Audrey Neuprez

Osteonecrosis of the jaw in a male osteoporotic patient treated with denosumab

Osteonecrosis of the jaw (ONJ) is a clinical condition associated with long-term exposure to inhibitors of bone resorption, mainly bisphosphonates. Denosumab (DMab) is a human monoclonal antibody of the receptor activator of nuclear factor kappa-B ligand. It prevents osteoclast-mediated bone resorption and is widely prescribed for the management of postmenopausal osteoporosis. Whereas ONJ has already been reported in women treated with DMab, we report for the first time the development of ONJ, following tooth extraction, in a male patient treated for idiopathic osteoporosis with DMab. Due to the constant increase in DMab prescription, for the management of osteoporosis, in both genders, physicians should be made aware of this potential risk.

Efficacy and safety of currently marketed anti-osteoporosis medications

During the past 2 decades, many interventions were proven effective in the management of postmenopausal osteoporosis. The objective of an anti-osteoporosis treatment is to reduce fracture rates, ideally at all skeletal sites (i.e. spine, hip, and other non-spine). The armamentarium against osteoporosis includes anti-resorptive agents (i.e. bisphosphonates, selective estrogen receptor modulators and denosumab), bone-forming agents (i.e. peptides from the parathyroid hormone family) and one agent with a dual mechanism of action (i.e. strontium ranelate). All these medications combine antifracture efficacy with a reasonable benefit/risk profile. However, the choice of a particular chemical entity, in one individual patient is based on the knowledge and expertise of the physician. Prioritization of drugs should be based on the individual profile of the patient, the severity of osteoporosis and the specific contraindications, warnings and precautions of use of the various available medications.

Assessment and determinants of aesthetic discomfort in hand osteoarthritis

Background Dissatisfaction with hand appearance is frequently the presenting complaint of patients with hand osteoarthritis (HOA), yet no tool exists for its measurement and few studies have examined aesthetic discomfort. Objectives The aims of this study were to measure the extent and to explore the associations of aesthetic concerns in HOA. Methods 172 patients with HOA were assessed with tender joint and node count, global and pain scores, Functional Index for Hand Osteoarthritis, Short Form-12, Hospital Anxiety and Depression Scale and posterior–anterior hand radiographs. Patients scored the aesthetic impact of the disease on a Visual Analogue Scale of 0–100 mm and were classifi ed into low, intermediate and high aesthetic concern (HAC) based on this score. Results Of 172 patients (155 women), the majority (92%) had nodes and 46% had erosive disease. The mean aesthetic score was 44.8 mm (SD 35.9), and 59 (34.3%) patients scored their aesthetic discomfort ≥66 mm. Factors associated with HAC were female gender, a high number of tender joints and nodes, high global and pain scores, high radiological damage scores, the presence of erosions and high depression and anxiety levels. The multivariate analysis identifi ed two independent factors associated with HAC: patient’s global assessment (p=0.0005) and radiographic erosions (p=0.03). Conclusions Aesthetic discomfort is a major concern for a signifi cant number of patients with HOA, particularly women, those with a high burden of HOA disease and those with erosive osteoarthritis, and is also associated with depression, anxiety and poor health-related quality of life.

Patients' expectations impact their satisfaction following total hip or knee arthroplasty

Introduction The objective of this study was to assess the number and magnitude of preoperative expectations and to correlate them with the degree of satisfaction expressed one year after Total Hip Arthroplasty (THA) or Total Knee Arthroplasty (TKA), in patients with severe and painful osteoarthritis (OA). Materials and Methods Preoperative expectations (within 20 days prior to surgery) and postoperative satisfaction (one year after the intervention) were measured using the previously validated French version of the Hospital for Special Surgery Hip or Knee Replacement Expectations Survey. Postoperative satisfaction was measured using a specific scale, following the same methodology as that used for the assessment of expectations. Prediction of the satisfaction of the patients was performed using multivariate linear regression modelling. Results A total of 138 patients (80 THA and 58 TKA) completed the two parts of the study. The expectations score (mean ± SD) (range 0–100) was 72.58 ± 12.63 before THA and 69.10 ± 13.72 before TKA (p = 0.13). The number of expectations expressed was 14.34 ± 1.32 (out of a potential maximum of 18) before THA and 14.70 ± 2.29 (out of a potential maximum of 19) before TKA. After 1 year, THA generated a significantly higher degree of satisfaction compared to TKA (69.70 ± 14.46 v 60.44 ± 17.54, p<0.001) (range 0–100). The pre-operative expectations score was the single best positive predictor of the post-surgery satisfaction assessment both for TKA and THA. Conclusion Patients undergoing total joint arthroplasty for end-stage OA have a high level of expectations, before both THA and TKA. While both types of interventions significantly improve essential and non-essential activities, the rate of satisfaction is significantly greater post THA. Preoperative expectations are a major contributor to the final degree of satisfaction, one year after surgery. These results re-emphasize the need for an optimal preoperative interaction between health care providers and patients, to allow patients a chance to foresee a reasonable outcome after TJA.

Profile of osteoarthritic patients undergoing hip or knee arthroplasty, a step toward a definition of the “need for surgery”

AimsThe objective of this study is to characterize, based on clinical, radiographic, health-related, quality-of-life-related, and demographic variables, the profile of a large, homogeneous, cohort of patients undergoing knee or hip arthroplasty, in a public hospital. Current regulatory guidelines for structure-modifying agent are not clear regarding hard clinical endpoint. The “need for surgery” has been suggested as a potential relevant outcome, but, until now, it is poorly defined. By characterizing a large number of patients who undergo total hip or total knee replacement, this paper aims at providing a contribution to the better definition of the “need for surgery” in advanced OA of the lower limbs.MethodsConsecutive patients who underwent primary knee arthroplasty (KA) or hip arthroplasty (HA) between December 2008 and February 2013, in an academic hospital, and who were diagnosed with hip or knee osteoarthritis (OA) (ACR criteria). Data collected at baseline included demographic and clinical data; Kellgren–Lawrence radiological grading; Western Ontario and Mc Master Universities Arthritis Index (WOMAC); EuroQol five dimensions questionnaire and EuroQol visual analog scale; and 36-item Short Form Health Survey.Results626 subjects were included, 346 with hip OA and 280 with knee OA. Significant differences between subjects in need of an HA or of a KA were seen in terms of age (66.5xa0years versus 65 for hip), duration of complaints (2188xa0days versus 1146.5 for hip), BMI (28.68xa0kg/m² versus 27.07), radiological status (severe OA were found in 79.85% in knee group and 68.73% in hip group), comorbidities (FCI higher in knee group), traumatic of surgical history (37 versus 6%), and health-related quality of life and function (patients with HA had a poorer clinical status regarding WOMAC and WOMAC subscale).ConclusionSignificant differences were observed between patients undergoing KA or HA. These differences might be useful to better understand the “need for surgery” status in these indications. This concept may help to define responders and failures to pharmacological treatment of OA.

A scoping review of the public health impact of vitamin D-fortified dairy products for fracture prevention.

PurposeDairy products are rich in nutrients that positively influence bone health and hence fracture risk, and have therefore been recommended and used for fracture prevention. To help decision makers to efficiently allocate scare resources, it is further important to assess the public health and economic impact of any health intervention. In recent years, several studies have been conducted to estimate the public health and/or economic impact of dairy products but no overview is currently available. This article aims therefore to summarize evidence and review articles that estimated the public health and/or economic impact of vitamin D-fortified dairy products for fracture prevention.MethodsA literature review was conducted using PubMed to identify original studies that assessed the public health and/or economic impact of dairy products (or of calcium/vitamin D supplementation) for fracture prevention up to January 15, 2017.ResultsSeven articles were identified. Different strategies were used by the authors to model the economic/public health impact of dairy products. The four studies assessing the public health impact of dairy products revealed a substantial benefit in terms of fracture prevented, life years, disability-adjusted life years and/or quality-adjusted life years gained. Studies assessing the cost-effectiveness revealed that the use of dairy products is generally cost-effective in the general population aged above 70xa0years, and from the age of 60xa0years in populations at high risk of fractures.ConclusionThis systematic review suggests that the use of dairy products could substantially reduce the burden of osteoporotic fractures and seem to be an economically beneficial strategy.

Development and validation of the French version of a tool assessing patient's expectations in lower limb osteoarthritis

OBJECTIVEnThe Hospital for Special Surgery (HSS) Hip Replacement Expectations Survey and Knee Replacement Expectations Survey are validated tools developed to measure patients preoperative expectations for hip and knee arthroplasty. These instruments have possible uses in both daily practice and research. Our objective was to assess the test-retest reliability and the construct validity of the French version of the surveys.nnnMETHODSnPatients scheduled for total hip (nxa0=xa082) or knee replacement (nxa0=xa061) aged 38-90 years were included. All completed the HSS Hip or Knee Replacement Expectations Survey and the Expectation WOMAC to determine concurrent validity. The test-retest reliability was assessed using the intraclass coefficient correlation (ICC), the Bland and Altman Method and the coefficient of variation; the internal consistency was assessed by the Cronbach α coefficient. The construct validity was investigated using the Pearson correlation coefficient and floor and ceiling effects by percentage frequency of lowest or highest possible score achieved by respondents.nnnRESULTSn143 patients scheduled for hip or knee arthroplasty were included. The reliability was excellent between the test and the rested total score, with an ICC of 0.902 (0.853-0.936) and CV of 4.06% for the French Hip Replacement Expectations Survey and 0.865 (0.786-0.917) and CV of 7.7% for the French Knee Replacement Expectations Survey, without bias. The Cronbach α coefficient was 0.72 for hip Survey and 0.82 for knee Survey showing a good internal consistency. Pearson correlation coefficients of 0.45 and 0.48 between Expectations WOMAC and HSS, respectively for hip Survey and knee Survey, were observed but with systematic bias. The lowest possible score was not reported by any patient and only three patients (3.66%) scheduled for hip arthroplasty reported the highest possible score.nnnCONCLUSIONSnThe French version of the HSS Hip or Knee Replacement Expectations Survey is a reliable and valid questionnaire and compares favourably with the original English version. Therefore, this new version may help French-speaking clinicians to evaluate expectations before lower limb arthroplasty.

Aesthetic discomfort in hand osteoarthritis: results from the LIège Hand Osteoarthritis Cohort (LIHOC)

IntroductionThe primary complaint of patients with hand osteoarthritis (OA) is frequently the inelegant appearance of their hands. Only one study has been conducted to assess the magnitude of and identify the determinants of aesthetic discomfort in hand OA.MethodsThe LIège Hand Osteoarthritis Cohort is a prospective cohort of 203 patients diagnosed with hand OA. At baseline, these patients rated their aesthetic discomfort on a 100-mm visual analogue scale (VAS) and used a Likert scale (range 0–7) to quantify the magnitude of their aesthetic damage.ResultsThe median value of the aesthetic discomfort VAS was 35.0 [interquartile range (Q1–Q3) 6.0–59.0]. The median damage was rated 3.0 (Q1–Q3 1.0–4.0), corresponding to a moderate level. Both were significantly (pu2009<u20090.02) associated with the female gender, the duration of hand OA, the radiological severity of OA (Verbruggen–Veys and Kellgren–Lawrence scales) and pain, disability, or stiffness [Australian Canadian Osteoarthritis Hand Index (AUSCAN) and Functional Index for Hand Osteoarthritis ]. After a stepwise analysis, the parameters correlated to the aesthetic discomfort were the presence of erosive joints (pu2009=u20090.0048), the AUSCAN score (pu2009<u20090.0001), the number of joints with severe radiological damage (pu2009=u20090.023), and gender (pu2009=u20090.0009). For aesthetic damage, the parameters associated were AUSCAN score (pu2009<u20090.0001), duration of hand OA >10xa0years (pu2009=u20090.001), and presence of erosive joints (pu2009<u20090.0001). Compared with patients with low aesthetic discomfort (VAS ≤33xa0mm), those with the highest discomfort (VAS ≥66xa0mm) had more erosive OA (pu2009=u20090.014), a higher Verbruggen and Veys score (pu2009=u20090.0039), and a higher AUSCAN score (pu2009<u20090.001).ConclusionsAesthetic discomfort and damage are significant complaints in patients with hand OA. The determinants of the magnitude of these are gender, radiological severity, duration of hand OA, presence of erosive joints, and impact on pain, function, and stiffness as assessed with the AUSCAN.

Early Clinically Relevant Improvement in Quality of Life and Clinical Outcomes 1 Year Postsurgery in Patients with Knee and Hip Joint Arthroplasties.

Objective To measure and identify the determinants of the outcomes after hip/knee arthroplasty (HA/KA) in patients with osteoarthritis during the first postsurgical year. Design In this prospective observational study, we evaluated the preoperative and postoperative (3, 6, and 12 months) outcomes of 626 patients who underwent HA (346 with median age 65 years, 59% female) or KA (280 with median age 66.5 years, 54% female) between 2008 and 2013. Generic and specific tools were used to measure health-related quality of life (HRQoL) and utility. Good outcome was defined as an improvement in WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) greater than or equal to the minimal important difference (MID). Regressions were performed to evaluate the relationship between preoperative and postoperative measures and evolution of WOMAC/good outcome. Results We observed an almost systematic improvement of all parameters for up to 12 months, but especially at the 3-month follow-up. The low number of comorbidities and the absence of postoperative complications were the common determinants of improvement of WOMAC total score after 12 months. Other parameters (background of the joint, preoperative function and length of hospital stay in KA group; place of discharge in HA group) affected the evolution of WOMAC scores. 87.09% of HA and 73.06% of KA patients experienced a good outcome. A small number of comorbidities, a worse preoperative function, a shortened hospital stay (KA only), and an absence of early postoperative complications (HA only) significantly predicted a good outcome. Conclusions Intermediate HRQoL following HA or KA improved quickly from preoperative levels for all instruments. More than 70% of patients achieved a good outcome defined as improved pain, stiffness and disability and the predictors are slightly close.

Baseline characteristics of the Liège Hand Osteoarthritis Cohort (LIHOC)

Background Whereas hand osteoarthritis (OA) is a frequent disease, which may lead to considerable pain and physical limitations, limited research has been performed, compared to lower limbs OA. Objectives To better understand the impact of hand osteoarthritis on quality of life and health resources utilization of interdigital osteoarthritis. Methods We decided to prospectively follow a cohort of 203 individuals, diagnosed with hand OA during consultations held at a tertiary care facility specialized in bone and cartilage metabolism and called the Liège Hand Osteoarthritis Cohort (LIHOC). Results As expected, the vast majority of patients (90.1%) were of female gender with 46.8% having a family history of hand OA. The median age of the population was 69.1 years (Q1 61.9-Q3 75.6). Body Mass Index (kg/m2) median was 25.6 (22.9-28.9). Hand OA was associated with other joint involvement in 87.1% of the cases {mainly spine (70.8%) and knee (69.0%)}. On a Visual Analog Scale reflecting pain in hand joints, graded from 0 to 100, the median score was 50.0 (29.0-59.0), with a median number of painful joints at pressure of 5.0 (2.0-10.0). The median number of swollen joints and of joint with bony deformations was respectively 2.0 (1.0-4.0) and 10.0 (6.0-15.0). The total normalized Auscan score (0-300) median value was 129.0 (71.1-182.5) while the median Functional Index for Hand Osteoarthritis (FIHOA) score (0-30) was 5.0 (2.0-11.0). Radiologic assessment of hand OA showed a Verbruggen total score (0-218) median value of 31.6 (20.9-48.2) whereas the Kellgren-Lawrence total score (0-128) median value was 54.0 (40.0-66.0). Conclusions The LIHOC will be followed for a total duration of 5 years, with the objective to better understand the determinants of clinical and radiologic progression as well as the impact of hand OA on quality of life and health resources utilization. Disclosure of Interest None declared