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Hestnes I, Solberg LB, Meyer HE, Sundet M, Rimal R, Nordsletten L, Hakestad KA. The hip fracture incidence in the high-risk area Oslo continues to decline. Osteoporos Int 2024; 35:1615-1623. [PMID: 38922398 PMCID: PMC11364682 DOI: 10.1007/s00198-024-07156-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/16/2024] [Indexed: 06/27/2024]
Abstract
Oslo in Norway has had the highest incidence of hip fractures in the world. The incidence in Oslo has been thoroughly described every decade since the late 1970s. The incidence in Oslo has previously been higher compared to the rest of Norway but has now decreased to a level below the country average. PURPOSE The purpose of this study was to report the incidence of hip fractures in Oslo in 2019 and compare it with the incidence rates from the previous four decades. METHODS Patients residing in Oslo in 2019 with a new hip fracture identified by searching the Oslo hospital's patient administrative systems and protocols from the operating theaters. The diagnosis was verified through medical records and/or radiographs. To compare with previous studies, the direct standardization method was used with the population of Oslo in 2019 as the standard. RESULTS A total of 758 hip fractures, 70% women, were identified in 2019. The age-standardized incidence rates per 10,000 person-years in 2019 (95% CI) were 45 (41.1-48.8) for women and 30 (25.8-33.8) for men. In women, there has been a continuous decline in age-standardized rates the last three decades and in men the last two decades. The most pronounced decline was seen in the oldest age groups over 70 years. There has been a secular decline in both cervical and trochanteric fractures; however, the decrease in trochanteric fractures was most distinct for males, with more than two times higher risk in 1996/1997 compared to 2019. CONCLUSION Incidence rates for hip fractures in Oslo in 2019 were the lowest rate reported since 1978. The decrease was significant for both men and women. For the first time, the incidence rates are below the national rates of Norway. However, the rates are still among the highest worldwide.
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Affiliation(s)
- I Hestnes
- Division of Orthopaedic Surgery, Oslo University Hospital, Nydalen, Postbox 4950, 0424, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - L B Solberg
- Division of Orthopaedic Surgery, Oslo University Hospital, Nydalen, Postbox 4950, 0424, Oslo, Norway
| | - H E Meyer
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - M Sundet
- Department of Orthopaedic Surgery, Diakonhjemmet Hospital, Oslo, Norway
| | - R Rimal
- Institute of Basic Medicine, Department of Biostatics, OCBE, University of Oslo, Oslo, Norway
| | - L Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Nydalen, Postbox 4950, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - K A Hakestad
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Albergaria BH, Zerbini CAF, Lazaretti-Castro M, Eis SR, Vilaca T, Johansson H, Harvey NC, Liu E, Vandenput L, Lorentzon M, Schini M, McCloskey E, Kanis JA. A new FRAX model for Brazil. Arch Osteoporos 2023; 18:144. [PMID: 38015253 PMCID: PMC10684424 DOI: 10.1007/s11657-023-01354-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
Fracture probabilities derived from the original FRAX model for Brazil were compared to those from an updated model based on more recent regional estimates of the incidence of hip fracture. Fracture probabilities were consistently lower in the updated FRAX model. Despite large differences between models, differences in the rank order of fracture probabilities were minimal. OBJECTIVE Recent epidemiological data indicate that the risk of hip fracture in Brazil is lower than that used to create the original FRAX model. This paper describes the epidemiology of hip fracture in Brazil and the synthesis of an updated FRAX model with the aim of comparing this new model with the original model. METHODS Hip fracture rates from three cities in three regions were combined, weighted by the population of each region. For other major fractures, incidence rates for Brazil were estimated using Swedish ratios for hip to other major osteoporotic fracture (humerus, forearm or clinical vertebral fractures). Mortality estimates were taken from the UN. RESULTS Compared to the original FRAX model, the updated model gave lower 10-year fracture probabilities in men and women at all ages. Notwithstanding, there was a very close correlation in fracture probabilities between the original and updated models (r > 0.99) so that the revisions had little impact on the rank order of risk. CONCLUSION The disparities between the original and updated FRAX models indicate the importance of updating country-specific FRAX models with the advent of significant changes in fracture epidemiology.
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Affiliation(s)
- B H Albergaria
- Osteoporosis Research and Diagnosis Center - CEDOES, Vitoria, Brazil
- Federal University of Espirito Santo, Vitoria, Brazil
| | - C A F Zerbini
- Centro Paulista de Investigação Clinica, Sao Paulo, Brazil
| | | | - S R Eis
- Osteoporosis Research and Diagnosis Center - CEDOES, Vitoria, Brazil
| | - T Vilaca
- Mellanby Centre for Musculoskeletal Research, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - H Johansson
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - E Liu
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - L Vandenput
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - M Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - M Schini
- Mellanby Centre for Musculoskeletal Research, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - E McCloskey
- Mellanby Centre for Musculoskeletal Research, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
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3
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Chen TX, Zhang ZL, Yang SP, Zhu YQ. Frequency of osteoporosis in Chinese patients with rheumatoid arthritis: a meta-analysis. Arch Osteoporos 2023; 18:24. [PMID: 36689130 DOI: 10.1007/s11657-023-01212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/28/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the current frequency of osteoporosis (OP) in Chinese patients with rheumatoid arthritis (RA) through meta-analysis. METHODS The databases of PubMed, Web of Science, Cochrane Library, CNKI, Wan Fang, CBM, and VIP were searched for relevant literature regarding the occurrence of OP in Chinese patients with RA from January 1, 2000, to September 15, 2022. The literature was screened using inclusion and exclusion criteria, and qualifying articles were subjected to data extraction, quality evaluation, and meta-analysis using Stata 17.0 software. RESULTS Altogether, 44 publications were included in this study, with a total sample size of 12,264 RA cases and 4532 patients with OP. Meta-analysis revealed that the frequency of OP in patients with RA was 37.67% [95% CI: 34.38%, 40.97%], while subgroup analysis showed that the frequency in South China was 49.43% [95% CI: 40.53%, 58.32%]. Also, the frequency in men was 29.29% [95% CI: 22.42%, 36.16%], which was significantly lower than in women (41.89% [95% CI: 36.87%, 46.90%]). The incidence rate in pre-menopausal women was only 15.19% [95% CI: 8.79%, 21.59%], much lower than the figure of 54.29% [95% CI: 45.28%, 63.30%] for post-menopausal women. Additionally, the frequency rates in the low, intermediate, and high disease activity groups were 24.52% [95% CI: 11.52%, 37.52%)], 27.67% [95% CI: 13.50%, 41.85%], and 57.96% [95% CI: 37.35%, 78.56%], respectively. CONCLUSION The frequency of OP in the Chinese RA population is higher than the world average, and patients with RA should receive standardized anti-RA therapy at an early stage, with emphasis on bone health in postmenopausal women, patients with high disease activity or longer disease duration.
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Affiliation(s)
- Tian-Xin Chen
- Department of Orthopedics, Eye Hospital of China Academy of Chinese Medical Sciences, Beijing, 100040, China
| | - Zhi-Long Zhang
- Department of Orthopedics, Eye Hospital of China Academy of Chinese Medical Sciences, Beijing, 100040, China
| | - Sheng-Ping Yang
- Department of Orthopedics, Eye Hospital of China Academy of Chinese Medical Sciences, Beijing, 100040, China
| | - Yu-Qi Zhu
- Department of Orthopedics, Eye Hospital of China Academy of Chinese Medical Sciences, Beijing, 100040, China.
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Seroprevalence of Anti-tTg-IgA among Symptomized Celiac Disease Patients and Their Correlation with Rotavirus Infection. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6972624. [PMID: 36193310 PMCID: PMC9526599 DOI: 10.1155/2022/6972624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
Abstract
Celiac disease (CD) is a chronic inflammatory disorder in the intestinal tract as a response to the use of gluten in genetically predisposed individuals. It is a worldwide problem, with a high prevalence rate in North America. This is a descriptive cross-sectional study involving 1090 samples collected from different hospitals of Rawalpindi and Islamabad, Pakistan, from January 2019 to December 2019. In this study, 1090 blood samples screened for seroprevalence of anti-tTG antibodies in CD symptomatic patients via ELISA (enzyme-linked immunosorbent assay). 1090 fecal samples from the same CD patients were collected and tested for the presence of rotavirus (RV) via ELISA and RT-PCR. Of the 1090 patients tested for seroprevalence of anti-tTG antibodies, 112/1090 (10.3%) were found to be positive. Of the 112 anti-tTG-positive patients, 78/112 (70%) were positive for RV via ELISA and 74/112 (66.1%) were RV positive via RT-PCR. A statistically significant association was reported between rotavirus infection and celiac disease (p˂0.05). Anti-tTG antibodies were higher in age group 6 (12-18 years) patients (18.4%) and at minimum in age group 3 (1-3 years) patients (4.8%). However, there was a statistically insignificant relationship between group age and CD prevalence (p > 0.05). The highest CD prevalence was noted during winter season (19.6%) and the lowest (3.0%) during fall/autumn. Our study findings demonstrate that Pakistan has a high prevalence of CD compared to other studies. Further studies in the fields of environmental risk factors and treatment with more advanced serological and histopathological studies are needed in the future.
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5
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Dahl C, Madsen C, Omsland TK, Søgaard AJ, Tunheim K, Stigum H, Holvik K, Meyer HE. The Association of Cold Ambient Temperature With Fracture Risk and Mortality: National Data From Norway-A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) Study. J Bone Miner Res 2022; 37:1527-1536. [PMID: 35689442 PMCID: PMC9545665 DOI: 10.1002/jbmr.4628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/12/2022] [Accepted: 06/04/2022] [Indexed: 11/11/2022]
Abstract
Norway is an elongated country with large variations in climate and duration of winter season. It is also a high-risk country for osteoporotic fractures, in particular hip fractures, which cause high mortality. Although most hip fractures occur indoors, there is a higher incidence of both forearm and hip fractures during wintertime, compared with summertime. In a nationwide longitudinal cohort study, we investigated whether cold ambient (outdoor) temperatures could be an underlying cause of this high incidence and mortality. Hospitalized/outpatient forearm fractures (International Classification of Diseases and Related Health Problems, 10th Revision [ICD-10] code S52) and hospitalized hip fractures (ICD-10 codes S72.0-S72.2) from 2008 to 2018 were retrieved from the Norwegian Patient Registry. Average monthly ambient temperatures (degrees Celsius, °C) from the years 2008 to 2018 were provided by the Norwegian Meteorological Institute and linked to the residential area of each inhabitant. Poisson models were fitted to estimate the association (incidence rate ratios [IRRs], 95% confidence intervals [CIs]) between temperature and monthly incidence of total number of forearm and hip fractures. Flexible parametric survival models (hazard ratios [HR], 95% CI) were used to estimate the association between temperature and post-hip fracture mortality, taking the population mortality into account. Monthly temperature ranged from -20.2°C to 22.0°C, with a median of -2.0°C in winter and 14.4°C in summer. At low temperatures (<0°C) compared to ≥0°C, there was a 53% higher risk of forearm fracture (95% CI, 51%-55%) and 21% higher risk of hip fracture (95% CI, 19%-22%), adjusting for age, gender, calendar year, urbanization, residential region, elevation, and coastal proximity. When taking the population mortality into account, the post-hip fracture mortality in both men (HR 1.08; 95% CI, 1.02-1.13) and women (HR 1.09; 95% CI, 1.04-1.14) was still higher at cold temperatures. There was a higher risk of forearm and hip fractures, and an excess post-hip fracture mortality at cold ambient temperatures. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Cecilie Dahl
- University of Oslo, Institute of Health and Society, Department of Community Medicine and Global Health, Oslo, Norway
| | - Christian Madsen
- Norwegian Institute of Public Health, Department of Health and Inequality, Oslo, Norway
| | - Tone Kristin Omsland
- University of Oslo, Institute of Health and Society, Department of Community Medicine and Global Health, Oslo, Norway
| | - Anne-Johanne Søgaard
- Norwegian Institute of Public Health, Department of Physical Health and Ageing, Oslo, Norway
| | | | - Hein Stigum
- University of Oslo, Institute of Health and Society, Department of Community Medicine and Global Health, Oslo, Norway.,Norwegian Institute of Public Health, Department of Physical Health and Ageing, Oslo, Norway
| | - Kristin Holvik
- Norwegian Institute of Public Health, Department of Physical Health and Ageing, Oslo, Norway
| | - Haakon E Meyer
- University of Oslo, Institute of Health and Society, Department of Community Medicine and Global Health, Oslo, Norway.,Norwegian Institute of Public Health, Department of Physical Health and Ageing, Oslo, Norway
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Kwon DH, Paciorek A, Zhang L, Borno HT, Bucknor M, Small EJ, Aggarwal RR. Skeletal-related events after abiraterone or enzalutamide in patients with metastatic castration-resistant prostate cancer: A population-based study using the SEER-Medicare linked dataset. Urol Oncol 2022; 40:379.e17-379.e24. [DOI: 10.1016/j.urolonc.2022.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/18/2022] [Accepted: 05/27/2022] [Indexed: 12/19/2022]
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Sadat-Ali M, AlZamami JF, AlNaimi SN, Al-Noaimi DA, AlDakheel DA, AlSayed HN, Al-Turki HA, AlOmran AS. Osteoporosis: Is the prevalence increasing in Saudi Arabia. Ann Afr Med 2022; 21:54-57. [PMID: 35313406 PMCID: PMC9020622 DOI: 10.4103/aam.aam_79_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Objective: The objective of this analysis is to report from a teaching hospital in eastern Saudi Arabia hospital based prevalence of osteopenia and osteoporosis. Methods: This is a retrospective study of all patients who underwent dual-energy X-ray absorptiometry (DXA) scan between January 1, and December 31, 2018, at King Fahd Hospital of the University at Alkhobar, Saudi Arabia. Demographic data of patients, which included age, sex, diabetes mellitus status based on fasting blood sugar, hemoglobin A1C, Vitamin D level, parathormone level, and T score of the neck of femur and lumbar spine was extracted from the Quadrumed patient care system. The data was entered into database and analyzed. Results: Three hundred and one patients had a DXA scan for the year 2018, a jump of 27.2% of requests to diagnose osteoporosis. There were 55 (18.27%) were male and rest females (246). The average age for males was 65.2 ± 10.5 and females 62.9 ± 9.4 years. Using T score of the lumbar spine, 63.6% were osteoporotic in males and 52.8% in females. Conclusions: The hospital-based study shows that the prevalence of osteoporosis has significantly increased in men to 63.6%, while in postmenopausal women to 58.4%, this is high compared to the earlier reports.
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Affiliation(s)
- Mir Sadat-Ali
- Department of Orthopaedic Surgery and Obstetrics and Gynecology, King Fahd Hospital of the University, Imam AbdulRahman Bin Faisal University, AlKhobar, Saudi Arabia
| | - Jana F AlZamami
- Department of Orthopaedic Surgery and Obstetrics and Gynecology, King Fahd Hospital of the University, Imam AbdulRahman Bin Faisal University, AlKhobar, Saudi Arabia
| | - Shaykhah N AlNaimi
- Department of Orthopaedic Surgery and Obstetrics and Gynecology, King Fahd Hospital of the University, Imam AbdulRahman Bin Faisal University, AlKhobar, Saudi Arabia
| | - Dinah A Al-Noaimi
- Department of Orthopaedic Surgery and Obstetrics and Gynecology, King Fahd Hospital of the University, Imam AbdulRahman Bin Faisal University, AlKhobar, Saudi Arabia
| | - Dakheel A AlDakheel
- Department of Orthopaedic Surgery and Obstetrics and Gynecology, King Fahd Hospital of the University, Imam AbdulRahman Bin Faisal University, AlKhobar, Saudi Arabia
| | - Hasan N AlSayed
- Department of Orthopaedic Surgery and Obstetrics and Gynecology, King Fahd Hospital of the University, Imam AbdulRahman Bin Faisal University, AlKhobar, Saudi Arabia
| | - Haifa A Al-Turki
- Department of Orthopaedic Surgery and Obstetrics and Gynecology, King Fahd Hospital of the University, Imam AbdulRahman Bin Faisal University, AlKhobar, Saudi Arabia
| | - Abdallah S AlOmran
- Department of Orthopaedic Surgery and Obstetrics and Gynecology, King Fahd Hospital of the University, Imam AbdulRahman Bin Faisal University, AlKhobar, Saudi Arabia
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Ormeño Illanes JCR, Quevedo Langenegger I. Higher latitude and lower solar radiation influence on hip fracture admissions in Chilean older population. Osteoporos Int 2021; 32:2033-2041. [PMID: 33818634 DOI: 10.1007/s00198-021-05910-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/03/2021] [Indexed: 12/25/2022]
Abstract
UNLABELLED Data linking solar radiation with fractures are lacking. We found that lower solar radiation was associated with higher hip fracture admission rates in men from Chile. This supports the idea that solar radiation, a surrogate of vitamin D, may be involved in the development of fractures in older population. INTRODUCTION : To explore the associations between solar radiation and latitude with hip fracture admission rates in people aged 65 years or older in Chile, the country with the greatest variation in solar radiation in the world. METHODS In this ecological study, we investigated the associations between regional solar radiation and latitude with hospitalizations due to hip fracture in population aged 65 years or older, by reviewing national records between 2013 and 2018. We also evaluated the role of sociodemographic factors such as poverty, education, indigenous ethnicity, and rurality rates. RESULTS Between 2013 and 2018, there were 44,328 admissions due to hip fracture in people aged 65 years or older; 77.5% were women and 65.1% were aged 80 years or older. The national admission rate was 389.3 per 100,000 inhabitants (95% CI: 382.4-396.2). The highest admission rate was registered in the Region IX (445.3 per 100,000, 95% CI: 398.3-492.4), which has the highest poverty rates, indigenous ethnicity rates, and rurality rates. We found a north-south increasing gradient of admission rates in men (β=1.5 [95% CI: 0 to 3], p=0.044) and a significant association between solar radiation and admission rates in men (β=-4.4 [95% CI: -8 to 0.8], p=0.02). Admission rates in men were also associated with sociodemographic variables such as poverty (β=2.4 [95% CI: 0 to 4.8], p=0.048) and rurality rates (β=1.2 [95% CI: 0.1 to 2.4], p=0.039). CONCLUSION Regional solar radiation and latitude were associated with hip fracture admission rates in men aged 65 years or older in Chile, with highest admission rates at higher latitudes and lower solar radiation.
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Affiliation(s)
| | - I Quevedo Langenegger
- Endocrinology Section, Department of Internal Medicine, School of Medicine, University of Concepción, Concepción, Chile
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Sundkvist J, Brüggeman A, Sayed-Noor A, Möller M, Wolf O, Mukka S. Epidemiology, classification, treatment, and mortality of adult femoral neck and basicervical fractures: an observational study of 40,049 fractures from the Swedish Fracture Register. J Orthop Surg Res 2021; 16:561. [PMID: 34526047 PMCID: PMC8442466 DOI: 10.1186/s13018-021-02701-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/30/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although femoral neck fractures (FNFs) are common in orthopedic departments, optimal treatment methods remain in dispute. There are few large nationwide studies, including basicervical FNFs (bFNFs), on epidemiology, treatment, and mortality. This nationwide study aims to describe the epidemiology, fracture classification, current treatment regimens, and mortality of undisplaced and minimally displaced (Garden I-II, uFNF), displaced (Garden III-IV, dFNF) and bFNFs in adults. METHODS All FNFs, including bFNFs with a registered injury date between 1 April 2012 and 31 December 2020, were included in this observational study from the Swedish Fracture Register (SFR). Data on age, sex, injury mechanism, fracture classification, primary treatment, and seasonal variation were analyzed. RESULTS Some 40,049 FNFs were registered in the SFR. The mean age of the patients in the register was 80.3 (SD 11) years and 63.8% (25,567) were female. Of all FNFs, 25.0% (10,033) were uFNFs, 63.4% (25,383) dFNFs, and 11.6% (4,633) bFNFs. Non-surgical treatment was performed in 0.6% (261) of the patients. Internal fixation (IF) (84.7%) was the main treatment for uFNFs and arthroplasty (87.3%) for dFNFs. For bFNFs, IF (43.8%) and hip arthroplasty (45.9%) were performed equally often. Of the 33,105 patients with a 1-year follow-up mortality at 1-year was 20.6% for uFNF, 24.3% for dFNF, and 25.4% for bFNF. CONCLUSION The main treatment of uFNFs is IF with screws or pins. Hip arthroplasty is the predominant treatment for dFNF. bFNF are more common than previously reported and treated with IF or arthroplasty, depending on patient age. These results may help health care providers, researchers and clinicians better understand the panorama of FNFs in Sweden. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- Jonas Sundkvist
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden.
| | - Anders Brüggeman
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Arkan Sayed-Noor
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Olof Wolf
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden
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10
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Pekonen SR, Kopra J, Kröger H, Rikkonen T, Sund R. Regional and gender-specific analyses give new perspectives for secular trend in hip fracture incidence. Osteoporos Int 2021; 32:1725-1733. [PMID: 33712877 PMCID: PMC8387269 DOI: 10.1007/s00198-021-05906-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
UNLABELLED In this study, we found that regional disparity in incidence of hip fractures has converged. Also, annual hip fracture risk ratios between genders have systematically diminished over time. INTRODUCTION Several studies have reported secular trends in hip fracture incidence, but knowledge about the possible causes is limited. We studied potential explanations by examining spatio-temporal epidemiology of the fractures and estimating relative risks between genders. METHODS This observational study was based on all inpatient hospital discharges in 1972-2018 in Finland. We divided the data by gender, 5-year age groups and Finnish sub-regions and estimated gender and age standardized spatio-temporal rates of hip fractures by using a Bayesian age-period-cohort model. RESULTS In 1972, women's hip fracture incidence was 1.2-1.3 times higher in western and coastal Finland compared to eastern and inland areas. Also, women had approximately 1.7 times higher average risk to get a hip fracture compared to men. Today, the hip fracture differences between the areas have converged to insignificant and the relative risk between genders has diminished to 1.2. Age-specific relative risks indicate greater hip fracture risk for younger men and older women, and the women's risk increases beyond the risk of men at age 65 which is ten years later than in the beginning of the study period. CONCLUSION Incidence of hip fracture has converged significantly between regions and genders. Especially factors related with socioeconomic development and increased frailty and longevity seem to be important. The hip fracture incidence rate ratio between women and men has systematically decreased in time, and more attention should be paid to hip fracture risk in men in the future.
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Affiliation(s)
- S.-R. Pekonen
- grid.9668.10000 0001 0726 2490School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - J. Kopra
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - H. Kröger
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
- grid.410705.70000 0004 0628 207XDepartment of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - T. Rikkonen
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - R. Sund
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
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11
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Harvey NC, Lorentzon M, Kanis JA, McCloskey E, Johansson H. Incidence of myocardial infarction and associated mortality varies by latitude and season: findings from a Swedish Registry Study. J Public Health (Oxf) 2021; 42:e440-e448. [PMID: 31774530 DOI: 10.1093/pubmed/fdz131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We investigated whether the incidence of death following myocardial infarction (MI) varied by season and latitude in the Swedish population. METHODS We studied deaths following MI from January 1987 to December 2009, using the Swedish National Cause of Death Register. County of residence was used to determine latitude and population density. An extension of Poisson regression was used to study the relationship between risk of death following MI with age, latitude, time (from 1987), population density and calendar days. RESULTS Over the study period, there was a secular decrease in the incidence of MI-related death. In men, MI-related death incidence increased by 1.3% [95% confidence interval (CI) = 1.1-1.5] per degree of latitude (northwards). In women, MI-related death incidence increased by 0.6% (95% CI = 0.4-0.9) per degree of latitude. There was seasonal variation in the risk of MI-related death with peak values in the late winter and a nadir in the summer months in both the north and the south of Sweden. Findings were similar with incident MI as the outcome. CONCLUSIONS The incidence of MI-related death varied markedly by season and latitude in Sweden, with summer months and more southerly latitude associated with lower rates than winter months and more northerly latitude.
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Affiliation(s)
- Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Mattias Lorentzon
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Sweden.,Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.,Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
| | - Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.,Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - Helena Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.,Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
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12
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Dahl C, Madsen C, Omsland TK, Søgaard AJ, Tell GS, Holvik K, Meyer HE. Contribution of elevation and residential proximity to the coast in explaining geographic variations in hip fracture incidence. A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) study. Osteoporos Int 2021; 32:1001-1006. [PMID: 33247392 DOI: 10.1007/s00198-020-05736-y] [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: 09/29/2020] [Accepted: 11/08/2020] [Indexed: 12/21/2022]
Abstract
UNLABELLED A higher risk of hip fracture was found in areas of Norway at higher elevation and farther from the coast. However, the previously seen county variations could not be explained by these geographical factors. INTRODUCTION Norway is an elongated country extending north of the Arctic Circle with substantial coast-inland variation in topography and climate. Differences in hip fracture incidence between counties and a distinct seasonal variation have previously been shown. The aim of the current study was to explore these variations further by considering associations of height above sea level (elevation) and distance to the coast with hip fracture incidence. METHODS All patients with hip fractures admitted to Norwegian hospitals in the period 2009-2018 were included. Individual residential elevation and distance to the coast was calculated in Geographic Information Systems and combined with individual-level population data on all Norwegians 50 years of age or older during the observation period, including hospital information on fractures. Age-standardized incidences rate and incidence rate ratios with 95% confidence intervals (IRR, 95% CI) according to elevation and coastal proximity were estimated. The associations were tested using Poisson models adjusting for sex, urban/rural location of residency, country of birth, and season of hip fracture occurrence. RESULTS From 2009 to 2018, there were 85,776 first hip fractures. There was an increasing risk with higher residential elevation (above versus below mean) for women: IRR = 1.04, 95% CI: 1.02, 1.05), but not for men (IRR = 1.00, 95% CI: 0.97, 1.02). Incidence of hip fracture increased with distance from the coast. Women residing the farthest away from the coast (above versus below mean distance) had a higher age-adjusted incidence of hip fracture compared to those living closer to the coast (IRR = 1.04 (95% CI: 1.02, 1.06), whereas no association was found in men (IRR = 1.00 (95% CI: 1.00, 1.01). Combining elevation and distance to coast showed a higher incidence in women living at high elevation far from the coast compared with women living at low elevation near the coast (IRR = 1.07, 95% CI: 1.04, 1.10). A similar result was found in men but only for hip fractures occurring during March-May (IRR = 1.07, 95% CI: 1.00, 1.15). The previously shown patterns of county differences and seasonal variations were unchanged when considering geography. CONCLUSION We found a somewhat higher incidence of hip fracture in inland residents living in areas of high elevation, as compared to those living in more coastal proximity; however, the geographic variation did not explain county and seasonal differences in fracture incidence in Norway. More in-depth analyses on temperature and climate factors may give further clues.
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Affiliation(s)
- C Dahl
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Box 1130, Blindern, 0318, Oslo, Norway.
| | - C Madsen
- Department of Health and Inequality, Norwegian Institute of Public Health, Oslo, Norway
| | - T K Omsland
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Box 1130, Blindern, 0318, Oslo, Norway
| | - A-J Søgaard
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - G S Tell
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - K Holvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - H E Meyer
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Box 1130, Blindern, 0318, Oslo, Norway
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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13
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Johansson P, Kristjansdottir HL, Johansson H, Jakir A, Mellström D, Lewerin C. Highly increased risk of fracture in patients with myeloproliferative neoplasm. Leuk Lymphoma 2020; 62:211-217. [PMID: 32909485 DOI: 10.1080/10428194.2020.1817437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The risk for hip and vertebral fracture was determined in 10,752 patients diagnosed with myeloproliferative neoplasms (MPN) in Sweden 1995-2015. The mean follow-up time were 6.34 years. Five percent developed hip fracture and 1.3% a vertebral fracture. There was a significant increased risk for fracture among the MPN patients compared with the Swedish population. The ratio of observed (obs) and expected (exp) number of hip fracture in all MPN patients, polycythemia vera (PV), essential thrombocythemia and MPN undetermined (MPNu) was 1.20 (95% confidence interval (CI): 1.10-1.31), 1.37 (95% CI: 1.19-1.58), 1.02 (95% CI: 0.87-1.19), and 1.28 (95% CI: 1.07-1.52), respectively. Corresponding figures for vertebral fractures were 1.94 (95% CI: 1.64-2.29), 2.09 (95% CI: 1.56-2.75), 1.50 (95% CI: 1.06-2.07) and 2.47 (95% CI: 1.77-3.35), respectively. Patients with MPN had an increased risk of hip and vertebral fracture, especially patients with PV and MPNu in comparison with the entire Swedish population.
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Affiliation(s)
- Peter Johansson
- Section of Hematology and Coagulation, Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - Helena Johansson
- Department of Public Health, McKillop Health Institute, Australian Catholic University, Melbourne, Australia.,Community of Medicine, University of Gothenburg Faculty of Health Sciences, Goteborg, Sweden
| | - Ana Jakir
- Section of Hematology and Coagulation, Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Dan Mellström
- Center of Bone and Arthritis Research, University of Gothenburg Faculty of Health Sciences, Goteborg, Sweden.,Department of Geriatric Medicine, University of Gothenburg Faculty of Health Sciences, Goteborg, Sweden
| | - Cataharina Lewerin
- Section of Hematology, Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
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14
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Forsén L, Søgaard AJ, Holvik K, Meyer HE, Omsland TK, Stigum H, Dahl C. Geographic variations in hip fracture incidence in a high-risk country stretching into the Arctic: a NOREPOS study. Osteoporos Int 2020; 31:1323-1331. [PMID: 32095840 PMCID: PMC7280325 DOI: 10.1007/s00198-020-05346-8] [Citation(s) in RCA: 14] [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: 10/23/2019] [Accepted: 02/12/2020] [Indexed: 12/21/2022]
Abstract
UNLABELLED There are geographic variations in hip fracture incidence rates across Norway, with a lower incidence in the coastal areas of the southwest and in the Arctic north, contrary to what may be expected with regard to vitamin D exposure from sunlight. The regional differences have become smaller in recent years. INTRODUCTION To investigate geographic variation in hip fracture incidence within Norway and regional differences in time trends. METHODS All hip fractures treated in Norwegian hospitals 2002-2013 were included, and demographic information was obtained from Statistics Norway. Age-standardized incidence rates were calculated separately for 19 counties. Incidence rate ratios with 95% confidence intervals for county differences and time trends were estimated using Poisson regression. RESULTS Age-standardized number of hip fractures per 10,000 person-years varied between counties from 69 to 84 in women and from 34 to 41 in men. The highest rates were observed in the southeastern capital city of Oslo, while rates were low in the four northernmost counties. There was an east-west gradient, with lower incidence in the coastal southwest compared with the southeast. Women showed a statistically significant decline during 2002-2013 in almost all counties (up to 31%). In men, only a few counties showed a decline. In both genders, hip fracture rates at age 80 in the combined five counties with the highest rates were significantly higher than in the combined five counties with the lowest rates across the period, although the trends converged over time. CONCLUSIONS In Norway, the hip fracture incidence was lower in the north compared with the south. In addition, we observed an east-west gradient with the highest incidence in the southeast and lower incidence in the coastal southwest. While there has been an overall declining trend in hip fracture incidence over time, regional differences are still apparent.
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Affiliation(s)
- L Forsén
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - A J Søgaard
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - K Holvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - H E Meyer
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern, N-0318, Oslo, Norway
| | - T K Omsland
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern, N-0318, Oslo, Norway
| | - H Stigum
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern, N-0318, Oslo, Norway
| | - C Dahl
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern, N-0318, Oslo, Norway.
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15
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Affiliation(s)
- José M Belizán
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Gabriela Cormick
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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16
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Johansson P, Lind Kristjansdottir H, Johansson H, Jakir A, Mellström D, Lewerin C. Increased Risk of Hip Fracture in Patients with Lymphoma, a Swedish Population Study of 37,236 Lymphoma Patients. Calcif Tissue Int 2020; 106:591-598. [PMID: 32170330 DOI: 10.1007/s00223-020-00674-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/08/2020] [Indexed: 12/31/2022]
Abstract
Increased bone loss has been noted in lymphoma patients; however, the incidence of hip fracture is not known. The aim of our study was to explore the risk for hip fracture in patients with lymphoma compared with the entire Swedish population. The risk of hip fracture was determined in a retrospective population cohort study of adult Swedish lymphoma patients (n = 37,236), diagnosed 1995-2015 and compared with the entire Swedish population during the same period. The incidence of hip fracture in lymphoma patients was higher in women than in men, increased by age, and decreased by calendar year as also demonstrated in the total population. 2.2% of the men and 4.7% of women with lymphoma sustained a hip fracture. For the total group of females, the hazard ratio (HR) was 1.19 (95% CI 1.11-1.28) and for men, the hazard ratio was 1.06 (95% CI 0.97-1.17) compared with the Swedish population. The HR for hip fracture (2016) was 2.80 (95% CI 1.20-6.53), 2.04 (95% CI 1.30-3.20), 1.56 (95% CI 1.21-2.01), 1.08 (95% CI 0.89-1.30), and 1.07 (95% CI 0.92-1.25) in females aged 40, 50, 60, 70, and 80 years, respectively. Corresponding figures for men were not significant in 2016. Unmarried men with lymphoma had a two times higher risk for hip fracture (HR 2.02 95% CI 1.63-2.50) compared with married men. Patients with lymphoma had an increased risk of hip fracture, especially younger women and unmarried men. The incidence of hip fracture is decreased by calendar year in the lymphoma patients and the entire Swedish population.
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Affiliation(s)
- Peter Johansson
- Section of Hematology and Coagulation, Department of Internal Medicine, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy,, University of Gothenburg, Bruna Stråket 5, 413 45, Gothenburg, Sweden.
| | - Hallgerdur Lind Kristjansdottir
- Section of Hematology and Coagulation, Department of Internal Medicine, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy,, University of Gothenburg, Bruna Stråket 5, 413 45, Gothenburg, Sweden
| | - Helena Johansson
- McKillop Health Institute, Australian Catholic University, Melbourne, Australia
- Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ana Jakir
- Section of Hematology and Coagulation, Department of Internal Medicine, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy,, University of Gothenburg, Bruna Stråket 5, 413 45, Gothenburg, Sweden
| | - Dan Mellström
- Center for Bone and Arthritis Research (CBAR), Departments of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Catharina Lewerin
- Section of Hematology and Coagulation, Department of Internal Medicine, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy,, University of Gothenburg, Bruna Stråket 5, 413 45, Gothenburg, Sweden
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17
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Dela SS, Paruk F, Brown SL, Lukhele M, Kalla AA, Jordaan JD, Conradie M, Mohamed O, Chutterpaul P, Cassim B. Ethnic and gender-specific incidence rates for hip fractures in South Africa: A multi-centre study. Bone 2020; 133:115253. [PMID: 31987987 DOI: 10.1016/j.bone.2020.115253] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data exist on the incidence of hip fractures in South Africa (SA). We report gender and ethnic specific incidence rates of hip fractures in SA. METHODS In a multicentre prospective study, conducted in geographically defined municipalities of three provinces in SA, a structured questionnaire was administered to all subjects aged 40 years and over, presenting with a new atraumatic hip fracture, from 1 April 2017 to 31 March 2018. Gender and ethnic specific incidence rates (IR) of hip fractures were calculated using population statistics from Statistics SA. FINDINGS Of the 2767 subjects enrolled, 1914 (69·2%) were women and 853 (30·8%) were men. The majority of subjects were from the White population (40·9%) followed by those from the African (26·4%), Coloured (18·7%) and Indian (13·9%) populations. Men with hip fractures were significantly younger than women in the total group (69 [IQR 59-79] versus 77 years [IQR 68-84], p < 0·001) and in each ethnic group. White subjects were significantly older (p < 0·0001) and Africans significantly younger (p < 0·0001) than the other ethnic groups. In women, the highest IR was noted in the White population (176·0 per 100,000), followed by that in the Indian (147·7 per 100,000), Coloured (73·2 per 100,000) and African populations (43·6 per 100,000). A similar pattern was seen in men albeit at lower rates, with the highest rate in White men at 76·5 per 100,000. In the total study population and the African population, the IR was higher in men compared to women in subjects under 60 years. In the White population, the IR was higher in men compared to women in the 40-44 years age group. While in the Coloured and Indian populations the IR was higher in men compared to women in the 40-49 years and 45-54 years age groups, respectively. There was an increase in the relative risk ratios with age in the total study population, and in all ethnic groups in both women and men. INTERPRETATION Hip fractures occur in all ethnic groups in South Africa with higher IRs in the White and Indian populations compared to the Coloured and African populations. Consistent with the published literature, the overall hip fracture IR was higher in women than in men, except in the younger age groups, and increased with age. FUNDING South African Medical Research Council and the University of KwaZulu-Natal Competitive Research Grant.
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Affiliation(s)
- S S Dela
- Department of Internal Medicine, Edendale Hospital, School of Clinical Medicine (SCM), University of KwaZulu-Natal (UKZN), South Africa.
| | - F Paruk
- Division of Internal Medicine, SCM, College of Health Sciences, UKZN, South Africa
| | - S L Brown
- Mahatma Gandhi Memorial Hospital, Durban, South Africa
| | - M Lukhele
- Department of Orthopaedics, University of Witwatersrand, South Africa
| | - A A Kalla
- Division of Rheumatology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - J D Jordaan
- Division of Orthopaedics, Stellenbosch University, South Africa
| | - M Conradie
- Division of Endocrinology, Stellenbosch University, South Africa
| | - O Mohamed
- Discipline of Public Health Medicine, SCM, College of Health Sciences, UKZN, South Africa
| | - P Chutterpaul
- Division of Internal Medicine, SCM, College of Health Sciences, UKZN, South Africa
| | - B Cassim
- Department of Geriatrics, SCM, College of Health Sciences, UKZN, South Africa
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18
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Gratza SK, Chocano-Bedoya PO, Orav EJ, Fischbacher M, Freystätter G, Theiler R, Egli A, Kressig RW, Kanis JA, Bischoff-Ferrari HA. Influence of fall environment and fall direction on risk of injury among pre-frail and frail adults. Osteoporos Int 2019; 30:2205-2215. [PMID: 31377914 DOI: 10.1007/s00198-019-05110-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/24/2019] [Indexed: 12/29/2022]
Abstract
UNLABELLED In this prospective study, half of all falls resulted in injury. Pre-frail adults sustained more injuries, while more frail adults had injuries requiring hospitalization or fractures. Pre-frail adults fell more often when in movement compared with frail adults who fell more often when standing and in indoor public spaces. PURPOSE To assess prospectively how fall environment and direction are related to injury among pre-frail and frail adults. METHODS We included 200 community-dwelling adults with a prior fall (pre-frail, mean age 77 years) and 173 adults with acute hip fracture (frail, mean age 84 years; 77% community-dwelling). Falls were prospectively recorded using standardized protocols in monthly intervals, including date, time, fall direction and environment, and injury. We used logistic regression to assess the odds of injury adjusting for age, body mass index (BMI), and gender. RESULTS We recorded 513 falls and 331 fall-related injuries (64.5%) among the 373 participants. While the fall rate was similar between groups, pre-frail adults had more injuries (71% among pre-frail vs. 56% among frail, p = 0.0004) but a lower incidence of major injuries (9% among pre-frail vs. 27% among frail, p = 0.003). Pre-frail adults fell more often while in movement (84% among pre-frail vs. 55% among frail, p < 0.0001), and frail adults fell more often while standing (26% vs. 15% respectively, p = 0.01). The odds of injury among frail adults was increased 3.3-fold when falling sideways (OR = 3.29, 95% CI = 1.68-6.45) and 2.4-fold when falling in an indoor public space (OR = 2.35, 95% CI = 1.00-5.53), and was reduced when falling at home (OR = 0.55, 95% CI = 0.31-0.98). The odds of injury among pre-frail adults was not influenced by environment and was 53% lower when falling backwards (OR = 0.47, 95% CI = 0.26-0.82). CONCLUSION While pre-frail adults sustain more fall-related injuries, frail adults were more likely to sustain major injuries, especially when falling sideways or outside their home.
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Affiliation(s)
- S K Gratza
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
- Basel University Medicine of Aging, Felix-Platter Spital, Basel, Switzerland
| | - P O Chocano-Bedoya
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
| | - E J Orav
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - M Fischbacher
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - G Freystätter
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
- Department of Geriatrics and Aging Research, University Hospital Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - R Theiler
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
- Department of Geriatrics and Aging Research, University Hospital Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - A Egli
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
| | - R W Kressig
- Basel University Medicine of Aging, Felix-Platter Spital, Basel, Switzerland
| | - J A Kanis
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
- Centre of Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - H A Bischoff-Ferrari
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland.
- Department of Geriatrics and Aging Research, University Hospital Zurich, Raemistrasse 101, 8091, Zurich, Switzerland.
- University Clinic for Acute Geriatric Care, City Hospital Waid, Zurich, Switzerland.
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19
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Cram P, Lix LM, Bohm E, Yan L, Roos L, Matelski J, Gandhi R, Landon B, Leslie WD. Hip fracture care in Manitoba, Canada and New York State, United States: an analysis of administrative data. CMAJ Open 2019; 7:E55-E62. [PMID: 30755412 PMCID: PMC6404962 DOI: 10.9778/cmajo.20180126] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Nearly 30 years ago, a series of studies showed increased hip fracture mortality in Manitoba compared to the United States, but these data have not been updated. Our objective was to compare the organization of hip fracture care and short-term outcomes in Manitoba and New York State using contemporary data. METHODS This was a retrospective cohort study of administrative data for all adults aged 50 years or more admitted to hospital with hip fracture between Jan. 1, 2011, and Oct. 31, 2013 in Manitoba and New York State. We compared the 2 jurisdictions with respect to: 1) the proportion of hospitals treating hip fracture and annual hip fracture volume, 2) hospital length of stay, 3) death and 4) hospital readmission. We used descriptive statistics, univariate methods and regression models to compare differences in care between jurisdictions. RESULTS We identified 2845 patients (mean age 82.2 yr, 2061 women [72.4%]) with hip fracture in Manitoba and 31 524 patients (mean age 81.9 yr, 22 973 women [72.9%]) with hip fracture in New York. A smaller proportion of hospitals in Manitoba than in New York treated hip fracture (7/30 [23%] v. 180/239 [75.3%]) (p < 0.001); the mean annual hospital hip fracture volume was higher in Manitoba (140.0) than in New York (68.9), but the difference did not reach statistical significance (p = 0.2). For patients with femoral neck fractures, the median hospital length of stay was longer in Manitoba than in New York (13 d v. 7 d). The rate of death within 7 days of admission was similar in Manitoba and New York (1.3% v. 2.0%, p = 0.07), although the rate of in-hospital death was higher in Manitoba (5.7% v. 3.5%, p < 0.001). Readmission within 30 days of discharge was less frequent in Manitoba than in New York (9.8% v. 12.0%, p = 0.02). Results were similar for patients with intertrochanteric fractures. INTERPRETATION Poor short-term outcomes for patients with hip fracture in Manitoba that were documented in the 1980s seem to have been eliminated. Our results should provide optimism that reengineering of clinical care can produce substantive improvements in quality.
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Affiliation(s)
- Peter Cram
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass.
| | - Lisa M Lix
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| | - Eric Bohm
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| | - Lin Yan
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| | - Leslie Roos
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| | - John Matelski
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| | - Rajiv Gandhi
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| | - Bruce Landon
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
| | - William D Leslie
- North American Observatory on Health Systems and Policies (Cram), Institute for Health Policy, Management and Evaluation, University of Toronto; Departments of Medicine (Cram) and Surgery (Gandhi), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network, Toronto, Ont.; Departments of Community Health Sciences (Lix, Bohm, Yan, Roos), Surgery (Bohm) and Medicine (Leslie), University of Manitoba, Winnipeg, Man.; Biostatistics Research Unit (Matelski) and Arthritis Program (Gandhi), University Health Network, Toronto, Ont.; Department of Health Care Policy (Landon), Harvard Medical School; Division of General Medicine and Primary Care (Landon), Beth Israel Deaconess Medical Center, Boston, Mass
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The Effect of Season and Weather on Orthopaedic Trauma: Consult Volume Is Significantly Correlated with Daily Weather. Adv Orthop 2018; 2018:6057357. [PMID: 30245890 PMCID: PMC6139230 DOI: 10.1155/2018/6057357] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/08/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction On-call orthopedic clinicians have long speculated that daily consult volume is closely correlated with weather. While prior studies have demonstrated a relationship between weather and certain fracture types, the effect of weather on total orthopaedic consult volume has not yet been examined. The aim of this study was to investigate this relationship. Methods We retrospectively reviewed orthopaedic consult data from 405 consecutive days at an urban, level one trauma center. The number, mechanism of injury, and type of consult were collected, along with daily weather data (temperature, wind, and precipitation). Statistical analysis was then performed to determine the relationship between weather and orthopaedic trauma consults. Results A total of 4543 consults were received during the study period. There was a significant difference in total number of consults between months of the year (p<0.001). A post hoc analysis revealed that this was due to increased volume in the summer months relative to the winter months (i.e., August 13.7 consults/day; January 9.3 consults/day). Average daily temperature and consult volume were also positively correlated (p<0.001, r= 0.30). While there was no significant association between precipitation and total consult volume, when there was over 0.25 inches of rain, there were less penetrating trauma (p=0.034) and motorcycle collision consults (p=0.013). Conclusion Weather parameters, specifically average temperature and precipitation, were found to be associated with daily orthopedic consult type and volume. Additionally, consult volume varies significantly between months of the year. Because trauma centers are often resource scarce, this is an important relationship to understand for proper resource allocation.
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Kanis JA, Cooper C, Rizzoli R, Reginster JY. Review of the guideline of the American College of Physicians on the treatment of osteoporosis. Osteoporos Int 2018; 29:1505-1510. [PMID: 29869039 PMCID: PMC6037298 DOI: 10.1007/s00198-018-4504-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/11/2018] [Indexed: 10/14/2022]
Abstract
This review, endorsed by the International Osteoporosis Foundation and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, summarizes several failings of the recent guidelines of the American College of Physicians (ACP) on the treatment of low bone density or osteoporosis to prevent fractures. INTRODUCTION The ACP recently issued guidelines for the treatment of low bone density or osteoporosis to prevent fractures. METHODS Literature review and critical review of the ACP guidelines. RESULTS The guideline is lacking in scope due to the endorsement of treatment based on T-scores rather than fracture risk assessment and in failure to adequately consider anabolic therapies. CONCLUSIONS The ACP guideline appears outdated.
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Affiliation(s)
- J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia.
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - R Rizzoli
- Service of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
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22
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Johansson H, Hongslo Vala C, Odén A, Lorentzon M, McCloskey E, Kanis JA, Harvey NC, Ohlsson C, Stefan Lohmander L, Kärrholm J, Mellström D. Low risk for hip fracture and high risk for hip arthroplasty due to osteoarthritis among Swedish farmers. Osteoporos Int 2018; 29:741-749. [PMID: 29327294 PMCID: PMC5884415 DOI: 10.1007/s00198-017-4355-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/17/2017] [Indexed: 01/12/2023]
Abstract
We aimed to study the risk of hip fracture and risk of hip arthroplasty among farmers in Sweden. Our results indicate that farming, representing an occupation with high physical activity, in men is associated with a lower risk of hip fracture but an increased risk of hip arthroplasty. INTRODUCTION The risks of hip fracture and hip arthroplasty are influenced by factors including socioeconomic status, education, urbanization, latitude of residence, and physical activity. Farming is an occupation encompassing rural living and high level of physical activity. Therefore, we aimed to study the risk of hip fracture and risk of hip arthroplasty among farmers in Sweden. METHODS We studied the risk of hip fracture, and hip arthroplasty due to primary osteoarthritis, in all men and women aged 35 years or more in Sweden between 1987 and 2002. Documented occupations were available in 3.5 million individuals, of whom 97,136 were farmers. The effects of age, sex, income, education, location of residence, and occupation on risk of hip fracture or hip arthroplasty were examined using a modification of Poisson regression. RESULTS A total of 4027 farmers and 93,109 individuals with other occupations sustained a hip fracture, while 5349 farmers and 63,473 others underwent a hip arthroplasty. Risk of hip fracture was higher with greater age, lower income, lower education, higher latitude, and urban area for all men and women. Compared to all other occupations, male farmers had a 20% lower age-adjusted risk of hip fracture (hazard ratio (HR) 0.80, 95%CI 0.77-0.84), an effect that was not seen in female farmers (HR 0.96, 95% CI 0.91-1.01). Both male and female farmers had a higher age-adjusted risk for hip arthroplasty. CONCLUSIONS Our results indicate that farming, representing an occupation with high physical activity, in men is associated with a lower risk of hip fracture but an increased risk of hip arthroplasty.
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Affiliation(s)
- H Johansson
- Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia.
- Centre for Bone and Arthritis Research, Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
| | - C Hongslo Vala
- Centre for Bone and Arthritis Research, Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Odén
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - M Lorentzon
- Centre for Bone and Arthritis Research, Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - E McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - J A Kanis
- Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - C Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - L Stefan Lohmander
- Faculty of Medicine, Department of Clinical Sciences Lund, Lund University, Orthopedics, Sweden
| | - J Kärrholm
- Department of Orthopedics, Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - D Mellström
- Centre for Bone and Arthritis Research, Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
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23
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Rosas S, Ong AC, Buller LT, Sabeh KG, Law TY, Roche MW, Hernandez VH. Season of the year influences infection rates following total hip arthroplasty. World J Orthop 2017; 8:895-901. [PMID: 29312848 PMCID: PMC5745432 DOI: 10.5312/wjo.v8.i12.895] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/11/2017] [Accepted: 11/22/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To research the influence of season of the year on periprosthetic joint infections.
METHODS We conducted a retrospective review of the entire Medicare files from 2005 to 2014. Seasons were classified as spring, summer, fall or winter. Regional variations were accounted for by dividing patients into four geographic regions as per the United States Census Bureau (Northeast, Midwest, West and South). Acute postoperative infection and deep periprosthetic infections within 90 d after surgery were tracked.
RESULTS In all regions, winter had the highest incidence of periprosthetic infections (mean 0.98%, SD 0.1%) and was significantly higher than other seasons in the Midwest, South and West (P < 0.05 for all) but not the Northeast (P = 0.358). Acute postoperative infection rates were more frequent in the summer and were significantly affected by season of the year in the West.
CONCLUSION Season of the year is a risk factor for periprosthetic joint infection following total hip arthroplasty (THA). Understanding the influence of season on outcomes following THA is essential when risk-stratifying patients to optimize outcomes and reduce episode of care costs.
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Affiliation(s)
- Samuel Rosas
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27101, United States
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL 33334, United States
| | - Alvin C Ong
- Orthopedic Surgery, Thomas Jefferson University Hospital, Egg Harbor Town, NJ 08234, United States
| | - Leonard T Buller
- Department of Orthopedics Surgery, University of Miami, Miami, FL 33136, United States
| | - Karim G Sabeh
- Department of Orthopedics Surgery, University of Miami, Miami, FL 33136, United States
| | - Tsun yee Law
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL 33334, United States
- Department of Orthopedics Surgery, University of Miami, Miami, FL 33136, United States
| | - Martin W Roche
- Department of Orthopaedic Surgery, Holy Cross Hospital, Fort Lauderdale, FL 33316, United States
| | - Victor H Hernandez
- Department of Orthopedics Surgery, University of Miami, Miami, FL 33136, United States
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Abstract
The absence of descriptive epidemiological data on the frequency and distribution of fractures in a population is serious and may underestimate the actual importance of this public health problem. In this study, we report the crude and standardized incidence rates of fractures in the population of Kuwait during the period 2009-2012. Using the Ministry of Public Health's national registry, demographic data of all fracture cases between 2009 and 2012 were retrieved. These were further categorized into fractures at the hip or any other sites. Average annual incidence rates were calculated and standardized using the world's population in 2010 as a reference. Thus, 18,119 fractures among males and 6,362 among females were recorded. The overall estimated annual incidence rates of fractures per 100,000 person-years were 207 for males and 111.8 for females. Moreover, 13.3% of all fractures were in the hip, with incidence rates of 24.8 for males and 18.9 for females; while 86.7% were in other sites, with corresponding incidence rates of 182.2 and 92.8, respectively. The age-specific fracture incidence rates in females remained below the corresponding rates of males until ≥50 years of age, after which the female age groups showed successively higher rates. The age-standardized incidence rates for all fractures (hip and other sites) were 247.4 for males, 175.4 for females, and 216.2 for both sexes. The burden of this major public health challenge is set to rise, and such population-based incidence data call for an urgent need for action to reduce the projected human impact and socioeconomic costs of fracture.
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Affiliation(s)
- Fawaz Y Azizieh
- Department of Mathematics and Natural Sciences, International Centre for Applied Mathematics and Computational Bioengineering, College of Arts and Sciences, Gulf University for Science and Technology, Mubarak Al-Abdullah, Hawally, State of Kuwait
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25
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Trousdale WH, Abdel MP, Viste A, Trousdale RT, Callaghan JJ, Berry DJ. Seasonality of Periprosthetic Femur Fractures in 12,700 Primary and Revision Total Hip Arthroplasties. J Arthroplasty 2017; 32:2000-2004. [PMID: 28341277 DOI: 10.1016/j.arth.2017.02.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/14/2017] [Accepted: 02/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periprosthetic femur fractures after primary and revision total hip arthroplasty (THA) are one of the most common long-term reasons for reoperation after THA. Previous investigations have analyzed the incidence and risk factors of these fractures. No previous study, however, has analyzed a variation in periprosthetic femur fractures between meteorologic seasons. The aim of this study was to compare the incidence of periprosthetic femur fractures after primary and revision THAs depending on the meteorologic season. METHODS We identified 8920 patients (10,672 hips) who underwent primary THAs and 1830 patients (1998 hips) who underwent revision THAs at our institution between 1995 and 2011. All patients resided in the Upper Midwest at the time of surgery. Patients who experienced periprosthetic femur fractures were identified and categorized based on the meteorologic season. A Cox model was used to assess the association of seasonality with the risk of fracture. RESULTS During the study period, 165 primary THAs and 80 revision THAs sustained a periprosthetic femur fracture. Using winter as a reference, the risk of a periprosthetic femur fracture after primary THA was not statistically higher in the spring (hazard ratio [HR] = 1.3; P = .2), autumn (HR = 1.4; P = .2), and summer (HR = 1.415; P = .1). Similarly, the risk of periprosthetic femur fracture after revision THA was not statistically higher in the spring (HR = 0.9; P = .6), autumn (HR = 0.6; P = .1), and summer (HR = 0.9; P = 1.0). CONCLUSION The risk of periprosthetic femur fracture after primary and revision THA does not significantly differ between meteorologic seasons.
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Affiliation(s)
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony Viste
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - John J Callaghan
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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26
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Nikooyeh B, Abdollahi Z, Hajifaraji M, Alavi-Majd H, Salehi F, Yarparvar AH, Neyestani TR. Vitamin D status and cardiometabolic risk factors across latitudinal gradient in Iranian adults: National food and nutrition surveillance. Nutr Health 2017; 23:87-94. [PMID: 28397539 DOI: 10.1177/0260106017702918] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study aimed to evaluate the vitamin D status in an adult population across latitudinal gradient and to investigate its possible associations with certain cardiometabolic risk factors. METHODS A total of 1406 healthy subjects aged 19-60 years were randomly selected from six regions of Iran across latitudinal gradient from 29° N to 37.5° N. Anthropometric and biochemical assessments were performed. The combination of high body mass index (>25 kg/m2), low high-density lipoprotein cholesterol (< 40 mg/dl in males and < 50 mg/dl in females) and high triglycerides (> 150 mg/dl) was defined as cardiometabolic risk factors. RESULTS The mean concentration of serum 25-hydroxycalciferol (25(OH)D) was 26.8±17.7 nmol/l. There were no significant differences in the mean serum 25(OH)D levels among different latitudes. Undesirable vitamin D status (deficiency and insufficiency) was found in 90.7% of the subjects. After adjustment for age and gender, the association between weight status and serum 25(OH)D was significant ( p< 0.04, odds ratio:1.49; confidence interval: 1.01-2.19). The prevalence of cardiometabolic risk factors among the subjects with serum 25(OH)D less than 27.5 nmol/l was significantly higher than those with serum calcidiol concentrations above 27.5 nmol/l (13.3% vs. 10.0%, p = 0.033). CONCLUSION Undesirable vitamin D status is highly prevalent among Iranian adults of both sexes irrespective of latitude and even in sunny regions. The occurrence of cardiometabolic risk factors was significantly higher in those subjects with circulating calcidiol concentrations below 27.5 nmol/l.
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Affiliation(s)
- Bahareh Nikooyeh
- 1 Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Abdollahi
- 2 Nutrition Office, Iran Ministry of Health, Treatment and Medical Education, Tehran, Iran
| | - Majid Hajifaraji
- 3 Department of Nutritional Policy-Making Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Alavi-Majd
- 4 Department of Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Forouzan Salehi
- 2 Nutrition Office, Iran Ministry of Health, Treatment and Medical Education, Tehran, Iran
| | | | - Tirang R Neyestani
- 1 Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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27
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Nikooyeh B, Abdollahi Z, Hajifaraji M, Alavi-Majd H, Salehi F, Yarparvar AH, Neyestani TR. Vitamin D Status, Latitude and their Associations with Some Health Parameters in Children: National Food and Nutrition Surveillance. J Trop Pediatr 2017; 63:57-64. [PMID: 27594396 DOI: 10.1093/tropej/fmw057] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recent data indicate a role for vitamin D in many health aspects including anthropometric measures and blood lipid profiles. Dermal vitamin D synthesis may be influenced by latitude. However, the contribution of latitude in vitamin D status and its association with anthropometric and blood lipid measures in Iranian children have not been studied to date. METHODS We used data from the National Food and Nutritional Surveillance Program. In total, 667 apparently healthy children aged 5-18 years were randomly selected from six provinces of Iran with different latitudes, from 29 to 37°. Weight, height, circulating 25-hydroxycalciferol; calcidiol [25(OH)D] and blood lipids were measured. RESULTS In total, 16.7 and 4.1% of children were overweight or obese, respectively. The mean 25(OH)D concentration was 27.3 ± 17.6 nmol/l (95% confidence interval: 26.0-28.7 nmol/l). Over 93% of all children had suboptimal circulating calcidiol concentrations. Undesirable status of vitamin D, serum triglyceride and low-density lipoprotein were all more prevalent in children living in regions >33° latitude than those in <33°, significantly. There was no significant difference in duration of sun exposure between children living in latitudes below and above 33° (p = 0.093). In multivariate regression model, sex, latitude, body mass index for age z-score and sun exposure duration were independently related to 25(OH)D concentrations, but age was not. CONCLUSION Despite significant association of latitude and vitamin D status, hypovitaminosis D is prevalent across latitude gradient in Iranian children. Our findings warrant immediate sustainable nutritional intervention, including supplementation, to protect children from hypovitaminosis D irrespective of the latitude of their residence.
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Affiliation(s)
- Bahareh Nikooyeh
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran 1981619573, Iran
| | - Zahra Abdollahi
- Nutrition Office, Iran Ministry of Health, Treatment and Medical Education, Tehran 1467664961, Iran
| | - Majid Hajifaraji
- Department of Nutritional Policy-Making Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran 1981619573, Iran
| | - Hamid Alavi-Majd
- Department of Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran 1971653313, Iran
| | - Forouzan Salehi
- Nutrition Office, Iran Ministry of Health, Treatment and Medical Education, Tehran 1467664961, Iran
| | | | - Tirang R Neyestani
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran 1981619573, Iran
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28
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Povoroznyuk VV, Grygorieva NV, Kanis JA, EV M, Johansson H, Harvey NC, Korzh MO, Strafun SS, Vaida VM, Klymovytsky FV, Vlasenko RO, Forosenko VS. Epidemiology of hip fracture and the development of FRAX in Ukraine. Arch Osteoporos 2017; 12:53. [PMID: 28567714 PMCID: PMC5486686 DOI: 10.1007/s11657-017-0343-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/28/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED A country-specific FRAX model has been developed for the Ukraine to replace the Austrian model hitherto used. Comparison of the Austrian and Ukrainian models indicated that the former markedly overestimated fracture probability whilst correctly stratifying risk. INTRODUCTION FRAX has been used to estimate osteoporotic fracture risk since 2009. Rather than using a surrogate model, the Austrian version of FRAX was adopted for clinical practice. Since then, data have become available on hip fracture incidence in the Ukraine. METHODS The incidence of hip fracture was computed from three regional estimates and used to construct a country-specific FRAX model for the Ukraine. The model characteristics were compared with those of the Austrian FRAX model, previously used in Ukraine by using all combinations of six risk factors and eight values of BMD (total number of combinations =512). RESULTS The relationship between the probabilities of a major fracture derived from the two versions of FRAX indicated a close correlation between the two estimates (r > 0.95). The Ukrainian version, however, gave markedly lower probabilities than the Austrian model at all ages. For a major osteoporotic fracture, the median probability was lower by 25% at age 50 years and the difference increased with age. At the age of 60, 70 and 80 years, the median value was lower by 30, 53 and 65%, respectively. Similar findings were observed for men and for hip fracture. CONCLUSION The Ukrainian FRAX model should enhance accuracy of determining fracture probability among the Ukrainian population and help to guide decisions about treatment. The study also indicates that the use of surrogate FRAX models or models from other countries, whilst correctly stratifying risk, may markedly over or underestimate the absolute fracture probability.
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Affiliation(s)
- VV Povoroznyuk
- State Institution, D. F. Chebotarev Institute of Gerontology NAMS Ukraine, Ukrainian Scientific Medical Center of Osteoporosis, Kyiv, Ukraine
| | - NV Grygorieva
- State Institution, D. F. Chebotarev Institute of Gerontology NAMS Ukraine, Ukrainian Scientific Medical Center of Osteoporosis, Kyiv, Ukraine
| | - JA Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, S10 2RX, Sheffield, UK ,Institute for Health and Aging, Catholic University of Australia, Melbourne, Australia
| | - McCloskey EV
- Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - H Johansson
- Institute for Health and Aging, Catholic University of Australia, Melbourne, Australia
| | - NC Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD UK ,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - MO Korzh
- State Institution, D. F. Chebotarev Institute of Gerontology NAMS Ukraine, Ukrainian Scientific Medical Center of Osteoporosis, Kyiv, Ukraine
| | - SS Strafun
- State Institution, D. F. Chebotarev Institute of Gerontology NAMS Ukraine, Ukrainian Scientific Medical Center of Osteoporosis, Kyiv, Ukraine
| | - VM Vaida
- State Institution, D. F. Chebotarev Institute of Gerontology NAMS Ukraine, Ukrainian Scientific Medical Center of Osteoporosis, Kyiv, Ukraine
| | - FV Klymovytsky
- State Institution, D. F. Chebotarev Institute of Gerontology NAMS Ukraine, Ukrainian Scientific Medical Center of Osteoporosis, Kyiv, Ukraine
| | - RO Vlasenko
- State Institution, D. F. Chebotarev Institute of Gerontology NAMS Ukraine, Ukrainian Scientific Medical Center of Osteoporosis, Kyiv, Ukraine
| | - VS Forosenko
- State Institution, D. F. Chebotarev Institute of Gerontology NAMS Ukraine, Ukrainian Scientific Medical Center of Osteoporosis, Kyiv, Ukraine
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Namatovu F, Lindkvist M, Olsson C, Ivarsson A, Sandström O. Season and region of birth as risk factors for coeliac disease a key to the aetiology? Arch Dis Child 2016; 101:1114-1118. [PMID: 27528621 PMCID: PMC5256417 DOI: 10.1136/archdischild-2015-310122] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 06/14/2016] [Accepted: 06/26/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Coeliac disease (CD) incidence has increased in recent decades, characterised by variations according to sex, age at diagnosis, year of birth, month of birth and region of birth. Genetic susceptibility and exposure to gluten are the necessary factors in CD aetiology, although several environmental factors are considered. METHODS A nationwide prospective cohort longitudinal study was conducted consisting of 1 912 204 children aged 0-14.9 years born in Sweden from 1991 to 2009. A total of 6569 children were diagnosed with biopsy-verified CD from 47 paediatric departments. Using Cox regression, we examined the association between CD diagnosis and season of birth, region of birth and year of birth. RESULTS Overall, CD risk was higher for children born during spring, summer and autumn as compared with children born during winter: adjusted HR for spring 1.08 (95% CI 1.01 to 1.16), summer 1.10 (95% CI 1.03 to 1.18) and autumn 1.10 (95% CI 1.02 to 1.18). Increased CD risk was highest if born in the south, followed by central Sweden when compared with children born in northern Sweden. Children diagnosed at <2 years had an increased CD risk if born in spring while those diagnosed at 2-14.9 years the risk was increased for summer and autumn births. The birth cohort of 1991-1996 had increased CD risk if born during spring, for the 1997-2002 birth cohort the risk increased for summer and autumn births, while for the birth cohort of 2003-2009 the risk was increased if born during autumn. CONCLUSIONS Season of birth and region of birth are independently and jointly associated with increased risk of developing CD during the first 15 years of life. Seasonal variation in infectious load is the likely explanation.
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Affiliation(s)
- Fredinah Namatovu
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Cecilia Olsson
- Department of Food and Nutrition, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Olof Sandström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden,Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Carlsson M, Wanby P, Brudin L, Lexne E, Mathold K, Nobin R, Ericson L, Nordqvist O, Petersson G. Older Swedish Adults with High Self-Perceived Health Show Optimal 25-Hydroxyvitamin D Levels Whereas Vitamin D Status Is Low in Patients with High Disease Burden. Nutrients 2016; 8:E717. [PMID: 27845703 PMCID: PMC5133103 DOI: 10.3390/nu8110717] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 10/29/2016] [Accepted: 11/08/2016] [Indexed: 12/02/2022] Open
Abstract
Controversy pervades the definition of adequate and optimal vitamin D status. The Institutes of Medicine have recommended serum 25(OH)D levels above 50 nmol/L based upon evidence related to bone health, but some experts, including the Endocrine Society and International Osteoporosis Foundation, suggest a minimum serum 25(OH)D level of 75 nmol/L to reduce the risk of falls and fractures in older adults. In a cross-sectional study, we compared vitamin D status in people ≥75 years selected from four groups with a frailty phenotype, combined with a control group free from serious illness, and who considered themselves completely healthy. Only 13% of the 169 controls were vitamin D deficient (S-25(OH)D) < 50 nmol/L), in contrast with 49% of orthopedic patients with hip fractures (n = 133), 31% of stroke patients (n = 122), 39% of patients visiting the hospital's emergency department ≥4 times a year (n = 81), and 75% of homebound adult residents in long-term care nursing homes (n = 51). The mean vitamin D concentration of the healthy control group (74 nmol/L) was similar to a suggested optimal level based on physiological data and mortality studies, and much higher than that of many officially recommended cut-off levels for vitamin D deficiency (<50 nmol/L). The present study provides a basis for planning and implementing public guidelines for the screening of vitamin D deficiency and vitamin D treatment for frail elderly patients.
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Affiliation(s)
- Martin Carlsson
- Department of Clinical Chemistry, County Hospital of Kalmar, 391 85 Kalmar, Sweden.
- Department of Medicine and Optometry, Linnaeus University, 392 34 Kalmar, Sweden.
| | - Pär Wanby
- Section of Endocrinology, Department of Internal Medicine, County Hospital of Kalmar, 391 85 Kalmar, Sweden.
| | - Lars Brudin
- Department Medical and Health Sciences, University of Linkoping, 581 83 Linköping, Sweden.
- Department of Clinical Physiology, County Hospital, 391 85 Kalmar, Sweden.
| | - Erik Lexne
- Department of Psychiatry, County Hospital of Kalmar, 391 85 Kalmar, Sweden.
| | - Karin Mathold
- Department Geriatric Medicine, County Hospital of Kalmar, 391 85 Kalmar, Sweden.
| | - Rebecca Nobin
- Department of Orthopaedics, County Hospital of Kalmar, 391 85 Kalmar, Sweden.
| | - Lisa Ericson
- Department of Medicine and Optometry, Linnaeus University, 392 34 Kalmar, Sweden.
| | - Ola Nordqvist
- The Pharmaceutical Department, Kalmar County Council, 392 44 Kalmar, Sweden.
| | - Göran Petersson
- Department of Medicine and Optometry, Linnaeus University, 392 34 Kalmar, Sweden.
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Wetmore JB, Liu J, Wirtz HS, Gilbertson DT, Cooper K, Nieman KM, Collins AJ, Bradbury BD. Geovariation in Fracture Risk among Patients Receiving Hemodialysis. Clin J Am Soc Nephrol 2016; 11:1413-1421. [PMID: 27269611 PMCID: PMC4974888 DOI: 10.2215/cjn.11651115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/04/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Fractures are a major source of morbidity and mortality in patients receiving dialysis. We sought to determine whether rates of fractures and tendon ruptures vary geographically. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from the US Renal Data System were used to create four yearly cohorts, 2007-2010, including all eligible prevalent patients on hemodialysis in the United States on January 1 of each year. A secondary analysis comprising patients in a large dialysis organization conducted over the same period permitted inclusion of patient-level markers of mineral metabolism. Patients were grouped into 10 regions designated by the Centers for Medicare and Medicaid Services and divided by latitude into one of three bands: south, <35°; middle, 35° to <40°; and north, ≥40°. Poisson regression was used to calculate unadjusted and adjusted region-level rate ratios for events. RESULTS Overall, 327,615 patients on hemodialysis were included. Mean (SD) age was 61.8 (15.0) years old, 52.7% were white, and 55.0% were men. During 716,962 person-years of follow-up, 44,014 fractures and tendon ruptures occurred, the latter being only 0.3% of overall events. Event rates ranged from 5.36 to 7.83 per 100 person-years, a 1.5-fold rate difference across regions. Unadjusted region-level rate ratios varied from 0.83 (95% confidence interval, 0.81 to 0.85) to 1.20 (95% confidence interval, 1.18 to 1.23), a 1.45-fold rate difference. After adjustment for a wide range of case mix variables, a 1.33-fold variation in rates remained. Rates were higher in north and middle bands than the south (north rate ratio, 1.18; 95% confidence interval, 1.13 to 1.23; middle rate ratio, 1.13; 95% confidence interval, 1.10 to 1.17). Latitude explained 11% of variation, independent of region. A complementary analysis of 87,013 patients from a large dialysis organization further adjusted for circulating mineral metabolic parameters and protein energy wasting yielded similar results. CONCLUSIONS Rates of fractures vary geographically in the United States dialysis population, even after adjustment for known patient characteristics. Latitude seems to contribute to this phenomenon, but additional analyses exploring whether other factors might influence variation are warranted.
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Affiliation(s)
- James B. Wetmore
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Jiannong Liu
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | | | - David T. Gilbertson
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Kerry Cooper
- Global Medical Organization, Amgen, Inc., Thousand Oaks, California; and
| | - Kimberly M. Nieman
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Allan J. Collins
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Curtis EM, van der Velde R, Moon RJ, van den Bergh JPW, Geusens P, de Vries F, van Staa TP, Cooper C, Harvey NC. Epidemiology of fractures in the United Kingdom 1988-2012: Variation with age, sex, geography, ethnicity and socioeconomic status. Bone 2016; 87:19-26. [PMID: 26968752 PMCID: PMC4890652 DOI: 10.1016/j.bone.2016.03.006] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/09/2016] [Accepted: 03/07/2016] [Indexed: 12/18/2022]
Abstract
UNLABELLED Rates of fracture worldwide are changing. Using the Clinical Practice Research Datalink (CPRD), age, and gender, geographical, ethnic and socioeconomic trends in fracture rates across the United Kingdom were studied over a 24-year period 1988-2012. Previously observed patterns in fracture incidence by age and fracture site were evident. New data on the influence of geographic location, ethnic group and socioeconomic status were obtained. INTRODUCTION With secular changes in age- and sex-specific fracture incidence observed in many populations, and global shifts towards an elderly demography, it is vital for health care planners to have an accurate understanding of fracture incidence nationally. We aimed to present up to date fracture incidence data in the UK, stratified by age, sex, geographic location, ethnicity and socioeconomic status. METHODS The Clinical Practice Research Datalink (CPRD) contains anonymised electronic health records for approximately 6.9% of the UK population. Information comes from General Practitioners, and covers 11.3 million people from 674 practices across the UK, demonstrated to be representative of the national population. The study population consisted of all permanently registered individuals aged ≥18years. Validated data on fracture incidence were obtained from their medical records, as was information on socioeconomic deprivation, ethnicity and geographic location. Age- and sex-specific fracture incidence rates were calculated. RESULTS Fracture incidence rates by age and sex were comparable to those documented in previous studies and demonstrated a bimodal distribution. Substantial geographic heterogeneity in age- and sex adjusted fracture incidence was observed, with rates in Scotland almost 50% greater than those in London and South East England. Lowest rates of fracture were observed in black individuals of both sexes; rates of fragility fracture in white women were 4.7 times greater than in black women. Strong associations between deprivation and fracture risk were observed in hip fracture in men, with a relative risk of 1.3 (95% CI 1.21-1.41) in Index of Multiple Deprivation category 5 (representing the most deprived) compared to category 1. CONCLUSIONS This study presents robust estimates of fracture incidence across the UK, which will aid decisions regarding allocation of healthcare provision to populations of greatest need. It will also assist the implementation and design of strategies to reduce fracture incidence and its personal and financial impact on individuals and health services.
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Affiliation(s)
- Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- Correspondence and reprint requests to: Professor Cyrus Cooper, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK. Tel: +44 (0) 23 8077 7624 Fax: +44 (0) 23 8070 4021,
| | - Robert van der Velde
- Dept of Internal Medicine, VieCuri Medical Center, Venloseweg 595971 PB Venlo, the Netherlands
| | - Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Joop P W van den Bergh
- Dept of Internal Medicine, VieCuri Medical Center, Venloseweg 595971 PB Venlo, the Netherlands
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Piet Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
- University Hasselt, Hasselt, Belgium
| | - Frank de Vries
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tjeerd P van Staa
- Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, 1.003 Vaughan House, Portsmouth Road, M13 9PL, UK
- Department of Pharmacoepidemiology & Clinical Pharmacology, University of Utrecht, Utrecht, the Netherlands, 3508 TB
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopedic Centre, Headington, Oxford, OX3 7HE, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
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Klingberg E, Oleröd G, Konar J, Petzold M, Hammarsten O. Seasonal variations in serum 25-hydroxy vitamin D levels in a Swedish cohort. Endocrine 2015; 49:800-8. [PMID: 25681052 PMCID: PMC4512566 DOI: 10.1007/s12020-015-0548-3] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 02/03/2015] [Indexed: 02/04/2023]
Abstract
To study seasonal inter-individual and intra-individual variations in serum 25-hydroxy vitamin D (25(OH)D) and to explore parameters associated with 25(OH)D in a healthy Swedish adult population. 540 blood donors (60 % men; mean age 41 ± 13 years) and 75 thrombocyte donors (92 % men, aged 46 ± 11 years) were included. Serum was collected during 12 months and analyzed for 25(OH)D and parathyroid hormone (S-iPTH). The blood donors answered questionnaires concerning vitamin D supplements, smoking, physical activity, sunbed use and sun holidays. Repeated serum samples were collected from the thrombocyte donors to study the intra-individual variations in S-25(OH)D. S-25(OH)D varied greatly over the year correlating with the intensity of the UV-B irradiation (r S = 0.326; p < 0.001). During January-March, a S-25(OH)D level below the thresholds of 50 and 75 nmol/L was observed in 58 and 88 %, respectively, and during July-September in 11 and 50 % (p < 0.001). S-25(OH)D was negatively correlated with body mass index and S-iPTH, but was significantly higher in holiday makers in sunny destinations, sunbed users, non-smokers, and in the physically active. The intra-individual analyses showed a mean increase in S-25(OH)D by 8 nmol/L/month between April and August. Approximately 75 % had serum 25(OH)D values <75 nmol/L during 75 % of the year and 50 % had serum 25(OH)D <50 nmol/L during 50 % of the year. Serum 25(OH)D was strongly associated with parameters related to sun exposure, but only weakly with intake of vitamin D supplements.
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Affiliation(s)
- Eva Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden,
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Wihlborg A, Englund M, Åkesson K, Gerdhem P. Fracture predictive ability of physical performance tests and history of falls in elderly women: a 10-year prospective study. Osteoporos Int 2015; 26:2101-9. [PMID: 25832178 DOI: 10.1007/s00198-015-3106-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED In a large cohort of elderly women followed for 10 years, we found that balance, gait speed, and self-reported history of fall independently predicted fracture. These clinical risk factors are easily evaluated and therefore advantageous in a clinical setting. They would improve fracture risk assessment and thereby also fracture prevention. INTRODUCTION The aim of this study was to identify additional risk factors for osteoporosis-related fracture by investigating the fracture predictive ability of physical performance tests and self-reported history of falls. METHODS In the population-based Osteoporosis Prospective Risk Assessment study (OPRA), 1044 women were recruited at the age of 75 and followed for 10 years. At inclusion, knee extension force, standing balance, gait speed, and bone mineral density (BMD) were examined. Falls the year before investigation was assessed by questionnaire. Cox proportional hazards regression analysis was used to determine fracture hazard ratios (HR) with BMD, history of fracture, BMI, smoking habits, bisphosphonate, vitamin D, glucocorticoid, and alcohol use as covariates. Continuous variables were standardized and HR shown for each standard deviation change. RESULTS Of all women, 427 (41%) sustained at least one fracture during the 10-year follow-up. Failing the balance test had an HR of 1.98 (1.18-3.32) for hip fracture. Each standard deviation decrease in gait speed was associated with an HR of 1.37 (1.14-1.64) for hip fracture. Previous fall had an HR of 1.30 (1.03-1.65) for any fracture; 1.39 (1.08-1.79) for any osteoporosis-related fracture; and 1.60 (1.03-2.48) for distal forearm fracture. Knee extension force did not show fracture predictability. CONCLUSION The balance test, gait speed test, and self-reported history of fall all hold independent fracture predictability. Consideration of these clinical risk factors for fracture would improve the fracture risk assessment and subsequently also fracture prevention.
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Affiliation(s)
- A Wihlborg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Department of Orthopedics, K54, Karolinska University Hospital, Huddinge, SE-141 86, Stockholm, Sweden,
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Ramnemark A, Norberg M, Pettersson-Kymmer U, Eliasson M. Adequate vitamin D levels in a Swedish population living above latitude 63°N: The 2009 Northern Sweden MONICA study. Int J Circumpolar Health 2015; 74:27963. [PMID: 28417824 PMCID: PMC4432023 DOI: 10.3402/ijch.v74.27963] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Even though vitamin D is mainly produced by exposure to sunlight, little is known regarding vitamin D levels in populations living in sub-Arctic areas with little or no daylight during winter. Objective We describe distributions of vitamin D3 and the prevalence of adequate levels in a population living above 63°N. Design We sampled 1,622 randomly selected subjects, aged 25–74 years, between January and May, 2009, as part of the Northern Sweden MONICA study (69.2% participation rate). By using HPLC, 25(OH) vitamin D3 was analysed. Levels used for definitions were deficient, D3<25 nmol/l (<10 ng/ml); insufficient, D3 25–49.9 nmol/l (10–20 ng/ml); and adequate, D3≥50 nmol/l (20 ng/ml). Results Mean (median) level of vitamin D3 was 65.2 (63.6) nmol/l in men and 71.0 (67.7) nmol/l in women. Adequate levels were found in 79.2%, more often in women (82.7%) than in men (75.6%). Only 0.7% of the population were vitamin D3–deficient but 23.1% of men and 17.1% of women had insufficient levels. Levels of vitamin D3 increased with age and insufficient status was most common among those aged 25–34 years, 41.0% in men and 22.3% in women. If subjects using vitamin D-supplementation are excluded, the population level of D3 is 1–2 nmol/l lower than in the general population across sex- and age groups. There were no differences between the northern or the southern parts, between urban or rural living or according to educational attainment. Those subjects born outside of Sweden or Finland had lower levels. Conclusion The large majority living close to the Arctic Circle in Sweden have adequate D3 levels even during the second half of the dark winter. Subjects with D3 deficiency were uncommon but insufficient levels were often found among young men.
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Affiliation(s)
- Anna Ramnemark
- a Geriatric Medicine Department of Community Medicine and Rehabilitation, Umeå University , Umeå , Sweden
| | - Margareta Norberg
- b Epidemiology and global health Department of Public Health and Clinical Medicine, Umeå University , Umeå , Sweden
| | - Ulrika Pettersson-Kymmer
- c Clinical Pharmacology Department of Pharmacology and Clinical Neuroscience, Umeå University , Umeå , Sweden
| | - Mats Eliasson
- d Department of Public Health and Clinical Medicine Sunderby Research Unit, Umeå University , Umeå , Sweden.,e Arctic Research Centre (Arcum) , Umeå University , Umeå , Sweden
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The role of vitamin D in osteoporosis. Maturitas 2015; 80:329-32. [PMID: 25660912 DOI: 10.1016/j.maturitas.2014.12.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 12/28/2014] [Accepted: 12/29/2014] [Indexed: 12/31/2022]
Abstract
It is known that circulating vitamin D predominantly originates from cutaneous synthesis and therefore should be considered as a hormone rather than a vitamin. Vitamin D deficiency (<50nmol/L) is a worldwide epidemic with multiple implications on human health, due to its role in various physiological systems. Various studies have shown that with higher serum 25 hydroxyvitamin D levels, there is a decrease in the incidence of non-vertebral and hip fractures. There is limited research data on the management of vitamin D deficiency using therapeutic doses. The majority of studies focus on lower physiological doses rather than high pharmacological doses. In order to reach serum levels of 75nmol/L from a deficiency state, higher doses than 800-1000IU/day are required. Future focus should be on the implications of a rise in systemic 25(OH)D3 levels from a deficiency state to 75nmol/L on bone density and fracture risk, and the use of high doses in cases of vitamin D deficiency. Vitamin D treatment and supplementation need to be re-evaluated in the light of new evidence suggesting that high pharmacological doses need to be used in order to obtain the desired effect in the prevention of osteoporosis and recurrence of osteoporotic fractures.
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Wallace IJ, Nesbitt A, Mongle C, Gould ES, Grine FE. Age-related variation in limb bone diaphyseal structure among Inuit foragers from Point Hope, northern Alaska. Arch Osteoporos 2014; 9:202. [PMID: 25491658 DOI: 10.1007/s11657-014-0202-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 11/26/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED Age-related deterioration of limb bone diaphyseal structure is documented among precontact Inuit foragers from northern Alaska. These findings challenge the concept that bone loss and fracture susceptibility among modern Inuit stem from their transition away from a physically demanding traditional lifestyle toward a more sedentary Western lifestyle. INTRODUCTION Skeletal fragility is rare among foragers and other traditional-living societies, likely due to their high physical activity levels. Among modern Inuit, however, severe bone loss and fractures are apparently common. This is possibly because of recent Western influences and increasing sedentism. To determine whether compromised bone structure and strength among the Inuit are indeed aberrant for a traditional-living group, data were collected on age-related variation in limb bone diaphyseal structure from a group predating Western influences. METHODS Skeletons of 184 adults were analyzed from the Point Hope archaeological site. Mid-diaphyseal structure was measured in the humerus, radius, ulna, femur, and tibia using CT. Structural differences were assessed between young, middle-aged, and old individuals. RESULTS In all bones examined, both females and males exhibited significant age-related reductions in bone quantity. With few exceptions, total bone (periosteal) area did not significantly increase between young and old age in either sex, nor did geometric components of bending rigidity (second moments of area). CONCLUSIONS While the physically demanding lifestyles of certain traditional-living groups may protect against bone loss and fracture susceptibility, this is not the case among the Inuit. It remains possible, however, that Western characteristics of the modern Inuit lifestyle exacerbate age-related skeletal deterioration.
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Affiliation(s)
- I J Wallace
- Department of Anthropology, Stony Brook University, Stony Brook, NY, 11794-4364, USA,
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