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Age-related sarcopenia, resulting from a gradual loss in skeletal muscle mass and strength, is pivotal to the increased prevalence of functional limitation among the older adult community. The purpose of this meta-analysis of individual patient data is to investigate the difference in health-related quality of life between sarcopenic individuals and those without the condition using the Sarcopenia Quality of Life (SarQoL) questionnaire. A protocol was published on PROSPERO. Multiple databases and the grey literature were searched until March 2023 for studies reporting quality of life assessed with the SarQoL for patients with and without sarcopenia. Two researchers conducted the systematic review independently. A two-stage meta-analysis was performed. First, crude (mean difference) and adjusted (beta coefficient) effect sizes were calculated within each database; then, a random effect meta-analysis was applied to pool them. Heterogeneity was measured using the Q-test and I 2 value. Subgroup analyses were performed to investigate the source of potential heterogeneity. The strength of evidence of this association was assessed using GRADE. From the 413 studies identified, 32 were eventually included, of which 10 were unpublished data studies. Sarcopenic participants displayed significantly reduced health-related quality of life compared with non-sarcopenic individuals (mean difference = -12.32; 95 % CI = [-15.27; -9.37]). The model revealed significant heterogeneity. Subgroup analyses revealed a substantial impact of regions, clinical settings, and diagnostic criteria on the difference in health-related quality of life between sarcopenic and non-sarcopenic individuals. The level of evidence was moderate. This meta-analysis of individual patient data suggested that sarcopenia is associated with lower health-related quality of life measured with SarQoL., Competing Interests: Declaration of competing interest B.C., B.O., and R.J.Y. are shareholders of the SarQoL sprl. However, they never received any financial compensation for this role. The other authors declare they have no competing interest., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

We conducted a study evaluating incidence rates and influencing factors in Romanian hip fracture patients. Our results showed that the type of fracture and its respective surgical procedure as well as hospital characteristics correlate with mortality. Updated incidences can result in updated treatment guidelines., Purpose: The aim of our study was to assess incidence rates for a revision-calibration of the Romanian FRAX tool and to evaluate particularities of hip fracture cases to determine patient- and hospital-related variables affecting mortality., Methods: We conducted a retrospective study using hospital reports of hip fracture codes to the National School of Statistics (NSS) from January 1, 2019, until December 31, 2019. The study population included 24,950 patients presenting to Romanian public hospitals in all 41 counties: ≥ the age of 40 with diagnostic ICD 10 codes: S72.0 femoral neck fracture, S72.1 pertrochanteric femoral fracture, and S72.2 subtrochanteric femoral fracture and procedure codes: O11104 (trochanteric/sub capital internal fixation), O12101 (hemiarthroplasty), O11808 (closed femoral reduction with internal fixation), O12103 (partial arthroplasty), O12104 (total arthroplasty). Hospital length of stay (LoS) was classified as follows: < 6, 6-9, 10-14, and ≥ 15 days., Results: Incidence of hip fractures was 248/100,000 among those aged 50 + and 184/100,000 within the 40 + age category. Average age of the patients was 77 years (80 for females, 71 for males); 83.7% of the patients were 65 + with equivalent urban-rural distributions. Males had a 1.7 times higher mortality risk. Each year increase in age added a mortality risk of 6.9%. In-hospital mortality was 1.34 times higher among patients living in urban areas. Hemiarthroplasty and partial/total unilateral/bilateral arthroplasty had a lower risk of mortality than trochanteric/sub capital internal fixation (p < 0.02, p < 0.033)., Conclusion: Gender, age, residence, and procedure type had significant impact on mortality. Updated incidence rates will allow the revision of Romania's FRAX model., (© 2023. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Background: Economic evaluations are widely used to predict the economic impact of new treatment alternatives. Comprehensive economic reviews in the field of chronic lymphocytic leukemia (CLL) are warranted to supplement the existing analyses focused on specific therapeutic areas., Methods: A systematic literature review was conducted based on literature searches in Medline and EMBASE to summarize the published health economics models related to all types of CLL therapies. Narrative synthesis of relevant studies was performed focusing on compared treatments, patient populations, modelling approaches and key findings., Results: We included 29 studies, the majority of which were published between 2016 and 2018, when data from large clinical trials in CLL became available. Treatment regimens were compared in 25 cases, while the remaining four studies considered treatment strategies with more complex patient pathways. Based on the review results, Markov modelling with a simple structure of three health states (progression-free, progressed, death) can be considered as the traditional basis to simulate cost effectiveness. However, more recent studies added further complexity, including additional health states for different therapies (e.g. best supportive care or stem cell transplantation), for progression-free state (e.g. by differentiating between with or without treatment), or for response status (i.e. partial response and complete response)., Conclusions: As personalized medicine is increasingly gaining recognition, we expect that future economic evaluations will also incorporate new solutions, which are necessary to capture a larger number of genetic and molecular markers and more complex patient pathways with individual patient-level allocation of treatment options and thus economic assessments., (© 2023. The Author(s).)

Background: Following the publication of a culturally adapted version of the original SarQoL® questionnaire in Hungarian language, we aimed to test its psychometric properties and its association with the SARC-F screening instrument., Design: This cross-sectional validation study recruited elderly people from 2 nursing homes and an endocrinology clinic. All participants were screened for sarcopenia with the SARC-F tool, had their muscle mass measured with bioelectrical impedance analysis, as well as grip strength and gait speed. Sarcopenia was diagnosed with the EWGSOP2 criteria. Participants completed the SarQoL questionnaire, the SF-36, the EQ-5D and the EQ-VAS. Validation consisted of analyzing discriminative power, internal consistency, construct validity and floor- and ceiling effects. A multivariate regression model was used to evaluate the association between QoL, the SARC-F questionnaire, and a number of demographic and clinical variables., Results: A total of 70 participants, aged 80.00 (68.50 - 82.50) years, were included. Discriminative power between sarcopenic and nonsarcopenic subjects was found for all domains, except domain 7 (Fears) when dividing study population based on the SARC-F score. We also found significantly lower QoL for domains 4 (Functionality) and 5 (Activities of daily living) when splitting participants based on muscle strength (Probable sarcopenia - EWGSOP2 definition). All domains showed a strong or moderate correlation with the total SarQoL score. Conceptually similar domains of other generic QoL questionnaires significantly correlated with the total SarQol score, confirming its convergent validity. Low correlations were found with different domains (divergent validity). No floor or ceiling effects were observed. Using a regression model, the components "strength" and "stair climbing" of the SARC-F questionnaire were significantly associated with the QoL of our patients assessed with the SarQoL instrument., Conclusion: Sarcopenia risk assessed with the Sarc-F instrument was significantly associated with QoL measured with the SarQol questionnaire. High internal consistency, convergent and divergent validity and no floor and ceiling effects characterised the Hungarian language SarQoL® questionnaire. Due to some limitations, further multi-center designed studies are needed to verify the validity of the SarQol questionnaire., Competing Interests: Charlotte Beaudart is a shareholder of SarQoL sprl. All other authors have no conflicts to declare.

Összefoglaló. Bevezetés: A sarcopenia - időskori izomerő- és izomtömeg-csökkenés - a természetes öregedés része, ha viszont súlyos működési zavarokat okoz, már betegségnek tekintendő. Ezért a szövődményes, rossz kimenetelek mérsékléséhez minél korábbi felismerése nélkülözhetetlen. Célkitűzés: A sarcopenia kockázatának gyors értékelésére a SARC-F szerzői egyszerű szűrő kérdőívet alkottak, amelyet a sarcopeniát meghatározó diagnosztikus ajánlások kiemelten javallanak. E kérdőív magyar változatának jellemzőit vizsgáltuk, annak validálása céljából. Módszer: A kérdőívet 105, 65 éves vagy ennél idősebb személy bevonásával teszteltük. Az izomtömeg, az izomerő és a teljesítmény értékelése előtt a résztvevők kitöltöttek két generikus, valamint egy betegségspecifikus életminőség-kérdőívet. A megbízhatóság, konvergens, divergens, valamint konstruktumérvényesség vizsgálata mellett az eszköz diagnosztikus alkalmasságát is teszteltük. Statisztikai analízis: A Cronbach-alfa-érték, a Spearman/Pearson-féle korrelációs koefficiensek, a khi-négyzet-teszt, a szenzitivitás, a specificitás meghatározásához, a pozitív és negatív predikciós számításokhoz az SPSS 17.0 programot használtuk. Eredmények: A sarcopenia várható kockázata a SARC-F-teszt szerint (≥4 pont) 36%, míg az európai konszenzusdefiníció alapján sarcopeniásnak minősített esetek előfordulása 40% volt. A sarcopeniás egyéneknek jelentősen magasabb - domének szerinti és összesített - SARC-F-pontjaik voltak. A kérdőívet nagyon jó belső konzisztencia (Cronbach-alfa: 0,755), jó specificitás és magas negatív predikciós értékek jellemezték. Következtetés: A SARC-F magyar változata megbízható eszköznek tekinthető a sarcopenia kockázatának gyors és olcsó előrejelzésére. Orv Hetil. 2020; 161(47): 2000-2005., Introduction: Sarcopenia is an age-related involution process, causing a significant functional disability, therefore it can be classified as a disease. Early recognition of the disease is essential. Objetive: Authors of the original SARC-F questionnaire developed a simple and rapid screening tool, recommended by the European Working Group on Sarcopenia as the mandatory first step in the diagnostic process of sarcopenia. Our study aimed to test and validate the Hungarian version of this instrument., Method: 105 volunteers of 65+ years were recruited and evaluated for sarcopenia (muscle mass, strength and performance). Participants completed the SARC-F, other two generic and one disease-specific quality-of-life questionnaires. We checked the instrument for reliability, validity (discriminative power, construct, convergent and divergent validity) and screening performance., Statistical Analysis: Cronbach's alpha test, the Pearson/Spearman's correlation coefficient, chi-square test, sensitivity, specificity, positive and negative predictive value calculations have been performed. The SPSS 17.0 statistical program was used., Results: The prevalence of sarcopenia according to the SARC-F test (score: ≥4) was 36%, while 40% was diagnosed with the European consensus definition. Sarcopenic individuals had significantly higher SARC-F total and domain scores. Very good internal consistency (Cronbach's alpha 0.755), specificity and negative predictive values were found., Conclusion: A reliable, rapid and inexpensive sarcopenia indicator is now available to timely detect the Hungarian-speaking patients at risk of sarcopenia. Orv Hetil. 2020; 161(47): 2000-2005.

Objective: To identify the effect of social capital on adolescent smoking., Method: A stratified random sample of 1313 7th and 8th grade students from three counties in Transylvania, Romania, completed a self-administered questionnaire on smoking-related knowledge, attitudes and behaviours. The impact of social capital was measured (personal and community activities, school achievements and smoking-related knowledge). Multivariate multinomial logistic regression models were used to measure the association between social participation and smoking., Results: Experimenting with smoking was mostly related to knowledge about smoking, academic performance and second-hand tobacco smoke exposure at home. The strongest risk factor of adolescent smoking was the smoking behaviour of classmates: those who reported a significant proportion of smokers among their classmates were nine times more likely to smoke themselves than in other cases (adjusted odds ratio [aOR]: 9.05). Those who considered smoking to be harmless were 4 times more likely to be smokers than those who considered this behaviour to be dangerous (aOR: 4.28). Poor academic results increased adolescents' smoking (aOR: 3.22 and 2.66). The odds were significantly higher for smoking, if they had an active social life (aOR: 2.54). Regular church attendance proved to be a protective factor (aOR: 0.45)., Conclusions: Several social capital factors can play a role in adolescent smoking. The organization and the development of community activities aimed at prevention must strengthen the factors related to the community's social capital to reduce the likelihood of teenage smoking., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The impact of the two adipokines, visfatin and retinol-binding protein 4 (RBP-4) on bone mineral density (BMD) has been analysed in various studies with conflicting results. Visfatin is highly expressed in visceral fat with stimulatory effect on osteoblast proliferation and inhibition on osteoclast formation, while RBP-4 acts as a transporter protein for retinol, associated with changes in insulin sensitivity, independent of obesity, with no consensus on its effect on bone metabolism. We evaluated the relationship between serum concentrations of visfatin, RBP-4, markers of insulin resistance and current BMD in treated postmenopausal osteoporosis (PO)., Methods: Demographics, previous treatment, metabolic status, anthropometry, serum Alkaline phosphatise (ALP), visfatin, RBP-4, the HOMA IR (homeostatic model assessment of insulin resistance) index and BMD were evaluated in 61 subjects with PO. Statistical analysis used SPSS v. 25.0, with a level of significance α = 0.05. Regression models were constructed to evaluate the relationship between adipokines and BMD, adjusting for covariates., Results: In multilinear regression analysis, the strongest predictor for current BMD was a previous BMD, followed by ALP and age. RBP4 and HOMA IR were significant predictors, while visfatin had no significant effect. A significant correlation between body mass index (BMI) and BMD at the femoral neck was observed. ALP was negatively correlated with BMD and visfatin positively with RBP4., Conclusions: Data indicate a positive relationship between BMD and RBP-4, an inverse relationship between markers of insulin resistance, bone turn-over and current BMD. No significant effect of visfatin on BMD was observed.

The name and surname of the authors have been inverted. The correct order would be like this: Andrea Ildiko Gasparik, Gabriela Mihai, Charlotte Beaudart, Olivier Bruyere, Raluca-Monica Pop, Jean-Yves Reginster, Ionela Maria Pascanu.

Introduction: Sarcopenia, or age-related muscle loss, is emerging as a serious public health concern. Due to the impaired physical performance associated with sarcopenia, a reduced quality of life (QoL) has been evidenced in the affected individuals. Generic instruments, such as Rand Corporation Short Form 36 (SF-36) or the European Quality of Life (EuroQoL-5D) questionnaires do not accurately assess the impact of sarcopenia on QoL. SarQoL (Sarcopenia Quality of Life) questionnaire, was the first disease-specific questionnaire addressing the quality of life in patients with sarcopenia and has been recently designed for providing a global assessment of the quality of life in community-dwelling elderly subjects aged 65 years and older., Aim: Our aim was the development of a valid Hungarian version of the original SarQoL, through the translation, cultural adaptation and content validation of the original questionnaire., Method: We followed the recommended process, the international protocol of translation in five steps: two initial translations, synthesis of the two translations, backward translation, expert committee to compare translations with the original questionnaire and pretest. The pretest process involved 20 subjects (10 clinically sarcopenic and 10 non-sarcopenic with different educational and socioeconomic backgrounds) who were asked to complete the questionnaire. Feedbacks were requested from all subjects regarding the comprehensibility of questions or difficulties in completing the test., Results: Using the recommended best practice protocol for translation, the pre-final version is comparable with the original instrument in terms of content and accuracy., Conclusion: After the content validation with clinically sarcopenic persons it should be a useful tool to assess the quality of life of people with sarcopenia among elderly Hungarian patients. Orv Hetil. 2018; 159(36): 1483-1486.

Our study assessed the psychometric properties of the Romanian SarQoL ® questionnaire. Normal distribution and high internal consistency were found. Sarcopenic subjects reported a reduced global quality of life compared to non-sarcopenics. The Romanian version of the SarQoL ® questionnaire, conceptually and literally equivalent with the source instrument, is qualified in terms of psychometric properties., Purpose/introduction: We have recently provided a translated and culturally tailored version of the first quality of life (QoL) questionnaire specific for sarcopenia, the SarQoL ® , in Romanian language. The aim of this study was to assess the psychometric performances of the translated questionnaire., Methods: A total of 100 volunteers were enrolled in the study. Sarcopenia was diagnosed according to the algorithm proposed by the European Working Group on Sarcopenia in Older People (EWGSOP). To test the psychometric performance, discriminative power, internal consistency, floor and ceiling effects, and construct validity analyses were made. We assessed the correlation between SarQoL ® and similar/different domains of other two QoL questionnaires., Results: Sarcopenic subjects reported a reduced global QoL compared to non-sarcopenic individuals. Significantly (p = 0.018) higher total scores for non-sarcopenic subjects compared to those of sarcopenics indicate a good discriminative power of the Romanian questionnaire. Sarcopenic individuals had significantly lower scores in almost all domains. The Cronbach's alpha value of 0.946 indicates a high internal consistency. No floor or ceiling effects were found. A strong positive correlation was also found between similar domain scores from SF-36 and EQ-5D questionnaires with the Total SarQoL ® score. Moreover, lower scores of quality of life have been shown to be significantly associated with lower muscle strength, in univariate analyses, and lower gait speed, both in univariate and multivariate analyses., Conclusions: Our results indicate that the Romanian version of the SarQoL ® questionnaire, qualified in terms of psychometric properties, could be a useful tool to assess the sarcopenia-related QoL among frail Romanian individuals.

Purpose: Sarcopenia is an age-related muscle condition which is frequently a precursor of frailty, mobility disability and premature death. It has a high prevalence in older populations and presents a considerable social and economic burden. Potential treatments are under development but, as yet, no guidelines support regulatory studies for new drugs to manage sarcopenia. The objective of this position paper is therefore to suggest a set of potential endpoints and target population definitions to stimulate debate and progress within the medico-scientific and regulatory communities., Methods: A multidisciplinary expert working group was hosted by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, which reviewed and discussed the recent literature from a perspective of clinical experience and guideline development. Relevant parallels were drawn from the development of definition of osteoporosis as a disease and clinical assessment of pharmaceutical treatments for that indication., Results: A case-finding decision tree is briefly reviewed with a discussion of recent prevalence estimations of different relevant threshold values. The selection criteria for patients in regulatory studies are discussed according to the aims of the investigation (sarcopenia prevention or treatment) and the stage of project development. The possible endpoints of such studies are reviewed and a plea is made for the establishment of a core outcome set to be used in all clinical trials of sarcopenia., Conclusions: The current lack of guidelines for the assessment of new therapeutic treatments for sarcopenia could potentially hinder the delivery of effective medicines to patients at risk.

The importance of healthy behavior for bone health, as well as low adherence to anti-osteoporosis medication are well-described problems. Both, lifestyle habits and compliance with drug-therapy are influenced by the relationship between patients and physicians. We analyzed 152 consecutive doctor-patient interactions conducted in public and private practices specialized in the management of osteoporosis. We recorded the duration of the consultation and the relative length of: (a) Personal and medical history collection, (b) Physical examination, (c) Explanation of the diagnosis and treatment modalities, and (d) Administrative tasks. The overall length and the respective duration of the four phases of the consultation significantly differ in private versus public practices. In the private practice, doctors spend more time with the patient and dedicate a higher proportion of their time to history collection and explanation of diagnosis/treatment for osteoporosis. While we do not integrate data on medication adherence, we believe that since more time is dedicated to health education, patients consulting in the private sector have a greater probability to adopt a healthy lifestyle and better/ longer take anti-osteoporosis medications. Further investigations are needed to assess if the differences in patient and doctor behaviors in the public-private settings have a significant impact on therapeutic adherence and subsequently fracture reduction in patients receiving anti-osteoporosis treatment.