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Editor's Notes

• #2: Geen tekst: alleen laten zien
• #5: These are 3-D micro-CT images of biopsies of vertebrae from human cadavers. The image on the left is a vertebra from a woman who died at 52 without osteoporosis. The image on the right comes from a 84 year old woman who died with osteoporosis (and a prevalent vertebral fracture). Comparing the two, there is obviously a considerable loss of bone mass in the 84 year old women with osteoporosis (image on the right). In addition, however, we can also see differences in how the bone is oriented and interconnected. There is still a sense of maintenance of the vertically oriented bone in the osteoporotic vertebra (right image), but there are considerably fewer horizontal cross-struts connecting the vertical elements. This loss of horizontal support is critical to overall bone strength, and is illustrated on the next slide.
• #6: Patients with IBD have been shown to have a greater incidence of fracture than do those without IBD. In a population-based, matched-cohort study, 6027 patients with IBD were matched to 60,270 individuals without IBD. The incidence of hip fracture was determined on the basis of hospital discharge abstracts. Outpatient medical billing records and hospital discharge abstracts were used to calculate the incidence of spine, rib, and forearm fractures. Rates were calculated on the basis of person-years of follow-up from 1984 to 1997. Patients with IBD had a significantly higher incidence of fractures at the spine (P<.001), hip (P<.001), wrist/forearm (P=.001), and rib (P=.03), and of all types of fractures combined (P<.001), than did controls. Thus, it is apparent that the incidence of fracture among persons with IBD is approximately 40% greater than that in the general population.24
• #7: Patients with IBD may experience fractures that are not clinically apparent but can contribute to chronic pain, loss of function, loss of height, and future fracture risk. In a study in CD, 156 patients with osteoporosis (defined by the World Health Organization as a T-score less than -2.5 standard deviations below the norm) or osteopenia (defined as a T-score lower than -1) underwent x-rays of their thoracic and lumbar spines. Thirty-four patients (22%) had at least 1 fracture each, for a total of 63 fractures. Only 14 (22%) of these fractures – in 4 patients – were clinically detectable, manifested by severe back pain and disability.25 Thus, it is important to identify patients with IBD who are at risk for fracture and to monitor their status vigilantly.
• #12: Spearman correlation coefficient
• #23: DEXA has been shown to predict fracture risk reliably and with low variability. It can be performed rapidly and with little radiation exposure. Although BMD does not, on its own, predict all fractures among postmenopausal women, DEXA remains the gold standard for assessing risk.32 The results of DEXA scanning are generally discussed as T-scores – the number of standard deviations from mean peak bone mass in healthy young adults. For patients with T-scores above -1, the ACG recommends just providing education regarding preventive measures patients can take and minimizing corticosteroid use. For those with T-scores between -2.5 and -1, the ACG recommends considering therapeutic options in addition to preventive measures and repeating DEXA in 1 to 2 years. For patients whose T-scores are at or below -2.5, the ACG advises consultation with a bone specialist in addition to preventive measures and possible therapy.20
• #27: At the end of the study (12 months), BMD at all sites (lumbar spine, femoral neck and femoral trochanter) was significantly higher compared to baseline after treatment with risedronate (p<0.05), whereas a significant decrease was seen in the placebo group (p<0.05). The difference between the risedronate group and the placebo group was statistically significant at all sites (p<0.001). Take note the significant bone loss that occurred in the placebo group in just 1 year, and this occurred in patients not receiving steroids. BMD values (g/cm2) Lumbar Spine: Placebo: Baseline 0.54, 1 year 0.504 = -6.67% Risedronate: Baseline 0.561, 1 year 0.602 = +7.31% Trochanter: Placebo: Baseline 0.484, 1 year 0.454 = -6.20% Risedronate: Baseline 0.502, 1 year 0.525 = +4.58% Femoral Neck: Placebo: Baseline 0.479, 1 year 0.461 = -3.76% Risedronate: Baseline 0.493, 1 year 0.513 = +4.06%
• #28: Recall that at study entry, a similar proportion of patients in each group (~50%) had previous vertebral fractures (prevalent vertebral fractures). No patients had experienced a nonvertebral fracture prior to enrollment. At 1 year, 14 patients in the placebo group experienced a new vertebral fracture (34.1%) compared with 5 patients (12.5%) in the risedronate group (p<0.05). This corresponds to a 1 year relative risk of 0.36 (95% CI 0.14-0.85) and a relative risk reduction of 64% (absolute risk reduction 21.6%). The NNT was calculated to be 5 (ranging from 3-26). When evaluating the distribution of vertebral fractures according to form of IBD, of the 14 fractures in the placebo group, 11 of 29 CD patients experienced a new vertebral fracture (37.9%), 3 of 10 UC patients (30%), and 0 of 2 IC patients. Of the 5 fractures in the risedronate group, 4 of 28 CD patients experienced a new vertebral fracture (14.3%), 1 of 11 UC patients (9.1%), and 0 of 1 IC patients.
• #32: Geen tekst: alleen laten zien