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      Japanese 2011 guidelines for prevention and treatment of osteoporosis—executive summary

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          Abstract

          Introduction

          In 1998, the first Japanese practice guidelines on osteoporosis was published. It has been updated several times, with the most recent being the full-scale 2011 edition and its abridged edition. The present guidelines provide information for the managements of primary osteoporosis in postmenopausal women and men over 50 years old, a summary of the evidence for the treatment of secondary osteoporosis, and a summary of the evidence for the prevention of osteoporosis in younger people.

          Method

          The present Executive Summary is primarily based on the content of the 2011 Japanese abridged edition. One of the key changes is revision of the criteria for initiation of pharmacological treatment, along with an introduction of the fracture risk factors used in FRAX®. Key figures and tables were selected from the Japanese abridged edition and a reference list was added.

          Result and conclusions

          The essential points of the Japanese practice guidelines on osteoporosis were translated into English for the first time. It is hoped that the content of the guidelines becomes known throughout the world.

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          Most cited references9

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          Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japanese men and women: the research on osteoarthritis/osteoporosis against disability study.

          Musculoskeletal diseases, especially osteoarthritis (OA) and osteoporosis (OP), impair activities of daily life (ADL) and quality of life (QOL) in the elderly. Although preventive strategies for these diseases are urgently required in an aging society, epidemiological data on these diseases are scant. To clarify the prevalence of knee osteoarthritis (KOA), lumbar spondylosis (LS), and osteoporosis (OP) in Japan, and estimate the number of people with these diseases, we started a large-scale population-based cohort study entitled research on osteoarthritis/osteoporosis against disability (ROAD) in 2005. This study involved the collection of clinical information from three cohorts composed of participants located in urban, mountainous, and coastal areas. KOA and LS were radiographically defined as a grade of > or =2 by the Kellgren-Lawrence scale; OP was defined by the criteria of the Japanese Society for Bone and Mineral Research. The 3,040 participants in total were divided into six groups based on their age: or =80 years. The prevalence of KOA in the age groups or =80 years 0, 9.1, 24.3, 35.2, 48.2, and 51.6%, respectively, in men, and the prevalence in women of the same age groups was 3.2, 11.4, 30.3, 57.1, 71.9, and 80.7%, respectively. With respect to the age groups, the prevalence of LS was 14.3, 45.5, 72.9, 74.6, 85.3, and 90.1% in men, and 9.7, 28.6, 41.7, 55.4, 75.1, and 78.2% in women, respectively. Data of the prevalence of OP at the lumbar spine and femoral neck were also obtained. The estimated number of patients with KOA, LS, and L2-L4 and femoral neck OP in Japan was approximately 25, 38, 6.4, and 11 million, respectively. In summary, we estimated the prevalence of OA and OP, and the number of people affected with these diseases in Japan. The ROAD study will elucidate epidemiological evidence concerning determinants of bone and joint disease.
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            Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis.

            Although several agents are available to treat osteoporosis, the relative efficacy and toxicity of these agents when used to prevent fractures has not been well described. To compare the benefits in fracture reduction and the harms from adverse events of various therapies for osteoporosis. MEDLINE (1966 to November 2007) and other selected databases were searched for English-language studies. For the efficacy analysis, investigators selected studies that reported the rate of or risk for fractures. For the adverse event analysis, they selected studies that reported the relationship between an agent and cardiovascular, thromboembolic, or upper gastrointestinal events; malignant conditions; and osteonecrosis. Using a standardized protocol, investigators abstracted data on fractures and adverse events, agents and comparators, study design, and variables of methodological quality. Good evidence suggests that alendronate, etidronate, ibandronate, risedronate, zoledronic acid, estrogen, parathyroid hormone (1-34), and raloxifene prevent vertebral fractures more than placebo; the evidence for calcitonin was fair. Good evidence suggests that alendronate, risedronate, and estrogen prevent hip fractures more than placebo; the evidence for zoledronic acid was fair. The effects of vitamin D varied with dose, analogue, and study population for both vertebral and hip fractures. Raloxifene, estrogen, and estrogen-progestin increased the risk for thromboembolic events, and etidronate increased the risk for esophageal ulcerations and gastrointestinal perforations, ulcerations, and bleeding. Few studies have directly compared different agents or classes of agents used to treat osteoporosis. Although good evidence suggests that many agents are effective in preventing osteoporotic fractures, the data are insufficient to determine the relative efficacy or safety of these agents.
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              Vitamin K and the prevention of fractures: systematic review and meta-analysis of randomized controlled trials.

              Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture. To assess whether oral vitamin K (phytonadione and menaquinone) supplementation can reduce bone loss and prevent fractures. The search included the following electronic databases: MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005), the Cochrane Library (issue 2, 2005), the ISI Web of Science (1945 to June 2005), the National Research Register (inception to the present), Current Controlled Trials, and the Medical Research Council Research Register. Randomized controlled trials that gave adult participants oral phytonadione and menaquinone supplements for longer than 6 months were included in this review. Four authors extracted data on changes in bone density and type of fracture. All articles were double screened and double data extracted. Thirteen trials were identified with data on bone loss, and 7 reported fracture data. All studies but 1 showed an advantage of phytonadione and menaquinone in reducing bone loss. All 7 trials that reported fracture effects were Japanese and used menaquinone. Pooling the 7 trials with fracture data in a meta-analysis, we found an odds ratio (OR) favoring menaquinone of 0.40 (95% confidence interval [CI], 0.25-0.65) for vertebral fractures, an OR of 0.23 (95% CI, 0.12-0.47) for hip fractures, and an OR of 0.19 (95% CI, 0.11-0.35) for all nonvertebral fractures. This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss. In the case of the latter, there is a strong effect on incident fractures among Japanese patients.
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                Author and article information

                Contributors
                +81-562-462311 , +81-562-469595 , t-hosoi@ncgg.go.jp
                Journal
                Arch Osteoporos
                Arch Osteoporos
                Archives of Osteoporosis
                Springer-Verlag (London )
                1862-3522
                1862-3514
                1 December 2012
                1 December 2012
                December 2012
                : 7
                : 1-2
                : 3-20
                Affiliations
                [1 ]Japan Osteoporosis Foundation, Tokyo, Japan
                [2 ]Department of Orthopedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka Japan
                [3 ]Department of Clinical Research and Development, National Center for Geriatrics and Gerontology, 35 Gengo, Morioka-machi, Obu City, Aichi Prefecture 474-8511 Japan
                [4 ]Department of Public Health, Kinki University Faculty of Medicine, Osakasayama, Osaka Japan
                [5 ]Laboratory of Physiological Nutrition, Kagawa Nutrition University, Sakato, Saitama Japan
                [6 ]Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata Japan
                [7 ]Clinical Medical Research Center, Women’s Medical Center of Sanno Medical Center, Tokyo, Japan
                [8 ]Research Institute and Practice for Involutional Diseases, Azumino, Nagano Japan
                [9 ]Internal Medicine I, Shimane University Faculty of Medicine, Shimane, Shimane Japan
                [10 ]Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi Japan
                [11 ]Department of Orthopaedic Surgery and Rheumatology, Nara Hospital, Kinki University School of Medicine, Ikoma, Nara Japan
                [12 ]Osaka City University, Osaka, Osaka Japan
                [13 ]School of Health Science, Tottori University Faculty of Medicine, Yonago, Tottori Japan
                [14 ]Kawasaki Medical School, Kurashiki, Okayama Japan
                [15 ]Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Hiroshima Japan
                Article
                109
                10.1007/s11657-012-0109-9
                3517709
                23203733
                761c7465-ea34-4cb9-be11-d6865ac9b24b
                © The Author(s) 2012
                History
                : 7 September 2012
                : 16 October 2012
                Categories
                Position Paper
                Custom metadata
                © International Osteoporosis Foundation and National Osteoporosis Foundation 2012

                Orthopedics
                criteria for initiation of pharmacological treatment,diagnosis of osteoporosis,fracture risk assessment,prevention of osteoporosis,secondary osteoporosis,treatment of osteoporosis

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