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Michaëlsson K, Baron JA, Byberg L, Larsson SC, Melhus H, Gedeborg R. Declining hip fracture burden in Sweden 1998-2019 and consequences for projections through 2050. Sci Rep 2024; 14:706. [PMID: 38184745 PMCID: PMC10771431 DOI: 10.1038/s41598-024-51363-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 01/04/2024] [Indexed: 01/08/2024] Open
Abstract
We aimed to estimate the absolute and age-standardized number of hip fractures in Sweden during the past two decades to produce time trends and future projections. We used nationwide register data from 1998 to 2019 and a validated algorithm to calculate the annual absolute and age-standardized number of incident hip fractures over time. The total hip fracture burden was 335,399 incident events over the 22 years, with a change from 16,180 in 1998 to 13,929 in 2019, a 14% decrease. One decade after the index hip fracture event, 80% of the patients had died, and 11% had a new hip fracture. After considering the steady growth of the older population, the decline in the age-standardized number of hip fractures from 1998 through 2019 was 29.2% (95% CI 28.1-30.2%) in women and 29.3% (95% CI 27.5-30.7%) in men. With a continued similar reduction in hip fracture incidence, we can predict that 14,800 hip fractures will occur in 2034 and 12,000 in 2050 despite doubling the oldest old (≥ 80 years). Without an algorithm, a naïve estimate of the total number of hip fractures over the study period was 539,947, with a second 10-year hip fracture risk of 35%. We note an ongoing decline in the absolute and age-standardized actual number of hip fractures in Sweden, with consequences for future projections.
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Affiliation(s)
- Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden.
| | - John A Baron
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Liisa Byberg
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | - Susanna C Larsson
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Melhus
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Rolf Gedeborg
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
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2
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Arman S. What is the role of risedronate in the primary and secondary prevention of fractures associated with osteoporosis in postmenopausal women? A Cochrane review summary with commentary. Int J Rheum Dis 2024; 27:e14940. [PMID: 37904317 DOI: 10.1111/1756-185x.14940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 11/01/2023]
Affiliation(s)
- Sina Arman
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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3
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Tabor E, Bach M, Werner A, Drozdzowska B, Pluskiewicz W. The Impact of Environmental and Genetic Factors on Bone Quality in Monozygotic and Dizygotic Twins. Biomedicines 2022; 10:biomedicines10102360. [PMID: 36289621 PMCID: PMC9598072 DOI: 10.3390/biomedicines10102360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
The purpose of the research was to assess the genetic and environmental influences on bone properties. One hundred thirty-two pairs of twins (99/33 monozygotic/dizygotic) underwent anthropometric measurements and phalangeal quantitative ultrasound (DBM Sonic 1200, Igea, Italy) measuring the amplitude speed of sound (AD-SoS, m/s). The mean age was 16.78 ± 12.35 years for monozygotic twins and 14.30 ± 8 years for dizygotic. Interpair and intrapair correlations between twins were calculated. In the groups of monozygotic and dizygotic twins, Ad-SoS correlated significantly with age (r = 0.56−0.73, p < 0.05), weight (r = 0.73−0.78, p < 0.05), and height (r = 0.80−0.81, p < 0.05). The strongest intrapair correlation (r = 0.99−0.998) was noted in monozygotic females for Ad-SoS, weight, and height. There was a statistically significant correlation between the intrapair difference of Ad-SoS and age but only in the groups of monozygotic and dizygotic females (r = 0.281, r2 = 0.079, and p = 0.028; r = 0.544, r2 = 0.296, and p = 0.01, respectively). After age adjustment, it was estimated that 28.62% of Ad-SoS in women and 13.2% of Ad-SoS in men was explained by genetic influence, leading to the conclusion that Ad-SoS changed with age, weight, and height. The strongest correlation between pairs of twins was observed in monozygotic twins. The differences in bone values between female twins arose with age, which indicated the role of environmental factors.
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Affiliation(s)
- Elżbieta Tabor
- Department and Clinic of Internal Diseases, Diabetology, and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Correspondence:
| | - Małgorzata Bach
- Department of Applied Informatics, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Aleksandra Werner
- Department of Applied Informatics, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Bogna Drozdzowska
- Department of Pathomorphology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Wojciech Pluskiewicz
- Metabolic Bone Diseases Unit, Department and Clinic of Internal Diseases, Diabetology, and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
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4
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Liang Y, Deng MG, Jian Q, Zhang M, Chen S. The causal impact of childhood obesity on bone mineral density and fracture in adulthood: A two-sample Mendelian randomization study. Front Nutr 2022; 9:945125. [PMID: 36185695 PMCID: PMC9515586 DOI: 10.3389/fnut.2022.945125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Observational studies have indicated the associations between obesity with bone mineral density (BMD) and fracture but yield inconsistent results. The impact of childhood obesity on bone health in adulthood is even less clear. The present study adopted the Mendelian randomization methods to determine whether the genetically predicted childhood obesity was causally associated with BMD and the risk of fracture. Genetic variants were extracted from genome-wide association studies (GWAS) to identify childhood obesity loci [IEU open GWAS project: childhood obesity (ID: ieu-a-1096)] and single nucleotide polymorphisms (SNPs) as instrumental variables to investigate causality. We used two-sample univariable Mendelian randomization (MR) to estimate causal relationships between childhood obesity on BMD and fracture subtypes based on SNPs from European samples. To avoid bias, Cochran's Q test and leave-one-out variant analysis were performed. The MR analysis shows strong evidence that childhood obesity is causally associated with eBMD (OR 1.068, 95% CI 1.043–1.095, P < 0.001) and a weak decreased risk of leg fracture (OR 0.9990, 95% CI 0.9981–0.9999, P =0.033) based on the inverse variance weighting (IVW) method. After adjusting for diabetes and adult obesity, the results of eBMD remained the same. The MR analysis revealed sufficient evidence to indicate childhood obesity was causally associated with increased BMD and decreased risk of leg fracture in adults. Childhood obesity could be taken into consideration when assessing eBMD.
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Affiliation(s)
- Yuehui Liang
- School of Public Health, Wuhan University, Wuhan, China
| | | | - Qinghong Jian
- Da Ping Hospital, Third Military Medical University, Chongqing, China
| | - Minjie Zhang
- School of Public Health, Wuhan University, Wuhan, China
| | - Shuai Chen
- School of Public Health, Wuhan University, Wuhan, China
- *Correspondence: Shuai Chen
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Meyer AC, Ebeling M, Drefahl S, Hedström M, Ek S, Sandström G, Modig K. The Impact of Hip Fracture on Geriatric Care and Mortality Among Older Swedes: Mapping Care Trajectories and Their Determinants. Am J Epidemiol 2022; 192:41-50. [PMID: 35968686 PMCID: PMC9825727 DOI: 10.1093/aje/kwac149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 06/16/2022] [Accepted: 08/10/2022] [Indexed: 01/12/2023] Open
Abstract
In this study, we examined the impact of hip fractures on trajectories of home care, nursing home residence, and mortality among individuals aged 65 years or more and explored the impacts of living arrangements, cohabitation, frailty, and socioeconomic position on these trajectories. Based on a linkage of nationwide Swedish population registers, our study included 20,573 individuals with first hip fracture in 2014-2015. Care trajectories during the 2 years following the fracture were visualized and compared with those of 2 hip-fracture-free control groups drawn from the general population: age- and sex-matched controls and health-matched controls identified through propensity score matching. Multistate modeling was employed to identify sociodemographic and health-related factors associated with care trajectories among hip fracture patients. We found that hip fracture patients already had worse health than the general population before their fracture. However, when controlling for prefracture health, hip fractures still had a considerable impact on use of elder-care services and mortality. Comparisons with the health-matched controls suggest that hip fractures have an immediate, yet short-term, impact on care trajectories. Long-term care needs are largely attributable to poorer health profiles independent of the fracture itself. This emphasizes the importance of adequate comparison groups when examining the consequences of diseases which are often accompanied by other underlying health problems.
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Affiliation(s)
- Anna C Meyer
- Correspondence to Dr. Anna C. Meyer, Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, P.O. Box 210, SE-171 77 Stockholm, Sweden (e-mail: )
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6
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Nordström P, Bergman J, Ballin M, Nordström A. Trends in Hip Fracture Incidence, Length of Hospital Stay, and 30-Day Mortality in Sweden from 1998-2017: A Nationwide Cohort Study. Calcif Tissue Int 2022; 111:21-28. [PMID: 35166892 PMCID: PMC9232476 DOI: 10.1007/s00223-022-00954-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/25/2022] [Indexed: 01/01/2023]
Abstract
In this nationwide cohort study, we investigated trends in hip fracture incidence, hospital length of stay (LOS), and 30-day mortality after admission in Sweden. The cohort included all individuals in Sweden aged ≥ 50 years with a first hip fracture diagnosis during 1998-2017 (N = 313,761). The outcomes were hip fracture incidence and 30-day mortality. The results showed that the incidence of hip fracture decreased from 79.2 to 46.7/10,000 population in women and from 35.7 to 26.5/10,000 population in men. In contrast, 30-day mortality increased from 4.3% to 6.2% in women (P < 0.001) and from 8.4% to 11.1% in men (P < 0.001). Strong risk factors (P < 1 × 10-25 for all) for 30-day mortality were older age, male sex, and shorter LOS. From 1998 to 2017, LOS decreased by on average 4 days and was shorter in both male and female aged ≥ 90 years compared to those aged 80-89 (P < 0.001 for comparisons). In conclusion, despite population aging, hip fracture incidence in Sweden has decreased over the last 20 years. However, short-term mortality has increased, which to some extent may partly be explained by the fact that LOS has decreased without being adapted to important risk factors.
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Affiliation(s)
- Peter Nordström
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden.
| | - Jonathan Bergman
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden
| | - Marcel Ballin
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Anna Nordström
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
- School of Sport Sciences, UiT the Arctic University of Norway, Tromsø, Norway
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Burm SW, Hong N, Lee SH, Yu M, Kim JH, Park KK, Rhee Y. Fall Patterns Predict Mortality After Hip Fracture in Older Adults, Independent of Age, Sex, and Comorbidities. Calcif Tissue Int 2021; 109:372-382. [PMID: 33830276 DOI: 10.1007/s00223-021-00846-z] [Citation(s) in RCA: 3] [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: 02/03/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
Falls are the most frequent cause of hip fracture. We aimed to investigate whether specific fall patterns have predictive value for mortality after hip fracture. In this cohort study, data of individuals presented to the Severance Hospital, Seoul, Korea, between 2005 and 2019 due to fragility hip fracture (n = 1986) were analyzed. Fall patterns were defined as causes, activities leading to falls, and a combination of both, based on electronic medical records using pre-specified classification from a prior study on video-captured falls. Mean age of study subjects were 77 years (71% women) and 211 patients (10.6%) died during follow-up (median 544 days). Indoor falls at home had a higher mortality than outdoor falls (11.9 vs. 8.0%, p = 0.009). Among 16 fall patterns, incorrect weight shift while sitting down (adjusted hazard ratio [aHR] 4.03) or getting up (aHR 2.01), collapse during low-risk activity (aHR 2.39), and slipping while walking (aHR 2.90, p < 0.01 for all) were associated with increased mortality compared to outdoor falls, after adjustment for age, sex, and Charlson comorbidity index (CCI), constituting a high-risk pattern. High-risk fall patterns were associated with a higher risk of mortality (aHR 2.56, p < 0.001) than low-risk patterns (aHR 1.37, p = 0.080) and outdoor falls (referent; log rank p < 0.001), which improved mortality prediction when added to a base model including age, sex, and CCI (integrative area under receiver-operating characteristics curve 0.675 to 0.698, p < 0.001). Specific fall patterns were associated with higher mortality in older adults with hip fracture, independent of age, sex, and comorbidities.
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Affiliation(s)
- Seung Won Burm
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Seung Hyun Lee
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Minheui Yu
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Ji Hoon Kim
- Department of Emergency Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kwan Kyu Park
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
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8
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Mitchell A, Fall T, Melhus H, Lind L, Michaëlsson K, Byberg L. Type 2 Diabetes and Change in Total Hip Bone Area and Bone Mineral Density in Swedish Men and Women Older Than 55 Years. J Clin Endocrinol Metab 2021; 106:2840-2854. [PMID: 34214157 PMCID: PMC8475243 DOI: 10.1210/clinem/dgab490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Indexed: 11/24/2022]
Abstract
CONTEXT In a cross-sectional study, we found an association between type 2 diabetes mellitus (T2DM) and smaller bone area together with greater bone mineral density (BMD) at the total hip. OBJECTIVE This work aims to investigate these associations longitudinally, by studying T2DM status (no T2DM n = 1521, incident T2DM n = 119, or prevalent T2DM n = 106) in relation to changes in total hip bone area and BMD. METHODS In 3 cohorts, the Swedish Mammography Cohort Clinical (SMCC; n = 1060), Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; n = 483), and Uppsala Longitudinal Study of Adult Men (ULSAM; n = 203), with repeat assessment of T2DM status and dual energy x-ray absorptiometry (DXA) measurements of total hip bone area and BMD on average 8 years apart, a linear regression model was used to assess the effect of T2DM status on change in bone area and BMD at the total hip. RESULTS After meta-analysis, the change in bone area at the total hip was 0.5% lower among those with incident T2DM compared to those without T2DM (-0.18 cm2; 95% CI, -0.30 to -0.06). The change in bone area was similar among those with prevalent T2DM compared to those without (0.00 cm2; 95% CI, -0.13 to 0.13). For BMD, the combined estimate was 0.004 g/cm2 (95% CI, -0.006 to 0.014) among those with incident T2DM and 0.010 g/cm2 (95% CI, -0.000 to 0.020) among those with prevalent T2DM, compared to those without T2DM. CONCLUSION Those with incident T2DM have a lower expansion in bone area at the total hip compared to those without T2DM.
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Affiliation(s)
- Adam Mitchell
- Department of Surgical Sciences, Medical Epidemiology, Uppsala University, 751 85 Uppsala, Sweden
- Correspondence: Adam Mitchell, MMedSci, Epihubben, MTC, Department of Surgical Sciences, Medical Epidemiology, Uppsala University, Uppsala Science Park, 751 85 Uppsala, Sweden.
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, 751 85 Uppsala, Sweden
| | - Håkan Melhus
- Department of Medical Sciences, Clinical Pharmacogenomics and Osteoporosis, Uppsala University, 751 85 Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, 751 85 Uppsala, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Medical Epidemiology, Uppsala University, 751 85 Uppsala, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Medical Epidemiology, Uppsala University, 751 85 Uppsala, Sweden
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Gani L, Anthony N, Dacay L, Tan P, Chong LR, King TF. Incidence of Atypical Femoral Fracture and Its Mortality in a Single Center in Singapore. JBMR Plus 2021; 5:e10515. [PMID: 34368607 PMCID: PMC8328799 DOI: 10.1002/jbm4.10515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 12/29/2022] Open
Abstract
Bisphosphonates (BP) are the most commonly prescribed effective form of osteoporosis treatment with adverse effects associated with prolonged use such as atypical femoral fractures (AFF). Asians have an elevated risk of AFF at 5 to 6 times those of whites and Hispanics. In this study, we characterize factors associated with AFF and its mortality in a single center in Singapore. We conducted a cohort study of subjects older than 50 years admitted to Changi General Hospital (CGH), Singapore, with fragility subtrochanteric femoral fractures from 2009 to 2015. Using the ASBMR 2014 criteria, fractures are classified into atypical and typical subtrochanteric femoral fractures. CGH uses a nationalized electronic health record that allows review of information on patients' demographics, clinical history and previous investigations. Mortality was assessed as of December 31, 2019. Between 2009 and 2015, there were 3097 hip fractures, of which 393 were subtrochanteric femoral fractures and 69 were classified as AFF by ASBMR 2014 criteria. A total of 52.2% of AFF occurred with BP exposure of median duration 56.5 (28 to 66) months. Multivariate regression showed that BP exposure was associated with the highest risk of AFF (odds ratio [OR] = 6.65 [2.35–18.9]). AFF patients had higher 5‐year survival (0.85 versus 0.62, p = 0.001) compared with typical subtrochanteric fracture patients. However, after adjusting for variables, the type of subtrochanteric femoral fractures were no longer significantly associated with progression to death, whereas older age, higher mean Charlson comorbidity score, and Malay ethnicity were the strongest predictors of death. AFF constitutes a small proportion of hip and femoral fractures with prolonged BP use being the highest risk factor for its development. There is no evidence of increased mortality or morbidity in patients with AFF compared with the typical subtrochanteric fracture. The fear of AFF should not impede treatment of typical osteoporotic fractures in this population. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Linsey Gani
- Department of Endocrinology Department of Medicine Changi General Hospital 2 Simei Street 3 529889 Singapore Singapore
| | - Natasha Anthony
- Department of Endocrinology Department of Medicine Changi General Hospital 2 Simei Street 3 529889 Singapore Singapore
| | - Lily Dacay
- Department of Endocrinology Department of Medicine Changi General Hospital 2 Simei Street 3 529889 Singapore Singapore
| | - Pei Tan
- Centre of Trial Research Unit Changi General Hospital Singapore Singapore
| | - Le Roy Chong
- Department of Radiology Changi General Hospital Singapore Singapore
| | - Thomas Fj King
- Department of Endocrinology Department of Medicine Changi General Hospital 2 Simei Street 3 529889 Singapore Singapore
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Circulating Alpha-Tocopherol Levels, Bone Mineral Density, and Fracture: Mendelian Randomization Study. Nutrients 2021; 13:nu13061940. [PMID: 34198753 PMCID: PMC8228419 DOI: 10.3390/nu13061940] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 12/28/2022] Open
Abstract
Recent cohort studies indicate a potential role of the antioxidant α-tocopherol in reducing bone loss and risk of fractures, especially hip fractures. We performed a Mendelian randomization investigation of the associations of circulating α-tocopherol with estimated bone mineral density (eBMD) using heel ultrasound and fractures, identified from hospital records or by self-reports and excluding minor fractures. Circulating α-tocopherol was instrumented by three genetic variants associated with α-tocopherol levels at p < 5 × 10-8 in a genome-wide association meta-analysis of 7781 participants of European ancestry. Summary-level data for the genetic associations with eBMD in 426,824 individuals and with fracture (53,184 cases and 373,611 non-cases) were acquired from the UK Biobank. Two of the three genetic variants were strongly associated with eBMD. In inverse-variance weighted analysis, a genetically predicted one-standard-deviation increase of circulating α-tocopherol was associated with 0.07 (95% confidence interval, 0.05 to 0.09) g/cm2 increase in BMD, which corresponds to a >10% higher BMD. Genetically predicted circulating α-tocopherol was not associated with odds of any fracture (odds ratio 0.97, 95% confidence interval, 0.91 to 1.05). In conclusion, our results strongly strengthen a causal link between increased circulating α-tocopherol and greater BMD. Both an intervention study in those with a low dietary intake of α-tocopherol is warranted and a Mendelian randomization study with fragility fractures as an outcome.
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11
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Mitchell A, Fall T, Melhus H, Wolk A, Michaëlsson K, Byberg L. Is the effect of Mediterranean diet on hip fracture mediated through type 2 diabetes mellitus and body mass index? Int J Epidemiol 2021; 50:234-244. [PMID: 33367703 PMCID: PMC7938512 DOI: 10.1093/ije/dyaa239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND We examined whether the inverse association between adherence to a Mediterranean diet and hip fracture risk is mediated by incident type 2 diabetes mellitus (T2DM) and body mass index (BMI). METHODS We included 50 755 men and women from the Cohort of Swedish Men and the Swedish Mammography Cohort who answered lifestyle and medical questionnaires in 1997 and 2008 (used for calculation of the Mediterranean diet score 9mMED; low, medium, high) and BMI in 1997, and incident T2DM in 1997-2008). The cumulative incidence of hip fracture from the National Patient Register (2009-14) was considered as outcome. RESULTS We present conditional odds ratios (OR) 9[95% confidence interval, CI) of hip fracture for medium and high adherence to mMED, compared with low adherence. The total effect ORs were 0.82 (0.71, 0.95) and 0.75 (0.62, 0.91), respectively. The controlled direct effect of mMED on hip fracture (not mediated by T2DM, considering BMI as an exposure-induced confounder), calculated using inverse probability weighting of marginal structural models, rendered ORs of 0.82 (0.72, 0.95) and 0.73 (0.60, 0.88), respectively. The natural direct effect ORs (not mediated by BMI or T2DM, calculated using flexible mediation analysis) were 0.82 (0.71, 0.95) and 0.74(0.61, 0.89), respectively. The path-specific indirect and partial indirect natural effects ORs (through BMI or T2DM) were close to 1. CONCLUSIONS Mediterranean diet has a direct effect on hip fracture risk via pathways other than through T2DM and BMI. We cannot exclude mediating effects of T2DM or BMI, or that their effects cancel each other out.
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Affiliation(s)
- Adam Mitchell
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Håkan Melhus
- Department of Medical Sciences, Clinical Pharmacogenomics and Osteoporosis, Uppsala University, Uppsala, Sweden
| | - Alicja Wolk
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
- Institute of Environmental Medicine, Cardiovascular and Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
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12
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Dahl C, Holvik K, Meyer HE, Stigum H, Solbakken SM, Schei B, Søgaard AJ, Omsland TK. Increased Mortality in Hip Fracture Patients Living Alone: A NOREPOS Study. J Bone Miner Res 2021; 36:480-488. [PMID: 33403722 DOI: 10.1002/jbmr.4212] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/16/2020] [Accepted: 11/04/2020] [Indexed: 12/29/2022]
Abstract
Hip fracture is associated with excess mortality, persisting for many years after the fracture. Several factors may affect survival; however, the role of social support has been less studied. Living situation could be an indicator of a person's social support, which predicts mortality in the general population. In this longitudinal cohort study, we considered whether living alone was a risk factor for post-hip fracture mortality compared with living with a partner. Information on hip fractures from all hospitals in Norway from 2002 to 2013 was combined with the 2001 National Population and Housing Census. The association between living situation and mortality during 12.8 years of follow-up in 12,770 men and 22,067 women aged 50 to 79 years at fracture was investigated using flexible parametric survival analysis. We also estimated relative survival of hip fracture patients compared with that of the non-fractured background population in the same living situation (alone or with a partner). Higher mortality after hip fracture was found in both men and women living alone versus with a partner (hazard ratio [HR] men = 1.37, 95% confidence interval [CI] 1.29-1.44; HR women = 1.23, 95% CI 1.18-1.28, adjusting for age, education level, urbanization degree, and number of children). We demonstrated the strongest association in male hip fracture patients aged <60 years (long-term mortality HR = 3.29, 95% CI 2.25-6.49). Compared with the general population, relative survival 8 years after a hip fracture was 43% in men and 61% in women living alone, whereas relative survival in those living with a partner was 51% in men and 67% in women. In conclusion, hip fracture patients who lived alone had higher mortality than those living with a partner and lower survival relative to the general population. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Cecilie Dahl
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kristin Holvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Haakon E Meyer
- Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Hein Stigum
- Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri M Solbakken
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Berit Schei
- Institute of Community Medicine and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim, Norway
| | - Anne-Johanne Søgaard
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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13
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Byberg L, Warensjö Lemming E. Milk Consumption for the Prevention of Fragility Fractures. Nutrients 2020; 12:E2720. [PMID: 32899514 PMCID: PMC7551481 DOI: 10.3390/nu12092720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 12/17/2022] Open
Abstract
Results indicating that a high milk intake is associated with both higher and lower risks of fragility fractures, or that indicate no association, can all be presented in the same meta-analysis, depending on how it is performed. In this narrative review, we discuss the available studies examining milk intake in relation to fragility fractures, highlight potential problems with meta-analyses of such studies, and discuss potential mechanisms and biases underlying the different results. We conclude that studies examining milk and dairy intakes in relation to fragility fracture risk need to study the different milk products separately. Meta-analyses should consider the doses in the individual studies. Additional studies in populations with a large range of intake of fermented milk are warranted.
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Affiliation(s)
- Liisa Byberg
- Department of Surgical Sciences, Orthopaedics, Uppsala University, SE-751 85 Uppsala, Sweden;
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14
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Michaëlsson K, Baron JA, Byberg L, Höijer J, Larsson SC, Svennblad B, Melhus H, Wolk A, Warensjö Lemming E. Combined associations of body mass index and adherence to a Mediterranean-like diet with all-cause and cardiovascular mortality: A cohort study. PLoS Med 2020; 17:e1003331. [PMID: 32941436 PMCID: PMC7497998 DOI: 10.1371/journal.pmed.1003331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It is unclear whether the effect on mortality of a higher body mass index (BMI) can be compensated for by adherence to a healthy diet and whether the effect on mortality by a low adherence to a healthy diet can be compensated for by a normal weight. We aimed to evaluate the associations of BMI combined with adherence to a Mediterranean-like diet on all-cause and cardiovascular disease (CVD) mortality. METHODS AND FINDINGS Our longitudinal cohort design included the Swedish Mammography Cohort (SMC) and the Cohort of Swedish Men (COSM) (1997-2017), with a total of 79,003 women (44%) and men (56%) and a mean baseline age of 61 years. BMI was categorized into normal weight (20-24.9 kg/m2), overweight (25-29.9 kg/m2), and obesity (30+ kg/m2). Adherence to a Mediterranean-like diet was assessed by means of the modified Mediterranean-like diet (mMED) score, ranging from 0 to 8; mMED was classified into 3 categories (0 to <4, 4 to <6, and 6-8 score points), forming a total of 9 BMI × mMED combinations. We identified mortality by use of national Swedish registers. Cox proportional hazard models with time-updated information on exposure and covariates were used to calculate the adjusted hazard ratios (HRs) of mortality with their 95% confidence intervals (CIs). Our HRs were adjusted for age, baseline educational level, marital status, leisure time physical exercise, walking/cycling, height, energy intake, smoking habits, baseline Charlson's weighted comorbidity index, and baseline diabetes mellitus. During up to 21 years of follow-up, 30,389 (38%) participants died, corresponding to 22 deaths per 1,000 person-years. We found the lowest HR of all-cause mortality among overweight individuals with high mMED (HR 0.94; 95% CI 0.90, 0.98) compared with those with normal weight and high mMED. Using the same reference, obese individuals with high mMED did not experience significantly higher all-cause mortality (HR 1.03; 95% CI 0.96-1.11). In contrast, compared with those with normal weight and high mMED, individuals with a low mMED had a high mortality despite a normal BMI (HR 1.60; 95% CI 1.48-1.74). We found similar estimates among women and men. For CVD mortality (12,064 deaths) the findings were broadly similar, though obese individuals with high mMED retained a modestly increased risk of CVD death (HR 1.29; 95% CI 1.16-1.44) compared with those with normal weight and high mMED. A main limitation of the present study is the observational design with self-reported lifestyle information with risk of residual or unmeasured confounding (e.g., genetic liability), and no causal inferences can be made based on this study alone. CONCLUSIONS These findings suggest that diet quality modifies the association between BMI and all-cause mortality in women and men. A healthy diet may, however, not completely counter higher CVD mortality related to obesity.
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Affiliation(s)
- Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - John A. Baron
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Liisa Byberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas Höijer
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Susanna C. Larsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bodil Svennblad
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Håkan Melhus
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Alicja Wolk
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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15
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Fracture Risk in Patients With Inflammatory Bowel Disease: A Nationwide Population-Based Cohort Study From 1964 to 2014. Am J Gastroenterol 2019; 114:291-304. [PMID: 30730858 DOI: 10.14309/ajg.0000000000000062] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Most studies on fractures in inflammatory bowel disease (IBD) are based on patients from tertiary centers or patients followed up before the introduction of immunomodulators or biologics. In addition, the role of corticosteroids in fracture risk has rarely been examined. METHODS We conducted a nationwide population-based cohort study of 83,435 patients with incident IBD (ulcerative colitis [UC]: n = 50,162, Crohn's disease [CD]: n = 26,763, and IBD unclassified: 6,510) and 825,817 reference individuals from 1964 to 2014. Using multivariable Cox regression, we estimated hazard ratios (HRs) for hip fracture and any fracture and the association with cumulative corticosteroid exposure. RESULTS During 1,225,415 person-years of follow-up in patients with IBD, there were 2,491 first-time hip fractures (203/100,000 person-years) compared with 20,583 hip fractures during 12,405,642 person-years in reference individuals (159/100,000 person-years). This corresponded to an HR of 1.42 (95% confidence interval [CI] = 1.36-1.48). The risk for hip fracture was higher in CD compared with UC (P < 0.001). Inflammatory bowel disease was also associated with any fracture (IBD: HR = 1.18; 95% CI = 1.15-1.20). Hazard ratios for hip fracture had not changed since the introduction of immunomodulators or biologics. Increasing exposure to corticosteroids was associated with hip fracture in both IBD and non-IBD individuals (P < 0.001), but only in elderly (>60 years) patients with IBD. The association between IBD and hip fracture was nonsignificant among individuals without corticosteroids (HR = 1.11; 95% CI = 0.86-1.44). CONCLUSIONS Inflammatory bowel disease (CD and UC) is associated with an increased risk of hip fracture and any fracture, but not in individuals without a history of corticosteroid treatment. The association between corticosteroids and hip fracture was restricted to elderly patients with IBD.
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Mitchell A, Fall T, Melhus H, Wolk A, Michaëlsson K, Byberg L. Type 2 Diabetes in Relation to Hip Bone Density, Area, and Bone Turnover in Swedish Men and Women: A Cross-Sectional Study. Calcif Tissue Int 2018; 103:501-511. [PMID: 29946974 PMCID: PMC6182615 DOI: 10.1007/s00223-018-0446-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/19/2018] [Indexed: 12/12/2022]
Abstract
Men and women with type 2 diabetes mellitus (T2DM) have higher risk of hip fracture, but the mechanisms are not fully understood. We aimed to investigate how T2DM, glucose, and insulin were associated with femoral bone mineral density (BMD), bone mineral area (BMA), and bone turnover markers. We used two cross-sectional cohorts: the Uppsala Longitudinal Study of Adult Men (ULSAM, n = 452, mean age 82 years) and the Swedish Mammography Cohort Clinical (SMCC, n = 4713, mean age 68 years). We identified men and women with normal fasting glucose (NFG), impaired fasting plasma glucose (IFG), and T2DM. BMD and BMA at the total hip and femoral shaft were measured using dual energy X-ray absorptiometry (DXA). Bone turnover markers; CrossLaps and osteocalcin were measured in women. Linear regression models were applied. Men and women showed a progressively higher BMD following the clinical cutoffs of fasting glucose from NFG to IFG to T2DM. In contrast, there was a progressively lower BMA. Men and women with T2DM, compared to those with NFG, had lower BMA at the total hip (- 1.7%; 95% CI - 3.2, - 0.2 and - 1.0%; 95% CI - 1.6, - 0.4) and the femoral shaft (- 2.0%; 95% CI - 3.5, - 0.4 and - 0.6%; 95% CI - 1.2, - 0.01), respectively. T2DM was associated with lower concentrations of CrossLaps (- 8.1%; 95% CI - 12.7, - 3.6) and osteocalcin (- 15.2%; 95% CI - 19.0, - 11.2). These cross-sectional results indicate that those with T2DM have smaller bone area and lower bone turnover, which could increase the risk of hip fracture.
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Affiliation(s)
- Adam Mitchell
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Epihubben, Uppsala Science Park, 751 85, Uppsala, Sweden.
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Håkan Melhus
- Department of Medical Sciences, Clinical Pharmacogenomics and Osteoporosis, Uppsala University, Uppsala, Sweden
| | - Alicja Wolk
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Epihubben, Uppsala Science Park, 751 85, Uppsala, Sweden
- Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Epihubben, Uppsala Science Park, 751 85, Uppsala, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Epihubben, Uppsala Science Park, 751 85, Uppsala, Sweden
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17
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Calais-Ferreira L, Oliveira VC, Craig JM, Flander LB, Hopper JL, Teixeira-Salmela LF, Ferreira PH. Twin studies for the prognosis, prevention and treatment of musculoskeletal conditions. Braz J Phys Ther 2018; 22:184-189. [PMID: 29361503 PMCID: PMC5993967 DOI: 10.1016/j.bjpt.2017.12.004] [Citation(s) in RCA: 6] [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: 12/05/2017] [Revised: 12/08/2017] [Accepted: 12/14/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Musculoskeletal conditions are highly prevalent in our ageing society and are therefore incurring substantial increases in population levels of years lived with disability (YLD). An evidence-based approach to the prognosis, prevention, and treatment of those disorders can allow an overall improvement in the quality of life of patients, while also softening the burden on national health care systems. METHODS In this Masterclass article, we provide an overview of the most relevant twin study designs, their advantages, limitations and major contributions to the investigation of traits related to the domain of musculoskeletal physical therapy. CONCLUSIONS Twin studies can be an important scientific tool to address issues related to musculoskeletal conditions. They allow researchers to understand how genes and environment combine to influence human health and disease. Twin registries and international collaboration through existing networks can provide resources for achieving large sample sizes and access to expertise in study design and analysis of twin data.
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Affiliation(s)
- Lucas Calais-Ferreira
- The University of Melbourne, Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, Melbourne, Victoria, Australia.
| | - Vinicius C Oliveira
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Diamantina, MG, Brazil
| | - Jeffrey M Craig
- Deakin University, School of Medicine, Centre for Molecular and Medical Research, Geelong, Victoria, Australia; Royal Children's Hospital, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; The University of Melbourne, Department of Paediatrics, Melbourne, Victoria, Australia
| | - Louisa B Flander
- The University of Melbourne, Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, Melbourne, Victoria, Australia
| | - John L Hopper
- The University of Melbourne, Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, Melbourne, Victoria, Australia
| | - Luci F Teixeira-Salmela
- Universidade Federal de Minas Gerais (UFMG), Departamento de Fisioterapia, Belo Horizonte, MG, Brazil
| | - Paulo H Ferreira
- The University of Sydney, Faculty of Health Sciences, Musculoskeletal Health Research Group, Sydney, New South Wales, Australia
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18
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Michaëlsson K, Wolk A, Lemming EW, Melhus H, Byberg L. Intake of Milk or Fermented Milk Combined With Fruit and Vegetable Consumption in Relation to Hip Fracture Rates: A Cohort Study of Swedish Women. J Bone Miner Res 2018; 33:449-457. [PMID: 29083056 DOI: 10.1002/jbmr.3324] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 11/11/2022]
Abstract
Milk products may differ in pro-oxidant properties and their effects on fracture risk could potentially be modified by the intake of foods with antioxidant activity. In the population-based Swedish Mammography Cohort study, we aimed to determine how milk and fermented milk combined with fruit and vegetable consumption are associated with hip fracture. Women born in 1914-1948 (n = 61,240) answered food frequency and lifestyle questionnaires in 1987-1990 and 38,071 women contributed with updated information in 1997. During a mean follow-up of 22 years, 5827 women had a hip fracture (ascertained via official register data). Compared with a low intake of milk (<1 glass/day) and a high intake of fruits and vegetables (≥5 servings/day), a high intake of milk (≥3 glasses/day) with a concomitant low intake of fruits and vegetables (<2 servings/day) resulted in a hazard ratio (HR) of 2.49 (95% CI, 2.03 to 3.05). This higher hip fracture rate among high consumers of milk was only modestly attenuated with a concomitant high consumption of fruit and vegetables (HR, 2.14; 95% CI, 1.69 to 2.71). The combination of fruits and vegetables with fermented milk (yogurt or soured milk) yielded a different pattern with lowest rates of hip fracture in high consumers: HR, 0.81 (95% CI, 0.68 to 0.97) for ≥2 servings/day of fermented milk and ≥5 servings/day of fruits and vegetables compared with low consumption of both fruit and vegetables and fermented milk. We conclude that the amount and type of dairy products as well as fruit and vegetable intake are differentially associated with hip fracture rates in women. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Karl Michaëlsson
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Alicja Wolk
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.,National Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Eva Warensjö Lemming
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Håkan Melhus
- Department of Medical Sciences, Section of Clinical Pharmacology, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
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Variables to Predict Mortality in Hip Fractures in Patients Over 65 Years of Age: A Study on the Role of Anticoagulation as a Risk Factor. J Trauma Nurs 2017; 24:326-334. [DOI: 10.1097/jtn.0000000000000313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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The impact of comorbidities on hip fracture mortality: a retrospective population-based cohort study. Arch Osteoporos 2017; 12:76. [PMID: 28849347 DOI: 10.1007/s11657-017-0370-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/17/2017] [Indexed: 02/07/2023]
Abstract
UNLABELLED The impact of comorbidities on hip fracture-related excess mortality was assessed in a population-based age- and sex-matched cohort over 10 years. On average, only 1 out of 12 excess deaths over 10 years was related to pre-fracture life-threatening comorbidities. The presence of life-threatening comorbidities increased the excess risk of death after hip fracture. PURPOSE This work aimed to estimate the impact of pre-fracture comorbidities on the 10-year excess risk of all-cause death after hip fracture among Estonian men and women ≥ 50 years of age. METHODS Retrospective, population-based 10-year study of people aged ≥ 50 in two cohorts: those with a hip fracture and an age- and sex-matched random sample from the national health insurance fund for comparison. RESULTS We found that hip fracture was a strong independent risk factor for death. Upon adjustment for Charlson Comorbidities Index (CCI) score, the impact of life-threatening comorbidities on average hip fracture-related excess mortality was modest: only 8% of excess deaths over 10 years were related to comorbidities. Upon stratification by CCI groups, the excess risk of patients in CCI groups ≥ 3 and 1-2 exceeded that in the CCI 0 group over 5-7 years, indicating that in patients with life-threatening comorbidities, a hip fracture accelerates the chain of lethal events and brings deaths from other conditions forward. The impact of comorbidities was age- and time-dependent: in younger hip fracture patients, the comorbidities almost doubled the excess risk from a fracture in 10 years; in older patients, the effect was shorter and modest. CONCLUSIONS The presence of pre-fracture comorbidities increases the risk of excess death in hip fracture patients, but the comorbidity impact on aggregated excess mortality is modest.
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Stattin K, Michaëlsson K, Larsson SC, Wolk A, Byberg L. Leisure-Time Physical Activity and Risk of Fracture: A Cohort Study of 66,940 Men and Women. J Bone Miner Res 2017; 32:1599-1606. [PMID: 28460152 DOI: 10.1002/jbmr.3161] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/12/2017] [Accepted: 04/26/2017] [Indexed: 01/29/2023]
Abstract
Physical activity has been associated with reduced risk of fracture, but it is not known how the intensity or frequency of physical activity influences this risk reduction. We aim to compare the risk of hip fracture and fracture of any locale between men and women with different levels of leisure-time walking/bicycling and exercise. A total of 37,238 women (born 1914-1948) from the Swedish Mammography Cohort and 45,906 men (born 1918-1952) from the Cohort of Swedish Men were followed for a maximum of 17 years. Exposure and covariate information was collected through a self-administered questionnaire in 1997. Incident fractures (5153 individuals with hip fracture and 15,043 with any type of fracture) and comorbidities were gathered from national and local patient registries. Hazard ratios (HRs) were calculated using Cox proportional hazards regression. Individuals who walked/bicycled less than 20 minutes per day had a lower rate of hip fracture (multivariable adjusted HR = 0.77; 95% confidence interval [CI] 0.70 to 0.85) and any fracture (HR = 0.87; 95% CI 0.82 to 0.92) compared with those who hardly ever walked/bicycled. These reduced rates were also evident in both sexes, in different age categories, for vertebral fractures and for non-hip, non-vertebral fractures. Those who reported exercise 1 hour per week had a lower rate of hip fracture (HR = 0.87; 95% CI 0.80 to 0.96) and any fracture (HR = 0.94; 95% CI 0.89 to 0.99) compared with those who exercised less than 1 hour per week. Only minor differences in HRs were observed in individuals with moderate compared with higher levels of walking/bicycling or exercise. Walking/bicycling and exercise showed almost equal reductions in rate of fracture when compared with those in a joint category with lowest activity. In conclusion, both moderate and high self-reported frequency of physical activity is associated with reduced future risk of fracture. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Karl Stattin
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
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The impact of hip fracture on mortality in Estonia: a retrospective population-based cohort study. BMC Musculoskelet Disord 2017; 18:243. [PMID: 28583096 PMCID: PMC5460499 DOI: 10.1186/s12891-017-1606-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/26/2017] [Indexed: 12/21/2022] Open
Abstract
Background Estimates of hip fracture mortality in Eastern Europe are scarce. We aimed to estimate the magnitude and duration of excess mortality after hip fracture in Estonia. Methods Retrospective, population-based 10-year study of persons aged ≥50 in two cohorts: with hip fracture and an age- and sex-matched (in a 1:4 ratio) random sample from the national health insurance fund database for comparison. Cumulative risks, excess risks and relative risks of death were estimated using Poisson regression with 95% bootstrap confidence intervals (CI). Risks were adjusted for age and Charlson comorbidity index. Results We identified 8298 (2383 men, 5915 women) incident hip fracture patients from 2005 to 2013 and 33,191 (9531 men, 23,660 women) individuals for the reference group. 5552 (1564 men, 3988 women) cases and 14,037 (3514 men, 10,523 women) reference individuals died during the 10-year follow-up period. Among hip fracture patients we observed a pronounced and durable excess risk of death that was highest within 3–6 months after fracture and persisted for the full 10-year follow-up period. After adjustment for age and Charlson index, hip fracture was associated with a 21.1% (95% CI 20.0–22.5%) 10-year cumulative excess risk of death (RR 1.37, 95% CI 1.35–1.40). We found a high immediate excess risk of death in older age groups (≥80 years) and gradually accumulating excess risk in younger age groups (50–79 years). The excess risk was more pronounced among men than women. Conclusions By the end of the 10-year follow-up, 1 in 4 deaths in the hip fracture group was attributable to the hip fracture. The results indicate a high attributable impact of hip fracture as an independent risk factor for death.
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Papadimitriou N, Tsilidis KK, Orfanos P, Benetou V, Ntzani EE, Soerjomataram I, Künn-Nelen A, Pettersson-Kymmer U, Eriksson S, Brenner H, Schöttker B, Saum KU, Holleczek B, Grodstein FD, Feskanich D, Orsini N, Wolk A, Bellavia A, Wilsgaard T, Jørgensen L, Boffetta P, Trichopoulos D, Trichopoulou A. Burden of hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the CHANCES consortium. Lancet Public Health 2017; 2:e239-e246. [PMID: 29253489 DOI: 10.1016/s2468-2667(17)30046-4] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND No studies have estimated disability-adjusted life-years (DALYs) lost due to hip fractures using real-life follow-up cohort data. We aimed to quantify the burden of disease due to incident hip fracture using DALYs in prospective cohorts in the CHANCES consortium, and to calculate population attributable fractions based on DALYs for specific risk factors. METHODS We used data from six cohorts of participants aged 50 years or older at recruitment to calculate DALYs. We applied disability weights proposed by the National Osteoporosis Foundation and did a series of sensitivity analyses to examine the robustness of DALY estimates. We calculated population attributable fractions for smoking, body-mass index (BMI), physical activity, alcohol intake, type 2 diabetes and parity, use of hormone replacement therapy, and oral contraceptives in women. We calculated summary risk estimates across cohorts with pooled analysis and random-effects meta-analysis methods. FINDINGS 223 880 men and women were followed up for a mean of 13 years (SD 6). 7724 (3·5%) participants developed an incident hip fracture, of whom 413 (5·3%) died as a result. 5964 DALYs (27 per 1000 individuals) were lost due to hip fractures, 1230 (20·6%) of which were in the group aged 75-79 years. 4150 (69·6%) DALYs were attributed to disability. Current smoking was the risk factor responsible for the greatest hip fracture burden (7·5%, 95% CI 5·2-9·7) followed by physical inactivity (5·5%, 2·1-8·5), history of diabetes (2·8%, 2·1-4·0), and low to average BMI (2·0%, 1·4-2·7), whereas low alcohol consumption (0·01-2·5 g per day) and high BMI had a protective effect. INTERPRETATION Hip fracture can lead to a substantial loss of healthy life-years in elderly people. National public health policies should be strengthened to reduce hip fracture incidence and mortality. Primary prevention measures should be strengthened to prevent falls, and reduce smoking and a sedentary lifestyle. FUNDING European Community's Seventh Framework Programme.
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Affiliation(s)
- Nikos Papadimitriou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; Hellenic Health Foundation, Athens, Greece; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - Philippos Orfanos
- Hellenic Health Foundation, Athens, Greece; WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vassiliki Benetou
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelia E Ntzani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; Center for Evidence-Based Medicine, Department of Health Services, Policy and Practice, School of Public Health, Brown University, RI, USA
| | | | - Annemarie Künn-Nelen
- Department of Health Economics and Management, University of Wuppertal, Wuppertal, Germany; Research Centre for Education and the Labour Market, Maastricht University, Maastricht, Netherlands
| | | | - Sture Eriksson
- Department of Biobank Research, Umeå University, Umeå, Sweden
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany; Institute of Health Care and Social Management, FOM University of Applied Sciences, Essen, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Francine D Grodstein
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston MA, USA
| | - Diane Feskanich
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston MA, USA
| | - Nicola Orsini
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Bellavia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Lone Jørgensen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Clinical Therapeutic Services, University Hospital of Northern Norway, Tromsø, Norway
| | - Paolo Boffetta
- Hellenic Health Foundation, Athens, Greece; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dimitrios Trichopoulos
- Hellenic Health Foundation, Athens, Greece; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece; WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Bisphosphonate Use After Hip Fracture in Older Adults: A Nationwide Retrospective Cohort Study. J Am Med Dir Assoc 2017; 18:515-521. [PMID: 28238673 DOI: 10.1016/j.jamda.2016.12.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the association between bisphosphonate use and the risk of new fracture in a nationwide cohort of individuals with previous hip fractures, with emphasis on individuals above 80 years of age. DESIGN, SETTING, AND PARTICIPANTS From a nationwide cohort with hip fracture (2006-2012) (n = 93, 601), each individual prescribed bisphosphonates after hip fracture (n = 5845) was matched with up to three individuals not prescribed bisphosphonates, resulting in a cohort of 21,363 individuals. MAIN OUTCOME MEASURE A new hip fracture. RESULTS During a mean follow-up period of 2.98 (range, 0.02-8) years, 4581 fractures occurred in the cohort. Before the initiation of bisphosphonate therapy, individuals later prescribed bisphosphonates had an increased risk of hip fracture (multivariable adjusted odds ratio [OR], 2.63; 95% confidence interval [CI], 2.23-3.24) compared with controls. In the period after bisphosphonate therapy initiation, individuals prescribed bisphosphonates had a lower risk of hip fracture (multivariable adjusted hazard ratio [HR], 0.76; 95% CI, 0.65-0.90) compared with controls. Similar effects were seen after the initiation of bisphosphonates in individuals aged more than 80 years (HR, 0.79; 95% CI, 0.62-0.99). In contrast, the initiation of bisphosphonate therapy did not influence the risk of injurious falls not resulting in fracture (HR, 0.95; 95% CI, 0.86-1.05). CONCLUSION Bisphosphonate use was associated with a decreased risk of hip fracture in this nationwide cohort of older men and women, with similar risk reductions in individuals older than 80 years.
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25
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Leavy B, Michaëlsson K, Åberg AC, Melhus H, Byberg L. The Impact of Disease and Drugs on Hip Fracture Risk. Calcif Tissue Int 2017; 100:1-12. [PMID: 27671989 PMCID: PMC5214955 DOI: 10.1007/s00223-016-0194-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/13/2016] [Indexed: 11/13/2022]
Abstract
We report the risks of a comprehensive range of disease and drug categories on hip fracture occurrence using a strict population-based cohort design. Participants included the source population of a Swedish county, aged ≥50 years (n = 117,494) including all incident hip fractures during 1 year (n = 477). The outcome was hospitalization for hip fracture (ICD-10 codes S72.0-S72.2) during 1 year (2009-2010). Exposures included: prevalence of (1) inpatient diseases [International Classification of Diseases (ICD) codes A00-T98 in the National Patient Register 1987-2010] and (2) prescribed drugs dispensed in 2010 or the year prior to fracture. We present age- and sex-standardized risk ratios (RRs), risk differences (RDs) and population attributable risks (PARs) of disease and drug categories in relation to hip fracture risk. All disease categories were associated with increased risk of hip fracture. Largest risk ratios and differences were for mental and behavioral disorders, diseases of the blood and previous fracture (RRs between 2.44 and 3.00; RDs (per 1000 person-years) between 5.0 and 6.9). For specific drugs, strongest associations were seen for antiparkinson (RR 2.32 [95 % CI 1.48-1.65]; RD 5.2 [1.1-9.4]) and antidepressive drugs (RR 1.90 [1.55-2.32]; RD 3.1 [2.0-4.3]). Being prescribed ≥10 drugs during 1 year incurred an increased risk of hip fracture, whereas prescription of cardiovascular drugs or ≤5 drugs did not appear to increase risk. Diseases inferring the greatest PARs included: cardiovascular diseases PAR 22 % (95 % CI 14-29) and previous injuries (PAR 21 % [95 % CI 16-25]; for specific drugs, antidepressants posed the greatest risk (PAR 16 % [95 % CI 12.0-19.3]).
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Affiliation(s)
- Breiffni Leavy
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
- Stockholms Sjukhem Foundation, Stockholm, Sweden.
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Anna Cristina Åberg
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Håkan Melhus
- Department of Medical Sciences, Osteoporosis and Clinical Pharmacogenetics, Uppsala University, Uppsala, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
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26
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Aspenberg P, Malouf J, Tarantino U, García-Hernández PA, Corradini C, Overgaard S, Stepan JJ, Borris L, Lespessailles E, Frihagen F, Papavasiliou K, Petto H, Caeiro JR, Marin F. Effects of Teriparatide Compared with Risedronate on Recovery After Pertrochanteric Hip Fracture: Results of a Randomized, Active-Controlled, Double-Blind Clinical Trial at 26 Weeks. J Bone Joint Surg Am 2016; 98:1868-1878. [PMID: 27852903 PMCID: PMC5551693 DOI: 10.2106/jbjs.15.01217] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteoporosis drugs might affect fracture-healing. We therefore studied the effects of teriparatide in comparison with risedronate on recovery after pertrochanteric hip fractures. METHODS The study was a randomized, multicenter, active-controlled, 78-week trial comparing teriparatide (20 μg/day) with risedronate (35 mg/week) initiated within 2 weeks after fixation of a low-trauma pertrochanteric hip fracture (AO/OTA 31-A1 or 31-A2). The main inclusion criteria were a bone mineral density T-score of ≤-2.0 and 25-OH-vitamin D of ≥9.2 ng/mL. During the first 26 weeks, patients received study medication with oral or injectable placebo plus calcium and vitamin D in a double-blinded fashion. Secondary (Timed Up-and-Go [TUG] test, hip pain, Short Form [SF]-36 health status, and safety) and exploratory (radiographic outcomes and ability to walk) 26-week end points are reported. RESULTS Of the 224 patients who were randomized, 171 (86 teriparatide, 85 risedronate) were included in the analysis. The mean age was 77 ± 8 years, 77% were female, and 26% had a prior history of low-trauma fracture. The teriparatide group completed the TUG test in a shorter time at 6, 12, 18, and 26 weeks (differences of -5.7, -4.4, -3.1, and -3.1 seconds, respectively; p = 0.021 for the overall difference). They also reported less pain on a visual analog scale immediately after the TUG test at 12 and 18 weeks (adjusted absolute differences of 10.6 and 11.9 mm, respectively; p < 0.05). There were no significant between-group differences in the SF-36 score, Charnley hip pain score, ability to walk, or use of walking aids during follow-up. Radiographic healing at 6, 12, and 26 weeks, mechanical failure of the implant (teriparatide, 7; risedronate, 8), loss of reduction (teriparatide, 2; risedronate, 4), and nonunion (0 cases) were not significantly different. Mild hypercalcemia and hyperuricemia were more frequent with teriparatide. CONCLUSIONS Teriparatide was associated with less pain and a shorter time to complete the TUG test between 6 and 26 weeks compared with risedronate. Other fracture-recovery outcomes were similar. The results should be interpreted with caution as these were secondary end points. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Per Aspenberg
- Department of Clinical and Experimental Medicine,
Linköping University, Linköping, Sweden,E-mail address for P. Aspenberg:
| | - Jorge Malouf
- Internal Medicine, Hospital San Pablo, Barcelona,
Spain,E-mail address for J. Malouf:
| | - Umberto Tarantino
- Orthopaedic Surgery, University Tor Vergata, Rome,
Italy,E-mail address for U. Tarantino:
| | - Pedro A. García-Hernández
- Osteoporosis Center, University Hospital, Monterrey,
Mexico,E-mail address for P.A.
García-Hernández:
| | - Costantino Corradini
- Department of Biomedical Surgical and Dental
Sciences, University of Milan, c/o I Division of Orthopaedics and Traumatology,
A.O. Orthopaedic Institute, Milan, Italy,E-mail address for C. Corradini:
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology,
Odense University Hospital, Odense, Denmark,Institute of Clinical Research, University of
Southern Denmark, Odense, Denmark,E-mail address for S. Overgaard:
| | - Jan J. Stepan
- Institute of Rheumatology and Faculty of Medicine 1,
Charles University, Prague, Czech Republic,E-mail address for J.J. Stepan:
| | - Lars Borris
- Orthopaedic Surgery, University Hospital, Aarhus,
Denmark,E-mail address for L. Borris:
| | - Eric Lespessailles
- IPROS, Department of Rheumatology, C.H.R
Orléans, Orléans, France,I3MTO, Orléans University, Orléans,
France,E-mail address for E. Lespessailles:
| | - Frede Frihagen
- Orthopaedic Surgery, Oslo University Hospital,
Oslo, Norway,E-mail address for F. Frihagen:
| | - Kyriakos Papavasiliou
- 3rd Orthopaedic Department, Aristotle University of
Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece,E-mail address for K. Papavasiliou:
| | - Helmut Petto
- Eli Lilly, Vienna, Austria,E-mail address for H. Petto:
| | - José Ramón Caeiro
- Department of Orthopaedic Surgery and Traumatology,
Santiago de Compostela University Hospital, Health Research Institute,
University of Santiago de Compostela, Santiago de Compostela, Spain,E-mail address for J. Ramón Caeiro:
| | - Fernando Marin
- Eli Lilly Research Centre, Windlesham, United
Kingdom,E-mail address for F. Marin:
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27
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Giannini S, Sella S, Rossini M, Braghin D, Gatti D, Vilei MT, Amabile A, Fusaro M, Frigo AC, Sergi G, Lovato R, Nobile M, Fabris F, Adami S. Declining trends in the incidence of hip fractures in people aged 65years or over in years 2000-2011. Eur J Intern Med 2016; 35:60-65. [PMID: 27363306 DOI: 10.1016/j.ejim.2016.06.007] [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: 03/22/2016] [Revised: 05/27/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to explore hip fracture (HFx) incidence in the Veneto Region of Italy, looking at potential differences with the national data. METHODS We analyzed HFx incidence for people aged 65years or over, in years 2000-2011, using data from the Regional Hospitalization Database. Patients were stratified by sex, calendar year and 5-year age class. Data for the single provinces of the Region were also obtained. Absolute number of HFx, crude incidence for 10,000 inhabitants and age-standardized fracture rates were calculated. RESULTS During the study period, there were 53,917 hospitalizations for HFx (77.7% in females). In the whole 11year period of observation, the absolute HFx number increased by 17.7% in males and 10.6% females, respectively. However, age-standardized incidence rates declined by 18% in the same period (IRR 0.82, 95% CI 0.78-0.87). This decreasing trend was almost identical through all the age-cohorts up to 84years. In the whole study period, HFx incidence was lower for Padova (IRR 0.63, 95% CI 0.60-0.66) and Verona (IRR 0.66, 95% CI 0.63-0.70) provinces as compared to the others. This regional profile was quite different with respect to the data published, for the same calendar years, for Italy as a whole, in spite of an almost identical demography of the population. CONCLUSIONS HFx incidence is declining in the Veneto Region of Italy. Further studies, aimed to investigate factors involved in this figure are needed.
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Affiliation(s)
- Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy.
| | - Stefania Sella
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona and Regional Center for Osteoporosis, Verona, Italy
| | - Daniela Braghin
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Davide Gatti
- Rheumatology Unit, Department of Medicine, University of Verona and Regional Center for Osteoporosis, Verona, Italy
| | - Maria Teresa Vilei
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Annalisa Amabile
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Maria Fusaro
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Giuseppe Sergi
- Geriatrics Division, Department of Medicine, University of Padova, Italy
| | - Roberto Lovato
- Osteoporosis Center, Casa di Cura Villa Berica, Vicenza, Italy
| | - Martino Nobile
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Fabrizio Fabris
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Silvano Adami
- Rheumatology Unit, Department of Medicine, University of Verona and Regional Center for Osteoporosis, Verona, Italy
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28
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von Friesendorff M, McGuigan FE, Wizert A, Rogmark C, Holmberg AH, Woolf AD, Akesson K. Hip fracture, mortality risk, and cause of death over two decades. Osteoporos Int 2016; 27:2945-53. [PMID: 27172936 DOI: 10.1007/s00198-016-3616-5] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED Men and women with hip fracture have higher short-term mortality. This study investigated mortality risk over two decades post-fracture; excess mortality remained high in women up to 10 years and in men up to 20 years. Cardiovascular disease (CVD) and pneumonia were leading causes of death with a long-term doubling of risk. INTRODUCTION Hip fractures are associated with increased mortality, particularly short term. In this study with a two-decade follow-up, we examined mortality and cause of death compared to the background population. METHODS We followed 1013 hip fracture patients and 2026 matched community controls for 22 years. Mortality, excess mortality, and cause of death were analyzed and stratified for age and sex. Hazard ratio (HR) was estimated by Cox regression. A competing risk model was fitted to estimate HR for common causes of death (CVD, cancer, pneumonia) in the short and long term (>1 year). RESULTS For both sexes and at all ages, mortality was higher in hip fracture patients across the observation period with men losing most life years (p < 0.001). Mortality risk was higher for up to 15 years (women (risk ratio (RR) 1.9 [95 % confidence interval (CI) 1.7-2.1]); men (RR 2.8 [2.2-3.5])) and until end of follow-up ((RR 1.8 [1.6-2.0]); (RR 2.7 [2.1-3.3])). Excess mortality by time intervals, censored for the first year, was evident in women (<80 years, up to 10 years; >80 years, for 5 years) and in men <80 years throughout. CVD and pneumonia were predominant causes of death in men and women with an associated higher risk in all age groups. Pneumonia caused excess mortality in men over the entire observation period. CONCLUSION In a remaining lifetime perspective, all-cause and excess mortality after hip fracture was higher even over two decades of follow-up. CVD and pneumonia reduce life expectancy for the remaining lifetime and highlights the need to further improve post-fracture management.
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Affiliation(s)
- M von Friesendorff
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden
- Department of Orthopedics Malmö, Skåne University Hospital, 205 02, Malmö, Sweden
| | - F E McGuigan
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden
- Department of Orthopedics Malmö, Skåne University Hospital, 205 02, Malmö, Sweden
| | - A Wizert
- ERC Syd - Epidemiology and Register Centre South, Skåne University Hospital, Lund, Sweden
| | - C Rogmark
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden
- Department of Orthopedics Malmö, Skåne University Hospital, 205 02, Malmö, Sweden
| | - A H Holmberg
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden
- Department of Orthopedics Malmö, Skåne University Hospital, 205 02, Malmö, Sweden
| | - A D Woolf
- Department of Rheumatology Royal Cornwall Hospital, Truro, UK
| | - K Akesson
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden.
- Department of Orthopedics Malmö, Skåne University Hospital, 205 02, Malmö, Sweden.
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29
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Kharazmi M, Hallberg P, Schilcher J, Aspenberg P, Michaëlsson K. Mortality After Atypical Femoral Fractures: A Cohort Study. J Bone Miner Res 2016; 31:491-7. [PMID: 26676878 DOI: 10.1002/jbmr.2767] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/19/2015] [Accepted: 12/11/2015] [Indexed: 11/06/2022]
Abstract
Although osteoporotic fracture rates can be reduced by bisphosphonates, prolonged therapy is associated with higher risk of atypical femoral fractures. Ordinary fragility fractures are linked to high mortality rates. We aimed to determine whether atypical femoral fractures also confer excess mortality. Radiographs were reviewed for all patients aged ≥55 years who had experienced a subtrochanteric or femoral shaft fracture in Sweden in 2008 to 2010. The fractures were classified as either atypical or ordinary. Data on medication use, coexisting conditions, and date of death were obtained from national registers. We estimated multivariable-adjusted relative risks of death after atypical femoral fractures compared with ordinary subtrochanteric or femoral shaft fractures and calculated age- and sex-standardized mortality ratios (SMRs) for atypical and ordinary fractures compared with the population average. During a mean of 4 years of follow-up, 39 of 172 (23%) patients with an atypical fracture had died compared with 588 of 952 (62%) with an ordinary fracture, corresponding to a relative risk of 0.51 (95% confidence interval [CI] 0.38-0.68). The lower risk was evident in both users and nonusers of bisphosphonates. No patient with atypical fracture died in the first year after fracture. Individuals with an ordinary fracture had a higher mortality risk than the general population (SMR = 1.82; 95% CI 1.69-1.99), but no excess risk was found in patients with atypical fracture (SMR = 0.92; 95% CI 0.65-1.26). We conclude that in contrast to ordinary subtrochanteric and femoral shaft fractures, atypical femoral fractures are not associated with excess mortality.
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Affiliation(s)
- Mohammad Kharazmi
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Pär Hallberg
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jörg Schilcher
- Section of Orthopedics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Per Aspenberg
- Section of Orthopedics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Karl Michaëlsson
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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30
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Robinson D, Garmo H, Stattin P, Michaëlsson K. Risk of Fractures and Falls during and after 5-α Reductase Inhibitor Use: A Nationwide Cohort Study. PLoS One 2015; 10:e0140598. [PMID: 26469978 PMCID: PMC4607359 DOI: 10.1371/journal.pone.0140598] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/27/2015] [Indexed: 12/13/2022] Open
Abstract
Background Lower urinary tract symptoms are common among older men and 5-α reductase inhibitors (5-ARI) are a group of drugs recommended in treating these symptoms. The effect on prostate volume is mediated by a reduction in dihydrotestosterone; however, this reduction is counterbalanced by a 25% rise in serum testosterone levels. Therefore, 5-ARI use might have systemic effects and differentially affect bone mineral density, muscular mass and strength, as well as falls, all of which are major determinants of fractures in older men. Methods We conducted a nationwide cohort study of all Swedish men who used 5-ARI by comparing their risk of hip fracture, any type of fracture and of falls with matched control men randomly selected from the population and unexposed to 5-ARI. Results During 1 417 673 person-years of follow-up, 10 418 men had a hip fracture, 19 570 any type of fracture and 46 755 a fall requiring hospital care. Compared with unexposed men, current users of 5-ARI had an adjusted hazard ratio (HR) of 0.96 (95% CI 0.91–1.02) for hip fracture, an HR of 0.94 (95% CI 0.90–0.98) for all fracture and an HR of 0.99 (95% CI 0.96–1.02) for falls. Former users had an increased risk of hip fractures (HR 1.10, 95% CI 1.01–1.19). Conclusion 5-ARI is safe from a bone health perspective with an unaltered risk of fractures and falls during periods of use. After discontinuation of 5-ARI, there is a modest increase in the rate of fractures and falls.
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Affiliation(s)
- David Robinson
- Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
- Department of Urology, Ryhov County Hospital, Jönköping, Sweden
- * E-mail:
| | - Hans Garmo
- Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden
- King´s College London, Medical School, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
| | - Pär Stattin
- Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Karl Michaëlsson
- Orthopedics Section, Department of Surgical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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Karampampa K, Ahlbom A, Michaëlsson K, Andersson T, Drefahl S, Modig K. Declining incidence trends for hip fractures have not been accompanied by improvements in lifetime risk or post-fracture survival--A nationwide study of the Swedish population 60 years and older. Bone 2015; 78:55-61. [PMID: 25933944 DOI: 10.1016/j.bone.2015.04.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/20/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hip fracture is a common cause of disability and mortality among the elderly. Declining incidence trends have been observed in Sweden. Still, this condition remains a significant public health problem since Sweden has one of the highest incidences worldwide. Yet, no Swedish lifetime risk or survival trends have been presented. By examining how hip fracture incidence, post-fracture survival, as well as lifetime risk have developed between 1995 and 2010 in Sweden, this study aims to establish how the burden hip fractures pose on the elderly changed over time, in order to inform initiatives for improvements of their health. MATERIAL AND METHODS The entire Swedish population 60 years-old and above was followed between 1987 and 2010 in the National Patient Register and the Cause of Death Register. Annual age-specific hip fracture cumulative incidence was estimated using hospital admissions for hip fractures. Three-month and one-year survival after the first hip fracture were also estimated. Period life table was used to assess lifetime risk of hip fractures occurring from age 60 and above, and the expected mean age of the first hip fracture. RESULTS The age-specific hip fracture incidence decreased between 1995 and 2010 in all ages up to 94 years, on average by 1% per year. The lifetime risk remained almost stable, between 9% and 11% for men, and between 18% and 20% for women. The expected mean age of a first hip fracture increased by 2.5 years for men and by 2.2 years for women. No improvements over time were observed for the 3-month survival for men, while for women a 1% decrease per year was observed. The 1-year survival slightly increased over time for men (0.4% per year) while no improvement was observed for women. CONCLUSIONS The age-specific hip fracture incidence has decreased over time. Yet the lifetime risk of a hip fracture has not decreased because life expectancy in the population has increased in parallel. Overall, survival after hip fracture has not improved.
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Affiliation(s)
- Korinna Karampampa
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden.
| | - Anders Ahlbom
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Karl Michaëlsson
- Uppsala Clinical Research center (UCR) and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tomas Andersson
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Sven Drefahl
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden; Department of Sociology, Demography Unit, Stockholm University, Stockholm, Sweden
| | - Karin Modig
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden
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Abstract
UNLABELLED Current prevention strategies for low-trauma fractures amongst older persons depend on the notions that fractures are mainly caused by osteoporosis (pathophysiology), that patients at high risk can be identified (screening) and that the risk is amenable to bone-targeted pharmacotherapy (treatment). However, all these three notions can be disputed. PATHOPHYSIOLOGY Most fracture patients have fallen, but actually do not have osteoporosis. A high likelihood of falling, in turn, is attributable to an ageing-related decline in physical functioning and general frailty. SCREENING Currently available fracture risk prediction strategies including bone densitometry and multifactorial prediction tools are unable to identify a large proportion of patients who will sustain a fracture, whereas many of those with a high fracture risk score will not sustain a fracture. TREATMENT The evidence for the viability of bone-targeted pharmacotherapy in preventing hip fracture and other clinical fragility fractures is mainly limited to women aged 65-80 years with osteoporosis, whereas the proof of hip fracture-preventing efficacy in women over 80 years of age and in men at all ages is meagre or absent. Further, the antihip fracture efficacy shown in clinical trials is absent in real-life studies. Many drugs for the treatment of osteoporosis have also been associated with increased risks of serious adverse events. There are also considerable uncertainties related to the efficacy of drug therapy in preventing clinical vertebral fractures, whereas the efficacy for preventing other fractures (relative risk reductions of 20-25%) remains moderate, particularly in terms of the low absolute risk reduction in fractures with this treatment.
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Affiliation(s)
- T L N Järvinen
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - K Michaëlsson
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - P Aspenberg
- Clinical Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - H Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
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Leavy B, Byberg L, Michaëlsson K, Melhus H, Åberg AC. The fall descriptions and health characteristics of older adults with hip fracture: a mixed methods study. BMC Geriatr 2015; 15:40. [PMID: 25887407 PMCID: PMC4428087 DOI: 10.1186/s12877-015-0036-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In light of the multifactorial etiology of fall-related hip fracture, knowledge of fall circumstances may be especially valuable when placed in the context of the health of the person who falls. We aimed to investigate the circumstances surrounding fall-related hip fractures and to describe fall circumstances in relation to participants' health and functional characteristics. METHODS The fall circumstances of 125 individuals (age ≥ 50 years) with hip fracture were investigated using semi-structured interviews. Data concerning participants' health (comorbidities and medications) and function (self-reported performance of mobility, balance, personal activities of daily living and physical activity, previous falls and hand grip strength) were collected via medical records, questionnaires and dynamometry. Using a mixed methods design, both data sets were analysed separately and then merged in order to provide a comprehensive description of fall events and identify eventual patterns in the data. RESULTS Fall circumstances were described as i) Activity at the time of the fall: Positional change (n = 24, 19%); Standing (n = 16, 13%); Walking (n =71, 57%); Balance challenging (n = 14, 11%) and ii) Nature of the fall: Environmental (n = 32, 26%); Physiological (n = 35, 28%); Activity-related indoor (n = 8, 6%) and outdoor (n = 8, 6%); Trips and slips on snow (n = 20, 16%) and in snow-free conditions (n = 12, 10%) and Unknown (n = 10, 8%). We observed the following patterns regarding fall circumstances and participants' health: those who fell i) during positional change had the poorest functional status; ii) due to environmental reasons (indoors) had moderate physical function, but high levels of comorbidity and fall risk increasing medications; iii) in snow-free environments (outdoors) appeared to have a poorer health and functional status than other outdoor groups. CONCLUSIONS Our findings indicate that patterns exist in relation to the falls circumstances and health characteristics of people with hip fracture which build upon that previously reported. These patterns, when verified, can provide useful information as to the ways in which fall prevention strategies can be tailored to individuals of varying levels of health and function who are at risk for falls and hip fracture.
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Affiliation(s)
- Breiffni Leavy
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden.
| | - Liisa Byberg
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden.
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden.
| | - Håkan Melhus
- Department of Medical Sciences, Osteoporosis and Clinical Pharmacogenetics, Uppsala University, Uppsala, Sweden.
| | - Anna Cristina Åberg
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden. .,School of Education, Health and Society, Dalarna University, Falun, Sweden.
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Nordström P, Gustafson Y, Michaëlsson K, Nordström A. Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden. BMJ 2015; 350:h696. [PMID: 25700551 PMCID: PMC4353281 DOI: 10.1136/bmj.h696] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate relation between inpatient length of stay after hip fracture and risk of death after hospital discharge. SETTING Population ≥50 years old living in Sweden as of 31 December 2005 with a first hip fracture the years 2006-12. PARTICIPANTS 116,111 patients with an incident hip fracture from a closed nationwide cohort. MAIN OUTCOME MEASURE Death within 30 days of hospital discharge in relation to hospital length of stay after adjustment for multiple covariates. RESULTS Mean inpatient length of stay after a hip fracture decreased from 14.2 days in 2006 to 11.6 days in 2012 (P<0.001). The association between length of stay and risk of death after discharge was non-linear (P<0.001), with a threshold for this non-linear effect of about 10 days. Thus, for patients with length of stay of ≤10 days (n=59,154), each 1-day reduction in length of stay increased the odds of death within 30 days of discharge by 8% in 2006 (odds ratio 1.08 (95% confidence interval 1.04 to 1.12)), which increased to16% in 2012 (odds ratio 1.16 (1.12 to 1.20)). In contrast, for patients with a length of stay of ≥11 days (n=56,957), a 1-day reduction in length of stay was not associated with an increased risk of death after discharge during any of the years of follow up. LIMITATIONS No accurate evaluation of the underlying cause of death could be performed. CONCLUSION Shorter length of stay in hospital after hip fracture is associated with increased risk of death after hospital discharge, but only among patients with length of stay of 10 days or less. This association remained robust over consecutive years.
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Affiliation(s)
- Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatrics, Umeå University, SE-910 87 Umeå, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatrics, Umeå University, SE-910 87 Umeå, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Anna Nordström
- Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå
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Xiao F, Qu X, Zhai Z, Jiang C, Li H, Liu X, Ouyang Z, Gu D. Association between loop diuretic use and fracture risk. Osteoporos Int 2015; 26:775-84. [PMID: 25491766 DOI: 10.1007/s00198-014-2979-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/26/2014] [Indexed: 11/27/2022]
Abstract
SUMMARY Loop diuretic use has been shown to be associated with an increased fracture risk, but the findings have been inconsistent. The present meta-analysis suggests that loop diuretics show a significant positive association with the overall risk of total fractures and, specifically, hip fractures. INTRODUCTION Despite being widely used, there is limited, prospective randomized trial evidence regarding the skeletal effects of loop diuretics. Previous observational studies have reported conflicting findings regarding the association between loop diuretic use and the risk of fractures. METHODS This meta-analysis of observational studies assessed the association between loop diuretic use and the risk of fractures. The PubMed, EMBASE, and OVID databases were searched for prospective cohort and case-control studies. Relative risks (RR) with 95% confidence intervals (CI) were derived using random-effects models throughout the analysis. RESULTS Thirteen studies (4 cohort studies and 9 case-control studies) were included, involving 842,644 participants and 108,247 fracture cases. Compared with non-users, people who had taken loop diuretics had an approximately 15% higher risk of total fractures (95% CI, 1.04-1.26; p<0.01), with high heterogeneity between studies (I2=80.5%; p<0.01). The RR was 1.14 (95% CI, 1.08-1.19) for hip fractures and 0.99 (95% CI, 0.93-1.05) for lower arm or wrist fractures. The RR was 1.05 (95% CI, 1.00-1.11) in prospective cohort studies and 1.22 (95% CI, 1.00-1.44) in case-control studies. There was no evidence of publication bias. CONCLUSION The results suggest that loop diuretics show a significant positive association with the overall risk of total fractures and hip fractures.
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Affiliation(s)
- F Xiao
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
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Bernfort L, Eckard N, Husberg M, Alwin J. A case of community-based fall prevention: Survey of organization and content of minor home help services in Swedish municipalities. Scand J Public Health 2014; 42:643-8. [PMID: 25114065 DOI: 10.1177/1403494814544400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study was to survey minor home help services provided by Swedish municipalities with the main purpose to prevent fall injuries. METHODS If minor home help services were presented on the homepage of a municipality, an initial telephone contact was taken. Thereafter a questionnaire was administered, including questions about target groups, aim with the services, tasks included, costs and restrictions for users, budget, and experienced gains with the services. Municipalities not providing minor home help services were asked about the reason therefore and if the municipality had previously provided the services Results: The questionnaire response rate was 92%. In 191 of Sweden's 290 municipalities services were provided by, or in cooperation with, the municipality. Reasons for not providing the services were mainly financial and lack of demand. Services were more often provided in larger cities and in municipalities located in populous regions. In some municipalities services were performed by persons with functional disabilities or unemployed persons. CONCLUSIONS Both providers and users expressed satisfaction with the services aspects expressed were that services lead to greater sense of safety and social gains the effect of the services in terms of fall prevention is yet to be proved with only a small fall-preventive effect services are probably cost-effective improved quality of life, sense of safety, and being able to offer meaningful work to otherwise unemployed persons are important aspects that might in themselves motivate the provision of minor home help services.
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Affiliation(s)
- Lars Bernfort
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Nathalie Eckard
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Magnus Husberg
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jenny Alwin
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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O'Malley CD, Tran N, Zapalowski C, Daizadeh N, Olenginski TP, Cauley JA. Multimorbidity in women with and without osteoporosis: results from a large US retrospective cohort study 2004-2009. Osteoporos Int 2014; 25:2117-30. [PMID: 24859882 DOI: 10.1007/s00198-014-2740-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/01/2014] [Indexed: 01/10/2023]
Abstract
UNLABELLED To determine the incidence of comorbidities in women with and without osteoporosis, incidence rates per 1,000 person-years were calculated using electronic health records from an integrated healthcare system. The overall comorbidity burden and health service utilization were greater in women with osteoporosis than in the controls. INTRODUCTION This retrospective cohort study describes the incidence of an array of comorbidities in women with and without osteoporosis (OP). METHODS Using electronic health records from an integrated healthcare system, we identified 22,414 women aged 55-89 years with OP and 22,414 age-matched controls without OP. Incidence rates (IRs) per 1,000 person-years (P-Y) were calculated and 95% confidence intervals (CI) were estimated. RESULTS Women with OP had significantly more comorbidities, medications, hospitalizations, and outpatient visits than the controls. Most cardiac comorbidity rates were 20-25% lower in the OP cohort than in the control cohort. Hypertension had the largest rate difference; the IR was 42.0 per 1,000 P-Y (95% CI 40.2-44.0) in the OP cohort compared to 94.0 (95% CI 90.7-97.4) in the control cohort. Rates for cerebrovascular disease were similar for both cohorts at 26 per 1,000 P-Y. Bronchitis, sinusitis, and cystitis were each 55 per 1,000 P-Y in the OP cohort, whereas they ranged from 28 to 34 per 1,000 P-Y in the controls. The OP cohort had decreased incidence of ovarian, uterine, colorectal, and liver cancers and increased incidence of lung cancer, breast cancer, and multiple myeloma, compared to the non-OP cohort. Falls, depression, vision, and musculoskeletal issues were higher for the OP cohort than the controls. CONCLUSIONS This study demonstrates the high disease burden in women with OP. This knowledge may help guide the clinical management of this population and may aid in the interpretation of adverse events in randomized clinical trials of OP therapies.
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Affiliation(s)
- C D O'Malley
- Amgen Inc., MS: ASF 2 1120 Veterans Blvd, South San Francisco, CA, 94080, USA,
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