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Hussain MA, Qaisar R, Karim A, Ahmad F, Franzese F, Awad A, Al-Masri AA, Alsaeed M, Alkahtani SA. Predictors of hip fracture in 15 European countries: a longitudinal study of 48,533 geriatric adults using SHARE dataset. Arch Osteoporos 2024; 19:60. [PMID: 39023661 DOI: 10.1007/s11657-024-01420-4] [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: 03/28/2024] [Accepted: 07/07/2024] [Indexed: 07/20/2024]
Abstract
We investigated the risk factors for hip fracture in 48,533 European older adults for 8 years from 2013 onward. We identified female gender, age above 80, low handgrip strength, and depression as significant risk factors for hip fracture. Our findings may help identify high-risk populations for hip fractures in pre-clinical settings. OBJECTIVES Hip fracture is a major cause of functional disability, mortality, and health costs. However, the identification and characterization of its causative factors remain poor. METHODS We investigated demography, handgrip strength (HGS), depression, and multiple age-associated comorbidities for predicting future hip fracture in individuals aged 50 or above from 15 European countries (n = 48,533). All participants were evaluated from 2013 to 2020 using four successive waves of the Survey of Health, Aging, and Retirement in Europe (SHARE). RESULTS Altogether, 1130 participants developed hip fractures during the study period. We identified female gender, an advancing age from quinquagenarians onward, and a poor socioeconomic status as critical risk factors for future hip fracture. Having mobility difficulty, a low HGS (< 27 kg in men, < 16 kg in women) and higher scores on Euro-D depression scales were also significant risk factors for hip fracture. Summated scales of hypertension, diabetes mellitus, cancer, Alzheimer's disease, and stroke did not appear as risk factors. CONCLUSION Collectively, we report advancing age, female gender, low HGS, and depression as independent risk factors for hip fracture. Our findings are useful in identifying high-risk populations for hip fractures in pre-clinical settings before rigorous evaluation and treatment in clinics.
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Affiliation(s)
- M Azhar Hussain
- Department of Finance and Economics, College of Business Administration, University of Sharjah, Sharjah, 27272, UAE
- Department of Social Sciences and Business, Roskilde University, 4000, Roskilde, Denmark
| | - Rizwan Qaisar
- Basic Medical Sciences, College of Medicine, University of Sharjah, 27272, Sharjah, United Arab Emirates
- Cardiovascular Research Group, Research Institute for Medical and Health Sciences, University of Sharjah, 27272, Sharjah, United Arab Emirates
| | - Asima Karim
- Basic Medical Sciences, College of Medicine, University of Sharjah, 27272, Sharjah, United Arab Emirates
| | - Firdos Ahmad
- Basic Medical Sciences, College of Medicine, University of Sharjah, 27272, Sharjah, United Arab Emirates
- Cardiovascular Research Group, Research Institute for Medical and Health Sciences, University of Sharjah, 27272, Sharjah, United Arab Emirates
| | - Fabio Franzese
- SHARE Berlin Institute, Chausseestraße 111, 10115, Berlin, Germany
| | - Atif Awad
- Department of Finance and Economics, College of Business Administration, University of Sharjah, Sharjah, 27272, UAE
| | - Abeer A Al-Masri
- Department of Physiology, College of Medicine, King Saud University, 11451, Riyadh, Saudi Arabia
| | - Mohammed Alsaeed
- Department of Biomechanics & Motor Behavior, College of Sport Sciences and Physical Activity, King Saud University, 11451, Riyadh, Saudi Arabia
| | - Shaea A Alkahtani
- Exercise Physiology Department, College of Sport Sciences and Physical Activity, King Saud University, PO Box: 1949, 11451, Riyadh, Saudi Arabia.
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Hellman-Bronstein AT, Luukkaala TH, Ala-Nissilä SS, Nuotio MS. Associated factors of stress, urgency, and mixed urinary incontinence in a geriatric outpatient assessment of older women with hip fracture. Eur Geriatr Med 2024:10.1007/s41999-024-00997-w. [PMID: 38802641 DOI: 10.1007/s41999-024-00997-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Urinary incontinence (UI) is known to be common among older female hip fracture patients. Little is known about different subtypes of UI among these patients. Our aim was to identify factors associated with subtypes of UI in a cross-sectional design. METHODS 1,675 female patients aged ≥ 65 and treated for their first hip fracture in Seinäjoki Central Hospital, Finland, during 2007-2019, were included in a prospective cohort study. Of these, 1,106 underwent comprehensive geriatric assessment (CGA), including questions on continence, at our geriatric outpatient clinic 6 month post-fracture. A multivariable-adjusted multinomial logistic regression model was used to examine factors associated with UI subtypes. RESULTS Of the 779 patients included, 360 (46%) were continent and 419 (54%) had UI 6-month post-fracture. Of the women with UI, 117 (28%) had stress UI, 183 (44%) had urgency UI and 119 (28%) had mixed UI, respectively. Mean age of the patients was 82 ± 6,91. In multivariable analysis, depressive mood and poor mobility and functional ability were independently associated with stress UI. Fecal incontinence (FI) and Body Mass Index (BMI) over 28 were independently associated with urgency UI. Mixed UI shared the aforementioned factors with stress and urgency UI and was independently associated with constipation. CONCLUSIONS Mixed UI was associated with most factors, of which depressive mood and impaired mobility and poor functional ability were shared with stress UI, and FI and higher BMI with urgency UI. CGA is key in assessing UI in older hip fracture patients, regardless of subtype.
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Affiliation(s)
- Aino T Hellman-Bronstein
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland.
| | - Tiina H Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Seija S Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Milton-Cole R, Kazeem K, Gibson A, Guerra S, Sheehan KJ. Effectiveness of exercise rehabilitation interventions on depressive symptoms in older adults post hip fracture: a systematic review and meta-analysis. Osteoporos Int 2024; 35:227-242. [PMID: 37831102 DOI: 10.1007/s00198-023-06923-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
This study determines the effectiveness of exercise rehabilitation interventions on depressive symptoms in older adults after hip fracture. Ovid MEDLINE, Embase, Global Health, APAPsych, CENTRAL, CIHAHL, PEDro and Open Grey were searched from database inception to June 10, 2022 for definitive, pilot or feasibility randomised controlled trials of rehabilitation interventions (versus any comparator) which reported depressive symptoms among older adults post hip fracture. Nonrandomised trials and those not published in English were excluded. Selection, quality appraisal (Cochrane Risk of Bias 2) and extraction in duplicate. Results were synthesised narratively and with meta-analysis (Hedge's g for intervention effect, I2 for heterogeneity). Eight trials (1146 participants) were included. Interventions were predominantly face-to-face exercise rehabilitation (range three to 56 sessions) at home versus usual care. Three trials were assigned overall low risk of bias, three some concerns and two high risk. The pooled effect of rehabilitation on depressive symptoms at intervention end favoured the intervention group (Hedges's g -0.43; 95% CI: -0.87, 0.01; four trials). Three trials demonstrated no between group difference following adjustment for baseline depressive symptoms. One trial found lower odds of depression when the intervention additionally included falls prevention, nutrition consultation and depression management. There is a potential benefit of exercise rehabilitation interventions on depressive symptoms after hip fracture. A mechanism for benefit may relate to baseline symptom severity, exercise frequency, frequency of health professional contacts, addition of a psychological component or of the quality of the underlying trials. To appropriately inform clinical guidelines, further appropriately powered trials with follow-up are warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: CRD42022342099.
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Affiliation(s)
- Rhian Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Kareema Kazeem
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Alexander Gibson
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Stefanny Guerra
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Katie Jane Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK.
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Cedeno-Veloz BA, Casadamon-Munarriz I, Rodríguez-García A, Lozano-Vicario L, Zambom-Ferraresi F, Gonzalo-Lázaro M, Hidalgo-Ovejero ÁM, Izquierdo M, Martínez-Velilla N. Effect of a Multicomponent Intervention with Tele-Rehabilitation and the Vivifrail© Exercise Programme on Functional Capacity after Hip Fracture: Study Protocol for the ActiveFLS Randomized Controlled Trial. J Clin Med 2023; 13:97. [PMID: 38202104 PMCID: PMC10779784 DOI: 10.3390/jcm13010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Hip fractures are the most common fracture leading to hospitalization and are associated with high costs, mortality rates and functional decline. Although several guidelines exist for preventing new fractures and promoting functional recovery, they tend to focus on osteoporosis treatment and do not take into account the complexity of frailty in older adults and geriatric syndromes, which are important factors in individuals at risk of suffering from frailty fractures. Moreover, most health systems are fragmented and are incapable of providing appropriate management for frail and vulnerable individuals who are at risk of experiencing fragility fractures. Multicomponent interventions and physical exercise using tele-rehabilitation could play a role in the management of hip fracture recovery. However, the effectiveness of exercise prescription and its combination with a comprehensive geriatric assessment (CGA) is still unclear. METHODS This randomized clinical trial will be conducted at the Hospital Universitario de Navarra (Pamplona, Spain). A total of 174 older adults who have suffered a hip fracture and fulfil the criteria for inclusion will be randomly allocated to either the intervention group or the control group. The intervention group will receive a multicomponent intervention consisting of individualized home-based exercise using the @ctive hip app for three months, followed by nine months of exercise using Vivifrail. Additionally, the intervention group will receive nutrition intervention, osteoporosis treatment, polypharmacy adjustment and evaluation of patient mood, cognitive impairment and fear of falling. The control group will receive standard outpatient care according to local guidelines. This research aims to evaluate the impact of the intervention on primary outcome measures, which include changes in functional status during the study period based on the Short Physical Performance Battery. DISCUSSION The findings of this study will offer valuable insights into the efficacy of a comprehensive approach that considers the complexity of frailty in older adults and geriatric syndromes, which are important factors in individuals at risk of suffering from frailty fractures. This study's findings will contribute to the creation of more effective strategies tailored to the requirements of these at-risk groups.
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Affiliation(s)
- Bernardo Abel Cedeno-Veloz
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
| | - Irache Casadamon-Munarriz
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
| | - Alba Rodríguez-García
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
| | - Lucia Lozano-Vicario
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
| | - Fabricio Zambom-Ferraresi
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Av Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - María Gonzalo-Lázaro
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
| | - Ángel María Hidalgo-Ovejero
- Department of Orthopaedics Clinics and Traumatology, University Hospital of Navarre (HUN), 31008 Pamplona, Navarra, Spain;
| | - Mikel Izquierdo
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Av Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Nicolás Martínez-Velilla
- Navarre University Hospital (HUN), Irunlarrea 3, 31008 Pamplona, Navarra, Spain; (I.C.-M.); (A.R.-G.); (L.L.-V.); (F.Z.-F.); (M.G.-L.); (N.M.-V.)
- Navarrabiomed, Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008 Pamplona, Navarra, Spain;
- Department of Health Sciences, Public University of Navarre, Av Cataluña s/n, 31006 Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Av Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
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Gu A. Letter to the Editor: What Are Orthopaedic Patients' and Clinical Team Members' Perspectives Regarding Whether and How to Address Mental Health in the Orthopaedic Care Setting? A Qualitative Investigation of Patients With Neck or Back Pain. Clin Orthop Relat Res 2023; 481:1049-1050. [PMID: 36763515 PMCID: PMC10097582 DOI: 10.1097/corr.0000000000002593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Alex Gu
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Erdem AS, Şimşek Kaya G, Kaya M, Altunay B, Alkan TY, Toru HS. Comparison of the effects of fluoxetine and venlafaxine on bone healing in a rat calvarial defect model. Injury 2023:S0020-1383(23)00290-5. [PMID: 37003871 DOI: 10.1016/j.injury.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/02/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the effects of the selective serotonin reuptake inhibitor (SSRI) fluoxetine and the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine on bone defect healing. MATERIALS AND METHODS Wistar rats were randomly divided into three groups of eight animals each. The first received 0.1 ml/kg sterile saline solution, the second 5 mg/kg fluoxetine, and the third 5 mg/kg venlafaxine, daily by gastric gavage over 7 weeks. At week 3 of drug therapy, 5-mm diameter calvarial defects were created in the parietal bone of all of the animals. All rats were euthanized four weeks after surgery, micro-CT analysis and histomorphometric analysis were carried out to evaluate the following parameters: Bone volume fraction (BV/TV), bone surface (BS), bone surface density (BS/BV; bone surface/bone volume, 1/mm), trabecular number (Tb. N), trabecular thickness (Tb. Th), areas of new bone structure (positive areas), areas of mature bone structure (negative areas). RESULTS Micro-CT analysis showed the presence of similar levels of bone formation within the defect site in all three groups (p>0.05). Histomorphometric analysis revealed the presence of bone-forming cells at the defect periphery, with less activity indicating bone formation at the center. No statistically significant difference was observed between the groups (p>0.05). CONCLUSION Based on the findings of this study, it can be said that the use of both antidepressants hasn't any effect on bone defect healing.
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Affiliation(s)
- Arif Sermed Erdem
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Göksel Şimşek Kaya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey.
| | - Mahir Kaya
- Department of Medical Imaging Techniques, Vocational School of Health Services, Akdeniz University, Antalya, Turkey
| | - Büşra Altunay
- Department of Pathology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Taha Yiğit Alkan
- Department of Computer Engineering, Institute of Natural and Applied Sciences, Akdeniz University, Antalya, Turkey
| | - Havva Serap Toru
- Department of Pathology, School of Medicine, Akdeniz University, Antalya, Turkey
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Bevilacqua G, Westbury LD, Bloom I, Zhang J, Ward KA, Cooper C, Dennison EM. Investigating the relationship between self-perception of fracture risk and prior fracture: findings from the Hertfordshire Cohort Study. Aging Clin Exp Res 2023; 35:599-606. [PMID: 36529804 PMCID: PMC9760539 DOI: 10.1007/s40520-022-02322-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Self-perceived risk of fracture (SPR) is associated with fracture independent of FRAX calculated risk. To understand this better we considered whether lifestyle factors not included in the FRAX algorithm and psychosocial factors (social isolation, self-efficacy, or mental health status) explain the relationship between SPR and fracture. METHODS We studied 146 UK community-dwelling older adults from the Hertfordshire Cohort Study. SPR ranked as 'lower', 'similar' and 'higher' relative to others of the same age, was assessed by questionnaire. Social isolation was assessed using the six-item Lubben Social Network Scale; self-efficacy was assessed using a shortened General Self-Efficacy Scale (GSE); mental health status was assessed using the anxiety/depression item from the EuroQoL questionnaire. SPR in relation to previous self-reported fracture was examined using logistic regression. RESULTS Among participants of median age 83.4 (IQR 81.5-85.5) years, SPR was lower for 54.1% of participants, similar for 30.8%, and higher for 15.1%; 74.7% reported no previous fractures. Greater SPR was associated with increased odds of previous fractures when adjusting for sex and age only (OR 1.72, 95% CI 1.03-2.87, per higher band of SPR). While further individual adjustment for social isolation (1.73, 1.04-2.89), self-efficacy (1.71, 1.02-2.85), or mental health (1.77, 1.06-2.97) did not attenuate the relationship, individual adjustment for diet quality and number of comorbidities did. CONCLUSIONS Adjustment for social isolation, self-efficacy or mental health status did not attenuate the relationship between SPR and fracture. By contrast, lifestyle factors not included in FRAX, such as diet quality, did attenuate relationships, suggesting a possible future area of investigation.
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Affiliation(s)
- Gregorio Bevilacqua
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Leo D Westbury
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Ilse Bloom
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health and Care Research (NIHR), Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
| | - Jean Zhang
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health and Care Research (NIHR), Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
| | - Kate A Ward
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Cyrus Cooper
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health and Care Research (NIHR), Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
- National Institute for Health and Care Research (NIHR), Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Elaine M Dennison
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK.
- National Institute for Health and Care Research (NIHR), Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK.
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand.
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Adekkanattu P, Olfson M, Susser LC, Patra B, Vekaria V, Coombes BJ, Lepow L, Fennessy B, Charney A, Ryu E, Miller KD, Pan L, Yangchen T, Talati A, Wickramaratne P, Weissman M, Mann J, Biernacka JM, Pathak J. Comorbidity and healthcare utilization in patients with treatment resistant depression: A large-scale retrospective cohort analysis using electronic health records. J Affect Disord 2023; 324:102-113. [PMID: 36529406 PMCID: PMC10327872 DOI: 10.1016/j.jad.2022.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/09/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Medical comorbidity and healthcare utilization in patients with treatment resistant depression (TRD) is usually reported in convenience samples, making estimates unreliable. There is only limited large-scale clinical research on comorbidities and healthcare utilization in TRD patients. METHODS Electronic Health Record data from over 3.3 million patients from the INSIGHT Clinical Research Network in New York City was used to define TRD as initiation of a third antidepressant regimen in a 12-month period among patients diagnosed with major depressive disorder (MDD). Age and sex matched TRD and non-TRD MDD patients were compared for anxiety disorder, 27 comorbid medical conditions, and healthcare utilization. RESULTS Out of 30,218 individuals diagnosed with MDD, 15.2 % of patients met the criteria for TRD (n = 4605). Compared to MDD patients without TRD, the TRD patients had higher rates of anxiety disorder and physical comorbidities. They also had higher odds of ischemic heart disease (OR = 1.38), stroke/transient ischemic attack (OR = 1.57), chronic kidney diseases (OR = 1.53), arthritis (OR = 1.52), hip/pelvic fractures (OR = 2.14), and cancers (OR = 1.41). As compared to non-TRD MDD, TRD patients had higher rates of emergency room visits, and inpatient stays. In relation to patients without MDD, both TRD and non-TRD MDD patients had significantly higher levels of anxiety disorder and physical comorbidities. LIMITATIONS The INSIGHT-CRN data lack information on depression severity and medication adherence. CONCLUSIONS TRD patients compared to non-TRD MDD patients have a substantially higher prevalence of various psychiatric and medical comorbidities and higher health care utilization. These findings highlight the challenges of developing interventions and care coordination strategies to meet the complex clinical needs of TRD patients.
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Affiliation(s)
| | - Mark Olfson
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | | | | | | | | | - Lauren Lepow
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian Fennessy
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Lifang Pan
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Tenzin Yangchen
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Ardesheer Talati
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Priya Wickramaratne
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Myrna Weissman
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - John Mann
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
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Lian Z, Zhu C, Yuan H, Wang J. Association between changes in depressive symptoms and hip fracture among middle-aged and older Chinese individuals: a prospective cohort study. BMC Geriatr 2022; 22:844. [PMID: 36348273 PMCID: PMC9644634 DOI: 10.1186/s12877-022-03484-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although studies have shown that depressive symptoms are associated with an increased risk of hip fracture (HF). Depressive symptoms are dynamic, and it is unclear whether HF risk persists if depressive symptoms remit. This study aims to examine the associations between changes in depressive symptoms and HF risk. Methods Data were from the China Health and Retirement Longitudinal Study from 2011 to 2018. Depressive symptoms were measured using the 10-item version of the Center for Epidemiological Studied Depression scale (cutoff ≥ 10). Changes in depressive symptoms were classified into four groups by two successive surveys (stable low/no, recent-onset, recently remitted, and stable high depressive symptoms). Multivariable logistic regressions were performed to assess whether changes in depressive symptoms were associated with HF incidents reported through 2018, adjusting for age, sex, educational level, marital status and other potential confounding factors. Results In total, 8574 participants were included, 265 (3.1%) of whom had reported HF incidents in the subsequent 5-year period. Participants with recent-onset (OR = 1.97, 95% CI = 1.40–2.77) or stable high (OR = 2.15, 95% CI = 1.53–3.02) symptoms had a higher risk of HF than those with stable low/no depressive symptoms, whereas those with improved depressive symptoms (OR = 1.27, 95% CI = 0.89–1.82) had no elevation in HF risk. Conclusion Stable high and recent-onset depressive symptoms were associated with increased HF risk, and no elevated HF risk was observed if symptoms remitted, suggesting that strategies to reduce depressive symptoms may be beneficial for HF prevention. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03484-8.
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Factors associated with urinary and double incontinence in a geriatric post-hip fracture assessment in older women. Aging Clin Exp Res 2022; 34:1407-1418. [PMID: 34984652 PMCID: PMC9151507 DOI: 10.1007/s40520-021-02046-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/02/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Incontinence and hip fractures are common in older people, especially women, and associated with multiple adverse effects. Incontinence is a risk factor for falls. AIMS We aimed to investigate the prevalence of urinary (UI) and double incontinence (DI, concurrent UI and faecal incontinence), and to identify factors associated with UI and DI 6 months post-fracture. METHODS A prospective real-life cohort study was conducted consisting of 910 women aged ≥ 65 who were treated for their first hip fracture in Seinäjoki Central Hospital, Finland, between May 2008 and April 2018. Continence status was elicited at baseline and 6 months postoperatively at our geriatric outpatient clinic where all participants underwent a multidisciplinary comprehensive geriatric assessment (CGA) consisting of an evaluation of cognition, nutrition, mood, mobility, and functional ability. RESULTS At baseline, 47% of the patients were continent, 45% had UI and 8% had DI, and at follow up, 38%, 52%, and 11%, respectively. The mean age of the patients was 82.7 ± 6.8. Both UI and DI were associated with functional disability and other factors related to frailty. The associations were particularly prominent for patients with DI who also had the worst performance in the domains of CGA. We identified several modifiable risk factors: depressive mood (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.16-2.84) and constipation (OR 1.48, 95% CI 1.02-2.13) associated with UI and, late removal of urinary catheter (OR 2.33, 95% CI 1.31-4.14), impaired mobility (OR 2.08, 95% CI 1.05-4.15), and poor nutrition (OR 2.31, 95% CI 1.11-4.79) associated with DI. CONCLUSIONS This study demonstrates a high prevalence of UI and DI in older women with hip fracture and modifiable risk factors, which should be targeted in orthogeriatric management and secondary falls prevention. Patients with DI were found to be an especially vulnerable group.
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11
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Wu S, Shi H, Cheng R, Xiang Z, Huang SS. Impairment in activities of daily living and cognitive decline mediate the association between depressive symptoms and incident hip fractures in Chinese older adults. Bone 2022; 159:116374. [PMID: 35227932 DOI: 10.1016/j.bone.2022.116374] [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: 12/11/2021] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The presence of depressive symptoms is associated with increasing risks of hip fractures (HFs). However, few studies investigated the longitudinal relationship between depressive symptoms and incident HFs among Chinese older adults, and the underlying mechanisms remain unclear. OBJECTIVES To investigate the association between depressive symptoms and incident HFs, and the mediating role of cognitive function and impairment in activities of daily living (ADL) in the association among the older adults in China. METHODS This population-based cohort study included 6336 Chinese older adults (age range, 60-101 years) without the history of HFs at baseline and with complete data during the follow-up. Discrete-time Cox regression was used to evaluate the relationship between depressive symptoms and incident HFs, and bootstrapped multiple mediation analyses were conducted to examine the effects of cognitive function and ADL impairment on the association. RESULTS Among 6336 participants (3172 women [50.1%]; mean [SD] age, 67.9 [6.6] years), 264 (4.2%) subjects had HFs onset. After adjusting for age, sex, education, marital status, current residence, smoking status, drinking status, body mass index, number of chronic conditions, and falls history, elevated depressive symptoms were independently associated with increasing risks of HFs (adjusted hazard ratio [aHR]: 1.42; 95% CI: 1.07 to 1.88). However, this association was no longer significant (aHR: 1.09; 95% CI: 0.78 to 1.53) after adjusting for cognitive function and ADL impairment. When mortality and incident HFs were modeled as a composite outcome, the association between depressive symptoms and combined outcomes also remained non-significant after adjusting for cognitive function and ADL impairment. Furthermore, the mediation model demonstrated that cognitive decline (indirect effect: β = 0.002, 95% CI: 0.001 to 0.003) and ADL impairment (indirect effect: β = 0.002, 95% CI: 0.000 to 0.003) fully mediated the association between depressive symptoms and incident HFs after adjusting for age, sex, falls history, and number of chronic conditions. CONCLUSIONS The positive association between depressive symptoms and incident HFs was confirmed among Chinese older adults, which was fully mediated by cognitive decline and ADL impairment. This study shed new light on the potential role played by depressive symptoms in incident HFs.
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Affiliation(s)
- Shuang Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610000, China
| | - Hui Shi
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15260, USA.
| | - Rui Cheng
- The Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Xiang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610000, China
| | - Shi-Shu Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610000, China.
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de Filippis R, Mercurio M, Spina G, De Fazio P, Segura-Garcia C, Familiari F, Gasparini G, Galasso O. Antidepressants and Vertebral and Hip Risk Fracture: An Updated Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10050803. [PMID: 35627940 PMCID: PMC9140335 DOI: 10.3390/healthcare10050803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/14/2022] [Accepted: 04/23/2022] [Indexed: 12/10/2022] Open
Abstract
Although antidepressant drugs appear to play an active role in increasing fracture risk, their weight is still unclear. We conducted a PRISMA compliant systematic review and meta-analysis through PubMed/Scopus/Cochrane libraries and registered with PROSPERO (registration number CRD42021254006) to investigate the relationship between antidepressant drugs categories, including SSRIs, SNRIs, and TCAs, and the risk of hip and vertebral fractures. After screening 3122 items, we finally found 26 papers for qualitative analysis and 11 for quantitative synthesis. A total of 15,209,542 adult and elderly patients were identified, with a mean follow-up of 51 months and a major prevalence of women. We identified results largely for SSRIs, with only a small amount of data for SNRIs, TCAs, and NaSSA. No data were found among the most recent categories of antidepressants, such as vortioxetine and esketamine. All included studies reported hip fractures, while three of them also included vertebral fractures. Overall, we observed a significant effect of SSRIs on fracture risk with a mean effect of 0.98 (95% CI = 0.75–1.20). This meta-analysis reveals that the use of SSRIs increases the risk of fractures. Clinicians’ awareness in antidepressant prescription should optimize their potential while reducing this risk.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (R.d.F.); (P.D.F.)
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
- Correspondence: ; Tel.: +39-0961-3647122
| | - Giovanna Spina
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (R.d.F.); (P.D.F.)
| | - Cristina Segura-Garcia
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
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13
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Vitamin D Deficiency in Patients Receiving Antidepressant Medications. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Тhis study aimed at exploring vitamin D levels in treated depressive patients in comparison to healthy individuals. The cross-sectional study included 20 ambulatory and inpatients with depressive episodes taking antidepressants and 30 healthy individuals. The serum concentration of 25(OH)D from collected blood samples was determined using biochemical analyzers. Serum 25(OH)D levels (ng/mL) in patients were significantly lower (the mean 13.1, standard deviation 7.3, median 11.4, minimal 3.8, maximal 35.9) then in control subjects (19.4, 9.1, 15.8, 7.6, 43.6) (p=0.004). Additional targeted research is needed because some lifestyle and dietary habits which are known to influence vitamin D status may confound observed effects.
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14
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Zhu C, Yu H, Lian Z, Wang J. Prospective association between depressive symptoms and hip fracture and fall among middle-aged and older Chinese individuals. BMC Psychiatry 2022; 22:258. [PMID: 35413849 PMCID: PMC9004028 DOI: 10.1186/s12888-022-03906-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/01/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The effect of depressive symptoms on hip fracture (HF) and falls among the Chinese population is unclear. This study aims to examine the prospective association between depressive symptoms and HF as well as fall accidents in a nationally representative Chinese population. METHODS We used data from 10,596 participants in the Chinese Health and Retirement Longitudinal Study (from 2011 to 2018) who were aged ≥45 years and had no HFs at baseline. Depressive symptoms were assessed using the 10-item version of the Center for Epidemiological Studied Depression scale (cutoff for distinguishing high versus low at ≥12). Logistic regression analyses adjusted for demographic characteristics, lifestyle factors and physical comorbidities were performed. RESULTS For the analysis of baseline depressive symptoms and HF, 399 (3.8%) participants reported HF accidents in the following 7-year period. Individuals with elevated depressive symptoms at baseline experienced a markedly higher HF risk (odds ratio [OR] = 1.33, 95% confidence interval [CI] = 1.06-1.67) than those without elevated depressive symptoms, after adjusting for a wide range of potential confounders. For the analysis of baseline depressive symptoms and falls, 3974 (37.5%) experienced fall accidents during the follow-up. The presence of elevated depressive symptoms was independently associated with an increased risk of fall events (OR = 1.21, 95% CI = 1.10-1.33). These associations were consistent across multiple characteristics. CONCLUSIONS In conclusion, elevated depressive symptoms were associated with an increased risk of HF and falls, which may have considerable clinical and preventive implications.
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Affiliation(s)
- Chunsu Zhu
- grid.415110.00000 0004 0605 1140Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014 China
| | - Hongyu Yu
- grid.415110.00000 0004 0605 1140Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014 China
| | - Zhiwei Lian
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014, China.
| | - Jianmin Wang
- grid.415110.00000 0004 0605 1140Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014 China
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Ma R, Perera G, Romano E, Vancampfort D, Koyanagi A, Stewart R, Mueller C, Stubbs B. Predictors of falls and fractures leading to hospitalisation in 36 101 people with affective disorders: a large representative cohort study. BMJ Open 2022; 12:e055070. [PMID: 35277405 PMCID: PMC8919445 DOI: 10.1136/bmjopen-2021-055070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate predictors of falls and fractures leading to hospitalisation in people with affective disorders. DESIGN Cohort study. SETTING The South London and Maudsley National Health Service (NHS) Foundation Trust (SLaM) Biomedical Research Centre (BRC) Case Register. PARTICIPANTS A large cohort of people with affective disorders (International Classification of Diseases- 10th version [ICD-10] codes F30-F34) diagnosed between January 2008 and March 2016 was assembled using data from the SLaM BRC Case Register. PRIMARY AND SECONDARY OUTCOME MEASURES Falls and fractures leading to hospitalisation were ascertained from linked national hospitalisation data. Multivariable Cox proportional hazards analyses were administrated to identify predictors of first falls and fractures. RESULTS Of 36 101 people with affective disorders (mean age 44.4 years, 60.2% female), 816 (incidence rate 9.91 per 1000 person-years) and 1117 (incidence rate 11.92 per 1000 person-years) experienced either a fall or fracture, respectively. In multivariable analyses, older age, analgesic use, increased physical illness burden, previous hospital admission due to certain comorbid physical illnesses and increase in attendances to accident and emergency services following diagnosis were significant risk factors for both falls and fractures. Having a history of falls was a strong risk factor for recurrent falls, and a previous fracture was also associated with future fractures. CONCLUSIONS Over a mean 5 years' follow-up, approximately 8% of people with affective disorders were hospitalised with a fall or fracture. Several similar factors were found to predict risk of falls and fracture, for example, older age, comorbid physical disorders and analgesic use. Routine screening for bone mineral density and fall prevention programmes should be considered for this clinical group.
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Affiliation(s)
- Ruimin Ma
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Gayan Perera
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Eugenia Romano
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- University Psychiatric Centre KU Leuven, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Spain
- Institució Catalana de Recerca i Estudis Avancats (ICREA), Barcelona, Spain
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, London, UK
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, London, UK
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, London, UK
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16
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Saito Y, Miura K, Arima H, Hayakawa T, Takashima N, Kita Y, Okuda N, Fujiyoshi A, Iwahori T, Miyagawa N, Kondo K, Torii S, Kadota A, Ohkubo T, Okayama A, Okamura T, Ueshima H. Predictors of lower limb fractures in general Japanese: NIPPON DATA90. PLoS One 2022; 17:e0261716. [PMID: 35108263 PMCID: PMC8809608 DOI: 10.1371/journal.pone.0261716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022] Open
Abstract
Objective This study aimed to investigate the incidence rates and predictors of lower limb fractures in a general Japanese population. Methods NIPPON DATA is a nationwide, long-term, prospective cohort study of individuals who participated in the National Cardiovascular Survey Japan and the National Nutrition Survey in 1990. Overall, 3,134 individuals (1,827 women, 1,307 men) who participated in follow-up assessments in 1995, 2000, and/or 2006 were included in the present analysis. The outcomes of this study were lower limb fractures (including proximal femur fractures). Results The mean age at baseline was 63.8 years in women and 63.1 years in men. The average body mass index (BMI) was 23.3 kg/m2 in women and 22.9 kg/m2 in men. During a mean follow-up of 12.1 years, 271 total lower limb fractures were observed. In women, older age, lower BMI, and less intake of vegetables were associated with increased risks of proximal femur fractures. With regard to the outcome of total lower limb fractures, less intake of vegetables and regular exercise were significant predictors in women. Calcium intake was not significantly associated with proximal femur or total lower limb fractures. There were no significant predictors of proximal femur or total lower limb fractures in men, except for age. Conclusions Aging was a significant risk factor for proximal femur and total lower limb fractures in both men and women. With regard to modifiable risk factors, low BMI and low intake of vegetables were associated with increased risks of proximal femur and/or total lower limb fractures in the general population of Japanese women.
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Affiliation(s)
- Yoshino Saito
- Department of Nursing Faculty of Health Science, Aino University, Osaka, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- * E-mail:
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- NCD Epidemiology Research Center Shiga University of Medical, Science, Shiga, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Takehito Hayakawa
- Research Center for Social Studies of Health and Community Ritsumeikan University, Kyoto, Japan
| | - Naoyuki Takashima
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
| | | | - Nagako Okuda
- Department of Health Science, Kyoto Prefectural University, Kyoto, Japan
| | | | - Toshiyuki Iwahori
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Naoko Miyagawa
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Sayuki Torii
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- NCD Epidemiology Research Center Shiga University of Medical, Science, Shiga, Japan
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Perskin CR, Maseda M, Konda SR, Ganta A, Egol KA. Major depressive disorder, when under treatment, may not affect functional outcomes in patients with tibial plateau fractures. Knee 2022; 34:141-146. [PMID: 34920233 DOI: 10.1016/j.knee.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study is to determine if treated psychological depression is associated with poorer functional outcomes in patients who sustain tibial plateau fractures. METHODS Patients with a tibia plateau fracture were prospectively followed. Functional status was assessed using the Short Musculoskeletal Function Assessment (SMFA) at baseline (pre-injury), 3 months, 6 months, and 1 year post injury. Clinical outcomes were recorded at each follow up visit and radiographic outcomes were obtained from follow up radiographs. Records were reviewed to identify patients who were being treated for major depressive disorder (MDD). SMFA scores and clinical outcomes were compared between the depression and no depression cohorts. RESULTS 420 patients were treated for a tibial plateau fracture and the mean age was 50.83 ± 15.60 years. Forty-two (10%) patients with 42 fractures were being treated for MDD at the time of their fracture. Patients with MDD were older (p = 0.05) and were more likely female (p < 0.01). At baseline, the clinical depression cohort had worse Total SMFA scores compared to the non-depressed cohort (5.90 ± 14.41 vs. 2.69 ± 8.35, p < 0.01). There were no differences in total SMFA score or any SMFA subscores at 3, 6, and 12 months. The incidence of wound complications, reoperations, and radiographic outcomes also did not differ between the cohorts. CONCLUSION Despite patients with MDD reporting higher SMFA (poorer) scores at baseline, MDD was not associated with worse injuries, diminished clinical or poorer functional outcomes following tibial plateau fractures.
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Affiliation(s)
- Cody R Perskin
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States
| | - Meghan Maseda
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States
| | - Sanjit R Konda
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States; Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY, United States
| | - Abhishek Ganta
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States; Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY, United States
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States; Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY, United States.
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Webster J, Rycroft CE, Greenwood DC, Cade JE. Dietary risk factors for hip fracture in adults: An umbrella review of meta-analyses of prospective cohort studies. PLoS One 2021; 16:e0259144. [PMID: 34758048 PMCID: PMC8580223 DOI: 10.1371/journal.pone.0259144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023] Open
Abstract
AIM To summarise the totality of evidence regarding dietary risk factors for hip fracture in adults, evaluating the quality of evidence, to provide recommendations for practice and further research. DESIGN Systematic review of meta-analyses of prospective cohort studies. ELIGIBILITY CRITERIA Systematic reviews with meta-analyses reporting summary risk estimates for associations between hip fracture incidence and dietary exposures including oral intake of a food, food group, beverage, or nutrient, or adherence to dietary patterns. INFORMATION SOURCES Medline, Embase, Web of Science, and the Cochrane Library from inception until November 2020. DATA SYNTHESIS The methodological quality of systematic reviews and meta-analyses was assessed using AMSTAR-2, and the quality of evidence for each association was assessed using GRADE. Results were synthesised descriptively. RESULTS Sixteen systematic reviews were identified, covering thirty-four exposures, including dietary patterns (n = 2 meta-analyses), foods, food groups, or beverages (n = 16), macronutrients (n = 3), and micronutrients (n = 13). Identified meta-analyses included 6,282 to 3,730,424 participants with between 322 and 26,168 hip fractures. The methodological quality (AMSTAR-2) of all systematic reviews was low or critically low. The quality of evidence (GRADE) was low for an inverse association between hip fracture incidence and intake of fruits and vegetables combined (adjusted summary relative risk for higher vs lower intakes: 0.92 [95% confidence interval: 0.87 to 0.98]), and very low for the remaining thirty-three exposures. CONCLUSION Dietary factors may play a role in the primary prevention of hip fracture, but the methodological quality of systematic reviews and meta-analyses was below international standards, and there was a lack of high-quality evidence. More long-term cohort studies reporting absolute risks and robust, well-conducted meta-analyses with dose-response information are needed before policy guidelines can be formed. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020226190.
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Affiliation(s)
- James Webster
- School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Catherine E. Rycroft
- School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | | | - Janet E. Cade
- School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
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Marchenkova LA, Fesyun AD, Gerasimenko MY. [Study of the psycho-emotional disorders' severity in patients with osteoporotic vertebral fractures and factors affecting them]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2021; 98:18-28. [PMID: 34223751 DOI: 10.17116/kurort20219803118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
UNLABELLED There are convincing data on the association of psycho-emotional disorders with the degree of bone mineral density (BMD) loss and the risk of fractures on the basis of osteoporosis (OP) but the nature of the causal relationship has not yet been clearly established. The study of this issue is important to substantiate the need and nature of psychological correction within the framework of comprehensive rehabilitation programs in patients with osteoporotic fractures. OBJECTIVE Study of the severity of symptoms of depression and anxiety in patients who have suffered compression fractures of the vertebrae (VF) of osteoporotic genesis who entered the II stage of medical rehabilitation, as well as the contribution to the development of psycho-emotional age disorders, the severity of OP, pain syndrome and the use of orthotics. MATERIAL AND METHODS The study sample consisted of 120 women 50 to 80 years old with an established diagnosis of OP based on the results of bone densitometry. The main group included 60 patients with OP complicated by at least one VF. The control group included 60 patients with OP without a history of osteoporotic fractures comparable in age, body mass index and BMD in the spine with the main group. The complex of examination included the collection of complaints, anamnesis of OP, previous fractures, assessment of pain syndrome according to VAS, BMD study and verification of VF by X-ray methods. To assess the level of depression (DL) we used the Tsung depression scale modified by T.I. Balashova, situational (SA) and personal anxiety (PA) - Spielberger-Khanin questionnaire. RESULTS In the main group in comparison with the control group the proportion of patients without symptoms of depression was lower (66.7 and 88.3%, respectively; p=0.042), as well as the frequency of detection of high degree of SA was higher (85.0 and 73.4%, respectively; p=0.039). In patients with VF it was higher than in the control, DL - 46.0 [42.0; 54.5] (27-70) and 43.0 [38.0; 47.5] (25-65) points, respectively (p=0.0009), as well as the SA degree - 61.5 [54.0; 71.0] (20-75) and 52.5 [43.5; 64.0] (20-68) points, respectively (p=0.0006). Statistically significant direct correlation dependences of DL on age (r=0.317; p=0.00042), the duration of the postmenopausal period (r=0.325; p=0.0003), the number of VFs (g= -0.245; p=0.00013) were established. Moreover, the intensity of pain syndrome (g= -0.234; p=0.00034), as well as feedbacks of this indicator with BMD in the spine (r= -0.342; p=0.00017) and the duration of the use of thoracolumbar orthoses (r = -0.504; p = 0.00016). There were direct dependence of the SA degree on age (r=0.281; p=0.0019) and the intensity of pain syndrome (g=0.258; p=0.0044). Negative correlation of SA with body weight (r= -0.183; p=0.045), BMD in the spine (r= -0.207; p=0.026), duration of orthosis application (r= -0.327; p=0.0095) and the amount of VF in the lumbar spine (g= -0.214; p=0.044) were detected. There was a significant correlation between the degree of PA and BMD in the lumbar vertebrae (r= -0.18; p=0.046) and the intensity of pain syndrome (g=0.137; p=0.039). CONCLUSION The results obtained indicate the need for psychological correction in the framework of the complex rehabilitation of women who underwent VF based on OP due to increased DL and SA especially in older age groups.
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Affiliation(s)
- L A Marchenkova
- National Medical Research Center of Rehabilitation and Balneology, Moscow, Russia
| | - A D Fesyun
- National Medical Research Center of Rehabilitation and Balneology, Moscow, Russia
| | - M Yu Gerasimenko
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
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Stubbs B, Perara G, Koyanagi A, Veronese N, Vancampfort D, Firth J, Sheehan K, De Hert M, Stewart R, Mueller C. Risk of Hospitalized Falls and Hip Fractures in 22,103 Older Adults Receiving Mental Health Care vs 161,603 Controls: A Large Cohort Study. J Am Med Dir Assoc 2020; 21:1893-1899. [PMID: 32321678 PMCID: PMC7723983 DOI: 10.1016/j.jamda.2020.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the risk of hospitalized fall or hip fracture among older adults using mental health services. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Residents of a South London catchment aged >60 years receiving specialist mental health care between 2008 and 2016. MEASURES Falls and/or a hip fracture leading to hospitalization were ascertained from linked national records. Incidence rates and incidence rate ratios (IRRs) were age- and gender-standardized to the catchment population. Multivariable survival analyses were applied investigating falls and/or hip fractures as outcomes. RESULTS In 22,103 older adults, incidence rates were 60.1 per 1000 person-years for hospitalized falls and 13.7 per 1000 person-years for hip fractures, representing standardized IRRs of 2.17 [95% confidence interval (CI) 2.07-2.28] and 4.18 (3.79-4.60), respectively. The IRR for falls was high in those with substance-use disorder [IRR = 6.72 (5.35-8.33)], bipolar disorder [IRR = 3.62 (2.50-5.05)], depression [IRR = 2.28 (2.00-2.59)], and stress-related disorders [IRR = 2.57 (2.10-3.11)]. Hip fractures were increased in all populations (IRR > 2.5), with greatest risk in substance use disorders [IRR = 12.64 (7.22-20.52)], dementia [IRR = 4.38 (3.82-5.00)], and delirium [IRR = 4.03 (3.00-5.29)]. Comparing mental disorder subgroups with each other, after the adjustment for 25 potential confounders, patients with dementia and substance use had a significantly increased risk of falls, and patients with dementia also had an increased risk of hip fractures. CONCLUSION AND IMPLICATIONS Older people using mental health services have more than double the incidence of falls and 4 times the incidence of hip fractures compared to the general population. Although incidences differ between diagnostic subgroups, all groups have a higher incidence than the general population. Targeted interventions to prevent falls and hip fractures among older adult mental health service users are urgently needed.
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Affiliation(s)
- Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom.
| | - Gayan Perara
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain; ICREA, Barcelona, Spain
| | - Nicola Veronese
- Primary Care Department, Azienda ULSS (Unità Locale Socio Sanitaria) 3 "Serenissima," Dolo, Venice, Italy
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium; University Psychiatric Centre, KU Leuven, University of Leuven, Kortenberg, Belgium
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Katie Sheehan
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, King's College London, London, United Kingdom
| | - Marc De Hert
- University Psychiatric Centre KU Leuven, Kortenberg, Belgium; Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Christoph Mueller
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
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ÇAMUR S, ÖZCAN Ç, SÖNMEZ M, BATİBAY S. The effect of nutrition, depression, activity scores on mortality in patients with geriatric hip fractures. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2020. [DOI: 10.25000/acem.708840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Effects of a fast track surgery nursing program in perioperative care of older patients with a hip fracture. Eur Geriatr Med 2020; 11:519-525. [DOI: 10.1007/s41999-020-00298-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/07/2020] [Indexed: 12/14/2022]
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