractures, mainly in the thoracolumbar zone, is accentuated on extension views and associated with benign fractures. Most patients are neurologically intact, and continued pain is a common symptom that responds well to stabilization. Various theories exist in the literature about the pathogenesis; data support a combination of ischemia and psuedarthrosis. The ultimate treatment plan must be individualized and involve decompression of neurologic elements--when present--and sufficient stabilization, which varies according to surgeon preference and the patient's combordities.

14 Clinical Trial Implementing an intervention to improve bone mineral density in survivors of childhood acute lymphoblastic leukemia: BONEII, a prospective placebo-controlled double-blind randomized interventional longitudinal study design. 2008

Rai, Shesh N / Hudson, Melissa M / McCammon, Elizabeth / Carbone, Laura / Tylavsky, Francis / Smith, Karen / Surprise, Harriet / Shelso, John / Pui, Chin-Hon / Kaste, Sue. ·Department of Bioinformatics and Biostatistics, School of Public Health; and Biostatistics Shared Facility, JG Brown Cancer Center, University of Louisville, KY, USA. ·Contemp Clin Trials · Pubmed #18586578.

ABSTRACT: The BONEII study is a large two-phase study. The baseline study (Study 1) aims to estimate the prevalence of diminished bone mineral density (BMD) in patients treated for childhood acute lymphoblastic leukemia (ALL) and identify risk factors for BMD deficits. The interventional phase (Study 2) of BONEII has a placebo-controlled double-blind randomized longitudinal design to evaluate the effects of nutritional counseling and calcium and vitamin D supplementation on changes in BMD and serum and urine markers of bone metabolism. The extensive information being collected through this large study will serve as a repository of relational data about BMD and bone turnover and will support further investigations to assess the association of calcium metabolism, bone turnover, nutritional intake, lifestyle factors (such as exercise and the use of alcohol and tobacco), and the specific agents used in ALL therapy in this rapidly increasing population of childhood cancer survivors.

15 Article Combined effects of photobiomodulation and alendronate on viability of osteoporotic bone marrow-derived mesenchymal stem cells. 2018

Fallahnezhad, Somaye / Amini, Abdollah / Hajihossainlou, Behnam / Chien, Sufan / Dadras, Sara / Rezaei, Fatemehalsadat / Bayat, Mohammad. ·Department of Biology and Anatomical sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. · Internist, department of internal medicine, Aroura Bay Area Medical Center, Marinette, WI, USA. · Price Institue of Surgical Reseach, University of Louisville, and Noveratech LLC of Louisville, Louisville, KY, USA. · Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran. · Best Journal Center, P. O. Box: 16315-365, Tehran, Iran. · Cellular and Molecular Biology Research Center, Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran. Electronic address: mohbayat@sbmu.ac.ir. ·J Photochem Photobiol B · Pubmed #29627514.

ABSTRACT: Osteoporotic bone marrow mesenchymal stem cells (BMMSCs) are involved in the pathogenesis of osteoporosis (OP). Photobiomodulation (PBM) has positive effects on healthy BMMSCs. The goal of current experiment was to evaluate the combined influence of photobiomodulation PBM and alendronate (ALN) incubation on ovariectomized induced osteoporosis(OVX)- BMMSC viability in vitro. 15 female adult Wistar rats were distributed into the 2 groups: (1) 3 healthy (sham)control rats, (2) 12 OVX- rats. All OVX rats underwent ovariectomy. After 3.5 months sham and OVX rats were euthanized and their MSC harvested and cultured in a complete osteogenic incubation medium (OM). As the next step, in sham and OVX groups flowcytometry and osteogenic differentiation assays were performed. OVX- rats were divided into (2) OVX-control, (3) OVX- PBM (HeNe laser, 623.8 nm, 1.2 J/cm

16 Article Impact of coexisting overactive bladder in Medicare patients with osteoporosis. 2018

Caplan, Eleanor O / Abbass, Ibrahim M / Suehs, Brandon T / Ng, Daniel B / Gooch, Katherine / Kirby, Cindy / Abbott, Paul. ·Comprehensive Health Insights Inc., 515 W. Market Street, 7th Floor, Louisville, KY, United States. Electronic address: ecaplan@humana.com. · Comprehensive Health Insights Inc., 515 W. Market Street, 7th Floor, Louisville, KY, United States. · Astellas Pharma Global Development, 1 Astellas Way, Northbrook, IL, 60062, United States. · Humana Inc.,101 South 5th St., Louisville, KY, 40202, United States. ·Arch Gerontol Geriatr · Pubmed #29180131.

ABSTRACT: BACKGROUND: Osteoporosis and overactive bladder (OAB) are prevalent conditions in older adults and are independent risk factors for falls and fractures. A paucity of evidence exists examining the impact of coexisting OAB in patients with osteoporosis. OBJECTIVE: To examine the impact of OAB on healthcare resource utilization (HRU), clinical outcomes, and healthcare costs among older adult patients with osteoporosis. METHODS: This retrospective analysis compared patients with osteoporosis with and without OAB. Patients with an osteoporosis diagnosis, enrolled in a Medicare Advantage plan, and aged 65-89 inclusive were eligible. Incident OAB among patients with prevalent osteoporosis was identified. A comparison group of patients with osteoporosis but no evidence of OAB was propensity score matched on baseline characteristics. Fall and/or fracture outcomes, HRU and healthcare costs were evaluated during 12 months of follow-up. Bivariate comparisons of outcomes were conducted. Ordinary least squared regression was used to examine the relationship between OAB and total healthcare costs. RESULTS: After matching, 5,526 patients in each group were included. Patients with osteoporosis and OAB demonstrated greater all-cause HRU across all encounter types compared to patients without OAB (all P values<0.001). Patients with osteoporosis and OAB had a greater frequency of any fall/fracture (17.7% vs. 14.9%, P<0.001). Patients with osteoporosis and OAB had 35% greater all-cause total healthcare costs than patients without OAB (P<0.001). CONCLUSIONS: Patients with OAB and osteoporosis had significantly greater all-cause HRU and costs. Falls and fractures were significantly more common in patients with osteoporosis and OAB compared to patients with osteoporosis without OAB.

17 Article Two-year cortical and trabecular bone loss in CKD-5D: biochemical and clinical predictors. 2018

Malluche, H H / Monier-Faugere, M-C / Blomquist, G / Davenport, D L. ·Division of Nephrology Bone and Mineral Metabolism, University of Kentucky, 800 Rose Street, Room MN 564, Lexington, KY, 40503, USA. hhmall@uky.edu. · Division of Nephrology Bone and Mineral Metabolism, University of Kentucky, 800 Rose Street, Room MN 564, Lexington, KY, 40503, USA. · Department of Radiology, University of Kentucky, Lexington, KY, USA. · Department of Surgery, University of Kentucky, Lexington, KY, USA. ·Osteoporos Int · Pubmed #28993865.

ABSTRACT: This prospective two-year study of patients on chronic dialysis measured changes in bone mineral density (BMD). Patients with higher baseline BMD and shorter dialysis vintage lost more bone. Treatment with anti-hypertensives acting on the central nervous system was protective against bone loss. Baseline serum levels of sclerostin and bone-specific alkaline phosphatase predicted bone loss. INTRODUCTION: This prospective 2-year study of chronic kidney disease on dialysis (CKD-5D) patients assessed trabecular and cortical bone loss at the hip and spine and examined potential demographic, clinical, and serum biochemical predictors of bone loss. METHODS: Eighty-nine CKD-5D patients had baseline, year 1, and year 2 bone mineral density (BMD) measurements using dual X-ray absorptiometry (DXA) and quantitative computed tomography (QCT); concurrent blood samples were drawn and clinical variables recorded. No study treatments occurred. RESULTS: The 2-year total hip BMD change was - 5.9% by QCT and - 3.1% by DXA (p < 0.001). Spinal BMD was unchanged. QCT total hip cortical mass and volume decreased (- 7.3 and - 10.0%); trabecular volume increased by 5.9% (ps < 0.001). BMD changes did not vary with age, BMI, race, diabetes, smoking, or exercise. Patients with higher baseline BMD and shorter dialysis vintage lost more bone (p < 0.05). Vitamin D analogs and phosphate binders were not protective against bone loss; cinacalcet was protective by univariate but not by multivariable analysis. CNS-affecting antihypertensives were protective against loss of BMD, cortical mass, cortical volume (ps < 0.05) and trabecular mass (p = 0.007). These effects remained after adjustment. BSAP correlated with changes in BMD, cortical mass, and volume (p < 0.01) as did sclerostin (inversely). CONCLUSIONS: There was severe cortical bone loss at the hip best recognized by QCT. Patients with shorter dialysis vintage and less pre-existing bone loss lost more bone, while treatment with CNS-acting antihypertensives was protective. BSAP and sclerostin were useful markers of bone loss.

18 Article Patient and Provider Characteristics Associated With Optimal Post-Fracture Osteoporosis Management. 2017

Boytsov, Natalie N / Crawford, Albert G / Hazel-Fernandez, Leslie Ann / McAna, John F / Nair, Radhika / Saundankar, Vishal / Varga, Stefan / Yang, Fan Emily. ·1 Eli Lilly and Company, Indianapolis, IN. · 2 Thomas Jefferson University, Philadelphia, PA. · 3 Comprehensive Health Insights, Louisville, KY. ·Am J Med Qual · Pubmed #28693331.

ABSTRACT: Despite an estimated 2 million osteoporosis (OP)-related fractures annually, quality of care for post-fracture OP management remains low. This study aimed to identify patient and provider characteristics associated with achieving or not achieving optimal post-fracture OP management, as defined by the current HEDIS quality measure. The study included women 67 to 85 years of age, with ≥1 fracture, and continuous enrollment in a Humana insurance plan. The study identified a higher percentage of black women in the not achieved group (6.2% vs 5.4%; P < .0001) and Hispanic women in the achieved group (3.0% vs 1.3%; P < .0001). The not achieved group largely included patients residing in the South and urban and suburban areas. The majority of providers were primary care or OP-related specialty, and 66% did not achieve the 4-star OP rating. The study findings can guide development of predictive models to identify at-risk women to improve post-fracture OP management.

19 Article Body Composition and Bone Mineral Density in Patients With Heart Failure. 2017

Abshire, Demetrius A / Moser, Debra K / Clasey, Jody L / Chung, Misook L / Pressler, Susan J / Dunbar, Sandra B / Heo, Seongkum / Lennie, Terry A. ·1 Washington State University College of Nursing, Spokane, WA, USA. · 2 University of Kentucky College of Nursing, Lexington, KY, USA. · 3 University of Kentucky Department of Kinesiology and Health Promotion, Lexington, KY, USA. · 4 Indiana University School of Nursing, Indianapolis, IN, USA. · 5 Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA. · 6 University of Arkansas for Medical Sciences College of Nursing, Little Rock, AR, USA. ·West J Nurs Res · Pubmed #27401014.

ABSTRACT: The purpose of this study was to examine associations among bone mineral density, osteopenia/osteoporosis, body mass index (BMI), and body composition in patients with heart failure (HF). A total of 119 patients (age = 61 ± 12 years, 65% male) underwent dual-energy X-ray absorptiometry scans to determine bone mineral density and body composition. In multivariable linear regressions, BMI, relative skeletal muscle index (RSMI), and mineral-free lean mass were positively associated with total body bone mineral density. Mineral-free lean mass was most strongly associated with bone mineral density (β = .398). In multivariable logistic regressions, higher BMI, RSMI, and mineral-free lean mass were associated with lower odds for osteopenia/osteoporosis. Fat mass was not associated with total body bone mineral density or osteopenia/osteoporosis. These results suggest that muscle mass may be the important component of body mass associated with bone mineral density in patients with HF.

20 Article Stiffness and strength of bone in osteoporotic patients treated with varying durations of oral bisphosphonates. 2016

Ward, J / Wood, C / Rouch, K / Pienkowski, D / Malluche, H H. ·Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA. · Department of Statistics, University of Kentucky, Lexington, KY, USA. · Department of Mechanical Engineering, University of Kentucky, Lexington, KY, USA. · Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA. hhmall@uky.edu. · Division of Nephrology, Bone & Mineral Metabolism, University of Kentucky Chandler Medical Center, 800 Rose Street, MN-564, Lexington, KY, 40536-0298, USA. hhmall@uky.edu. ·Osteoporos Int · Pubmed #27448808.

ABSTRACT: INTRODUCTION: The purpose of this study was to clarify the relationship between bisphosphonate (BP) treatment duration and human bone quality. This study quantified changes in the apparent modulus and failure stress of trabecular bone biopsied from patients with osteoporosis who were treated with BPs for widely varying durations. METHODS: Forty-five iliac crest bone samples were obtained from women with osteoporosis who were continuously treated with oral BPs for varying periods of up to 16 years. Micro-CT imaging was used to develop three-dimensional virtual models of the trabecular bone from these samples. Apparent modulus and failure stress of these virtual models were determined using finite element analyses (FEA). Polynomial regression and cubic splines, adjusted for relevant (age and BV/TV) covariates, were used to statistically model the data and quantify the relationships between BP treatment duration and apparent modulus or failure stress. RESULTS: Second-order polynomial models were needed to relate apparent modulus or failure stress to BP treatment duration. These models showed that these bone quality parameters (a) increased with increasing BP treatment duration up to approximately 7.3 years, (b) reached a maximum at this (~7.3 years) time, and then (c) declined with BP treatment durations exceeding ~7.3 years. A similar result was obtained by modeling with cubic splines. CONCLUSIONS: Changes in FEA-derived apparent stiffness and failure stress are attributable to changes in trabecular bone structure, which in turn are related to the duration of BP treatment. These relationships are evident even after adjustments are made in the statistical models for changes in age and BV/TV. According to these models, increases in trabecular bone apparent stiffness and failure stress linked to BPs cease and appear to reverse after approximately 7.3 years of treatment. Conclusions regarding optimal BP therapy duration await study of additional bone quality parameters.

21 Article High Parathyroid Hormone Level and Osteoporosis Predict Progression of Coronary Artery Calcification in Patients on Dialysis. 2015

Malluche, Hartmut H / Blomquist, Gustav / Monier-Faugere, Marie-Claude / Cantor, Thomas L / Davenport, Daniel L. ·Division of Nephrology, Bone and Mineral Metabolism and hhmall@uky.edu. · Departments of Radiology and. · Division of Nephrology, Bone and Mineral Metabolism and. · Scantibodies Laboratory Inc., Santee, California. · Surgery, University of Kentucky, Lexington, Kentucky; and. ·J Am Soc Nephrol · Pubmed #25838468.

ABSTRACT: Coronary artery calcifications (CACs) are observed in most patients with CKD on dialysis (CKD-5D). CACs frequently progress and are associated with increased risk for cardiovascular events, the major cause of death in these patients. A link between bone and vascular calcification has been shown. This prospective study was designed to identify noninvasive tests for predicting CAC progression, including measurements of bone mineral density (BMD) and novel bone markers in adult patients with CKD-5D. At baseline and after 1 year, patients underwent routine blood tests and measurement of CAC, BMD, and novel serum bone markers. A total of 213 patients received baseline measurements, of whom about 80% had measurable CAC and almost 50% had CAC Agatston scores>400, conferring high risk for cardiovascular events. Independent positive predictors of baseline CAC included coronary artery disease, diabetes, dialysis vintage, fibroblast growth factor-23 concentration, and age, whereas BMD of the spine measured by quantitative computed tomography was an inverse predictor. Hypertension, HDL level, and smoking were not baseline predictors in these patients. Three quarters of 122 patients completing the study had CAC increases at 1 year. Independent risk factors for CAC progression were age, baseline total or whole parathyroid hormone level greater than nine times the normal value, and osteoporosis by t scores. Our results confirm a role for bone in CKD-associated CAC prevalence and progression.

22 Article Osteoporosis and bisphosphonate-related osteonecrosis in a dental school implant patient population. 2015

Al-Sabbagh, Mohanad / Robinson, Fonda G / Romanos, Georgios / Thomas, Mark V. ·*Division Chief and Graduate Program Director of Periodontology, Department of Oral Health Practice, University of Kentucky College of Dentistry, Lexington, KY. †Associate Dean, Clinic Administration and Patient Care, The Ohio State University College of Dentistry, Columbus, OH. ‡Professor, Department of Periodontology, Stony Brook University School of Dental Medicine, New York, NY. §Former Chair and Professor, Department of Oral Health Practice, University of Kentucky College of Dentistry, Lexington, KY. ·Implant Dent · Pubmed #25764480.

ABSTRACT: PURPOSE: Studies have demonstrated an inconsistent association between implant failure and bone mineral density. The prevalence of osteoporosis in US adults has been reported to range from 5% to 10% in women and from 2% to 4% in men. The prevalence of bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) has been reported to range from 0% to 4.3% of patients taking oral BPs. The purpose of this study was to calculate the risk of dental implant loss and the incidence of BRONJ in patients with osteoporosis at the University of Kentucky College of Dentistry (UKCD). MATERIALS AND METHODS: This study analyzed data collected from patients who had implants placed between 2000 and 2004 at UKCD. Data were gathered from patient interviews regarding implant survival and patient-satisfaction parameters, and interviews were conducted either chairside at a scheduled maintenance appointment or by telephone interview. RESULTS: Among 203 patients who received 515 implants, the prevalence of osteoporosis was 23.3% for women and 1.2% for men. None of the 20 patients who reported a history of oral BP use exhibited BRONJ, and there were no implant failures in patients with a history of osteoporosis. CONCLUSIONS: In this study, osteoporosis conferred no risk of implant failure, and oral BP therapy was not associated with BRONJ.

23 Article Inhibition of CaMKK2 reverses age-associated decline in bone mass. 2015

Pritchard, Zachary J / Cary, Rachel L / Yang, Chang / Novack, Deborah V / Voor, Michael J / Sankar, Uma. ·Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, USA. · James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA. · Department of Medicine and Pathology, Washington University School of Medicine, St. Louis, MO, USA. · Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA; Department of Bioengineering, University of Louisville Speed School of Engineering, Louisville, KY, USA. Electronic address: michael.voor@louisville.edu. · Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, USA; James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA; Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA. Electronic address: usankar@iupui.edu. ·Bone · Pubmed #25724145.

ABSTRACT: Decline in bone formation is a major contributing factor to the loss of bone mass associated with aging. We previously showed that the genetic ablation of the tissue-restricted and multifunctional Ca(2+)/calmodulin (CaM)-dependent protein kinase kinase 2 (CaMKK2) stimulates trabecular bone mass accrual, mainly by promoting anabolic pathways and inhibiting catabolic pathways of bone remodeling. In this study, we investigated whether inhibition of this kinase using its selective cell-permeable inhibitor STO-609 will stimulate bone formation in 32 week old male WT mice and reverse age-associated of decline in bone volume and strength. Tri-weekly intraperitoneal injections of saline or STO-609 (10 μM) were performed for six weeks followed by metabolic labeling with calcein and alizarin red. New bone formation was assessed by dynamic histomorphometry whereas micro-computed tomography was employed to measure trabecular bone volume, microarchitecture and femoral mid-shaft geometry. Cortical and trabecular bone biomechanical properties were assessed using three-point bending and punch compression methods respectively. Our results reveal that as they progress from 12 to 32 weeks of age, WT mice sustain a significant decline in trabecular bone volume, microarchitecture and strength as well as cortical bone strength. However, treatment of the 32 week old WT mice with STO-609 stimulated apposition of new bone and completely reversed the age-associated decrease in bone volume, quality, as well as trabecular and cortical bone strength. We also observed that regardless of age, male Camkk2(-/-) mice possessed significantly elevated trabecular bone volume, microarchitecture and compressive strength as well as cortical bone strength compared to age-matched WT mice, implying that the chronic loss of this kinase attenuates age-associated decline in bone mass. Further, whereas STO-609 treatment and/or the absence of CaMKK2 significantly enhanced the femoral mid-shaft geometry, the mid-shaft cortical wall thickness and material bending stress remained similar among the cohorts, implying that regardless of treatment, the material properties of the bone remain similar. Thus, our cumulative results provide evidence for the pharmacological inhibition of CaMKK2 as a bone anabolic strategy in combating age-associated osteoporosis.

24 Article Bone mineral density and serum biochemical predictors of bone loss in patients with CKD on dialysis. 2014

Malluche, Hartmut H / Davenport, Daniel L / Cantor, Tom / Monier-Faugere, Marie-Claude. ·Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine and hhmall@uky.edu. · Department of Surgery, University of Kentucky, Lexington, Kentucky; and. · Scantibodies Laboratory, Inc., Santee, California. · Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine and. ·Clin J Am Soc Nephrol · Pubmed #24948144.

ABSTRACT: BACKGROUND AND OBJECTIVES: Use of bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) is controversial for diagnosing bone loss in CKD patients on dialysis. The alternative quantitative computed tomography (QCT) is expensive and requires high radiation exposure. This study compared the two techniques and evaluated serum biochemical parameters for prediction of bone loss. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This prospective study enrolled patients from dialysis centers throughout Kentucky. BMD of the spine and hip was measured at baseline and after 1 year by DXA and QCT. Customary and novel serum biochemical parameters were obtained at the same times, including calcium, phosphorus, whole and intact parathyroid hormone, bone-specific alkaline phosphatase, procollagen type 1 N-terminal propeptide, tartrate-resistant acid phosphatase-5b, Dickkopf-1, fibroblast growth factor, and sclerostin. Rates of detection of osteoporosis by DXA and QCT were compared. Correlations were calculated between baseline biochemical parameters and BMD at baseline and changes over 1 year. Multivariable regression was performed to adjust for age, sex, body mass index, and race. RESULTS: Eighty-one patients completed the study (mean age=52.6 ± 12.3 years, 56% men, 53% African American, and median dialysis vintage=41 months). At baseline, QCT and DXA of the spine identified similar rates of osteoporosis (13.6% and 13.6%), but at the hip, DXA identified more osteoporosis (22.2% versus 13.6%). At any site and by either method, 33.3% of the patients were osteoporotic. Baseline BMD correlated with sclerostin, intact parathyroid hormone, bone-specific alkaline phosphatase, tartrate-resistant acid phosphatase-5b, and fibroblast growth factor. At 1 year, hip QCT identified a higher number of patients experiencing bone loss (51.3%) than DXA (38.5%). After multivariable adjustment, baseline sclerostin and tartrate-resistant acid phosphatase-5b predicted bone loss measured by QCT of the hip; procollagen type 1 N-terminal propeptide predicted cortical spine bone gain by QCT. CONCLUSIONS: QCT identified prospectively more bone loss at the hip than DXA. The baseline serum biochemical parameters sclerostin and tartrate-resistant acid phosphatase-5b were noninvasive independent predictors of bone loss in CKD patients on dialysis.

25 Article Expression and function of the homeostatic molecule Del-1 in endothelial cells and the periodontal tissue. 2013

Shin, Jieun / Hosur, Kavita B / Pyaram, Kalyani / Jotwani, Ravi / Liang, Shuang / Chavakis, Triantafyllos / Hajishengallis, George. ·Department of Microbiology, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA 19104, USA. · Department of Microbiology, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA 19104, USA ; Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI 48109, USA. · Oral Health and Systemic Disease Research Group, University of Louisville School of Dentistry, Louisville, KY 40292, USA. · Division of Vascular Inflammation, Diabetes and Kidney, Department of Medicine, Technical University Dresden, 01307 Dresden, Germany ; Department of Clinical Pathobiochemistry and Institute for Clinical Chemistry and Laboratory Medicine, Technical University Dresden, 01307 Dresden, Germany. ·Clin Dev Immunol · Pubmed #24416060.

ABSTRACT: Developmental endothelial locus-1 (Del-1) is an endothelial cell-secreted protein that limits the recruitment of neutrophils by antagonizing the interaction between the LFA-1 integrin on neutrophils and the intercellular adhesion molecule (ICAM)-1 on endothelial cells. Mice with genetic or age-associated Del-1 deficiency exhibit increased neutrophil infiltration in the periodontium resulting in inflammatory bone loss. Here we investigated additional novel mechanisms whereby Del-1 could interfere with neutrophil recruitment and inflammation. Treatment of human endothelial cells with Del-1 did not affect the expression of endothelial molecules involved in the leukocyte adhesion cascade (ICAM-1, VCAM-1, and E-selectin). Moreover, genetic or age-associated Del-1 deficiency did not significantly alter the expression of these adhesion molecules in the murine periodontium, further ruling out altered adhesion molecule expression as a mechanism whereby Del-1 regulates leukocyte recruitment. Strikingly, Del-1 inhibited ICAM-1-dependent chemokine release (CXCL2, CCL3) by neutrophils. Therefore, Del-1 could potentially suppress the amplification of inflammatory cell recruitment mediated through chemokine release by infiltrating neutrophils. Interestingly, Del-1 was itself regulated by inflammatory stimuli, which generally exerted opposite effects on adhesion molecule expression. The reciprocal regulation between Del-1 and inflammation may contribute to optimally balance the protective and the potentially harmful effects of inflammatory cell recruitment.