An index of open-access Osteoporosis content relevant to primary care
Status and Improvement Recommendations for Bi-directional Referrals for Community Osteoporosis Patients
YANG Lan，ZHOU Peng，DU Jie，XUE Bin，WEI Yangyang，LIU Haijiao，GU Wenqin
Chinese General Practice 2021, 24 (28): 3555-3559. DOI: 10.12114/j.issn.1007-9572.2021.00.097
Abstract
Background Bi-directional referrals are essential in the promotion of community-based prevention and treatment of single diseases，but there is a lack of practical guidance scheme for clinical referrals. We aimed to explore the bi-directional referrals for osteoporosis between primary care and secondary or tertiary care involving primary care physicians，orthopedic specialists and other medical workers. Objective To summarize the facilitators and barriers to successful bi-directional referrals for community osteoporosis patients based the reviewing of such studies，providing a reference for the improvement of bi-directional referrals for such patients. Methods Databases of CNKI，Wanfang Data，Web of Science and Science Direct were searched in June 2019 for studies about bi-directional referrals for community osteoporosis patients included during January 1，1999 to June 15，2019. Meta-analysis was conducted on the practices and explorations of bi-directional referrals for community osteoporosis patients with a focus on the expected goal，types of referrals，development methods for new referral patterns，effects and problems during the implementation of referrals，and based on the results，improvement recommendations were proposed. Results Finally, 14 Chinese documents and 5 English documents were included. The management modes and standards for transferring community osteoporosis patients were different in China and foreign countries during the period. Domestic residents did not attach much weight to osteoporosis，and showed poor adherence to treatment. Moreover，there were no osteoporosis department and sophisticated equipments for detecting osteoporosis as well as a sound system for communicating with higher level hospitals in domestic community hospitals. The types of referrals for such patients in foreign countries were mainly about the referrals for post-osteoporotic fracture patients. Conclusion To promote community-based prevention and control of osteoporosis，bi-directional referrals for community osteoporosis patients should be implemented effectively，and to do this，priority should be given to：the determination of coverage of long-term preventive and control services of osteoporosis，enriching general practitioners' osteoporosis-related knowledge，improving the resources needed by community-based prevention and treatment of osteoporosis，and the development of a procedure for bi-directional referrals for osteoporosis including four factors such as division of labor，referral indicators and other details.
Osteoporosis Prevention and Treatment Pathway in the Community Based on Primary Osteoporosis Management Guidelines：Exploration and Development
SONG Huijiang，LIU Huailei，ZHUANG Kanglu
Chinese General Practice 2021, 24 (28): 3548-3554. DOI: 10.12114/j.issn.1007-9572.2021.00.175
Abstract
Background In Shanghai，the construction of community-based prevention and treatment of osteoporosis has entered the second round，during which many new relevant guides have been issued，such as osteoporosis guidelines for primary care，guiding principles for osteoporosis management，and standardized management options for osteoporosis，providing rich evidence for primary care practice. However，successful application of guides in primary practice can not be achieved overnight，which should be done according to the real conditions of the community，such as human，financial and material resources，size and roles of the community. Objective To develop a pathway for the second round construction of community-based prevention and treatment of osteoporosis based on our experience summarized from the first round of construction，and the latest osteoporosis guidelines，offering a reference for appropriate use of guidelines in community-based practice. Methods The entire development process of the pathway to community-based osteoporosis prevention and treatment includes pre-development preparation phase，development phase，information realization phase，and acceptance phase before the offline use. The first two phases were completed from May 2018 to December 2019. In the pre-development preparation phase，we formulated project management options for developing the pathway by reviewing the latest evidence-based studies regarding osteoporosis prevention and treatment and two rounds of group discussions. In the development phase，we developed a standardized process of osteoporosis prevention and treatment used as a reference guide to primary care by analyzing and modifying the first version of osteoporosis prevention and treatment pathway in the community based on the literature review results of in the pre-development preparation phase，three rounds of expert consultation and two rounds of group discussions. Results The document library formed in the pre-development preparation phase has updated 7 domestic guidelines and 5 foreign guidelines. The osteoporosis prevention and treatment pathway in the community was developed by general medical management and executive representatives from the community health center，orthopedics specialists from the general hospital，in collaboration with the information company，with the help of a third-party healthcare and medical and health consulting firm for data collection，analysis and translation. The final osteoporosis prevention and treatment pathway in the community demonstrates logic in terms of community-based osteoporosis screening and diagnosis，transferring to the general hospital，and osteoporosis follow-up for monitoring treatment. Conclusion The successful application of osteoporosis guidelines in primary care practice requires multilateral cooperation（the general hospital，community health center，information company，translator as well as third-party communication and coordination）. Our exploratory process may be used as a reference for colleagues to carry out new explorations，and our pathway may be considered as a logical basis for community-based prevention and treatment of osteoporosis using the guidelines appropriately.
Hospital-community-home Integrated Management Path for Patients with Osteoporosis：Exploratory Analysis and Insights to Primary Care
CAI Yaoting，FANG Ronghua
Chinese General Practice 2021, 24 (15): 1938-1942. DOI: 10.12114/j.issn.1007-9572.2021.00.431
Abstract
Osteoporosis prevalence is increasing with rapid acceleration of aging，which is the fifth major common chronic disease，easily leading to serious outcomes，such as brittle fracture，disability，and even death.The prevalence rate of osteoporosis in Chinese people aged over 60 is 36%.It is predicted that by 2050，the numbers of Chinese people suffering from osteoporosis and osteoporotic fractures will be 202 million，and 6 million，respectively，which will impose a serious burden on society and families.So it is essential to carry out effective systematic management of osteoporosis.We introduced the definition of hospital-community-home integrated management，and explained the necessity of using it in osteoporosis management，and interpreted the development of path of hospital-community-home integrated osteoporosis management，which is composed of five aspects：building a multidisciplinary management team for osteoporosis，constructing an online osteoporosis health management platform，modifying the management of osteoporosis patients' health records，strengthening osteoporosis-related trainings for general practitioner teams，and strengthening osteoporosis-related health education for osteoporosis patients and their families.We consider this path to be feasible for osteoporosis management，and for the building of an efficient and standardized osteoporosis management mode，to cope with the rapid growth of osteoporosis prevalence in China.
Glucose Variability and Osteoporosis in Newly Diagnosed Male Patients with Type 2 Diabetes Mellitus
HU Jing
Chinese General Practice 2021, 24 (9): 1057-1060. DOI: 10.12114/j.issn.1007-9572.2020.00.630
Abstract
Background Diabetic patients have high risk of osteoporosis.There have been many reports on the adverse effects of persistent hyperglycemia on bone mineral density（BMD），but there are few reports on the relationship between glucose variability and osteoporosis.Objective To explore the relationship between glucose variability and osteoporosis in newly diagnosed male T2DM patients.Methods 115 newly diagnosed male T2DM patients were prospectively selected from Department of Endocrinology，People's Hospital of Ningxia Hui Autonomous Region from January 2018 to January 2019.Clinical data were collected，including calculated BMI，fasting plasma glucose，serum calcium，phosphorus，and lipid profile indicators（total cholesterol，triacylglycerol，high-density lipoprotein and low-density lipoprotein） in the sample collected from the median cubital vein in the early morning after fasting for more than 8 hours，and 2-hour postprandial glucose，fasting insulin，fasting C-peptide（FC-P），2-hour postprandial insulin，2-hour postprandial C-peptide（2 hC-P），homeostasis model assessment-insulin resistance（HOMA-IR），and glycosylated hemoglobin（HbA1c），L1-L4 BMD，glucose variability evaluated based on plasma glucose measured at 7 time points（before and after three meals，and at 2：00），and calculated standard deviation of blood glucose（SDBG），postprandial glucose excursion（PPGE），largest amplitude of glycemic excursion（LAGE），coefficient of variation for fasting plasma glucose（CV-FPG），and mean plasma glucose.The above-mentioned indicators were compared between those who were detected with osteoporosis（n=60） and those without（n=55）.Correlation of glucose variability with BMD was analyzed by Pearson correlation analysis.Results T2DM patients with osteoporosis were found with higher mean HOMA-IR，HbA1c，SDBG，PPGE，LAGE，CV-FPG and mean plasma glucose，and lower mean high-density lipoprotein，FC-P，2 hC-P and BMD compared to those without（P<0.05）.BMD was negatively correlated with age，SDBG，PPGE，LAGE，2 hPG，low-density lipoprotein，HOMA-IR and HbA1c（r=-0.501，-0.325，-0.436，-0.111，-0.603，-0.506，-0.324，-0.712，P<0.05），and positively correlated with serum calcium and 2 hC-P （r=0.029，0.015，P<0.05）.After adjusting for age and BMI，BMD was positively correlated with 2 hC-P（r=0.008，P<0.05） and negatively correlated with HbA1c，SDBG and LAGE（r=0.519，0.285，0.399，P<0.05）.Conclusion BMD was positively correlated with 2 hC-P and negatively correlated with HbA1c，SDBG and LAGE，indicating that glucose variability may be closely related to BMD in newly diagnosed male patients with T2DM，and controlling glucose variability may have a positive effect on the prevention and treatment of osteoporosis.
Recent Progresses on Osteoporotic Refractures in the Elderly
ZHANG Huaguo，SONG Mi，XU Yue，PI Hongying
Chinese General Practice 2021, 24 (7): 886-889. DOI: 10.12114/j.issn.1007-9572.2020.00.529
Abstract
Osteoporosis is a prevalent disease in the elderly. It has become a prominent public health problem in China with rapid population aging. Fracture is the most serious outcome of osteoporosis. Elderly patients with osteoporotic fractures are prone to recurrent fractures，which are major barriers to healthy aging due to induced difficulty in functional recovery，reduced quality of life and increased morbidity and mortality. The purpose of this review is to systematically examine recent literature regarding the risk factors，risk assessment and intervention for recurrence of osteoporotic fractures in the elderly，providing a basis for developing strategies for osteoporotic refractures in this group.
Clinical Application of Balance Disorder Rehabilitation-assisted Robot in Postoperative Rehabilitation of Elderly Patients with Fall-related Lower Limb Fractures
FENG Yuning，LI Kainan，JIA Zishan
Chinese General Practice 2021, 24 (25): 3233-3237. DOI: 10.12114/j.issn.1007-9572.2021.00.260
Abstract
Background According to the results of China's seventh national census，Chinese population aged 60 and above is 264.02 million，the proportion of which，compared with that of 2010，has increased by 5.44 percentage points. The accelerated population aging has aroused increased concerns about postoperative rehabilitation of elderly patients with lower limb fractures after fall. Given many unfavorable factors for postoperative rehabilitation，such as lack of rehabilitation physicians，few rehabilitation schemes，and nonuniform subjective judgment of rehabilitation physicians，robot-associated balance disorder rehabilitation might be a safer and more effective rehabilitation training choice. Objective To explore the clinical effect of balance disorder rehabilitation-assisted robot in postoperative rehabilitation of elderly patients with fall-related lower limb fractures. Methods One hundred elderly patients with lower limb fractures caused by fall were recruited from Orthopedic Ward，Affiliated Hospital of Chengdu University and Chinese PLA General Hospital from April to October 2020，and equally divided into case group and control group using a computer algorithm，receiving physical exercise therapy with robot-assisted balance disorder rehabilitation，physical exercise therapy with walking for weight loss，respectively. Major indicators for postoperative rehabilitation effect were stride time，speed of 3-meter straight walking and step size of 3-meter straight walking measured by the attitude sensor at the end of the 16th week of postoperative training，and the Berg Balance Scale score measured at the end of the 8th，12th and 16th weeks of postoperative training. Results All the participants were included for final analysis except 5 dropouts（3 in the case group，and 2 in the control group）. Two groups showed no significant differences in gender ratio，and mean age and BMI（P>0.05）. The mean course of fractures differed significantly between the groups（P<0.05）. The case group had much shorter mean left and right stride time than the control group（P<0.05）. The case group had quicker average speed of 3-meter straight walking and greater average step size of 3-meter straight walking（P<0.05）. The interaction between training contents and time was statistically significant in both groups（F=53.116，P<0.001）. The recovery degree of lower limb motor function was different between the two groups（F=3.675，P=0.013）. The Berg Balance Scale scores for both groups differed significantly by measurement time（F=1 364.425，P<0.001）. Conclusion For older adults with fall-related lower limb fractures，robot-assisted balance disorder rehabilitation may yield a better outcome concerning lower limb motor function recovery compared with walking for weight loss，but the speed of recovery may slow down with the extension of rehabilitation time.
Sex-specific Correlations of Fracture Risk with Nutritional Status，Body Composition and Balance Condition in Parkinson's Disease Patients
XU Xiaohui，TIAN Junmei，CAI Weiwei，ZHAO Yongfei，WANG Yupeng，LIU Chao，DUAN Zhihui
Chinese General Practice 2021, 24 (36): 4607-4611. DOI: 10.12114/j.issn.1007-9572.2021.02.060
Abstract
Sex-specific Correlations of Fracture Risk with Nutritional Status，Body Composition and Balance Condition in Parkinson's Disease Patients XU Xiaohui1，TIAN Junmei2，CAI Weiwei1，ZHAO Yongfei2，WANG Yupeng1，LIU Chao1， DUAN Zhihui1* 1.Department of Neurology，Luoyang Central Hospital Affiliated to Zhengzhou University，Luoyang 471000，China 2.Department of Nutrition，Luoyang Central Hospital Affiliated to Zhengzhou University，Luoyang 471000，China *Corresponding author：DUAN Zhihui，Chief physician；E-mail：duanzhihui76@126.com 【Abstract】 Background Sufficient attention has not been paid to malnutrition，one of the non-motor symptoms of Parkinson's disease （PD），for a long time. Malnutrition，sarcopenia and balance disorders increase fracture risk in PD patients. Currently，the research in this field is relatively rare in China. Objective To examine sex-specific correlations of nutritional status，bodycomposition and balance condition with fracture risk in PD patients.Methods A total of 68 PD patients （37 males and 31 females）treated in Luoyang Central Hospital Affiliated to Zhengzhou University from December 2018 to December 2020 were enrolled，and their general data were collected. Then，the 10-year risks for major osteoporotic fractures （MOF） and hip fractures （HF） were predicted using the Fracture Risk Assessment Tool. Motor and balance functions were assessed using the Unified Parkinson Disease Rating Scale-part Ⅲ （UPDRS Ⅲ ）. Nutrition status was assessed using the Mini-Nutritional Assessment （MNA）. Balance ability was measured by the Berg Balance Scale （BBS）. Balance confidence for performing activities was rated by the Activities-specific Balance Confidence（ABC） Scale. The T-score of femoral neck bone mineral density（BMD） was calculated and body composition was measured. The correlations of fracture risk with various factors were analyzed. And fracture risk and various factors were subjected to partial correlation analysis after controlling for age，gender and T-score of femoral neck BMD. Results Compared to women PD patients，men had lower the 10-year risk for MOF，UPDRS Ⅲ score，and body fat rate （BFR），as well as greater mean triceps skin fold thickness，but higher mean T-score of femoral neck BMD，mean trunk muscle mass，upper limb muscle mass，lower limb muscle mass and BBS score （P<0.05）. In men PD patients，the 10-year risks for MOF and HF were negatively correlated with the MNA score，lower limbs muscle mass，BBS score and ABC score （P<0.05），but were positively correlated with the UPDRS Ⅲ score （P<0.05）；the T-score of femoral neck BMD was positively correlated with lower limbs muscle mass （P<0.05），while negatively correlated with BFR （P<0.05）. In women PD patients，the 10-year risk for MOF was positively correlated with the UPDRS Ⅲ score and age，while negatively correlated with the MNA score，muscle mass of lower limbs，BBS score and ABC score （P<0.05）；the 10-year risk for HF was positively correlated with the UPDRS Ⅲ score，while negatively correlated with MNA score，muscle mass of upper limbs and lower limbs，BBS score and ABC score （P<0.05）. Besides，the T-score of femoral neck BMD was positively correlated with muscle mass of lower limbs （P<0.05），while negatively correlated with age and waist-to-hip ratio （P<0.05）. The results of partial correlation analysis revealed that the 10-year risks for MOF and HF had negative correlations with MNA score，muscle mass of lower limbs，BBS score and ABC score （P<0.05），and a positive association was found between the 10-year risk for MOF and UPDRS Ⅲ score （P<0.05）. Conclusion The body composition and T-score of femoral neck BMD in males are different from those in females. Malnutrition，decreased muscle mass of lower limbs，reduced balance capacity and severity of PD are important predictors of the risk of MOF in PD patients. In view of this，to prevent and treat osteoporosis and fractures in PD patients，it is essential to pay attention to nutritional status and muscle mass of them，especially female patients