Bone mineral density and fractures in older men with chronic obstructive pulmonary disease or asthma

In 5,541 community dwelling men, chronic obstructive pulmonary disease, or asthma was associated with lower bone mineral density (BMD) at the spine and total hip and an increased risk of vertebral and nonvertebral fractures independent of age, body mass index, and smoking. Men prescribed with corticosteroids had the lowest BMD. It is unclear whether chronic obstructive pulmonary disease (COPD) is independently associated with BMD and fractures. In 5,541 men from the Osteoporotic Fractures in Men Study, history of COPD or asthma, current treatment with corticosteroids, BMD, bone loss after 4.5 years and fractures were ascertained. Seven hundred fourteen (13%) men reported COPD or asthma, of which 103 were prescribed an oral steroid and 177 an inhaled steroid. Independent of confounders, men prescribed corticosteroids for COPD or asthma had the lowest BMD and a 2-fold increased risk of vertebral osteoporosis compared to men with no history of COPD or asthma (OR 2.13, 95% CI (confidence interval) 1.15–3.93 oral steroids; OR 2.05, 95% CI 1.27–3.31 inhaled steroids). During follow-up, BMD increased at the spine, but there was no difference in bone loss at the hip. However, men with COPD or asthma had a 2.6- and 1.4-fold increased risk of vertebral and nonvertebral fractures, respectively. Chronic obstructive pulmonary disease or asthma was associated with lower BMD at the spine and hip and increased risk of vertebral and nonvertebral fractures independent of age, clinic site, BMI, and smoking. A history of COPD or asthma may be a useful clinical risk factor to identify patients with osteoporosis

Management of osteoporosis in central and eastern Europe (CEE): conclusions of the “2nd Summit on Osteoporosis—CEE”, 21–22 November 2008, Warsaw, Poland

In November 2008, the “2nd Summit on Osteoporosis—Central and Eastern Europe (CEE)” was held in Warsaw, Poland. Discussions at this meeting focused on the identification and discussion of diagnostic, preventive, and therapeutic measures used in CEE. Evaluated information was used to identify issues regarding diagnosis and therapy of osteoporosis in these countries to facilitate the subsequent setup of appropriate support and development strategies. The main debate was structured according to the following five subjects: (1) present status and future perspectives for implementation of FRAX® into local (CEE) diagnostic algorithms, (2) principles of drug selection in osteoporosis treatment in CEE countries, (3) nonpharmacological interventions in osteoporosis treatment and prophylaxis in CEE countries, (4) treatment benefit evaluation, and (5) cost–effectiveness and evaluation of reimbursement policies in CEE countries. The most important and substantial comments of the delegates are summarized in the present article. The multinational panel of experts with representatives from many CEE countries as well as Austria and Switzerland made the “2nd Summit on Osteoporosis—CEE” a perfect platform to identify issues and needs regarding diagnosis and therapy of osteoporosis as well as the cost–effectiveness of osteoporosis management in CEE countries. The information gained will serve as a basis for the development of strategies to resolve the identified issues at the “3rd Summit on Osteoporosis—CEE” in November 2009

Tibial Loading Increases Osteogenic Gene Expression and Cortical Bone Volume in Mature and Middle-Aged Mice

There are conflicting data on whether age reduces the response of the skeleton to mechanical stimuli. We examined this question in female BALB/c mice of different ages, ranging from young to middle-aged (2, 4, 7, 12 months). We first assessed markers of bone turnover in control (non-loaded) mice. Serum osteocalcin and CTX declined significantly from 2 to 4 months (p<0.001). There were similar age-related declines in tibial mRNA expression of osteoblast- and osteoclast-related genes, most notably in late osteoblast/matrix genes. For example, Col1a1 expression declined 90% from 2 to 7 months (p<0.001). We then assessed tibial responses to mechanical loading using age-specific forces to produce similar peak strains (−1300 µε endocortical; −2350 µε periosteal). Axial tibial compression was applied to the right leg for 60 cycles/day on alternate days for 1 or 6 weeks. qPCR after 1 week revealed no effect of loading in young (2-month) mice, but significant increases in osteoblast/matrix genes in older mice. For example, in 12-month old mice Col1a1 was increased 6-fold in loaded tibias vs. controls (p = 0.001). In vivo microCT after 6 weeks revealed that loaded tibias in each age group had greater cortical bone volume (BV) than contralateral control tibias (p<0.05), due to relative periosteal expansion. The loading-induced increase in cortical BV was greatest in 4-month old mice (+13%; p<0.05 vs. other ages). In summary, non-loaded female BALB/c mice exhibit an age-related decline in measures related to bone formation. Yet when subjected to tibial compression, mice from 2–12 months have an increase in cortical bone volume. Older mice respond with an upregulation of osteoblast/matrix genes, which increase to levels comparable to young mice. We conclude that mechanical loading of the tibia is anabolic for cortical bone in young and middle-aged female BALB/c mice

Die Ausbildung erstjähriger Medizinstudierender in der Durchführung grundlegender klinischer Fertigkeiten - Ein neues Ausbildungskonzept an einer österreichischen Medizinuniversität

Introduction: Clerkships are still the main source for undergraduate medical students to acquire necessary skills. However, these educational experiences may not be sufficient, as there are significant deficiencies in the clinical experience and practical expertise of medical students.Project description: An innovative course teaching basic clinical and procedural skills to first-year medical students has been implemented at the Medical University of Graz, aiming at preparing students for clerkships and clinical electives. The course is based on several didactic elements: standardized and clinically relevant contents, dual (theoretical and virtual) pre-course preparation, student peer-teaching, small teaching groups, hands-on training, and the use of medical simulation. This is the first course of its kind at a medical school in Austria, and its conceptual design as well as the implementation process into the curriculum shall be described.Evaluation: Between November 2011 and January 2013, 418 students have successfully completed the course. Four online surveys among participating students have been performed, with 132 returned questionnaires. Students' satisfaction with all four practical course parts was high, as well as the assessment of clinical relevance of contents. Most students (88.6%) strongly agreed/agreed that they had learned a lot throughout the course. Two thirds of the students were motivated by the course to train the acquired skills regularly at our skills laboratory. Narrative feedbacks revealed elements contributing most to course success.Conclusions: First-year medical students highly appreciate practical skills training. Hands-on practice, peer-teaching, clinically relevant contents, and the use of medical simulation are valued most.Einleitung: Medizinstudierende erlernen erforderliche Fertigkeiten nach wie vor primär im Rahmen von Praktika und Famulaturen. Diese Form der praktischen Ausbildung erscheint jedoch als nicht ausreichend, da signifikante Defizite in der klinischen Erfahrung und praktischen Kompetenz von Medizinstudierenden bestehen.Projektbeschreibung: An der Medizinischen Universität Graz wurde eine innovative Lehrveranstaltung eingeführt, um erstjährigen Medizinstudierenden die Durchführung grundlegender klinischer Fertigkeiten und praktischer Maßnahmen als Vorbereitung auf Famulaturen und Praktika zu vermitteln. Die Lehrveranstaltung basiert auf mehreren didaktischen Elementen: Standardisierte, klinisch relevante Lehrinhalte, duale (theoretische und virtuelle) Vorbereitung, studentisches Peer-Teaching, Kleingruppenunterricht, praktisches Training und die Verwendung medizinischer Simulation. Dies ist die erste Lehrveranstaltung dieser Art an einer österreichischen Medizinuniversität, und das Konzept sowie die Implementierung in das Curriculum sollen zur Beschreibung gelangen.Evaluierung: Zwischen November 2011 und Januar 2013 haben 418 Studierende erfolgreich an der Lehrveranstaltung teilgenommen. Es wurden vier Online-Evaluierungen unter den teilnehmenden Studierenden durchgeführt und 132 Fragebögen beantwortet. Die studentische Zufriedenheit mit allen vier praktischen Lehrveranstaltungsteilen war ebenso wie die Beurteilung der klinischen Relevanz der Lehrinhalte hoch. Die meisten Studierenden (88,6%) stimmten zu, im Rahmen der Lehrveranstaltung viel gelernt zu haben. Zwei Drittel der Studierenden wurden motiviert, die erworbenen Fähigkeiten regelmäßig in unserem klinischen Trainingszentrum zu trainieren. Die am meisten geschätzten Lehrveranstaltungsaspekte wurden durch Auswertung der Freitextevaluierungen identifiziert.Schlussfolgerung: Praktisches Fertigkeitentraining wird von erstjährigen Medizinstudierenden mit großem Enthusiasmus angenommen. Am meisten geschätzt werden die Möglichkeit aktiven Trainings, Peer-Teaching, klinisch relevante Lehrinhalte und die Nutzung medizinischer Simulation