exudates and Osteoporosis--Postmenopausal

From the perspective of Malaysian health care providers, denosumab was cost-effective in the treatment of postmenopausal osteoporosis, with an optimal outcome starting at age 60 years. Our results provide important insights into the value for money of anti-osteoporotic agents that can serve as a reference for other countries with comparable epidemiological data.. The study aimed to compare the cost-effectiveness of denosumab with alendronate and no treatment in the management of postmenopausal osteoporosis among the Malaysian population.. A well-validated Markov model was used to estimate the cost-effectiveness of denosumab in a hypothetical cohort of postmenopausal osteoporotic women between 50 and 80 years old who had no history of fractures. A 10-year time horizon from the perspective of Malaysian health care providers was used in this analysis. The model parameters, including transition probabilities and costs, were based on Malaysian sources. Treatment efficacy data were obtained from a network meta-analysis. The study outcomes were presented as incremental cost per quality-adjusted life-year (QALY) gained. Sensitivity analyses were performed to ensure the robustness of the results. A cost-effectiveness threshold was set at MYR 21,438 (USD 5175) per QALY.. Denosumab was found to be a cost-effective option for postmenopausal osteoporotic women aged 60 and older. The incremental cost-effectiveness ratios (ICERs) for denosumab versus alendronate ranged from MYR 16,955 (USD 4093) per QALY at age 60 to MYR 4380 (USD 1057) per QALY at age 80. The cost-effectiveness of denosumab improved monotonically with increasing age. Denosumab was 72.8-92.7% likely to be cost-effective at the cost-effectiveness threshold. Sensitivity analyses demonstrated that the results were robust across all parameter variations, with the annual cost of denosumab being the most sensitive.. From the perspective of the Malaysian health care provider, denosumab appears to be a cost-effective treatment choice for postmenopausal osteoporotic women over 60 years of age.

Topics: Aged; Aged, 80 and over; Alendronate; Bone Density Conservation Agents; Cost-Benefit Analysis; Denosumab; Female; Humans; Malaysia; Middle Aged; Osteoporosis, Postmenopausal; Quality-Adjusted Life Years

This Clinical Guidance is aimed to help practitioners assess, diagnose and manage their patients with osteoporosis (OP), using the best available evidence.. A literature search using PubMed (MEDLINE) and The Cochrane Library identified all relevant articles on OP and its assessment, diagnosis and treatment, from 2005, to update from the previous edition published in 2006. The studies were assessed and the level of evidence assigned; for each statement, studies with the highest level of evidence were used to frame the recommendation.. This article summarizes the diagnostic and treatment pathways for OP, highlighting the new data that have changed the way we assess and treat OP. Instead of starting treatment based on bone mineral density alone, there has been a move to assessing 10-year fracture risk before treatment, using tools such as the Fracture Risk Assessment Tool (FRAX). There has been a re-evaluation on calcium supplementation and more emphasis on the importance of vitamin D. There has been concern about the potential adverse effects of the long-term usage of bisphosphonates, which we have discussed fully. New drugs that have been licensed since 2006 in Malaysia have been included.. Adequate intake of calcium (1000 mg from both diet and supplements) and vitamin D (800 IU) daily remain important in the treatment of OP. However, in confirmed OP, pharmacological therapy with anti-resorptives is the mainstay of treatment. Patients need to be regularly assessed while on medication and treatment adjusted as required.

Topics: Bone Density; Bone Density Conservation Agents; Calcium Compounds; Combined Modality Therapy; Dietary Supplements; Female; Humans; Malaysia; Male; MEDLINE; Osteoporosis, Postmenopausal; Osteoporotic Fractures; Practice Guidelines as Topic; Risk Assessment; Risk Factors; Vitamin D

To review data on the prevalence of vitamin D inadequacy and its causes in postmenopausal women in Eastern Asia.. Data were obtained from the published biomedical literature as well as abstracts and posters presented at scientific meetings. Using MEDLINE, EMBASE and BIOSIS databases (to July 2007), epidemiological studies were identified using the search terms: 'human', 'vitamin D', 'vitamin D deficiency', 'vitamin D inadequacy', 'vitamin D insufficiency' and 'hypovitaminosis D', 'osteomalacia' and 'osteoporosis'. Additional references were also identified from the bibliographies of published articles.. The prevalence of vitamin D inadequacy in studies of postmenopausal women (ambulatory or with osteoporosis or related musculoskeletal disorders) in Eastern Asia ranged from 0 to 92%, depending on the cut-off level of serum 25-hydroxycholecalciferol [25(OH)D] that was applied (range < or =6-35 ng/mL [< or = 15-87 nmol/L]). One large international study found that 71% of postmenopausal women with osteoporosis in Eastern Asia had vitamin D inadequacy, defined as serum levels of 25(OH)D < 30 ng/mL (75 nmol/L). Prevalence rates using this cut-off level were 47% in Thailand, 49% in Malaysia, 90% in Japan and 92% in South Korea. High prevalences of vitamin D inadequacy were evident in two studies using a lower 25(OH)D level cut-off value of < 12 ng/mL (30 nmol/L) - 21% in China and 57% in South Korea. Dietary deficiency and inadequate exposure or reactivity to sunlight (due to lifestyle choices, cultural customs and/or aging) were identified as important risk factors for vitamin D inadequacy.. Non-uniform, epidemiological studies indicate a high prevalence of vitamin D inadequacy in postmenopausal women in Eastern Asia. Recommended remedial approaches are education campaigns and broad-based provision of vitamin D supplementation.

Topics: Asia, Eastern; Female; Humans; Malaysia; Musculoskeletal Diseases; Osteoporosis, Postmenopausal; Postmenopause; Prevalence; Thailand; Vitamin D Deficiency

Vitamin D3 (cholecalciferol) dose required to maintain sufficiency in non- Caucasian women with postmenopausal osteoporosis (PMO) inthe tropics has not been well studied. Some guidelines mandate 800-1000 IU vitamin D/day but the Endocrine Society (US) advocates 1500-2000 IU/day to maintain 25-hydroxyvitamin-D (25(OH)D) concentration at >75 nmol/L. We aimed to establish oral cholecalciferol dose required to maintain 25(OH)D concentration at >75 nmol/L in PMO Chinese Malaysian women, postulating lower dose requirements amongst light-skinned subjects in the tropics.. 90 Chinese Malaysian PMO women in Kuala Lumpur, Malaysia (2°30'N) with baseline serum 25(OH)D levels >=50 nmol/L were recruited. Prior vitamin D supplements were discontinued and subjects randomized to oral cholecalciferol 25,000 IU/4-weekly (Group-A) or 50,000 IU/4-weekly (Group- B) for 16 weeks, administered under direct observation. Serum 25(OH)D, PTH, serum/urinary calcium were measured at baseline, 8 and 16 weeks.. Baseline characteristics, including osteoporosis severity, sun exposure (~3 hours/week), and serum 25(OH)D did not differ between treatment arms. After 16 weeks, 91% of women sufficient at baseline, remained sufficient on 25,000 IU/4-weekly compared with 97% on 50,000 IU/4-weekly with mean serum 25(OH)D 108.1±20.4 and 114.7±18.4 SD nmol/L respectively (p=0.273). At trial's end, 39% and 80% of insufficient women at baseline attained sufficiency in Group A and Group B (p=0.057). Neither dose was associated with hyperparathyroidism or toxicity.. Despite pretrial vitamin D supplementation and adequate sun exposure, 25.6% Chinese Malaysian PMO women were vitamin D insufficient indicating sunshine alone cannot ensure sufficiency in the tropics. Both ~900 IU/day and ~1800 IU/day cholecalciferol can safely maintain vitamin D sufficiency in >90% of Chinese Malaysian PMO women. Higher doses are required with baseline concentration <75 nmol/L.

Topics: Aged; Asian People; Calcium; China; Cholecalciferol; Dietary Supplements; Dose-Response Relationship, Drug; Female; Humans; Malaysia; Middle Aged; Osteoporosis, Postmenopausal; Sunlight; Tropical Climate; Vitamin D; Vitamin D Deficiency

Pharmacists have been involved in providing comprehensive interventions to osteoporosis patients, but pharmaceutical care issues (PCIs) encountered during such interventions have not been well documented. Therefore, the aim of this study was to document PCIs encountered by post-menopausal osteoporotic women prescribed bisphosphonates.. A randomized controlled study was conducted from September 2005-February 2009 in the University Malaya Medical Centre, Malaysia. This main intervention study measured the effects of pharmaceutical care on medication adherence, persistence, quality of life, knowledge and patient satisfaction. However, this manuscript is part of the main intervention study and focuses only on the PCIs encountered.. post-menopausal women diagnosed with osteoporosis (T-score≤-2·5/low-trauma fracture) and prescribed weekly alendronate/risedronate.. those with metabolic bone disease and could not communicate in English. The PCIs identified were collected via personal interviews or telephone calls, and each participant was followed-up for a period of 2 years. All PCIs were discussed with and confirmed by a physician.. Of the 198 participants recruited, 64 (32·3%) experienced adverse effects because of bisphosphonates whereas one participant (0·5%) refused to start bisphosphonates because of fear of adverse effects. Most adverse effects [50 (74·6%)] were reported during the first 3 months of therapy with gastrointestinal problems being the main issue [23 (11·6%)]. Of the nine participants (4·5%) who discontinued bisphosphonates, only three agreed to take another medication. From the 97 PCIs identified, 77 issues could be classified as drug-related problems [according to the Pharmaceutical Care Network Europe Classification v6·2]. There were 87 causes, 178 interventions and 77 outcomes. The main problem and cause of the PCIs encountered were adverse drug events (83·1% and 74·7% respectively), whereas the main intervention provided was patient counselling (41·0%). All problems were solved (98·5%) except for one because of the lack of cooperation of a patient. After 2 years, 36 participants (20%) were no longer persistent with therapy, 19 (10·6%) did not have clinic follow-up and 53 (26·8%) did not have a bone mineral density scan.. The main PCIs identified were related to the use of bisphosphonates and its adverse effects. The study showed that the presence of a clinical pharmacist has enabled patients to voice their medication-related issues and to allow appropriate recommendations and actions to be taken to resolve these issues.

Topics: Adult; Aged; Aged, 80 and over; Alendronate; Bone Density; Bone Density Conservation Agents; Diphosphonates; Etidronic Acid; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Medication Adherence; Middle Aged; Osteoporosis, Postmenopausal; Outcome Assessment, Health Care; Patient Satisfaction; Pharmaceutical Services; Quality of Life; Risedronic Acid

To develop and validate the Osteoporosis Patient Satisfaction Questionnaire (OPSQ) and to assess the opinion of postmenopausal osteoporotic women towards pharmaceutical care.. A 16-item instrument was designed. Each response consists of a five-point Likert-like scale with higher scores indicating greater satisfaction. The face and content validity was established via consultation with an endocrinologist and three pharmacists as well as feedback from participants in a preliminary study. Postmenopausal osteoporotic women taking bisphosphonates were recruited and randomly allocated to the intervention (n=90) and control groups (n=90). Pharmaceutical care was provided at month 2 to the intervention group while the control group received standard pharmacy services. The OPSQ was administered at month 6 (end of the intervention period), to assess patients' satisfaction. Factor analysis was performed using varimax rotation. Internal reliability was established using Cronbach's alpha. Construct validity was performed by using the Mann-Whitney U test.. The internal reliability of the OPSQ produced a Cronbach's alpha of 0.86. Factor analysis identified one component in the OPSQ, which measured patient satisfaction. The intervention group showed significantly better overall OPSQ score than the control group (91.89+/-7.22% versus 84.32+/-7.48%, p<0.001). This indicates that the OPSQ was able to differentiate between participants who received pharmaceutical care from those who did not.. The 16-item OPSQ developed in this study has high internal reliability and is a valid instrument for assessing osteoporotic women's satisfaction with pharmaceutical care service in Malaysia.

Topics: Aged; Bone Density Conservation Agents; Cohort Studies; Counseling; Female; Humans; Malaysia; Middle Aged; Osteoporosis, Postmenopausal; Outcome Assessment, Health Care; Patient Education as Topic; Patient Satisfaction; Prospective Studies; Psychometrics; Quality of Life; Reproducibility of Results; Surveys and Questionnaires; Women's Health

Dietary studies often report low calcium intake amongst post-menopausal Malaysian women and calcium deficiency has been implicated as part of the etiology of age-related bone loss leading to osteoporosis. Therefore, the objective of this study was to examine the effectiveness of high calcium skimmed milk (Anlene Gold, New Zealand Milk, Wellington, New Zealand) to reduce bone loss in Chinese postmenopausal women. Two hundred subjects aged 55-65 years and who were more than 5 years postmenopausal were randomized to a milk group and control group. The milk group consumed 50 g of high calcium skimmed milk powder daily, which contained 1200 mg calcium (taken as two glasses of milk a day). The control group continued with their usual diet. Using repeated measures ANCOVA, the milk supplement was found to significantly reduce the percentage of bone loss at the total body compared to the control group at 24 months (control -1.04%, milk -0.13%; P<0.001). At the lumbar spine, the percentage of bone loss in the control group was significantly higher (-0.90%) when compared to the milk (-0.13%) supplemented group at 24 months (P<0.05). Similarly, milk supplementation reduced the percentage of bone loss at the femoral neck (control -1.21%, milk 0.51%) (P<0.01) and total hip (control -2.17%, milk -0.50%) (P<0.01). The supplemented group did not experience any significant weight gain over the 24 months. The serum 25-hydroxy vitamin D level improved significantly (P<0.01) from 69.1 +/- 16.1 nmol/l at baseline to 86.4 +/- 22.0 nmol/l at 24 months in the milk group. In conclusion, ingestion of high calcium skimmed milk was effective in reducing the rate of bone loss at clinically important lumbar spine and hip sites in postmenopausal Chinese women in Malaysia. Supplementing with milk had additional benefits of improving the serum 25-hydroxy vitamin D status of the subjects.

Topics: Aged; Analysis of Variance; Animals; Anthropometry; Asian People; Biomarkers; Bone Density; Calcium, Dietary; Dietary Supplements; Female; Femur Neck; Humans; Lumbar Vertebrae; Malaysia; Middle Aged; Milk; Osteoporosis, Postmenopausal; Parathyroid Hormone; Patient Compliance; Vitamin D

This study evaluated the financial impact of increasing denosumab usage for managing postmenopausal osteoporosis over a 5-year period from the Malaysian healthcare provider's perspective. A gradual moderate increase in denosumab uptake would have a minimal budget impact, with potential savings in fracture treatment expenses. Optimizing denosumab usage could be a cost-effective and potentially affordable strategy to alleviate the economic burden of osteoporosis in Malaysia.. The study aimed to evaluate the budget impact of increasing the uptake of denosumab for the management of postmenopausal osteoporosis in Malaysia.. A Markov budget impact model was developed to estimate the financial impact of osteoporosis treatment. We modelled a scenario in which the uptake of denosumab would increase each year compared with a static scenario. A 5-year time horizon from the perspective of a Malaysian MOH healthcare provider was used. Model inputs were based on Malaysian sources where available. Sensitivity analyses were performed to examine the robustness of the modelled results.. An increase in denosumab uptake of 8% per year over a 5-year time horizon would result in an additional budget impact, from MYR 0.26 million (USD 0.06 million) in the first year to MYR 3.25 million (USD 0.78 million) in the fifth year. When expressed as cost per-member-per-month (PMPM), these were less than MYR 0.01 across all five years of treatment. In sensitivity analyses, the acquisition cost of denosumab and medication persistence had the largest impact on the budget.. From the perspective of a Malaysian MOH healthcare provider, moderately increasing uptake of denosumab would have a minimal additional budget impact, partially offset by savings in fracture treatment costs. Increasing the use of denosumab appears affordable to reduce the economic burden of osteoporosis in Malaysia.

Topics: Cost-Benefit Analysis; Denosumab; Female; Health Care Costs; Humans; Malaysia; Osteoporosis; Osteoporosis, Postmenopausal

Background Population screening for osteoporosis using bone mineral density scan is not feasible in Malaysia as this test is costly. Hence, there is a need to develop a more efficient method to screen for osteoporosis.Objectives To determine the feasibility of an interprofessional collaborative osteoporosis screening programme (IPC-OSP). Methods Postmenopausal women aged ≥ 50 years, who had not been diagnosed with osteoporosis were recruited from a primary care clinic from June to August 2014. Patients were assessed for their osteoporosis risk and were counselled on prevention methods. Patients at risk were referred to the doctor with a recommendation for a bone mineral density (BMD) scan. Results Fifty out of 55 patients were recruited (response rate = 90.9%). A total 26/50 (52.0%) went for a bone mineral density scan, none were osteoporotic, 17/50 (34%) were osteopenic, 2/50 (4.0%), were started on osteoporosis medications and 14/50 (28%) modified their lifestyle to improve bone health or started on calcium supplements. Osteoporosis knowledge significantly increased from baseline to month two (46.3 ± 21.4 vs. 79.1 ± 14.3, p < 0.001). Patients had a satisfaction score of 89.8 ± 12.4. Follow-up rates were 83.9% and 100% at months 1 (BMD appointment) and 2 (phone follow up), respectively. The intervention was successfully coordinated. Data entry was determined to be viable based on the researchers' experience. Conclusion The interprofessional collaborative osteoporosis screening programme was found to be feasible in Malaysia.

Topics: Aged; Feasibility Studies; Female; Follow-Up Studies; Humans; Interprofessional Relations; Intersectoral Collaboration; Malaysia; Mass Screening; Middle Aged; Osteoporosis, Postmenopausal

This study examined the relationship between reproductive characteristics and bone mineral density (BMD) in postmenopausal women who had been referred to the menopause clinics of the National Population and Family Development Board and of the Hospital Kuala Lumpur from July 2011 to January 2012. The participants of this study were 201 postmenopausal Malaysian women aged 45-71 years. Some socio-demographic, lifestyle, and reproductive factors were recorded. Calcaneal BMD was measured by quantitative ultra-sonography. Correlations of reproductive factors with BMD were assessed by Pearson's correlation test and multiple regression analysis. Age at menopause was not significantly correlated with BMD, while the years after menopause, age at the first menstrual period, number of pregnancies, and total lactation periods were inversely correlated with it. Among reproductive factors, only the association between lactation duration and BMD remained significant after adjusting for age, body mass index, activity, and calcium intake. The results indicated that except for prolonged total time of lactation, other reproductive factors were not significantly associated with BMD in postmenopausal women.

Topics: Aged; Body Mass Index; Bone Density; Breast Feeding; Cross-Sectional Studies; Female; Humans; Lactation; Malaysia; Menstruation; Middle Aged; Osteoporosis, Postmenopausal; Postmenopause; Reproductive History; Risk Factors; Ultrasonography

To develop and validate Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia.. The OPAAT was modified from the Malaysian Osteoporosis Knowledge Tool and developed from an exploratory study on patients. Face and content validity was established by an expert panel. The OPAAT consists of 30 items, categorized into three domains. A higher score indicates higher knowledge level. English speaking non-osteoporotic postmenopausal women ≥ 50 years of age and pharmacists were included in the study.. A total of 203 patients and 31 pharmacists were recruited. Factor analysis extracted three domains. Flesch reading ease was 59.2. The mean ± SD accuracy rate was 0.60 ± 0.22 (range: 0.26-0.94). The Cronbach's α for each domain ranged from 0.286-0.748. All items were highly correlated (Spearman's rho: 0.761-0.990, p < 0.05), with no significant change in the overall test-retest scores, indicating that OPAAT has achieved stable reliability. Pharmacists had higher knowledge score than patients (80.9 ± 8.7 vs 63.6 ± 17.4, p < 0.001), indicating that the OPAAT was able to discriminate between the knowledge levels of pharmacists and patients.. The OPAAT was found to be a valid and reliable instrument for assessing patient's knowledge about osteoporosis and its prevention in Malaysia. The OPAAT can be used to identify individuals in need of osteoporosis educational intervention.

Topics: Aged; Aged, 80 and over; Factor Analysis, Statistical; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Middle Aged; Osteoporosis, Postmenopausal; Psychometrics; Reproducibility of Results

A vast amount of literature describes the incidence of fracture as a risk for recurrent osteoporotic fractures in western and Asian countries. Osteoporosis evaluation and treatment after a low-trauma fracture, however, has not been well characterized in postmenopausal women in Asia. The purpose of this study was to characterize patient and health system characteristics associated with the diagnosis and management of osteoporosis among postmenopausal women hospitalized with a fragility fracture in Asia.. Patient surveys and medical charts of postmenopausal women (N=1,122) discharged after a fragility hip fracture from treatment centers in mainland China, Hong Kong, Singapore, South Korea, Malaysia, Taiwan, and Thailand between July 1, 2006 and June 30, 2007 were reviewed for bone mineral density (BMD) measurement, osteoporosis diagnosis, and osteoporosis treatment.. The mean (SD) age was 72.9 (11.5) years. A BMD measurement was reported by 28.2% of patients, 51.5% were informed that they had osteoporosis, and 33.0% received prescription medications for osteoporosis in the 6 months after discharge. Using multivariate logistic regression analyses, prior history of fracture decreased the odds of a BMD measurement (OR 0.63, 95% CI 0.45-0.88). Having a BMD measurement increased the odds of osteoporosis diagnosis (OR 10.1, 95% CI 6.36-16.0), as did having health insurance (OR 4.95, 95% CI 1.51-16.21 for private insurance with partial self-payment relative to 100% self-payment). A history of fracture was not independently associated with an osteoporosis diagnosis (OR 0.80, 95% CI 0.56-1.15). Younger age reduced the odds of receiving medication for osteoporosis (OR 0.59, 95% CI 0.36-0.96 relative to age ≥65), while having a BMD measurement increased the odds (OR 1.79, 95% CI 1.23-2.61).. Osteoporosis diagnosis and treatment in Asian countries were driven by BMD measurement but not by fracture history. Future efforts should emphasize education of general practitioners and patients about the importance of fracture.

Topics: Adult; Bone Density; China; Comorbidity; Female; Hong Kong; Humans; Logistic Models; Malaysia; Middle Aged; Odds Ratio; Osteoporosis, Postmenopausal; Osteoporotic Fractures; Postmenopause; Radiography; Republic of Korea; Retrospective Studies; Risk Factors; Singapore; Taiwan; Thailand; Women's Health

Postmenopausal estrogen deficiency often causes bone density loss and osteoporosis. This study evaluated the effects of an oral administration of oil palm leaf extract (OPL) on bone calcium content and structure, bone density, ash weights, and serum total alkaline phosphatase (T-ALP) of estrogen-deficient ovariectomized (OVX) rats.. Female Sprague-Dawley rats were divided into five experimental groups: 1) intact (normal control); 2) ovariectomized (OVX control), and OVX rats supplemented with 3) 2% (w/v) green tea (OVX + GT), 4) OPL 150 mg/kg of body weight, or 5) OPL 300 mg/kg of body weight in the drinking water.. After 3 mo, the OVX control rats had significantly decreased femur and tibia masses (-5% and -3%, respectively), ash (-15% and -10%), calcium content (-0.5% and -2.7%), and bone density and T-ALP concentrations (-40%) compared with intact rats. The catechin-rich OPL dose dependently increased the OVX bone density and structure, femur and tibia masses (by +8% and +12% respectively), ash (by +30% and +20% respectively), calcium (by +3% and +5%), and T-ALP concentrations (by +76%) compared with the OVX rats. The increases by OPL were higher than that in OVX + GT and control intact rats.. The catechin-rich OPL increased the bone mass in estrogen-deficient rats by increasing osteoblast activities to higher levels than in normal rats and those supplemented with GT. This was shown by the modulation of serum T-ALP levels, bone calcium content, total mineral content, and bone histologic structure. The OPL is a potential inexpensive ingredient for protection against osteoporosis and influences bone metabolism by encouraging bone formation.

Topics: Alkaline Phosphatase; Animals; Arecaceae; Biomarkers; Bone and Bones; Bone Density; Bone Density Conservation Agents; Calcium; Catechin; Dietary Supplements; Female; Humans; Malaysia; Osteoblasts; Osteoporosis, Postmenopausal; Ovariectomy; Phytoestrogens; Plant Extracts; Plant Leaves; Random Allocation; Rats; Rats, Sprague-Dawley

A cross-sectional study was conducted to determine bone health status and nutrient intakes among post-menopausal women residing in low cost houses in Cheras, Kuala Lumpur.. A total of 125 subjects aged 60 +/- 4 years who had attained menopause at age 50 +/- 5 years participated in this study. Subjects' weight and height were measured and calculated for body mass index (BMI). They were also assessed for bone health status using the Quantitative Ultrasound (QUS). Nutrient intake was assessed using a dietary history Questionnaire. Fasting serum lipid and blood pressure measurements were also taken.. The majority of the subjects were overweight and obese (80%) based on BMI status. Calcaneal measurements using the QUS indicated that while 57% or the subjects had normal bone mineral density, 37% were osteopenic and 6% osteoporotic. Calcium intake of the subjects was 505 +/- 263 mg /day, which is only 50% of the Malaysian Recommended Nutrient Intake for calcium (1000 mg/d). About 74% of the subjects were hypercholesterolemic and 58% were hypertriglyceridemic. Two-thirds reported that they were taking medication for hypertension, diabetes mellitus and heart disease.. The results showed low health and nutritional status among post-menopausal women living in low-cost flats in Kuala Lumpur. They have low bone mass which may be due to their predominantly non-milk based diets which places them at high risk of hip fractures. Apart from milk, other food sources of calcium, including soya bean products such as 'tempeh' and healthy ways of cooking should be recommended to older people.

Topics: Aged; Body Mass Index; Bone Density; Bone Diseases, Metabolic; Cross-Sectional Studies; Diet; Energy Intake; Female; Health Status; Humans; Lipids; Malaysia; Middle Aged; Nutritional Status; Obesity; Osteoporosis, Postmenopausal; Overweight; Postmenopause; Surveys and Questionnaires

Generic medicines are often used in public hospitals. However, data on the quality of generic alendronate, its efficacy, side-effects and medication adherence in clinical practice is scarce. Therefore, this study aimed to compare the side-effects and medication adherence of generic (apo-alendronate*) and proprietary alendronate (Fosamax†).. This prospective study involved two groups of patients: (1) postmenopausal osteoporotic women prescribed once-weekly Fosamax (proprietary group) but were switched to apo-alendronate after 2 years ('switched over' group); and (2) patients initiated with once-weekly apo-alendronate (generic group). Participants were recruited from the Osteoporosis Clinic of a tertiary hospital. Data were collected through interviews.. Side-effects and medication adherence.. A total of 131 participants were recruited: proprietary group = 64 and generic group = 67. An intergroup and a within-group comparison were made. Side-effects were reported by 6 (9.4%), 30 (44.8%) and 12 (18.8%) participants in the proprietary, generic and 'switched over' groups, respectively. Participants who were on generic alendronate were at a significantly higher risk of experiencing side-effects compared to those who were taking proprietary alendronate [odds ratio (OR):7.84 (95% CI: 2.98-20.65), p < 0.001]. However, no significant statistical difference was found between the 'switched over' and the proprietary group [OR: 2.23 (95% CI: 0.78-6.37), p = 0.127]. Four out of 12 (33.3%) patients who experienced side-effects immediately after switching to generic alendronate discontinued generic alendronate due to intolerable gastrointestinal side-effects. There was no difference in medication adherence to generic or proprietary alendronate.. Medication adherence to both generic and proprietary alendronate appeared similar although patients who were taking generic alendronate* were significantly more likely to experience side-effects than those on proprietary alendronate. Therefore, the switch from proprietary alendronate to the generic forms should not only consider the cost of the products but must also ensure that the generic and proprietary alendronate are equivalent in all aspects of efficacy and safety.

Topics: Aged; Aged, 80 and over; Alendronate; Bone Density Conservation Agents; Data Collection; Drug Substitution; Female; Humans; Interviews as Topic; Malaysia; Mandatory Programs; Medication Adherence; Middle Aged; Osteoporosis, Postmenopausal; Patient Compliance

Postmenopausal osteoporosis is mainly treated with estrogen replacement therapy (ERT). However, ERT causes side effects, mainly breast cancer, uterine cancer and thromboembolic problems. Labisia pumila var. arata (LPva), a herb with phytoestrogenic effects has the potential to be used as an alternative agent to ERT. This study was conducted to determine the effects of LPva on bone biochemical markers and bone calcium content in ovariectomised rats.. Thirty two Wistar rats were divided into 4 groups, with 8 rats in each group. The first group was sham operated (Sham), the second group was ovariectomised (OVX), the third (LPva) and fourth group (ERT) were also ovariectomised and given LPva 17.5 mg/kg and Premarin(®) 64.5 μg/kg, respectively. Blood samples were taken before and after treatment to measure osteocalcin and C-terminal telopeptide of type 1 collagen levels using ELISA while the fifth lumbar bone samples were taken to measure bone calcium content using the Atomic Absorption Spectrophotometer (AAS).. The osteocalcin levels were significantly higher in both the LPva and ERT groups compared to the OVX group. The CTX levels were significantly lower in both the LPva and ERT groups compared to the OVX group. However, only the ERT group had significantly higher bone calcium level compared to the OVX group.. The supplementation of 17.5 mg/kg of LPva to ovariectomised rats for 8 weeks was able to prevent the changes in bone biochemical markers but failed to prevent the bone calcium loss induced by ovariectomy.

Topics: Animals; Biomarkers; Bone and Bones; Calcium; Disease Models, Animal; Ethnopharmacology; Female; Humans; Malaysia; Medicine, East Asian Traditional; Osteoporosis, Postmenopausal; Phytotherapy; Plant Extracts; Plants, Medicinal; Primulaceae; Rats; Rats, Wistar

Osteoporotic fracture is a major health burden. Early diagnosis and management would improve the quality of life and reduce costs to the society.. We aimed to identify risk factors associated with osteoporosis followed by development and validation of a screening tool in the hope of providing an appropriate regime to detect low bone density (BMD) in Malaysia.. Between November 1999 and November 2002, 514 healthy women aged ≥ 45 with intact uterus, non-HRT users were recruited. Following BMD testing, a screening tool was developed. For validation, 72 women were recruited from June 2003 to December 2003.. Age and a longer duration postmenopause were negatively linked to BMD. Higher family income, BMI, waist and hip circumference were positively correlated. A score of ≥ 4, the screening tool had a sensitivity of 73.2%, a specificity of 61.6% for identifying women with low BMD (T score ≤ -2) plus a sensitivity of 80.2% in selecting women with osteoporosis. The tool enabled a 45.9% reduction in unnecessary DEXA testing. Validation of the screening tool showed a negative predictive value of 97.8%, sensitivity and specificity of 87.5% and 70.3%, respectively.. The Malaysian Osteoporosis Screening Tool (MOST) is relatively simple. Its usage may reduce unnecessary DEXA test.

Topics: Absorptiometry, Photon; Age Factors; Body Mass Index; Body Weights and Measures; Bone Density; Early Diagnosis; Female; Humans; Income; Malaysia; Mass Screening; Middle Aged; Osteoporosis; Osteoporosis, Postmenopausal; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Waist Circumference; Waist-Hip Ratio

To design a valid and reliable questionnaire, the Malaysian Osteoporosis Knowledge Tool (MOKT), to assess the knowledge of postmenopausal osteoporotic women in Malaysia, on osteoporosis and its treatment.. A 40-item instrument was designed and tested in this study. The scores ranged from 1 to 40, which were then converted into percentage. This was administered to 88 postmenopausal osteoporotic women who were taking alendronate (patient group) and 43 pharmacists (professional group). The MOKT was administered again to the patient group after 1 month.. Flesch reading ease was 57, which is satisfactory, while the mean difficulty factor+/-S.D. was 0.73+/-0.25, indicating that the MOKT is moderately easy. Internal consistency of the instrument was good with Cronbach's alpha=0.82. The test and retest scores showed no significant difference for 38 out of the 40 items, indicating that the questionnaire has achieved a stable reliability. Level of knowledge on osteoporosis and its treatment was good with a mean score+/-S.D. of 69.0+/-13.9 and 81.6+/-9.5 in the patient and professional group, respectively. The difference in knowledge scores between the two groups was statistically significant (p<0.001).. In conclusion, the 40-item questionnaire (MOKT) is a reliable and valid instrument for measuring knowledge on osteoporosis in the Malaysian setting. Therefore, it can be used to identify individuals in need of educational interventions and to assess the effectiveness of education efforts as part of osteoporosis management.

Topics: Aged; Aged, 80 and over; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Middle Aged; Osteoporosis, Postmenopausal; Psychometrics; Surveys and Questionnaires

The aim of this study was to identify risk factors associated with osteoporosis in urban midlife Malaysian women and to assess the effectiveness of lifestyle intervention in bone loss prevention with hormone replacement therapy (HRT) as a positive control. A total of 514 disease-free, uterus-intact, non-HRT-using women aged 45 years and older were recruited into the study. After initial bone mineral density (BMD) assessments, they were randomized into three groups: GI (control), G2 (lifestyle intervention), and G3 (lifestyle intervention with HRT). The study group was composed of 67.5% Chinese, 27.8% Malay, and 4.2% Indians with a mean age of 51.07+/-5.28 years. Two-fifths were postmenopausal, and the prevalence of osteoporosis was 24.1%, seen predominantly at the hip. Postmenopausal women had significantly lower mean BMD and a higher incidence of osteoporosis compared with the premenopausal women, 42.1% vs. 11.1% (p<0.0005). A lower incidence of osteoporosis was found in women who took calcium supplementation regularly as opposed to those who do not, 18.7% vs. 29.3% (p=0.036). Age and a greater postmenopausal duration showed a significant negative association with BMD, whereas higher family income, weight, body mass index, and waist and hip circumference were positively correlated. After 18-20 months, the effect of intervention was assessed based on BMD values of 279 women at baseline and after intervention. Lifestyle intervention alone was effective in premenopausal women, preventing over 90% of spinal bone loss compared with the controls, who lost 11.6% (0.046 g/cm2) bone mass with similar losses of hip bone, 2.0% (0.026 g/cm2) vs. 1.5% (0.020 g/cm2). Premenopausal women on HRT also showed a substantial decrease in spine and hip BMD, 18.6% (0.081 g/cm2) and 9.0% (0.122 g/cm2), respectively. The lifestyle intervention program retarded postmenopausal bone loss by 21% and 37% compared with controls, who lost 9.6% (0.141 g/cm2) and 6.0% (0.138 g/cm2) bone mass at the spine and hip. In comparison, lifestyle intervention with HRT increased postmenopausal BMD by 12.7% (0.216 g/cm2) at the spine and 1.9% (0.042 g/cm2) at the hip. The changes in hip BMD were influenced by current age, ethnicity, and income, while intervention had the strongest effect on spine BMD changes. In conclusion, lifestyle intervention prevented spinal bone loss in premenopausal women and retarded postmenopausal spine and hip bone loss compared with controls. The benefits of physical act

Topics: Adult; Age Distribution; Body Size; Bone Density; Calcium, Dietary; Dietary Supplements; Female; Hip; Hormone Replacement Therapy; Humans; Incidence; Life Style; Malaysia; Middle Aged; Osteoporosis; Osteoporosis, Postmenopausal; Perimenopause; Risk Factors; Spine; Treatment Outcome; Urban Health