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      Prediction of musculoskeletal pain after the first intravenous zoledronic acid injection in patients with primary osteoporosis: development and evaluation of a new nomogram

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          Abstract

          Objective

          To construct a new prediction nomogram to predict the risk of musculoskeletal pain in patients with primary osteoporosis who receive zoledronic acid intravenously for the first time.

          Method

          Clinical data of 368 patients with primary osteoporosis who received the first intravenous injection of zoledronic acid in our hospital from December 2019 to December 2022 were studied. Patients were divided into a musculoskeletal pain group (n = 258) and a non-musculoskeletal pain group (n = 110) based on the presence or absence of musculoskeletal pain 3 days after injection. Statistically significant predictors were screened by logistic regression analysis and the minimum absolute contraction and selection operator (LASSO) to construct a nomogram. The nomogram was evaluated by the receiver operating characteristic (ROC) curve, the calibration curve, the C-index, and the decision curve analysis (DCA) and verified in a validation cohort.

          Results

          The independent predictors of the nomogram were age, serum 25-hydroxyvitamin D, NSAIDs, prior Vitamin D intake, and BMI. The area under the ROC curve (AUC) was 0.980 (95% CI, 0.915–0.987), showing excellent predictive performance. The nomogram c index was 0.980, and the nomogram c index for internal verification remained high at 0.979. Moreover, calibration curves show that the nomogram has good consistency. Finally, the DCA showed that the net benefit of the nomogram was 0.20–0.49.

          Conclusion

          Musculoskeletal pain is a common symptom of APR in OP patients treated with intravenous zoledronic acid. Risk factors for musculoskeletal pain after zoledronic acid injection in OP patients were: non-use of NSAIDs, youth (<80 years old), serum 25 (OH) D<30ng /mL, no prior intake of vitamin D, BMI<24 kg /m 2. A nomogram constructed from the above predictors can be used to predict musculoskeletal pain after the first zoledronic acid injection.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12891-023-06965-y.

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          Most cited references21

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          Clinical Practice. Postmenopausal Osteoporosis.

          Caren G. Solomon, Dennis M. Black, Clifford Rosen (2016)
          Key Clinical Points Postmenopausal Osteoporosis Fractures and osteoporosis are common, particularly among older women, and hip fractures can be devastating. Treatment is generally recommended in postmenopausal women who have a bone mineral density T score of -2.5 or less, a history of spine or hip fracture, or a Fracture Risk Assessment Tool (FRAX) score indicating increased fracture risk. Bisphosphonates (generic) and denosumab reduce the risk of hip, nonvertebral, and vertebral fractures; bisphosphonates are commonly used as first-line treatment in women who do not have contraindications. Teriparatide reduces the risk of nonvertebral and vertebral fractures. Osteonecrosis of the jaw and atypical femur fractures have been reported with treatment but are rare. The benefit-to-risk ratio for osteoporosis treatment is strongly positive for most women with osteoporosis. Because benefits are retained after discontinuation of alendronate or zoledronic acid, drug holidays after 5 years of alendronate therapy or 3 years of zoledronic acid therapy may be considered for patients at lower risk for fracture.
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            Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Synopsis of a WHO report

            J Kanis (1994)
            Article 0 comments Cited 185 times – based on 0 reviews     Review now
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              Prevalence of Osteoporosis and Fracture in China : The China Osteoporosis Prevalence Study

              Linhong Wang, Wei Yu, Xiangjun Yin … (2021)
              This cross-sectional study evaluates the prevalence of and factors associated with osteoporosis, clinical fractures, and vertebral fractures among adults 40 years or older in mainland China by sex, age group, and urban vs rural residence. Question What is the prevalence of osteoporosis and clinical and vertebral fracture in the adult population of mainland China? Findings In this cross-sectional study of 20 416 individuals, the prevalence of osteoporosis among adults 40 years or older was 5.0% among men and 20.6% among women, and the prevalence of vertebral fracture was 10.5% among men and 9.7% among women. Meaning These findings suggest that recommendations for screening and treatment of fractures should include both men and women in China. Importance The aging of the population is associated with an increasing burden of fractures worldwide. However, the epidemiological features of fractures in mainland China are not well known. Objective To assess the prevalence of and factors associated with osteoporosis, clinical fractures, and vertebral fractures in an adult population 40 years or older in mainland China. Design, Setting. and Participants This cross-sectional study, the China Osteoporosis Prevalence Study, was conducted from December 2017 to August 2018. A random sample of individuals aged 20 years or older who represented urban and rural areas of China were enrolled, with a 99% participation rate. Main Outcomes and Measures Weighted prevalence of osteoporosis, clinical fracture, and vertebral fracture by age, sex, and urban vs rural residence as determined by x-ray absorptiometry, questionnaire, and radiography. Results A total of 20 416 participants were included in this study; 20 164 (98.8%; 11 443 women [56.7%]; mean [SD] age, 53 [13] years) had a qualified x-ray absorptiometry image and completed the questionnaire, and 8423 of 8800 (95.7%) had a qualified spine radiograph. The prevalence of osteoporosis among those aged 40 years or older was 5.0% (95% CI, 4.2%-5.8%) among men and 20.6% (95% CI, 19.3%-22.0%) among women. The prevalence of vertebral fracture was 10.5% (95% CI, 9.0%-12.0%) among men and 9.7% (95% CI, 8.2%-11.1%) among women. The prevalence of clinical fracture in the past 5 years was 4.1% (95% CI, 3.3%-4.9%) among men and 4.2% (95% CI, 3.6%-4.7%) among women. Among men and women, 0.3% (95% CI, 0.0%-0.7%) and 1.4% (95% CI, 0.8%-2.0%), respectively, with osteoporosis diagnosed on the basis of bone mineral density or with fracture were receiving antiosteoporosis treatment to prevent fracture. Conclusions and Relevance In this cross-sectional study of an adult population in mainland China, the prevalence of osteoporosis and vertebral fracture were high and the prevalence of vertebral fracture and clinical fracture was similarly high in men and women. These findings suggest that current guidelines for screening and treatment of fractures among patients in China should focus equally on men and women and should emphasize the prevention of vertebral fractures.
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                Author and article information

                Contributors
                Chongzheng Qu: 873397214@qq.com , 13250554474@139.com
                Journal
                Journal ID (nlm-ta): BMC Musculoskelet Disord
                Journal ID (iso-abbrev): BMC Musculoskelet Disord
                Title: BMC Musculoskeletal Disorders
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2474
                Publication date (Electronic): 25 October 2023
                Publication date PMC-release: 25 October 2023
                Publication date Collection: 2023
                Volume: 24
                Electronic Location Identifier: 841
                Affiliations
                [1 ]Guangzhou University of Traditional Chinese Medicine, ( https://ror.org/05ar8rn06) Guangzhou, Guangdong China
                [2 ]GRID grid.411304.3, ISNI 0000 0001 0376 205X, Chengdu University of Traditional Chinese Medicine, ; Chengdu, Sichuan China
                [3 ]The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, ( https://ror.org/036csaq39) No.261, Longxi Avenue, Guangzhou, 510000 Guangdong China
                Article
                Publisher ID: 6965
                DOI: 10.1186/s12891-023-06965-y
                PMC ID: 10598955
                PubMed ID: 37880626
                SO-VID: 35c78089-b591-4e59-ad13-a355dc1adaf5
                Copyright © © BioMed Central Ltd., part of Springer Nature 2023
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 16 April 2023
                Date accepted : 14 October 2023
                Funding
                Funded by: The Third Affiliated Hospital of Guangzhou University of Chinese Medicine
                Award ID: ZYSY2022040
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2023

                ScienceOpen disciplines: Orthopedics
                Keywords: zoledronic acid,osteoporosis,pain,nomogram,acute phase reaction
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: zoledronic acid, osteoporosis, pain, nomogram, acute phase reaction

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