751
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Klintström E, Klintström B, Moreno R, Brismar TB, Pahr DH, Smedby Ö. Predicting Trabecular Bone Stiffness from Clinical Cone-Beam CT and HR-pQCT Data; an In Vitro Study Using Finite Element Analysis. PLoS One 2016; 11:e0161101. [PMID: 27513664 PMCID: PMC4981445 DOI: 10.1371/journal.pone.0161101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 07/29/2016] [Indexed: 11/18/2022] Open
Abstract
Stiffness and shear moduli of human trabecular bone may be analyzed in vivo by finite element (FE) analysis from image data obtained by clinical imaging equipment such as high resolution peripheral quantitative computed tomography (HR-pQCT). In clinical practice today, this is done in the peripheral skeleton like the wrist and heel. In this cadaveric bone study, fourteen bone specimens from the wrist were imaged by two dental cone beam computed tomography (CBCT) devices and one HR-pQCT device as well as by dual energy X-ray absorptiometry (DXA). Histomorphometric measurements from micro-CT data were used as gold standard. The image processing was done with an in-house developed code based on the automated region growing (ARG) algorithm. Evaluation of how well stiffness (Young’s modulus E3) and minimum shear modulus from the 12, 13, or 23 could be predicted from the CBCT and HR-pQCT imaging data was studied and compared to FE analysis from the micro-CT imaging data. Strong correlations were found between the clinical machines and micro-CT regarding trabecular bone structure parameters, such as bone volume over total volume, trabecular thickness, trabecular number and trabecular nodes (varying from 0.79 to 0.96). The two CBCT devices as well as the HR-pQCT showed the ability to predict stiffness and shear, with adjusted R2-values between 0.78 and 0.92, based on data derived through our in-house developed code based on the ARG algorithm. These findings indicate that clinically used CBCT may be a feasible method for clinical studies of bone structure and mechanical properties in future osteoporosis research.
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Affiliation(s)
- Eva Klintström
- Department of Medical and Health Science, Division of Radiology, Linköping University, Linköping, Sweden
- Center for medical Image Science and Visualization, Linköping University, Linköping, Sweden
- * E-mail:
| | - Benjamin Klintström
- Center for medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Rodrigo Moreno
- KTH Royal Institute of Technology, School of Technology and Health, Huddinge, Stockholm, Sweden
| | - Torkel B. Brismar
- Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Dieter H. Pahr
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Vienna, Austria
| | - Örjan Smedby
- Department of Medical and Health Science, Division of Radiology, Linköping University, Linköping, Sweden
- KTH Royal Institute of Technology, School of Technology and Health, Huddinge, Stockholm, Sweden
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752
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Abstract
The treatment of hip fractures in the elderly represents a major public health priority and a source of ongoing debate among orthopaedic surgeons and anesthesiologists. Most of these injuries are treated with surgery in an expedient fashion. From the surgical perspective, there are certain special considerations in this population including osteoporosis, pre-existing arthritis, age, activity level, and overall health that contribute to the type of surgical fixation performed. Open reduction and internal fixation versus arthroplasty remain the two major categories of treatment. While the indications and treatment algorithms still remain controversial, the overall goal for these patients is early mobilization and prevention of morbidity and mortality. The use of preoperative, regional anesthesia has aided in this effort. The purpose of this review article is to examine the various treatment modalities for hip fractures in the elderly and discuss the most recent evidence in the face of a rapidly aging population.
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Affiliation(s)
- Joshua C Rozell
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Hasenauer
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Derek J Donegan
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Neuman
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
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753
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Schupfner R, Käsmann LT, Wagner W, Schulz AP. Complications in Treatment of 31-A Fractures with Trochanteric Gamma Nail (TGN) Versus Gamma3 Nail (G3N) - A Review of 217 Cases. Open Orthop J 2016; 10:389-395. [PMID: 28523080 PMCID: PMC5436381 DOI: 10.2174/1874325001610010389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 05/11/2016] [Accepted: 06/19/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to clinically evaluate two generations of intramedullary gamma-nail used in the treatment of 31-A femur fractures. MATERIALS AND METHODS In two consecutive series, 117 trochanteric gamma nails (TGN) and 100 Gamma3 nails (G3N) were implanted for the treatment of inter- and subtrochanteric fractures between 2009 and 2011. Clinical and radiological follow-up examinations were assessed. An analysis of surgical time, hemoglobin drop and complications were performed. RESULTS Average surgical time, fluoroscopy time, haemoglobin drop and length-of-stay (LOS) were similar in both groups. No significant differences were found in surgery-related complications like wound hematomas (p=0,59), abscesses (p=0,38), wound infections (p=0,69) and Cut-outs (p=0,69) between the two groups. The cumulative surgery-related complication rate was higher in the TGN group compared to the G3N group (13,68% vs. 8%) but this did not reach statistical significance (p=0,2). CONCLUSION Our findings suggest that both TGN and G3N allow adequate treatment of trochanteric fractures with an acceptable complication rate.
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Affiliation(s)
- R Schupfner
- Department of Traumatology, Orthopaedics & Reconstructive Surgery, Clinic Bayreuth, Germany
| | - L T Käsmann
- Department of Orthopaedics & Traumatology, University of Lübeck, Germany
| | - W Wagner
- Department of Traumatology, Orthopaedics & Reconstructive Surgery, Clinic Bayreuth, Germany
| | - A P Schulz
- Department of Orthopaedics & Traumatology, University of Lübeck, Germany
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754
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Lee SH, Chen IJ, Li YH, Fan Chiang CY, Chang CH, Hsieh PH. Incidence of second hip fractures and associated mortality in Taiwan: A nationwide population-based study of 95,484 patients during 2006-2010. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:437-42. [PMID: 27473531 PMCID: PMC6197401 DOI: 10.1016/j.aott.2016.06.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 11/15/2015] [Accepted: 01/09/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of the study is was to determine the incidence and mortality of second hip fracture using a nationwide database. PATIENTS AND METHODS A nationwide epidemiological study was conducted using the Taiwan National Health Insurance Research Database from 2001 to 2011. Patients older than 50 years with hip fractures from 2006 to 2011 were included in the study. A total of 95,484 hip fractures were identified, with subsequent second hip fracture occurred in 4102 of them. RESULTS The incidence rate ratio of second hip fracture showed a 7.13 fold of risk of further hip fracture in 3 months, 5.21 fold in one year, and remained more than 2 fold in the end of 6th year when compared with the general population. The 6-year cumulative incidence of a second hip fracture was higher in female (8.0%) than in male (6.2%). A significantly higher 1-year mortality rate was seen after a second hip fracture (18.8%) compared to the first hip fracture (14.1%) (p < 0.05). Men had higher 1- and 5-year mortality rates after second hip fractures (12.1% and 41.2%, respectively) than women (17.4% and 47.3%, respectively). CONCLUSIONS Patients with hip fractures would have a 2-7 fold of risk of a second fracture within 6 years. Women were more prone to a second hip fracture than men but men had a higher mortality rate.
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Affiliation(s)
- Sheng-Hsun Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Shin St., Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Taiwan.
| | - I-Jung Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Shin St., Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Taiwan.
| | - Ya-Hsin Li
- Department of Health Policy and Management, Chung Shan Medical University, No. 110, Section 1, Chien-Kuo N. Road, Taichung, Taiwan.
| | - Chih-Yun Fan Chiang
- Department of Orthopaedic Surgery, Da Chien General Hospital, No. 36, Gongjing Road, Miaoli, Taiwan.
| | - Chih-Hsiang Chang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Shin St., Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Taiwan.
| | - Pang-Hsin Hsieh
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Shin St., Taoyuan, Taiwan; College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kuei-Shan, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Taiwan.
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755
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Redmond J, Fulford AJ, Jarjou L, Zhou B, Prentice A, Schoenmakers I. Diurnal Rhythms of Bone Turnover Markers in Three Ethnic Groups. J Clin Endocrinol Metab 2016; 101:3222-30. [PMID: 27294326 PMCID: PMC4971334 DOI: 10.1210/jc.2016-1183] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Ethnic groups differ in fragility fracture risk and bone metabolism. Differences in diurnal rhythms (DRs) of bone turnover and PTH may play a role. OBJECTIVE We investigated the DRs of plasma bone turnover markers (BTMs), PTH, and 1,25(OH)2D in three groups with pronounced differences in bone metabolism and plasma PTH. PARTICIPANTS Healthy Gambian, Chinese, and white British adults (ages 60-75 years; 30 per country). INTERVENTIONS Observational study with sample collection every 4 hours for 24 hours. MAIN OUTCOMES Levels of plasma C-terminal telopeptide of type I collagen, procollagen type-1 N-propeptide, N-mid osteocalcin, bone alkaline phosphatase, PTH, and 1,25-dihydroxyvitamin D were measured. DRs were analyzed with random-effects Fourier regression and cross-correlation and regression analyses to assess associations between DRs and fasting and 24-hour means of BTMs and PTH. RESULTS Concentrations of BTMs, PTH, and 1,25-dihydroxyvitamin D were higher in Gambians compared to other groups (P < .05). The DRs were significant for all variables and groups (P < .03) and were unimodal, with a nocturnal peak and a daytime nadir for BTMs, whereas PTH had two peaks. The DRs of BTMs and PTH were significantly cross-correlated for all groups (P < .05). There was a significant positive association between C-terminal telopeptide of type I collagen and PTH in the British and Gambian groups (P = .03), but not the Chinese group. CONCLUSIONS Despite ethnic differences in plasma BTMs and PTH, DRs were similar. This indicates that alteration of rhythmicity and loss of coupling of bone resorption and formation associated with an elevated PTH in other studies may not uniformly occur across different populations and needs to be considered in the interpretation of PTH as a risk factor of increased bone loss.
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Affiliation(s)
- Jean Redmond
- Medical Research Council (MRC) Human Nutrition Research (J.R., A.P., I.S.), Cambridge CB1 9NL, United Kingdom; MRC Keneba (A.J.F., L.J., A.P.), Banjul, The Gambia; MRC International Nutrition Group (A.J.F.), London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom; and Department of Public Health (B.Z.), Shenyang Medical College, Shenyang 110034, People's Republic of China
| | - Anthony J Fulford
- Medical Research Council (MRC) Human Nutrition Research (J.R., A.P., I.S.), Cambridge CB1 9NL, United Kingdom; MRC Keneba (A.J.F., L.J., A.P.), Banjul, The Gambia; MRC International Nutrition Group (A.J.F.), London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom; and Department of Public Health (B.Z.), Shenyang Medical College, Shenyang 110034, People's Republic of China
| | - Landing Jarjou
- Medical Research Council (MRC) Human Nutrition Research (J.R., A.P., I.S.), Cambridge CB1 9NL, United Kingdom; MRC Keneba (A.J.F., L.J., A.P.), Banjul, The Gambia; MRC International Nutrition Group (A.J.F.), London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom; and Department of Public Health (B.Z.), Shenyang Medical College, Shenyang 110034, People's Republic of China
| | - Bo Zhou
- Medical Research Council (MRC) Human Nutrition Research (J.R., A.P., I.S.), Cambridge CB1 9NL, United Kingdom; MRC Keneba (A.J.F., L.J., A.P.), Banjul, The Gambia; MRC International Nutrition Group (A.J.F.), London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom; and Department of Public Health (B.Z.), Shenyang Medical College, Shenyang 110034, People's Republic of China
| | - Ann Prentice
- Medical Research Council (MRC) Human Nutrition Research (J.R., A.P., I.S.), Cambridge CB1 9NL, United Kingdom; MRC Keneba (A.J.F., L.J., A.P.), Banjul, The Gambia; MRC International Nutrition Group (A.J.F.), London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom; and Department of Public Health (B.Z.), Shenyang Medical College, Shenyang 110034, People's Republic of China
| | - Inez Schoenmakers
- Medical Research Council (MRC) Human Nutrition Research (J.R., A.P., I.S.), Cambridge CB1 9NL, United Kingdom; MRC Keneba (A.J.F., L.J., A.P.), Banjul, The Gambia; MRC International Nutrition Group (A.J.F.), London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom; and Department of Public Health (B.Z.), Shenyang Medical College, Shenyang 110034, People's Republic of China
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756
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Marques A, Lourenço Ó, Ortsäter G, Borgström F, Kanis JA, da Silva JAP. Cost-Effectiveness of Intervention Thresholds for the Treatment of Osteoporosis Based on FRAX(®) in Portugal. Calcif Tissue Int 2016; 99:131-41. [PMID: 27016370 DOI: 10.1007/s00223-016-0132-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/14/2016] [Indexed: 12/21/2022]
Abstract
Cost-effective intervention thresholds (ITs) based on FRAX(®) were determined for Portugal. Assuming a willingness to pay (WTP) of €32,000 per quality-adjusted life years (QALYs), treatment with generic alendronate is cost effective for men and women aged 50 years or more, with 10-year probabilities for major osteoporotic fractures and hip above 8.8 and 2.5 %, respectively. The aim of the present study was to identify the 10-year probabilities of a major and hip osteoporotic fracture using FRAX(®) validated for Portugal, above which pharmacologic interventions become cost effective in the Portuguese context. A previously developed and validated state transition Markov cohort model was populated with epidemiologic, economic and quality-of-life fracture data from Portugal. Cost-effectiveness of FRAX(®)-based ITs was calculated for generic alendronate and proprietary zoledronic acid, denosumab and teriparatide were compared to "no intervention", assuming a WTP of €32,000 (two times national Gross Domestic Product per capita) per QALYs. In the Portuguese epidemiological and economic context, treatment with generic alendronate was cost effective for men and women aged 50 years or more, with 10-year probabilities at or above 8.8 % for major osteoporotic fractures and 2.5 % for hip fractures. Cost-effective threshold 10-year probabilities for major osteoporotic and hip fractures were higher for zoledronic acid (20.4 and 10.1 %), denosumab (34.9 and 10.1 %) and teriparatide (77.8 and 62.6 %), respectively. A tool is provided to perform the calculation of cost-effective ITs for different medications, according to age group and diverse levels of WTP. Cost-effective ITs, for different medications, age groups and WTP, based on 10-year probabilities of major and hip fracture probabilities calculated with FRAX are provided.
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Affiliation(s)
- Andréa Marques
- Rheumatology Department, Centro Hospitalar Universitário de Coimbra, 3000-075, Coimbra, Portugal.
- Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal.
| | - Óscar Lourenço
- Faculty of Economics, Centro de Estudos e Investigação em Saúde da Universidade de Coimbra, University of Coimbra, Coimbra, Portugal
| | - Gustaf Ortsäter
- Quantify Research, Hantverkargatan 8, 112 21, Stockholm, Sweden
| | | | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - José António P da Silva
- Rheumatology Department, Centro Hospitalar Universitário de Coimbra, 3000-075, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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757
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Pedersen AB, Christiansen CF, Gammelager H, Kahlert J, Sørensen HT. Risk of acute renal failure and mortality after surgery for a fracture of the hip. Bone Joint J 2016; 98-B:1112-8. [DOI: 10.1302/0301-620x.98b8.37497] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/06/2016] [Indexed: 11/05/2022]
Abstract
Aims We examined risk of developing acute renal failure and the associated mortality among patients aged > 65 years undergoing surgery for a fracture of the hip. Patients and Methods We used medical databases to identify patients who underwent surgical treatment for a fracture of the hip in Northern Denmark between 2005 and 2011. Acute renal failure was classified as stage 1, 2 and 3 according to the Kidney Disease Improving Global Outcome criteria. We computed the risk of developing acute renal failure within five days after surgery with death as a competing risk, and the short-term (six to 30 days post-operatively) and long-term mortality (31 days to 365 days post-operatively). We calculated adjusted hazard ratios (HRs) for death with 95% confidence intervals (CIs). Results Among 13 529 patients who sustained a fracture of the hip, 1717 (12.7%) developed acute renal failure post-operatively, including 1218 (9.0%) with stage 1, 364 (2.7%) with stage 2, and 135 (1.0%) with stage 3 renal failure. The short-term mortality was 15.9% and 5.6% for patients with and without acute renal failure, respectively (HR 2.8, 95% CI 2.4 to 3.2). The long-term mortality was 25.0% and 18.3% for those with and without acute renal failure, respectively (HR 1.3, 95% CI 1.2 to 1.5). The mortality was higher in patients with an increased severity of renal failure. Conclusion Acute renal failure is a common complication of surgery in elderly patients who sustain a fracture of the hip, and is associated with increased mortality up to one year after surgery despite adjustment for coexisting comorbidity and medication before surgery. Cite this article: Bone Joint J 2016;98-B:1112–18.
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Affiliation(s)
- A. B. Pedersen
- Aarhus University Hospital, Olof
Palmes Alle 43-45, Aarhus, 8200, Denmark
| | - C. F. Christiansen
- Aarhus University Hospital, Olof
Palmes Alle 43-45, Aarhus, 8200, Denmark
| | - H. Gammelager
- Aarhus University Hospital, Olof
Palmes Alle 43-45, Aarhus, 8200, Denmark
| | - J. Kahlert
- Aarhus University Hospital, Olof
Palmes Alle 43-45, Aarhus, 8200, Denmark
| | - H. T. Sørensen
- Aarhus University Hospital, Olof
Palmes Alle 43-45, Aarhus, 8200, Denmark
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758
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Rivas-Ruiz R, Méndez-Sánchez L, Castelán-Martínez OD, Clark P, Tamayo J, Talavera JO, Huitrón G, Salmerón-Castro J. Comparison of International Reference Values for Bone Speed of Sound in Pediatric Populations: Meta-analysis. J Clin Densitom 2016; 19:316-25. [PMID: 26088387 DOI: 10.1016/j.jocd.2015.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 04/07/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to compare international reference values (RV) for tibial and radial speed of sound (SoS) assessed by quantitative ultrasound (QUS) in pediatric populations. These values were compared by age and country of origin in a systematic review with meta-analysis from studies published on QUS (Sunlight Omnisense). A search was carried out in electronic databases. Nine studies with 6963 patients were included in the meta-analysis. For the newborn populations, 3 studies (from Italy, Portugal, and Israel) were used. These studies included subjects with 27-42 wk gestational age. The mean difference (Portugal-Israel) was found to be 23.62 m/s [95% confidence interval [CI] 6.29, 40.95]. Additionally, no difference was found between Italy-Portugal (p = 0.69), or Italy-Israel (p = 0.28). In pediatric populations, we compared 8 studies from Canada, Mexico, Israel, Greece, Portugal, and Turkey. No significant differences found for SoS RV between Israel-Turkey, Israel-Greece, or Israel-Canada (p > 0.05). Significant differences were found in Mexico-Israel -105.29 m/s (95% CI -140.05, -70.54) (p < 0.001); Mexico-Portugal -115.14 m/s (95% CI -164.86, -65.42) (p < 0.001); Mexico-Greece: -239.14 m/s (95% CI -267.67, -210.62) (p < 0.001); Mexico-Turkey: -115.14 m/s (95% CI -164.86, -65.42) (p < 0.001); Mexico-Canada: -113.51 m/s (95% CI -140.25, -86.77) (p < 0.001).This study demonstrates that there are differences in SoS-RV obtained by tibial and radial QUS in pediatric populations between Mexico and other countries (Israel, Portugal, Greece, Turkey, and Canada).
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Affiliation(s)
- R Rivas-Ruiz
- Centro de Adiestramiento en Investigación Clínica, Coordinación de Investigación en Salud, Centro Médico Nacional S. XXI, IMSS, México, D.F.; Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F
| | - L Méndez-Sánchez
- Unidad de Epidemiología Clínica, Hospital Infantil de México Federico Gómez, México, D.F.; Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F..
| | - O D Castelán-Martínez
- Unidad de Epidemiología Clínica, Hospital Infantil de México Federico Gómez, México, D.F
| | - P Clark
- Unidad de Epidemiología Clínica, Hospital Infantil de México Federico Gómez, México, D.F.; Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F
| | - J Tamayo
- Comité Mexicano para la Prevención de la Osteoporosis, México, D.F
| | - J O Talavera
- Centro de Adiestramiento en Investigación Clínica, Coordinación de Investigación en Salud, Centro Médico Nacional S. XXI, IMSS, México, D.F.; Centro de Investigación en Ciencias Médicas, Universidad Autónoma del Estado de México, Toluca, México
| | - G Huitrón
- Centro de Investigación en Ciencias Médicas, Universidad Autónoma del Estado de México, Toluca, México
| | - J Salmerón-Castro
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, México; Centro de Investigación de Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, México
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759
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Hilliard CB. High osteoporosis risk among East Africans linked to lactase persistence genotype. BONEKEY REPORTS 2016; 5:803. [PMID: 27408710 PMCID: PMC4926535 DOI: 10.1038/bonekey.2016.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 03/15/2016] [Indexed: 02/06/2023]
Abstract
This ecological correlation study explores the marked differential in osteoporosis susceptibility between East and West Africans. African tsetse belt populations are lactase non-persistent (lactose intolerant) and possess none of the genetic polymorphisms carried by lactase persistent (lactose tolerant) ethnic populations. What appears paradoxical, however, is the fact that Niger-Kordofanian (NK) West African ethnicities are also at minimal risk of osteoporosis. Although East Africans share a genetic affinity with NK West Africans, they display susceptibility rates of the bone disorder closer to those found in Europe. Similar to Europeans, they also carry alleles conferring the lactase persistence genetic traits. Hip fracture rates of African populations are juxtaposed with a global model to determine whether it is the unique ecology of the tsetse-infested zone or other variables that may be at work. This project uses MINITAB 17 software for regression analyses. The research data are found on AJOL (African Journals Online), PUBMED and JSTOR (Scholarly Journal Archive). Data showing the risk of osteoporosis to be 80 times higher among East Africans with higher levels of lactase persistence than lactase non-persistence West Africans are compared with global statistics. Hip fracture rates in 40 countries exhibit a high Pearson's correlation of r=0.851, with P-value=0.000 in relation to dairy consumption. Lower correlations are seen for hip fracture incidence vis-à-vis lactase persistence, per capita income and animal protein consumption. Ethnic populations who lack lactase persistence single-nucleotide polymorphisms may be at low risk of developing osteoporosis.
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760
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Osteoporosis: Modern Paradigms for Last Century's Bones. Nutrients 2016; 8:nu8060376. [PMID: 27322315 PMCID: PMC4924217 DOI: 10.3390/nu8060376] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 11/22/2022] Open
Abstract
The skeleton is a metabolically active organ undergoing continuously remodelling. With ageing and menopause the balance shifts to increased resorption, leading to a reduction in bone mineral density and disruption of bone microarchitecture. Bone mass accretion and bone metabolism are influenced by systemic hormones as well as genetic and lifestyle factors. The classic paradigm has described osteoporosis as being a “brittle bone” disease that occurs in post-menopausal, thin, Caucasian women with low calcium intakes and/or vitamin D insufficiency. However, a study of black women in Africa demonstrated that higher proportions of body fat did not protect bone health. Isoflavone interventions in Asian postmenopausal women have produced inconsistent bone health benefits, due in part to population heterogeneity in enteric bacterial metabolism of daidzein. A comparison of women and men in several Asian countries identified significant differences between countries in the rate of bone health decline, and a high incidence rate of osteoporosis in both sexes. These studies have revealed significant differences in genetic phenotypes, debunking long-held beliefs and leading to new paradigms in study design. Current studies are now being specifically designed to assess genotype differences between Caucasian, Asian, African, and other phenotypes, and exploring alternative methodology to measure bone architecture.
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761
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Mellström D, Yang X, Li Z, Fan CPS, Waern E, Modi A, Sajjan S, Salomonsson S. Proportion and Characteristics of Patients in Sweden Remaining at High Risk of Fracture Despite Prior Treatment. Clin Ther 2016; 38:1686-1695.e3. [PMID: 27288211 DOI: 10.1016/j.clinthera.2016.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 05/04/2016] [Accepted: 05/10/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Fragility fractures are a clinical consequence of osteoporosis (OP). Evidence suggests however, current OP treatments may be inadequate in reducing fracture risk. The purpose of this study was to estimate the proportion and characteristics of Swedish patients who remain at high risk of fracture after 2 years of treatment, as evidenced by osteoporotic bone mineral density (BMD), a decrease in BMD, or the occurrence of new fractures. METHODS This was a retrospective, descriptive analysis of a subset of participants obtained from a Swedish osteoporosis patient registry from 1991 to 2009. Patients were required to be osteoporotic, to be treatment naive at baseline, to have returned for at least 1 follow-up visit, and to have reported osteoporosis treatment use for ≥2 years after the baseline visit with a BMD T score. Two overlapping cohorts remaining at high risk of fracture were defined using the BMD T score measured after 2 years of treatment from baseline. The osteoporosis cohort comprised patients who remained osteoporotic, whereas the BMD decrease cohort included patients whose total hip or lumbar spine T score decreased by ≥3%. FINDINGS A total of 3292 osteoporotic patients were identified in the registry, of whom 392 met the study inclusion criteria. The mean (SD) patient age was 68.3 (8.5) years, with most patients being female (92.3%). Among all patients, 297 (75.8%) remained osteoporotic after at least 2 years of treatment, 90 (23.0%) experienced a BMD decrease of ≥3%, and 23 (5.9%) reported an incident fracture between the baseline and first follow-up visit. More than three-quarters (76.8%) of all patients reported taking bisphosphonates, whereas only 72.4% and 47.8% reported this in the osteoporosis and BMD decrease cohorts, respectively. Raloxifene was the only nonbisphosphonate used, with 24.2% of all patients reportedly taking it. IMPLICATIONS This study highlighted that despite 2 years of osteoporosis treatment, a high percentage of patients remain at high risk of fracture. There is a need for improved treatment strategies that reduce fracture risk and improve patient outcomes in the real-world setting.
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Affiliation(s)
- Dan Mellström
- Centre for Bone and Arthritis Research, University of Gothenburg, Gothenburg, Sweden
| | | | - Zhiyi Li
- AsclepiusAnalytics LLC, New York, New York
| | | | - Ewa Waern
- Centre for Bone and Arthritis Research, University of Gothenburg, Gothenburg, Sweden
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762
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Driessen JHM, Hansen L, Eriksen SA, van Onzenoort HAW, Henry RMA, van den Bergh J, Abrahamsen B, Vestergaard P, de Vries F. The epidemiology of fractures in Denmark in 2011. Osteoporos Int 2016; 27:2017-25. [PMID: 26846775 PMCID: PMC4863906 DOI: 10.1007/s00198-016-3488-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/07/2016] [Indexed: 12/03/2022]
Abstract
UNLABELLED In the present study, we used national health care databases to estimate fracture incidence rates (IRs) and compared these IRs based on imputed data. We showed that imputation could lead to both over- and underestimation of IRs, and future research should therefore focus on how to improve those imputations. INTRODUCTION Osteoporosis is a major public health burden through associated (osteoporotic) fractures. In Denmark, the incidence rates (IRs) of hip fracture are widely available. However, there is limited data about other fracture sites. A recent report could only provide imputed IRs, although nationwide data is readily available in electronic healthcare databases. Therefore, our aim was to estimate fracture site-specific IRs for Denmark in 2011 and to compare those to the previously reported imputed data. METHODS Data from the Danish National Hospital Discharge Register was used to estimate age- and gender-specific IRs for any fracture as well as for different fracture sites in the Danish population aged 20 years and older in 2011. Hip fracture IRs were stratified to sub-sites, and IRs were determined for all hip fractures which were confirmed by surgery. RESULTS The total number of incident fractures in 2011 was 80,760 (IR 191, 95 % confidence interval (CI) 190-192 (per 10,000 person-years)), of which 35,398 (43.8 %, IR 171, 95 % CI 169-173) occurred in men and 45,362 (56.2 %, IR 211, 95 % CI 209-213) in women. The majority of the fractures occurred in the population aged 50 years and older (n = 50,470, IR 249, 95 % CI 247-251). The numbers of any hip fracture were lower than the previously imputed estimates, whereas the number of forearm fractures was higher. CONCLUSION We showed age- and gender-specific fracture rates for any fracture as well as for different fracture sites. The IRs of most fracture sites increased with age. Estimating the number of fractures for Denmark based on imputation of data from other countries led to both over- and underestimation. Future research should therefore focus on how to improve those imputations as not all countries have nationwide registry data.
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Affiliation(s)
- J H M Driessen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - L Hansen
- Danish Centre for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg, Denmark
| | - S A Eriksen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - H A W van Onzenoort
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - R M A Henry
- Department of Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J van den Bergh
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Biomedical Research Institute, University Hasselt, Hasselt, Belgium
| | - B Abrahamsen
- Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbaek Hospital, Holbaek, Denmark
| | - P Vestergaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - F de Vries
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, The Netherlands.
- Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands.
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
- MRC Epidemiology Lifecourse Unit, Southampton General Hospital, Southampton, UK.
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763
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Curtis EM, van der Velde R, Moon RJ, van den Bergh JPW, Geusens P, de Vries F, van Staa TP, Cooper C, Harvey NC. Epidemiology of fractures in the United Kingdom 1988-2012: Variation with age, sex, geography, ethnicity and socioeconomic status. Bone 2016; 87:19-26. [PMID: 26968752 PMCID: PMC4890652 DOI: 10.1016/j.bone.2016.03.006] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/09/2016] [Accepted: 03/07/2016] [Indexed: 12/18/2022]
Abstract
UNLABELLED Rates of fracture worldwide are changing. Using the Clinical Practice Research Datalink (CPRD), age, and gender, geographical, ethnic and socioeconomic trends in fracture rates across the United Kingdom were studied over a 24-year period 1988-2012. Previously observed patterns in fracture incidence by age and fracture site were evident. New data on the influence of geographic location, ethnic group and socioeconomic status were obtained. INTRODUCTION With secular changes in age- and sex-specific fracture incidence observed in many populations, and global shifts towards an elderly demography, it is vital for health care planners to have an accurate understanding of fracture incidence nationally. We aimed to present up to date fracture incidence data in the UK, stratified by age, sex, geographic location, ethnicity and socioeconomic status. METHODS The Clinical Practice Research Datalink (CPRD) contains anonymised electronic health records for approximately 6.9% of the UK population. Information comes from General Practitioners, and covers 11.3 million people from 674 practices across the UK, demonstrated to be representative of the national population. The study population consisted of all permanently registered individuals aged ≥18years. Validated data on fracture incidence were obtained from their medical records, as was information on socioeconomic deprivation, ethnicity and geographic location. Age- and sex-specific fracture incidence rates were calculated. RESULTS Fracture incidence rates by age and sex were comparable to those documented in previous studies and demonstrated a bimodal distribution. Substantial geographic heterogeneity in age- and sex adjusted fracture incidence was observed, with rates in Scotland almost 50% greater than those in London and South East England. Lowest rates of fracture were observed in black individuals of both sexes; rates of fragility fracture in white women were 4.7 times greater than in black women. Strong associations between deprivation and fracture risk were observed in hip fracture in men, with a relative risk of 1.3 (95% CI 1.21-1.41) in Index of Multiple Deprivation category 5 (representing the most deprived) compared to category 1. CONCLUSIONS This study presents robust estimates of fracture incidence across the UK, which will aid decisions regarding allocation of healthcare provision to populations of greatest need. It will also assist the implementation and design of strategies to reduce fracture incidence and its personal and financial impact on individuals and health services.
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Affiliation(s)
- Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- Correspondence and reprint requests to: Professor Cyrus Cooper, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK. Tel: +44 (0) 23 8077 7624 Fax: +44 (0) 23 8070 4021,
| | - Robert van der Velde
- Dept of Internal Medicine, VieCuri Medical Center, Venloseweg 595971 PB Venlo, the Netherlands
| | - Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Joop P W van den Bergh
- Dept of Internal Medicine, VieCuri Medical Center, Venloseweg 595971 PB Venlo, the Netherlands
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Piet Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
- University Hasselt, Hasselt, Belgium
| | - Frank de Vries
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tjeerd P van Staa
- Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, 1.003 Vaughan House, Portsmouth Road, M13 9PL, UK
- Department of Pharmacoepidemiology & Clinical Pharmacology, University of Utrecht, Utrecht, the Netherlands, 3508 TB
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopedic Centre, Headington, Oxford, OX3 7HE, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
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764
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Bliemel C, Sielski R, Doering B, Dodel R, Balzer-Geldsetzer M, Ruchholtz S, Buecking B. Pre-fracture quality of life predicts 1-year survival in elderly patients with hip fracture-development of a new scoring system. Osteoporos Int 2016; 27:1979-87. [PMID: 26733375 DOI: 10.1007/s00198-015-3472-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Hip fractures are common in elderly people. Despite great progress in surgical care, the outcome of patients with hip fracture remains disappointing. This study determined four prognostic factors (lower ASA score, higher pre-fracture EQ-5D index, higher MMSE score, and female gender) to predict 1-year survival in patients with hip fracture. INTRODUCTION This study determined the prognostic factors for 1-year survival in patients with hip fracture. Based on these predictors, a scoring system was developed for use upon patients' admission to the hospital. METHODS Hip fracture patients, aged ≥60 years, were prospectively enrolled. Upon admission, patients' sociodemographic data, type of fracture, American Society of Anesthesiologists (ASA) score, health-related quality of life scores (EQ-5D index) and Mini-Mental State Examination (MMSE) scores were recorded, among other parameters. Correlational analysis was performed on all potential variables to identify relevant predictor variables of 1-year survival. Univariate regression analysis was performed on all selected variables, followed by a multivariate analysis for variables that were significant in the univariate analysis. The final score was developed by converting the β-coefficients of each variable from the multivariate analysis into a scoring system. RESULTS For 391 hip fracture patients, complete data were available at the time of the 1-year follow-up. In multivariate regression analysis, independent predictors of 1-year survival were lower ASA score, higher pre-fracture EQ-5D index, higher MMSE score, and female gender. The different variables were weighted according to their β-coefficient to build the prognostic score, which ranged from 0 to 10 points. The ROC curve for 1-year mortality after hip fracture showed an area under the curve of 0.74 (R (2) = 0.272; 95 % CI 0.68-0.79; p < 0.001). CONCLUSIONS With only four instruments, the new score represents a useful tool for estimating 1-year survival in elderly patients with hip fractures. At present, the score is limited due to a lack of validation. A validation study is currently underway to prove its reliability.
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Affiliation(s)
- C Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - R Sielski
- Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany
| | - B Doering
- Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany
| | - R Dodel
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - M Balzer-Geldsetzer
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - S Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - B Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany
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765
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Pedersen AB, Baggesen LM, Ehrenstein V, Pedersen L, Lasgaard M, Mikkelsen EM. Perceived stress and risk of any osteoporotic fracture. Osteoporos Int 2016; 27:2035-45. [PMID: 26786258 DOI: 10.1007/s00198-016-3490-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED Perceived stress is associated with several adverse health outcomes; however, little is known about the impact of stress on fracture risk. In this population-based cohort study, persons with high perceived stress have an increased 5-year risk of any osteoporotic fracture, in particular hip fracture. INTRODUCTION We conducted a population-based cohort study in Denmark to examine the association between perceived stress and risk of subsequent osteoporotic fracture. METHODS A 2006 population-based health survey in the Central Danish Region (with 1.25 million inhabitants) was used to identify 7943 persons who were 55 years or older on the survey date and completed the Perceived Stress Scale. Individuals were categorized into two groups: high level of stress and low level of stress (including no stress). We obtained information on all osteoporotic fractures through linkage to the Danish National Registry of Patients. We used Cox regression to compute hazard ratios (HRs) with 95 % confidence interval (CI) adjusted for a number of lifestyle factors, socioeconomic data, perceived general health, and prescription history, comparing high- and low-stress persons. RESULTS A total of 1799 persons (22.6 %) reported high level of perceived stress, whereas 6144 (77.4 %) reported low level or no stress. The 5-year risk of any osteoporotic fracture was 7.4 and 5.4 % in persons with high and low perceived stress, respectively, corresponding to adjusted HR of 1.37 (CI 1.00-1.89). The adjusted HR for hip fracture within 5 years associated with high perceived stress was 1.68 (CI 1.04-2.72). The associations weakened with increasing follow-up time. CONCLUSIONS Persons with high perceived stress have an increased risk of any osteoporotic fracture, in particular risk of hip fracture within 5 years of stress assessment even after adjusting for differences in lifestyle, comorbidities, osteoporosis presence, medication use, and socioeconomic status at the time of stress level evaluation. The association attenuated after longer follow-up time.
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Affiliation(s)
- A B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - L M Baggesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - V Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - M Lasgaard
- Public Health and Quality Improvement, Central Denmark Region, Region House Aarhus, Olof Palmes Allé 15, 8200, Aarhus N, Denmark
- Department of Psychology, Southern University of Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - E M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
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766
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Chin KY, Wan Ngah WZ, Ima-Nirwana S. Lessons from the Bone Chapter of the Malaysian Aging Men Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060531. [PMID: 27231930 PMCID: PMC4923988 DOI: 10.3390/ijerph13060531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 05/17/2016] [Accepted: 05/23/2016] [Indexed: 12/17/2022]
Abstract
Male osteoporosis in Malaysia is a largely neglected problem. Therefore, a bone health study in men using quantitative ultrasonometry was launched as part of the Malaysian Aging Men Study in 2009–2012. This review aimed to summarize the findings of the aforementioned bone health study. The study examined the bone health of Chinese and Malaysian men aged 20 years and above living in Kuala Lumpur using a quantitative ultrasound device. Participants answered a questionnaire on their demographic details and physical activity status. Body anthropometry of the participants was measured and their blood collected for biochemical analysis. Results showed that a significant proportion of the Malaysian Chinese and Malay men had suboptimal bone health indicated by calcaneal speed of sound and vitamin D status. Age-related decline of the calcaneal speed of sound in these men was gradual and biphasic without ethnic difference. Body anthropometry such as height, weight, body mass index, and body fat percentage contributed to the variation of the calcaneal speed of sound in Malaysian men. Age-related changes in testosterone, insulin-like growth factor 1, and thyroid stimulating hormone also influenced the calcaneal speed of sound in these men. This study serves as a reminder that male osteoporosis in Malaysia should be an issue of concern. It is also a basis for a more comprehensive study on bone health in men in the future.
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Affiliation(s)
- Kok-Yong Chin
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia.
| | - Wan Zurinah Wan Ngah
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia.
| | - Soelaiman Ima-Nirwana
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia.
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767
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Overgaard JA, Larsen CM, Holtze S, Ockholm K, Kristensen MT. Interrater Reliability of the 6-Minute Walk Test in Women With Hip Fracture. J Geriatr Phys Ther 2016; 40:158-166. [PMID: 27213999 DOI: 10.1519/jpt.0000000000000088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE The 6-minute walk test (6MWT) is widely used as a clinical outcome measure. However, the reliability of the 6MWT is unknown in individuals who have recently experienced a hip fracture. The aim of this study was to evaluate the relative and absolute interrater reliability of the 6MWT in individuals with hip fracture. METHODS Two senior physical therapy students independently examined a convenience sample of 20 participants in a randomized order. Their assessments were separated by 2 days and followed the guidelines of the American Thoracic Society. Hip fracture-related pain was assessed with the Verbal Ranking Scale. RESULTS Participants (all women) with a mean (standard deviation) age of 78.1 (5.9) years performed the test at a mean of 31.5 (5.8) days postsurgery. Of the participants, 10 had a cervical fracture and 10 had a trochanteric fracture. Excellent interrater reliability (intraclass correlation coefficient [ICC2.1] = 0.92; 95% confidence interval, 0.81-0.97) was found, and the standard error of measurement and smallest real difference were calculated to be 21.4 and 59.4 m, respectively. Bland-Altman plots revealed no significant difference (mean of 3.2 [31.5] m, P = .83) between the 2 raters, and no heteroscedasticity was observed (r = -0.196, P = .41). By contrast, participants walked an average of 21.7 (22.5) m longer during the second trial (P = .002). Participants with moderate hip fracture-related pain walked a shorter distance than those with no or light pain during the first test (P = .04), but this was not the case during the second test (P = .25). CONCLUSION The interrater reliability of the 6MWT is excellent, and changes of more than 21.4 m (group level) and 59.4 m (individual participants with hip fracture) indicate a real change in the 6MWT. Measuring hip fracture-related pain during testing is recommended for individuals with hip fracture who undergo the 6MWT.
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Affiliation(s)
- Jan Arnholtz Overgaard
- 1Department of Rehabilitation, Municipality of Lolland, Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Maribo, Denmark. 2Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. 3Health Sciences Research Centre, University College Lillebaelt, Denmark. 4Department of Rehabilitation, Municipality of Lolland, Maribo, Denmark. 5Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Departments of Physiotherapy and Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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768
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Chuang PY, Shen SH, Yang TY, Huang TW, Huang KC. Non-steroidal anti-inflammatory drugs and the risk of a second hip fracture: a propensity-score matching study. BMC Musculoskelet Disord 2016; 17:201. [PMID: 27141945 PMCID: PMC4855841 DOI: 10.1186/s12891-016-1047-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/22/2016] [Indexed: 11/30/2022] Open
Abstract
Background Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for elderly patients, particularly after a hip fracture. However, we are not clear about the effect of NSAIDs on the risk of a second hip fracture because of confounding factors. Methods This was a Taiwan National Health Insurance Research Database-based study using propensity-score matching (PSM) to control for confounding. Enrollees were selected from patients with a hip fracture during 1996–2004 and followed longitudinally until December 2009. After PSM for comorbidities and bisphosphonate therapy, 94 patients with a second hip fracture were assigned to the Cases group and 461 without it to the Controls group. The target drugs are NSAIDs; paracetamol and dexamethasone are used for comparison. Results The correlation between the mean daily-dose (MDD) ratios of NSAIDs and the probability values of the current statistical tests were highly negative (Pearson’s r = −0.920, P = 0.003), which indicated that the higher the MDD ratios, the greater the risks of a second hip fracture. A Kaplan-Meier survival analysis showed a time-dependent trend of increasing risk of a second hip fracture in patients taking NSAIDs (P < 0.001). Moreover, patients ≥60 years old had a higher risk of a second hip fracture than did those <60 and taking the NSAIDs diclofenac (P = 0.016) and celecoxib (P = 0.003) and the corticosteroid dexamethasone (P = 0.018), but not those taking analgesic paracetamol (P = 0.074). Conclusions We conclude that taking NSAIDs after a fragility hip fracture dose- and time-dependently significantly increases the risk of a second hip fracture, especially in elderly patients. To lower the risk of a second hip fracture, any underlying causes for excessively using NSAIDs should be treated and thus fewer NSAIDs prescribed after a first hip fracture.
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Affiliation(s)
- Po-Yao Chuang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Hsun Shen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tien-Yu Yang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsan-Wen Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chin Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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769
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Lu YC, Lin YC, Lin YK, Liu YJ, Chang KH, Chieng PU, Chan WP. Prevalence of Osteoporosis and Low Bone Mass in Older Chinese Population Based on Bone Mineral Density at Multiple Skeletal Sites. Sci Rep 2016; 6:25206. [PMID: 27143609 PMCID: PMC4855183 DOI: 10.1038/srep25206] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/13/2016] [Indexed: 01/25/2023] Open
Abstract
Diagnosis of osteoporosis is based on bone mineral density (BMD) measurement, which is site dependent and commonly discordant between measurement sites. We aimed to determine the prevalence of osteoporosis diagnosed based on BMD T-scores measured by dual-energy x-ray absorptiometry (DXA) at different sites: the lumbar spine (LS) alone, femoral neck (FN) alone, or both. A total of 1712 women and 2028 men with LS and FN BMD measurements were enrolled. Over 50% discordance was found between osteoporosis classifications based on T-scores measured at the LS and FN. Use of the lowest T-scores measured at both the LS and right and left FN (rather than one site) significantly increased the prevalence of osteoporosis from 4.03 to 10.75% in postmenopausal women and 1.82 to 4.29% in men aged ≧50 years (p < 0.001). The trends of overall and age-adjusted prevalence of osteoporosis were similar in women and men. Osteoporosis was diagnosed at a higher rate if the USA reference rather than the Asia reference was used to calculate the T-score (26.64% vs. 10.75%). In conclusion, diagnosis based on the lowest T-score from multiple site BMD measurement can increase the prevalence of osteoporosis, demonstrating the higher sensitivity of the multiple site measurement strategy.
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Affiliation(s)
- Yi-Chien Lu
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan, Republic of China
| | - Ying Chin Lin
- Department of Health Management Center, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan, Republic of China.,Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan, Republic of China.,Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan, Republic of China
| | - Yen-Kuang Lin
- Biostatistics Center, Taipei Medical University, Taipei 110, Taiwan, Republic of China.,Graduate Institute of Nursing, Taipei Medical University, Taipei 110, Taiwan, Republic of China
| | - Yi-Jui Liu
- Department of Automatic Control Engineering, Feng Chia University, Taichung 407, Taiwan, Republic of China
| | - Kwang-Hwa Chang
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan, Republic of China.,Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei 110, Taiwan, Republic of China
| | - Poon-Ung Chieng
- Department of Radiology, Taiwan Adventist Hospital, Taipei 105, Taiwan, Republic of China
| | - Wing P Chan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan, Republic of China.,Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan, Republic of China
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770
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Haring B, Crandall CJ, Wu C, LeBlanc ES, Shikany JM, Carbone L, Orchard T, Thomas F, Wactawaski-Wende J, Li W, Cauley JA, Wassertheil-Smoller S. Dietary Patterns and Fractures in Postmenopausal Women: Results From the Women's Health Initiative. JAMA Intern Med 2016; 176:645-52. [PMID: 27019044 PMCID: PMC7057761 DOI: 10.1001/jamainternmed.2016.0482] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Considerable efforts have been undertaken to relate single nutrients to bone health. To this point, results are inconsistent. Suboptimal single nutrient intake does not occur in isolation but rather reflects a poor diet quality. OBJECTIVE To assess the association between adherence to a diet quality index constructed on the basis of dietary recommendations or existing healthy dietary patterns and fractures in postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS Post hoc analysis was conducted of longitudinal data from 40 clinical centers throughout the United States included in the Women's Health Initiative (WHI) observational study. Participants in the prospective cohort included 93 676 women who were eligible for the WHI if they were aged 50 to 79 years. Recruitment was conducted from October 1, 1993, to December 31, 1998, with the study ending August 29, 2014. The WHI food frequency questionnaire was used to derive nutrient and food intake at baseline. Diet quality and adherence were assessed by scores on the alternate Mediterranean Diet (aMED), a 9-category measure of adherence to a Mediterranean dietary pattern; the Healthy Eating Index 2010 (HEI-2010), a 100-point measure of 12 food components; the 11-item Alternate Healthy Eating Index 2010 (AHEI-2010); or the 8-component Dietary Approaches to Stop Hypertension (DASH) diet score. MAIN OUTCOMES AND MEASURES Outcome measures included incident total and hip fractures. Hazard ratios (HRs) by quintiles of dietary index scores were estimated using Cox proportional hazards regression analyses. RESULTS Of the 93 676 participants, 90 014 were included in the analysis (mean [SD] age, 63.6 [7.4]) years. During a median follow-up time of 15.9 years, there were 2121 cases of hip fractures and 28 718 cases of total fractures. Women scoring in the highest quintile (Q5) of the aMED index had a lower risk for hip fractures (HR, 0.80; 95% CI, 0.66-0.97), with an absolute risk reduction of 0.29% and a number needed to treat of 342 (95% CI, 249-502). No association between the aMED score and total fractures was observed (Q5 HR, 1.01; 95% CI, 0.95-1.07). Higher HEI-2010 or DASH scores tended to be inversely related to hip fracture risk, but the results were nonsignificant (Q5 HR, 0.87; 95% CI, 0.75-1.02; and Q5 HR, 0.89; 95% CI, 0.75-1.06, respectively). The AHEI-2010 score was associated with neither hip nor total fractures. CONCLUSIONS AND RELEVANCE Higher adherence to a Mediterranean diet is associated with a lower risk for hip fractures. These results support that a healthy dietary pattern may play a role in maintaining bone health in postmenopausal women.
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Affiliation(s)
- Bernhard Haring
- Department of Internal Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Bavaria, Germany
| | - Carolyn J Crandall
- Department of Medicine, David Geffen School of Medicine, UCLA (University of California at Los Angeles)
| | - Chunyuan Wu
- Women's Health Initiative, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research Northwest, Portland, Oregon
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham
| | - Laura Carbone
- Department of Medicine, Medical College of Georgia at Georgia Regents University, Augusta
| | - Tonya Orchard
- Human Nutrition Program, Department of Human Sciences, The Ohio State University, Columbus
| | - Fridtjof Thomas
- Division of Biostatistics and Epidemiology, Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis
| | - Jean Wactawaski-Wende
- Department of Epidemiology and Environmental Health, State University of New York at Buffalo
| | - Wenjun Li
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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771
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Orimo H, Yaegashi Y, Hosoi T, Fukushima Y, Onoda T, Hashimoto T, Sakata K. Hip fracture incidence in Japan: Estimates of new patients in 2012 and 25-year trends. Osteoporos Int 2016; 27:1777-84. [PMID: 26733376 PMCID: PMC4873530 DOI: 10.1007/s00198-015-3464-8] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 12/15/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED We estimated the number of hip fracture patients in 2012 in Japan and investigated the trends in incidence during a 25-year period from 1987 to 2012. Despite the increasing number of patients, the incidence of hip fracture in both men and women aged 70-79 years showed the possibility of decline. INTRODUCTION The objectives of this study were to estimate the number of hip fracture patients in 2012, to investigate the trends in incidence during a 25-year period from 1987 to 2012, and to determine the regional differences in Japan. METHODS Data were collected through a nationwide survey based on hospitals by a mail-in survey. Hip fracture incidences by sex and age and standardized incidence ratios by region were calculated. RESULTS The estimated numbers of new hip fracture patients in 2012 were 175,700 in total (95 % CI 170,300-181,100), 37,600 (36,600-38,600) for men and 138,100 (134,300-141,900) for women. The incidence rates in both men and women aged 70-79 years were the lowest in the 20-year period from 1992 to 2012. The incidence was higher in western areas of Japan than that in eastern areas in both men and women; however, the difference in the incidence of hip fracture between western and eastern areas is becoming smaller. CONCLUSIONS Despite the increasing number of new patients, the incidence of hip fracture in both men and women aged 70-79 years showed the possibility of decline. The exact reasons for this are unknown, but various drugs for improving bone mineral density or preventing hip fracture might have influenced the results. A decrease in the differences in nutrient intake levels might explain some of the change in regional differences in Japan.
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Affiliation(s)
- H Orimo
- Kenkoin Clinic, Chuo-ku, Tokyo, Japan
| | - Y Yaegashi
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, 2-1-1 Nishitokuta, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan.
| | - T Hosoi
- Kenkoin Clinic, Chuo-ku, Tokyo, Japan
| | - Y Fukushima
- Ministry of Health, Labour and Welfare, Chiyoda-ku, Tokyo, Japan
| | - T Onoda
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, 2-1-1 Nishitokuta, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - T Hashimoto
- Department of Public Health, Wakayama Medical University, Wakayama, Japan
| | - K Sakata
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, 2-1-1 Nishitokuta, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
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772
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Chen FP, Hsu KH, Fu TS, Chao AS, Yu YW, Fan CM, Sung CM, Chern IYY. Risk factor for first-incident hip fracture in Taiwanese postmenopausal women. Taiwan J Obstet Gynecol 2016; 55:258-62. [PMID: 27125411 DOI: 10.1016/j.tjog.2015.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The variation in hip fracture risk between countries is greater than 10-fold. The present study aimed at identifying risk factors that resulted in the first occurrence of hip fracture in Taiwanese postmenopausal women. MATERIALS AND METHODS A case-control study with a patient group of 50 postmenopausal women, who were admitted to Keelung Chang Gung Hospital, Keelung, Taiwan due to the first incident of accidental hip fracture, was used to examine potential risk factors, including bone mass. Fifty women without hip fracture, selected from those undergoing general health evaluation at the Gynecology Outpatient Clinic at Keelung Chang Gung Hospital, were used as the control group and were matched to the case patients according to age. Evaluation consisted of a questionnaire, interview to document risk factors, physical examination (to record body height and body weight), and examination [dual-energy X-ray absorptiometry used to measure bone mineral density (BMD) of the hip and spine]. RESULTS The average age of participants of both groups was 79.6 years. Lower level of education, younger age at menopause, increased body height, weight-bearing exercise less than three times per week, and lower BMD were associated with first-incident hip fracture. Total hip BMD was a stronger predictor than the BMD of different sites. Participants in the control group had a significantly higher prevalence of chronic diseases and a history of cataracts or glaucoma compared with those in the patient group. CONCLUSION While total hip BMD is the strongest predictor of hip fracture, increasing awareness of osteoporosis prevention by educating people about good lifestyle habits and how to maintain BMD is prioritized for preventing the first-incident hip fracture in Taiwanese women.
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Affiliation(s)
- Fang-Ping Chen
- Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital and Chang Gung University, Taiwan.
| | - Kuang-Hung Hsu
- Department of Health Care Management, College of Management, Chang Gung University, Taiwan
| | - Tsai-Sheng Fu
- Department of Orthopaedic Surgery, Keelung Chang Gung Memorial Hospital and Chang Gung University, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital and Chang Gung University, Taiwan
| | - Yu-Wei Yu
- Department of Medical Research and Development, Keelung Chang Gung Memorial Hospital and Chang Gung University, Taiwan
| | - Chih-Ming Fan
- Department of Radiology, Keelung Chang Gung Memorial Hospital and Chang Gung University, Taiwan
| | - Chen-Ming Sung
- Department of Radiology, Keelung Chang Gung Memorial Hospital and Chang Gung University, Taiwan
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773
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Chan DC, McCloskey EV, Chang CB, Lin KP, Lim LC, Tsai KS, Yang RS. Establishing and evaluating FRAX ® probability thresholds in Taiwan. J Formos Med Assoc 2016; 116:161-168. [PMID: 27117886 DOI: 10.1016/j.jfma.2016.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/19/2016] [Accepted: 03/21/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/PURPOSE The Taiwanese FRAX® calculator was launched in 2010. However, cost-effectiveness thresholds for the prescription of antiosteoporosis medications were not established. This study aims to establish and evaluate FRAX®-based probability thresholds in Taiwan. METHODS Using previous data from Taiwan and literature, we determined cost-effectiveness thresholds for prevention of osteoporotic fractures by alendronate with a Markov model, as well as using two other translational approaches. Sensitivity analysis was applied using different alendronate prices. A clinical sample was used to test these Taiwan-specific thresholds by determining the percentages of high-risk patients who would be qualified for current National Health Insurance reimbursement. RESULTS With the Markov model, the intervention threshold for hip fracture was 7% for women and 6% for men; for major osteoporotic fracture, it was 15% for women and 12.5% for men. Both translational approach models were cost effective only for certain age groups. However, if branded alendronate was reimbursed at 60% of the current price, they became cost effective in almost all age groups. This clinical screening study showed that the National Health Insurance Administration model identified the highest proportion (44%) of patients qualified for National Health Insurance reimbursements, followed by the Markov model (30%), and the United States model (22%). CONCLUSION Three FRAX®-based models of alendronate use were established in Taiwan to help optimize treatment strategies. The government is encouraged to incorporate FRAX®-based approaches into the reimbursement policy for antiosteoporosis medicines.
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Affiliation(s)
- Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Superintendent's Office, National Taiwan University Hospital Chu-Tong Branch, Hsinchu City, Taiwan
| | - Eugene V McCloskey
- Metabolic Bone Centre, Northern General Hospital, Sheffield, United Kingdom
| | - Chirn-Bin Chang
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Chu-Tong Branch, Hsinchu County, Taiwan
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Lay Chin Lim
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan
| | - Keh-Sung Tsai
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Rong-Sen Yang
- Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan.
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774
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Abstract
BACKGROUND It remains uncertain whether kidney transplant recipients are a high-risk group for fracture. METHODS We conducted a cohort study using Ontario, Canada health care databases to estimate the 3-, 5- and 10-year cumulative incidence of nonvertebral fracture (proximal humerus, forearm, hip) in adult kidney transplant recipients between 1994 and 2009, stratifying by sex and age (<50 versus ≥50 years) at transplant. We also assessed the 3-year cumulative incidence of all fracture locations (excluding skull, toes, and fingers) and falls, 10-year cumulative incidence of hip fracture alone, and nonvertebral fracture incidence in recipients compared to nontransplant reference groups matched on age, sex, and cohort entry year. We studied 4821 recipients (median age, 50 years). RESULTS Among the age and sex strata, female recipients aged 50 years or older had the highest 3-year cumulative incidence of nonvertebral fracture (3.1%; 95% confidence interval [95% CI], 2.1-4.4%). Recipients had a higher 3-year cumulative incidence of nonvertebral fracture (1.6%; 95% CI, 1.3-2.0%) compared to the general population with no previous nonvertebral fracture (0.5%; 95% CI, 0.4-0.6%; P < 0.0001) and nondialysis chronic kidney disease (1.1%; 95% CI, 0.9-1.2%; P = 0.03), but a lower fracture incidence than the general population with a previous nonvertebral fracture (2.3%; 95% CI, 1.9-2.8%; P = 0.007). The 10-year cumulative incidence of hip fracture in all recipients was 1.7% (≥3% defined as high risk in clinical guidelines). CONCLUSIONS Kidney transplant recipients may have a lower fracture risk than previously suggested in the literature. Results inform our understanding of fracture incidence after kidney transplantation and how it compares to nontransplant populations.
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775
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Chodick G, Moser SS, Goldshtein I. Non-adherence with bisphosphonates among patients with osteoporosis: impact on fracture risk and healthcare cost. Expert Rev Pharmacoecon Outcomes Res 2016; 16:359-70. [PMID: 27015247 DOI: 10.1586/14737167.2016.1171145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Osteoporosis-related fractures at the spine and hip have a substantial impact on mortality, morbidity, and quality of life in older adults worldwide. Adherence to bisphosphonates is essential for effective treatment and fracture prevention. Nevertheless, numerous studies from various populations and study designs clearly indicated that adherence and persistence are poor with more than 50% of patients discontinuing therapy within one year. This is primarily explained by mild adverse effects, dosing regimens, and costs. Studies have also shown that good adherence is associated with reduced osteoporosis-related and non-related healthcare costs as soon as 2 years from therapy initiation. Nonetheless, we found only little improvement in adherence rates over the years. In light of the importance of medication adherence and the limited success of previous programs, other than reducing dosing frequency, new directions should be explored to engage patients and care givers in order to improve adherence and prevent fractures.
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Affiliation(s)
- Gabriel Chodick
- a Medical division , Maccabi Healthcare Services , Tel Aviv , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | | | - Inbal Goldshtein
- a Medical division , Maccabi Healthcare Services , Tel Aviv , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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776
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Soares DS, Mello LMD, Silva ASD, Martinez EZ, Nunes AA. [Femoral fractures in elderly Brazilians: a spatial and temporal analysis from 2008 to 2012]. CAD SAUDE PUBLICA 2016; 30:2669-78. [PMID: 26247995 DOI: 10.1590/0102-311x00218113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 06/24/2014] [Indexed: 02/07/2023] Open
Abstract
Fractures in the elderly (≥ 60 years) have a major public health impact and take a heavy social and economic toll. This article aimed to describe spatial and time trends in femoral fractures among elderly men and women in all regions of Brazil. Bayesian descriptive analyses of spatial and time series were performed on data obtained from the Hospital Information System of the Brazilian Unified National Health System, using Poisson regression for femoral fractures in individuals 60 years of age or older from 2008 to 2012. There were more than 181,000 femoral fractures during this period, predominantly in women, without important spatial correlations or temporal differences. Despite the lack of temporal and spatial correlations, the number of femoral fractures in elderly Brazilians was high, with heavy financial and social costs. Public health policies are urgently needed to control predisposing factors for femoral fractures in elderly Brazilians.
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Affiliation(s)
- Danilo Simoni Soares
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Luane Marques de Mello
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
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777
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Lewis SR, Butler AR, Brammar A, Nicholson A, Smith AF. Perioperative fluid volume optimization following proximal femoral fracture. Cochrane Database Syst Rev 2016; 3:CD003004. [PMID: 26976366 PMCID: PMC7138038 DOI: 10.1002/14651858.cd003004.pub4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Proximal femoral fracture (PFF) is a common orthopaedic emergency that affects mainly elderly people at high risk of complications. Advanced methods for managing fluid therapy during treatment for PFF are available, but their role in reducing risk is unclear. OBJECTIVES To compare the safety and effectiveness of the following methods of perioperative fluid optimization in adult participants undergoing surgical repair of hip fracture: advanced invasive haemodynamic monitoring, such as transoesophageal Doppler and pulse contour analysis; a protocol using standard measures, such as blood pressure, urine output and central venous pressure; and usual care.Comparisons of fluid types (e.g. crystalloid vs colloid) and other methods of optimizing oxygen delivery, such as blood product therapies and pharmacological treatment with inotropes and vasoactive drugs, are considered in other reviews. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 9); MEDLINE (October 2012 to September 2015); and EMBASE (October 2012 to September 2015) without language restrictions. We ran forward and backward citation searches on identified trials. We searched ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform for unpublished trials. This is an updated version of a review published originally in 2004 and updated first in 2013 and again in 2015. Original searches were performed in October 2003 and October 2012. SELECTION CRITERIA We included randomized controlled trials (RCTs) in adult participants undergoing surgical treatment for PFF that compared any two of advanced haemodynamic monitoring, protocols using standard measures or usual care, irrespective of blinding, language or publication status. DATA COLLECTION AND ANALYSIS Two review authors assessed the impact of fluid optimization interventions on outcomes of mortality, length of hospital stay, time to medical fitness, whether participants were able to return to pre-fracture accommodation at six months, participant mobility at six months and adverse events in-hospital. We pooled data using risk ratio (RR) or mean difference (MD) for dichotomous or continuous data, respectively, on the basis of random-effects models. MAIN RESULTS We included in this updated review five RCTs with a total of 403 participants, and we added two new trials identified during the 2015 search. One of the included studies was found to have a high risk of bias; no trial featured all pre-specified outcomes. We found two trials for which data are awaited for classification and one ongoing trial.Three studies compared advanced haemodynamic monitoring with a protocol using standard measures; three compared advanced haemodynamic monitoring with usual care; and one compared a protocol using standard measures with usual care. Meta-analyses for the two advanced haemodynamic monitoring comparisons are consistent with both increased and decreased risk of mortality (RR Mantel-Haenszel (M-H) random-effects 0.41, 95% confidence interval (CI) 0.14 to 1.20; 280 participants; RR M-H random-effects 0.45, 95% CI 0.07 to 2.95; 213 participants, respectively). The study comparing a protocol with usual care found no difference between groups for this outcome.Three studies comparing advanced haemodynamic monitoring with usual care reported data for length of stay and time to medical fitness. There was no statistically significant difference between groups for these outcomes in the two studies that we were able to combine (MD IV fixed 0.63, 95% CI -1.70 to 2.96); MD IV fixed 0.01, 95% CI -1.74 to 1.71, respectively) and no statistically significant difference in the third study. One study reported reduced time to medical fitness when comparing advanced haemodynamic monitoring with a protocol, and when comparing protocol monitoring with usual care.The number of participants with one or more complications showed no statistically significant differences in each of the two advanced haemodynamic monitoring comparisons (RR M-H random-effects 0.83, 95% CI 0.59 to 1.17; 280 participants; RR M-H random-effects 0.72, 95% CI 0.40 to 1.31; 173 participants, respectively), nor any differences in the protocol and usual care comparison.Only one study reported the number of participants able to return to normal accommodation after discharge with no statistically significant difference between groups.There were few studies with a small number of participants, and by using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation Working Group) approach, we judged the quality of the outcome evidence as low. We had included one study with a high risk of bias, but upon applying GRADE, we downgraded the quality of this outcome evidence to very low. AUTHORS' CONCLUSIONS Five studies including a total of 403 participants provided no evidence that fluid optimization strategies improve outcomes for participants undergoing surgery for PFF. Further research powered to test some of these outcomes is ongoing.
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Affiliation(s)
- Sharon R Lewis
- Royal Lancaster InfirmaryPatient Safety ResearchPointer Court 1, Ashton RoadLancasterUKLA1 1RP
| | - Andrew R Butler
- University Hospitals of Morecambe Bay NHS Foundation TrustResearch DepartmentRoyal Lancaster InfirmaryAshton RoadLancasterUKLA1 4RP
| | - Andrew Brammar
- University Hospital of South ManchesterDepartment of AnaesthesiaManchesterUK
| | - Amanda Nicholson
- University of LiverpoolLiverpool Reviews and Implementation GroupSecond FloorWhelan Building, The Quadrangle, Brownlow HillLiverpoolUKL69 3GB
| | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterLancashireUKLA1 4RP
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778
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Beall DP, Feldman RG, Gordon ML, Gruber BL, Lane JM, Valenzuela G, Yim D, Alam J, Krege JH, Krohn K. Patients with prior vertebral or hip fractures treated with teriparatide in the Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) observational study. Osteoporos Int 2016; 27:1191-1198. [PMID: 26556737 DOI: 10.1007/s00198-015-3353-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/29/2015] [Indexed: 12/31/2022]
Abstract
SUMMARY In patients in the Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) observational study with and without a prior vertebral or hip fracture, the incidence of nonvertebral fractures was lower with >6 months of teriparatide treatment than during the first 6 months. INTRODUCTION Clinical evidence on the effect of teriparatide in patients with prior fracture is limited. In the DANCE observational study, the incidence of nonvertebral fragility fractures (NVFX) decreased significantly in patients receiving teriparatide for >6 months (6-24 months) versus >0 to ≤6 months (reference period). METHODS We performed a post hoc analysis to assess the effect of teriparatide 20 μg/day in patients who entered DANCE with prior vertebral or hip fractures. The incidence of patients experiencing a NVFX for four 6-month intervals during and after treatment was compared with the reference period. RESULTS Overall, 4085 patients received ≥1 dose of teriparatide. Of 3720 with sufficient data for efficacy analysis, 692 had prior vertebral fracture, including 179 with previous kyphoplasty/vertebroplasty; 290 had prior hip fracture. These patients were older, and those with prior vertebral fractures had more comorbid conditions at baseline than those without prior vertebral fractures. The incidence of patients experiencing NVFX declined over time in all patient groups. The fracture incidence rate declined 49 and 46%, respectively, in patients with and without prior vertebral fracture and was 63 and 46% lower in patients with previous kyphoplasty/vertebroplasty and without prior vertebral fracture. NVFX declined 43 and 48% in patients with and without prior hip fracture. The reduced incidence over time was consistent in the subgroups (all interaction p values >0.05). Patients with prior fracture were more likely to experience serious adverse events. CONCLUSION The incidence of NVFX decreased over time in patients receiving teriparatide in DANCE regardless of prior fracture status.
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Affiliation(s)
- D P Beall
- Clinical Radiology of Oklahoma, 1800 S. Renaissance Blvd, Edmond, OK, 73013, USA
| | - R G Feldman
- Senior Clinical Trials, Inc., 23961 Calle de la Magdalena Suite 429, Laguna Hills, CA, 92653, USA
| | - M L Gordon
- Newport Orthopedic Institute, Newport Beach 22 Corporate Plaza Drive, Newport Beach, CA, 92660, USA
| | - B L Gruber
- Long Island Regional Arthritis and Osteoporosis Care, PC, 500 West Main Street, Suite 110, Babylon, NY, 11702, USA
| | - J M Lane
- Hospital for Special Surgery, Weill Cornell Medical College, Ground Floor 523 East 72nd Street, New York, NY, 10021, USA
| | - G Valenzuela
- Integral Rheumatology & Immunology Specialists, 140 SW 84th Avenue, Fort Lauderdale, FL, 33324, USA
| | - D Yim
- UC Irvine Medical Center, 101 The City Drive South, Route 140, Orange, CA, 92868, USA
| | - J Alam
- Lilly USA, LLC, Indianapolis, IN, 46285, USA
| | - J H Krege
- Lilly USA, LLC, Indianapolis, IN, 46285, USA
| | - K Krohn
- Lilly USA, LLC, Indianapolis, IN, 46285, USA.
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779
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Thingstad P, Taraldsen K, Saltvedt I, Sletvold O, Vereijken B, Lamb SE, Helbostad JL. The long-term effect of comprehensive geriatric care on gait after hip fracture: the Trondheim Hip Fracture Trial--a randomised controlled trial. Osteoporos Int 2016; 27:933-942. [PMID: 26370827 DOI: 10.1007/s00198-015-3313-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 09/01/2015] [Indexed: 10/23/2022]
Abstract
SUMMARY At present, most hip fracture patients are treated in orthopaedic wards. This study showed that a relatively short hospital intervention based on principles of comprehensive geriatric assessment resulted in safer and more efficient gait as long as 1 year following the fracture as compared to conventional orthopaedic treatment. INTRODUCTION Hip fracture patients are frail, and the fracture is usually followed by substantial decline in gait function. Few studies have assessed gait characteristics other than gait speed and knowledge about the effect of early intervention on long-term gait outcome is sparse. The purpose of this study was to evaluate the long-term effect of pre- and post-surgery Comprehensive Geriatric Care (CGC) on ability to walk, self-reported mobility and gait characteristics in hip fracture patients. METHODS Two armed, parallel group randomised controlled trial comparing CGC to conventional Orthopaedic Care (OC) in pre- and early post-surgery phase. Hip fracture patients (n = 397), community-dwelling, age >70 years and able to walk at time of the fracture were included. Spatial and temporal gait characteristics were collected using an instrumented walkway (GAITRite® system) 4 and 12 months post-surgery. RESULTS Participants who received CGC had significantly higher gait speed, less asymmetry, better gait control and more efficient gait patterns, more participants were able to walk and participants reported better mobility 4 and 12 months following the fracture as compared to participants receiving OC. CONCLUSIONS Pre- and post-surgery CGC showed an effect on gait as long as 1 year after hip fracture. These findings underscore the importance of targeting the vulnerability of these patients at an early stage to prevent gait decline in the long run. As presently, most hip fracture patients are treated in orthopaedic wards with larger focus on the fracture than on frailty, these results are important to inform new models for hip fracture care.
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Affiliation(s)
- P Thingstad
- Department of Neuroscience, Norwegian University of Science and Technology, PO Box 8905, 7491, Trondheim, Norway.
| | - K Taraldsen
- Department of Neuroscience, Norwegian University of Science and Technology, PO Box 8905, 7491, Trondheim, Norway
| | - I Saltvedt
- Department of Neuroscience, Norwegian University of Science and Technology, PO Box 8905, 7491, Trondheim, Norway
- Department of Geriatrics, St. Olav University Hospital, Trondheim, Norway
| | - O Sletvold
- Department of Neuroscience, Norwegian University of Science and Technology, PO Box 8905, 7491, Trondheim, Norway
- Department of Geriatrics, St. Olav University Hospital, Trondheim, Norway
| | - B Vereijken
- Department of Neuroscience, Norwegian University of Science and Technology, PO Box 8905, 7491, Trondheim, Norway
| | - S E Lamb
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - J L Helbostad
- Department of Neuroscience, Norwegian University of Science and Technology, PO Box 8905, 7491, Trondheim, Norway
- Department of Clinical Services, St. Olav University Hospital, Trondheim, Norway
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780
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Wiklund R, Toots A, Conradsson M, Olofsson B, Holmberg H, Rosendahl E, Gustafson Y, Littbrand H. Risk factors for hip fracture in very old people: a population-based study. Osteoporos Int 2016; 27:923-931. [PMID: 26537711 PMCID: PMC4767860 DOI: 10.1007/s00198-015-3390-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/27/2015] [Indexed: 12/05/2022]
Abstract
SUMMARY Knowledge of risk factors for hip fracture among very old people is limited. Walking indoors with help from ≤1 person, Parkinson's disease, currently smoking, delirium in the previous month, underweight, and age were associated with increased risk of hip fracture and could be important for preventive strategy development. INTRODUCTION The purpose of this study is to investigate risk factors for hip fracture among a representative sample of very old people. METHODS In total, 953 participants from the Umeå 85+/Gerontological Regional Database population-based cohort study were interviewed and assessed during home visits. Associations of baseline characteristics with hip fracture during the maximum 5-year follow-up period were analyzed using Cox proportional hazards regression. RESULTS Participants had a mean age of 89.3 ± 4.7 years; 65.8% were women, 36.8% lived in residential care facilities, 33.6% had dementia, and 20.4% had histories of hip fracture. During a mean follow-up period of 2.7 years, 96 (10.1%) individuals sustained hip fracture. Walking indoors with help from no more than one person (hazard ratio [HR] = 8.57; 95% confidence interval [CI], 1.90-38.71), Parkinson's disease (HR = 5.12; 95% CI, 1.82-14.44), currently smoking (HR = 4.38; 95% CI 2.06-9.33), delirium in the previous month (HR = 2.01; 95% CI, 1.15-3.49), underweight (body mass index <22; HR = 1.74, 95% CI, 1.09-2.77), and age (HR = 1.09; 95% CI, 1.04-1.14) were associated independently with an increased risk of hip fracture. Hip prosthesis at baseline decreased the risk of hip fracture (HR = 0.37; 95% CI, 0.15-0.91), but only for those with bilateral hip prostheses. CONCLUSIONS Seven factors were associated independently with incident hip fracture during follow-up in this sample of very old people. These factors could have important clinical implications in identifying persons at high risk of hip fracture, as well as in the development of effective preventive strategies.
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Affiliation(s)
- R Wiklund
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
| | - A Toots
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - M Conradsson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - B Olofsson
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Science, Orthopedics, Umeå University, Umeå, Sweden
| | - H Holmberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - E Rosendahl
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Y Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - H Littbrand
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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781
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Jang EJ, Lee YK, Choi HJ, Ha YC, Jang S, Shin CS, Cho NH. Osteoporotic Fracture Risk Assessment Using Bone Mineral Density in Korean: A Community-based Cohort Study. J Bone Metab 2016; 23:34-9. [PMID: 26981519 PMCID: PMC4791436 DOI: 10.11005/jbm.2016.23.1.34] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 11/27/2022] Open
Abstract
Background Fracture-risk assessment tool (FRAX) using just clinical risk factors of osteoporosis has been developed to estimate individual risk of osteoporotic fractures. We developed prediction model of fracture risk using bone mineral density (BMD) as well as clinical risk factors in Korean, and assessed the validity of the final model. Methods To develop and validate an osteoporotic FRAX, a total of 768 Korean men and women aged 50 to 90 years were followed for 7 years in a community-based cohort study. BMD as well as clinical risk factors for osteoporotic fracture including age, sex, body mass index, history of fragility fracture, family history of fracture, smoking status, alcohol intake, use of oral glucocorticoid, rheumatoid arthritis, and other causes of secondary osteoporosis were assessed biannually. Results During the follow-up period, 86 osteoporotic fractures identified (36 in men and 50 in women). The developed prediction models showed high discriminatory power and had goodness of fit. Conclusions The developed a Korean specific prediction model for osteoporotic fractures can be easily used as a screening tool to identify individual with high risk of osteoporotic fracture. Further studies for validation are required to confirm the clinical feasibility in general Korean population.
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Affiliation(s)
- Eun Jin Jang
- Department of Information Statistics, Andong National University, Andong, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung Jin Choi
- Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, School of Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sunmee Jang
- College of Pharmacy, Gachon University, Incheon, Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Han Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Korea
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782
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Yazdanshenas H, Washington ER, Shamie AN, Madadi F, Washington ER. Senior Managed Care System for Hip Fracture in the United States. Clin Orthop Surg 2016; 8:19-28. [PMID: 26929795 PMCID: PMC4761597 DOI: 10.4055/cios.2016.8.1.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 11/02/2015] [Indexed: 01/06/2023] Open
Abstract
Background It is debatable whether a managed care model would affect the quality of care and length of hospital stay in the treatment of hip fractures in elderly patients. Methods This prospective study was undertaken to determine whether or not a managed care critical pathway tool shortened hospital stay in a group of 102 senior patients with fractures of the hip during follow-up. We compared our study findings with two equivalent populations of senior hip fracture patients not treated using a critical care pathway concerning specific markers of quality. Results The managed care group had a 9% mortality rate, 95% return to prefracture living and 63% return to ambulatory status. The rates compared favorably with previous studies. The quality of care provided before and after the critical pathway was equivalent, while the post-pathway length of stay dropped 30%. Conclusions The proposed care protocol is recommended to shorten hospital stay in elderly patients with hip fractures.
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Affiliation(s)
- Hamed Yazdanshenas
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.; Department of Family Medicine, University of California, Los Angles (UCLA), Los Angeles, CA, USA.; Department of Orthopaedic Surgery, University of California, Los Angles (UCLA), Los Angeles, CA, USA
| | - Eleby R Washington
- Department of Orthopaedic Surgery, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Arya Nick Shamie
- Department of Orthopaedic Surgery, University of California, Los Angles (UCLA), Los Angeles, CA, USA
| | - Firooz Madadi
- Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran
| | - Eleby R Washington
- Department of Orthopaedic Surgery, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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783
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784
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Weihrauch S, Gradl G, Beck M, Rotter R, Mittlmeier T, Gierer P. [Biaxial reconstruction nail for pertrochanteric femoral fractures. Osteosynthesis]. Unfallchirurg 2016; 118:245-50. [PMID: 24599028 DOI: 10.1007/s00113-013-2498-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The steady rise in life expectancy of our population leads to an exponential increase in proximal femoral fractures. The growing increase of comorbidities in these patients requires continuous development of modern implant systems for internal fixation of proximal femoral fractures. MATERIALS AND METHODS In this study we enrolled 116 patients with pertrochanteric femoral fractures who were treated with a proximal femoral nail (Targon PF, Aesculap) over a period of 1 year. The indications for this implant system were set at unstable fracture types. Data of the operative and postoperative course were collected prospectively. RESULTS The average age of the 116 predominantly female subjects was 77±14 years and the most commonly observed fracture subtype was 31-A1.2. The follow-up rate was 55 %. We observed a decrease in the postoperative modified Harris hip score of 22.7 %. The 1-year mortality was 21.6 %. CONCLUSIONS The results of this study showed a low rate of perioperative complications and implant loss anda decline in patient mobility was typically observed within 1 year.
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Affiliation(s)
- S Weihrauch
- Abteilung für Unfall- und Wiederherstellungschirurgie, Universität Rostock, Schillingallee 35, 18055, Rostock, Deutschland,
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785
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Prevention and rehabilitation of osteoporosis. Wien Med Wochenschr 2016; 166:22-7. [DOI: 10.1007/s10354-015-0417-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
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786
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Sullivan KJ, Husak LE, Altebarmakian M, Brox WT. Demographic factors in hip fracture incidence and mortality rates in California, 2000-2011. J Orthop Surg Res 2016; 11:4. [PMID: 26746904 PMCID: PMC4705624 DOI: 10.1186/s13018-015-0332-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/04/2015] [Indexed: 02/02/2023] Open
Abstract
Background Hip fractures result in both health and cost burdens from a public health perspective and have a major impact on the health care system in the USA. The purpose was to examine whether there were systematic differences in hip fracture incidence and 30-, 90-, and 365-day mortality after hip fracture in the California population as a function of age, gender, and race/ethnicity from 2000–2011. Methods This was a population-based study from 2000 to 2011 using data from the California Office of Statewide Health and Planning and Development (OSHPD, N = 317,677), California State Death Statistical Master File records (N = 224,899), and the US Census 2000 and 2010. There were a total of 317,677 hospital admissions for hip fractures over the 12-year span and 24,899 deaths following hip fractures. All participants without linkage (substituted for social security) numbers were excluded from mortality rate calculations. Variation in incidence and mortality rates across time, gender, race/ethnicity, and age were assessed using Poisson regression models. Odds ratio and 95 % confidence intervals are provided. Results The incidence rate of hip fractures decreased between 2000 and 2011 (odds ratio (OR) = 0.98, 95 % confidence interval (CI) 0.98, 0.98). Mortality rates also decreased over time. There were gender, race/ethnicity, and age group differences in both incidence and mortality rates. Conclusions Males were half as likely to sustain a hip fracture, but their mortality within a year of the procedure is almost twice the rate than women. As age increased, the prevalence of hip fracture increased dramatically, but mortality did not increase as steeply. Caucasians were more likely to sustain a hip fracture and to die within 1 year after a hip fracture. The disparities in subpopulations will allow for targeted population interventions and opportunities for further research.
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Affiliation(s)
| | - Lisa E Husak
- Orthopaedic Surgery, UCSF-Fresno, 155 N Fresno Street, Fresno, CA, 93701, USA.
| | - Maria Altebarmakian
- Orthopaedic Surgery, UCSF-Fresno, 155 N Fresno Street, Fresno, CA, 93701, USA.
| | - W Timothy Brox
- Orthopaedic Surgery, Kaiser Permanente Medical Center, 7300 N Fresno Street, Fresno, CA, 93720, USA.
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787
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Çankaya D, Yoldaş B, Çankaya E, Çakir Y, Aydin C, Tabak AY. Analysis of the hip fracture records of a central training and research hospital by selected characteristics. Turk J Med Sci 2016; 46:35-41. [PMID: 27511330 DOI: 10.3906/sag-1406-150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 02/11/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Despite the importance of hip fractures, very few studies have assessed their epidemiological characteristics in Turkey. The aim of this study was to evaluate the frequency and demography of hip fractures from the recent data of a central training and research hospital. MATERIALS AND METHODS In this descriptive study, we identified hip fracture cases between 2009 and 2013. The age, sex, region, injury pattern, and calendar year for all patients were evaluated. RESULTS Among the 687 patients (488 women, 199 men) described in our clinic's records, 122, 131, 144, 138, and 154 patients applied with hip fractures from the years 2009 to 2013, respectively. The mean ages of the women and men were 74.8 and 68.5 years, respectively. There were 220 patients who had femoral neck fracture (32%), 419 who had intertrochanteric fracture (61%), and 48 who had subtrochanteric fracture (7%). CONCLUSION The female geriatric population may have an increasing and distinct hip fracture risk, mainly in the trochanteric region. Furthermore, recent studies that show variations in the frequency and demography of hip fractures highlight the importance of meticulous recording of patients' information. A nationwide survey of different categories of hospitals and various geographic regions of Turkey is also needed to inform effective prevention strategies.
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Affiliation(s)
- Deniz Çankaya
- Department of Orthopedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Burak Yoldaş
- Department of Orthopedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Elif Çankaya
- Department of Internal Audit, Ministry of Health, Ankara, Turkey
| | - Yalçın Çakir
- Department of Orthopedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Cemal Aydin
- Department of Orthopedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Abdullah Yalçın Tabak
- Department of Orthopedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
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788
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Unmet needs and current and future approaches for osteoporotic patients at high risk of hip fracture. Arch Osteoporos 2016; 11:37. [PMID: 27800591 PMCID: PMC5306171 DOI: 10.1007/s11657-016-0292-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/25/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED This review provides a critical analysis of currently available approaches to increase bone mass, structure and strength through drug therapy and of possible direct intra-osseous interventions for the management of patients at imminent risk of hip fracture. PURPOSE Osteoporotic hip fractures represent a particularly high burden in morbidity-, mortality- and health care-related costs. There are challenges and unmet needs in the early prevention of hip fractures, opening the perspective of new developments for the management of osteoporotic patients at imminent and/or at very high risk of hip fracture. Amongst them, preventive surgical intervention needs to be considered. METHODS A European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)/International Osteoporosis Foundation (IOF) working group reviewed the presently available intervention modalities including preventive surgical options for hip fragility. This paper represents a summary of the discussions. RESULTS Prevention of hip fracture is currently based on regular physical activity; prevention of falls; correction of nutritional deficiencies, including vitamin D repletion; and pharmacological intervention. However, efficacy of these various measures to reduce hip fractures is at most 50% and may need months or years before becoming effective. To face the challenges of early prevention of hip fractures for osteoporotic patients at imminent and/or at very high risk of hip fracture, preventive surgical intervention needs further investigation. CONCLUSION Preventive surgical intervention needs to be appraised for osteoporotic patients at imminent and/or at very high risk of hip fracture.
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789
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Rozenberg S, Body JJ, Bruyère O, Bergmann P, Brandi ML, Cooper C, Devogelaer JP, Gielen E, Goemaere S, Kaufman JM, Rizzoli R, Reginster JY. Effects of Dairy Products Consumption on Health: Benefits and Beliefs--A Commentary from the Belgian Bone Club and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. Calcif Tissue Int 2016; 98:1-17. [PMID: 26445771 PMCID: PMC4703621 DOI: 10.1007/s00223-015-0062-x] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/21/2015] [Indexed: 02/07/2023]
Abstract
Dairy products provide a package of essential nutrients that is difficult to obtain in low-dairy or dairy-free diets, and for many people it is not possible to achieve recommended daily calcium intakes with a dairy-free diet. Despite the established benefits for bone health, some people avoid dairy in their diet due to beliefs that dairy may be detrimental to health, especially in those with weight management issues, lactose intolerance, osteoarthritis, rheumatoid arthritis, or trying to avoid cardiovascular disease. This review provides information for health professionals to enable them to help their patients make informed decisions about consuming dairy products as part of a balanced diet. There may be a weak association between dairy consumption and a possible small weight reduction, with decreases in fat mass and waist circumference and increases in lean body mass. Lactose intolerant individuals may not need to completely eliminate dairy products from their diet, as both yogurt and hard cheese are well tolerated. Among people with arthritis, there is no evidence for a benefit to avoid dairy consumption. Dairy products do not increase the risk of cardiovascular disease, particularly if low fat. Intake of up to three servings of dairy products per day appears to be safe and may confer a favourable benefit with regard to bone health.
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Affiliation(s)
- Serge Rozenberg
- Department of Gynaecology-Obstetrics, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Jacques Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Pierre Bergmann
- Department of Radioisotopes, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Luisa Brandi
- Metabolic Bone Unit, Department of Internal Medicine, University of Florence, Florence, Italy
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- University of Oxford, Oxford, UK
| | - Jean-Pierre Devogelaer
- Department of Rheumatology, Saint Luc University Hospital, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Evelien Gielen
- Gerontology and Geriatrics Section, Department of Experimental Medicine, Katholiek Universiteit Leuven, Leuven, Belgium
| | - Stefan Goemaere
- Department of Rheumatology and Endocrinology, State University of Ghent, Ghent, Belgium
| | - Jean-Marc Kaufman
- Department of Endocrinology, State University of Ghent, Ghent, Belgium
| | - René Rizzoli
- Division of Bones Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
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790
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Fan Y, Wei F, Lang Y, Liu Y. Diabetes mellitus and risk of hip fractures: a meta-analysis. Osteoporos Int 2016; 27:219-28. [PMID: 26264604 DOI: 10.1007/s00198-015-3279-7] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/05/2015] [Indexed: 01/01/2023]
Abstract
UNLABELLED This meta-analysis revealed that diabetic adults had a twofold greater risk of hip fractures compared with non-diabetic populations, and this association was more pronounced in type 1 diabetes. INTRODUCTION The relationship between diabetes mellitus and risk of hip fracture yielded conflicting results. We conducted a meta-analysis to investigate the association between diabetes mellitus and the risk of hip fractures based on observational studies. METHODS We conducted a systematic literature search of PubMed and Embase databases through May 2015. We selected cohort and case-control studies providing at least age-adjusted risk ratio (RR) and corresponding 95 % confidence intervals (CI) of hip fractures among diabetic and non-diabetic subjects. Moreover, we pooled the female-to-male RR of hip fractures from studies that reported gender-specific risk estimate in a single study. RESULTS Twenty-one studies involving 82,293 hip fracture events among 6,995,272 participants were identified. Diabetes mellitus was associated with an increased risk of hip fractures (RR 2.07; 95 % CI 1.83-2.33) in a random effects model. Subgroup analysis indicated that excess risk of hip fracture was more pronounced in type 1 diabetes (RR 5.76; 95 % CI 3.66-9.07) than that in type 2 diabetes (RR 1.34; 95 % CI 1.19-1.51). The pooled female-to-male RR of hip fractures was 1.09 (95 % CI 0.93-1.28). CONCLUSIONS Individuals with diabetes mellitus have an excessive risk of hip fractures, and this relationship is more pronounced in type 1 diabetes. The association between diabetes and hip fracture risk is similar in men and women.
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Affiliation(s)
- Y Fan
- Institute of Molecular Biology and Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China, 212002
| | - F Wei
- Institute of Molecular Biology and Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China, 212002
| | - Y Lang
- Institute of Molecular Biology and Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China, 212002
| | - Y Liu
- Department of Endocrinology, The Affiliated People's Hospital, Jiangsu University, No. 8 Dianli Road, Zhenjiang, Jiangsu, People's Republic of China, 212002.
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791
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Thorin MH, Wihlborg A, Åkesson K, Gerdhem P. Smoking, smoking cessation, and fracture risk in elderly women followed for 10 years. Osteoporos Int 2016; 27:249-55. [PMID: 26302684 DOI: 10.1007/s00198-015-3290-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/11/2015] [Indexed: 01/01/2023]
Abstract
UNLABELLED This study examines the impact of smoking and smoking cessation on fracture risk in 75-year-old women followed for 10 years. Smoking increased fracture risk, especially for vertebral fractures. Smoking cessation decreased the risk for vertebral fractures but not for other fracture types. INTRODUCTION The purpose of this study was to examine effects of smoking and smoking cessation on fracture risk. METHODS This prospective observational population-based study followed 1033 women during 10 years from age 75. Data regarding smoking were collected at age 75. Hazard ratios (HRs) and 95 % confidence intervals for fracture were calculated using competing risks proportional hazards regression. RESULTS Both former smokers and current smokers had an increased risk for any fracture (HR 1.30; 1.03-1.66, and HR 1.32; 1.01-1.73, respectively) and any osteoporotic fracture (hip, proximal humerus, distal radius, vertebra) (HR 1.31; 1.01-1.70 and HR 1.49; 1.11-1.98, respectively) compared to non-smokers. Former smokers had an increased risk for proximal humerus fractures (HR 2.23; 1.35-3.70), and current smokers had an increased risk for vertebral fractures (HR 2.30; 1.57-3.38) compared to non-smokers. After adjustment for weight, previous fractures, alcohol habits, bone mineral density (BMD), use of corticoids, vitamin D, bisphosphonates, and previous falls, former smokers had an increased risk for proximal humerus fracture (HR 2.07; 1.19-3.57) and current smokers had an increased risk for osteoporotic (HR 1.47; 1.05-2.05) and vertebral fractures (HR 2.50; 1.58-3.95) compared to non-smokers. Former smokers had a decreased risk for vertebral fractures, but not for other types of fractures, compared to current smokers. CONCLUSIONS Smoking increased the risk for fracture among elderly women, especially vertebral fractures. Smoking cessation decreased the risk for vertebral fractures but not for other types of fractures.
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Affiliation(s)
- M H Thorin
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Department of Orthopedics, K54, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden
| | - A Wihlborg
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Department of Orthopedics, K54, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden
| | - K Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Science Malmö, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, 205 02, Malmö, Sweden
| | - P Gerdhem
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Department of Orthopedics, K54, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.
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792
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Kuo WY, Shyu YIL, Wang JS, Chen MC, Wu CC, Huang YF. The impact of sleep duration on recovery post-hip fracture among older diabetic adults in Taiwan. Geriatr Nurs 2015; 37:137-44. [PMID: 26708140 DOI: 10.1016/j.gerinurse.2015.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/15/2015] [Accepted: 11/23/2015] [Indexed: 01/24/2023]
Abstract
This study explored postoperative changes in sleep duration and physical activity and their relationships with physical function recovery, the muscular strength of the affected side and blood glucose control in elderly adults (n = 41) with diabetes mellitus (DM) who underwent surgery for hip fracture. Thirty-two participants (78.0%) had abnormal sleep durations for at least two time points, and they all had low physical activity levels (an average of 1348.2 kcal/day for the first month, 1377.9 kcal/day for the third month, and 1389.1 kcal/day for the sixth month) during the six months post-hip fracture. The participants with normal sleep durations showed greater femoral muscle improvement on the affected side (adduction: β = 3.70, p = 0.029; abduction: β = 7.25, p = 0.016) and better blood glucose control before meals (β = -73.29, p < 0.001) and after meals (β = -47.90, p = 0.007) compared with those with abnormal sleep durations. Those with higher physical activity levels had better physical function recovery.
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Affiliation(s)
- Wen-Yu Kuo
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan City 33302, Taiwan
| | - Yea-Ing Lotus Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan City 33302, Taiwan.
| | - Jong-Shyan Wang
- Department of Physical Therapy, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan City 33302, Taiwan
| | - Min-Chi Chen
- Department of Public Health & Biostatistics Consulting Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan City 33302, Taiwan
| | - Chi-Chuan Wu
- Traumatological Division, Department of Orthopedics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Guishan District, Taoyuan City 33305, Taiwan
| | - Yueh-Fang Huang
- School of Nursing, Chang Gung University of Science and Technology, 261 Wenhwa 1st Rd, Kwei-shan District, Taoyuan City 33302, Taiwan
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793
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Hommel A, Bååth C. A national quality registers as a tool to audit items of the fundamentals of care to older patients with hip fractures. Int J Older People Nurs 2015; 11:85-93. [DOI: 10.1111/opn.12101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 06/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ami Hommel
- Department of Health Sciences; Lund University; Lund Sweden
- Department of Orthopedics; Skåne University Hospital; Lund Sweden
| | - Carina Bååth
- Department of Health Sciences; Karlstad University; Karlstad Sweden and Country Council of Varmland, Sweden
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794
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How evolution of the nailing system improves results and reduces orthopedic complications: more than 2000 cases of trochanteric fractures treated with the Gamma Nail System. Musculoskelet Surg 2015; 100:1-8. [PMID: 26667625 DOI: 10.1007/s12306-015-0391-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 11/21/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The incidence of trochanteric fractures has increased significantly during the last few decades, especially in elderly patients with osteoporosis. The dynamic/sliding hip screw and the cephalomedullary nail are the most commonly used fixation methods to treat trochanteric fractures. The improvements in the Gamma Nail System (GNS) associated with a correct surgical technique reduced the postoperative orthopedic complications. The purpose of this study was to compare the results of the different Gamma Nails. METHODS The present study is a retrospective analysis of 2144 patients treated with GNS between January 1997 and December 2011 for trochanteric fractures, classified according to AO classification method. The patients were divided into three groups according to the nailing system: 525 were treated with Standard Gamma Nail (SGN), 422 with Trochanteric Gamma Nail (TGN) and 1197 with Gamma3 Nail. RESULTS The overall incidence of intra-operative complications was 1.21 %; the incidence of intra-operative complications for each group was 1.71 % for SGN group, 0.47 % for TGN group and 1.25 % for Gamma3 Nail group. The overall incidence of postoperative complications was 5.48 %, and the incidence for each group was 10.73 % for SGN group, 9.92 % for TGN group and 2.92 % for Gamma3 Nail group. CONCLUSION The GNS is a safe device with a low rate of intra-operative complications. The evolution of this nail system reduces postoperative complications, thus improving the results at follow-up and confirming that the Gamma3 Nail is a safe and predictable device to fix trochanteric fracture.
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795
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Pampaloni B, Cianferotti L, Gronchi G, Bartolini E, Fabbri S, Tanini A, Brandi ML. Growing Strong and Healthy with Mister Bone: An Educational Program to Have Strong Bones Later in Life. Nutrients 2015; 7:9985-98. [PMID: 26633485 PMCID: PMC4690062 DOI: 10.3390/nu7125510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 01/03/2023] Open
Abstract
Optimal peak bone mass and bone health later in life are favored by a sufficient calcium intake in infancy, childhood and adolescence. The purpose of this study was to test a new educational program created to monitor and to improve calcium and vitamin D intake in children. Nutritional habits in children were evaluated through a food frequency questionnaire (FFQ) to assess the intake of calcium, vitamin D, dairy products, and total caloric energy at baseline and after seven months of exposure to a unique educational program applied between November 2013 and May 2014 in 176 schoolchildren (48% male, 52% female) attending the fourth and fifth grades of two selected primary schools in Florence, Italy. A significant increase of calcium (from 870 ± 190 to 1100 ± 200 mg/day, p < 0.05), and vitamin D (from 3.6 ± 1.53 to 4.1 ± 2 µg/day) intake in children was documented after the educational program. The amount of specific foods important for bone health consumed, such as milk and vegetables, increased significantly, both in male and female children (p < 0.05). The proposed educational program appears to be effective in modifying calcium intake in children, with a significant increase in the consumption of dairy products and vegetables, but without a significant change in the total caloric intake.
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Affiliation(s)
- Barbara Pampaloni
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Luisella Cianferotti
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Giorgio Gronchi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Elisa Bartolini
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Sergio Fabbri
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Annalisa Tanini
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
| | - Maria Luisa Brandi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy.
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796
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Incidence of hip fracture in Kuwait: a national registry-based study. Arch Osteoporos 2015; 10:40. [PMID: 26577246 DOI: 10.1007/s11657-015-0248-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 11/09/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED The crude and age-standardized rates of hip fractures in elderly Kuwaiti subpopulation were determined for the years 2009-2012. Both rates have increased and are further expected to rise substantially in the coming decades. INTRODUCTION It is projected that rates of hip fractures will increase in most of the Middle East countries. There are only few population-based studies investigating the incidence of hip fractures in the Arabian Gulf region. The objective of this study is to report the crude and age-standardized incidence rates of hip fracture in the Kuwaiti elderly population. METHODS Using the Ministry of Public Health's registry data, this population-based study evaluated the incidence of hip fractures in Kuwaiti subpopulation aged 50 and above for the years 2009, 2010, 2011, and 2012. Using the world population in 2010 as a reference, these incidence rates were age-standardized and compared to data from several regions. RESULTS Hip fracture crude incidence rates varied between 113.7 and 147.4/100,000 for males and between 135.3 and 148.1/100,000 for females, with a female/male ratio of 1.3-1.5. The combined (men and women) incidence rate of hip fractures increased by 17.1 % over the 4-year period of study (125.9/100,000 in 2009 to 147.8/100,000 in 2012). Using the world population in 2010 as a reference, the age-standardized rates were 129.5, 131.5, 154.6, and 169.8 for males and 189.6, 192.9, 197.2, and 214.4 for females, for the years 2009, 2010, 2011, and 2012, respectively. CONCLUSIONS The hip fracture age-standardized incidence rates in the Kuwaiti subpopulation aged 50 years and above are rising and expected to increase substantially in the coming decades.
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797
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Wang H, Li C, Zhang Y, Jia Y, Zhu Y, Sun R, Li W, Liu Y. The influence of inpatient comprehensive geriatric care on elderly patients with hip fractures: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 2015; 8:19815-19830. [PMID: 26884892 PMCID: PMC4723737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/02/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the efficacy of in-patient comprehensive geriatric care for elderly patients with hip fracture. METHODS Relevant literatures were searched using the following databases including PubMed, OVID, Web of science, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trails until August 1, 2015. Eligible studies were restricted to randomized controlled trials (RCTs). The available data was extracted by two independent authors and pooled through using Review manager version 5.2. For data deemed not appropriate for synthesis, a narrative overview was conducted. RESULTS 15 trials evaluating 3458 participants were identified in our meta-analysis. Our findings indicated patients who underwent comprehensive geriatric cares showed no significant greater improvement than control in in-patient mortality (Odds risk (OR) 0.73, 95% confidence interval (CI) 0.51 to 1.05, P=0.09), 3-(OR 0.96, 95% CI 0.51 to 1.81, P=0.90), 6-(OR 1.03, 95% CI 0.73 to 1.45, P=0.86) and 12-months mortality (OR 0.93, 95% CI 0.77 to 1.12, P=0.30). The proportion of patients who were discharged from hospital to the same place of residence as before the fracture was higher in intervention group than control (OR 1.67, 95% CI 0.80 to 3.37, P=0.0003). In addition, the pooled results showed that the number of patients in intervention group who had regained the same level of activities of daily living (ADL) (43.9% vs 30.2%, 46.0% vs 29.1%) and walking ability (71.3% vs 53.2%, 68.9% vs 56.3%) as before the fracture was higher than control at 3 and 12 months after discharge, respectively. CONCLUSION Comprehensive geriatric care promoted the functional improvement for elderly patients with hip fracture. Meanwhile, the proportion of patients who were discharged from hospital to the same place as before fracture in intervention group was higher as compared to control. However, our finding showed no significant difference on in-patients mortality, follow-up mortality and length of stay between both groups.
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Affiliation(s)
- Huichao Wang
- Luoyang Orthopedic Hospital of Henan Province, Orthopedic Institute of Henan ProvinceLuoyang 471002, China
| | - Chunbo Li
- Shanghai First Maternity and Infant Hosiptal, Tongji University of MedicineShanghai 200126, China
| | - Ying Zhang
- Luoyang Orthopedic Hospital of Henan Province, Orthopedic Institute of Henan ProvinceLuoyang 471002, China
| | - Yudong Jia
- Luoyang Orthopedic Hospital of Henan Province, Orthopedic Institute of Henan ProvinceLuoyang 471002, China
| | - Yingjie Zhu
- Luoyang Orthopedic Hospital of Henan Province, Orthopedic Institute of Henan ProvinceLuoyang 471002, China
| | - Ruibo Sun
- Luoyang Orthopedic Hospital of Henan Province, Orthopedic Institute of Henan ProvinceLuoyang 471002, China
| | - Wuyin Li
- Luoyang Orthopedic Hospital of Henan Province, Orthopedic Institute of Henan ProvinceLuoyang 471002, China
| | - Youwen Liu
- Luoyang Orthopedic Hospital of Henan Province, Orthopedic Institute of Henan ProvinceLuoyang 471002, China
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798
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The relevance of gender in the care of hip fracture patients. Int J Orthop Trauma Nurs 2015; 22:3-12. [PMID: 27215748 DOI: 10.1016/j.ijotn.2015.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/26/2015] [Accepted: 10/28/2015] [Indexed: 01/10/2023]
Abstract
As in many conditions, gender interplays with other social structures of inequality to impact upon women's and men's health and healthcare. This narrative review examines knowledge about sex, gender and hip fracture and suggests ways of highlighting the influence of gender in hip fracture healthcare. These will be considered in relation to two areas. Firstly the multifactorial dimension of hip fractures which identifies ethnicity, marital status, lifestyle, co-morbidities, environment in relation to falls and osteoporosis as important factors influencing the experience of hip fracture. Secondly the importance of acknowledging gender as a key element within research and management of care. Implications for practice are that we need a raised awareness of gender when we assess and care for patients, to ask critical questions about the gender bias in the evidence we use and reflect on how services and care practices may be biased towards gendered assumptions.
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799
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Marques A, Lourenço Ó, da Silva JAP. The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality. Osteoporos Int 2015; 26:2623-30. [PMID: 25986386 DOI: 10.1007/s00198-015-3171-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/07/2015] [Indexed: 02/08/2023]
Abstract
UNLABELLED The study rationale was to provide a detailed overview of the costs, quality of life and mortality of hip fractures in Portugal. Mean individual fracture-related costs were estimated at €13,434 [12,290; 14,576] for the first year and €5985 [4982; 7045] for the second year following the fracture. INTRODUCTION Osteoporotic fractures represent a remarkable burden to health care systems and societies worldwide, which will tend to increase as life expectancy expands and lifestyle changes favour osteoporosis. The cost-effectiveness evaluation of intervention strategies demands accurate data on the epidemiological and economical reality to be addressed. METHODS Information was collected retrospectively on consumption of resources and changes in quality of life attributable to fracture as well as mortality, regarding 186 patients randomly selected to represent the distribution of hip fractures in the Portuguese population, in terms of gender, age and geographical provenience. Data were cross-tabulated with socio-demographic variables and individual resource consumption to estimate the burden of disease. A societal perspective was adopted, including direct and indirect costs. Multivariate analyses were carried out to assess the main determinants of health-related quality of life (HrQoL). RESULTS Mean individual fracture-related costs were estimated at €13,434 [12,290; 14,576] for the first year and €5985 [4982; 7045] for the second year following the fracture. In 2011 the economic burden attributable to osteoporotic hip fractures in Portugal could be estimated at €216 million. Mean reduction in HrQoL 12 months after fracture was estimated at 0.34. Regression analysis showed that age was associated with a higher loss of HrQoL, whereas education had the opposing effect. We observed 12 % excess mortality in the first year after hip fracture, when compared to the gender and age-matched general population. CONCLUSIONS Results of this study indicate that osteoporotic hip fractures are, also in Portugal, despite its low incidence of fractures and cost per event, associated with a high societal burden, in terms of costs, loss in HrQoL and mortality. These data provide valuable input to the design and selection of fracture prevention strategies.
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Affiliation(s)
- A Marques
- Rheumatology Department, Centro Hospitalar Universitário de Coimbra, 3000-075, Coimbra, Portugal.
| | - Ó Lourenço
- Centro de Estudos e Investigação em Saúde da Universidade de Coimbra, Faculty of Economics, University of Coimbra, Av. Dias da Silva, 1653004-512, Coimbra, Portugal
| | - J A P da Silva
- Rheumatology Department, Centro Hospitalar Universitário de Coimbra, 3000-075, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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800
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Johansson H, Odén A, Lorentzon M, McCloskey E, Kanis JA, Harvey NC, Karlsson MK, Mellström D. Is the Swedish FRAX model appropriate for Swedish immigrants? Osteoporos Int 2015; 26:2617-22. [PMID: 26018091 DOI: 10.1007/s00198-015-3180-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/14/2015] [Indexed: 11/24/2022]
Abstract
UNLABELLED The incidence of hip fracture in Sweden is substantially lower in immigrants than in the population born in Sweden. Thus, the use of a FRAX® model in immigrants overestimates the risk of fracture, and the use of country of origin-specific models may be more appropriate. INTRODUCTION Age-specific fracture and mortality rates vary between countries so that FRAX tools are country-specific. In the case of immigrants, it is not known whether the model for the original or the new country is most appropriate. The aim of this study was to compare the incidence of hip fractures in foreign-born and Swedish-born individuals residing in Sweden. METHODS We studied the incidence of hip fracture in all men and women aged 50 years or more in Sweden between 1987 and 2002. The population comprised 2.8 million Swedish-born and 270,000 foreign-born individuals. RESULTS Incident hip fractures occurred in 239,842 Swedish-born and 12,563 foreign-born individuals. The hip fracture incidence rose with age for both groups and was higher for women than men amongst both Swedish-born and foreign-born individuals. The hip fracture incidence for the Swedish-born cohort was approximately twice that of immigrants. For example, at the age of 70 years, the annual hip fracture incidence (per 100,000) was 450 (95 % CI 446-454) for a Swedish-born woman and 239 (95 % CI 223-257) for a foreign-born woman at the time of immigration. The hip fracture incidence rose slowly with time from immigration (0.6 % per annum, 95 % CI 0.5-0.8 %) but remained significantly lower than for Swedish-born individuals even after 40 years of residence. CONCLUSIONS The incidence of hip fracture in Sweden is substantially lower in immigrants than in the population native to Sweden. Although there was a small rise in age- and sex-specific incidence after immigration, the incidence remained markedly lower than that observed in Swedish-born individuals. Thus, the use of a FRAX model for Sweden will overestimate the risk of fracture for foreign-born individuals living in Sweden.
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Affiliation(s)
- H Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
- Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - A Odén
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - M Lorentzon
- Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - M K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmo, Sweden
| | - D Mellström
- Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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