@Article{info:doi/10.2196/57511,
author="Fathalla, M. Ahmed
and Chiang, Cherie
and Audehm, Ralph
and Gorelik, Alexandra
and Chang, Shanton
and Yates, J. Christopher
and Snow, Steve
and Barmanray, Rahul
and Price, Sarah
and Collins, Lucy
and Wark, D. John",
title="Developing and Evaluating an Interactive, Case-Based, Web-Based Active Learning Tool for Primary Care Physicians (Community Fracture Capture Learning Hub): Protocol for an Acceptability and Engagement Study",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="25",
volume="14",
pages="e57511",
keywords="community-based fracture capture bone hub",
keywords="osteoporosis",
keywords="virtual communities of practice",
keywords="continuing professional development",
keywords="primary care physicians",
keywords="web-based learning platform",
keywords="case-based education",
abstract="Background: The lack of osteoporosis treatment initiation after fragility fractures is a significant gap, especially in primary care. It is unclear whether barriers for primary care physicians (PCPs) arise from uncertainty about investigations, treatment initiation, or medication side effects. Key questions remain about whether active learning platforms improve treatment initiation rates better than passive methods and how PCP demographics affect learning outcomes. With PCPs increasingly using web-based platforms for continuing professional development due to time constraints and heavy workloads, an interactive community fracture capture (CFC) tool may serve as an effective alternative to in-person learning. Our CFC pilot study tested this new program's design and content, showing promising potential. Objective: We aim to evaluate the interactive, case-based, web-based CFC Learning Hub, examining user acceptance and engagement with the platform, focusing on participants' interactions, satisfaction levels, and overall experience. Methods: Participating PCPs are recruited through Praxhub, a web-based medical education platform, and provide electronic consent for data use after deidentification. They have been allocated into small groups (12-20 members) and join the CFC Learning Hub, a secure web-based community. This hub includes a web-based discussion forum with participant-contributed case studies and a knowledge repository. Over the 6-week program, participants will receive weekly modules with instructions, resources, discussion threads, and quizzes, along with interactive discussions moderated by experienced PCPs and physicians. The platform also hosts web-based surveys that, in combination with platform analytics, allow assessment of baseline knowledge gaps, level of activity or engagement, and improvements following the course completion. This study protocol demonstrates the creation and proposed evaluation of the CFC Learning Hub, featuring an interactive, case-based, small-group web-based learning platform equipped with flexibly scheduled, tailored modules to address the fracture treatment gap within the community. Both qualitative (via thematic analysis) and quantitative (by using 2-tailed paired t tests, Wilcoxon signed rank tests, and multivariable regression analysis) analyses will be used to assess levels of engagement and acceptance and changes in PCPs' knowledge and confidence after engagement with the CFC Learning Hub. Results: Recruitment of participants started in May 2022. Data collection, analysis, and reporting will be completed following the completion of four 6-week cycles of the program. Conclusions: The study described in this protocol will provide important insights into the function and effectiveness of the CFC Learning Hub. This information will guide the expansion of the program. This initiative offers a simple digital solution for promoting current bone health practices tailored to PCPs' needs and thereafter to expand the rollout of the e-learning hub and implementation of fracture liaison models at a primary care level in Australia and elsewhere. Future applications may extend to other clinical areas and professions. International Registered Report Identifier (IRRID): DERR1-10.2196/57511 ",
doi="10.2196/57511",
url="https://www.researchprotocols.org/2025/1/e57511"
}


@Article{info:doi/10.2196/56611,
author="Jamil, Aini Nor
and Dhanaseelan, Jashwiny
and Buhari, Athirah Nurin",
title="Effectiveness of an e-Book on Bone Health as Educational Material for Adolescents: Single-Group Experimental Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Aug",
day="26",
volume="7",
pages="e56611",
keywords="osteoporosis",
keywords="bone health",
keywords="adolescent",
keywords="knowledge",
keywords="calcium",
keywords="physical activity",
keywords="e-book",
keywords="effectiveness",
keywords="educational",
keywords="teens",
keywords="youth",
keywords="bone fragility",
keywords="bone",
keywords="Malaysia",
keywords="online questionnaire",
keywords="sociodemographic",
keywords="calcium intake",
keywords="diet",
keywords="behavior change",
abstract="Background: Improved bone health during adolescence can have lifelong implications, reducing the risk of bone fragility. Objective: This study aims to evaluate the effectiveness of an e-book in increasing knowledge about and promoting healthy practices related to bone health among Malay adolescents in Kuala Lumpur, Malaysia. Methods: A total of 72 adolescents (female: n=51, 71\%; age: mean 15, SD 0.74 y) were recruited from selected secondary schools. The participants answered a pretest web-based questionnaire on sociodemographic data, knowledge about osteoporosis, and physical activity. A video call was conducted to assess dietary calcium intake. Participants were provided with a link to an e-book on bone health and instructed to read it within 2 weeks. Postintervention assessments included those for knowledge, physical activity, dietary calcium intake, and acceptance of the e-book. Results: There was a significant increase in the median knowledge score, which was 40.6\% (IQR 31.3\%-46.9\%) during the pretest and 71.9\% (IQR 53.9\%-81.3\%) during the posttest (P<.001). However, no changes were observed in dietary calcium intake or physical activity levels. Most participants did not meet the recommended calcium requirements (61/62, 98\%) and exhibited sedentary behavior (pretest: 51/62, 82\%; posttest: 48/62, 77\%). The e-book, however, was well accepted, with the majority reporting that they understood the contents (70/72, 97\%), liked the graphics (71/72, 99\%), and approved of the layout (60/72, 83\%) and font size (66/72, 92\%) used. Conclusions: The developed e-book effectively increases knowledge levels related to bone health and is well accepted among participants. However, this educational material did not improve bone health practices. Additional strategies are necessary to bridge the gap between knowledge and behavior change. ",
doi="10.2196/56611",
url="https://pediatrics.jmir.org/2024/1/e56611"
}


@Article{info:doi/10.2196/48535,
author="Kong, Hye Sung
and Cho, Wonwoo
and Park, Bae Sung
and Choo, Jaegul
and Kim, Hee Jung
and Kim, Wan Sang
and Shin, Soo Chan",
title="A Computed Tomography--Based Fracture Prediction Model With Images of Vertebral Bones and Muscles by Employing Deep Learning: Development and Validation Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="12",
volume="26",
pages="e48535",
keywords="fracture",
keywords="bone",
keywords="bones",
keywords="muscle",
keywords="muscles",
keywords="musculoskeletal",
keywords="prediction",
keywords="deep learning",
keywords="prospective cohort",
keywords="fracture risk assessment",
keywords="predict",
keywords="predictive",
keywords="machine learning",
keywords="develop",
keywords="development",
keywords="validate",
keywords="validation",
keywords="imaging",
keywords="tomography",
keywords="scanning",
abstract="Background: With the progressive increase in aging populations, the use of opportunistic computed tomography (CT) scanning is increasing, which could be a valuable method for acquiring information on both muscles and bones of aging populations. Objective: The aim of this study was to develop and externally validate opportunistic CT-based fracture prediction models by using images of vertebral bones and paravertebral muscles. Methods: The models were developed based on a retrospective longitudinal cohort study of 1214 patients with abdominal CT images between 2010 and 2019. The models were externally validated in 495 patients. The primary outcome of this study was defined as the predictive accuracy for identifying vertebral fracture events within a 5-year follow-up. The image models were developed using an attention convolutional neural network--recurrent neural network model from images of the vertebral bone and paravertebral muscles. Results: The mean ages of the patients in the development and validation sets were 73 years and 68 years, and 69.1\% (839/1214) and 78.8\% (390/495) of them were females, respectively. The areas under the receiver operator curve (AUROCs) for predicting vertebral fractures were superior in images of the vertebral bone and paravertebral muscles than those in the bone-only images in the external validation cohort (0.827, 95\% CI 0.821-0.833 vs 0.815, 95\% CI 0.806-0.824, respectively; P<.001). The AUROCs of these image models were higher than those of the fracture risk assessment models (0.810 for major osteoporotic risk, 0.780 for hip fracture risk). For the clinical model using age, sex, BMI, use of steroids, smoking, possible secondary osteoporosis, type 2 diabetes mellitus, HIV, hepatitis C, and renal failure, the AUROC value in the external validation cohort was 0.749 (95\% CI 0.736-0.762), which was lower than that of the image model using vertebral bones and muscles (P<.001). Conclusions: The model using the images of the vertebral bone and paravertebral muscle showed better performance than that using the images of the bone-only or clinical variables. Opportunistic CT screening may contribute to identifying patients with a high fracture risk in the future. ",
doi="10.2196/48535",
url="https://www.jmir.org/2024/1/e48535",
url="http://www.ncbi.nlm.nih.gov/pubmed/38995678"
}


@Article{info:doi/10.2196/50542,
author="Myers, J. Sarah
and Knight, L. Rebecca
and Wardle, L. Sophie
and Waldock, AM Kirsty
and O'Leary, J. Thomas
and Jones, K. Richard
and Muckelt, E. Paul
and Eisenhauer, Anton
and Tang, CY Jonathan
and Fraser, D. William
and Greeves, P. Julie",
title="Effect of Menstrual Cycle and Hormonal Contraception on Musculoskeletal Health and Performance: Protocol for a Prospective Cohort Design and Cross-Sectional Comparison",
journal="JMIR Res Protoc",
year="2024",
month="Jul",
day="11",
volume="13",
pages="e50542",
keywords="estrogens",
keywords="oestradiol",
keywords="progesterone",
keywords="calcium",
keywords="musculoskeletal health",
keywords="hormonal contraceptive",
abstract="Background: Women of reproductive age experience cyclical variation in the female sex steroid hormones 17$\beta$-estradiol and progesterone during the menstrual cycle that is attenuated by some hormonal contraceptives. Estrogens perform a primary function in sexual development and reproduction but have nonreproductive effects on bone, muscle, and sinew tissues (ie, ligaments and tendons), which may influence injury risk and physical performance. Objective: The purpose of the study is to understand the effect of the menstrual cycle and hormonal contraceptive use on bone and calcium metabolism, and musculoskeletal health and performance. Methods: A total of 5 cohorts of physically active women (aged 18-40 years) will be recruited to participate: eumenorrheic, nonhormonal contraceptive users (n=20); combined oral contraceptive pill (COCP) users (n=20); hormonal implant users (n=20); hormonal intrauterine system users (n=20); and hormonal injection users (n=20). Participants must have been using the COCP and implant for at least 1 year and the intrauterine system and injection for at least 2 years. First-void urine samples and fasted blood samples will be collected for biochemical analysis of calcium and bone metabolism, hormones, and metabolic markers. Knee extensor and flexor strength will be measured using an isometric dynamometer, and lower limb tendon and stiffness, tone, and elasticity will be measured using a Myoton device. Functional movement will be assessed using a single-leg drop to assess the frontal plane projection angle and the qualitative assessment of single leg loading. Bone density and macro- and microstructure will be measured using ultrasound, dual-energy x-ray absorptiometry, and high-resolution peripheral quantitative computed tomography. Skeletal material properties will be estimated from reference point indentation, performed on the flat surface of the medial tibia diaphysis. Body composition will be assessed by dual-energy x-ray absorptiometry. The differences in outcome measures between the hormonal contraceptive groups will be analyzed in a one-way between-group analysis of covariance. Within the eumenorrheic group, the influence of the menstrual cycle on outcome measures will be assessed using a linear mixed effects model. Within the COCP group, differences across 2 time points will be analyzed using the paired-samples 2-tailed t test. Results: The research was funded in January 2020, and data collection started in January 2022, with a projected data collection completion date of August 2024. The number of participants who have consented at the point of manuscript submission is 66. It is expected that all data analysis will be completed and results published by the end of 2024. Conclusions: Understanding the effects of the menstrual cycle and hormonal contraception on musculoskeletal health and performance will inform contraceptive choices for physically active women to manage injury risk. Trial Registration: ClinicalTrials.gov NCT05587920; https://classic.clinicaltrials.gov/ct2/show/NCT05587920 International Registered Report Identifier (IRRID): DERR1-10.2196/50542 ",
doi="10.2196/50542",
url="https://www.researchprotocols.org/2024/1/e50542",
url="http://www.ncbi.nlm.nih.gov/pubmed/38990638"
}


@Article{info:doi/10.2196/13642,
author="Dogaru, Emanuel Dumitru
and Rosu, Serban
and Barattini, Franco Dionisio
and Guadagna, Simone
and Barattini, Luca
and Andor, Bogdan",
title="Assessment of the Feasibility of Objective Parameters as Primary End Points for Patients Affected by Knee Osteoarthritis: Protocol for a Pilot, Open Noncontrolled Trial (:SMILE:)",
journal="JMIR Res Protoc",
year="2024",
month="Jun",
day="28",
volume="13",
pages="e13642",
keywords="pilot trial",
keywords="feasibility study",
keywords="knee osteoarthritis",
keywords="hyaluronic acid",
keywords="outcome assessment",
keywords="osteoarthritis",
keywords="ultrasonography",
keywords="knee",
keywords="pain",
abstract="Background: Osteoarthritis (OA) is a disabling condition that affects more than one-third of people older than 65 years. Currently, 80\% of these patients report movement limitations, 20\% are unable to perform major activities of daily living, and approximately 11\% require personal care. In 2014, the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) recommended, as the first step in the pharmacological treatment of knee osteoarthritis, a background therapy with chronic symptomatic slow-acting osteoarthritic drugs such as glucosamine sulfate, chondroitin sulfate, and hyaluronic acid. The latter has been extensively evaluated in clinical trials as intra-articular and oral administration. Recent reviews have shown that studies on oral hyaluronic acid generally measure symptoms using only subjective parameters, such as visual analog scales or quality of life questionnaires. As a result, objective measures are lacking, and data validity is generally impaired. Objective: The main goal of this pilot study with oral hyaluronic acid is to evaluate the feasibility of using objective tools as outcomes to evaluate improvements in knee mobility. We propose ultrasound and range of motion measurements with a goniometer that could objectively correlate changes in joint mobility with pain reduction, as assessed by the visual analog scale. The secondary objective is to collect data to estimate the time and budget for the main double-blind study randomized trial. These data may be quantitative (such as enrollment rate per month, number of screening failures, and new potential outcomes) and qualitative (such as site logistical issues, patient reluctance to enroll, and interpersonal difficulties for investigators). Methods: This open-label pilot and feasibility study is conducted in an orthopedic clinic (Timisoara, Romania). The study includes male and female participants, aged 50-70 years, who have been diagnosed with symptomatic knee OA and have experienced mild joint discomfort for at least 6 months. Eight patients must be enrolled and treated with Syalox 300 Plus (River Pharma) for 8 weeks. It is a dietary supplement containing high-molecular-weight hyaluronic acid, which has already been marketed in several European countries. Assessments are made at the baseline and final visits. Results: Recruitment and treatment of the 8 patients began on February 15, 2018, and was completed on May 25, 2018. Data analysis was planned to be completed by the end of 2018. The study was funded in February 2019. We expect the results to be published in a peer-reviewed clinical journal in the last quarter of 2024. Conclusions: The data from this pilot study will be used to assess the feasibility of a future randomized clinical trial in OA. In particular, the planned outcomes (eg, ultrasound and range of motion), safety, and quantitative and qualitative data must be evaluated to estimate in advance the time and budget required for the future main study. Finally, the pilot study should provide preliminary information on the efficacy of the investigational product. Trial Registration: ClinicalTrials.gov NCT03421054; https://clinicaltrials.gov/study/NCT03421054 International Registered Report Identifier (IRRID): RR1-10.2196/13642 ",
doi="10.2196/13642",
url="https://www.researchprotocols.org/2024/1/e13642"
}


@Article{info:doi/10.2196/54970,
author="Mahanani, Srinalesti
and Kertia, Nyoman
and Madyaningrum, Ema",
title="Combination of Curcuminoids and Acupressure for Inflammation and Pain in Older People with Osteoarthritis Genu: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Jun",
day="24",
volume="13",
pages="e54970",
keywords="osteoarthritis",
keywords="acupressure",
keywords="curcuminoids",
keywords="endorphins",
keywords="biomarkers",
keywords="genu",
keywords="older people",
keywords="randomized controlled trial",
abstract="Background: Curcuminoids and acupressure have beneficial effects in reducing pain and inflammation in patients with osteoarthritis. However, only a few clinical trials are investigating biomarkers to prove this objectively. Objective: This study aims to investigate the effect of acupressure and curcuminoids on inflammatory markers and pain in older people with osteoarthritis genu. Methods: A randomized controlled trial (RCT) was conducted among older people with osteoarthritis. All participants were randomized to a group that received 30 mg of curcuminoids in turmeric extract capsules and acupressure (group 1) or a group that received a placebo and sham acupressure (group 2) for 3 weeks. Results: The study was approved by the research ethics board; ClinicalTrials.gov reviewed this protocol. The extracts were manufactured from May 2023 to June 2023. Participant recruitment was conducted in September and October 2023; a total of 72 participants aged 60 years or older participated, of whom 75\% (n=54) were female. Data were analyzed in April 2024, and dissemination of results is expected by the end of 2024. Conclusions: Primary outcomes were assessed at baseline and after the intervention. Relationships were assessed with inflammatory markers, endorphin hormones, and blood level of cycloxygenase-2 hormone. Additionally, secondary outcomes included pain, ability to perform activities of daily living, and quality of life. The beneficial effects that may be found in this trial may be exceptionally relevant in clinical practice, justifying this scientific inquiry. The benefits of herbs and acupressure can be helpful as additional options in treating inflammation and pain in patients with osteoarthritis. Trial Registration: ClinicalTrials.gov NCT06105840; https://clinicaltrials.gov/study/NCT06105840 International Registered Report Identifier (IRRID): DERR1-10.2196/54970 ",
doi="10.2196/54970",
url="https://www.researchprotocols.org/2024/1/e54970",
url="http://www.ncbi.nlm.nih.gov/pubmed/38771152"
}


@Article{info:doi/10.2196/53798,
author="Zhu, Dian
and Zhao, Jianan
and Wang, Mingxuan
and Cao, Bochen
and Zhang, Wenhui
and Li, Yunlong
and Zhang, Chenqi
and Han, Ting",
title="Rehabilitation Applications Based on Behavioral Therapy for People With Knee Osteoarthritis: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="May",
day="2",
volume="12",
pages="e53798",
keywords="knee osteoarthritis",
keywords="digital application",
keywords="behavioral therapy",
keywords="behavior change therapy",
keywords="cognitive behavioral therapy",
abstract="Background: The development of digital applications based on behavioral therapies to support patients with knee osteoarthritis (KOA) has attracted increasing attention in the field of rehabilitation. This paper presents a systematic review of research on digital applications based on behavioral therapies for people with KOA. Objective: This review aims to describe the characteristics of relevant digital applications, with a special focus on the current state of behavioral therapies, digital interaction technologies, and user participation in design. The secondary aim is to summarize intervention outcomes and user evaluations of digital applications. Methods: A systematic literature search was conducted using the keywords ``Knee Osteoarthritis,'' ``Behavior Therapy,'' and ``Digitization'' in the following databases (from January 2013 to July 2023): Web of Science, Embase, Science Direct, Ovid, and PubMed. The Mixed Methods Assessment Tool (MMAT) was used to assess the quality of evidence. Two researchers independently screened and extracted the data. Results: A total of 36 studies met the inclusion criteria and were further analyzed. Behavioral change techniques (BCTs) and cognitive behavioral therapy (CBT) were frequently combined when developing digital applications. The most prevalent areas were goals and planning (n=31) and repetition and substitution (n=27), which were frequently used to develop physical activity (PA) goals and adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email (n=12), which has tremendous potential. This area of application design offers notable advantages, primarily manifesting in pain mitigation (n=24), reduction of physical dysfunction (n=21), and augmentation of PA levels (n=12). Additionally, when formulating design strategies, it is imperative to consider the perspectives of stakeholders, especially in response to the identified shortcomings in application design elucidated within the study. Conclusions: The results demonstrate that ``goals and planning'' and ``repetition and substitution'' are frequently used to develop PA goals and PA behavior adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email, which has tremendous potential. Moreover, incorporating several stakeholders in the design and development stages might enhance user experience, considering the distinct variations in their requirements. To improve the efficacy and availability of digital applications, we have several proposals. First, comprehensive care for patients should be ensured by integrating multiple behavioral therapies that encompass various aspects of the rehabilitation process, such as rehabilitation exercises and status monitoring. Second, therapists could benefit from more precise recommendations by incorporating additional intelligent algorithms to analyze patient data. Third, the implementation scope should be expanded from the home environment to a broader social community rehabilitation setting. ",
doi="10.2196/53798",
url="https://mhealth.jmir.org/2024/1/e53798",
url="http://www.ncbi.nlm.nih.gov/pubmed/38696250"
}


@Article{info:doi/10.2196/55829,
author="Novella-Navarro, Marta
and Iniesta-Chamorro, M. Jose
and Benavent, Diego
and Bachiller-Corral, Javier
and Calvo-Aranda, Enrique
and Borrell, Helena
and Berbel-Arcob{\'e}, Laura
and Navarro-Compan, Victoria
and Michelena, Xabier
and Lojo-Oliveira, Leticia
and Arroyo-Palomo, Jaime
and Diaz-Almiron, Mariana
and Garc{\'i}a Garc{\'i}a, Ver{\'o}nica
and Monjo-Henry, Irene
and G{\'o}mez Gonz{\'a}lez, Mar{\'i}a Claudia
and Gomez, J. Enrique
and Balsa, Alejandro
and Plasencia-Rodr{\'i}guez, Chamaida",
title="Toward Telemonitoring in Immune-Mediated Inflammatory Diseases: Protocol for a Mixed Attention Model Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="22",
volume="13",
pages="e55829",
keywords="digital health",
keywords="mHealth, telemonitoring, rheumatic musculoskeletal diseases",
keywords="digital resources, mixed attention model",
keywords="rheumatic disease",
keywords="musculoskeletal diseases",
keywords="chronic diseases",
keywords="pain",
keywords="inflammation",
keywords="antirheumatic drugs",
keywords="telemonitoring",
keywords="rheumatology",
keywords="hybrid care model",
keywords="care model",
keywords="MAM",
keywords="implementation",
keywords="clinical outcome",
abstract="Background: Rheumatic and musculoskeletal diseases (RMDs) are chronic diseases that may alternate between asymptomatic periods and flares. These conditions require complex treatments and close monitoring by rheumatologists to mitigate their effects and improve the patient's quality of life. Often, delays in outpatient consultations or the patient's difficulties in keeping appointments make such close follow-up challenging. For this reason, it is very important to have open communication between patients and health professionals. In this context, implementing telemonitoring in the field of rheumatology has great potential, as it can facilitate the close monitoring of patients with RMDs. The use of these tools helps patients self-manage certain aspects of their disease. This could result in fewer visits to emergency departments and consultations, as well as enable better therapeutic compliance and identification of issues that would otherwise go unnoticed. Objective: The main objective of this study is to evaluate the implementation of a hybrid care model called the mixed attention model (MAM) in clinical practice and determine whether its implementation improves clinical outcomes compared to conventional follow-up. Methods: This is a multicenter prospective observational study involving 360 patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) from 5 Spanish hospitals. The patients will be followed up by the MAM protocol, which is a care model that incorporates a digital tool consisting of a mobile app that patients can use at home and professionals can review asynchronously to detect incidents and follow patients' clinical evolution between face-to-face visits. Another group of patients, whose follow-up will be conducted in accordance with a traditional face-to-face care model, will be assessed as the control group. Sociodemographic characteristics, treatments, laboratory parameters, assessment of tender and swollen joints, visual analog scale for pain, and electronic patient-reported outcome (ePRO) reports will be collected for all participants. In the MAM group, these items will be self-assessed via both the mobile app and during face-to-face visits with the rheumatologist, who will do the same for patients included in the traditional care model. The patients will be able to report any incidence related to their disease or treatment through the mobile app. Results: Participant recruitment began in March 2024 and will continue until December 2024. The follow-up period will be extended by 12 months for all patients. Data collection and analysis are scheduled for completion in December 2025. Conclusions: This paper aims to provide a detailed description of the development and implementation of a digital solution, specifically an MAM. The goal is to achieve significant economic and psychosocial impact within our health care system by enhancing control over RMDs. Trial Registration: ClinicalTrials.gov NCT06273306; https://clinicaltrials.gov/ct2/show/NCT06273306 International Registered Report Identifier (IRRID): PRR1-10.2196/55829 ",
doi="10.2196/55829",
url="https://www.researchprotocols.org/2024/1/e55829",
url="http://www.ncbi.nlm.nih.gov/pubmed/38501508"
}


@Article{info:doi/10.2196/48947,
author="Fan, Yao
and Li, Qun
and Liu, Yu
and Miao, Jing
and Zhao, Ting
and Cai, Jinxin
and Liu, Min
and Cao, Jun
and Xu, Haifeng
and Wei, Lai
and Li, Mengxia
and Shen, Chong",
title="Sex- and Age-Specific Prevalence of Osteopenia and Osteoporosis: Sampling Survey",
journal="JMIR Public Health Surveill",
year="2024",
month="Apr",
day="5",
volume="10",
pages="e48947",
keywords="cross-sectional study",
keywords="osteopenia",
keywords="osteoporosis",
keywords="prevalence",
keywords="quantitative ultrasound",
abstract="Background: Osteopenia and osteoporosis are posing a long-term influence on the aging population's health contributing to a higher risk of mortality, loss of autonomy, hospitalization, and huge health system costs and social burden. Therefore, more pertinent data are needed to demonstrate the current state of osteoporosis. Objective: This sampling survey seeks to assess the trends in the prevalence of osteopenia and osteoporosis in a Chinese Han population. Methods: A community-based cross-sectional study involving 16,377 participants used a multistage sampling method. Bone mineral density was measured using the quantitative ultrasonic densitometry. Student t test and Mann-Whitney U test were used to test the difference between normally and nonnormally distributed quantitative variables between male and female participants. A chi-square ($\chi$2) test was used to compare categorized variables. Stratified analysis was conducted to describe the prevalence rates of osteoporosis (T score ?--2.5) and osteopenia (T score --2.5 to --1.0) across age, sex, calcium intake, and menopause. A direct standardization method was used to calculate the age-standardized prevalence rates of osteoporosis and osteopenia. T-score was further categorized into quartiles (T1-T4) by age- and sex-specified groups. Results: The prevalence rates of osteopenia and osteoporosis were 40.5\% (6633/16,377) and 7.93\% (1299/16,377), respectively, and the age-standardized prevalence rates were 27.32\% (287,877,129.4/1,053,861,940) and 3.51\% (36,974,582.3/1,053,861,940), respectively. There was an increase in osteopenia and osteoporosis prevalence from 21.47\% (120/559) to 56.23\% (754/1341) and 0.89\% (5/559) to 17.23\% (231/1341), respectively, as age increased from 18 years to 75 years old. The prevalence rates of osteopenia and osteoporosis were significantly higher in female participants (4238/9645, 43.94\% and 1130/9645, 11.72\%) than in male participants (2395/6732, 35.58\% and 169/6732, 2.51\%; P<.001), and in postmenopausal female participants (3638/7493, 48.55\% and 1053/7493, 14.05\%) than in premenopausal female participants (538/2026, 26.55\% and 53/2026, 2.62\%; P<.001). In addition, female participants with a history of calcium intake had a lower osteoporosis prevalence rate than female participants without any history of calcium intake in all age groups (P=.004). From low quartile to high quartile of T-score, the prevalence of diabetes mellitus (752/4037, 18.63\%; 779/4029, 19.33\%; 769/3894, 19.75\%; and 869/3879, 22.4\%) and dyslipidemia (2228/4036, 55.2\%; 2304/4027, 57.21\%; 2306/3891, 59.26\%; and 2379/3878, 61.35\%) were linearly increased (P<.001), while the prevalence of cancer (112/4037, 2.77\%; 110/4029, 2.73\%; 103/3894, 2.65\%; and 77/3879, 1.99\%) was decreased (P=.03). Conclusions: Our data imply that as people age, osteopenia and osteoporosis are more common in females than in males, particularly in postmenopausal females than in premenopausal females, and bone mineral density significantly affects the prevalence of chronic diseases. These findings offer information that can be applied to intervention programs meant to prevent or lessen the burden of osteoporosis in China. ",
doi="10.2196/48947",
url="https://publichealth.jmir.org/2024/1/e48947",
url="http://www.ncbi.nlm.nih.gov/pubmed/38578689"
}


@Article{info:doi/10.2196/53995,
author="Bendtsen, Gr{\o}nlund Magnus
and Sch{\"o}nwandt, Thuesen Bodil Marie
and Rub{\ae}k, Mette
and Hitz, Friberg Mette",
title="Evaluation of an mHealth App on Self-Management of Osteoporosis: Prospective Survey Study",
journal="Interact J Med Res",
year="2024",
month="Apr",
day="1",
volume="13",
pages="e53995",
keywords="eHealth literacy",
keywords="health literacy",
keywords="mHealth",
keywords="mobile health",
keywords="eHealth",
keywords="mobile health apps",
keywords="self-management",
keywords="osteoporosis",
keywords="usability",
keywords="acceptability",
abstract="Background: Mobile health (mHealth) technologies can be used for disease-specific self-management, and these technologies are experiencing rapid growth in the health care industry. They use mobile devices, specifically smartphone apps, to enhance and support medical and public health practices. In chronic disease management, the use of apps in the realm of mHealth holds the potential to improve health outcomes. This is also true for mHealth apps on osteoporosis, but the usage and patients' experiences with these apps are underexplored. Objective: This prospective survey study aimed to investigate the eHealth literacy of Danish patients with osteoporosis, as well as the usability and acceptability of the app ``My Bones.'' Methods: Data on patient characteristics, disease knowledge, eHealth literacy, usability, and acceptability were collected using self-administered questionnaires at baseline, 2 months, and 6 months. The following validated questionnaires were used: eHealth Literacy Questionnaire, System Usability Scale, and Service User Technology Acceptability Questionnaire. Results: Mean scores for eHealth literacy ranged from 2.6 to 3.1, with SD ranging from 0.5 to 0.6 across the 7 domains. The mean (SD) System Usability Scale score was 74.7 (14.4), and the mean (SD) scores for domains 1, 2, and 6 of the Service User Technology Acceptability Questionnaire were 3.4 (1.2), 4.5 (1.1), 4.1 (1.2), respectively. Conclusions: Danish patients with osteoporosis are both motivated and capable of using digital health services. The app's usability was acceptable, and it has the potential to reduce visits to general practitioner clinics, enhance health outcomes, and serve as a valuable addition to regular health or social care services. ",
doi="10.2196/53995",
url="https://www.i-jmr.org/2024/1/e53995",
url="http://www.ncbi.nlm.nih.gov/pubmed/38557362"
}


@Article{info:doi/10.2196/32557,
author="Alhussein, Ghada
and Hadjileontiadis, Leontios",
title="Digital Health Technologies for Long-term Self-management of Osteoporosis: Systematic Review and Meta-analysis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="21",
volume="10",
number="4",
pages="e32557",
keywords="mHealth",
keywords="digital health",
keywords="osteoporosis",
keywords="self-management",
keywords="systematic review",
keywords="meta-analysis",
keywords="chronic disease",
keywords="bone health",
keywords="nutrition",
keywords="physical activity",
keywords="risk assessment",
keywords="mobile phone",
abstract="Background: Osteoporosis is the fourth most common chronic disease worldwide. The adoption of preventative measures and effective self-management interventions can help improve bone health. Mobile health (mHealth) technologies can play a key role in the care and self-management of patients with osteoporosis. Objective: This study presents a systematic review and meta-analysis of the currently available mHealth apps targeting osteoporosis self-management, aiming to determine the current status, gaps, and challenges that future research could address, as well as propose appropriate recommendations. Methods: A systematic review of all English articles was conducted, in addition to a survey of all apps available in iOS and Android app stores as of May 2021. A comprehensive literature search (2010 to May 2021) of PubMed, Scopus, EBSCO, Web of Science, and IEEE Xplore was conducted. Articles were included if they described apps dedicated to or useful for osteoporosis (targeting self-management, nutrition, physical activity, and risk assessment) delivered on smartphone devices for adults aged ?18 years. Of the 32 articles, a random effects meta-analysis was performed on 13 (41\%) studies of randomized controlled trials, whereas the 19 (59\%) remaining studies were only included in the narrative synthesis as they did not provide enough data. Results: In total, 3906 unique articles were identified. Of these 3906 articles, 32 (0.81\%) articles met the inclusion criteria and were reviewed in depth. The 32 studies comprised 14,235 participants, of whom, on average, 69.5\% (n=9893) were female, with a mean age of 49.8 (SD 17.8) years. The app search identified 23 relevant apps for osteoporosis self-management. The meta-analysis revealed that mHealth-supported interventions resulted in a significant reduction in pain (Hedges g ?1.09, 95\% CI ?1.68 to ?0.45) and disability (Hedges g ?0.77, 95\% CI ?1.59 to 0.05). The posttreatment effect of the digital intervention was significant for physical function (Hedges g 2.54, 95\% CI ?4.08 to 4.08) but nonsignificant for well-being (Hedges g 0.17, 95\% CI ?1.84 to 2.17), physical activity (Hedges g 0.09, 95\% CI ?0.59 to 0.50), anxiety (Hedges g ?0.29, 95\% CI ?6.11 to 5.53), fatigue (Hedges g ?0.34, 95\% CI ?5.84 to 5.16), calcium (Hedges g ?0.05, 95\% CI ?0.59 to 0.50), vitamin D intake (Hedges g 0.10, 95\% CI ?4.05 to 4.26), and trabecular score (Hedges g 0.06, 95\% CI ?1.00 to 1.12). Conclusions: Osteoporosis apps have the potential to support and improve the management of the disease and its symptoms; they also appear to be valuable tools for patients and health professionals. However, most of the apps that are currently available lack clinically validated evidence of their efficacy and focus on a limited number of symptoms. A more holistic and personalized approach within a cocreation design ecosystem is needed. Trial Registration: PROSPERO 2021 CRD42021269399; https://tinyurl.com/2sw454a9 ",
doi="10.2196/32557",
url="https://mhealth.jmir.org/2022/4/e32557",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451968"
}


@Article{info:doi/10.2196/32724,
author="Kraus, Moritz
and Saller, Michael Maximilian
and Baumbach, Felix Sebastian
and Neuerburg, Carl
and Stumpf, Cordula Ulla
and B{\"o}cker, Wolfgang
and Keppler, Martin Alexander",
title="Prediction of Physical Frailty in Orthogeriatric Patients Using Sensor Insole--Based Gait Analysis and Machine Learning Algorithms: Cross-sectional Study",
journal="JMIR Med Inform",
year="2022",
month="Jan",
day="5",
volume="10",
number="1",
pages="e32724",
keywords="wearables",
keywords="insole sensors",
keywords="orthogeriatric",
keywords="artificial intelligence",
keywords="prediction models",
keywords="machine learning",
keywords="gait analysis",
keywords="digital sensors",
keywords="digital health",
keywords="aging",
keywords="prediction algorithms",
keywords="geriatric",
keywords="mobile health",
keywords="mobile insoles",
abstract="Background: Assessment of the physical frailty of older patients is of great importance in many medical disciplines to be able to implement individualized therapies. For physical tests, time is usually used as the only objective measure. To record other objective factors, modern wearables offer great potential for generating valid data and integrating the data into medical decision-making. Objective: The aim of this study was to compare the predictive value of insole data, which were collected during the Timed-Up-and-Go (TUG) test, to the benchmark standard questionnaire for sarcopenia (SARC-F: strength, assistance with walking, rising from a chair, climbing stairs, and falls) and physical assessment (TUG test) for evaluating physical frailty, defined by the Short Physical Performance Battery (SPPB), using machine learning algorithms. Methods: This cross-sectional study included patients aged >60 years with independent ambulation and no mental or neurological impairment. A comprehensive set of parameters associated with physical frailty were assessed, including body composition, questionnaires (European Quality of Life 5-dimension [EQ 5D 5L], SARC-F), and physical performance tests (SPPB, TUG), along with digital sensor insole gait parameters collected during the TUG test. Physical frailty was defined as an SPPB score?8. Advanced statistics, including random forest (RF) feature selection and machine learning algorithms (K-nearest neighbor [KNN] and RF) were used to compare the diagnostic value of these parameters to identify patients with physical frailty. Results: Classified by the SPPB, 23 of the 57 eligible patients were defined as having physical frailty. Several gait parameters were significantly different between the two groups (with and without physical frailty). The area under the receiver operating characteristic curve (AUROC) of the TUG test was superior to that of the SARC-F (0.862 vs 0.639). The recursive feature elimination algorithm identified 9 parameters, 8 of which were digital insole gait parameters. Both the KNN and RF algorithms trained with these parameters resulted in excellent results (AUROC of 0.801 and 0.919, respectively). Conclusions: A gait analysis based on machine learning algorithms using sensor soles is superior to the SARC-F and the TUG test to identify physical frailty in orthogeriatric patients. ",
doi="10.2196/32724",
url="https://medinform.jmir.org/2022/1/e32724",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989684"
}


@Article{info:doi/10.2196/25607,
author="Stephens, Alastair
and Rudd, Hannah
and Stephens, Emilia
and Ward, Jayne",
title="Secondary Prevention of Hip Fragility Fractures During the COVID-19 Pandemic: Service Evaluation of ``MRS BAD BONES''",
journal="JMIR Aging",
year="2020",
month="Dec",
day="22",
volume="3",
number="2",
pages="e25607",
keywords="osteoporosis",
keywords="fragility fracture",
keywords="guideline",
keywords="mnemonic",
keywords="acronym",
keywords="COVID-19",
keywords="bone",
keywords="morbidity",
keywords="mortality",
keywords="fracture",
keywords="elderly",
keywords="older adults",
keywords="geriatrics",
keywords="audit",
keywords="prevention",
abstract="Background: Management of osteoporosis is an important consideration for patients with femoral neck fractures due to the morbidity and mortality it poses. The input of orthogeriatric teams is invaluable in coordinating secondary fragility fracture prevention. The COVID-19 pandemic resulted in the rapid restructuring of health care teams and led to the redeployment of orthogeriatricians. Objective: This study aimed to determine the impact COVID-19 had on the secondary prevention of fragility fractures among patients with femoral neck fractures, and to optimize management in this population. Methods: A retrospective audit was conducted of patients with femoral neck fractures before and after the lockdown in response to the COVID-19 pandemic in the United Kingdom. A reaudit was conducted following the development of our new mnemonic, ``MRS BAD BONES,'' which addressed key factors in the assessment and management of osteoporosis: medication review, rheumatology/renal advice, smoking cessation; blood tests, alcohol limits, DEXA (dual energy X-ray absorptiometry) scan; bone-sparing medications, orthogeriatric review, nutrition, exercise, supplements. The Fisher exact test was used for comparison analyses between each phase. Results: Data for 50 patients were available in each phase. The orthogeriatric team reviewed 88\% (n=44) of patients prelockdown, which fell to 0\% due to redeployment, before recovering to 38\% (n=19) in the postintervention period. The lockdown brought a significant drop in the prescription of vitamin D/calcium supplements from 81.6\% (n=40) to 58.0\% (n=29) (P=.02); of bone-sparing medications from 60.7\% (n=17) to 18.2\% (n=4) (P=.004), and DEXA scan requests from 40.1\% (n=9) to 3.6\% (n=1) (P=.003). Following the implementation of our mnemonic, there was a significant increase in the prescription of vitamin D/calcium supplements to 85.7\% (n=42) (P=.003), bone-sparing medications to 72.4\% (n=21) (P<.001), and DEXA scan requests to 60\% (n=12) (P<.001). Conclusions: The redeployment of the orthogeriatric team, due to the COVID-19 pandemic, impacted the secondary prevention of fragility fractures in the study population. The ``MRS BAD BONES'' mnemonic significantly improved management and could be used in a wider setting. ",
doi="10.2196/25607",
url="https://aging.jmir.org/2020/2/e25607",
url="http://www.ncbi.nlm.nih.gov/pubmed/33326412"
}