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Cited by 2,262Bone health and osteoporosis researchBone Metabolism and DiseasesMenopause: Health Impacts and Treatments

An overview and management of osteoporosis

Open access
Sözen, Tümay, Özışık, Lale, Çalık Başaran, Nursel·2019·European Journal of Rheumatology
DOI 10.5152/eurjrheum.2016.048PMC PMC5335887
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Abstract

Abstract Osteoporosis -related to various factors including menopause and aging- is the most common chronic metabolic bone disease, which is characterized by increased bone fragility. Although it is seen in all age groups, gender, and races, it is more common in Caucasians (white race), older people, and women. With an aging population and longer life span, osteoporosis is increasingly becoming a global epidemic. Currently, it has been estimated that more than 200 million people are suffering from osteoporosis. According to recent statistics from the International Osteoporosis Foundation, worldwide, 1 in 3 women over the age of 50 years and 1 in 5 men will experience osteoporotic fractures in their lifetime. Every fracture is a sign of another impending one. Osteoporosis has no clinical manifestations until there is a fracture. Fractures cause important morbidity; in men, in particular, they can cause mortality. Moreover, osteoporosis results in a decreased quality of life, increased disability-adjusted life span, and big financial burden to health insurance systems of countries that are responsible for the care of such patients. With an early diagnosis of this disease before fractures occur and by assessing the bone mineral density and with early treatment, osteoporosis can be prevented. Therefore, increasing awareness among doctors, which, in turn, facilitates increase awareness of the normal populace, will be effective in preventing this epidemic.

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Cites

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Claims the paper makes

0 of 38 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Senile osteoporosis (Type II) is related to bone mass lost due to aging of cortical and trabecular bones.

    “It is also called senile osteoporosis, and it is related to bone mass lost due to the aging of cortical and trabecular bones (2, 9).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [2] 2. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician's guide to prevention and treatment of osteoporosis. Os- teoporos Int 2014; 25: 2359-81. [CrossRef]

      Not checked in the free run.

    • cites [9] 9. Hannan MT, Felson DT, Dawson-Hughes B, Tuck- er KL, Cupples LA, Wilson PW, et al. Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res 2000; 15: 710-20. [CrossRef]

      Not checked in the free run.

  • Premisecitation

    Fractures result when weakened bone is overloaded, often by falls or daily chores.

    “Fractures result when weakened bone is overloaded, often by falls or certain daily chores (8).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] 8. Riggs BL, Wahner HW, Seeman E, Offord KP, Dunn WL, Mazess RB, et al. Changes in bone mineral density of the proximal femur and spine with aging. Differences between the postmenopausal and senile osteoporosis syndromes. J Clin Invest 1982; 70: 716-23. [CrossRef]

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  • Premisecitation

    Falls are the precipitating cause for most osteoporotic fractures.

    “Falls are the precipitating cause for most osteoporotic fractures; some measures should be taken to prevent falls in the household, particularly for patients who are frail, taking some medications that affect mental alertness, thereby resulting in a stroke (40) (Table 3).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] 40. Robertson MC, Campbell AJ, Gardner MM, Devlin N. Preventing injuries in older people by preventing falls: a meta-analysis of individu- al-level data. J Am Geriatr Soc 2002; 50: 905-11. [CrossRef]

      Not checked in the free run.

  • Premisecitation

    Osteoporosis has no clinical manifestations until a fracture occurs.

    “It is a silent disease until fractures occur, which causes important secondary health problems and even death (Figure 1) (2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] 2. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician's guide to prevention and treatment of osteoporosis. Os- teoporos Int 2014; 25: 2359-81. [CrossRef]

      Not checked in the free run.

  • Premisecitation

    Secondary osteoporosis can be caused by different diseases, medications, and lifestyle changes.

    “Different diseases, medications, and lifestyle changes can cause osteoporosis (Table 1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Table 1

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  • May combine two claims. 24
  • Classified as probably not a substantial claim. 12

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    Interpretationreasoning

    With early diagnosis before fractures, assessment of bone mineral density, and early treatment, osteoporosis can be prevented.

    “With an early diagnosis of this disease before fractures occur and by assessing the bone mineral density and with early treatment, osteoporosis can be prevented.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Worldwide, 1 in 3 women over 50 and 1 in 5 men will experience an osteoporotic fracture in their lifetime.

    “According to recent statistics from the International Osteoporosis Foundation, worldwide, 1 in 3 women over the age of 50 years and 1 in 5 men will experience osteoporotic fractures in their lifetime.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites International Osteoporosis Foundation

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Osteoporosis is a disease marked by low bone mass, deterioration of bone tissue, disruption of bone microarchitecture, compromised bone strength, and increased fracture risk.

    “Osteoporosis is a disease that is characterized by low bone mass, deterioration of bone tissue, and disruption of bone microarchitecture: it can lead to compromised bone strength and an increase in the risk of fractures (1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] 1. NIH Consensus Development Panel on Osteo- porosis Prevention, Diagnosis, and Therapy. Os- teoporosis prevention, diagnosis, and therapy. JAMA 2001; 285: 785-95.

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Osteopenia or low bone mass is defined as a T-score between -1 and -2.5 SD.

    “A second, higher threshold describes “low bone mass” or osteopenia as a T-score that lies between -1 and -2.5 SD.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] 26. Kanis JA on behalf of the World Health Orga- nization Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Dis- eases, University of Sheffield, UK. 2007.

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Severe or established osteoporosis denotes osteoporosis with one or more documented fragility fractures.

    ““Severe” or “established” osteoporosis denotes osteoporosis that has been defined in the presence of one or more documented fragility fractures (Table 4) (26).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] 26. Kanis JA on behalf of the World Health Orga- nization Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Dis- eases, University of Sheffield, UK. 2007.

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  • May combine two claims.

    Premisecitation

    Vertebral fractures can occur during daily chores without trauma or fall and predict future fracture risk: fivefold for subsequent vertebral fractures and twofold to threefold for fractures at other sites.

    “Vertebral fractures might occur during daily chores without any trauma or fall, and they are the predictors of future fracture risk: the probability is fivefold for subsequent vertebral fractures and twofold to threefold for fractures at other sites (14,15).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [14] 14. Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, et al. Frailty and risk of falls, frac- ture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 2007; 62: 744-51. [CrossRef]

      Not checked in the free run.

    • cites [15] 15. Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone 2004; 35: 375-82. [CrossRef]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Postmenopausal osteoporosis (Type I) is caused by estrogen deficiency and mainly affects trabecular bone; women are more susceptible than men, with a men/women ratio of 4/5.7.

    “It is also known as postmenopausal osteoporosis, caused by the deficiency of estrogen, mainly affecting the trabecular bone; therefore, women are more susceptible to osteoporosis than men, as evident by a men/women ratio of 4/5.7 (2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] 2. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician's guide to prevention and treatment of osteoporosis. Os- teoporos Int 2014; 25: 2359-81. [CrossRef]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Worldwide, more than 200 million patients have osteoporotic hip fractures.

    “It was estimated that the number of patients worldwide with osteoporotic hip fractures is more than 200 million (3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] 3. Cooper C, Campion G, Melton LJ 3rd. Hip frac- tures in the elderly: a world-wide projection. Osteoporos Int 1992; 2: 285-9. [CrossRef]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    WHO defines osteoporosis as BMD 2.5 SD or more below the average value for young healthy women (T-score < -2.5).

    “As defined by the World Health Organization (WHO), osteoporosis is present when BMD is 2.5 SD or more below the average value for young healthy women (a T-score of <-2.5 SD).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] 26. Kanis JA on behalf of the World Health Orga- nization Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Dis- eases, University of Sheffield, UK. 2007.

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Approximately 20-50% of hip fracture patients require long-term nursing home care and suffer decreased quality of life, social isolation, depression, and loss of self-esteem.

    “Approximately 20-50% hip fracture patients require long-term nursing homecare and suffer from decreased quality of life, social isolation, depression, and loss of self-esteem (12).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] 12. Melton LJ 3rd, Achenbach SJ, Atkinson EJ, Ther- neau TM, Amin S. Long-term mortality follow- ing fractures at different skeletal sites: a popula- tion-based cohort study. Osteoporos Int 2013; 24: 1689-96. [CrossRef]

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    Ibandronate reduces vertebral and non-vertebral fracture risk but has no effect on hip fracture.

    “Ibandronat demonstrated | Yes | Yes | No effect”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Zoledronic acid reduces the risk of vertebral, non-vertebral, and hip fractures.

    “Zolendronic Acid | Yes | Yes | Yes”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Raloxifene raises the incidence of hot flushes and is contraindicated in fertile women and in those with a history of venous thromboembolic disease.

    “Increases in hot flushes are contraindicated in fertile women and those who have had venous thromboembolic disease (46).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] 46. Siris ES, Harris ST, Eastell R, Zanchetta JR, Goe- maere S, Diez-Perez A, et al. Skeletal effects of raloxifene after 8 years: results from the continu- ing outcomes relevant to Evista (Core) study. J Bone Miner Res 2005; 20: 1514-24. [CrossRef]

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    Premisecitation

    Ibandronate has been studied in trials up to 3 years, and its efficacy and safety beyond 3 years are unknown.

    “Ibandronate has been studied in trials of up to 3 years and its efficacy and safety beyond 3 years is not known (43).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] 43. Chesnut CH 3rd, Skag A, Christiansen C, Recker R, Stakkestad JA, Hoiseth A, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 2004; 19: 1241-9. [CrossRef]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The IOM recommends 600 IU/day of vitamin D until age 70 and 800 IU/day thereafter.

    “The IOM recommends a dose of 600 IU/ day until the age of 70 years in adults and 800 IU/day thereafter (34)(35)(36).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites (34)(35)(36)

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    Premisecitation

    Raloxifene lowers the risk of vertebral fractures in women with postmenopausal osteoporosis, but it has not been shown to reduce non-vertebral or hip fractures.

    “Raloxifene has been shown to reduce the risk of fractures of the spine in women with postmenopausal osteoporosis, but its efficacy in reducing non-vertebral or hip fractures has not been demonstrated.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] 46. Siris ES, Harris ST, Eastell R, Zanchetta JR, Goe- maere S, Diez-Perez A, et al. Skeletal effects of raloxifene after 8 years: results from the continu- ing outcomes relevant to Evista (Core) study. J Bone Miner Res 2005; 20: 1514-24. [CrossRef]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Strontium ranelate has not been approved by the FDA, but the European Medicines Agency approved it for treating osteoporosis in men with increased fracture risk.

    “Although SR has not been approved by the FDA, it was approved by the European Medicines Agency (EMA) in the treatment of osteoporosis in men with an increased risk of fracture.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] 48. Committee for Medicinal Products for Human Use. Summary of opinion (post authorisation): treatment of osteoporosis in men at increased risk of fracture. European Medicines Agency Website. http://www.ema.europa.eu/docs/ en_GB/document_library/Summary_of_opin- ion/human/000560/WC500127765.pdf. Pub- lished May 24, 2012. Accessed June 12, 2012.

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Alendronate reduces the risk of vertebral, non-vertebral, and hip fractures.

    “Alendronate | Yes | Yes | Yes”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The IOM recommends a daily calcium intake of 1000 mg/day for men aged 50-70 and 1200 mg for women over 50 and men over 70.

    “The Institute of Medicine (IOM) recommends a daily intake of 1000 mg/ day for men aged 50-70 years and 1200 mg of calcium for women aged over 50 years and men aged over 70 years (33,34).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [33] 33. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Cal- cium; Ross AC, Taylor CL, Yaktine AL, et al., edi- tors. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Acade- mies Press (US); 2011. Available from: http:// www.ncbi.nlm.nih.gov/books/NBK56070/ doi: 10.17226/13050. [CrossRef]

      Not checked in the free run.

    • cites [34] 34. Moyer VA. Vitamin D and calcium supplemen- tation to prevent fractures in adults: U.S. Pre- ventive Services Task Force recommendation statement. Ann Intern Med 2013; 158: 691-6. [CrossRef]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Among older patients, exercise helps slow bone loss from disuse, improve balance, and increase muscle strength, ultimately reducing fall risk.

    “Among older patients, these exercises help slow bone loss attributable to disuse, improve balance, and increase muscle strength, ultimately reducing the risk of falls (39).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] 39. Kelley GA, Kelley KS, Tran ZV. Exercise and lum- bar spine bone mineral density in postmeno- pausal women: a meta-analysis of individual patient data. J Gerontol A Biol Sci Med Sci 2002; 57: M599-604. [CrossRef]

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    Teriparatide reduces vertebral and non-vertebral fracture risk but has no effect on hip fracture.

    “Teriparatid demonstrated | Yes | Yes | No effect”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Bisphosphonates may lead to musculoskeletal pain, osteonecrosis of the jaw, and alendronate may cause atypical fractures.

    “BPs have been reported to cause bone, joint, or muscle complaints; osteonecrosis of the jaw (ONJ); and alendronate causing atypical fractures (45).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] 45. Shane E, Burr D, Ebeling PR, Abrahamsen B, Ad- ler RA, Brown TD, et al. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2010; 25: 2267-94. [CrossRef]

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    Raloxifene reduces vertebral and non-vertebral fracture risk but has no effect on hip fracture.

    “Raloxifene demonstrated | Yes | Yes | No effect”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Ibandronate has proven efficacy in reducing spinal fractures in postmenopausal women with osteoporosis, but is not proven to reduce non-vertebral or hip fractures except in a higher-risk subgroup.

    “Ibandronate is another BP used for the prevention and treatment of postmenopausal osteoporosis, which has proven efficacy in reducing the risk of spinal fractures of postmenopausal women suffering from osteoporosis, but it is not proven in reducing non-vertebral or hip fractures except for higher-risk subgroup.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] 43. Chesnut CH 3rd, Skag A, Christiansen C, Recker R, Stakkestad JA, Hoiseth A, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 2004; 19: 1241-9. [CrossRef]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Denosumab lowers the risk of vertebral, hip, and non-vertebral fractures.

    “It has been shown to reduce the risk of fractures of the spine, hip, and non-vertebral sites.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] 49. -See more at: http://press.endocrine.org/doi/ full/10.1210/jc.2012-3048#sthash.M7MrgBEV. dpuf.

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Risedronate reduces the risk of vertebral, non-vertebral, and hip fractures.

    “Risedronate | Yes | Yes | Yes”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    ISCD recommends using ethnic- or race-adjusted Z-scores: Z-scores of -2.0 or lower are low bone mineral density for chronological age, and those above -2.0 are within the expected range for age.

    “The International Society for Clinical Densitometry (ISCD) recommends using ethnic-or race-adjusted Z-scores: Z-scores of -2.0 or lower are defined as “low bone mineral density for chronological age” or “below the expected range for age” and those above -2.0 are defined as “within the expected range for age” (28).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] 28. Schousboe JT SJ, Bilezikian JP, Baim S. Executive Summary of the 2013 ISCD Position Develop- ment Conference on Bone Densitometry. J Clin Densitom 2013; 16: 455-66. [CrossRef]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Serum calcium, parathyroid hormone, and 25-hydroxyvitamin D levels should be checked before starting teriparatide.

    “Serum calcium, PTH, and 25 (OH) D levels should be checked before treatment (50).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] 50. Bone HG, Chapurlat R, Brandi ML, Brown JP, Czerwinski E, Krieg MA, et al. The effect of three or six years of denosumab exposure in wom- en with postmenopausal osteoporosis: results from the freedom extension. J Clin Endocrinol Metab 2013; 98: 4483-92. [CrossRef]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Strontium ranelate raises bone mineral density and lowers fracture risk among postmenopausal women and men with osteoporosis.

    “It was demonstrated that SR increases BMD and reduces fracture risk in postmenopausal women and in men with osteoporosis.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [47] 47. Seeman E. Strontium ranelate: vertebral and non-vertebral fracture risk reduction. Curr Opin Rheumatol 2006; 18 (Suppl 1): S17-20. [CrossRef]

      Not checked in the free run.

    • cites [48] 48. Committee for Medicinal Products for Human Use. Summary of opinion (post authorisation): treatment of osteoporosis in men at increased risk of fracture. European Medicines Agency Website. http://www.ema.europa.eu/docs/ en_GB/document_library/Summary_of_opin- ion/human/000560/WC500127765.pdf. Pub- lished May 24, 2012. Accessed June 12, 2012.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Osteoporosis is preventable and treatable, but because there are no warning signs before fracture, many people are not diagnosed in time to receive effective therapy during the early phase.

    “Osteoporosis is preventable and treatable, but because there are no warning signs prior to a fracture, many people are not being diagnosed in time to receive effective therapy during the early phase of this disease.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The IOF/IFCC working group recommended bone formation marker s-PINP and bone resorption marker s-CTX as reference markers, measured by standardized assays in observational and intervention studies.

    “it was recommended that bone formation markers (s-PINP) and bone resorption markers (s-CTX) should be used as reference markers and measured by standardized assays in observational and intervention studies (31).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] 31. Vasikaran S, Eastell R, Bruyere O, Foldes AJ, Gar- nero P, Griesmacher A, et al. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteopo- ros Int 2011; 22: 391-420. [CrossRef]

      Not checked in the free run.

31 of 31

  • The paper relies on this without support.

    Osteoporosis is more common in Caucasians, women, and older people.

    “It is more common in Caucasians, women, and older people.”

  • The paper relies on this without support.

    Fracture risk is closely correlated with bone strength and increases exponentially as BMD decreases.

    “Fracture risk is closely correlated with bone strength and increases exponentially as the BMD decreases.”

  • The paper relies on this without support.

    DXA measurements of hips are the best predictors of hip fracture risk.

    “Dual energy X-ray absorptiometry (DXA) measurements of hips are the best predictors of hip fracture risks.”

  • The paper relies on this without support.

    No evidence shows that combining two or more osteoporosis drugs or using them sequentially improves the natural history of osteoporosis or reduces fracture risk.

    “There is no evidence showing that a combination treatment with 2 or more osteoporosis drugs or sequential use of therapeutically agents shows any benefit on the natural history of osteoporosis or fracture risk reduction.”

  • The paper relies on this without support.

    The beneficial effects of osteoporosis drugs other than bisphosphonates diminish soon after treatment stops, while bisphosphonate effects may persist longer after cessation.

    “The beneficial effects of treatment with drugs other than BPs wear off soon after the therapy is discontinued, but they may be maintained for longer periods of time after the cessation of BP therapy.”

  • The paper relies on this without support.

    Osteoporosis often remains asymptomatic and widespread until fractures, which are frequent, occur.

    “Osteoporosis is a common and silent disease until it is complicated by fractures that become common.”

  • The paper relies on this without support.

    An estimated 50% of women and 20% of men over age 50 will experience an osteoporosis-related fracture in their remaining lifetime.

    “It was estimated that 50% women and 20% of men over the age of 50 years will have an osteoporosis-related fracture in their remaining life.”

  • The paper relies on this without support.

    Osteoporotic fractures lead to long-term disability, reduced quality of life, and higher mortality, imposing substantial medical and personal costs.

    “These fractures are responsible for lasting disability, impaired quality of life, and increased mortality, with enormous medical and heavy personnel burden on both the patient's and nation's economy.”
8 of 8

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The FRAX is the most commonly used algorithm in the US for estimating future fracture risk.

    “The most commonly used algorithm in the US is the Fracture Risk Assessment Tool (FRAX).”

    From Osteoporosis: Molecular Pathology, Diagnostics, and Therapeutics (2023) · cites this paper as [14]

    The “Fracture Risk Assessment Tool Model (FRAX)” section describes FRAX as an algorithm for estimating 10-year fracture risk. It does not say that FRAX is the most commonly used such algorithm in the US; that comparative claim is unsupported by our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Femoral neck is recommended by the World Health Organization (WHO) to determine the fragility fracture risk associated T-score and to diagnose osteoporosis in clinical practice.

    “Femoral neck was chosen between other weight-bearing bones because it is the recommended by the World Health Organization (WHO) [25] to determine the fragility fracture risk associated T-score, as well as to diagnose osteoporosis in clinical practice [18].”

    From A human mission to Mars: Predicting the bone mineral density loss of astronauts (2020) · cites this paper as [25]

  • In the U.S. and Europe, 40% of post-menopausal women and 30% of men will experience osteoporotic fractures.

    “In the U.S. and Europe, it has been reported that 30% of women have osteoporosis, and that 40% of post-menopausal women and 30% of men will experience osteoporotic fractures [25].”

    From The Utility of Body Composition Assessment in Nutrition and Clinical Practice: An Overview of Current Methodology (2021) · cites this paper as [25]

  • In the U.S. and Europe, 30% of women have osteoporosis.

    “In the U.S. and Europe, it has been reported that 30% of women have osteoporosis, and that 40% of post-menopausal women and 30% of men will experience osteoporotic fractures [25].”

    From The Utility of Body Composition Assessment in Nutrition and Clinical Practice: An Overview of Current Methodology (2021) · cites this paper as [25]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Denosumab omitted from the stated list of drugs that prevent hip fractures

    Major

    The text says only four named antiresorptive agents reduce both vertebral and hip fractures, excluding denosumab. Later, it explicitly says denosumab reduces hip fractures.

  • Conflicting lifetime fracture estimates for women over 50

    Minor

    The abstract estimates that one in three women over 50 will have an osteoporotic fracture, while the conclusion gives 50% for women over 50. These are different estimates for the same stated population and outcome.

  • Osteoporosis threshold excludes and includes a T-score of −2.5

    Minor

    "2.5 SD or more below" includes a T-score exactly equal to −2.5, but the parenthetical threshold of <−2.5 excludes it.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. [11]11. Cooper C, Melton LJ 3rd. Epidemiology of os- teoporosis. Trends Endocrinol Metab 1992; 3: 224-9. [CrossRef]
  2. [28]28. Schousboe JT SJ, Bilezikian JP, Baim S. Executive Summary of the 2013 ISCD Position Develop- ment Conference on Bone Densitometry. J Clin Densitom 2013; 16: 455-66. [CrossRef]

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Authors
Sözen, T., Özışık, L., & Çalık Başaran, N.
Affiliations
  • Near East University (CY)
  • Hacettepe University (TR)
ORCID
Venue
European Journal of Rheumatology
Publisher
AVES YAYINCILIK A.Ş.
Published
2019-09-03
Volume
4
Issue
1
Pages
46-56
ISSN
  • 2147-9720 (ISSN-L)
  • 2148-4279
DOI
10.5152/eurjrheum.2016.048
PMC
PMC5335887
OpenAlex
W2559809466
Cited by
2,262
References
59
Citations by year
2026: 175 · 2025: 324 · 2024: 406 · 2023: 368 · 2022: 331 · 2021: 306 · 2020: 199 · 2019: 110 · 2018: 37 · 2017: 4
FWCI
8.00
Type
journal article
Language
en
Open access
Locations
  • European Journal of Rheumatology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Keywords
osteoporosis, osteoporotic fractures, bone fragility, menopause, aging, bone mineral density, fracture risk, osteoporosis prevention, early diagnosis, quality of life, health care costs, awareness

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-30.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-30.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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