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Karimi SM, Bayat M, Rahimi R. Plant-derived natural medicines for the management of osteoporosis: A comprehensive review of clinical trials. J Tradit Complement Med 2024; 14:1-18. [PMID: 38223808 PMCID: PMC10785263 DOI: 10.1016/j.jtcme.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 01/16/2024] Open
Abstract
Background Osteoporosis is a chronic and systemic skeletal disease that is defined by low bone mineral density (BMD) along with an increase in bone fragility and susceptibility to fracture. This study aimed to overview clinical evidence on the use of herbal medicine for management of osteoporosis. Methods Electronic databases including Pubmed, Medline, Cochrane library, and Scopus were searched until November 2022 for any clinical studies on the efficacy and/or safety of plant-derived medicines in the management of osteoporosis. Results The search yielded 57 results: 19 on single herbs, 16 on multi-component herbal preparations, and 22 on plant-derived secondary metabolites. Risk of fracture, bone alkaline phosphatase, BMD, and specific bone biomarkers are investigated outcomes in these studies. Medicinal plants including Acanthopanax senticosus, Actaea racemosa, Allium cepa, Asparagus racemosus, Camellia sinensis, Cissus quadrangularis, Cornus mas, Nigella sativa, Olea europaea, Opuntia ficus-indica, Pinus pinaster, Trifolium pretense and phytochemicals including isoflavones, ginsenoside, Epimedium prenyl flavonoids, tocotrienols are among plant-derived medicines clinically investigated on osteoporosis. It seems that multi-component herbal preparations were more effective than single-component ones; because of the synergistic effects of their constituents. The investigated herbal medicines demonstrated their promising results in osteoporosis via targeting different pathways in bone metabolism, including balancing osteoblasts and osteoclasts, anti-inflammatory, immunomodulatory, antioxidant, and estrogen-like functions. Conclusion It seems that plant-derived medicines have beneficial effects on bone and may manage osteoporosis by affecting different targets and pathways involved in osteoporosis; However, Future studies are needed to confirm the effectiveness and safety of these preparations.
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Affiliation(s)
- Seyedeh Mahnaz Karimi
- Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Bayat
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roja Rahimi
- Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Tari E, Vörhendi N, Kiss S, Teutsch B, Váradi A, Sisák K, Alizadeh H, Hegyi P, Erőss B. Anaemia Is Associated with an Increased Risk of Fractures, a Systematic Review, and Meta-Analysis. Gerontology 2022; 69:1-13. [PMID: 35314584 PMCID: PMC9808740 DOI: 10.1159/000522591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/08/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Anaemia and osteoporotic fractures are both major health problems among older adults worldwide. OBJECTIVES Previous studies suggest that anaemia may be associated with elevated fracture risk among older adults; however, the exact relationship between them is unknown. We aimed to investigate the association between anaemia and fracture risk. METHODS A comprehensive literature search was performed in four medical databases. We included articles that were published from inception to February 18, 2021. Odds ratios (ORs), hazard ratios (HRs) with 95% confidence intervals (CIs), and original raw incidences from studies comparing fracture rates in anaemic versus non-anaemic patients were extracted and pooled with the random-effects model. I2 test was used to assess heterogeneity. Risk of bias assessment was performed using the Quality of Prognostic Studies tool. PROSPERO CRD42021241109. RESULTS A total of 13 studies were identified; 8 of them were included in the quantitative synthesis. Anaemia was found to be a risk factor for fracture compared to non-anaemia. Anaemia increased hip fracture risk in both older men (HR = 1.71; CI: 1.46-2.00, p< 0.001, I2 = 83.2%) and women (HR = 1.31; CI: 1.13-1.52, p< 0.001), but the fracture risk was more increased among men. There was also an increased chance of hip fracture in the presence of anaemia in populations, including both older men and women (OR = 1.64; CI: 1.35-2.01, p< 0.001, I2 = 61.1%). Anaemia was also associated with increased vertebral (HR = 1.21; CI: 1.04-1.40, p = 0.012) and all-type (HR = 1.49; CI: 1.19-1.86, p< 0.001) fracture risk in older men. CONCLUSION Our results suggest that there is a significant relationship between anaemia and fracture risk in older adults. This association is stronger among older men than women and differs in the different types of fractures.
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Affiliation(s)
- Edina Tari
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Nóra Vörhendi
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Szabolcs Kiss
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Brigitta Teutsch
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Alex Váradi
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Krisztián Sisák
- Department of Orthopaedics, University of Szeged, Szeged, Hungary
| | - Hussain Alizadeh
- Division of Hematology, First Department of Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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Vilaca T, Schini M, Harnan S, Sutton A, Poku E, Allen IE, Cummings SR, Eastell R. The risk of hip and non-vertebral fractures in type 1 and type 2 diabetes: A systematic review and meta-analysis update. Bone 2020; 137:115457. [PMID: 32480023 DOI: 10.1016/j.bone.2020.115457] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diabetes is associated with increased fracture risk but we do not know what affects this risk. We investigated the risk of hip and non-vertebral fractures in diabetes and whether this risk was affected by age, gender, body mass index, diabetes type and duration, insulin use and diabetic complications. METHODS We selected a previously published review to be updated. MEDLINE, Embase and Cochrane databases were searched up to March 2020. We included observational studies with age and gender-adjusted risk of fractures in adults with diabetes compared to adults without diabetes. We extracted data from published reports that we summarised using random effects model. FINDINGS From the 3140 records identified, 49 were included, 42 in the hip fracture analysis, reporting data from 17,571,738 participants with 319,652 fractures and 17 in the non-vertebral fracture review, reporting data from 2,978,487 participants with 181,228 fractures. We found an increase in the risk of fracture in diabetes both for hip (RR 4.93, 3.06-7.95, in type 1 diabetes and RR1.33, 1.19-1.49, in type 2 diabetes) and for non-vertebral fractures (RR 1.92, 0.92-3.99, in type 1 and RR 1.19, 1,11-1.28 in type 2). At the hip, the risk was higher in the younger population in both type 1 and type 2 diabetes. In those with type 2 diabetes, longer diabetes duration and insulin use was associated with an increased risk. We did not investigate the effect of bone density, falls, anti-diabetic drugs and hypoglycemia. CONCLUSION Diabetes is associated with an increase in both hip and non-vertebral fracture risk.
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Affiliation(s)
- Tatiane Vilaca
- Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, UK.
| | - Marian Schini
- Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, UK.
| | - Susan Harnan
- School of Health and Related Research (ScHARR), University of Sheffield, UK.
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, UK.
| | - Edith Poku
- School of Health and Related Research (ScHARR), University of Sheffield, UK.
| | | | - Steven R Cummings
- San Francisco Coordinating Center, Sutter Health, University of California, San Francisco, USA.
| | - Richard Eastell
- Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, UK.
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Cheraghi Z, Doosti-Irani A, Almasi-Hashiani A, Baigi V, Mansournia N, Etminan M, Mansournia MA. The effect of alcohol on osteoporosis: A systematic review and meta-analysis. Drug Alcohol Depend 2019; 197:197-202. [PMID: 30844616 DOI: 10.1016/j.drugalcdep.2019.01.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Osteoporosis is a multifactorial disease hallmarked by the interaction of genetic, nutritional and environmental factors. We aimed to assess the effect of alcohol consumption on the osteoporosis by undertaking a systematic review and meta-analysis. METHODS We searched electronic databases including MEDLINE, Scopus, and Web of Science until June 2018. We identified all pertinent observational studies that examined the risk of OSTEOPOROSIS with alcohol use including cohort, case-control and cross-sectional studies. Relative risks (RR) for cohort studies and odds ratios (ORs) for case-control studies were pooled using the random effects model. Risk of bias was assessed using the Newcastle-Ottawa scale. RESULTS From a pool of 3479 studies identified six met the study inclusion criteria (three case control, two cohorts and one cross-sectional study). Compared with abstainers of alcohol, persons consuming 0.5-1 drinks per day had 1.38 times the risk of developing osteoporosis (adjusted RR = 1.38, 95% CI: 0.90-2.12), persons consuming 1-2 drinks per day had 1.34 times the risk of developing OSTEOPOROSIS (adjusted RR = 1.34, 95% CI: 1.11-1.62), and persons consuming two drinks or more per day had 1.63 times the risk of developing osteoporosis (adjusted RR = 1.63, 95% CI: 1.01-2.65). We found a positive association between alcohol consumption and osteoporosis in the case-control studies (adjusted OR = 2.95, 95% CI: 1.78-4.90). CONCLUSION Our study demonstrates a positive relationship between alcohol consumption and osteoporosis.
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Affiliation(s)
- Zahra Cheraghi
- Department of Epidemiology, Research Center of Modeling of Non-Communicable Disease, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Amin Doosti-Irani
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
| | - Vali Baigi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nasrin Mansournia
- Department of Endocrinology, AJA University of Medical Sciences, Tehran, Iran.
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences, The Eye Care Center, University of British Columbia, Room 323-2550 Willow Street, Vancouver BC, V5Z 3N9, Canada.
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, 6517838695, Iran.
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Kanis JA, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2019; 30:3-44. [PMID: 30324412 PMCID: PMC7026233 DOI: 10.1007/s00198-018-4704-5] [Citation(s) in RCA: 858] [Impact Index Per Article: 171.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/12/2018] [Indexed: 12/25/2022]
Abstract
Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis. INTRODUCTION The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2013. This manuscript updates these in a European setting. METHODS Systematic reviews were updated. RESULTS The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; monitoring of treatment; assessment of fracture risk; case-finding strategies; investigation of patients; health economics of treatment. The update includes new information on the evaluation of bone microstructure evaluation in facture risk assessment, the role of FRAX® and Fracture Liaison Services in secondary fracture prevention, long-term effects on fracture risk of dietary intakes, and increased fracture risk on stopping drug treatment. CONCLUSIONS A platform is provided on which specific guidelines can be developed for national use.
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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
- University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Jia P, Bao L, Chen H, Yuan J, Liu W, Feng F, Li J, Tang H. Risk of low-energy fracture in type 2 diabetes patients: a meta-analysis of observational studies. Osteoporos Int 2017; 28:3113-3121. [PMID: 28795239 DOI: 10.1007/s00198-017-4183-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/30/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED In this meta-analysis, evidence of an association between type 2 diabetes mellitus (T2DM) and low-energy fractures has been evaluated including 12 observational studies. The results suggested that T2DM patients had an enhanced risk of low-energy fractures. INTRODUCTION Type 1 diabetes mellitus (T1DM) patients have been shown to be at enhanced risk of fracture injury, but less is known about low-energy fractures among patients with T2DM. METHODS We performed a meta-analysis of 12 observational studies identified in Medline and EMBASE that included 938,742 participants, including 30,827 low-energy fracture cases. The incidence rate ratios (IRRs) of low-energy fractures were determined using a random-effects model. RESULTS The IRRs of low-energy fracture for men and women were 1.37 (95% confidence interval [CI], 0.94-2.00; p = 0.096) and 1.22 (95% CI, 1.09-1.35; p = 0.000), respectively, and the overall IRR was 1.23 (95% CI, 1.12-1.35; p = 0.000). The IRRs for hip and vertebral fractures were 1.08 (95% CI, 1.02-1.15; p = 0.007) and 1.21 (95% CI, 0.98-1.48; p = 0.073), respectively. The IRRs of low-energy fracture in case-control, prospective, retrospective, and cross-sectional studies were 1.18 (95% CI, 0.81-1.72; p = 0.380), 1.17 (95% CI, 1.05-1.32, p = 0.006), 1.15 (95% CI, 1.02-1.29; p = 0.020), and 1.60 (95% CI, 1.21-2.12; p = 0.001), respectively. The IRRs of low-energy fracture for less than 5 years, 5 to 10 years, and more than 10 years were 1.30 (95%, CI 1.13-1.50; p = 0.000), 1.05 (95% CI, 1.03-1.08; p = 0.000), and 1.19 (95% CI, 1.00-1.41; p = 0.049), respectively. CONCLUSIONS Patients with T2DM had a greater risk of low-energy fracture especially of the hip, compared with that in non-diabetic subjects. However, since according to our funnel plot a publication bias may be present and due to study heterogeneity as well as the limited number of publications, the finding needs to be interpreted with caution.
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Affiliation(s)
- P Jia
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - L Bao
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - H Chen
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China.
| | - J Yuan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - W Liu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - F Feng
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - J Li
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - H Tang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China.
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Lin HL, Lin HC, Tseng YF, Liao HH, Worly JA, Pan CY, Hsu CY. Hip fracture after first-ever stroke: a population-based study. Acta Neurol Scand 2015; 131:158-63. [PMID: 25263230 DOI: 10.1111/ane.12301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study is to estimate the risk of hip fracture after first-ever stroke, using a nationwide population-base data set and a retrospective cohort design. MATERIALS AND METHODS The cohort study involved 18,413 patients surviving a first-ever stroke during the 12-year period from 1997 to 2008. Another 18,413 control subjects were randomly selected with adjustment for age, gender and enrolled year. Stroke type, duration between stroke and hip fracture, six comorbidities and five categories of medication prior to hip fracture were investigated. RESULTS This study found that 788 (4.3%) subjects in the study group suffered from hip fracture, with a 4.2 years median time frame (interquartile range = 1.8-7.1). In the control group, 492 subjects (2.7%) suffered from hip fracture during a 4.8 years median time frame (interquartile range = 2.0-7.5). The relative risk of hip fracture for stroke was increased in the first four years (1.4-2.4) and gradually declined to the level of the general population. Cox regression analysis showed osteoporosis-related factors, including ageing, female and antidepressants, significantly increased hip fracture risk (hazard ratios 1.89, 1.57, 1.92). CONCLUSIONS These findings imply that osteoporosis may play a major role in the occurrence of hip fracture in the first four years after a first-ever stroke. Early intervention to prevent bone loss should be regarded as an important part in stroke management, especially in older females, and should be sustained for four years at least. The benefit of antidepressants in stroke patients should be weighed against the increased risk of hip fracture.
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Affiliation(s)
- H.-L. Lin
- Department of Neurology; Sijhih Cathay General Hospital; New Taipei City Taiwan
- Graduate Institute of Biomedical Informatics; Taipei Medical University; Taipei Taiwan
| | - H.-C. Lin
- Department of Pediatrics; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
- Department of Laboratory Medicine; Taipei Medical University Hospital; Taipei Taiwan
| | - Y.-F. Tseng
- Department of Neurology; Sijhih Cathay General Hospital; New Taipei City Taiwan
| | - H.-H. Liao
- Graduate Institute of Biomedical Informatics; Taipei Medical University; Taipei Taiwan
| | - J. A. Worly
- Graduate Institute of Biomedical Informatics; Taipei Medical University; Taipei Taiwan
| | - C.-Y. Pan
- Department of Neurology; Sijhih Cathay General Hospital; New Taipei City Taiwan
| | - C.-Y. Hsu
- Graduate Institute of Biomedical Informatics; Taipei Medical University; Taipei Taiwan
- Center of Excellence for Cancer Research (CECR); Taipei Medical University; Taipei Taiwan
- Bioinformatics computing center; Taipei Medical University; Taipei Taiwan
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Abstract
Hip fracture after stroke is a frequently occurring and costly complication. The bone quality of stroke survivors is affected by decreased mobility, asymmetric weight bearing, and impaired vitamin D stores. Simultaneously, the risk of falling after stroke is often increased by various impairments. Yet, attempts to limit falls are not enough to prevent fractures. Closer attention to bone health is also needed. Bone markers, which reflect the dynamics of bone remodeling, are becoming more available. Activity is necessary for bone health, but there are no clear guidelines for the type and amount of therapeutic exercise. New metrics for studying bone mineral density and exercise are on the horizon. Finally, there appears to be a role for bisphosphonate prophylaxis in a yet-to-be-defined at-risk population of stroke survivors. The purpose of this review is to discuss the setting for hip fracture after stroke and assess emerging treatments and technologies that may be used to combat the problem.
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Affiliation(s)
- Brian A Bast
- Department of Orthopaedics, Sports and Spine Rehabilitation, Beth Israel Medical Center, New York, USA
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Shi X, Wheeler KK, Shi J, Stallones L, Ameratunga S, Shakespeare T, Xiang H. Increased risk of unintentional injuries in adults with disabilities: a systematic review and meta-analysis. Disabil Health J 2014; 8:153-64. [PMID: 25458975 DOI: 10.1016/j.dhjo.2014.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/28/2014] [Accepted: 09/28/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND An increased risk of unintentional injuries among individuals with disability has been reported in many studies, yet quantitative syntheses of findings from previous studies have not been done. OBJECTIVES We conducted a systematic review and meta-analysis to characterize the relationship between pre-existing disability and unintentional injuries. METHODS We searched 14 electronic databases to identify original research published between Jan 1, 1990 and Feb 28, 2013. Included studies reported the odds ratio (OR) or relative risk (RR) of unintentional injuries in adults 18+ years of age with pre-existing disabilities compared with adults without disabilities. Twenty six eligible studies were included covering 54,586 individuals with disabilities. We conducted quality assessments and then analyzed the pooled effects using random-effect models. RESULTS The pooled OR of unintentional injuries was 1.77 (95% CI 1.51-2.07) for all studies in individuals with disabilities compared with individuals without disabilities. The pooled ORs were 1.87 (95% CI 1.52-2.30) for overall unintentional injuries, 1.64 (95% CI 1.39-1.94) for falls-related injuries, 1.62 (95% CI 1.24-2.13) for occupational injuries, and 1.91 (95% CI 1.59-2.30) for non-occupational injuries. CONCLUSIONS Compared with adults without disabilities, individuals with disabilities are at a significantly higher risk of unintentional injuries. Evidence about the association between cognitive disabilities and unintentional injuries is weak. Future researchers are encouraged to use International Classification of Functioning, Disability and Health (ICF) to classify disability and use rigorous evaluation methods to assess and implement the most appropriate injury prevention efforts to mitigate the risks identified.
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Affiliation(s)
- Xiuquan Shi
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, OH, USA; Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical College, Zunyi, PR China
| | - Krista K Wheeler
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, OH, USA
| | - Junxin Shi
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, OH, USA
| | - Lorann Stallones
- Colorado Injury Control Research Center, Colorado State University, CO, USA
| | - Shanthi Ameratunga
- Section of Epidemiology & Biostatistics, School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tom Shakespeare
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Huiyun Xiang
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, OH, USA.
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Lizaur-Utrilla A, Calduch Broseta JV, Miralles Muñoz FA, Segarra Soria M, Díaz Castellano M, Andreu Giménez L. [Effectiveness of co-management between orthopaedic surgeons and internists for inpatient elders with hip fracture]. Med Clin (Barc) 2014; 143:386-91. [PMID: 24485164 DOI: 10.1016/j.medcli.2013.07.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/09/2013] [Accepted: 07/15/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Hip fracture is a common injury in elder patients who have comorbidities, and it increases the risk of morbimortality. They could benefit from co-management (CM) between orthopaedic surgeons and internists. The objective was to evaluate the effectiveness of this CM. PATIENTS AND METHOD Prospective study of 138 patients over 64 years with hip fracture treated with CM care and one-year of follow-up. The control group was a cohort of 153 patients with similar criteria who had been treated with conventional care. Several pre- and postsurgical variables, complications, and potential risk factors for mortality were analyzed. The Charlson index, mental test, Katz and SF-12 quality of life questionnaires, and Merle D'Aubigné hip score were used. RESULTS Surgical delay was lower in the CM cohort (P=.001). The rates of complications and readmissions were similar in both cohorts. The average stay was lower (P=.001) in the CM cohort. In-hospital and 3-month mortality were similar, but it was lower in the CM cohort at 6 (P=.04) and 12 months (P=.03). In both cohorts, gender, number of comorbidities, ASA score, Charlson index or surgery type were not predictors of mortality. Surgical delay>2 days was a predictor in the CM cohort, whereas age was a predictor in the control cohort. The final functional outcomes were similar in both cohorts. CONCLUSION Our results show the effectiveness of this CM to reduce surgical delay, hospital stay and mortality at 6 months.
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Affiliation(s)
| | - Juan V Calduch Broseta
- Unidad de Corta Estancia, Servicio de Medicina Interna, Hospital Universitario de Elda, Elda, Alicante, España
| | | | - Mar Segarra Soria
- Unidad de Corta Estancia, Servicio de Medicina Interna, Hospital Universitario de Elda, Elda, Alicante, España
| | - Manuel Díaz Castellano
- Unidad de Corta Estancia, Servicio de Medicina Interna, Hospital Universitario de Elda, Elda, Alicante, España
| | - Lucio Andreu Giménez
- Unidad de Corta Estancia, Servicio de Medicina Interna, Hospital Universitario de Elda, Elda, Alicante, España
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12
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Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2013; 24:23-57. [PMID: 23079689 PMCID: PMC3587294 DOI: 10.1007/s00198-012-2074-y] [Citation(s) in RCA: 877] [Impact Index Per Article: 79.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 06/25/2012] [Indexed: 12/12/2022]
Abstract
UNLABELLED Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk of fractures due to osteoporosis. INTRODUCTION The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2008. This manuscript updates these in a European setting. METHODS Systematic literature reviews. RESULTS The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk, general and pharmacological management of osteoporosis, monitoring of treatment, assessment of fracture risk, case finding strategies, investigation of patients and health economics of treatment. CONCLUSIONS A platform is provided on which specific guidelines can be developed for national use.
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Affiliation(s)
- J A Kanis
- WHO Collaborating Centre, UK University of Sheffield Medical School, Sheffield, UK.
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Litwic A, Edwards M, Cooper C, Dennison E. Geographic differences in fractures among women. WOMEN'S HEALTH (LONDON, ENGLAND) 2012; 8:673-84. [PMID: 23181532 PMCID: PMC3736314 DOI: 10.2217/whe.12.54] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Osteoporotic fracture is associated with considerable morbidity and mortality in women throughout the world. However, significant variation in hip fracture rates among women from different nations has been observed and is likely to represent a combination of real and apparent differences due to ascertainment bias. Higher rates are observed in Caucasian women, with lowest rates observed in black women and intermediate rates among Asian women. These differences are likely to represent a combination of genetic and environmental differences; for example, among European women, the highest fracture rates are observed in Scandinavian women where vitamin D insufficiency is common. In all groups, an increase in absolute fracture numbers is anticipated due to demographic changes.
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Affiliation(s)
- Anna Litwic
- The MRC Lifecourse Epidemiology Unit, (University of Southampton), Southampton General Hospital, Southampton SO16 6YD, UK
| | - Mark Edwards
- The MRC Lifecourse Epidemiology Unit, (University of Southampton), Southampton General Hospital, Southampton SO16 6YD, UK
| | - Cyrus Cooper
- The MRC Lifecourse Epidemiology Unit, (University of Southampton), Southampton General Hospital, Southampton SO16 6YD, UK
- University of Oxford, UK
| | - Elaine Dennison
- The MRC Lifecourse Epidemiology Unit, (University of Southampton), Southampton General Hospital, Southampton SO16 6YD, UK
- Victoria University, Wellington, New Zealand
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Drake MT, Murad MH, Mauck KF, Lane MA, Undavalli C, Elraiyah T, Stuart LM, Prasad C, Shahrour A, Mullan RJ, Hazem A, Erwin PJ, Montori VM. Clinical review. Risk factors for low bone mass-related fractures in men: a systematic review and meta-analysis. J Clin Endocrinol Metab 2012; 97:1861-70. [PMID: 22466344 DOI: 10.1210/jc.2011-3058] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
CONTEXT Testing men at increased risk for osteoporotic fractures has been recommended. OBJECTIVE The aim of this study was to estimate the magnitude of association and quality of supporting evidence linking multiple risk factors with low bone mass-related fractures in men. DATA SOURCES We searched MEDLINE, EMBASE, Web of Science, SCOPUS and Cochrane CENTRAL through February 2010. We identified further studies by reviewing reference lists from selected studies and reviews. STUDY SELECTION Eligible studies had to enroll men and quantitatively evaluate the association of risk factors with low bone density-related fractures. DATA EXTRACTION Reviewers working independently and in duplicate determined study eligibility and extracted study description, quality, and outcome data. DATA SYNTHESIS Fifty-five studies provided data sufficient for meta-analysis. The quality of these observational studies was moderate with fair levels of multivariable adjustment and adequate exposure and outcome ascertainment. Statistically significant associations were established for age, low body mass index, current smoking, excessive alcohol use, chronic corticosteroid use, history of prior fractures, history of falls, history of hypogonadism, history of stroke, and history of diabetes. Statistical heterogeneity of the meta-analytic estimates of all associations was significant except for chronic corticosteroid use. None of these associations were of large magnitude (i.e. adjusted odds ratios were generally <2). No evidence supporting a particular effective testing or screening strategy was identified. CONCLUSIONS Multiple risk factors for fractures in men were identified, but their usefulness for stratifying and selecting men for bone density testing remains uncertain.
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Affiliation(s)
- Matthew T Drake
- College of Medicine, Mayo Clinic, The Knowledge and Evaluation Research Unit, Division of Endocrinology, Rochester, Minnesota 55905, USA.
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Biver E, Borg S, Chopin F, Hoppé E, Morel G, Cortet B. Male osteoporosis: Who should be treated and how? Joint Bone Spine 2011; 78 Suppl 2:S202-7. [DOI: 10.1016/s1297-319x(11)70005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cullen MW, Gullerud RE, Larson DR, Melton LJ, Huddleston JM. Impact of heart failure on hip fracture outcomes: a population-based study. J Hosp Med 2011; 6:507-12. [PMID: 22042721 PMCID: PMC3230699 DOI: 10.1002/jhm.918] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 01/22/2011] [Accepted: 02/21/2011] [Indexed: 01/29/2023]
Abstract
BACKGROUND Hip fracture and heart failure are becoming more prevalent conditions in hospitalized patients. Despite differences in postoperative outcomes from other intermediate risk procedures, guidelines classify hip fracture repair as an intermediate risk operation. OBJECTIVE This population-based study sought to examine the prevalence and incidence of heart failure in hip fracture patients. DESIGN, SETTING, AND PATIENTS We conducted a population-based historical cohort study of 1116 Olmsted County, MN residents undergoing 1212 hip surgeries from 1988 through 2002. Data were obtained through medical record review. Heart failure was defined by Framingham criteria. RESULTS The prevalence of preoperative heart failure in our study population was 27% (327 of 1212 cases). Those with preoperative heart failure demonstrated longer lengths of stay, were more often discharged to a skilled facility, and had higher inpatient mortality rates. Rates of postoperative heart failure were 6.7% at seven days and 21.3% at one year. Postoperative heart failure was more common among those with preoperative heart failure (HR 3.0), and those with preoperative heart failure demonstrated higher postoperative mortality rates. Men had a higher risk of postoperative mortality compared to women. Overall survival was lowest among those with both preoperative and postoperative heart failure. CONCLUSIONS Heart failure represents a common and serious perioperative condition in hip fracture patients. Hip fracture patients with and without heart failure carry higher postoperative risk than guidelines may suggest. Future work must focus on the perioperative management of hip fracture patients with and without heart failure to mitigate postoperative morbidity.
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Affiliation(s)
- Michael W Cullen
- College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen TV. Risk factors for in-hospital post-hip fracture mortality. Bone 2011; 49:553-8. [PMID: 21689802 DOI: 10.1016/j.bone.2011.06.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 04/22/2011] [Accepted: 06/02/2011] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Approximately 10% of hip fracture patients die during hospitalization; however, it is not clear what risk factors contribute to the excess mortality. This study sought to examine risk factors of, and to develop prognostic model for, predicting in-hospital mortality among hip fracture patients. METHODS We studied outcomes among 410 men and 1094 women with a hip fracture who were admitted to a major-teaching-hospital in Sydney (Australia) between 1997 and 2007. Clinical data, including concomitant illnesses, were obtained from inpatient data. The primary outcome of the study was in-hospital mortality regardless of length of stay. A Log-binomial regression model was used to identify risk factors for in-hospital mortality. Using the identified risk factors, prognostic nomograms were developed for predicting short term risk of mortality for an individual. RESULTS The median duration of hospitalization was 9 days. During hospitalization, the risk of mortality was higher in men (9%) than in women (4%). After adjusting for multiple risk factors, increased risk of in-hospital mortality was associated with advancing age (rate ratio [RR] for each 10-year increase in age: 1.91 95% confidence interval [CI]: 1.47 to 2.49), in men (RR 2.13; 95% CI 1.41 to 3.22), and the presence of comorbid conditions on admission (RR for one or more comorbid conditions vs. none: 2.30; 95% CI 1.52 to 3.48). Specifically, the risk of mortality was increased in patients with a pre-existing congestive heart failure (RR 3.02; 95% CI: 1.65 to 5.54), and liver disease (RR 4.75; 95% CI: 1.87 to 12.1). These factors collectively accounted for 69% of the risk for in-hospital mortality. A nomogram was developed from these risk factors to individualize the risk of in-hospital death following a hip fracture. The area under the receiver operating characteristic curve of the final model containing age, sex and comorbid conditions was 0.76. CONCLUSION These data suggest that among hip fracture patients, advancing age, gender (men), and pre-existing concomitant diseases such as congestive heart failure and liver disease were the main risk factors for in-hospital mortality. The nomogram developed from this study can be used to convey useful prognostic information to help guide treatment decisions.
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Affiliation(s)
- Steven A Frost
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, NSW, Australia.
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Ryan CS, Petkov VI, Adler RA. Osteoporosis in men: the value of laboratory testing. Osteoporos Int 2011; 22:1845-53. [PMID: 20936403 DOI: 10.1007/s00198-010-1421-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 09/13/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED Evaluation of 234 men referred for osteoporosis found many with undiagnosed secondary causes and multiple unrecognized risk factors. INTRODUCTION Studies in women with postmenopausal osteoporosis suggest that many have unrecognized disorders affecting bone. Men are considered more likely to have underlying, possibly correctable causes. We studied the prevalence of risk factors, secondary causes, and laboratory abnormalities in men with and without previously known causes for osteoporosis. METHODS We reviewed the charts of 234 men with osteoporosis diagnosed by bone mineral density testing. In addition to screening chemistries, 25-hydroxyvitamin D, testosterone, luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, and spot urinary calcium-to-creatinine ratio were measured. RESULTS The mean age was 70.6 years and mean weight was 76.4 kg. The mean T-score for spine, femoral neck, and forearm was -2.2, -2.4, and -2.3, respectively. Evaluation revealed secondary osteoporosis in 75% overall including hypogonadism, vitamin D deficiency, hypercalciuria, subclinical hyperthyroidism, and hyperparathyroidism. In those men with known secondary osteoporosis at the time of dual energy X-ray absorptiometry testing, additional diagnoses were found in just over half. Vitamin D deficiency and insufficiency were very common, and other common risk factors for osteoporosis included age >65, current smoking, and prior fracture. Half of the subjects had ≥ 4 risk factors. CONCLUSION Evaluation revealed a specific cause in about half of men thought to have primary osteoporosis. Among men with known secondary osteoporosis, additional risk factors and secondary causes were frequently identified. In conclusion, a relatively modest evaluation of men with osteoporosis will often provide useful information.
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Affiliation(s)
- C S Ryan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
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von Friesendorff M, McGuigan FE, Besjakov J, Åkesson K. Hip Fracture in Men-Survival and Subsequent Fractures: A Cohort Study with 22-Year Follow-Up. J Am Geriatr Soc 2011; 59:806-13. [DOI: 10.1111/j.1532-5415.2011.03399.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Marks R. Physical activity and hip fracture disability: a review. J Aging Res 2011; 2011:741918. [PMID: 21584248 PMCID: PMC3092612 DOI: 10.4061/2011/741918] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 11/11/2010] [Accepted: 01/28/2011] [Indexed: 01/08/2023] Open
Abstract
Objective. The present paper examines pertinent literature sources published in the peer-reviewed English language between 1980 and November 1, 2010 concerning hip fractures. The aim was to highlight potential intervention points to offset the risk of incurring a hip fracture and its attendant disability. Methods. An in-depth search of the literature using the key terms: disability, epidemiology, hip fracture, prevention, and risk factors was conducted, along with data from the author's research base detailing the disability associated with selected hip fracture cases. All articles that dealt with these key topics were reviewed, and relevant data were tabulated and analyzed. Results. Hip fractures remain an important but potentially preventable public health problem. Among the many related remediable risk factors, low physical activity levels are especially important. Related determinants of suboptimal neuromuscular function also contribute significantly to hip fracture disability. Conclusion. Physical activity participation can help to reduce the prevalence and excess disability of hip fractures and should be encouraged.
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Affiliation(s)
- Ray Marks
- Department of Health and Behavior Studies, Teachers College, Columbia University, Box 114, 525W 120th Street, New York, NY 10027, USA
- Gerontological Studies and Services, Department of Health and Physical Education, York College, City University of New York, New York, NY 10016-4309, USA
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McComsey GA, Tebas P, Shane E, Yin MT, Overton ET, Huang JS, Aldrovandi GM, Cardoso SW, Santana JL, Brown TT. Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clin Infect Dis 2011; 51:937-46. [PMID: 20839968 DOI: 10.1086/656412] [Citation(s) in RCA: 278] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected subjects. Initiation of antiretroviral therapy is associated with a 2%-6% decrease in BMD over the first 2 years, a decrease that is similar in magnitude to that sustained during the first 2 years of menopause. Recent studies have also described increased fracture rates in the HIV-infected population. The causes of low BMD in individuals with HIV infection appear to be multifactorial and likely represent a complex interaction between HIV infection, traditional osteoporosis risk factors, and antiretroviral-related factors. In this review, we make the point that HIV infection should be considered as a risk factor for bone disease. We recommend screening patients with fragility fractures, all HIV-infected post-menopausal women, and all HIV-infected men ⩾50 years of age. We also discuss the importance of considering secondary causes of osteoporosis. Finally, we discuss treatment of the more severe cases of bone disease, while outlining the caveats and gaps in our knowledge.
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Affiliation(s)
- Grace A McComsey
- Department of Pediatrics and Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
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Geusens P. Osteoporosis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Haentjens P, Magaziner J, Colón-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 2010. [PMID: 20231569 DOI: 10.1059/0003-4819-152-6-201003160-00008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although an increased risk for death after hip fracture is well established, whether this excess mortality persists over time is unclear. PURPOSE To determine the magnitude and duration of excess mortality after hip fracture in older men and women. DATA SOURCES Electronic search of MEDLINE and EMBASE for English and non-English articles from 1957 to May 2009 and manual search of article references. STUDY SELECTION Prospective cohort studies were selected by 2 independent reviewers. The studies had to assess mortality in women (22 cohorts) or men (17 cohorts) aged 50 years or older with hip fracture, carry out a life-table analysis, and display the survival curves of the hip fracture group and age- and sex-matched control groups. DATA EXTRACTION Survival curve data and items relevant to study validity and generalizability were independently extracted by 2 reviewers. DATA SYNTHESIS Time-to-event meta-analyses showed that the relative hazard for all-cause mortality in the first 3 months after hip fracture was 5.75 (95% CI, 4.94 to 6.67) in women and 7.95 (CI, 6.13 to 10.30) in men. Relative hazards decreased substantially over time but did not return to rates seen in age- and sex-matched control groups. Through use of life-table methods, investigators estimated that white women having a hip fracture at age 80 years have excess annual mortality compared with white women of the same age without a fracture of 8%, 11%, 18%, and 22% at 1, 2, 5, and 10 years after injury, respectively. Men with a hip fracture at age 80 years have excess annual mortality of 18%, 22%, 26%, and 20% at 1, 2, 5, and 10 years after injury, respectively. LIMITATIONS Cohort studies varied, sometimes markedly, in size, duration of observation, selection of control populations, ascertainment of death, and adjustment for comorbid conditions. Only published data that displayed findings with survival curves were examined. Publication bias was possible. CONCLUSION Older adults have a 5- to 8-fold increased risk for all-cause mortality during the first 3 months after hip fracture. Excess annual mortality persists over time for both women and men, but at any given age, excess annual mortality after hip fracture is higher in men than in women. PRIMARY FUNDING SOURCE Fund for Scientific Research and Willy Gepts Foundation, Universitair Ziekenhuis Brussel.
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Affiliation(s)
- Patrick Haentjens
- Centre for Outcomes Research and Laboratory for Experimental Surgery, Universitair Ziekenhuis Brussel, Jette, Vrije Universiteit Brussel, Elsene, Belgium.
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Haentjens P, Magaziner J, Colón-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 2010; 152:380-90. [PMID: 20231569 PMCID: PMC3010729 DOI: 10.7326/0003-4819-152-6-201003160-00008] [Citation(s) in RCA: 880] [Impact Index Per Article: 62.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Although an increased risk for death after hip fracture is well established, whether this excess mortality persists over time is unclear. PURPOSE To determine the magnitude and duration of excess mortality after hip fracture in older men and women. DATA SOURCES Electronic search of MEDLINE and EMBASE for English and non-English articles from 1957 to May 2009 and manual search of article references. STUDY SELECTION Prospective cohort studies were selected by 2 independent reviewers. The studies had to assess mortality in women (22 cohorts) or men (17 cohorts) aged 50 years or older with hip fracture, carry out a life-table analysis, and display the survival curves of the hip fracture group and age- and sex-matched control groups. DATA EXTRACTION Survival curve data and items relevant to study validity and generalizability were independently extracted by 2 reviewers. DATA SYNTHESIS Time-to-event meta-analyses showed that the relative hazard for all-cause mortality in the first 3 months after hip fracture was 5.75 (95% CI, 4.94 to 6.67) in women and 7.95 (CI, 6.13 to 10.30) in men. Relative hazards decreased substantially over time but did not return to rates seen in age- and sex-matched control groups. Through use of life-table methods, investigators estimated that white women having a hip fracture at age 80 years have excess annual mortality compared with white women of the same age without a fracture of 8%, 11%, 18%, and 22% at 1, 2, 5, and 10 years after injury, respectively. Men with a hip fracture at age 80 years have excess annual mortality of 18%, 22%, 26%, and 20% at 1, 2, 5, and 10 years after injury, respectively. LIMITATIONS Cohort studies varied, sometimes markedly, in size, duration of observation, selection of control populations, ascertainment of death, and adjustment for comorbid conditions. Only published data that displayed findings with survival curves were examined. Publication bias was possible. CONCLUSION Older adults have a 5- to 8-fold increased risk for all-cause mortality during the first 3 months after hip fracture. Excess annual mortality persists over time for both women and men, but at any given age, excess annual mortality after hip fracture is higher in men than in women. PRIMARY FUNDING SOURCE Fund for Scientific Research and Willy Gepts Foundation, Universitair Ziekenhuis Brussel.
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Affiliation(s)
- Patrick Haentjens
- Centre for Outcomes Research and Laboratory for Experimental Surgery, Universitair Ziekenhuis Brussel, Jette, Vrije Universiteit Brussel, Elsene, Belgium.
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Kanis JA, Johansson H, Oden A, McCloskey EV. Assessment of fracture risk. Eur J Radiol 2009; 71:392-7. [PMID: 19716672 DOI: 10.1016/j.ejrad.2008.04.061] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2008] [Accepted: 04/30/2008] [Indexed: 11/17/2022]
Abstract
Fractures are a common complication of osteoporosis. Although osteoporosis is defined by bone mineral density at the femoral neck, other sites and validated techniques can be used for fracture prediction. Several clinical risk factors contribute to fracture risk independently of BMD. These include age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis and the use of oral glucocorticoids. These risk factors in conjunction with BMD can be integrated to provide estimates of fracture probability using the FRAX tool. Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis.
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Affiliation(s)
- John A Kanis
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK.
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Greenlund LJS, Nair KS, Brennan MD. Changes in body composition in women following treatment of overt and subclinical hyperthyroidism. Endocr Pract 2009; 14:973-8. [PMID: 19095595 DOI: 10.4158/ep.14.8.973] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine changes in weight, body composition, and bone density after treatment of overt hyperthyroidism (OH) and subclinical hyperthyroidism (SCH) in women. METHODS Women with OH and SCH referred to the Mayo Clinic Thyroid Clinic were recruited. Hyperthyroid patients and euthyroid control women were matched for age (within decade) and body mass index. Patients with OH and SCH were treated to normalize thyroid function test results and were restudied after 6 months of normal thyroid function. Baseline and posttreatment studies included measurement of height, weight, bone density, lean mass, fat mass, and thigh muscle cross-sectional area. All participants had normal thyroid function test results for at least 6 months before completion of the posttreatment studies. RESULTS Twenty-four patients with OH, 21 patients with SCH, and 36 control patients were studied. In the OH group, fat-free mass increased from a mean of 36.8 kg (95% confidence interval [CI], 34.8-38.8) to 40.4 kg (95% CI, 38.5-42.3); in the SCH group, fat-free mass increased from a mean of 40.3 kg (95% CI, 38.1-42.5) to 42.2 kg (95% CI, 39.7-44.7). In both groups, fat mass increased to approximately the same extent, and both groups experienced significant weight gain with no change in percent body fat. Thigh muscle cross-sectional area increased in both groups -- from 100.6 cm(2) (95% CI, 92.7-108.5) to 113.3 cm(2) (95% CI, 105.5-121.1) in the OH group and from 106.1 cm(2) (95% CI, 96.7-115.5) to 112.2 cm(2) (95% CI, 102.0-122.4) in the SCH group. Bone density increased in patients with OH (P<.01) and in patients with SCH (P<.05). CONCLUSIONS Treatment of OH and SCH leads to increases in muscle area and bone density. Weight gain reflects increases in both fat and fat-free mass. While these results provide some support for actively treating SCH in women, further prospective studies are needed to determine whether the changes documented translate into real patient benefit.
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Affiliation(s)
- Laura J S Greenlund
- Division of Endocrinology, Endocrine Research Unit, Mayo Clinic, Rochester, MN 55905, USA
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Briot K, Cortet B, Trémollières F, Sutter B, Thomas T, Roux C, Audran M. Male osteoporosis: Diagnosis and fracture risk evaluation. Joint Bone Spine 2009; 76:129-33. [DOI: 10.1016/j.jbspin.2008.07.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2008] [Indexed: 11/17/2022]
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Abstract
Osteoporosis represents a major public health problem through its association with fragility fractures. All osteoporotic fractures increase patient morbidity; however, fractures of the hip and vertebrae are also linked with significant mortality. The public health burden of osteoporotic fracture is likely to rise in future generations, due in part to an increase in life expectancy. Understanding the epidemiology of this disease is therefore essential in trying to develop strategies to help reduce this load. This chapter will review the epidemiology of osteoporosis, including the relationship between low bone mass and fracture. It will review the epidemiology of fractures, concentrating on the sites where the majority of age-related fractures occur. Finally it will discuss new developments in the assessment of fracture risk.
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Affiliation(s)
- Christopher Holroyd
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK
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A Preliminary Study of the Effectiveness of an Otolaryngology-based Multidisciplinary Falls Prevention Clinic. EAR, NOSE & THROAT JOURNAL 2008. [DOI: 10.1177/014556130808700908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Because the cause of falls is often multifactorial, efforts to identify risk factors and promote prevention would benefit from a multidisciplinary approach in which the contributions of a broad range of body systems are considered. We describe the practices and procedures followed at the otolaryngology-based multidisciplinary Falls Prevention Clinic at Henry Ford Hospital in Detroit. Our team is made up of an otolaryngologist, an audiologist, an internist, and a physical therapist. Our multidisciplinary approach involves evaluations of vestibular and balance function, cardiovascular function, and visual function; lower-extremity strength and sensation; cognition and mood; and medication use. We also assess a number of nonmedical risk factors. Evaluations are made over the course of two clinic visits. To assess the effectiveness of our approach, we conducted a preliminary study based on chart reviews and telephone interviews of 52 patients who had been referred to our clinic for evaluation and counseling. The basis of our study was a comparison of the number of falls that patients had experienced during the 6 months prior to their first visit to our clinic and the number of falls they experienced during the 6 months after their second visit. We found that among “true fallers” (i.e., those who had actually experienced a fall at some point during the study), 64.7% reported that they had experienced fewer falls after their clinic visits than before (p < 0.001). Also, 59.1% of patients who had been “frequent fallers” prior to their clinic evaluation (i.e., ≥3 falls during the previous 6 mo) reported that they had not fallen at all during the 6 months following their last visit. Finally, our evaluations identified a substantial number of risk factors in individual patients that had been missed previously, including many nonvestibular factors that might not have been detected without a multidisciplinary approach. We conclude that the results of this preliminary study demonstrate the potential that a comprehensive falls prevention clinic can have in reducing the number of falls among outpatients at risk, and we believe that further study is warranted.
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Abstract
(1) While a number of medications have been shown to induce bone loss, the actual incidence and prevalence of medication-induced osteoporosis has not been well quantified. (2) Oral corticosteroids contribute to an increased prevalence of osteoporosis and an increased incidence of fracture in a number of different populations. The increased incidence of fracture in patients receiving inhaled corticosteroids for respiratory disease may be attributed to disease pathogenesis rather than the effects of medication. (3) Other therapies that increase the incidence and/or prevalence of medication-induced osteoporosis and fracture include androgen-deprivation therapy, aromatase inhibitors, protease inhibitors, selective serotonin reuptake inhibitors and prolactin-raising antiepileptic agents. (4) It is difficult to make definitive conclusions on the actual increase in the prevalence and/or incidence of osteoporosis in patients receiving certain medications, as values are often reported differently and studies are mainly retrospective and are therefore open to inherent selection biases and other confounders. Furthermore, there is little available information as to whether specific medications within a class are associated with a higher rate of bone disease than others.
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Al-oanzi ZH, Tuck SP, Mastana SS, Summers GD, Cook DB, Francis RM, Datta HK. Vitamin D-binding protein gene microsatellite polymorphism influences BMD and risk of fractures in men. Osteoporos Int 2008; 19:951-60. [PMID: 18038108 DOI: 10.1007/s00198-007-0516-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2007] [Accepted: 10/29/2007] [Indexed: 02/05/2023]
Abstract
UNLABELLED Here we report the results of a vitamin D-binding protein gene microsatellite polymorphism study in 170 men, comprising healthy male subjects and men with osteoporosis-related symptomatic vertebral fractures. We confirm the results of an earlier study in a different cohort, showing relationship between certain genotypes of (TAAAn)-Alu repeats and reduced BMD and vertebral fractures. INTRODUCTION Vitamin D-binding protein (DBP) plays a critical role in the transport and metabolism of metabolites of vitamin D, including the key calciotropic hormone 1alpha,25-dihydroxyvitamin D3 (1,25(OH)2D3). METHODS We have investigated intra-intronic variable tandem (TAAA)n-Alu repeat expansion in the DBP gene in 170 men, comprising healthy male subjects and men with idiopathic osteoporosis and low trauma fractures. RESULTS AND CONCLUSIONS The predominant DBP-Alu genotype in the control subjects was 10/10 (frequency 0.421), whereas the frequency of this genotype in men with osteoporosis was 0.089. DBP-Alu alleles *10, *8 and *9, respectively, were the three commonest in both healthy subjects and men with osteoporosis. Allele *10 was associated with a lower risk of osteoporosis (OR 0.39, 95% CI 0.25-0.64; p < 0.0005), as was allele *11 (odds ratio 0.09, 95% CI 0.01-0.67; p < 0.007). Logistic regression gave similar results, showing that individuals with genotype 10/10 and 19-20 repeats (genotypes 9/10, 9/11, 10/10,) are protected from fracture or osteoporosis. Overall, there was a relationship between DBP Alu genotype and BMD, suggesting that DBP-Alu genotype may influence fracture risk. This effect may be mediated by changes in the circulating concentrations of DBP which influences free concentrations of vitamin D.
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Affiliation(s)
- Z H Al-oanzi
- School of Clinical & Laboratory Sciences, The Medical School, University of Newcastle, Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
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Frazão P, Naveira M. [Factors associated with low bone mineral density among white women]. Rev Saude Publica 2008; 41:740-8. [PMID: 17923895 DOI: 10.1590/s0034-89102007000500008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 05/08/2007] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze whether the factors causing low bone mineral density among elderly women are the same as those observed in other age groups. METHODS A cross-sectional study was carried out on the medical records of a random sample of 413 white women seen at an imaging diagnostics service in a city of Southern Brazil, in 2003. Femoral bone mineral densities with adjustment using T-scores were used. The following variables were investigated: age, body mass index, tobacco smoking, alcohol consumption, milk consumption, physical activity and hormone replacement therapy. Univariate and multivariate unconditional logistic regression were used. RESULTS In the sample, 52.5% were up to 59 years old and 47.5% were 60 or over. The mean bone mineral density was 0.867 g/cm2 (SD=0.151) for the femoral neck. Significant age-adjusted values were obtained for physical activity (adjusted OR=0.47; 95% CI: 0.23;0.97), body mass index greater than or equal to 30.0 kg/m2 (adjusted OR=0.10; 95% CI: 0.05;0.21), alcohol consumption (adjusted OR=7.90; 95% CI: 2.17;28.75), low milk consumption (adjusted OR=3.29; 95% CI: 1.91;5.68) and hormone replacement (adjusted OR = 0.44; 95% CI: 0.21;0.90). Among the elderly women, body mass, milk consumption and physical activity were independent protection factors. CONCLUSIONS Advanced age, body mass, physical activity, milk and alcohol consumption were important factors in bone mass regulation. The influence of behavioral factors was maintained among the women of advanced aged, thus reinforcing the role of preventive measures in medical practice and public health promotion policies aimed at healthy aging.
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Affiliation(s)
- Paulo Frazão
- Programa de Pós-Graduação Mestrado em Saúde Coletiva, Universidade Católica de Santos, Santos, SP, Brasil.
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Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster JY, Borgstrom F, Rizzoli R. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2008; 19:399-428. [PMID: 18266020 PMCID: PMC2613968 DOI: 10.1007/s00198-008-0560-z] [Citation(s) in RCA: 604] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 11/20/2007] [Indexed: 02/06/2023]
Abstract
UNLABELLED Guidance is provided in a European setting on the assessment and treatment of postmenopausal women with or at risk from osteoporosis. INTRODUCTION The European Foundation for Osteoporosis and Bone disease (subsequently the International Osteoporosis Foundation) published guidelines for the diagnosis and management of osteoporosis in 1997. This manuscript updates these in a European setting. METHODS The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; monitoring of treatment; assessment of fracture risk; case finding strategies; investigation of patients; health economics of treatment. RESULTS AND CONCLUSIONS A platform is provided on which specific guidelines can be developed for national use.
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Affiliation(s)
- J A Kanis
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK.
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Szulc P, Kiel DP, Delmas PD. Calcifications in the abdominal aorta predict fractures in men: MINOS study. J Bone Miner Res 2008; 23:95-102. [PMID: 17892380 DOI: 10.1359/jbmr.070903] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED In a cohort of 781 men >or=50 yr of age followed up for 10 yr, extended calcifications in the abdominal aorta were associated with a 2- to 3-fold increase in the risk of osteoporotic fractures regardless of BMD and falls. INTRODUCTION Cardiovascular disease and osteoporotic fractures are public health problems that frequently coexist. MATERIALS AND METHODS We assessed the relation of the severity of aortic calcifications with BMD and the risk of fracture in 781 men >or=50 yr of age. During a 10-year follow-up, 66 men sustained incident clinical fractures. Calcifications in the abdominal aorta expressed as an aortic calcification score (ACS) were assessed by a semiquantitative method. BMD was measured at the lumbar spine, hip, whole body, and distal forearm. RESULTS ACS > 2 was associated with a 2-fold increase in the mortality risk after adjustment for age, weight, smoking, comorbidity, and medications. After adjustment for age, body mass index (BMI), smoking, and comorbidity, men in the highest quartile of ACS (>6) had lower BMD of distal forearm, ultradistal radius, and whole body than men in the lower quartiles. Log-transformed ACS predicted fractures when adjusted for age, BMI, age by BMI interaction, prevalent fractures, BMD, and history of two or more falls (e.g., hip BMD; OR = 1.44; p < 0.02). ACS, BMD at all the skeletal sites, and history of two or more falls were independent predictors of fracture. Men with ACS > 6 had a 2- to 3-fold increased risk of fracture after adjustment for confounding variables (OR = 2.54-3.04; p < 0.005-0.001 according to the site). CONCLUSIONS This long-term prospective study showed that elevated ACS (>6) is a robust and independent risk factor for incident fracture in older men regardless of age, BMI, BMD, prevalent fractures, history of two or more falls, comorbidities, and medications.
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Affiliation(s)
- Pawel Szulc
- INSERM Research Unit 831 and University of Lyon, Lyon, France.
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Abstract
Osteoporotic fractures represent a significant public health burden, which is set to increase in future generations. Lifetime risk is high and lies within the range of 40% to 50% in women and 13% to 22% in men. Life expectancy is increasing worldwide, and it is estimated that the number of individuals aged 65 years and older will increase from the current figure of 323 million to 1555 million by the year 2050. These demographic changes alone can be expected to cause the number of hip fractures occurring worldwide to increase from 1.66 million in 1990 to 6.26 million in 2050. Based on current trends, hip fracture rates might increase in the United Kingdom from 46,000 in 1985 to 117,000 in 2016. The societal cost of these fractures is high; cost-effectiveness analyses showed cost-effectiveness in treating high-risk patients with antiresorptive drugs, particularly if administered as soon as possible after a first fragility fracture.
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Affiliation(s)
- Elaine Dennison
- MRC Epidemiology Resource Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom.
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Vestergaard P. Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes--a meta-analysis. Osteoporos Int 2007; 18:427-44. [PMID: 17068657 DOI: 10.1007/s00198-006-0253-4] [Citation(s) in RCA: 1245] [Impact Index Per Article: 73.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 10/06/2006] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Diabetes affects bone metabolism. The hypothesis was that type 1 (T1D) and type 2 (T2D) affects BMD and fracture risk differently. MATERIAL AND METHODS Pubmed, Embase, and Web of Science were searched using the terms "diabetes", "fracture", and "bone mineral". RESULTS Hip fracture risk was increased in T1D (RR = 6.94, 95% CI: 3.25-14.78, five studies) and T2D (1.38, 95% CI: 1.25-1.53, eight studies) compared to subjects without diabetes. The increase in relative hip fracture risk was significantly higher in T1D than in T2D. BMD Z-score was decreased in the spine (mean +/- SEM -0.22 +/- 0.01) and hip (-0.37 +/- 0.16) in T1D and increased in the spine (0.41 +/- 0.01) and hip (0.27 +/- 0.01) in T2D. A meta-regression showed that body mass index (BMI) was a major determinant for BMD in both the spine and hip. Glycated haemoglobin (HbA1C) was not linked to BMD. The increase in fracture risk was higher and BMD lower in patients with complications to diabetes. CONCLUSIONS Hip fracture risk is increased in both T1D and T2D, whereas BMD is increased in T2D and decreased in T1D. A common factor such as complications may explain the increase in fracture risk, whereas BMI may ameliorate the increase in fracture risk in T2D.
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Affiliation(s)
- P Vestergaard
- The Osteoporosis Clinic, Aarhus Amtssygehus, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark.
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Takkouche B, Montes-Martínez A, Gill SS, Etminan M. Psychotropic medications and the risk of fracture: a meta-analysis. Drug Saf 2007; 30:171-84. [PMID: 17253881 DOI: 10.2165/00002018-200730020-00006] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Older adults throughout the developed world are at significant risk of osteoporotic fractures. Many studies have examined the relationship between the use of psychotropic medications and the risk of fractures, but these studies have reported conflicting results. PURPOSE To resolve discrepancies, we carried out a meta-analysis to assess the risk of fractures among users of several classes of psychotropic drugs. DATA SOURCES We retrieved studies published in any language by systematically searching MEDLINE, LILACS, EMBASE and ISI Proceedings databases and by manually examining the bibliographies of the articles retrieved electronically as well as those of recent reviews. STUDY SELECTION We included 98 cohort and case-control studies, published in 46 different articles, that reported relative risk (RR) estimates and confidence intervals (CIs) or sufficient data to calculate these values. DATA SYNTHESIS Study-specific RRs were weighted by the inverse of their variance to obtain fixed- and random effects pooled estimates. The random effects RR of fractures was 1.34 (95% CI 1.24, 1.45) for benzodiazepines (23 studies), 1.60 (95% CI 1.38, 1.86) for antidepressants (16 studies), 1.54 (95% CI 1.24, 1.93) for non-barbiturate antiepileptic drugs (13 studies), 2.17 (95% CI 1.35, 3.50) for barbiturate antiepileptic drugs (five studies), 1.59 (1.27, 1.98) for antipsychotics (12 studies), 1.15 (95% CI 0.94, 1.39) for hypnotics (13 studies) and 1.38 (95% CI 1.15, 1.66) for opioids (six studies). For non-specified psychotropic drugs (10 studies), the pooled RR was 1.48 (95% CI 1.41, 1.59). LIMITATIONS Main concerns were the potential for residual confounding and for publication bias. CONCLUSION Globally, the increase in the risk of fractures among psychotropic drug users is moderate. Further research is needed, especially to examine high-risk populations and newer medications. Future studies should be prospective and emphasise control of confounding bias.
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Affiliation(s)
- Bahi Takkouche
- Department of Preventive Medicine, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.
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Boonen S, Kaufman JM, Goemaere S, Bouillon R, Vanderschueren D. The diagnosis and treatment of male osteoporosis: Defining, assessing, and preventing skeletal fragility in men. Eur J Intern Med 2007; 18:6-17. [PMID: 17223036 DOI: 10.1016/j.ejim.2006.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 09/05/2006] [Accepted: 09/19/2006] [Indexed: 12/25/2022]
Abstract
Male osteoporosis is associated with a significant burden in terms of morbidity, mortality, and economic cost. Despite recent advances in the understanding of the male osteoporotic syndrome, the evaluation and treatment of men suffering from osteoporosis remains a clinical challenge. In men with osteoporosis, it remains particularly critical to exclude underlying pathological causes as these are much more likely to be present than in women. There is increasing evidence that the approaches developed to diagnose and treat the disorder in women may be equally useful in men. The available evidence suggests that the anti-fracture efficacy of treatment with alendronate, risedronate, or teriparatide is similar in both sexes. Additional research is warranted to prospectively address the usefulness of BMD measurements to predict fracture risk, to identify those men who are likely to benefit the most from therapy, and to monitor individual responses to therapy.
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Affiliation(s)
- Steven Boonen
- Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; The Leuven University Department of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; The Leuven University Laboratory for Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
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Abstract
BACKGROUND Little attention has been paid to the problem of male osteoporosis in Saudi Arabia. In this prospective study we assessed the prevalence of male osteoporosis among Saudi Arabs. SUBJECTS AND METHODS We studied Saudi Arabian males >50 years of age attending outpatient clinics at King Fahd Hospital of the University, Al-Khobar, between 1 May 2005 and 30 January 2006. We determined body mass index (BMI) and tests were done to rule out secondary osteoporosis. All subjects had a bone mineral density (BMD) measurement of the hip area and the lumbar spine using dual energy X-ray absorptiometry (DEXA). A T-score of < or = -2.5 SD that of young, healthy adults was taken as osteoporotic and scores between -1 to -2.5 SD were taken as osteopenic. RESULTS One hundred fifteen patients (mean age, 61.8+/-0.75 years; range, 50 to 76 years) had a mean BMI of 24.7+/-0.35 (range, 18.5 to 31). Based on hip scans, the prevalence of osteoporosis was 24.3%. Sixty- four percent were osteopenic. Based on scans of the lumbar spine, the prevalence of osteoporosis was 37.4% and 33.9% were osteopenic. Spinal osteoporosis was more common than hip osteoporosis. CONCLUSIONS Our study indicates that the prevalence of osteoporosis among Saudi Arabian males is higher than among Western males. More studies are needed to determine the national prevalence of male osteoporosis. It is recommended that serious measures to be undertaken to prevent male osteoporosis to stop any future epidemic of catastrophic osteoporosis-related fractures.
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Affiliation(s)
- Mir Sadat-Ali
- College of Medicine, King Fasial University, King Fahd University Hospital, Al-Khobar, Saudi Arabia.
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Fried LF, Shlipak MG, Stehman-Breen C, Mittalhenkle A, Seliger S, Sarnak M, Robbins J, Siscovick D, Harris TB, Newman AB, Cauley JA. Kidney function predicts the rate of bone loss in older individuals: the Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2006; 61:743-8. [PMID: 16870638 DOI: 10.1093/gerona/61.7.743] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Results of cross-sectional analyses of the association of kidney function with bone mineral density (BMD) have been conflicting. We examined the association of cystatin-C, a new marker of kidney function that is unrelated to lean mass, with initial and follow-up BMD, in an ancillary study of the Cardiovascular Health Study, a population-based cohort of individuals > or = 65 years old. METHODS Two years after measurement of cystatin-C and other covariates, the first BMD was measured in Pittsburgh, Pennsylvania and Davis, California, by using dual energy x-ray absorptiometry. Follow-up BMD was measured in Pittsburgh 4 years later. Associations of cystatin-C with initial BMD and the change in BMD (%/y) at the hip were examined with linear regression. Analyses were conducted separately for men and women. RESULTS In 1519 participants who had cystatin-C and initial BMD assessed, 614 had follow-up BMD. The percent annual change in BMD at the total hip by cystatin-C quartiles was -0.24, -0.13, -0.40, and -0.66%/y (first to fourth quartile) in women and -0.02, -0.30, -0.18, and -0.94%/y in men. After adjusting for potential confounders, cystatin-C was marginally associated with initial BMD in men but not women. Cystatin-C was associated with bone loss in men; after adjustment for weight loss, cystatin-C was not associated with bone loss in women. CONCLUSION Kidney dysfunction, as assessed by cystatin-C, is associated with a more rapid loss of BMD at the hip, especially in men. Further studies are needed to confirm these findings and to determine whether this loss leads to an elevated risk of fracture.
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Affiliation(s)
- Linda F Fried
- VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA.
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Jadoul M, Albert JM, Akiba T, Akizawa T, Arab L, Bragg-Gresham JL, Mason N, Prutz KG, Young EW, Pisoni RL. Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2006; 70:1358-66. [PMID: 16929251 DOI: 10.1038/sj.ki.5001754] [Citation(s) in RCA: 336] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The available data on bone fractures in hemodialysis (HD) patients are limited to results of a few studies of subgroups of patients in the United States. This study describes the prevalence of hip fractures and the incidence and risk factors associated with hip and other fractures in representative groups of HD facilities (n=320) and patients (n=12 782) from the 12 countries in the second phase of the Dialysis Outcomes and Practice Patterns Study (2002-2004). Among prevalent patients, 2.6% had a prior hip fracture. The incidence of fractures was 8.9 per 1000 patient years for new hip fractures and 25.6 per 1000 for any new fracture. Older age (relative risk (RR)(HIP)=1.91, RR(ANY)=1.33, P<0.0001), female sex (RR(HIP)=1.41, P=0.02; RR(ANY)=1.59, P<0.0001), prior kidney transplant (RR(HIP)=2.35, P=0.04; RR(ANY)=1.76, P=0.007), and low serum albumin (RR(HIP)=1.85, RR(ANY)=1.45, per 1 g/dl lower, P<0.0001) were predictive of new fractures. Elevated risk of new hip fracture was observed for selective serotonin reuptake inhibitors and combination narcotic medications (RR=1.63, RR=1.74, respectively, P<0.05). Several medications were associated with risk of any new fracture: narcotic pain medications (RR=1.67, P=0.02), benzodiazepines (RR=1.31, P=0.03), adrenal cortical steroids (RR=1.40, P<0.05), and combination narcotic medications (RR=1.72, P=0.001). Parathyroid hormone (PTH) levels >900 pg/ml were associated with an elevated risk of any new fracture (RR=1.72, P<0.05) versus PTH 150-300. The results suggest that greater selectivity in prescribing several classes of psychoactive drugs and more efficient treatment of secondary hyperparathyroidism may help reduce the burden of fractures in HD patients.
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Affiliation(s)
- M Jadoul
- Department of Nephrology, Clin. St-Luc, Université catholique de Louvain, Brussels, Belgium.
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Kenny AM, Waynik IY, Smith J, Fortinsky R, Kleppinger A, McGee D. Association between level of frailty and bone mineral density in community-dwelling men. J Clin Densitom 2006; 9:309-14. [PMID: 16931349 DOI: 10.1016/j.jocd.2006.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Revised: 03/06/2006] [Accepted: 03/17/2006] [Indexed: 11/28/2022]
Abstract
The goal of this study is to determine the associations between the components of a frailty definition and bone mineral density (BMD) in older men. A total of 392 community dwelling men (age range: 58-95 yr) with a mean age of 73+/-8 yr were evaluated. Femoral neck BMD T-scores ranged from -5.78 to +2.50, with 48.7% who had T-scores between -1 and -2.5 (low bone mass) and 8.7% who had T scores < or = -2.5 (osteoporosis). Participants were characterized as normal (39%), intermediate (55%), or frail (6%). Hand grip strength was 31.5+/-9.1 kg in those with normal BMD compared with 26.5+/-7.9 kg in those with osteoporotic BMD (p=0.0026). Walk speed (8 ft) was 2.32+/-0.49 s in those with normal BMD compared with 2.87+/-1.30 s with osteoporotic BMD (p=0.0015). Femoral neck T-score declined significantly with increasing level of frailty (p=0.014), but significance of decline was lost when corrected for age. Increasing frailty was associated with lower femoral neck BMD, although the association was not independent of age. Two components of the frailty model (i.e., hand grip strength and walking speed) were independently associated with lower femoral neck BMD, a finding that has not previously been reported in men.
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Affiliation(s)
- Anne M Kenny
- University of Connecticut Center on Aging, Farmington, CT 06030-5215, USA.
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44
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Abstract
Osteofragility fractures occur in men due to a compromise in bone strength, coupled with either trauma or a fall. In men >or= 65years of age, osteoporosis can be defined as bone mineral density (at the proximal femur, spine or distal forearm) of 2.5 standard deviations or less below the mean for a normal young adult man, using a male reference database (i.e., T-score value of <or=-2.5) [1,2]. In men 50 - 65 years of age, a similar definition is used if other risk factors for a fracture are present. Osteoporosis is increasingly recognised in men [3-11]. One in three men aged > 60 years will suffer an osteoporotic fracture [3]. Spinal fractures occur in 5% of men (compared with 16% of women) and hip fractures in 6% of men (compared with 18% of women) > 50 years of age [8]. The risk of hip fracture increases by approximately 2.6-fold for each standard deviation decrease in bone density measured at the hip [12,13]. At present, the life expectancy for men has increased to a mean age of 76.8 years. With men now living longer, they can be expected to develop multiple coexisting illnesses contributing to bone loss and an increased likelihood of falling and fragility fractures [5,14,15]. It is estimated that 30 - 60% of men presenting with spinal fractures have another illness contributing to their bone disease [4,6-10,16-20]. The ideal therapy for men with osteoporosis should include an intervention which significantly increases bone strength and reduces fracture rates, is safe, easy to administer and economical. This review outlines the current treatment strategies available for men with osteoporosis.
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Affiliation(s)
- Terrence H Diamond
- University of New South Wales, St George Hospital Campus, Sydney, NSW 2217, Australia.
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Bagaria V, Modi N, Panghate A, Vaidya S. Incidence and risk factors for development of venous thromboembolism in Indian patients undergoing major orthopaedic surgery: results of a prospective study. Postgrad Med J 2006; 82:136-9. [PMID: 16461477 PMCID: PMC2596707 DOI: 10.1136/pgmj.2005.034512] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The incidence of venous thromboembolism (VTE) in Western populations undergoing major orthopaedic surgery without any thromboprophylaxis has been reported to range from 32% to 88%. There is however limited information on incidence of VTE in Indian patients and most of the Indian patients undergoing these surgeries do not receive any form of prophylaxis regardless of their risk profile. METHODS A prospective study was performed on 147 patients undergoing major orthopaedic surgery for total knee replacement (TKR), total hip replacement (THR), and proximal femur fracture fixation (PFF) without any prophylaxis. These patients were profiled for presence of the known risk factors responsible for development of VTE. A duplex ultrasound on both lower limbs was done 6 to 10 days after surgery. Twenty three patients underwent THR, 22 patients underwent TKR, and 102 underwent surgery for PFF. The patients were assessed clinically for any signs of deep venous thrombosis (DVT) and pulmonary embolism (PE). A helical CT scan was done in case of suspicion of PE and a duplex ultrasound was done in case of clinical suspicion of DVT irrespective of the stage of study. RESULTS The overall incidence of VTE was 6.12% and that of PE was 0.6%. The risk factors that were found to be significantly responsible for development of VTE (p < 0.05) were: immobility greater than 72 hours, malignancy, obesity, surgery lasting more than two hours. CONCLUSION The study reconfirms the belief that DVT has a lower incidence in Indian patients as compared with other ethnic groups.
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Affiliation(s)
- V Bagaria
- Department of Orthopaedics, KEM Hospital, Parel, Mumbai, India 400013.
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Abstract
Osteoporosis and related fractures represent a major, and growing, public health concern for the United States and worldwide. The pathogenesis of osteoporosis is complex, requiring attention to the different life phases involved in growth, maintenance, and loss of bone, in addition to non-skeletal factors associated with falls and fractures. While the current clinical definition is based upon bone density measurements, other determinants of skeletal strength, particularly bone quality, are important to identify for future areas of research and prevention efforts. This epidemiologic review describes the definition, pathogenesis, and risk factors, as well as the frequency and impact of osteoporosis, with particular emphasis upon hip fracture.
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Affiliation(s)
- Elizabeth J Samelson
- Institute for Aging Research, Hebrew Senior Life, Harvard Medical School, 1200 Centre Street, Boston, MA 02131, USA.
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47
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Abstract
The role of the immune system in the development of senile osteoporosis, which arises primarily through the effects of estrogen deficiency and secondary hyperparathyroidism, is slowly being unraveled. This review focuses on our current understanding of how the components of this complex-interlinked system are regulated and how these fit with previous models of senile and postmenopausal osteoporosis. There is certainly substantial evidence that bone remodeling is a tightly regulated, finely balanced process influenced by subtle changes in proinflammatory and inhibitory cytokines as well as hormones and cellular components that act primarily but not exclusively through the receptor activator of nuclear factor-kappaB (RANK)/RANK ligand/osteoprotegerin system. In addition, an acute or chronic imbalance in the system due to infection or inflammation could contribute to systemic (or local) bone loss and increase the risk of fracture. Although significant progress has been made, there remains much to be done in unraveling this complex interaction between the immune system and bone.
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Affiliation(s)
- Jackie A Clowes
- Mayo Clinic College of Medicine, Endocrine Research Unit, St Mary's Hospital, Rochester, MN 55905, USA.
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48
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Melton LJ, Leibson CL, Achenbach SJ, Bower JH, Maraganore DM, Oberg AL, Rocca WA. Fracture risk after the diagnosis of Parkinson's disease: Influence of concomitant dementia. Mov Disord 2006; 21:1361-7. [PMID: 16703587 DOI: 10.1002/mds.20946] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In an inception cohort of 196 Olmsted County, Minnesota, residents with Parkinson's disease (PD) first recognized in 1976 to 1995, we tested whether the increased risk of bone fractures is associated with concomitant dementia. Using the data resources of the Rochester Epidemiology Project, information about PD, dementia, other clinical risk factors for fracture and fracture events was obtained from review of complete inpatient and outpatient medical records spanning each subject's residence in the community. Compared to an equal number of age- and sex-matched non-PD referent subjects from the community, PD patients were at a 2.2-fold increased risk of fractures generally and a 3.2-fold greater risk of hip fractures specifically. Adjusting for age, the independent predictors of overall fracture risk in the PD subjects included female sex (hazard ratio [HR] 1.6; 95% confidence interval [CI], 1.1-2.3), dementia (HR, 1.6; 95% CI, 1.1-2.4) and chronic depression, which was associated with a reduced risk (HR, 0.4; 95% CI, 0.2-0.8). Hip fractures were predicted by dementia (HR, 2.2; 95% CI, 1.2-4.1). The increased fracture risk in patients with PD is not entirely explained by concomitant dementia, and additional study is needed to determine the relative contributions to fracture risk of falls versus bone loss in these patients.
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Affiliation(s)
- L Joseph Melton
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Cauley JA, Fullman RL, Stone KL, Zmuda JM, Bauer DC, Barrett-Connor E, Ensrud K, Lau EMC, Orwoll ES. Factors associated with the lumbar spine and proximal femur bone mineral density in older men. Osteoporos Int 2005; 16:1525-37. [PMID: 15889316 DOI: 10.1007/s00198-005-1866-8] [Citation(s) in RCA: 180] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Accepted: 02/01/2005] [Indexed: 11/24/2022]
Abstract
Bone mass is a major determinant of fracture, but there have been few comprehensive studies of the correlates of bone mineral density (BMD) in older men. The objective of the current cross-sectional analysis was to determine the factors associated with BMD of the lumbar spine and proximal femur in a large population-based sample of older men enrolled in The Osteoporotic Fractures in Men Study, "Mr.OS." We enrolled 5,995 men 65 years of age or older, 89% Caucasian, in Mr.OS at six US clinical centers. Demographic, medical and family history and lifestyle information was obtained by interview and physical function and anthropometric data by examination. Spine and hip BMD was measured using dual-energy X-ray absorptimetry. The multivariable linear regression models predicted 19 and 10% of the overall variance in BMD of the femoral neck and spine, respectively. African-American men had 6 to 11% higher BMD than Caucasian men independent of multiple factors. Hip BMD declined with advancing age, while spine BMD increased. Body weight (per 10 kg) and self report of diabetes were each associated with 2 to 4% higher BMD, while history of a non-trauma fracture and current use of selective serotonin reuptake inhibitors, but not other antidepressants, were associated with at least 4% lower BMD. Both maternal and paternal histories of fracture were associated with 1.4-1.7% lower BMD. Osteoarthritis, physical activity, grip strength, alcohol intake, and dietary calcium were positively related to BMD, while a history of chronic lung disease, prostate cancer, and kidney stones was associated with lower BMD. Smoking, caffeine intake, and thiazide diuretics were not related to BMD in older men. A number of lifestyle and behavioral characteristics and medical conditions were associated with BMD in older men. Identification of these correlates could improve methods to identify men at risk for fracture and improve our understanding of fracture etiology.
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Affiliation(s)
- Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A524, Pittsburgh, PA 15261, USA.
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Dukas L, Schacht E, Stähelin HB. In elderly men and women treated for osteoporosis a low creatinine clearance of <65 ml/min is a risk factor for falls and fractures. Osteoporos Int 2005; 16:1683-90. [PMID: 15933802 DOI: 10.1007/s00198-005-1903-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Accepted: 03/21/2005] [Indexed: 11/26/2022]
Abstract
Recently, a low creatinine clearance (CrCl) of < 65 ml/min was described as a new significant and independent risk factor for the number of fallers and falls in a community-dwelling elderly population. In this study we investigated if a low creatinine clearance of < 65 ml/min is also a risk factor for falls and fractures in elderly men and women treated for osteoporosis. In a cross-sectional study with the help of questionnaires we assessed the prevalence of having experienced falls within the last 12 months according to renal function in 5,313 German men and women receiving treatment for osteoporosis. The CrCl was calculated using the established Cockcroft-Gault formula. The prevalence of falls and fractures was assessed in multivariate-controlled logistic regression models according to a CrCl cut off of 65 ml/min. The P-values were two-sided. In this study of elderly men and women treated for osteoporosis (n=5,313), 60.9% (n=3,238) had a CrCl of < 65 ml/min, which was associated in multivariate controlled analyses, compared to a CrCl of > or = 65 ml/min (n=2,075), with a significant increased risk of experiencing falls (1,775/3,238 vs. 773/2,075, OR 1.69, 95% CI 1.50-1.91, P<0.0001) and an increased risk for multiple falls (37.1 vs. 22.6%, OR 1.63, 95% CI 1.42-1.87, P<0.0001). Furthermore, compared to a creatinine clearance of > or = 65 ml/min, a creatinine clearance of < 65 ml/min was also associated with a significant increased multivariate controlled risk for hip fractures (OR 1.57, 95%CI 1.18-2.09, P=0.002), for radial fractures (OR 1.79, 95%CI 1.39-2.31, P=<0.0001), for total vertebral fractures (OR 1.31, 95%CI 1.19-1.55, P=0.003) and for fall-associated vertebral fractures (OR 1.24, 95% CI 1.03-1.54, P=0.031). Similar to community-dwelling elderly, in elderly men and women treated for osteoporosis a CrCl of less than 65 ml/min is a significant and independent risk factor for falls. Furthermore, we could show for the first time that a low creatinine clearance in elderly men and women treated for osteoporosis is also associated with a significantly increased risk of vertebral, hip and radial fractures.
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Affiliation(s)
- Laurent Dukas
- Geriatric University Clinic, Kantonsspital, Basel, Switzerland.
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