An innovative study made it possible to weight all the risk factors for osteoporosis according to our genes. Bone mineral density is believed to be the most important factor to act on to prevent fragility fractures. A clarification of the treatment.
A study, published in the British Medical Journal, allows to establish the real weight of several clinical risk factors of osteoporotic fractures. The study analyzed the real weight of the classic risk factors for fragility fracture: age, bone mineral density (BMD), muscle strength, diabetes, rheumatoid arthritis, vitamin D insufficiency, etc., by weighting them according to the genes carried by people with osteoporotic fractures.
“Mendelian randomization” analysis, which uses genetic information to determine causal relationships between risk factors and disease events, can determine that only bone mineral density (BMD) plays a potentially causal role. in the risk of osteoporotic fracture.
No need to over-vitamin the elderly
This study was carried out through a broad international collaboration of researchers from the United States, Europe, Canada, Asia and Australia. The study population included 185,057 people with osteoporotic fractures and 377,201 control people without fractures by recruiting them from the Genetic Factors for Osteoporosis (“GEFOS”) consortium, UKBiobank Study and 23andMe biotech.
One of the most important findings is that genetic factors associated with low vitamin D levels do not increase the risk of fractures. This means that vitamin D supplementation is not likely to prevent fractures, in the absence of proven deficiency.
Although vitamin D supplementation is one of the clinical recommendations, recent randomized controlled trials have failed to demonstrate a beneficial effect of supplementation in the absence of an insufficient intake of this vitamin (indeed insufficient not so rare).
A Mendelian randomization study
This large-scale study of fracture risk based on the complete genome provides insight into the biological mechanisms leading to fractures. More importantly, all of the genomic regions identified as being associated with a fracture have been previously associated with a change in bone mineral density (BMD), one of the most important fracture risk factors for osteoporotic fracture. .
According to Dr. Kiel, “Of the fracture risk factors assessed in the study, only BMD had a major causal effect on fractures. The genetic factors contributing to fractures are also the same that affect BMD. The study also identified new genetic variants that can be used to target future drug treatments to prevent fractures. “
Osteoporosis is underestimated and undertreated
The results of this remarkable study therefore strongly suggest that treatments aimed at increasing bone resistance (anti-osteoporotics) are more likely to prevent fractures than systematic supplementation with calcium and vitamin D. Similarly, it would not be very useful to target other risk factors for osteoporosis that are not necessarily the cause of the disease.
Fragility fractures are a major problem that affects more than 9 million people worldwide each year. Osteoporosis causes brittle bones and an increased risk of fractures, especially of the hip, spine and wrist. About a quarter of people over 50 who have a hip fracture die within a year of the fracture.
The study validates the interest of a therapeutic action on bone mineral density to reduce the risk of fragility fracture.
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