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Introduction: Lack of consideration for risk-based assessments that inform osteoporosis treatment decisions may contribute to disease burden. In this study, we examined the prevalence of patients at very high risk of fracture and evaluated real-world treatment practices for these patients., Methods: This retrospective observational cohort study used real-world data linked to commercial and Medicare medical claims from Symphony Health PatientSource. Patients 50 years and older with osteoporosis (determined by the presence of a diagnosis code) and at very high risk of fracture according to the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) (AACE/ACE) 2020 guidelines between January 1, 2018, and December 31, 2018, were included. The number and proportion of patients treated with any osteoporosis medication were evaluated., Results: Of the 10,739,286 patients with osteoporosis, 5,078,111 (47.3%) were identified as meeting the AACE criteria for very high risk of fracture and were selected for the analysis. Most (5,033,106 [99.1%]) had a high risk of falls and/or a history of falls resulting in injury. Among the 1,667,794 patients (32.8%) eligible for treatment, 280,777 (16.8%) received treatment. Of these, 63.6% received alendronate, an alternative therapy, and 21.2% received a risk-based guideline-recommended medicine (teriparatide, zoledronic acid, denosumab, abaloparatide, or romosozumab). A greater proportion of men were untreated, 161,978 (90.5) compared with 1,185,003 women (81.8)., Discussion: Most patients at very high risk of fracture remain untreated. Most of those treated do not receive the appropriate recommended treatments for patients at high risk. Risk-based treatment decisions may allow for more appropriate medication selection., (Copyright © 2023 by the American Academy of Orthopaedic Surgeons.)

Background: Some studies have reported that nitrate intake from vegetables was inversely associated with many vascular diseases, but few studies have paid attention to the relationship between urinary nitrate and cardiovascular diseases (CVDs). This cross-sectional study aimed to explore the connections between urinary nitrate and prevalence of CVDs., Methods: The data of this study was collected from National Health and Nutrition Examination Survey (NHANES). Finally, several years' data of NHANES were merged into 14,894 observations. Logistic regression models were used to examine the associations between urinary nitrate and CVDs by using the "survey" package in R software (version 3.2.3)., Results: In the univariable logistic analysis, significant association was discovered between urinary nitrate and congestive heart failure, coronary heart disease, angina pectoris, myocardial infarction (all P < 0.001). By adjusting related covariates, the multivariable logistic analysis showed that the significant association only existed between urinary nitrate and congestive heart failure (OR = 0.651, 95% CI 0.507-0.838, P < 0.001). Compared to Q1 urinary nitrate level as reference, the risk for prevalent heart failure diminished along with increasing levels of urinary nitrates, (OR of Q2 level = 0.633, 95% CI 0.403-0.994), (OR of Q3 level = 0.425, 95% CI 0.230-0.783), (OR of Q4 level = 0.375, 95% CI 0.210-0.661), respectively. Moreover, urinary nitrate levels were associated with congestive heart failure in a dose-dependent manner in both 20-60 years group, 60+ years group and male, female group (P < 0.001, P = 0.011 and P = 0.009, P = 0.004)., Conclusions: Independent of related covariates, higher urinary nitrate was associated with lower prevalent congestive heart failure.

This study aims to quantitatively evaluate the cumulative effective dose and associated cancer risk of pediatric patients of US and Hong Kong population undergoing repetitive whole-body scans with dual-energy X-ray absorptiometry (DXA) during their diagnosis and follow-up periods. Organ-absorbed doses of pediatric patients undergoing DXA whole-body scan have been computer simulated using patient imaging parameters input to the Monte Carlo software PCXMC. Gender- and age-specific effective doses have been calculated with the simulated organ-absorbed doses using the ICRP-103 approach. The associated radiation-induced cancer risk, expressed as lifetime attributable cancer risk (LAR), has been estimated according to the method introduced in the Biological Effects of Ionizing Radiation VII report. Mathematical fitting for effective dose and for LAR, as a function of age at exposure, has been analytically obtained to quantitatively estimate the cumulated effective dose and LAR for pediatric patients of US and Hong Kong population with repetitive DXA whole-body scan during their follow-up period. The effective dose of a single DXA whole-body scan for patients exposed at the age between 5 and 18 years was calculated as 8.47-17.68 µSv. The corresponding LAR for US and Hong Kong population was between the range of 4.57 × 10 -7 and 7.14 × 10 -7 . The cumulative effective dose of DXA whole-body scan for patients exposed annually at age between 5 and 18 years was calculated as 180 µSv for girls and 168 µSv for boys. The corresponding cumulative LAR for US and Hong Kong population was calculated as 3.77 × 10 -6 to 5.48 × 10 -6 . Girls would be at a statistically significant higher cumulated cancer risk than boys under the same whole-body DXA protocol (p = 0.03). The probability of cumulative LAR for pediatric populations undergoing annual DXA whole-body scan is regarded as minimal. We demonstrate the use of computer simulation and analytic formulation to quantitatively obtain the cumulated effective dose and cancer risk at any age of exposure, which are useful information for medical personnel to track patient radiation dose and to alleviate patients' parents concern about radiation safety in repetitive whole-body scan using DXA., (Copyright © 2017 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.)