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Sahota O, Narayanasamy M, Bastounis A, Paskins Z, Bishop S, Langley T, Gittoes N, Davis S, Baily A, Holmes M, Leonardi-Bee J. Bisphosphonate alternative regimens for the prevention of osteoporotic fragility fractures: BLAST-OFF, a mixed-methods study. Health Technol Assess 2024; 28:1-169. [PMID: 38634483 PMCID: PMC11056815 DOI: 10.3310/wypf0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Background Bisphosphonates are a class of medication commonly used to treat osteoporosis. Alendronate is recommended as the first-line treatment; however, long-term adherence (both treatment compliance and persistence) is poor. Alternative bisphosphonates are available, which can be given intravenously and have been shown to improve long-term adherence. However, the most clinically effective and cost-effective alternative bisphosphonate regimen remains unclear. What is the most cost-effective bisphosphonate in clinical trials may not be the most cost-effective or acceptable to patients in everyday clinical practice. Objectives 1. Explore patient, clinician and stakeholder views, experiences and preferences of alendronate compared to alternative bisphosphonates. 2. Update and refine the 2016 systematic review and cost-effectiveness analysis of bisphosphonates, and estimate the value of further research into their benefits. 3. Undertake stakeholder/consensus engagement to identify important research questions and further rank research priorities. Methods The study was conducted in two stages, stages 1A and 1B in parallel, followed by stage 2: • Stage 1A - we elicited patient and healthcare experiences to understand their preferences of bisphosphonates for the treatment of osteoporosis. This was undertaken by performing a systematic review and framework synthesis of qualitative studies, followed by semistructured qualitative interviews with participants. • Stage 1B - we updated and expanded the existing Health Technology Assessment systematic review and clinical and cost-effectiveness model, incorporating a more comprehensive review of treatment efficacy, safety, side effects, compliance and long-term persistence. • Stage 2 - we identified and ranked further research questions that need to be answered about the effectiveness and acceptability of bisphosphonates. Results Patients and healthcare professionals identified a number of challenges in adhering to bisphosphonate medication, balancing the potential for long-term risk reduction against the work involved in adhering to oral alendronate. Intravenous zoledronate treatment was generally more acceptable, with such regimens perceived to be more straightforward to engage in, although a portion of patients taking alendronate were satisfied with their current treatment. Intravenous zoledronate was found to be the most effective, with higher adherence rates compared to the other bisphosphonates, for reducing the risk of fragility fracture. However, oral bisphosphonates are more cost-effective than intravenous zoledronate due to the high cost of zoledronate administration in hospital. The importance of including patients and healthcare professionals when setting research priorities is recognised. Important areas for research were related to patient factors influencing treatment selection and effectiveness, how to optimise long-term care and the cost-effectiveness of delivering zoledronate in an alternative, non-hospital setting. Conclusions Intravenous zoledronate treatment was generally more acceptable to patients and found to be the most effective bisphosphonate and with greater adherence; however, the cost-effectiveness relative to oral alendronate is limited by its higher zoledronate hospital administration costs. Future work Further research is needed to support people to make decisions influencing treatment selection, effectiveness and optimal long-term care, together with the clinical and cost-effectiveness of intravenous zoledronate administered in a non-hospital (community) setting. Limitations Lack of clarity and limitations in the many studies included in the systematic review may have under-interpreted some of the findings relating to effects of bisphosphonates. Trial registration This trial is registered as ISRCTN10491361. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127550) and is published in full in Health Technology Assessment; Vol. 28, No. 21. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Opinder Sahota
- Department of Health Care for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Zoe Paskins
- School of Medicine, Keele University and Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK
| | - Simon Bishop
- Business School, University of Nottingham, Nottingham, UK
| | - Tessa Langley
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Neil Gittoes
- Centre for Endocrinology Diabetes and Metabolism, University of Birmingham, Birmingham, UK
| | - Sarah Davis
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ann Baily
- Lay Member, Nottingham Osteoporosis Society Patient Support group, Nottingham, UK
| | - Moira Holmes
- Lay Member, Nottingham Osteoporosis Society Patient Support group, Nottingham, UK
| | - Jo Leonardi-Bee
- School of Medicine, University of Nottingham, Nottingham, UK
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Guthrie B, Rogers G, Livingstone S, Morales DR, Donnan P, Davis S, Youn JH, Hainsworth R, Thompson A, Payne K. The implications of competing risks and direct treatment disutility in cardiovascular disease and osteoporotic fracture: risk prediction and cost effectiveness analysis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-275. [PMID: 38420962 DOI: 10.3310/kltr7714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Background Clinical guidelines commonly recommend preventative treatments for people above a risk threshold. Therefore, decision-makers must have faith in risk prediction tools and model-based cost-effectiveness analyses for people at different levels of risk. Two problems that arise are inadequate handling of competing risks of death and failing to account for direct treatment disutility (i.e. the hassle of taking treatments). We explored these issues using two case studies: primary prevention of cardiovascular disease using statins and osteoporotic fracture using bisphosphonates. Objectives Externally validate three risk prediction tools [QRISK®3, QRISK®-Lifetime, QFracture-2012 (ClinRisk Ltd, Leeds, UK)]; derive and internally validate new risk prediction tools for cardiovascular disease [competing mortality risk model with Charlson Comorbidity Index (CRISK-CCI)] and fracture (CFracture), accounting for competing-cause death; quantify direct treatment disutility for statins and bisphosphonates; and examine the effect of competing risks and direct treatment disutility on the cost-effectiveness of preventative treatments. Design, participants, main outcome measures, data sources Discrimination and calibration of risk prediction models (Clinical Practice Research Datalink participants: aged 25-84 years for cardiovascular disease and aged 30-99 years for fractures); direct treatment disutility was elicited in online stated-preference surveys (people with/people without experience of statins/bisphosphonates); costs and quality-adjusted life-years were determined from decision-analytic modelling (updated models used in National Institute for Health and Care Excellence decision-making). Results CRISK-CCI has excellent discrimination, similar to that of QRISK3 (Harrell's c = 0.864 vs. 0.865, respectively, for women; and 0.819 vs. 0.834, respectively, for men). CRISK-CCI has systematically better calibration, although both models overpredict in high-risk subgroups. People recommended for treatment (10-year risk of ≥ 10%) are younger when using QRISK-Lifetime than when using QRISK3, and have fewer observed events in a 10-year follow-up (4.0% vs. 11.9%, respectively, for women; and 4.3% vs. 10.8%, respectively, for men). QFracture-2012 underpredicts fractures, owing to under-ascertainment of events in its derivation. However, there is major overprediction among people aged 85-99 years and/or with multiple long-term conditions. CFracture is better calibrated, although it also overpredicts among older people. In a time trade-off exercise (n = 879), statins exhibited direct treatment disutility of 0.034; for bisphosphonates, it was greater, at 0.067. Inconvenience also influenced preferences in best-worst scaling (n = 631). Updated cost-effectiveness analysis generates more quality-adjusted life-years among people with below-average cardiovascular risk and fewer among people with above-average risk. If people experience disutility when taking statins, the cardiovascular risk threshold at which benefits outweigh harms rises with age (≥ 8% 10-year risk at 40 years of age; ≥ 38% 10-year risk at 80 years of age). Assuming that everyone experiences population-average direct treatment disutility with oral bisphosphonates, treatment is net harmful at all levels of risk. Limitations Treating data as missing at random is a strong assumption in risk prediction model derivation. Disentangling the effect of statins from secular trends in cardiovascular disease in the previous two decades is challenging. Validating lifetime risk prediction is impossible without using very historical data. Respondents to our stated-preference survey may not be representative of the population. There is no consensus on which direct treatment disutilities should be used for cost-effectiveness analyses. Not all the inputs to the cost-effectiveness models could be updated. Conclusions Ignoring competing mortality in risk prediction overestimates the risk of cardiovascular events and fracture, especially among older people and those with multimorbidity. Adjustment for competing risk does not meaningfully alter cost-effectiveness of these preventative interventions, but direct treatment disutility is measurable and has the potential to alter the balance of benefits and harms. We argue that this is best addressed in individual-level shared decision-making. Study registration This study is registered as PROSPERO CRD42021249959. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/12/22) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 4. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Bruce Guthrie
- Advanced Care Research Centre, Centre for Population Health Sciences, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Gabriel Rogers
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Shona Livingstone
- Population Health and Genomics Division, University of Dundee, Dundee, UK
| | - Daniel R Morales
- Population Health and Genomics Division, University of Dundee, Dundee, UK
| | - Peter Donnan
- Population Health and Genomics Division, University of Dundee, Dundee, UK
| | - Sarah Davis
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Rob Hainsworth
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Alexander Thompson
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Joeris A, Sprague S, Blauth M, Gosch M, Wattanapanom P, Jarayabhand R, Poeze M, Wong MK, Kwek EBK, Hegeman JH, Perez-Uribarri C, Guerado E, Revak TJ, Zohner S, Joseph D, Phillips MR. Cost-effectiveness analysis of the Geriatric Fracture Center (GFC) concept: a prospective multicentre cohort study. BMJ Open 2023; 13:e072744. [PMID: 37918921 PMCID: PMC10626854 DOI: 10.1136/bmjopen-2023-072744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/15/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Geriatric Fracture Centers (GFCs) are dedicated treatment units where care is tailored towards elderly patients who have suffered fragility fractures. The primary objective of this economic analysis was to determine the cost-utility of GFCs compared with usual care centres. METHODS The primary analysis was a cost-utility analysis that measured the cost per incremental quality-adjusted life-year gained from treatment of hip fracture in GFCs compared with treatment in usual care centres from the societal perspective over a 1-year time horizon. The secondary analysis was a cost-utility analysis from a societal perspective over a lifetime time horizon. We evaluated these outcomes using a cost-utility analysis using data from a large multicentre prospective cohort study comparing GFCs versus usual care centres that took place in Austria, Spain, the USA, the Netherlands, Thailand and Singapore. RESULTS GFCs may be cost-effective in the long term, while providing a more comprehensive care plan. Patients in usual care centre group were slightly older and had fewer comorbidities. For the 1-year analysis, the costs per patient were slightly lower in the GFC group (-$646.42), while the quality-adjusted life-years were higher in the usual care centre group (+0.034). The incremental cost-effectiveness ratio was $18 863.34 (US$/quality-adjusted life-year). The lifetime horizon analysis found that the costs per patient were lower in the GFC group (-$7210.35), while the quality-adjusted life-years were higher in the usual care centre group (+0.02). The incremental cost-effectiveness ratio was $320 678.77 (US$/quality-adjusted life-year). CONCLUSIONS This analysis found that GFCs were associated with lower costs compared with usual care centres. The cost-savings were greater when the lifetime time horizon was considered. This comprehensive cost-effectiveness analysis, using data from an international prospective cohort study, found that GFC may be cost-effective in the long term, while providing a more comprehensive care plan. A greater number of major adverse events were reported at GFC, nevertheless a lower mortality rate associated with these adverse events at GFC. Due to the minor utility benefits, which may be a result of greater adverse event detection within the GFC group and much greater costs of usual care centres, the GFC may be cost-effective due to the large cost-savings it demonstrated over the lifetime time horizon, while potentially identifying and treating adverse events more effectively. These findings suggest that the GFC may be a cost-effective option over the lifetime of a geriatric patient with hip fracture, although future research is needed to further validate these findings. LEVEL OF EVIDENCE Economic, level 2. TRIAL REGISTRATION NUMBER NCT02297581.
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Affiliation(s)
| | - Sheila Sprague
- Division of Orthopaedics, McMaster University, Hamilton, Ontario, Canada
| | - Michael Blauth
- Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Gosch
- Department of Internal Medicine, Paracelsus Universitat Nurnberg, Nuremberg, Germany
| | | | - Rahat Jarayabhand
- Department of Orthopedics, Bhumibol Adulyadej Hospital, Bangkok, Thailand
| | - Martijn Poeze
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Merng K Wong
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Ernest B K Kwek
- Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Carlos Perez-Uribarri
- Department of Orthopedics and Trauma Surgery, Hospital Son Llatzer, Palma de Mallorca, Spain
| | - Enrique Guerado
- Department of Orthopaedic Surgery and Traumatology Hospital Universitario Costa del Sol, Faculty of Medicine, University of Malaga, Malaga, Spain
| | - Thomas J Revak
- Department of Orthopaedic Surgery-Division of Orthopedic Trauma, Saint Louis University, Saint Louis, Missouri, USA
| | - Sebastian Zohner
- Klinik für Unfallchirurgie und Sporttraumatologie, Kepler Universitätsklinikum Med Campus III, Linz, Austria
| | - David Joseph
- Department of Orthopedics, Elmhurst Hospital Center, Elmhurst, New York, USA
| | - Mark R Phillips
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Varahra A, MacDermid JC, Szekeres M. A systematic review of biopsychosocial prognostic factors of recovery after a proximal humerus fracture. J Hand Ther 2023; 36:825-844. [PMID: 37481367 DOI: 10.1016/j.jht.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/02/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Proximal humerus fracture (PHF) is a common upper extremity injury. PHF often causes prolonged disability and interferes with independent function. PURPOSE This study reviewed and summarized prognostic factors of recovery following PHF and classified them within the International Classification of Functioning, Disability and Health (ICF) with each domain sub-categorized by modifiability. STUDY DESIGN Systematic review. METHODS We searched MEDLINE, CINAHL, EMBASE, and PsychINFO from the date of database inception to March 2019 and updated searches in December 2021. Studies included examining an association between prognostic factors and recovery with at least a 6-month follow-up. Two independent reviewers used the Quality in Prognosis Studies tool for methodological bias and levels of evidence. Designs showed wide variability in terms of characteristics of the included population, definition of recovery, assessment of prognostic factors, and outcome measures used. This prevented pooled estimates from being produced. Prognostic factors linked to ICF domains were possible. RESULTS Twenty-three studies including 4323 participants aged ≥18 met inclusion criteria. The risk of bias was low (35%), moderate (30%), and high (35%) across the included studies. Moderate evidence showed a significant association between pre-fracture functional independence and post-fracture complications with recovery. Fracture type, structural deformity, medication use, age, and gender were prognostic factors with inconclusive evidence. We assigned a weak level of evidence to the remaining 20 factors due to limited data. Immediate rehabilitation, compliance to post-fracture rehabilitation exercise, task-oriented exercise, and pain self-efficacy (i.e., coping behavior) are modifiable and are tapped into the ICF contextual factors. CONCLUSIONS An array of factors that fit within an ICF biopsychosocial framework have been investigated as potential mediators of outcomes after PHF. The evidence is incomplete conceptually and in terms of research design quality. Preoperative functional status is predictive of functional recovery emphasizing the importance of healthy aging.
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Affiliation(s)
- Azar Varahra
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada.
| | - Joy C MacDermid
- Department of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada; School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Mike Szekeres
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada; School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
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Bottai V, Filoni G, Andreani L, Creati G, Di Sacco F, Bonadio AG, Giannotti S, Capanna R. Bone turnover profile and muscular status in major orthopaedic surgery: a case series. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023099. [PMID: 37326278 PMCID: PMC10308471 DOI: 10.23750/abm.v94i3.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/20/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Sarcopenia refers to a chronic loss of skeletal muscle mass, often associated with hypovitaminosis D and advanced age, which involves a greater risk of falls and fractures. The association of sarcopenia and osteoporosis defines osteo-sarcopenia. In this work, the authors analyzed the osteometabolic profile and the loco-regional muscular state of patients undergoing major orthopedic surgery, in order to define the incidence of district osteosarcopenic states, linked to a condition of disuse. METHODS 19 patients (10M-9F), between 15 and 85 years old, underwent major orthopedic surgery (15 resection prosthesis and custom made, 2 resection and reconstruction with transplant) were evaluated, of which 9 on an oncological basis. In all patients, the phospho-calcium metabolism was assessed by blood tests and intraoperative muscle biopsy was performed at the intervention site and contralaterally; in 3 cases a densitometric comparative study of the affected/contralateral limb was performed. RESULTS Results shows 5 patients with hypovitaminosis D; 7 pcs with hypocalcemia; 5 with PTH rise; 4pcs with ALP increase. In 100% of cases, the biopsy revealed sarcopenic patterns exclusively on the affected limb. 2 out of 3 DEXAs (66%) showed loco-regional osteoporosis compared to the contralateral. CONCLUSIONS The fact that in our sample sarcopenia is unilateral affecting only the pathological limb, that it is frequently associated with osteoporosis which is also unilateral and that for the most part it is not associated with vitamin D deficiency, suggests that it is an independent condition, with etiopathogenetic mechanisms different from osteosarcopenia itself. In major orthopedic surgery, bone integration and muscle status are both essential for achieving and lasting positive results. Considering the high incidence of district osteosarcopenia, an integrated surgical, pharmacological, and rehabilitative approach is desirable for the optimization of results, as well as more studies for the definition of the etiopathogenesis of this pathological condition.
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Affiliation(s)
- Vanna Bottai
- Ortopedia e Traumatologia Universitaria II - Universita' di Pisa - Azienda Ospedaliera Universitaria Pisana.
| | - Gabriele Filoni
- a:1:{s:5:"en_US";s:88:"Resident Doctor on Orthopedic and Traumatologic Clinic, University of Pisa, Pisa, Italy ";}.
| | - Lorenzo Andreani
- Ortopedia e Traumatologia Universitaria II - Universita' di Pisa - Azienda Ospedaliera Universitaria Pisana.
| | - Gabriele Creati
- Ortopedia e Traumatologia Universitaria II - Universita' di Pisa - Azienda Ospedaliera Universitaria Pisana.
| | - Federico Di Sacco
- Ortopedia e Traumatologia Universitaria II - Universita' di Pisa - Azienda Ospedaliera Universitaria Pisana.
| | | | - Stefano Giannotti
- Ortopedia e Traumatologia - Universita' degli Studi di Siena - Azienda Ospedaliera Universitaria Senese.
| | - Rodolfo Capanna
- Ortopedia e Traumatologia Universitaria II - Universita' di Pisa - Azienda Ospedaliera Universitaria Pisana.
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Rufus-Membere P, Holloway-Kew KL, Diez-Perez A, Appelman-Dijkstra NM, Bouxsein ML, Eriksen EF, Farr JN, Khosla S, Kotowicz MA, Nogues X, Rubin M, Pasco JA. Reference Intervals for Bone Impact Microindentation in Healthy Adults: A Multi-Centre International Study. Calcif Tissue Int 2023; 112:338-349. [PMID: 36729139 PMCID: PMC9968254 DOI: 10.1007/s00223-022-01047-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/30/2022] [Indexed: 02/03/2023]
Abstract
Impact microindentation (IMI) is a novel technique for assessing bone material strength index (BMSi) in vivo, by measuring the depth of a micron-sized, spherical tip into cortical bone that is then indexed to the depth of the tip into a reference material. The aim of this study was to define the reference intervals for men and women by evaluating healthy adults from the United States of America, Europe and Australia. Participants included community-based volunteers and participants drawn from clinical and population-based studies. BMSi was measured on the tibial diaphysis using an OsteoProbe in 479 healthy adults (197 male and 282 female, ages 25 to 98 years) across seven research centres, between 2011 and 2018. Associations between BMSi, age, sex and areal bone mineral density (BMD) were examined following an a posteriori method. Unitless BMSi values ranged from 48 to 101. The mean (± standard deviation) BMSi for men was 84.4 ± 6.9 and for women, 79.0 ± 9.1. Healthy reference intervals for BMSi were identified as 71.0 to 97.9 for men and 59.8 to 95.2 for women. This study provides healthy reference data that can be used to calculate T- and Z-scores for BMSi and assist in determining the utility of BMSi in fracture prediction. These data will be useful for positioning individuals within the population and for identifying those with BMSi at the extremes of the population.
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Affiliation(s)
- Pamela Rufus-Membere
- IMPACT- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia.
- IMPACT Institute, School of Medicine, Deakin University, Geelong, VIC, Australia.
| | - Kara L Holloway-Kew
- IMPACT- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| | - Adolfo Diez-Perez
- Department of Internal Medicine, Hospital del Mar-IMIM, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Natasha M Appelman-Dijkstra
- Department of Internal Medicine: Division of Endocrinology and Center for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Erik F Eriksen
- Spesialistsenteret Pilestredet Park and Faculty of Odontology, University of Oslo, Oslo, Norway
| | - Joshua N Farr
- Kogod Center On Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Sundeep Khosla
- Kogod Center On Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Mark A Kotowicz
- IMPACT- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, Australia
| | - Xavier Nogues
- Department of Internal Medicine, Hospital del Mar-IMIM, Pompeu Fabra University Barcelona- and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Mishaela Rubin
- Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Julie A Pasco
- IMPACT- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Xu L, Chen M, Peng K, Hiligsmann M, Jan S, Si L. Socio-demographic disparities in health-related quality of life after hip fracture in China: evidence from the China Health and Retirement Longitudinal Study. Arch Osteoporos 2023; 18:29. [PMID: 36764986 DOI: 10.1007/s11657-023-01220-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023]
Abstract
This study analyzed the impact of hip fractures on people's health-related quality of life and its socio-demographic disparities in China. PURPOSE Hip fractures cause high mortality and worsened health-related quality of life (HRQoL). This study aimed to investigate whether socio-demographic-related inequities in post-hip fracture participants' HRQoL exist in China. METHODS Data from the China Health and Retirement Longitudinal Study (waves 2013, 2015, and 2018) were used. The measurement of HRQoL in this study focused on 5 health dimensions: depression, body pain, mobility, basic activities of daily living, and instrumental activities of daily living. A difference-in-differences (DID) analysis with multiple time periods was performed to gauge the impact of hip fracture on HRQoL. A multivariate regression approach was used to explore socio-demographic-related factors associated with inequities of HRQoL. RESULTS A total of 23,622 individuals were included, and 341 participants reported hip fracture events during the survey period. In participants with hip fracture, the presentation rate of body pain increased by 14% (p < 0.01) and the HRQoL of other health dimensions worsened (p ≤ 0.01) after hip fracture. The DID analysis showed that hip fracture had a negative impact on all HRQoL dimensions (p < 0.01). Socioeconomic-related factors of HRQoL inequities included school education level and location of residence. Study participants with hip fracture with greater educational attainment or living in urban areas had higher (p < 0.05) levels of HRQoL. In addition, comorbidities also correlated with a worse HRQoL (p < 0.05). CONCLUSION Hip fracture significantly affects people's HRQoL in China, and the impact is more profound for those with lower educational attainment or living in rural areas. Targeted interventions should be designed to narrow this inequity.
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Affiliation(s)
- Lizheng Xu
- The George Institute for Global Health, Sydney, NSW, Australia
- UNSW Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Mingsheng Chen
- School of Health Policy and Management, Nanjing Medical University, No. 101, Longmian Avenue, Nanjing, 211166, China.
- Creative Health Policy Research Group, Nanjing Medical University, Nanjing, China.
- Center for Global Health, Nanjing Medical University, Nanjing, China.
| | - Ke Peng
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Stephen Jan
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
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Effect of resistance exercise on bone health of old aged individuals: Review. Sci Sports 2022. [DOI: 10.1016/j.scispo.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Dziedzic M, Janiszewska M, Goździewska M, Kowalska W, Roliński J. Assessment of the Quality of Life of Women after Osteoporotic Vertebral Fracture with Consideration of Socio-Demographic Characteristics and Selected Factors Concerning the State of Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12237. [PMID: 36231538 PMCID: PMC9566652 DOI: 10.3390/ijerph191912237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Introduction: Fractures of the vertebral bodies are a frequent complication of osteoporosis, hospitalization, decline in physical fitness and, in consequence, deterioration in the quality of life. Objective: The aim of the study was assessment of the quality of life according to the QUALEFFO-41 questionnaire in patients who had undergone fractures of the vertebral bodies, and presentation of the relationships between the quality of life, socio-demographic characteristics, and selected factors concerning the state of health. Materials and Method: The study included 243 women with osteoporotic vertebral fractures, and was conducted in the Outpatient Departments for the Treatment of Osteoporosis in the city of Lublin (eastern Poland). For the purposes of the study, the Quality of Life Questionnaire (QUALEFFO-41) and the author's questionnaire were employed, and Spearman's rank correlation coefficient, t-Student test, and Tukey test were used, along with analysis of variance (ANOVA). The level of statistical significance was set at α = 0.05. Results: The quality of life of woman with vertebral compression fractures remains on a mediocre level. Significant relationships were observed between the respondents' quality of life and certain socio-demographic characteristics, duration of the disease, and complaints related with osteoporosis. Conclusions: It is important to implement appropriate therapy and provide comprehensive, holistic care to women after fractures.
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Affiliation(s)
- Małgorzata Dziedzic
- Independent Public Regional Specialist Hospital in Chełm, Ceramiczna 1, 22-100 Chełm, Poland
| | - Mariola Janiszewska
- Department of Medical Informatics and Statistics with e-Health Lab, Medical University of Lublin, K. Jaczewskiego 5 Street, 20-059 Lublin, Poland
| | | | - Wioleta Kowalska
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Jacek Roliński
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland
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Similarities and Differences in Bone Mineral Density between Multiple Sites in the Same Individual: An Elderly Cadaveric Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6094663. [PMID: 35711524 PMCID: PMC9197619 DOI: 10.1155/2022/6094663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
Abstract
Bone mineral density (BMD) is known to vary based on various factors, and the degree of variation is site-specific. However, few studies have investigated the relationship between bone density at trabecular bone-rich and cortical bone-rich sites in the same individual. In this study, we attempted to measure BMD at multiple sites using whole-body computed tomography images taken immediately after death and to clarify the similarities and differences between skeletal sites. Additionally, we aimed to examine the factors that influence changes in BMD, such as the loading environment, bone microstructure, and the ossification process of each skeletal region. A 3D model containing BMD data of the skull, clavicle, lumbar vertebrae, and femur (neck and diaphysis) was created using computed tomography images taken immediately after the death of 60 individuals (28 men and 32 women, average age: 84.0 years) who consented to participate in the study before death. Arbitrary measurement sites were defined, and bone density was measured at each site. We found that the BMDs of all regions were negatively correlated with age, but this correlation was weaker in the skull than in other regions. The negative correlation was especially pronounced in areas with more trabecular bones in men and in areas with more cortical bones in women. Furthermore, these findings suggest that factors, such as the loading environment, bone microstructure, and the ossification process of the skeletal sites, affect the BMD. Furthermore, our results suggest that it is important to assess the BMD of cortical bone in older women.
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11
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Sui SX, Holloway-Kew KL, Hyde NK, Williams LJ, Tembo MC, West E, Pasco JA. How Well Do Low Population-Specific Values for Muscle Parameters Associate with Indices of Poor Physical Health? Cross-Sectional Data from the Geelong Osteoporosis Study. J Clin Med 2022; 11:jcm11102906. [PMID: 35629032 PMCID: PMC9143052 DOI: 10.3390/jcm11102906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 02/04/2023] Open
Abstract
We aimed to examine associations between skeletal muscle deficits and indices of poor health. Cut-points for skeletal muscle deficits were derived using data from the Geelong Osteoporosis Study and definitions from the revised European Consensus on Definition and Diagnosis and the Foundation for the National Institutes of Health. Participants (n = 665; 323 women) aged 60–96 year had handgrip strength measured by dynamometry and appendicular lean mass by whole-body dual-energy X-ray absorptiometry. Physical performance was assessed using the Timed Up and Go test. Sex-specific cut-points were equivalent to two standard deviations below the mean young reference range from the Geelong Osteoporosis Study. Indices of poor health included fractures, falls, and hospitalisations. Low trauma fractures since age 50 year (excluding skull, face, digits) were self-reported and confirmed using radiological reports. Falls (≥1 in the past 12 months) and hospitalisations (past month) were self-reported. Logistic regression models (age- and sex-adjusted) were used to examine associations. Receiver Operating Characteristic curves were applied to determine optimal cut-points for handgrip strength, Timed Up and Go, appendicular lean mass/height2, and appendicular lean mass/body mass index that discriminated poor health outcomes. There were 48 participants (6.9%) with hospitalisations, 94 (13.4%) with fractures, and 177 (25.3%) with at least one fall (≥1). For all cut-points, low handgrip strength was consistently associated with falls. There was little evidence to support an association between low appendicular lean mass, using any cut-point, and indices of poor health. Optimal cut-offs for predicting falls (≥1) were: handgrip strength 17.5 kg for women and 33.5 kg for men; Timed Up and Go 8.6 s for women and 9.9 s for men; appendicular lean mass/height2 6.2 kg/m2 for women and 7.46 kg/m2 for men; and appendicular lean mass/body mass index 0.6 m2 for women and 0.9 m2 for men. In conclusion, muscle strength and function performed better than lean mass to indicate poor health. These findings add to the growing evidence base to inform decisions regarding the selection of skeletal muscle parameters and their optimal cut-points for identifying sarcopenia.
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Affiliation(s)
- Sophia X. Sui
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC 3220, Australia; (K.L.H.-K.); (N.K.H.); (L.J.W.); (M.C.T.); (E.W.); (J.A.P.)
- Correspondence: ; Tel.: +61-3-4215-3306; Fax: +61-3-4215-3491
| | - Kara L. Holloway-Kew
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC 3220, Australia; (K.L.H.-K.); (N.K.H.); (L.J.W.); (M.C.T.); (E.W.); (J.A.P.)
| | - Natalie K. Hyde
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC 3220, Australia; (K.L.H.-K.); (N.K.H.); (L.J.W.); (M.C.T.); (E.W.); (J.A.P.)
| | - Lana J. Williams
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC 3220, Australia; (K.L.H.-K.); (N.K.H.); (L.J.W.); (M.C.T.); (E.W.); (J.A.P.)
| | - Monica C. Tembo
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC 3220, Australia; (K.L.H.-K.); (N.K.H.); (L.J.W.); (M.C.T.); (E.W.); (J.A.P.)
| | - Emma West
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC 3220, Australia; (K.L.H.-K.); (N.K.H.); (L.J.W.); (M.C.T.); (E.W.); (J.A.P.)
| | - Julie A. Pasco
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC 3220, Australia; (K.L.H.-K.); (N.K.H.); (L.J.W.); (M.C.T.); (E.W.); (J.A.P.)
- Department of Medicine–Western Campus, The University of Melbourne, St Albans, VIC 3010, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
- Barwon Health, University Hospital Geelong, Geelong, VIC 3220, Australia
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12
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Screening for osteoporosis using L1 vertebral density on abdominal CT in an Australian population. Clin Radiol 2022; 77:e540-e548. [PMID: 35550303 DOI: 10.1016/j.crad.2022.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/05/2022] [Indexed: 11/21/2022]
Abstract
AIM To assess the utility of osteoporosis screening using abdominal computed tomography (CT) versus dual-energy X-ray absorptiometry (DXA) T-scores as the reference. MATERIALS AND METHODS Patients ≥30 years undergoing abdominal CT and DXA within 12 months were assessed retrospectively. Bone mineral density (BMD) was measured using axial CT attenuation at L1, correlating with DXA T-scores. Sensitivity, specificity, area under the curve (AUC), and odds ratio (OR) were calculated. RESULTS The study cohort comprised 407 CT-DXA pairs (58.2% women). The prevalence of osteoporosis was 11.8%. L1 density and T-score were significantly correlated in both women (r=0.35, p<0.001) and men (r=0.15, p=0.04). The AUC to distinguish osteoporosis from osteopenia and normal BMD was 0.64 (95% CI: 0.56-0.71). In women, a threshold of 190 HU detected T-scores ≤ -2.5 with a negative predictive value (NPV) of 94.4% (OR=4.4, p<0.01). In the entire cohort, a threshold of 180 HU detected T-scores ≤ -2.5 with a NPV of 96.2% (OR=4.7, p<0.01). CONCLUSIONS CT L1 attenuation correlates with L1 DXA T-scores. Density values < 190 and 180 HU increased the probability of an osteoporosis diagnosis in Australian women and the overall cohort, respectively. Opportunistic screening for osteoporosis using abdominal CT is feasible, enabling identification of at-risk subjects for formal DXA imaging, thereby improving treatment initiation and reducing fracture risk.
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Al Saedi A, Kirk B, Iuliano S, Zanker J, Vogrin S, Jayaram L, Thomas S, Golding C, Navarro-Perez D, Marusic P, Leng S, Nanan R, Duque G. Effects of 3 months of multi-nutrient supplementation on the immune system and muscle and respiratory function of older adults in aged care (The Pomerium Study): protocol for a randomised controlled trial. BMJ Open 2022; 12:e059075. [PMID: 35523505 PMCID: PMC9082724 DOI: 10.1136/bmjopen-2021-059075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Immunosenescence leads to increased morbidity and mortality associated with viral infections and weaker vaccine responses. This has been well documented for seasonal influenza and the current pandemic with SARS-CoV-2 (COVID-19), which disproportionately impact older adults, particularly those in residential aged care facilities. Inadequate nutrient intakes associated with impaired immunity, respiratory and muscle function are likely to augment the effects of immunosenescence. In this study, we test whether the impact of inadequate nutrition can be reversed using multi-nutrient supplementation, consequently enhancing vaccine responses, reducing the risk of viral infections and improving respiratory and muscle function. METHODS AND ANALYSIS The Pomerium Study is a 3-month, single-blind, randomised, controlled trial testing the effects of two daily servings of an oral multi-nutrient supplement (330 kcal, 20 g protein, 1.5 g calcium 3-hydroxy-3-methylbutyrate monohydrate (CaHMB), 449 mg calcium, 500 IU vitamin D3 and 25 vitamins and minerals) on the immune system and muscle and respiratory function of older adults in aged care in Melbourne, Australia. 160 older adults (≥75 years old) will be recruited from aged care facilities and randomised to treatment (multi-nutrient supplement) or control (usual care). The primary outcome is a change in T-cell subsets CD8 + and CD28null counts at months 1 and 3. Secondary outcomes measured at baseline and month 3 are multiple markers of immunosenescence (also at 1 month), body composition (bioimpedance), handgrip strength (dynamometer), physical function (short physical performance battery), respiratory function (spirometry) and quality of life (EQ-5D-5L). Incidence and complications of COVID-19 and/or viral infections (ie, hospitalisation, complications or death) will be recorded throughout the trial, including 3 months after supplementation is ceased. ETHICS AND DISSEMINATION This study was approved by Melbourne Health Human Research Ethics Committee (Ref No. HREC/73985/MH-2021, ERM Ref No. RMH73985, Melbourne Health Site Ref No. 2021.115). Written informed consent will be obtained from participants. Results will be published in peer-reviewed journals and made available to key aged care stakeholders, including providers, residents, and government bodies. TRIAL REGISTRATION NUMBER ACTRN12621000420842.
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Affiliation(s)
- Ahmed Al Saedi
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Ben Kirk
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Sandra Iuliano
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Jesse Zanker
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Sara Vogrin
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Lata Jayaram
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shane Thomas
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Christine Golding
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Diana Navarro-Perez
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Petra Marusic
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Sean Leng
- Johns Hopkins Center on Aging and Immune Remodeling, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ralph Nanan
- Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Gustavo Duque
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
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Kaya S, Schurman CA, Dole NS, Evans DS, Alliston T. Prioritization of Genes Relevant to Bone Fragility Through the Unbiased Integration of Aging Mouse Bone Transcriptomics and Human GWAS Analyses. J Bone Miner Res 2022; 37:804-817. [PMID: 35094432 PMCID: PMC9018503 DOI: 10.1002/jbmr.4516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 12/20/2021] [Accepted: 01/17/2022] [Indexed: 11/10/2022]
Abstract
Identifying new genetic determinants of bone mineral density (BMD) and fracture promises to yield improved diagnostics and therapies for bone fragility. However, prioritizing candidate genes from genome-wide screens can be challenging. To overcome this challenge, we prioritized mouse genes that are differentially expressed in aging mouse bone based on whether their human homolog is associated with human BMD and/or fracture. Unbiased RNA-seq analysis of young and old male C57BL/6 mouse cortical bone identified 1499, 1685, and 5525 differentially expressed genes (DEGs) in 1, 2, and 2.5-year-old bone, relative to 2-month-old bone, respectively. Gene-based scores for heel ultrasound bone mineral density (eBMD) and fracture were estimated using published genome-wide association studies (GWAS) results of these traits in the UK Biobank. Enrichment analysis showed that mouse bone DEG sets for all three age groups, relative to young bone, are significantly enriched for eBMD, but only the oldest two DEG sets are enriched for fracture. Using gene-based scores, this approach prioritizes among thousands of DEGs by a factor of 5- to 100-fold, yielding 10 and 21 genes significantly associated with fracture in the two oldest groups of mouse DEGs. Though these genes were not the most differentially expressed, they included Sost, Lrp5, and others with well-established functions in bone. Several others have, as yet, unknown roles in the skeleton. Therefore, this study accelerates identification of new genetic determinants of bone fragility by prioritizing a clinically relevant and experimentally tractable number of candidate genes for functional analysis. Finally, we provide a website (www.mouse2human.org) to enable other researchers to easily apply our strategy. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Serra Kaya
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Charles A. Schurman
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA
| | - Neha S. Dole
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Daniel S. Evans
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Tamara Alliston
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA
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Babatunde OO, Bucknall M, Burton C, Forsyth JJ, Corp N, Gwilym S, Paskins Z, van der Windt DA. Long-term clinical and socio-economic outcomes following wrist fracture: a systematic review and meta-analysis. Osteoporos Int 2022; 33:753-782. [PMID: 34766193 DOI: 10.1007/s00198-021-06214-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022]
Abstract
UNLABELLED A comprehensive review of studies shows that patients with wrist fracture, aged over 50 years, experience pain and functional limitation long after fracture. This is associated with increased healthcare costs, and reduced quality of life. Understanding factors that predict poor outcomes is important for future healthcare policy and planning. PURPOSE To summarise and appraise evidence on the prognosis and long-term clinical and socio-economic outcomes following wrist fracture among adults aged 50 years and over. METHODS Five databases (MEDLINE, EMBASE, AMED, CINAHL-P and PsycINFO) were comprehensively searched (supplemented by a grey-literature search) from inception till June 2021 for prospective/retrospective cohort studies of patients (≥ 50 years) with a history of wrist fracture and reporting long-term (≥ 6 months) outcomes. Peer study selection, data extraction and risk of bias assessment were conducted. A random effects meta-analysis was used to summarise estimates of pain and function outcomes. RESULTS 78 studies (n = 688,041 patients) were included. Patients report persistent moderate to severe pain (range: 7.5%-62%) and functional limitations (range: 5.5-78%) up to 12-months or later after wrist fracture. Mean Patient-Rated Wrist Evaluation (PRWE) score for pain and function (9 studies, n = 1759 patients) was 15.23 (95%CI 12.77, 17.69) at 6-months to 13-years follow-up. Mean disabilities of the arm, shoulder and hand (DASH) score (9 studies, n = 1346 patients) was 13.82 (95%CI 12.71, 14.93)( at 6- to 17-months follow-up. A 10-20% increase in healthcare encounters in the first 12-months after fracture was observed. Twelve prognostic factors were associated with poor long-term outcomes. CONCLUSION Evidence shows that a high proportion of people aged over 50 years with wrist fracture experience pain and functional limitation > 6 months after fracture. This is associated with increased healthcare costs, and reduced quality of life. Exploratory evidence was found for several candidate prognostic factors. Their predictive performance needs to be investigated further. PROSPERO CRD42018116478.
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Affiliation(s)
- O O Babatunde
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK.
| | - M Bucknall
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - C Burton
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - J J Forsyth
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, ST4 2DF, UK
| | - N Corp
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - S Gwilym
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Z Paskins
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, ST6 7AG, UK
| | - D A van der Windt
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
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What is the impact on work of osteoporotic fractures in active patients? A retrospective fracture-liaison-service study-Optiwork 1. Arch Osteoporos 2022; 17:46. [PMID: 35260944 DOI: 10.1007/s11657-021-00946-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/05/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Osteoporotic fractures have economic consequences and can alter the quality of life. Nevertheless, the direct impact on work has been infrequently reported. Our objective was to estimate the proportion of working patients resuming paid employment within the 3 months following an osteoporotic fracture, and to assess the consequences on their productivity and quality of life. METHODS Patients aged between 45 and 64, screened by the Fracture Liaison Service of Hospital Paris Saint Joseph for a fragility fracture occurring between January 2017 and December 2018, and being paid employees at the time of the fracture, were included retrospectively. Medical data were extracted from electronic medical records. Self-reporting questionnaires concerning work activity and quality of life before and after the fracture were sent by post. RESULTS Overall, 121 patients were included, with a mean age of 55.8; 82.6% of patients were female. Fracture of the lower extremity of the radius was the most frequent (38.2%), followed by the upper extremity of the humerus (23.1%). After the index fracture, 82.6% of the patients went back to work, including 76.0% within 3 months following the fracture. The median time to return to work was 2.2 months. Moreover, 19.8% of patients required adaptations of their current work. CONCLUSION Osteoporotic fractures have a direct impact on work activity, causing work stoppages. Productivity at work and quality of life were also impacted. Further studies are needed to confirm these findings.
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Larsson BAM, Johansson L, Mellström D, Johansson H, Axelsson KF, Harvey N, Vandenput L, McCloskey E, Liu E, Sundh D, Kanis JA, Lorentzon M. One leg standing time predicts fracture risk in older women independent of clinical risk factors and BMD. Osteoporos Int 2022; 33:185-194. [PMID: 34498096 PMCID: PMC8758616 DOI: 10.1007/s00198-021-06039-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
In women of ages 75-80 years, a low one leg standing time (OLST) was associated with an increased risk of incident fractures, independently of bone mineral density and clinical risk factors. OLST contributed substantially to fracture probability, indicating that the test should be considered when evaluating fracture risk in older women. INTRODUCTION Physical function and risk of falls are important risk factors for fracture. A few previous studies have suggested that a one leg standing time (OLST) less than 10 s predicts fracture risk, but the impact of OLST, in addition to known clinical risk factors, for fracture probability is unknown. The aim of this study was to determine the independent contribution of OLST to fracture probability in older women. METHODS The Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone Fractures (SUPERB) is a prospective population-based study of 3028 women 75-80 years old, recruited from the greater Gothenburg area in Sweden. At baseline, information on risk factors was collected using questionnaires, bone mineral density was measured with dual-energy X-ray absorptiometry (DXA), and OLST was performed. RESULTS During a median follow-up of 3.6 years (IQR 1.5 years), X-ray-verified incident fractures were identified using health records. OLST was available in 2405 women. OLST less than 10 s was associated with an increased risk for incident hip fracture (Hazard Ratio (HR) 3.02, 95% Confidence Interval (CI) [1.49-6.10]), major osteoporotic fracture (HR 95% CI 1.76 [1.34-1.46]), and nonvertebral fracture (HR 95% CI 1.61 [1.26-2.05]) in Cox regression analyses adjusted for age, height, and weight. Depending on BMD, the 4-year fracture probability increased by a factor of 1.3 to 1.5 in a 75-year-old woman with a low OLST (<10 s). CONCLUSION A low OLST has a substantial impact on fracture probability and should be considered when evaluating fracture risk in older women.
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Affiliation(s)
- B A M Larsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - L Johansson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - D Mellström
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - H Johansson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - K F Axelsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Norrmalm Health Centre, Skövde, Sweden
| | - N Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - L Vandenput
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - E McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - E Liu
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - D Sundh
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - J A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - M Lorentzon
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.
- Region Västra Götaland, Department of Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
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Talevski J, Sanders KM, Watts JJ, Nicholson GC, Seeman E, Iuliano S, Prince R, March L, Winzenberg T, Duque G, Ebeling PR, Borgström F, Kanis JA, Stuart AL, Beauchamp A, Brennan-Olsen SL. Sex differences in recovery of quality of life 12 months post-fracture in community-dwelling older adults: analyses of the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study (AusICUROS). Osteoporos Int 2022; 33:67-75. [PMID: 34235548 DOI: 10.1007/s00198-021-06058-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/29/2021] [Indexed: 12/21/2022]
Abstract
In this study of 695 Australian older adults (aged ≥50 years), we found that men and women had a similar trajectory of health-related quality of life (HRQoL) recovery following fragility fracture at any skeletal site. These results provide us with critical knowledge that improves our understanding of health outcomes post-fracture. INTRODUCTION Mortality is higher in men than that in women following a fragility fracture, but it is unclear whether recovery of patient-reported outcomes such as health-related quality of life (HRQoL) differs between sexes. This study aimed to identify sex differences in HRQoL recovery 12 months post-fracture. METHODS Data were from the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study (AusICUROS). Participants recruited to AusICUROS were adults aged ≥50 years who sustained a fragility fracture. HRQoL was measured using the EQ-5D-3L at three time-points post-fracture: within 2 weeks (including pre-fracture recall) and at 4 and 12 months. Multivariate logistic regression analyses were undertaken, adjusting for confounders including age, education, income, and healthcare utilization post-fracture. RESULTS Overall, 695 AusICUROS participants (536 women, 77.1%) were eligible for analysis with fractures at the hip (n = 150), distal forearm (n = 261), vertebrae (n = 61), humerus (n = 52), and other skeletal sites (n = 171). At the time of fracture, men were younger, reported a higher income, and were more likely to be employed, compared with women. For all fracture sites combined, there were no differences between men and women in recovery to pre-fracture HRQoL at 12-month follow-up (adjusted OR = 1.09; 95% CI: 0.75-1.61). When stratified by fracture site, no significant sex differences were seen for hip (OR = 1.02; 95% CI: 0.42-2.52), distal forearm (OR = 1.60; 95% CI: 0.68-3.78), vertebral (OR = 2.28; 95% CI: 0.61-8.48), humeral (OR = 1.62; 95% CI: 0.16-9.99), and other fractures (OR = 1.00; 95% CI: 0.44-2.26). CONCLUSION Community-dwelling men and women who survived the 12 months following fragility fracture had a similar trajectory of HRQoL recovery at any skeletal site.
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Affiliation(s)
- J Talevski
- Department of Medicine-Western Health, WCHRE Building, The University of Melbourne, 176 Furlong Road, St Albans, Victoria, VIC, 3021, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Victoria, Australia.
| | - K M Sanders
- Department of Medicine-Western Health, WCHRE Building, The University of Melbourne, 176 Furlong Road, St Albans, Victoria, VIC, 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Victoria, Australia
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - J J Watts
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - G C Nicholson
- Department of Medicine-Western Health, WCHRE Building, The University of Melbourne, 176 Furlong Road, St Albans, Victoria, VIC, 3021, Australia
- Rural Clinical School, The University of Queensland, Toowoomba, Australia
| | - E Seeman
- Departments of Endocrinology and Medicine, The University of Melbourne/Austin Health, Heidelberg, Victoria, Australia
- Mary McKillip Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - S Iuliano
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Victoria, Australia
- Departments of Endocrinology and Medicine, The University of Melbourne/Austin Health, Heidelberg, Victoria, Australia
| | - R Prince
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, Sir Charles Gardner Unit, The University Western Australia, Perth, Western Australia, Australia
| | - L March
- Institute of Bone and Joint Research, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - T Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - G Duque
- Department of Medicine-Western Health, WCHRE Building, The University of Melbourne, 176 Furlong Road, St Albans, Victoria, VIC, 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Victoria, Australia
| | - P R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - F Borgström
- Quantify Research, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - J A Kanis
- Mary McKillip Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - A L Stuart
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine Deakin University, Geelong, Victoria, Australia
| | - A Beauchamp
- Department of Medicine-Western Health, WCHRE Building, The University of Melbourne, 176 Furlong Road, St Albans, Victoria, VIC, 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Victoria, Australia
- School of Rural Health, Monash University, Victoria, Australia
| | - S L Brennan-Olsen
- Department of Medicine-Western Health, WCHRE Building, The University of Melbourne, 176 Furlong Road, St Albans, Victoria, VIC, 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Victoria, Australia
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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Edmunds K, Scuffham P, Newton RU, Galvão DA, Tuffaha H. Exercise in preventing falls for men with prostate cancer: a modelled cost-utility analysis. Support Care Cancer 2022; 30:5037-5046. [PMID: 35201385 PMCID: PMC9046330 DOI: 10.1007/s00520-022-06900-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/08/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Men who receive androgen deprivation therapy (ADT) for prostate cancer (PCa) are a vulnerable falls population due to the side effects of treatment. The purpose of this paper is to determine the cost-effectiveness of exercise in preventing falls and fractures for this high-risk population in Australia. METHODS A decision analytic model was constructed to evaluate the cost utility of an exercise intervention compared to usual care from a health system perspective. The intervention comprised two 1-h sessions of supervised exercise per week over 1 year for men with non-metastatic PCa receiving curative radiation therapy and ADT. A Markov model simulated the transition between five health states: (1) at risk of falling; (2) at recurrent risk of falling; (3) fracture (minor or major); (4) non-fracture injury (minor or major); and (5) death. Model inputs including transition probabilities and utility scores were obtained from published meta-analyses, and costs were drawn from Australian data sources (e.g. Medical Benefits Schedule). The model time horizon was 3 years, and costs and effects were discounted at 5% annual rate. Costs and quality-adjusted life years (QALYs) were aggregated and compared between the intervention and control to calculate incremental net monetary benefit (iNMB). Uncertainty in the results was explored using deterministic and probabilistic sensitivity analyses (PSA). RESULTS At a willingness-to-pay of AU$50,000 per QALY, the exercise intervention dominated, as it was less costly and more effective than usual care. The iNMB was $3010 per patient. The PSA showed a 58% probability the intervention was cost-effective. CONCLUSION This is the first modelled economic evaluation of exercise for men with PCa. Our results suggest supervised exercise is cost-effective in reducing the risks of falls and fractures in this population.
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Affiliation(s)
- Kim Edmunds
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia
| | - Haitham Tuffaha
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, QLD, 4072, Australia
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Low YL, Finkelstein E. Cost-Effective Analysis of Dual-Energy Computed Tomography for the Diagnosis of Occult Hip Fractures Among Older Adults. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1754-1762. [PMID: 34838273 DOI: 10.1016/j.jval.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Early and accurate diagnosis of hip fractures minimizes morbidity and mortality. Although current guidelines favor magnetic resonance imaging (MRI) for the diagnosis of occult hip fractures, a new technology called dual-energy computed tomography (DECT) seems an effective alternative. This article investigates a potentially cost-effective strategy for the diagnosis of occult hip fractures in older adults in Singapore. METHODS A decision tree model was developed to compare costs from a payer's perspective and outcomes in terms of quality-adjusted life-years (QALYs) of different imaging strategies for diagnosing occult hip fracture, comparing MRI with DECT supplementing single-energy computed tomography (SECT) and SECT alone. Model inputs were obtained from local sources where available. Sensitivity analyses are performed to test the robustness of the results. RESULTS The MRI strategy was dominated by the DECT strategy, whereas DECT supplementing SECT provided 0.30 more QALYs at an incremental cost of SGD106.41 with an incremental cost-effectiveness ratio of SGD352.52 per QALY relative to SECT alone. DECT seemed a cost-effective strategy at a willingness-to-pay threshold of SGD50 000 per QALY. CONCLUSION DECT supplementing SECT is a cost-effective imaging strategy to diagnose occult hip fractures among older adults in Singapore and should be included in clinical pathways to expedite timely treatment and considered for reimbursement schemes.
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Affiliation(s)
- Ying Liang Low
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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21
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Barcelos A, Lopes DG, Canhão H, da Cunha Branco J, Rodrigues AM. Multimorbidity is associated with fragility fractures in women 50 years and older: A nationwide cross-sectional study. Bone Rep 2021; 15:101139. [PMID: 34754887 PMCID: PMC8564033 DOI: 10.1016/j.bonr.2021.101139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/19/2021] [Accepted: 10/01/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Multimorbidity is a worldwide health problem, especially in elderly patients who have a higher risk of fragility fracture. Currently, there is insufficient knowledge about the burden of multimorbidity in patients with previous fragility fracture. The aim of this study was to evaluate the association between multimorbidity and previous fragility fracture, and to assess the effect of fragility fracture and/or multimorbidity in the perception of quality-of-life and physical function, in women 50 years of age and older. METHODS Women aged ≥50 years from the EpiReumaPt study (2011-2013), a nationwide population-based study, were evaluated. Self-reported data regarding sociodemographics, health-related quality of life, physical functioning, fragility fracture, and multimorbidity were collected using a semi-structured questionnaire. Multimorbidity was defined as 2 or more chronic non-communicable diseases. Descriptive exploratory analysis of the data was performed using hypothesis testing. Multiple logistic regression modelling was used to assess the association between multimorbidity and fragility fractures, and linear regression was used for the quality-of-life and physical function outcomes. RESULTS The estimated prevalence of fragility fracture in women older than 50 years was 17.5%. A higher prevalence of multimorbidity (74.6%) was found in the group of women with previous fragility fracture than in those without previous fragility fracture. Multivariate logistic regression analysis revealed that women with multimorbidity had a higher odds of fragility fracture (adjusted odds ratio, 1.38; 95% confidence interval, 1.12-1.69), compared with women with 1 or no self-reported non-communicable chronic diseases. In women with previous fragility fracture, rheumatic diseases (62.7%) and hypertension (58.6%) were the most frequently self-reported non-communicable chronic diseases. The combination of fragility fracture and multimorbidity was associated with a lower quality of life and higher degree of disability. CONCLUSIONS Women 50 years and older with multimorbidity had a significantly increased odds of fragility fracture. Fragility fracture combined with multimorbidity was negatively associated with quality of life and positively associated with disability. This study emphasizes the need to redesign health services to care for patients to prevent non-communicable chronic diseases and fragility fracture, particularly in women 50 years and older, in whom these diseases are likely to potentiate the risk of fragility fracture.
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Affiliation(s)
- Anabela Barcelos
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology Department, CHBV, Aveiro, Portugal
| | - David G. Lopes
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Helena Canhão
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology Department, CHULC, Lisboa, Portugal
| | - Jaime da Cunha Branco
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology Department, CHLO, Lisboa, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology Department, Hospital dos Lusíadas, Lisboa, Portugal
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Shah A, Wu F, Jones G, Cicuttini F, Toh LS, Laslett LL. The association between incident vertebral deformities, health-related quality of life and functional impairment: a 10.7-year cohort study. Osteoporos Int 2021; 32:2247-2255. [PMID: 34009448 DOI: 10.1007/s00198-021-06004-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/10/2021] [Indexed: 11/24/2022]
Abstract
UNLABELLED We aimed to describe longitudinal changes in health-related quality of life (HRQoL) measures associated with incident vertebral deformities (VDs) over 10.7 years. Incident VDs are associated with clinically significant functional impairment in men, and reduction in overall HRQoL in older women. Increasing severity and number of incident VDs are associated with clinically meaningful functional impairment in men, but not women. INTRODUCTION To describe associations between incident VD and changes in HRQoL and functional ability in older adults over 10.7 years. METHODS Participants (n = 780) underwent whole-body dual-energy X-ray absorptiometry (DXA) scans at baseline, 2.5, 5.1 and 10.7 years later. VD was defined as ≥ 25% reduction in anterior height relative to posterior height of vertebrae from T4 to L4. An incident VD was defined as a new VD at any follow-up visit. Assessment of Quality of Life (AQoL-4D) questionnaire and Health Assessment Questionnaire-Disability Index (HAQ-DI) were used to assess HRQoL and functional impairment. Changes in AQoL and HAQ-DI associated with incident VD were analysed using multilevel mixed-effects linear regression. Log binomial regression was used to examine clinically relevant changes and effects of severity and number of VD. RESULTS The incidence of VD was 37% over 10.7 years. In women, incident VDs were associated with annual reduction in AQoL utility score (β = -0.005, 95% CI -0.008 to -0.002). Men had increased risk of clinically significant reduction in HAQ-DI (IRR = 1.76, 95% CI 1.07-2.89). Men had increased risk of clinically important functional impairment with increasing severity (IRR 1.76, 95% CI 1.04-2.95 for mild vs IRR 1.98, 95% CI 1.13-3.47 for moderate to severe VD) as well as number of incident VD (IRR 1.85, 95% CI 1.17-2.93 for one vs IRR 1.88, 95% CI 0.94-3.78 for ≥ 2 VDs). Such associations were not observed in women. CONCLUSIONS Incident VDs are associated with clinically significant functional impairment in men, and reduction in overall HRQoL in older women. Increasing severity and number of incident VDs are associated with clinically meaningful functional impairment in men, but not women.
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Affiliation(s)
- A Shah
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
| | - F Wu
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | | | - L S Toh
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - L L Laslett
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
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Si L, Eisman JA, Winzenberg T, Sanders KM, Center JR, Nguyen TV, Tran T, Palmer AJ. Development and validation of the risk engine for an Australian Health Economics Model of Osteoporosis. Osteoporos Int 2021; 32:2073-2081. [PMID: 33856500 DOI: 10.1007/s00198-021-05955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED The Australian Health Economics Model of Osteoporosis (AusHEMO) has shown good face, internal and cross validities, and can be used to assist healthcare decision-making in Australia. PURPOSE This study aimed to document and validate the risk engine of the Australian Health Economics Model of Osteoporosis (AusHEMO). METHODS AusHEMO is a state-transition microsimulation model. The fracture risks were simulated using fracture incidence rates from the Dubbo Osteoporosis Epidemiology Study. The AusHEMO was validated regarding its face, internal and cross validities. Goodness-of-fit analysis was conducted and Lin's coefficient of agreement and mean absolute difference with 95% limits of agreement were reported. RESULTS The development of AusHEMO followed general and osteoporosis-specific health economics guidelines. AusHEMO showed good face validity regarding the model's structure, evidence, problem formulation and results. In addition, the model has been proven good internal and cross validities in goodness-of-fit test. Lin's coefficient was 0.99, 1 and 0.94 for validation against the fracture incidence rates, Australian life expectancies and residual lifetime fracture risks, respectively. CONCLUSIONS In summary, the development of the risk engine of AusHEMO followed the best practice for osteoporosis disease modelling and the model has been shown to have good face, internal and cross validities. The AusHEMO can be confidently used to predict long-term fracture-related outcomes and health economic evaluations when costs data are included. Health policy-makers in Australia can use the AusHEMO to select which osteoporosis interventions such as medications and public health interventions represent good value for money.
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Affiliation(s)
- L Si
- The George Institute for Global Health, UNSW Sydney, Kensington, Australia.
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China.
| | - J A Eisman
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
- St Vincent's Hospital, UNSW Sydney, Sydney, New South Wales, Australia
| | - T Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - K M Sanders
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - J R Center
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
- St Vincent's Hospital, UNSW Sydney, Sydney, New South Wales, Australia
| | - T V Nguyen
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
- St Vincent's Hospital, UNSW Sydney, Sydney, New South Wales, Australia
- School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia
| | - T Tran
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
| | - A J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
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Davis S, Simpson E, Hamilton J, James MMS, Rawdin A, Wong R, Goka E, Gittoes N, Selby P. Denosumab, raloxifene, romosozumab and teriparatide to prevent osteoporotic fragility fractures: a systematic review and economic evaluation. Health Technol Assess 2021; 24:1-314. [PMID: 32588816 DOI: 10.3310/hta24290] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture. OBJECTIVES The objectives were to evaluate the clinical effectiveness, safety and cost-effectiveness of non-bisphosphonates {denosumab [Prolia®; Amgen Inc., Thousand Oaks, CA, USA], raloxifene [Evista®; Daiichi Sankyo Company, Ltd, Tokyo, Japan], romosozumab [Evenity®; Union Chimique Belge (UCB) S.A. (Brussels, Belgium) and Amgen Inc.] and teriparatide [Forsteo®; Eli Lilly and Company, Indianapolis, IN, USA]}, compared with each other, bisphosphonates or no treatment, for the prevention of fragility fracture. DATA SOURCES For the clinical effectiveness review, nine electronic databases (including MEDLINE, EMBASE and the World Health Organization International Clinical Trials Registry Platform) were searched up to July 2018. REVIEW METHODS A systematic review and network meta-analysis of fracture and femoral neck bone mineral density were conducted. A review of published economic analyses was undertaken and a model previously used to evaluate bisphosphonates was adapted. Discrete event simulation was used to estimate lifetime costs and quality-adjusted life-years for a simulated cohort of patients with heterogeneous characteristics. This was done for each non-bisphosphonate treatment, a strategy of no treatment, and the five bisphosphonate treatments previously evaluated. The model was populated with effectiveness evidence from the systematic review and network meta-analysis. All other parameters were estimated from published sources. An NHS and Personal Social Services perspective was taken, and costs and benefits were discounted at 3.5% per annum. Fracture risk was estimated from patient characteristics using the QFracture® (QFracture-2012 open source revision 38, Clinrisk Ltd, Leeds, UK) and FRAX® (web version 3.9, University of Sheffield, Sheffield, UK) tools. The relationship between fracture risk and incremental net monetary benefit was estimated using non-parametric regression. A probabilistic sensitivity analysis and scenario analyses were used to assess uncertainty. RESULTS Fifty-two randomised controlled trials of non-bisphosphonates were included in the clinical effectiveness systematic review and an additional 51 randomised controlled trials of bisphosphonates were included in the network meta-analysis. All treatments had beneficial effects compared with placebo for vertebral, non-vertebral and hip fractures, with hazard ratios varying from 0.23 to 0.94, depending on treatment and fracture type. The effects on vertebral fractures and the percentage change in bone mineral density were statistically significant for all treatments. The rate of serious adverse events varied across trials (0-33%), with most between-group differences not being statistically significant for comparisons with placebo/no active treatment, non-bisphosphonates or bisphosphonates. The incremental cost-effectiveness ratios were > £20,000 per quality-adjusted life-year for all non-bisphosphonate interventions compared with no treatment across the range of QFracture and FRAX scores expected in the population eligible for fracture risk assessment. The incremental cost-effectiveness ratio for denosumab may fall below £30,000 per quality-adjusted life-year at very high levels of risk or for high-risk patients with specific characteristics. Raloxifene was dominated by no treatment (resulted in fewer quality-adjusted life-years) in most risk categories. LIMITATIONS The incremental cost-effectiveness ratios are uncertain for very high-risk patients. CONCLUSIONS Non-bisphosphonates are effective in preventing fragility fractures, but the incremental cost-effectiveness ratios are generally greater than the commonly applied threshold of £20,000-30,000 per quality-adjusted life-year. STUDY REGISTRATION This study is registered as PROSPERO CRD42018107651. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 29. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Davis
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Simpson
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Marrissa Martyn-St James
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Rawdin
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ruth Wong
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Edward Goka
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Neil Gittoes
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Selby
- School of Medical Sciences, University of Manchester, Manchester, UK
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Can Resistance Exercise Be a Tool for Healthy Aging in Post-Menopausal Women with Type 1 Diabetes? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168716. [PMID: 34444464 PMCID: PMC8393224 DOI: 10.3390/ijerph18168716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 11/25/2022]
Abstract
Due to improvements in diabetes care, people with type 1 diabetes (T1D) are living longer. Studies show that post-menopausal T1D women have a substantially elevated cardiovascular risk compared to those without T1D. As T1D may also accelerate age-related bone and muscle loss, the risk of frailty may be considerable for T1D women. Exercise and physical activity may be optimal preventative therapies to maintain health and prevent complications in this population: They are associated with improvements in, or maintenance of, cardiovascular health, bone mineral density, and muscle mass in older adults. Resistance exercise, in particular, may provide important protection against age-related frailty, due to its specific effects on bone and muscle. Fear of hypoglycemia can be a barrier to exercise in those with T1D, and resistance exercise may cause less hypoglycemia than aerobic exercise. There are currently no exercise studies involving older, post-menopausal women with T1D. As such, it is unknown whether current guidelines for insulin adjustment/carbohydrate intake for activity are appropriate for this population. This review focuses on existing knowledge about exercise in older adults and considers potential future directions around resistance exercise as a therapeutic intervention for post-menopausal T1D women.
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Talevski J, Sanders KM, Vogrin S, Duque G, Beauchamp A, Seeman E, Iuliano S, Svedbom A, Borgström F, Kanis JA, Stuart AL, Brennan-Olsen SL. Recovery of quality of life is associated with lower mortality 5-year post-fracture: the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study (AusICUROS). Arch Osteoporos 2021; 16:112. [PMID: 34264432 DOI: 10.1007/s11657-021-00981-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/02/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Little is known about factors that lead to excess mortality post-fracture. This study demonstrated that 5-year mortality is lower in older adults who recovered to their pre-fracture health-related quality of life (HRQoL) at 12-months compared to those who did not recover. Our results highlight the importance of post-fracture interventions known to improve HRQoL. INTRODUCTION Fragility fractures lead to increased mortality and decreased health-related quality of life (HRQoL) in older adults, although whether an association exists between these outcomes remains uncertain. The aim of this study was to determine whether recovery of HRQoL 12-month post-fracture is associated with lower 5-year mortality. METHODS This data linkage study included 524 adults (mean age: 70.2 years; 79.2% women) with fragility fracture (150 hip, 261 distal forearm, 61 vertebral, 52 humerus) from the Australian arm of the International Costs and Utilities Related to Osteoporotic fractures Study (AusICUROS). HRQoL was measured using the EQ-5D-3L and all-cause mortality post-fracture was ascertained from the Australian National Death Index (NDI). Cox proportional hazards models were used to assess the association between HRQoL recovery (vs. non-recovery) and all-cause mortality within 5 years. RESULTS Overall, 279 participants (53.2%) recovered to their pre-fracture HRQoL at 12-month follow-up. There were 70 deaths (13.4%) during the 5-year post-fracture. Mortality rate was the highest in hip fracture participants (24.7%), followed by vertebral (16.4%), humeral (13.5%), and distal forearm fracture participants (6.1%). After adjustment for age, pre-fracture HRQoL, and fracture site, mortality risk was lower in participants who recovered to their pre-fracture HRQoL at 12-months compared to those who did not recover (HR = 0.56, 95% CI: 0.33-0.96, p = 0.034). CONCLUSION This study provides evidence that HRQoL recovery post-fracture is associated with improved 5-year survival in older adults. The extent to whether current interventions known to improve HRQoL post-fracture could prevent some of these deaths is unknown.
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Affiliation(s)
- Jason Talevski
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia. .,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.
| | - Kerrie M Sanders
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Sara Vogrin
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
| | - Gustavo Duque
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
| | - Alison Beauchamp
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Rural Health, Monash University, Melbourne, VIC, Australia
| | - Ego Seeman
- Departments of Endocrinology and Medicine, The University of Melbourne/Austin Health, Heidelberg, VIC, Australia.,Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Sandra Iuliano
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,Departments of Endocrinology and Medicine, The University of Melbourne/Austin Health, Heidelberg, VIC, Australia
| | | | - Fredrik Borgström
- Quantify Research, Stockholm, Sweden.,Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - John A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.,Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Amanda L Stuart
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Sharon L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Health and Social Development, Deakin University, Geelong, VIC, Australia.,Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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Raisuddin AM, Vaattovaara E, Nevalainen M, Nikki M, Järvenpää E, Makkonen K, Pinola P, Palsio T, Niemensivu A, Tervonen O, Tiulpin A. Critical evaluation of deep neural networks for wrist fracture detection. Sci Rep 2021; 11:6006. [PMID: 33727668 PMCID: PMC7971048 DOI: 10.1038/s41598-021-85570-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/01/2021] [Indexed: 11/08/2022] Open
Abstract
Wrist Fracture is the most common type of fracture with a high incidence rate. Conventional radiography (i.e. X-ray imaging) is used for wrist fracture detection routinely, but occasionally fracture delineation poses issues and an additional confirmation by computed tomography (CT) is needed for diagnosis. Recent advances in the field of Deep Learning (DL), a subfield of Artificial Intelligence (AI), have shown that wrist fracture detection can be automated using Convolutional Neural Networks. However, previous studies did not pay close attention to the difficult cases which can only be confirmed via CT imaging. In this study, we have developed and analyzed a state-of-the-art DL-based pipeline for wrist (distal radius) fracture detection-DeepWrist, and evaluated it against one general population test set, and one challenging test set comprising only cases requiring confirmation by CT. Our results reveal that a typical state-of-the-art approach, such as DeepWrist, while having a near-perfect performance on the general independent test set, has a substantially lower performance on the challenging test set-average precision of 0.99 (0.99-0.99) versus 0.64 (0.46-0.83), respectively. Similarly, the area under the ROC curve was of 0.99 (0.98-0.99) versus 0.84 (0.72-0.93), respectively. Our findings highlight the importance of a meticulous analysis of DL-based models before clinical use, and unearth the need for more challenging settings for testing medical AI systems.
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Affiliation(s)
| | - Elias Vaattovaara
- University of Oulu, Oulu, Finland
- Oulu University Hospital, Oulu, Finland
| | - Mika Nevalainen
- University of Oulu, Oulu, Finland
- Oulu University Hospital, Oulu, Finland
| | | | | | | | - Pekka Pinola
- University of Oulu, Oulu, Finland
- Oulu University Hospital, Oulu, Finland
| | - Tuula Palsio
- University of Oulu, Oulu, Finland
- City of Oulu, Oulu, Finland
| | | | - Osmo Tervonen
- University of Oulu, Oulu, Finland
- Oulu University Hospital, Oulu, Finland
| | - Aleksei Tiulpin
- University of Oulu, Oulu, Finland
- Oulu University Hospital, Oulu, Finland
- Ailean Technologies Oy, Oulu, Finland
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Talevski J, Sanders KM, Busija L, Beauchamp A, Duque G, Borgström F, Kanis JA, Svedbom A, Stuart AL, Brennan-Olsen S. Health service use pathways associated with recovery of quality of life at 12-months for individual fracture sites: Analyses of the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS). Bone 2021; 144:115805. [PMID: 33321265 DOI: 10.1016/j.bone.2020.115805] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/27/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE We aimed to identify combinations of health service use specific to each major osteoporotic fracture (MOF) site - hip, distal forearm, vertebrae and humerus - associated with recovery of health-related quality of life (HRQoL) 12-months post-MOF. METHODS Patients were 4126 adults aged ≥50 years with a MOF (1657 hip, 1354 distal forearm, 681 vertebral, 434 humerus) from the International Costs and Utilities Related to Osteoporotic fractures Study (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain and the UK). HRQoL (pre-fracture and 12-months post-fracture) was measured using the EQ-5D-3L. Health service use data were collected via interviews and medical record reviews and included in-hospital care, outpatient care, supported living, community health services, and medication use. Latent class analyses were undertaken to identify different combinations of health service use ("classes"); and logistic regression to assess associations between classes and HRQoL recovery. Fracture site-specific analyses were performed using pooled data from all 10 countries. RESULTS The proportion of patients who recovered to their pre-fracture HRQoL at 12-month follow-up varied across fracture sites: 37.3%, 65.8%, 48.9% and 49.5% for hip, distal forearm, vertebrae, and humerus, respectively. We observed several site-specific classes associated with improved odds of HRQoL recovery. Generally, the combination of hospital presentations without admission; primary care center visits; use of osteoporosis-related medications; vitamin D/calcium supplementation; and non-opioid analgesic use was associated with greater likelihood of HRQoL recovery. CONCLUSION The identified fracture site-specific health service use pathways associated with recovery of HRQoL could potentially improve the management and health outcomes of patients treated for a MOF.
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Affiliation(s)
- Jason Talevski
- Department of Medicine-Western Health, The University of Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Victoria, Australia.
| | - Kerrie M Sanders
- Department of Medicine-Western Health, The University of Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Victoria, Australia; School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.
| | - Ljoudmila Busija
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
| | - Alison Beauchamp
- Department of Medicine-Western Health, The University of Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Victoria, Australia; School of Rural Health, Monash University, Victoria, Australia.
| | - Gustavo Duque
- Department of Medicine-Western Health, The University of Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Victoria, Australia.
| | - Fredrik Borgström
- Quantify Research, Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden.
| | - John A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Victoria, Australia; Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom.
| | | | - Amanda L Stuart
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, Victoria, Australia.
| | - Sharon Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Victoria, Australia; School of Health and Social Development, Deakin University, Geelong, Victoria, Australia; Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.
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Talevski J, Sanders KM, Busija L, Beauchamp A, Duque G, Borgström F, Kanis JA, Svedbom A, Connaughton C, Stuart AL, Brennan-Olsen SL. Health Service Use and Quality of Life Recovery 12 Months Following Major Osteoporotic Fracture: Latent Class Analyses of the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS). J Bone Miner Res 2021; 36:252-261. [PMID: 32960460 DOI: 10.1002/jbmr.4181] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 01/20/2023]
Abstract
Major osteoporotic fractures (MOFs) are associated with a rapid decline in health-related quality of life (HRQoL); however, there is limited knowledge about which healthcare services positively affect HRQoL postfracture. This study aimed to identify specific combinations of health service use associated with recovery of HRQoL 12 months post-MOF. The analyses included 4126 adults aged ≥50 years with an MOF (1657 hip, 1354 distal forearm, 681 vertebrae, 434 humerus) participating in the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS), a multinational observational study (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, United Kingdom, and United States). HRQoL at prefracture and 12 months postfracture was measured using the EuroQoL questionnaire (EQ-5D-3L). Health service use data were collected via participant interviews and medical record reviews including in-hospital care; outpatient care; community services; and medication use. Data analyses involved two stages: (i) latent class analyses to identify different combinations of health service use ("classes"); and (ii) logistic regression to assess effects of classes on HRQoL recovery. Analyses were repeated excluding hip fractures (non-hip MOFs). Overall, 2057 MOF participants (49.9%) recovered to their prefracture HRQoL at 12-month follow-up; this proportion was higher for non-hip MOFs (n = 1439; 58.3%). Several distinct classes were identified across countries (range, 2-5 classes). Classes that were associated with increased odds of HRQoL recovery were characterized by a combination of hospital presentations without admission; outpatient department visits; allied health visits; vitamin D/calcium supplementation; and/or non-opioid analgesic use. Similar classes were observed for non-hip MOFs. Understanding country-specific healthcare service pathways that influence greater recovery of HRQoL, particularly services that are uncommon in some countries and routine in others, could improve postfracture care on a global scale. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Jason Talevski
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
| | - Kerrie M Sanders
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Ljoudmila Busija
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Alison Beauchamp
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Rural Health, Monash University, Clayton, VIC, Australia
| | - Gustavo Duque
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
| | - Fredrik Borgström
- Quantify Research, Stockholm, Sweden.,Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - John A Kanis
- Mary McKillop Institute for Research, Australian Catholic University, Ballarat, VIC, Australia.,Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | | | - Catherine Connaughton
- Melbourne Academic Centre for Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Amanda L Stuart
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Sharon L Brennan-Olsen
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Health and Social Development, Deakin University, Geelong, VIC, Australia.,Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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30
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Talevski J, Guerrero-Cedeño V, Demontiero O, Suriyaarachchi P, Boersma D, Vogrin S, Brennan-Olsen S, Duque G. Implementation of an electronic care pathway for hip fracture patients: a pilot before and after study. BMC Musculoskelet Disord 2020; 21:837. [PMID: 33308200 PMCID: PMC7731480 DOI: 10.1186/s12891-020-03834-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 11/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Care pathways are generally paper-based and can cause communication failures between multidisciplinary teams, potentially compromising the safety of the patient. Computerized care pathways may facilitate better communication between clinical teams. This study aimed to investigate whether an electronic care pathway (e-pathway) reduces delays in surgery and hospital length of stay compared to a traditional paper-based care pathway (control) in hip fracture patients. METHODS A single-centre evaluation with a retrospective control group was conducted in the Orthogeriatric Ward, Nepean Hospital, New South Wales, Australia. We enrolled patients aged > 65 years that were hospitalized for a hip fracture in 2008 (control group) and 2012 (e-pathway group). The e-pathway provided the essential steps in the care of patients with hip fracture, including examinations and treatment to be carried out. Main outcome measures were delay in surgery and hospital length of stay; secondary outcomes were in-hospital mortality and discharge location. RESULTS A total of 181 patients were enrolled in the study (129 control; 54 e-pathway group). There was a significant reduction in delay to surgery in the e-pathway group compared to control group in unadjusted (OR = 0.19; CI 0.09-0.39; p < 0.001) and adjusted (OR = 0.22; CI 0.10-0.49; p < 0.001) models. There were no significant differences between groups for length of stay (median 11 vs 12 days; p = 0.567), in-hospital mortality (1 vs 7 participants; p = 0.206) or discharge location (p = 0.206). CONCLUSIONS This pilot study suggests that, compared to a paper-based care pathway, implementation of an e-pathway for hip fracture patients results in a reduction in total number of delays to surgery, but not hospital length of stay. Further evaluation is warranted using a larger cohort investigating both clinical and patient-reported outcome measures.
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Affiliation(s)
- Jason Talevski
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Viviana Guerrero-Cedeño
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Oddom Demontiero
- Department of Geriatric Medicine, Nepean Hospital, Penrith, NSW, Australia
| | | | - Derek Boersma
- Department of Geriatric Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sharon Brennan-Olsen
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Geriatric Medicine, Nepean Hospital, Penrith, NSW, Australia
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Pinheiro MB, Oliveira J, Bauman A, Fairhall N, Kwok W, Sherrington C. Evidence on physical activity and osteoporosis prevention for people aged 65+ years: a systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Act 2020; 17:150. [PMID: 33239014 PMCID: PMC7690138 DOI: 10.1186/s12966-020-01040-4] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Various physical activity interventions for prevention and treatment of osteoporosis have been designed and evaluated, but the effect of such interventions on the prevention of osteoporosis in older people is unclear. The aim of this review was to investigate the association between physical activity and osteoporosis prevention in people aged 65 years and above. METHODS A systematic review was conducted and searches for individual studies were conducted in PubMed (January 2010 to March 2020) and for systematic reviews were conducted in PubMed, Embase, CINAHL and SPORTDiscus (January 2008 to July 2020). Records were screened according to the following eligibility criteria: i) population: adults aged 65 years and older; ii) exposure: greater volume, duration, frequency, or intensity of physical activity; iii) comparison: no physical activity or lesser volume, duration, frequency, or intensity of physical activity; iv) outcome: osteoporosis related measures (e.g., bone mineral density). The methodological quality of included studies was assessed and meta-analysis summarised study effects. The GRADE approach was used to rate certainty of evidence. RESULTS We included a total of 59 studies, including 12 observational studies and 47 trials. Within the included trials, 40 compared physical activity with no intervention controls, 11 compared two physical activity programs, and six investigated different doses of physical activity. Included studies suggest that physical activity interventions probably improve bone health among older adults and thus prevent osteoporosis (standardised effect size 0.15, 95% CI 0.05 to 0.25, 20 trials, moderate-certainty evidence, main or most relevant outcome selected for each of the included studies). Physical activity interventions probably improve lumbar spine bone mineral density (standardised effect size 0.17, 95% CI 0.04 to 0.30, 11 trials, moderate-certainty evidence) and may improve hip (femoral neck) bone mineral density (standardised effect size 0.09, 95% CI - 0.03 to 0.21, 14 trials, low-certainty evidence). Higher doses of physical activity and programs involving multiple exercise types or resistance exercise appear to be most effective. Typical programs for which significant intervention impacts were detected in trials were undertaken for 60+ mins, 2-3 times/week for 7+ months. Observational studies suggested a positive association between long-term total and planned physical activity on bone health. CONCLUSIONS Physical activity probably plays a role in the prevention of osteoporosis. The level of evidence is higher for effects of physical activity on lumbar spine bone mineral density than for hip. Higher dose programs and those involving multiple exercises and resistance exercises appear to be more effective.
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Affiliation(s)
- Marina B Pinheiro
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Juliana Oliveira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Nicola Fairhall
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Wing Kwok
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Almog YA, Rai A, Zhang P, Moulaison A, Powell R, Mishra A, Weinberg K, Hamilton C, Oates M, McCloskey E, Cummings SR. Deep Learning With Electronic Health Records for Short-Term Fracture Risk Identification: Crystal Bone Algorithm Development and Validation. J Med Internet Res 2020; 22:e22550. [PMID: 32956069 PMCID: PMC7600029 DOI: 10.2196/22550] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/05/2020] [Accepted: 09/12/2020] [Indexed: 12/18/2022] Open
Abstract
Background Fractures as a result of osteoporosis and low bone mass are common and give rise to significant clinical, personal, and economic burden. Even after a fracture occurs, high fracture risk remains widely underdiagnosed and undertreated. Common fracture risk assessment tools utilize a subset of clinical risk factors for prediction, and often require manual data entry. Furthermore, these tools predict risk over the long term and do not explicitly provide short-term risk estimates necessary to identify patients likely to experience a fracture in the next 1-2 years. Objective The goal of this study was to develop and evaluate an algorithm for the identification of patients at risk of fracture in a subsequent 1- to 2-year period. In order to address the aforementioned limitations of current prediction tools, this approach focused on a short-term timeframe, automated data entry, and the use of longitudinal data to inform the predictions. Methods Using retrospective electronic health record data from over 1,000,000 patients, we developed Crystal Bone, an algorithm that applies machine learning techniques from natural language processing to the temporal nature of patient histories to generate short-term fracture risk predictions. Similar to how language models predict the next word in a given sentence or the topic of a document, Crystal Bone predicts whether a patient’s future trajectory might contain a fracture event, or whether the signature of the patient’s journey is similar to that of a typical future fracture patient. A holdout set with 192,590 patients was used to validate accuracy. Experimental baseline models and human-level performance were used for comparison. Results The model accurately predicted 1- to 2-year fracture risk for patients aged over 50 years (area under the receiver operating characteristics curve [AUROC] 0.81). These algorithms outperformed the experimental baselines (AUROC 0.67) and showed meaningful improvements when compared to retrospective approximation of human-level performance by correctly identifying 9649 of 13,765 (70%) at-risk patients who did not receive any preventative bone-health-related medical interventions from their physicians. Conclusions These findings indicate that it is possible to use a patient’s unique medical history as it changes over time to predict the risk of short-term fracture. Validating and applying such a tool within the health care system could enable automated and widespread prediction of this risk and may help with identification of patients at very high risk of fracture.
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Affiliation(s)
- Yasmeen Adar Almog
- Digital Health & Innovation, Amgen Inc, Thousand Oaks, CA, United States
| | - Angshu Rai
- Digital Health & Innovation, Amgen Inc, Thousand Oaks, CA, United States
| | - Patrick Zhang
- Digital Health & Innovation, Amgen Inc, Thousand Oaks, CA, United States
| | - Amanda Moulaison
- Digital Health & Innovation, Amgen Inc, Thousand Oaks, CA, United States
| | - Ross Powell
- Digital Health & Innovation, Amgen Inc, Thousand Oaks, CA, United States
| | - Anirban Mishra
- Digital Health & Innovation, Amgen Inc, Thousand Oaks, CA, United States
| | - Kerry Weinberg
- Digital Health & Innovation, Amgen Inc, Thousand Oaks, CA, United States
| | - Celeste Hamilton
- Global Medical Operations, Amgen Inc, Thousand Oaks, CA, United States
| | - Mary Oates
- US Medical, Amgen Inc, Thousand Oaks, CA, United States
| | - Eugene McCloskey
- Department of Oncology & Metabolism, The University of Sheffield, Sheffield, United Kingdom
| | - Steven R Cummings
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
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Miao Q, Yang S, Ding H, Liu J. Controlled degradation of chitosan-coated strontium-doped calcium sulfate hemihydrate composite cement promotes bone defect repair in osteoporosis rats. Biomed Mater 2020; 15:055039. [DOI: 10.1088/1748-605x/ab9fcf] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Hamza S, Fathy S, El-Azab S. Effect of diode laser biostimulation compared to Teriparatide on induced osteoporosis in rats: an animal study from Egypt. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:1970-1985. [PMID: 32922592 PMCID: PMC7476941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
Our aim in this study was to evaluate the effect of low-level laser therapy (LLLT) by means of diode laser bio-stimulation compared to Teriparatide in induced osteoporosis in rats. A total of 45 adult female Egyptian albino rats were used. Rats were divided into five groups: normal control, osteoporotic control, Teriparatide (TPTD) group (T), laser group (L), and laser and teriparatide (T+L) combination group. Osteoporosis was induced by performing double ovariectomy in rats. Lower jaws and left femurs were dissected. The specimens were tested using a Computed tomography unit, scanning EM (SEM) equipped with Energy Dispersive X-Ray Analyzer, and Rat PINP ELISA Kit. The histopathologic examination of experimental rat jaws and femurs revealed changes in bone architecture among the various groups throughout the experiment. CT examination showed a noticeable difference in radiodensity between jaw and femur bones. By SEM, bones of the Normal Control (NC) group showed normal bone porosity. However, bones of the Osteoporotic Control (OC) group showed a great difference as bone pores were large and numerous with irregular outlines. The ELISA test for PINP concentration showed a steady rise in the PINP concentrations in OC, T, L and T+L groups. We concluded that TPTD has osteogenic potential and is capable to enhance bone architecture by inducing the formation of new well-organized bone with narrower bone pore diameter. LLLT can be used as a good alternative local treatment strategy with minimal side effects and superior outcomes.
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Affiliation(s)
- Shymaa Hamza
- Department of Oral Pathology, Faculty of Dentistry, Cairo University Cairo, Egypt
| | - Safa Fathy
- Department of Oral Pathology, Faculty of Dentistry, Cairo University Cairo, Egypt
| | - Samia El-Azab
- Department of Oral Pathology, Faculty of Dentistry, Cairo University Cairo, Egypt
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Amarilla-Donoso FJ, Roncero-Martin R, Lavado-Garcia JM, Toribio-Felipe R, Moran-Garcia JM, Lopez-Espuela F. Quality of life after hip fracture: a 12-month prospective study. PeerJ 2020; 8:e9215. [PMID: 32587793 PMCID: PMC7304420 DOI: 10.7717/peerj.9215] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hip fracture is an important and frequent health problem worldwide. To date, there are still limited studies focused on the analysis of health-related quality of life (HRQOL) after a hip fracture in the Spanish population, especially with long-term follow-up. OBJECTIVE To determine the HRQOL at 12 months after hip fracture and to identify potential factors associated with HRQOL. DESIGN Prospective observational study. SETTING Traumatology units of two university hospitals in province Cáceres (Spain). PARTICIPANTS A total of 224 patients were admitted to the unit and required immediate surgery due to a hip fracture. METHODS HRQOL was measured with the EuroQol-5D questionnaire (EQ-5D) and the SF-12 Health Survey. RESULTS Scores from the visual analog scale EQ-5D decreased significantly (p < 0.001) from 72.8 at baseline to 48.3 after 1 month, to 48.2 after 6 months and to 46.1 after 12 months. The EQ-5D index score showed a similar significant reduction (p < 0.001) from 0.6 to 0.1, 0.3 and 0.3, respectively. Values of the physical component summary (PCS-12) significantly decreased (p < 0.001) from 38.6 at baseline to 31.0, 33.1 and 33.5. The mental component summary (MCS-12) decreased from 46.5 to 44.8 after 6 months (p = 0.022) and 44.3 after 12 months (p = 0.005). Factors potentially associated with HRQOL at 12 months after hip fracture were depression status after 12 months (B = 0-1.876; 95% CI [-2.409 to -1.343]; p < 0.001), functional ambulation classification after 12 months (B = -12.133; 95% CI [-17.970 to -6.297]; p < 0.001), EQ-5D VAS at baseline (B = 0.223; 95% CI [0.115-0.330]; p < 0.001), and age (B = -0.323; 95% CI [-0.594 to -0.053; p = 0.015). CONCLUSIONS Patients experience a significant impairment in HRQOL H after a hip fracture, especially in self-care, pain/discomfort, usual activities, mobility and anxiety/depression. The decline in the HRQOL is effective the first month and lasts at least 12 months after the surgical intervention.
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Affiliation(s)
| | - Raul Roncero-Martin
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Jesus Maria Lavado-Garcia
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | | | - Jose Maria Moran-Garcia
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Fidel Lopez-Espuela
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
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Barcenilla-Wong AL, Cross M, Fry M, March L. Ambiguity hindering self-management and prevention of osteoporosis in post-menopausal women. Arch Osteoporos 2020; 15:73. [PMID: 32417979 DOI: 10.1007/s11657-020-0683-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 02/03/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED As osteoporosis relies largely on self-managed prevention and adherence to long-term treatment regimens, it is imperative that those at risk understand the disease that they are attempting to prevent. Ambiguity regarding osteoporosis and reluctance to take anti-osteoporosis medication (AOM) as well as calcium was noted in Australian post-menopausal women. This may lead to underestimating women's own risk of osteoporosis and fracture. INTRODUCTION Fragility fractures caused by osteoporosis have been known to inflict significant personal and financial burden on individuals and society. As treatment of osteoporosis relies largely on self-managed prevention and adherence to long-term AOM regimens, it is imperative that women have a sound understanding of the disease that they are attempting to prevent. Much can also be gained from qualitatively exploring the level of osteoporosis knowledge particularly in post-menopausal women who are at greater risk of osteoporosis and fractures. This study thus aims to determine what post-menopausal Australian women know about osteoporosis and osteoporosis prevention. METHOD Six focus group sessions, using purposive sampling, were conducted with 23 female participants (mean age 68 years (range 62-83)). Women responded to a series of open-ended questions regarding their knowledge about osteoporosis. The audiotaped focus groups were transcribed verbatim and analysed using a thematic analysis framework. RESULTS Three key themes were identified: ambiguity about the nature of osteoporosis, ambiguity about osteoporosis prevention and reluctance to take AOM and calcium. CONCLUSION Ambiguity associated with risk and prevention may provide women with a false sense of security that they are adequately acting to prevent the disease. Underestimation of their risk of osteoporosis and fracture as well as reluctance associated with AOM may be barriers to osteoporotic fracture prevention.
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Affiliation(s)
- A L Barcenilla-Wong
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia.
| | - M Cross
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - M Fry
- Nursing Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - L March
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia.,Florance and Cope Professorial Rheumatology Department, University of Sydney Royal North Shore Hospital, St Leonards, Sydney, Australia
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Ferrari S, Lewiecki EM, Butler PW, Kendler DL, Napoli N, Huang S, Crittenden DB, Pannacciulli N, Siris E, Binkley N. Favorable skeletal benefit/risk of long-term denosumab therapy: A virtual-twin analysis of fractures prevented relative to skeletal safety events observed. Bone 2020; 134:115287. [PMID: 32092479 DOI: 10.1016/j.bone.2020.115287] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/30/2020] [Accepted: 02/15/2020] [Indexed: 11/18/2022]
Abstract
Antiresorptive therapies reduce fracture risk; however, long-term bone turnover inhibition may raise concerns about rare, but serious, skeletal adverse events-atypical femoral fracture (AFF) and osteonecrosis of the jaw (ONJ). Denosumab, a fully human monoclonal antibody against RANKL, has demonstrated sustained low vertebral and nonvertebral fracture rates with low skeletal adverse event rates in the 3-year FREEDOM trial and its 7-year Extension (in which all subjects received open-label denosumab). In this analysis, we aimed to estimate fractures prevented relative to skeletal adverse events observed with 10 years of denosumab therapy. We modeled a hypothetical placebo group using the virtual-twin method, thereby allowing calculation of fractures prevented with denosumab treatment (relative to the virtual-placebo group) in the context of AFF or ONJ events observed in the long-term denosumab group. Estimated virtual-placebo and observed long-term denosumab exposure-adjusted fracture rates per 100,000 subject-years were calculated for fractures classified as clinical (3180 and 1777, respectively), major osteoporotic (2699 and 1525), vertebral (1879 and 901), and nonvertebral (2924 and 1528), and compared with observed AFF and ONJ in the long-term denosumab group (5 and 35 per 100,000 subject-years, respectively). The skeletal benefit/risk ratio (fractures prevented per adverse event observed) for clinical fractures was 281 (AFF) and 40 (ONJ). Based on this model, denosumab treatment for up to 10 years has a favorable skeletal benefit/risk profile when comparing fractures prevented per skeletal adverse event observed. Clinical trial registration: NCT00089791, NCT00523341.
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Affiliation(s)
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | | | | | - Nicola Napoli
- Università Campus Bio-Medico di Roma, Roma, Italy; Division of Bone and Mineral Diseases, Washington University, St. Louis, MO, USA
| | | | | | | | - Ethel Siris
- Columbia University Medical Center, New York, NY, USA
| | - Neil Binkley
- University of Wisconsin-Madison, Madison, WI, USA
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Shahen VA, Gerbaix M, Koeppenkastrop S, Lim SF, McFarlane KE, Nguyen ANL, Peng XY, Weiss NB, Brennan-Speranza TC. Multifactorial effects of hyperglycaemia, hyperinsulinemia and inflammation on bone remodelling in type 2 diabetes mellitus. Cytokine Growth Factor Rev 2020; 55:109-118. [PMID: 32354674 DOI: 10.1016/j.cytogfr.2020.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 12/14/2022]
Abstract
Bones undergo continuous cycles of bone remodelling that rely on the balance between bone formation and resorption. This balance allows the bone to adapt to changes in mechanical loads and repair microdamages. However, this balance is susceptible to upset in various conditions, leading to impaired bone remodelling and abnormal bones. This is usually indicated by abnormal bone mineral density (BMD), an indicator of bone strength. Despite this, patients with type 2 diabetes mellitus (T2DM) exhibit normal to high BMD, yet still suffer from an increased risk of fractures. The activity of the bone cells is also altered as indicated by the reduced levels of bone turnover markers in T2DM observed in the circulation. The underlying mechanisms behind these skeletal outcomes in patients with T2DM remain unclear. This review summarises recent findings regarding inflammatory cytokine factors associated with T2DM to understand the mechanisms involved and considers potential therapeutic interventions.
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Affiliation(s)
- V A Shahen
- Department of Physiology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - M Gerbaix
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, Geneva, Switzerland
| | - S Koeppenkastrop
- Department of Physiology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - S F Lim
- Department of Physiology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - K E McFarlane
- Department of Physiology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Amanda N L Nguyen
- Department of Physiology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - X Y Peng
- Department of Physiology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - N B Weiss
- Department of Physiology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - T C Brennan-Speranza
- Department of Physiology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia.
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Trevino CM, Cooros JC, Chesney SA, deRoon-Cassini T, Carver TW, Milia DJ. A Call to Follow-Up: Results Regarding Trauma Clinic Follow-Up Patterns. J Trauma Nurs 2020; 26:290-296. [PMID: 31714489 DOI: 10.1097/jtn.0000000000000467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to assess the current practice pattern regarding posthospitalization follow-up of trauma patients among the members of the Eastern Association for the Surgery of Trauma (EAST). An anonymous online multiple-choice survey of EAST members in 2016 was conducted. Ten questions relating to the follow-up care of injured patients were presented to the Active, Senior, and Associate members of EAST. Data were screened for quantitative concerns prior to analysis. Of the 1,610 members surveyed, 289 responded (18%). Approximately 52% of respondents stated that their institution has a dedicated trauma follow-up clinic where most injured patients are seen after discharge. Less than 20% reported that nontrauma multidisciplinary providers are present in clinics. Most (89.5%) reported that follow-up is a single visit, unless a patient has long-standing issues. Only 3 respondents stated that patients are regularly seen 3+ months out from injury, and a significant minority (17.7%) acknowledged no set follow-up timeline. Only 3.6% of participants indicated that they have a psychologist embedded in the trauma team, and 11.5% reported that no system is currently in place to manage mental health. Despite more than 20 years of literature highlighting the long-term physical and mental health sequelae after trauma, these survey results demonstrate that there is a lack of standardized and multidisciplinary follow-up. Given the improvement in outcomes with the identification and treatment of these sequelae, greater attention should be paid to functional recovery, social and psychological well-being, and chronic pain.
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Affiliation(s)
- Colleen M Trevino
- Medical College of Wisconsin, Milwaukee (Drs Trevino, deRoon-Cassini, Carver, and Milia); Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Dr Cooros); and Marquette University, Milwaukee, Wisconsin (Ms Chesney)
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Yu WW, Linton D, Porteous J, Eatson H, Jain R, Sale JEM. Is a 'healthy diet' and a 'calcium-rich diet' the same thing? Qualitative study examining perceptions of a calcium-rich diet in individuals who have received bone health education. J Hum Nutr Diet 2020; 33:496-504. [PMID: 32128920 DOI: 10.1111/jhn.12730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In the present study, we aimed to (i) examine perceptions of achieving calcium and vitamin D recommended dietary allowance (RDA) and (ii) determine how participants talked about food in relation to RDA recommendations. METHODS Participants aged ≥50 years who were prescribed osteoporosis medication and received two modes of bone health education were eligible. Relying on a qualitative description design, we interviewed participants 1 month after they had attended an education session and received a self-management booklet. Calcium and vitamin D intakes were estimated by in-depth questions about diet and supplements and compared with perceptions of achieved RDA levels. Interview transcripts were analysed based on an analytic hierarchical process. RESULTS Forty-five participants (29 reporting previous fragility fractures) were included. Calcium and vitamin D RDA appeared to be potentially achieved by 64% and 93% of participants, respectively, primarily because of reliance on supplements. Few participants talked about vitamin D in relation to food intake and 49% of participants were unclear about the calcium content of food. Most considered that a healthy diet was equivalent to a calcium-rich diet. We noted no differences in our findings in the subset of individuals with fragility fractures. CONCLUSIONS Despite reporting a prescription for osteoporosis medication and receiving bone health education, a substantial number of individuals appeared to have sub-optimal calcium levels. This may be attributed to the challenge of achieving RDA with diet alone and the misconception of a healthy diet as a calcium-rich diet.
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Affiliation(s)
- W W Yu
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - D Linton
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - J Porteous
- Osteoporosis Canada, Toronto, Ontario, Canada
| | - H Eatson
- Osteoporosis Canada, Toronto, Ontario, Canada
| | - R Jain
- Osteoporosis Canada, Toronto, Ontario, Canada
| | - J E M Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Lesnyak O, Svedbom A, Belova K, Dobrovolskaya O, Ershova O, Golubev G, Grebenshikov V, Ivanov S, Kochish A, Menshikova L, Nikitinskaya O, Nurligayanov R, Solodovnikov A, Toroptsova N, Varavko J, Zotkin E, Borgstrom F, Kanis JA. Quality of life after fragility fracture in the Russian Federation: results from the Russian arm of the International Cost and Utility Related to Osteoporotic Fractures Study (ICUROS). Arch Osteoporos 2020; 15:37. [PMID: 32124066 PMCID: PMC7051923 DOI: 10.1007/s11657-020-0699-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/27/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Changes in health-related quality of life (QoL) due to hip, humeral, ankle, spine, and distal forearm fracture were measured in Russian adults age 50 years or more over the first 18 months after fracture. The accumulated mean QoL loss after hip fracture was 0.5 and significantly greater than after fracture of the distal forearm (0.13), spine (0.21), proximal humerus (0.26), and ankle (0.27). INTRODUCTION Data on QoL following osteoporotic fractures in Russia are scarce. The present study evaluated the impact of hip, vertebral, proximal humerus, distal forearm, and ankle fracture up to 18 months after fracture from the Russian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study. METHODS Individuals age ≥ 50 years with low-energy-induced humeral, hip, clinical vertebral, ankle, or distal forearm fracture were enrolled. After a recall of pre-fracture status, HRQoL was prospectively collected over 18 months of follow-up using EQ-5D-3L. Multivariate regression analysis was used to identify determinants of QALYs loss. RESULTS At 2 weeks, patients with hip fracture (n = 223) reported the lowest mean health state utility value (HSUV) compared with other fracture sites. Thereafter, utility values increased but remained significantly lower than before fracture. For spine (n = 183), humerus (n = 166), and ankle fractures (n = 214), there was a similar pattern of disutility with a nadir within 2 weeks and a progressive recovery thereafter. The accumulated mean QoL loss after hip fracture was 0.5 and significantly greater than after fracture of the distal forearm (0.13), spine (0.21), proximal humerus (0.26), and ankle (0.27). Substantial impairment in self-care and usual activities immediately after fracture were important predictors of recovery across at all fracture sites. CONCLUSIONS Fractures of the hip, vertebral, distal forearm, ankle, and proximal humerus incur substantial loss of QoL in Russia. The utility values derived from this study can be used in future economic evaluations.
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Affiliation(s)
- Olga Lesnyak
- North West Mechnikov State Medical University, St. Petersburg, Russia
| | | | - Ksenia Belova
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - Olga Dobrovolskaya
- grid.488825.bV.A. Nasonova Research Institute of Rheumatology named after V.A. Nasonova, Moscow, Russia
| | - Olga Ershova
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - Georgij Golubev
- Rostov-on-Don State Medical University, Rostov-on-Don, Russia
| | | | - Sergej Ivanov
- The L.G. Sokolov Memorial Hospital №122, St. Petersburg, Russia
| | - Alexander Kochish
- Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg, Russia
| | | | - Oxana Nikitinskaya
- Research Institute of Rheumatology named after V.A. Nasonova, Moscow, Russia
| | | | | | - Natalia Toroptsova
- Research Institute of Rheumatology named after V.A. Nasonova, Moscow, Russia
| | - Julia Varavko
- grid.446313.70000 0001 0451 2298Irkutsk State Medical University, Irkutsk, Russia
| | - Eugenij Zotkin
- Research Institute of Rheumatology named after V.A. Nasonova, Moscow, Russia
| | - Fredrik Borgstrom
- grid.4714.60000 0004 1937 0626LIME/MMC, Karolinska Institutet, Stockholm, Sweden
| | - John A Kanis
- grid.411958.00000 0001 2194 1270Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK and Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
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Valentin G, Pedersen SE, Christensen R, Friis K, Nielsen CP, Bhimjiyani A, Gregson CL, Langdahl BL. Socio-economic inequalities in fragility fracture outcomes: a systematic review and meta-analysis of prognostic observational studies. Osteoporos Int 2020; 31:31-42. [PMID: 31471664 DOI: 10.1007/s00198-019-05143-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/20/2019] [Indexed: 12/16/2022]
Abstract
UNLABELLED Individuals with low socio-economic status (SES) have a higher risk of dying following hip fracture compared with individuals with high SES. Evidence on social inequalities in non-hip fractures is lacking as well as evidence on the impact of SES on health-related quality of life post fracture. INTRODUCTION Fragility fractures, especially of the hip, cause substantial excess mortality and impairment in health-related quality of life (HRQoL). This systematic review and meta-analysis aimed to investigate the association between socio-economic status (SES) and post-fracture mortality and HRQoL. METHODS PubMed, EMBASE and CINAHL databases were searched from inception to the last week of November 2018 for studies reporting an association between SES and post-fracture mortality and/or HRQoL among people aged ≥ 50 years. Risk ratios (RRs) were meta-analyzed using a standard inverse-variance-weighted random effects model. Studies using individual-level and area-based SES measures were analyzed separately. RESULTS A total of 24 studies from 15 different countries and involving more than one million patients with hip fractures were included. The overall risk of mortality within 1-year post-hip fracture in individuals with low SES was 24% higher than in individuals with high SES (RR 1.24, 95% CI 1.19 to 1.29) for individual-level SES measures, and 14% (RR 1.14, 95% CI 1.09 to 1.19) for area-based SES measures. The quality of the evidence for the outcome mortality was moderate. Using individual SES measures, we estimated the excess HRQoL loss to be 5% (95% CI - 1 to 10%) among hip fracture patients with low SES compared with high SES. CONCLUSIONS We found a consistently increased risk of post-hip fracture mortality with low SES across SES measures and across countries with different political structures and different health and social care infrastructures. The impact of SES on post-fracture HRQoL remains uncertain due to sparse and low-quality evidence.
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Affiliation(s)
- G Valentin
- Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Denmark.
| | - S E Pedersen
- Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Denmark
| | - R Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispeberg and Frederiksberg Hospital & Research Unit of Rhematology, Copenhagen, Denmark & Department of Clinical Researh University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - K Friis
- Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Denmark
| | - C P Nielsen
- Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Denmark
| | - A Bhimjiyani
- Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, BS10 5NB, UK
| | - C L Gregson
- Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, BS10 5NB, UK
| | - B L Langdahl
- Department of Endocrinology (MEA), Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Tebé C, Martínez-Laguna D, Carbonell-Abella C, Reyes C, Moreno V, Diez-Perez A, Collins GS, Prieto-Alhambra D. The association between type 2 diabetes mellitus, hip fracture, and post-hip fracture mortality: a multi-state cohort analysis. Osteoporos Int 2019; 30:2407-2415. [PMID: 31444526 DOI: 10.1007/s00198-019-05122-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/31/2019] [Indexed: 12/20/2022]
Abstract
UNLABELLED Type 2 diabetes mellitus (T2DM) is associated with an excess risk of fractures and overall mortality. This study compared hip fracture and post-hip fracture mortality in T2DM and non-diabetic subjects. The salient findings are that subjects in T2DM are at higher risk of dying after suffering a hip fracture. INTRODUCTION Previous research suggests that individuals with T2DM are at an excess risk of both fractures and overall mortality, but their combined effect is unknown. Using multi-state cohort analyses, we estimate the association between T2DM and the transition to hip fracture, post-hip fracture mortality, and hip fracture-free all-cause death. METHODS Population-based cohort from Catalonia, Spain, including all individuals aged 65 to 80 years with a recorded diagnosis of T2DM on 1 January 2006; and non-T2DM matched (up to 2:1) by year of birth, gender, and primary care practice. RESULTS A total of 44,802 T2DM and 81,233 matched controls (53% women, mean age 72 years old) were followed for a median of 8 years: 23,818 died without fracturing and 3317 broke a hip, of whom 838 subsequently died. Adjusted HRs for hip fracture-free mortality were 1.32 (95% CI 1.28 to 1.37) for men and 1.72 (95% CI 1.65 to 1.79) for women. HRs for hip fracture were 1.24 (95% CI 1.08 to 1.43) and 1.48 (95% CI 1.36 to 1.60), whilst HRs for post-hip fracture mortality were 1.28 (95% CI 1.02 to 1.60) and 1.57 (95% CI 1.31 to 1.88) in men and women, respectively. CONCLUSION T2DM individuals are at increased risk of hip fracture, post-hip fracture mortality, and hip fracture-free death. After adjustment, T2DM men were at a 28% higher risk of dying after suffering a hip fracture and women had 57% excess risk of post-hip fracture mortality.
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Affiliation(s)
- C Tebé
- Biostatistics Unit at Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Spain
- Universitat de Barcelona, Barcelona, Spain
- Universitat Rovira i Virgili, Reus, Spain
| | - D Martínez-Laguna
- Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- Grupo de Investigación GREMPAL, IDIAP Jordi Gol and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | - C Carbonell-Abella
- Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- Grupo de Investigación GREMPAL, IDIAP Jordi Gol and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | - C Reyes
- Grupo de Investigación GREMPAL, IDIAP Jordi Gol and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | - V Moreno
- Biostatistics Unit at Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Spain
- Universitat de Barcelona, Barcelona, Spain
- Cancer Prevention and Control Program, Catalan Institute of Oncology-IDIBELL, 08908, L'Hospitalet de Llobregat, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - A Diez-Perez
- Musculoskeletal Research Unit, IMIM-Hospital del Mar and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, 08003, Barcelona, Spain
| | - G S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Windmill Road, Oxford, UK
| | - D Prieto-Alhambra
- Grupo de Investigación GREMPAL, IDIAP Jordi Gol and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain.
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Windmill Road, Oxford, UK.
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Gold T, Williams SA, Weiss RJ, Wang Y, Watkins C, Carroll J, Middleton C, Silverman S. Impact of fractures on quality of life in patients with osteoporosis: a US cross-sectional survey. J Drug Assess 2019; 8:175-183. [PMID: 31692954 PMCID: PMC6818103 DOI: 10.1080/21556660.2019.1677674] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022] Open
Abstract
Objective: To evaluate the impact of osteoporosis-related fractures on health-related quality of life (HRQoL). Methods: Data were obtained from the 2016 Adelphi US Osteoporosis Disease Specific Programme™, a cross-sectional survey of physicians and their male and female patients with osteoporosis. Patient-reported outcomes (PRO) measures included the European Quality of Life 5 Domains (EQ-5D), European Quality of Life Visual Analog Scale (EQ-VAS), and Osteoporosis Assessment Questionnaire short-version (OPAQ-SV; physical, emotional, and symptom domains). Associations between PRO scores and the number and site of fractures were evaluated using ANOVA. Multivariate analyses were conducted using linear regression. Results: Physicians provided records for 1848 patients with osteoporosis. Of these, 981 (53.1%) completed the patient survey, data for the number of fractures were available for 935/981 (95.3%), and 185/935 (19.8%) had a history of fracture. Experiencing fractures significantly influenced scores on all PRO measures (p < .0001). Hip and spine fractures were associated with the greatest reduction in most PRO scores. The number of fractures, age, body mass index, and Charlson Comorbidity Index (CCI) were significantly associated with PRO measures (p < .05) in multivariate analyses. In patients with a fracture, fracture site, CCI, gender (EQ-5D and EQ-VAS), and age (OPAQ-SV physical only) were significantly associated with PRO measures. Conclusions: In patients with osteoporosis, fractures are associated with lower HRQoL and lower overall health status. Fracture history, fracture site, age, and comorbidity burden significantly influence HRQoL in individuals with osteoporosis. These data suggest the need for interventions to reduce the risk of fractures in patients with osteoporosis.
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Affiliation(s)
- T Gold
- Duke University Medical Center, Duke University, Durham, NC, USA
| | | | | | | | | | | | | | - Stuart Silverman
- Cedars-Sinai, Los Angeles, CA, USA.,University of California Los Angeles Medical Center, University of California Los Angeles, Los Angeles, CA, USA
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45
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Ferrari S, Butler PW, Kendler DL, Miller PD, Roux C, Wang AT, Huang S, Wagman RB, Lewiecki EM. Further Nonvertebral Fracture Reduction Beyond 3 Years for Up to 10 Years of Denosumab Treatment. J Clin Endocrinol Metab 2019; 104:3450-3461. [PMID: 31125092 DOI: 10.1210/jc.2019-00271] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/20/2019] [Indexed: 01/22/2023]
Abstract
CONTEXT Evidence for further nonvertebral fracture (NVF) reductions with long-term antiresorptive therapy in osteoporosis is lacking. OBJECTIVE To evaluate NVF risk reduction in subjects receiving ≤10 years of denosumab treatment. DESIGN Phase 3, randomized, placebo-controlled, 3-year Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months (FREEDOM) trial (NCT00089791) and its open-label 7-year extension (NCT00523341). SETTING One hundred seventy-two study centers worldwide. PATIENTS Women 60 to 90 years, lumbar spine or total hip bone mineral density T-scores <-2.5 (≥-4.0 at both). INTERVENTIONS Subjects randomly assigned 1:1 denosumab 60 mg SC Q6M (long-term) or placebo (crossover) in FREEDOM; eligible subjects could enroll in the extension to receive denosumab 60 mg SC Q6M. MAIN OUTCOME MEASURES NVF Exposure-adjusted subject incidence (per 100 subject-years) during denosumab treatment years 1 to 3 and 4 to 7 (all subjects) and years 4 to 10 (long-term only), and rate ratios (RRs) for years 4 to 7 or 4 to 10 vs 1 to 3. RESULTS Among 4074 subjects (2343 long-term, 1731 crossover), NVF rates (95% CI) in all subjects were 2.15 (1.90 to 2.43) during years 1 to 3 and 1.53 (1.34 to 1.75) during years 4 to 7 of denosumab treatment [RR (95% CI) = 0.72 (0.61 to 0.86); P < 0.001]; in long-term only were 1.98 (1.67 to 2.34) during years 1 to 3 and 1.44 (1.24 to 1.66) during years 4 to 10 [RR = 0.74 (0.60 to 0.93); P = 0.008]. combined osteonecrosis of the jaw and atypical femoral fracture rate was 0.06. CONCLUSIONS Long-term denosumab treatment, >3 and ≤10 years, was associated with further reductions in NVF rates compared with the first 3 years.
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Affiliation(s)
| | | | - David L Kendler
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul D Miller
- Colorado Center for Bone Research, Lakewood, Colorado
| | | | | | | | | | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, New Mexico
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46
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Imamura T, Tsurumoto T, Saiki K, Nishi K, Okamoto K, Manabe Y, Oyamada J, Ogami-Takamura K. Morphological profile of atypical femoral fractures: age-related changes to the cross-sectional geometry of the diaphysis. J Anat 2019; 235:892-902. [PMID: 31355449 DOI: 10.1111/joa.13060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 12/14/2022] Open
Abstract
The use of bisphosphonates for osteoporosis patients has markedly decreased the incidence of femoral neck or trochanteric fractures. However, anti-osteoporosis drugs have been reported to increase the incidence of atypical femoral fractures, which involve stress fractures in the subtrochanteric region or the proximal diaphysis. In this study, the morphological characteristics of the cortical bone in human femoral diaphysis samples were analyzed from individuals who lived before bisphosphonate drugs were available in Japan. A total of 90 right femoral bones were arbitrarily selected (46 males and 44 females) from modern Japanese skeletal specimens. Full-length images of these femurs were acquired using a computed tomography scanner. An image processing method for binarization was used to calculate the threshold values of individual bones for determining their contours. The range between the lower end of the lesser trochanter and the adductor tubercle of each femur was divided at regular intervals to obtain 10 planes. The mean value of cortical bone thickness, periosteal border length, and the cortical cross-sectional area was evaluated for all planes. Moreover, the ratio of the area of the cortical bone to the total area of cross-section at the mid-diaphysis was calculated. A comparison between males and females demonstrated that most females had lower cortical bone area ratios at the mid-diaphysis. The femoral outer shape did not differ markedly according to age or sex; however, substantial individual differences were observed in the shape of the inner surface of the cortical bone. The cortical bone thickness and the cross-sectional area decreased with age in the femoral diaphysis; furthermore, in females, the decrease was higher for the former than for the latter. This may be due to a compensatory increase in the circumference of the femoral diaphysis. In addition, in about half of the subjects there was a discrepancy between the region with maximal value of the cortical bone thickness and that of the total cross-sectional area. Biological responses to mechanical stresses to the femoral diaphysis are thought not to be uniform. Bisphosphonates inhibit bone resorption and may promote non-physiological bone remodeling. Thus, a nonhomogeneous decrease in cortical thickness may be related to the fracture occurrence in the femoral diaphysis in some cases. Thus, long-term administration of bisphosphonates in patients with morphological vulnerability in the femoral cortical bones may increase the occurrence of atypical femoral fractures.
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Affiliation(s)
- Takeshi Imamura
- Department of Macroscopic Anatomy, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Toshiyuki Tsurumoto
- Department of Macroscopic Anatomy, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Kazunobu Saiki
- Department of Macroscopic Anatomy, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Keita Nishi
- Department of Oral Anatomy and Dental Anthropology, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Keishi Okamoto
- Department of Macroscopic Anatomy, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Yoshitaka Manabe
- Department of Oral Anatomy and Dental Anthropology, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Joichi Oyamada
- Department of Oral Anatomy and Dental Anthropology, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Keiko Ogami-Takamura
- Department of Macroscopic Anatomy, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
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47
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van de Ree CLP, Landers MJF, Kruithof N, de Munter L, Slaets JPJ, Gosens T, de Jongh MAC. Effect of frailty on quality of life in elderly patients after hip fracture: a longitudinal study. BMJ Open 2019; 9:e025941. [PMID: 31324679 PMCID: PMC6661564 DOI: 10.1136/bmjopen-2018-025941] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The aims of this study were to examine the pattern of changes over time in health status (HS) and quality of life (QoL) in the first year after hip fracture and to quantify the association between frailty at the onset of hip fracture and the change in HS and QoL 1 year later. The major hypothesis was that frailty, a clinical state of increased vulnerability, is a good predictor of QoL in patients recovering from hip fracture. DESIGN Prospective, observational, follow-up cohort study. SETTING Secondary care. Ten participating centres in Brabant, the Netherlands. PARTICIPANTS 1091 patients entered the study and 696 patients completed the study. Patients with a hip fracture aged 65 years and older or proxy respondents for patients with cognitive impairment were included in this study. MAIN OUTCOME MEASURES The primary outcomes were HS (EuroQol-5 Dimensions questionnaire) and capability well-being (ICEpop CAPability measure for Older people). Prefracture frailty was defined with the Groningen Frailty Indicator (GFI), with GFI ≥4 indicating frailty. Participants were followed up at 1 month, 3 months, 6 months and 1 year after hospital admission. RESULTS In total, 371 patients (53.3%) were considered frail. Frailty was negatively associated with HS (β -0.333; 95% CI -0.366 to -0.299), self-rated health (β -21.9; 95% CI -24.2 to -19.6) and capability well-being (β -0.296; 95% CI -0.322 to -0.270) in elderly patients 1 year after hip fracture. After adjusting for confounders, including death, prefracture HS, age, prefracture residential status, prefracture mobility, American Society of Anesthesiologists grading and dementia, associations were weakened but remained significant. CONCLUSIONS We revealed that frailty is negatively associated with QoL 1 year after hip fracture, even after adjusting for confounders. This finding suggests that early identification of prefracture frailty in patients with a hip fracture is important for prognostic counselling, care planning and the tailoring of treatment. TRIAL REGISTRATION NUMBER NCT02508675.
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Affiliation(s)
| | - Maud J F Landers
- Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Nena Kruithof
- Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Leonie de Munter
- Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Joris P J Slaets
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
- Department of Internal Medicine, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
| | - Taco Gosens
- Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
- Department of Orthopaedic Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Mariska A C de Jongh
- Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands
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48
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Kobayashi K, Imagama S, Ando K, Machino M, Ota K, Tanaka S, Morozumi M, Kanbara S, Ito S, Ishiguro N, Hasegawa Y. Epidemiology and effect on physical function of osteosarcopenia in community-dwelling elderly people in Japan. Mod Rheumatol 2019; 30:592-597. [DOI: 10.1080/14397595.2019.1623455] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kyotaro Ota
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayoshi Morozumi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Kanbara
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sadayuki Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Science, Osaka, Japan
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49
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Talevski J, Sanders KM, Duque G, Connaughton C, Beauchamp A, Green D, Millar L, Brennan-Olsen SL. Effect of Clinical Care Pathways on Quality of Life and Physical Function After Fragility Fracture: A Meta-analysis. J Am Med Dir Assoc 2019; 20:926.e1-926.e11. [PMID: 30975586 DOI: 10.1016/j.jamda.2019.02.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To evaluate the effect of clinical care pathways (CCPs) on health-related quality of life (HRQoL) and physical function following fragility fracture and identify the specific characteristics of CCPs that are associated with improved outcomes. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Randomized controlled studies and nonrandomized studies that involved participants aged ≥50 years who sustained a fragility fracture, evaluated the effects of a CCP compared to usual care, and reported outcomes of HRQoL or physical function. METHODS We systematically searched Ovid Medline, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials from the earliest records to July 25, 2018. Two reviewers independently extracted study data and assessed methodologic quality. RESULTS Overall, 22 studies (17 randomized controlled trials, 5 nonrandomized studies) were included, comprising 5842 participants. Twenty-one studies included hip fracture patients, and 1 included wrist fracture patients. Majority of studies (82%) were assessed as high quality. Meta-analyses showed moderate improvements in the CCP group for HRQoL [standardized mean difference (SMD) = 0.24, 95% confidence interval (CI) 0.12, 0.35] and physical function (SMD 0.21, 95% CI 0.10, 0.33) compared with usual care post hip fracture. Inpatient CCPs that extended to the outpatient setting showed greater improvements in HRQoL and physical function compared to CCPs that were only inpatient or outpatient. CCPs that included a care coordinator, geriatric assessment, rehabilitation, prevention of inpatient complications, nutritional advice, or discharge planning also showed greater improvements in outcomes. CONCLUSIONS AND IMPLICATIONS Treatment with CCPs following fragility fracture showed greater improvements in HRQoL and physical function compared with usual care. Further research is warranted to assess the combination of CCP components that provide the most beneficial results, evaluate the effect of CCPs in patients with nonhip fractures, and determine which patient groups are more likely to benefit from CCPs.
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Affiliation(s)
- Jason Talevski
- Department of Medicine-Western Health, University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, Melbourne, Victoria, Australia.
| | - Kerrie M Sanders
- Department of Medicine-Western Health, University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Gustavo Duque
- Department of Medicine-Western Health, University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Catherine Connaughton
- Institute for Health and Ageing, Australian Catholic University, Melbourne, Victoria, Australia
| | - Alison Beauchamp
- Department of Medicine-Western Health, University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, Melbourne, Victoria, Australia; School of Rural Health, Monash University, Moe, Victoria, Australia
| | - Darci Green
- Department of Medicine-Western Health, University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Lynne Millar
- Department of Medicine-Western Health, University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Sharon L Brennan-Olsen
- Department of Medicine-Western Health, University of Melbourne, Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, Melbourne, Victoria, Australia
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50
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Tatangelo G, Watts J, Lim K, Connaughton C, Abimanyi-Ochom J, Borgström F, Nicholson GC, Shore-Lorenti C, Stuart AL, Iuliano-Burns S, Seeman E, Prince R, March L, Cross M, Winzenberg T, Laslett LL, Duque G, Ebeling PR, Sanders KM. The Cost of Osteoporosis, Osteopenia, and Associated Fractures in Australia in 2017. J Bone Miner Res 2019; 34:616-625. [PMID: 30615801 DOI: 10.1002/jbmr.3640] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/22/2018] [Accepted: 11/11/2018] [Indexed: 11/08/2022]
Abstract
Osteoporosis and osteopenia are increasingly prevalent conditions among older adults. Not only do the fractures associated with poor bone health have significant health consequences for the individual, but also their economic impact is placing increasing financial burden on governments and society. This study aimed to determine the direct economic cost of osteoporosis, osteopenia, and fractures among Australians aged 50 years and older in 2017. This study uses previous Australian data on the incidence and prevalence of osteoporosis and osteopenia together with recent Australian data on health service utilization after fracture to provide an estimate of the economic burden of osteoporosis. A bottom-up costing approach was used to determine the average direct health care and non-health care total costs of a fracture, as well as the average community health service costs of managing individuals with osteoporosis or osteopenia. The total direct cost of osteoporosis in Australia in 2017 was estimated to be $3.44 billion (AUD 2017, USD 2.77 billion). Treatment of fractures accounted for 68% of total direct costs, and non-fracture management of osteoporosis accounted for 32%. Hip fractures accounted for the highest proportion (43%) of the total direct cost of fractures, although fractures at "other" sites accounted for 38.5%. Fractures among individuals aged 70 years and older accounted for 74% of the direct costs (55% and 19% in women and men, respectively). Fracture costs in those with osteopenia accounted for 50% of direct fracture treatment costs. This up-to-date cost analysis estimated that costs in 2017 were three times higher than in 2007. These estimates will aid clinicians, policy makers, researchers, and health care organizations to acknowledge the economic importance of reducing osteoporosis-related fractures and associated costs. This provides a strong public health case to promote bone health that will assist in reducing future fracture-related costs. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
| | - Jennifer Watts
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Australia
| | - Karen Lim
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Catherine Connaughton
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Julie Abimanyi-Ochom
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Australia
| | | | - Geoff C Nicholson
- Department of Medicine, The University of Melbourne and Western Health, Sunshine Hospital, Melbourne, Australia.,Rural Clinical School, The University of Queensland, Toowoomba, Australia
| | - Catherine Shore-Lorenti
- Department of Medicine, The University of Melbourne and Western Health, Sunshine Hospital, Melbourne, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | | | - Sandra Iuliano-Burns
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Ego Seeman
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Richard Prince
- School of Medicine and Dentistry, University of Western Australia, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Lyn March
- Institute of Bone and Joint Research, University of Sydney-Royal North Shore Hospital, Sydney, Australia
| | - Marita Cross
- Institute of Bone and Joint Research, University of Sydney-Royal North Shore Hospital, Sydney, Australia
| | - Tania Winzenberg
- Menzies Research Institute Tasmania, University of Tasmania, Tasmania, Australia
| | - Laura L Laslett
- Menzies Research Institute Tasmania, University of Tasmania, Tasmania, Australia
| | - Gustavo Duque
- Department of Medicine, The University of Melbourne and Western Health, Sunshine Hospital, Melbourne, Australia.,Ageing Bone Research Program, Sydney Medical School, Nepean Hospital, University of Sydney, Sydney, Australia
| | - Peter R Ebeling
- Department of Medicine, The University of Melbourne and Western Health, Sunshine Hospital, Melbourne, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Kerrie M Sanders
- Department of Medicine, The University of Melbourne and Western Health, Sunshine Hospital, Melbourne, Australia
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