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Kong SH, Kim S, Kim Y, Kim JH, Kim K, Shin CS. Development and validation of common data model-based fracture prediction model using machine learning algorithm. Osteoporos Int 2023:10.1007/s00198-023-06787-7. [PMID: 37195320 DOI: 10.1007/s00198-023-06787-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
The need for an accurate country-specific real-world-based fracture prediction model is increasing. Thus, we developed scoring systems for osteoporotic fractures from hospital-based cohorts and validated them in an independent cohort in Korea. The model includes history of fracture, age, lumbar spine and total hip T-score, and cardiovascular disease. PURPOSE Osteoporotic fractures are substantial health and economic burden. Therefore, the need for an accurate real-world-based fracture prediction model is increasing. We aimed to develop and validate an accurate and user-friendly model to predict major osteoporotic and hip fractures using a common data model database. METHODS The study included 20,107 and 13,353 participants aged ≥ 50 years with data on bone mineral density using dual-energy X-ray absorptiometry from the CDM database between 2008 and 2011 from the discovery and validation cohort, respectively. The main outcomes were major osteoporotic and hip fracture events. DeepHit and Cox proportional hazard models were used to identify predictors of fractures and to build scoring systems, respectively. RESULTS The mean age was 64.5 years, and 84.3% were women. During a mean of 7.6 years of follow-up, 1990 major osteoporotic and 309 hip fracture events were observed. In the final scoring model, history of fracture, age, lumbar spine T-score, total hip T-score, and cardiovascular disease were selected as predictors for major osteoporotic fractures. For hip fractures, history of fracture, age, total hip T-score, cerebrovascular disease, and diabetes mellitus were selected. Harrell's C-index for osteoporotic and hip fractures were 0.789 and 0.860 in the discovery cohort and 0.762 and 0.773 in the validation cohort, respectively. The estimated 10-year risks of major osteoporotic and hip fractures were 2.0%, 0.2% at score 0 and 68.8%, 18.8% at their maximum scores, respectively. CONCLUSION We developed scoring systems for osteoporotic fractures from hospital-based cohorts and validated them in an independent cohort. These simple scoring models may help predict fracture risks in real-world practice.
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Affiliation(s)
- Sung Hye Kong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sihyeon Kim
- Department of Integrative Medicine, Seoul National University Hospital, Seoul, 03080, Korea
| | - Yisak Kim
- Department of Integrative Medicine, Seoul National University Hospital, Seoul, 03080, Korea
- Interdisciplinary Program in Bioengineering, Seoul National University Graduate School, Seoul, Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
- Department of Internal Medicine, Seoul National University Hospital, Seoul, 03080, Korea.
| | - Kwangsoo Kim
- Department of Integrative Medicine, Seoul National University Hospital, Seoul, 03080, Korea.
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, 03080, Korea
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Gates M, Pillay J, Nuspl M, Wingert A, Vandermeer B, Hartling L. Screening for the primary prevention of fragility fractures among adults aged 40 years and older in primary care: systematic reviews of the effects and acceptability of screening and treatment, and the accuracy of risk prediction tools. Syst Rev 2023; 12:51. [PMID: 36945065 PMCID: PMC10029308 DOI: 10.1186/s13643-023-02181-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/02/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND To inform recommendations by the Canadian Task Force on Preventive Health Care, we reviewed evidence on the benefits, harms, and acceptability of screening and treatment, and on the accuracy of risk prediction tools for the primary prevention of fragility fractures among adults aged 40 years and older in primary care. METHODS For screening effectiveness, accuracy of risk prediction tools, and treatment benefits, our search methods involved integrating studies published up to 2016 from an existing systematic review. Then, to locate more recent studies and any evidence relating to acceptability and treatment harms, we searched online databases (2016 to April 4, 2022 [screening] or to June 1, 2021 [predictive accuracy]; 1995 to June 1, 2021, for acceptability; 2016 to March 2, 2020, for treatment benefits; 2015 to June 24, 2020, for treatment harms), trial registries and gray literature, and hand-searched reviews, guidelines, and the included studies. Two reviewers selected studies, extracted results, and appraised risk of bias, with disagreements resolved by consensus or a third reviewer. The overview of reviews on treatment harms relied on one reviewer, with verification of data by another reviewer to correct errors and omissions. When appropriate, study results were pooled using random effects meta-analysis; otherwise, findings were described narratively. Evidence certainty was rated according to the GRADE approach. RESULTS We included 4 randomized controlled trials (RCTs) and 1 controlled clinical trial (CCT) for the benefits and harms of screening, 1 RCT for comparative benefits and harms of different screening strategies, 32 validation cohort studies for the calibration of risk prediction tools (26 of these reporting on the Fracture Risk Assessment Tool without [i.e., clinical FRAX], or with the inclusion of bone mineral density (BMD) results [i.e., FRAX + BMD]), 27 RCTs for the benefits of treatment, 10 systematic reviews for the harms of treatment, and 12 studies for the acceptability of screening or initiating treatment. In females aged 65 years and older who are willing to independently complete a mailed fracture risk questionnaire (referred to as "selected population"), 2-step screening using a risk assessment tool with or without measurement of BMD probably (moderate certainty) reduces the risk of hip fractures (3 RCTs and 1 CCT, n = 43,736, absolute risk reduction [ARD] = 6.2 fewer in 1000, 95% CI 9.0-2.8 fewer, number needed to screen [NNS] = 161) and clinical fragility fractures (3 RCTs, n = 42,009, ARD = 5.9 fewer in 1000, 95% CI 10.9-0.8 fewer, NNS = 169). It probably does not reduce all-cause mortality (2 RCTs and 1 CCT, n = 26,511, ARD = no difference in 1000, 95% CI 7.1 fewer to 5.3 more) and may (low certainty) not affect health-related quality of life. Benefits for fracture outcomes were not replicated in an offer-to-screen population where the rate of response to mailed screening questionnaires was low. For females aged 68-80 years, population screening may not reduce the risk of hip fractures (1 RCT, n = 34,229, ARD = 0.3 fewer in 1000, 95% CI 4.2 fewer to 3.9 more) or clinical fragility fractures (1 RCT, n = 34,229, ARD = 1.0 fewer in 1000, 95% CI 8.0 fewer to 6.0 more) over 5 years of follow-up. The evidence for serious adverse events among all patients and for all outcomes among males and younger females (<65 years) is very uncertain. We defined overdiagnosis as the identification of high risk in individuals who, if not screened, would never have known that they were at risk and would never have experienced a fragility fracture. This was not directly reported in any of the trials. Estimates using data available in the trials suggest that among "selected" females offered screening, 12% of those meeting age-specific treatment thresholds based on clinical FRAX 10-year hip fracture risk, and 19% of those meeting thresholds based on clinical FRAX 10-year major osteoporotic fracture risk, may be overdiagnosed as being at high risk of fracture. Of those identified as being at high clinical FRAX 10-year hip fracture risk and who were referred for BMD assessment, 24% may be overdiagnosed. One RCT (n = 9268) provided evidence comparing 1-step to 2-step screening among postmenopausal females, but the evidence from this trial was very uncertain. For the calibration of risk prediction tools, evidence from three Canadian studies (n = 67,611) without serious risk of bias concerns indicates that clinical FRAX-Canada may be well calibrated for the 10-year prediction of hip fractures (observed-to-expected fracture ratio [O:E] = 1.13, 95% CI 0.74-1.72, I2 = 89.2%), and is probably well calibrated for the 10-year prediction of clinical fragility fractures (O:E = 1.10, 95% CI 1.01-1.20, I2 = 50.4%), both leading to some underestimation of the observed risk. Data from these same studies (n = 61,156) showed that FRAX-Canada with BMD may perform poorly to estimate 10-year hip fracture risk (O:E = 1.31, 95% CI 0.91-2.13, I2 = 92.7%), but is probably well calibrated for the 10-year prediction of clinical fragility fractures, with some underestimation of the observed risk (O:E 1.16, 95% CI 1.12-1.20, I2 = 0%). The Canadian Association of Radiologists and Osteoporosis Canada Risk Assessment (CAROC) tool may be well calibrated to predict a category of risk for 10-year clinical fractures (low, moderate, or high risk; 1 study, n = 34,060). The evidence for most other tools was limited, or in the case of FRAX tools calibrated for countries other than Canada, very uncertain due to serious risk of bias concerns and large inconsistency in findings across studies. Postmenopausal females in a primary prevention population defined as <50% prevalence of prior fragility fracture (median 16.9%, range 0 to 48% when reported in the trials) and at risk of fragility fracture, treatment with bisphosphonates as a class (median 2 years, range 1-6 years) probably reduces the risk of clinical fragility fractures (19 RCTs, n = 22,482, ARD = 11.1 fewer in 1000, 95% CI 15.0-6.6 fewer, [number needed to treat for an additional beneficial outcome] NNT = 90), and may reduce the risk of hip fractures (14 RCTs, n = 21,038, ARD = 2.9 fewer in 1000, 95% CI 4.6-0.9 fewer, NNT = 345) and clinical vertebral fractures (11 RCTs, n = 8921, ARD = 10.0 fewer in 1000, 95% CI 14.0-3.9 fewer, NNT = 100); it may not reduce all-cause mortality. There is low certainty evidence of little-to-no reduction in hip fractures with any individual bisphosphonate, but all provided evidence of decreased risk of clinical fragility fractures (moderate certainty for alendronate [NNT=68] and zoledronic acid [NNT=50], low certainty for risedronate [NNT=128]) among postmenopausal females. Evidence for an impact on risk of clinical vertebral fractures is very uncertain for alendronate and risedronate; zoledronic acid may reduce the risk of this outcome (4 RCTs, n = 2367, ARD = 18.7 fewer in 1000, 95% CI 25.6-6.6 fewer, NNT = 54) for postmenopausal females. Denosumab probably reduces the risk of clinical fragility fractures (6 RCTs, n = 9473, ARD = 9.1 fewer in 1000, 95% CI 12.1-5.6 fewer, NNT = 110) and clinical vertebral fractures (4 RCTs, n = 8639, ARD = 16.0 fewer in 1000, 95% CI 18.6-12.1 fewer, NNT=62), but may make little-to-no difference in the risk of hip fractures among postmenopausal females. Denosumab probably makes little-to-no difference in the risk of all-cause mortality or health-related quality of life among postmenopausal females. Evidence in males is limited to two trials (1 zoledronic acid, 1 denosumab); in this population, zoledronic acid may make little-to-no difference in the risk of hip or clinical fragility fractures, and evidence for all-cause mortality is very uncertain. The evidence for treatment with denosumab in males is very uncertain for all fracture outcomes (hip, clinical fragility, clinical vertebral) and all-cause mortality. There is moderate certainty evidence that treatment causes a small number of patients to experience a non-serious adverse event, notably non-serious gastrointestinal events (e.g., abdominal pain, reflux) with alendronate (50 RCTs, n = 22,549, ARD = 16.3 more in 1000, 95% CI 2.4-31.3 more, [number needed to treat for an additional harmful outcome] NNH = 61) but not with risedronate; influenza-like symptoms with zoledronic acid (5 RCTs, n = 10,695, ARD = 142.5 more in 1000, 95% CI 105.5-188.5 more, NNH = 7); and non-serious gastrointestinal adverse events (3 RCTs, n = 8454, ARD = 64.5 more in 1000, 95% CI 26.4-13.3 more, NNH = 16), dermatologic adverse events (3 RCTs, n = 8454, ARD = 15.6 more in 1000, 95% CI 7.6-27.0 more, NNH = 64), and infections (any severity; 4 RCTs, n = 8691, ARD = 1.8 more in 1000, 95% CI 0.1-4.0 more, NNH = 556) with denosumab. For serious adverse events overall and specific to stroke and myocardial infarction, treatment with bisphosphonates probably makes little-to-no difference; evidence for other specific serious harms was less certain or not available. There was low certainty evidence for an increased risk for the rare occurrence of atypical femoral fractures (0.06 to 0.08 more in 1000) and osteonecrosis of the jaw (0.22 more in 1000) with bisphosphonates (most evidence for alendronate). The evidence for these rare outcomes and for rebound fractures with denosumab was very uncertain. Younger (lower risk) females have high willingness to be screened. A minority of postmenopausal females at increased risk for fracture may accept treatment. Further, there is large heterogeneity in the level of risk at which patients may be accepting of initiating treatment, and treatment effects appear to be overestimated. CONCLUSION An offer of 2-step screening with risk assessment and BMD measurement to selected postmenopausal females with low prevalence of prior fracture probably results in a small reduction in the risk of clinical fragility fracture and hip fracture compared to no screening. These findings were most applicable to the use of clinical FRAX for risk assessment and were not replicated in the offer-to-screen population where the rate of response to mailed screening questionnaires was low. Limited direct evidence on harms of screening were available; using study data to provide estimates, there may be a moderate degree of overdiagnosis of high risk for fracture to consider. The evidence for younger females and males is very limited. The benefits of screening and treatment need to be weighed against the potential for harm; patient views on the acceptability of treatment are highly variable. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO): CRD42019123767.
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Affiliation(s)
- Michelle Gates
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada
| | - Jennifer Pillay
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada.
| | - Megan Nuspl
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada
| | - Aireen Wingert
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada
| | - Ben Vandermeer
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada
| | - Lisa Hartling
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada
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Lee A, McArthur C, Ioannidis G, Adachi JD, Griffith LE, Thabane L, Giangregorio L, Morin SN, Leslie WD, Lee J, Papaioannou A. Association among cognition, frailty, and falls and self‐reported incident fractures: results from the Canadian Longitudinal Study on Aging (
CLSA
). JBMR Plus 2022; 6:e10679. [PMID: 36248272 PMCID: PMC9549720 DOI: 10.1002/jbm4.10679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/25/2022] [Accepted: 09/01/2022] [Indexed: 11/12/2022] Open
Abstract
Cognition, frailty, and falls have been examined independently as potential correlates of fracture risk, but not simultaneously. Our objective was to explore the association between cognition, frailty, and falls and self‐reported incident fractures to determine if these factors show significant independent associations or interactions. We included participants who completed the Canadian Longitudinal Study on Aging (CLSA) 2012–2015 baseline comprehensive assessment, did not experience any self‐reported fractures in the year prior to cohort recruitment, and completed the follow‐up questionnaire at year 3 (n = 26,982). We compared all baseline cognitive measures available in the CLSA, the Rockwood Frailty Index (FI), and presence of self‐reported falls in the past 12 months in those with versus without self‐reported incident fractures in year 3 of follow‐up. We used multivariable logistic regression adjusted for covariates and examined two‐way interactions between cognition, frailty, and prior falls. CLSA specified analytic weights were applied. The mean ± standard error (SE) age of participants was 59.5 ± 0.1 years and 52.2% were female. A total of 715 participants (2.7%) self‐reported incident fractures at 3‐year follow‐up. Participants who experienced incident fractures had similar baseline cognition scores (mean ± SE; Rey Auditory Verbal Learning Test [RAVLT]: Immediate recall 6.1 ± 0.1 versus 5.9 ± 0.0; standardized difference [d] 0.124); higher FI scores (mean ± SE; FI 0.134 ± 0.005 versus 0.116 ± 0.001; d 0.193), and a greater percentage had fallen in the past 12 months (weighted n [%] 518 [7.2] versus 919 [3.5]; d 0.165). FI (each increment of 0.08) was associated with a significantly increased risk of self‐reported incident fractures in participants of all ages and those aged 65 years or older (adjusted odd ratio [OR] 1.24, 95% confidence limit [CL] 1.10–1.40; adjusted OR 1.44, 95% CL 1.11–1.52, respectively). The adjusted odds for self‐reported incident fractures in participants of all ages was also significantly associated with falls in the past 12 months prior to baseline (adjusted OR 1.83; 95% CL 1.13–2.97), but not in those aged 65 years or older. No interactions between cognition, frailty, and prior falls were found. However, considering the relatively young age of our cohort, it may be appropriate to make strong inferences in individuals older than 65 years of age. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Ahreum Lee
- GERAS Centre for Aging Research. Hamilton Ontario Canada
- McMaster University, Department of Health Research Methods, Evidence, and Impact Hamilton Ontario Canada
| | - Caitlin McArthur
- GERAS Centre for Aging Research. Hamilton Ontario Canada
- Dalhousie University, School of Physiotherapy Halifax Nova Scotia Canada
| | - George Ioannidis
- GERAS Centre for Aging Research. Hamilton Ontario Canada
- McMaster University, Department of Health Research Methods, Evidence, and Impact Hamilton Ontario Canada
| | - Jonathan D. Adachi
- McMaster University, Department of Health Research Methods, Evidence, and Impact Hamilton Ontario Canada
| | - Lauren E. Griffith
- McMaster University, Department of Health Research Methods, Evidence, and Impact Hamilton Ontario Canada
- McMaster University McMaster Institute for Research on Aging Hamilton Ontario Canada
| | - Lehana Thabane
- McMaster University, Department of Health Research Methods, Evidence, and Impact Hamilton Ontario Canada
| | - Lora Giangregorio
- University of Waterloo, Department of Kinesiology Waterloo Ontario Canada
- Schlegel‐UW Research Institute on Aging Waterloo Ontario Canada
| | - Suzanne N Morin
- McGill University, Department of Medicine, Montreal Quebec Canada
| | - William D. Leslie
- University of Manitoba, Department of Internal Medicine Winnipeg Manitoba Canada
| | - Justin Lee
- McMaster University, Department of Health Research Methods, Evidence, and Impact Hamilton Ontario Canada
| | - Alexandra Papaioannou
- GERAS Centre for Aging Research. Hamilton Ontario Canada
- McMaster University, Department of Health Research Methods, Evidence, and Impact Hamilton Ontario Canada
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Kang JH, Hong SW. Risk Factors of Frailty in Patients with Distal Radius Fractures. Geriatr Orthop Surg Rehabil 2022; 13:21514593221094736. [PMID: 35450302 PMCID: PMC9016613 DOI: 10.1177/21514593221094736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/30/2022] [Indexed: 12/01/2022] Open
Abstract
Aim The aim of this study was to determine risk factors for the incidence of
frailty in patients with distal radius fractures (DRFs). Methods In total, 116 patients (mean age, 66.3 ± 7.7 years) with DRFs were recruited.
The participants were categorized into two groups, “frail” and “non-frail,”
according to the presence or absence of frailty, respectively. The areal
bone mineral densities (aBMDs) of the total hip, femoral neck, and lumbar
spine were measured using dual-energy x-ray absorptiometry. The
participants’ levels of resilience, depression, anxiety, nutritional intake,
oral health-related quality of life, and social support were evaluated by
self-reported questionnaires. The participants’ grip strength, gait speed,
number of teeth present in their oral cavities, circumference of their upper
arms and calves, and serum levels of vitamin D were also assessed. Results The participants in the “frail” group seemed to have lower aBMDs and muscle
function and mass than those in the “non-frail” group. There were
significant differences in grip strength, calf circumference, gait speed,
and aBMD of the total hip, femoral neck, and lumbar spine between the
groups. There were also significant differences in the levels of resilience
and depression between the groups. A multivariate logistic regression
analyses demonstrated that levels of sarcopenia, malnutritional status, and
aBMDs of the total hip and femoral neck had significant relationships with
the development of frailty in patients with DRFs. Conclusions An interdisciplinary approach involving the management of osteoporosis,
sarcopenia, oral health, social relationships, and psychological support
would be required for the proper management of DRF patients in preventing
frailty.
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Affiliation(s)
- Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Korea
| | - Seok Woo Hong
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ховасова НО, Наумов АВ, Ткачева ОН, Дудинская ЕН. [Characteristics of geriatric and somatic status in patients with osteoporosis]. PROBLEMY ENDOKRINOLOGII 2021; 67:45-54. [PMID: 34297501 PMCID: PMC9112845 DOI: 10.14341/probl12751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/17/2021] [Accepted: 06/15/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Older adults with osteoporosis (OP) and high risk of falls are the most vulnerable group of patients with respect to the development of fractures. Falls and fractures in elderly patients with OP are associated with geriatric syndromes and worse functional status. AIM To аssess comorbidity and geriatric status in elderly and senile patients with and without OP. MATERIALS AND METHODS The study included 607 patients over 60 years of age hospitalized in the geriatric department. According to the presence of OP, the patients were divided into 2 groups: group 1 - patients with OP (n=178, 29.3%), group 2 - patients without OP (n=429, 70.7%). All patients underwent a general clinical study, an assessment of comorbidity -according to the Charlson index, and a comprehensive geriatric score. RESULTS OPs had 178 (29.3%) patients, more often these were women. 55.6% of patients with OP were disabled. Age--related diseases such as Alzheimer's disease, Parkinson's disease, osteoarthritis, anemia, thyroid disease, varicose veins were significantly more common in patients with OP. With almost all of these diseases, a univariate analysis revealed an association with OP. Geriatric syndromes such as frailty, hypodynamia, malnutrition, polypharmacy, urinary incontinence were significantly more common in group 1 patients. Patients with OP were more likely to live alone and use mobility aids compared to patients without OP.The univariate analysis demonstrated that OP is associated (OR 1.54 to 2.00) with frailty, hypodynamia, the use of aids in movement, sleep disorders, sensory vision deficiency, urinary incontinence. The Functional status of patients with OP was worse compared to patients without OP. Patients with OP suffered more fractures, and vertebral fractures were significantly more frequent. CONCLUSION Patients with OP have a high comorbidity, a burdened geriatric status. In elderly patients, it is necessary not only to screen and diagnose OP, to assess the risk of 10-years probability of major pathological fractures using the FRAX algorithm, but also to conduct a comprehensive geriatric assessment to diagnose geriatric syndromes that weaken the course of OP and lead to more serious consequences.
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Affiliation(s)
- Н. О. Ховасова
- Кафедра болезней старения Российского национального исследовательского медицинского университета им. Н.И. Пирогова; Российский геронтологический научно-клинический центр
| | - А. В. Наумов
- Кафедра болезней старения Российского национального исследовательского медицинского университета им. Н.И. Пирогова; Российский геронтологический научно-клинический центр
| | - О. Н. Ткачева
- Кафедра болезней старения Российского национального исследовательского медицинского университета им. Н.И. Пирогова; Российский геронтологический научно-клинический центр
| | - Е. Н. Дудинская
- Кафедра болезней старения Российского национального исследовательского медицинского университета им. Н.И. Пирогова; Российский геронтологический научно-клинический центр
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Middleton R, Poveda JL, Orfila Pernas F, Martinez Laguna D, Diez Perez A, Nogués X, Carbonell Abella C, Reyes C, Prieto-Alhambra D. Mortality, falls and fracture risk are positively associated with frailty: a SIDIAP cohort study of 890,000 patients. J Gerontol A Biol Sci Med Sci 2021; 77:148-154. [PMID: 33885746 PMCID: PMC8751782 DOI: 10.1093/gerona/glab102] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Indexed: 11/24/2022] Open
Abstract
Background Frail subjects are at increased risk of adverse outcomes. We aimed to assess their risk of falls, all-cause mortality, and fractures. Method We used a retrospective cohort study using the Sistema d’Informació per al Desenvolupament de l’Investigació en Atenció Primària database (>6 million residents). Subjects aged 75 years and older with ≥1 year of valid data (2007–2015) were included. Follow-up was carried out from (the latest of) the date of cohort entry up to migration, end of the study period or outcome (whichever came first). The eFRAGICAP classified subjects as fit, mild, moderate, or severely frail. Outcomes (10th revision of the International Classification of Diseases) were incident falls, fractures (overall/hip/vertebral), and all-cause mortality during the study period. Statistics: hazard ratios (HRs), 95% CI adjusted (per age, sex, and socioeconomic status), and unadjusted cause-specific Cox models, accounting for competing risk of death (fit group as the reference). Results A total of 893 211 subjects were analyzed; 54.4% were classified as fit, 34.0% as mild, 9.9% as moderate, and 1.6% as severely frail. Compared with the fit, frail had an increased risk of falls (adjusted HR [95% CI] of 1.55 [1.52–1.58], 2.74 [2.66–2.84], and 5.94 [5.52–6.40]), all-cause mortality (adjusted HR [95% CI] of 1.36 [1.35–1.37], 2.19 [2.16–2.23], and 4.29 [4.13–4.45]), and fractures (adjusted HR [95% CI] of 1.21 [1.20–1.23], 1.51 [1.47–1.55], and 2.36 [2.20–2.53]) for mild, moderate, and severe frailty, respectively. Severely frail had a high risk of vertebral (HR of 2.49 [1.99–3.11]) and hip fracture (HR [95% CI] of 1.85 [1.50–2.28]). Accounting for competing risk of death did not change results. Conclusion Frail subjects are at increased risk of death, fractures, and falls. The eFRAGICAP tool can easily assess frailty in electronic primary care databases in Spain.
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Affiliation(s)
- Robert Middleton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences Botnar Research Centre, University of Oxford, Oxford
| | | | - Francesc Orfila Pernas
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Daniel Martinez Laguna
- CIBERFes, Instituto Carlos III.,Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Adolfo Diez Perez
- CIBERFes, Instituto Carlos III.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Musculoskeletal Research Unit, IMIM-Hospital del Mar, Barcelona, Spain
| | - Xavier Nogués
- CIBERFes, Instituto Carlos III.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Internal Medicine Department IMIM-Hospital del Mar, Barcelona, Spain
| | - Cristina Carbonell Abella
- CIBERFes, Instituto Carlos III.,Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Carlen Reyes
- CIBERFes, Instituto Carlos III.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences Botnar Research Centre, University of Oxford, Oxford.,CIBERFes, Instituto Carlos III.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
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7
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Genest F, Schneider M, Zehnder A, Lieberoth-Leden D, Seefried L. Differential impact of osteoporosis, sarcopenia and obesity on physical performance in aging men. Endocr Connect 2021; 10:256-264. [PMID: 33475529 PMCID: PMC8052579 DOI: 10.1530/ec-20-0580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Aging and concurrent constitutional changes as sarcopenia, osteoporosis and obesity are associated with progressive functional decline. Coincidence and mutual interference of this risk factors require further evaluation. METHODS Cross-sectional evaluation of musculoskeletal health in a community-dwelling cohort of men aged 65-90 years. Objectives included descriptive analysis of age-related decline in physical performance, prevalence of osteoporosis (FRAX-Score), sarcopenia (EWGSOP criteria) and obesity (BMI > 30 kg/m2) and their coincidence/interference. RESULTS Based on 507 participants assessed, aging was associated with progressive functional deterioration, regarding power (chair rise test -1.54% per year), performance (usual gait speed -1.38% per year) and muscle force (grip strength -1.52% per year) while muscle mass declined only marginally (skeletal muscle index -0.29% per year). Prevalence of osteoporosis was 41.8% (n = 212) while only 22.9% (n = 116) of the participants met the criteria for sarcopenia and 23.7% (n = 120) were obese. Osteosarcopenia was found in n = 79 (15.6%), sarcopenic obesity was present in 14 men (2.8%). A combination of all three conditions could be confirmed in n = 8 (1.6%). There was an inverse correlation of BMI with physical performance whereas osteoporosis and sarcopenia did not interfere with functional outcomes. CONCLUSION Based on current definitions, there is considerable overlap in the prevalence of osteoporosis and sarcopenia, while obesity appears to be a distinct problem. Functional decline appears to be associated with obesity rather than osteoporosis or sarcopenia. It remains to be determined to what extend obesity itself causes performance deficits or if obesity is merely an indicator of insufficient activity eventually predisposing to functional decline.
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Affiliation(s)
- Franca Genest
- Clinical Trial Unit, Orthopedic Department, University of Wuerzburg, Wuerzburg, Germany
| | - Michael Schneider
- Clinical Trial Unit, Orthopedic Department, University of Wuerzburg, Wuerzburg, Germany
| | - Andreas Zehnder
- Clinical Trial Unit, Orthopedic Department, University of Wuerzburg, Wuerzburg, Germany
| | | | - Lothar Seefried
- Clinical Trial Unit, Orthopedic Department, University of Wuerzburg, Wuerzburg, Germany
- Correspondence should be addressed to L Seefried:
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8
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Li G, Compston JE, Leslie WD, Thabane L, Papaioannou A, Lau A, Wang X, Qin C, Chen B, Chen M, Adachi JD. Relationship Between Obesity and Risk of Major Osteoporotic Fracture in Postmenopausal Women: Taking Frailty Into Consideration. J Bone Miner Res 2020; 35:2355-2362. [PMID: 32717113 DOI: 10.1002/jbmr.4139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/02/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022]
Abstract
The role of obesity in fracture risk remains uncertain and inconclusive in postmenopausal women. Our study aimed to assess the relationship between obesity and risk of major osteoporotic fracture (MOF; ie, a clinical fracture of upper arm or shoulder, hip, spine, or wrist) in postmenopausal women, after taking frailty into consideration. We used the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 5-year Hamilton cohort for this study. Frailty was measured by a frailty index (FI) of deficit accumulation at baseline. We incorporated an interaction term (obesity × FI) in the Cox proportional hazards regression model. We included 3985 women (mean age 69.4 years) for analyses, among which 29% were obese (n = 1118). There were 200 (5.02%) MOF events documented during follow-up: 48 (4.29%) in obese women and 152 (5.65%) in the nonobese group. Significant relationships between obesity, frailty, and MOF risk were found: hazard ratio (HR) = 0.72 (95% confidence interval [CI] 0.67-0.78) for those with an FI of zero regarding MOF risk among obese women, and HR = 1.34 (95% CI 1.11-1.62) per SD increase in the FI among nonobese women. The interaction term was also significant: HR = 1.16 (95% CI 1.02-1.34) per SD increase in the FI among obese women. Increased HRs were found with higher FIs regarding the relationship between obesity and MOF risk, indicating increasing frailty attenuated the protective effect of obesity. For example, although the HR for obesity and MOF risk among those who were not frail (FI = 0) was 0.72 (95% CI 0.67-0.78), among those who were very frail (FI = 0.70), the HR was 0.91 (95% CI 0.85-0.98). To conclude, after taking frailty into consideration, obesity was significantly associated with decreased risk of MOF in postmenopausal women among those who were not frail; however, increasing frailty attenuated this protective effect of obesity. Evaluating frailty status may aid in understanding of the complex relationship between obesity and fracture risk. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China.,Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada
| | | | - William D Leslie
- Departments of Medicine and Radiology, University of Manitoba, Winnipeg, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada
| | | | - Arthur Lau
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Xiaojie Wang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Chenghe Qin
- Department of Orthopaedics and Traumatology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Bo Chen
- Department of Endocrinology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Maoshui Chen
- Department of Orthopedics No. 2 (Spinal Surgery), Guangdong Provincial Hospital of Chinese Medicine, Zhuhai, China
| | - Jonathan D Adachi
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
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9
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Bartosch PS, Kristensson J, McGuigan FE, Akesson KE. Frailty and prediction of recurrent falls over 10 years in a community cohort of 75-year-old women. Aging Clin Exp Res 2020; 32:2241-2250. [PMID: 31939201 PMCID: PMC7591409 DOI: 10.1007/s40520-019-01467-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/24/2019] [Indexed: 12/20/2022]
Abstract
Background Frailty captures the age-related declines in health leading to increased vulnerability, including falls which are commonplace in older women. The relationship between frailty and falls is complex, with one leading to the other in a vicious cycle. Aims This study addresses the gap in understanding how patterns of frailty and falls propensity interact, particularly in those who have not yet entered the falls-frailty cycle. Methods The Osteoporosis Risk Assessment cohort consists of 1044 community-dwelling women aged 75, with 10 years of follow-up. Investigations were performed and a frailty index constructed at baseline, 5 and 10 years. Falls were self-reported for each previous 12 months. Analysis was two-directional, firstly based on frailty status and second, based on falls status. Recurrent falls was the primary outcome. Results Baseline frailty was a significant predictor of recurrent falls after 5 and 10 years [(OR 2.55 (1.62–3.99); 3.04 (1.63–5.67)]. Among women who had no history of falls at age 75, frailty was a stronger predictor of falls at 5 years [OR 3.06 (1.59–5.89)] than among women who had previously fallen. Discussion Frailty is significantly associated with recurrent falls and most pronounced in those who are frail but have not yet fallen. Conclusions This suggests that frailty should be an integral part of falls-risk assessment to improve identification of those at risk of becoming fallers. Electronic supplementary material The online version of this article (10.1007/s40520-019-01467-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrik S Bartosch
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, IM Nilssonsgata 22, 205 02, Malmö, Sweden
| | | | - Fiona E McGuigan
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, IM Nilssonsgata 22, 205 02, Malmö, Sweden
| | - Kristina E Akesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
- Department of Orthopaedics, Skåne University Hospital, IM Nilssonsgata 22, 205 02, Malmö, Sweden.
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10
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Li G, Chen M, Li X, Cesta A, Lau A, Thabane L, Adachi JD, Tian J, Bombardier C. Frailty and risk of osteoporotic fractures in patients with rheumatoid arthritis: Data from the Ontario Best Practices Research Initiative. Bone 2019; 127:129-134. [PMID: 31185289 DOI: 10.1016/j.bone.2019.06.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/10/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
The evidence assessing the relationship between frailty and risk of adverse health outcomes in patients with rheumatoid arthritis (RA) remains limited and sparse in the literature. Data from the Ontario Best Practices Research Initiative (OBRI), a clinical registry of patients with RA, were used to explore the relationship between frailty and fracture risk in patients with RA. Patients were referred to OBRI by their participating rheumatologist, and contacted by OBRI trained interviewers. Primary outcome was time to first incident osteoporotic fractures during follow-up that led to a hospitalization or emergency room visit. Frailty was measured by a Rockwood-type frailty index (FI) of deficit accumulation that consisted of 32 health-related deficits. To quantify the relationship between frailty and risk of fracture, we used Cox proportional hazards models with hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) reported. We included 2923 patients (mean age 57.7 standard deviation [SD]: 12.7; 78% female,) for analyses. During a mean follow-up of 3.7 years, there were 125 (4.3%) incident fractures reported. The FI was significantly higher in patients with a fracture compared to controls (0.24 vs. 0.20, p = 0.02). The FI was found to be significantly related to increased risk of fracture in the fully-adjusted models, with a HR of 1.04 (95% CI: 1.02-1.06, p < 0.001) and 1.58 (95% CI: 1.32-1.89, p < 0.001) for per-0.01 and per-SD increase in the FI respectively. In summary, our study demonstrates that higher frailty status is significantly related to increased risk of osteoporotic fractures in patients with RA. Quantifying the frailty status as a research tool may aid in fracture risk assessment, management and decision-making in RA.
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Affiliation(s)
- Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China; Department of Health research methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.
| | - Maoshui Chen
- Department of Orthopedics No. 2 (Spinal Surgery), Guangdong Provincial Hospital of Chinese Medicine, Zhuhai, China
| | - Xiuying Li
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Angela Cesta
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Arthur Lau
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health research methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Jonathan D Adachi
- Department of Health research methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Junzhang Tian
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China.
| | - Claire Bombardier
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
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11
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Bartosch P, McGuigan FE, Akesson KE. Progression of frailty and prevalence of osteoporosis in a community cohort of older women-a 10-year longitudinal study. Osteoporos Int 2018; 29:2191-2199. [PMID: 29947868 PMCID: PMC6154042 DOI: 10.1007/s00198-018-4593-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/28/2018] [Indexed: 11/26/2022]
Abstract
UNLABELLED In community dwelling, 75-year-old women followed 10 years, a frailty index was created at each of three visits. Frailty score increased by ~ 6-7% annually. A higher frailty score was equivalent to being 5-10 years chronologically older. Frailty was associated with low bone density and higher risk of dying. INTRODUCTION To understand the distribution of frailty among a population-based sample of older community-dwelling women, progression over 10 years, and association with mortality and osteoporosis. METHODS The study is performed in a cohort designed to investigate osteoporosis. The OPRA cohort consists of 75-year-old women, n = 1044 at baseline, and follow-up at age 80 and 85. A frailty index (scored from 0.0-1.0) based on deficits in health across multiple domains was created at all time-points; outcomes were mortality up to 15 years and femoral neck bone density. RESULTS At baseline, the proportion least frail, i.e., most robust (FI 0.0-0.1) constituted 48%, dropping to 25 and 14% at age 80 and 85. On average, over 10 years, the annual linear frailty score progression was approximately 6-7%. Among the least frail, 11% remained robust over 10 years. A higher frailty score was equivalent to being 5 to 10 years older. Mortality was substantially higher in the highest quartile compared to the lowest based on baseline frailty score; after 10 years, 48.7% had died vs 17.2% (p = 1.7 × 10-14). Mortality risk over the first 5 years was highest in the frailest (Q4 vs Q1; HRunadj 3.26 [1.86-5.73]; p < 0.001) and continued to be elevated at 10 years (HRunadj 3.58 [2.55-5.03]; p < 0.001). Frailty was associated with BMD after adjusting for BMI (overall p = 0.006; Q1 vs Q4 p = 0.003). CONCLUSIONS The frailty index was highly predictive of mortality showing a threefold increased risk of death in the frailest both in a shorter and longer perspective. Only one in ten older women escaped progression after 10 years. Frailty and osteoporosis were associated.
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Affiliation(s)
- P Bartosch
- Lund University, Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, 20502, Malmö, Sweden
- Department of Orthopaedics, Skåne University Hospital, 205 02, Malmö, Sweden
| | - F E McGuigan
- Lund University, Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, 20502, Malmö, Sweden
- Department of Orthopaedics, Skåne University Hospital, 205 02, Malmö, Sweden
| | - K E Akesson
- Lund University, Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, 20502, Malmö, Sweden.
- Department of Orthopaedics, Skåne University Hospital, 205 02, Malmö, Sweden.
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12
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González Silva Y, Abad Manteca L, de la Red Gallego H, Álvarez Muñoz M, Rodríguez Carbajo M, Murcia Casado T, Ausín Pérez L, Abadía Otero J, Pérez-Castrillón JL. Relationship between the FRAX index and physical and cognitive functioning in older people. Ann Med 2018; 50:538-543. [PMID: 30041550 DOI: 10.1080/07853890.2018.1505052] [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] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To assess the relationship between the FRAX index and the Barthel index/MiniMental State Examination in older people. PATIENTS AND METHODS Observational descriptive study. Demographic data, comorbidity, dependency and cognitive state, and risk of osteoporotic fracture were collected. RESULTS A total of 375 patients were included (60% female) Patients with a low-risk FRAX for hip fractures had a higher Mini-mental (25, 95% CI = 24-27 vs. 22, 95% = 21 to 23, p = .0001), a higher Barthel index (88, 95% CI = 84-93 vs 72, 69 to 76, p = .0001) without differences in the Charlson index. Bivariate analysis showed an inverse association between FRAX and scales but logistic regression showed only female sex (OR 4.4, 95% CI = 2.6-7.6) and the non-dependent Barthel index (OR = 0.104, 95% CI = 0.014-0.792) remained significant and. Barthel index/Mini-mental constructed a significant model capable of predicting a risk of hip fracture of >3% measured by the FRAX index, with an area under the curve of 0.76 (95% CI = 0.7-0.81). CONCLUSIONS The FRAX index is related to other markers of geriatric assessment and the association between these variables can predict a risk of hip fracture of >3% measured by the FRAX index. Key messages Geriatric assessment indexes may be as important as the FRAX index, which is based on clinical risk factors, in predicting the fracture risk in older patient.
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Affiliation(s)
| | - Laura Abad Manteca
- b Internal Medicine Department , Hospital Universitario Río Hortega , Valladolid , Spain
| | | | - Mónica Álvarez Muñoz
- d Servicio de Urgencias de Atención Primaria Arturo Eyries , Valladolid Oeste , Spain
| | | | | | - Lourdes Ausín Pérez
- g Residencia Mixta Personas Mayores "Parquesol" , Gerencia Territorial de Servicios Sociales de Valladolid , Valladolid , Spain
| | - Jésica Abadía Otero
- b Internal Medicine Department , Hospital Universitario Río Hortega , Valladolid , Spain
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13
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Li G, Jin Y, Mbuagbaw L, Dolovich L, Adachi JD, Levine MAH, Cook D, Samaan Z, Thabane L. Enhancing research publications and advancing scientific writing in health research collaborations: sharing lessons learnt from the trenches. J Multidiscip Healthc 2018; 11:245-254. [PMID: 29844676 PMCID: PMC5961639 DOI: 10.2147/jmdh.s152681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Disseminating research protocols, processes, methods or findings via peer-reviewed publications has substantive merits and benefits to various stakeholders. PURPOSE In this article, we share strategies to enhance research publication contents (ie, what to write about) and to facilitate scientific writing (ie, how to write) in health research collaborations. METHODS Empirical experience sharing. RESULTS To enhance research publication contents, we encourage identifying appropriate opportunities for publications, publishing protocols ahead of results papers, seeking publications related to methodological issues, considering justified secondary analyses, and sharing academic process or experience. To advance writing, we suggest setting up scientific writing as a goal, seeking an appropriate mentorship, making full use of scientific meetings and presentations, taking some necessary formal training in areas such as effective communication and time and stress management, and embracing the iterative process of writing. CONCLUSION All the strategies we share are dependent upon each other; and they advocate gradual academic accomplishments through study and training in a "success-breeds-success" way. It is expected that the foregoing shared strategies in this paper, together with other previous guidance articles, can assist one with enhancing research publications, and eventually one's academic success in health research collaborations.
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Affiliation(s)
- Guowei Li
- Department of Health Research Methods, Impact and Evidence, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
- Centre for Evaluation of Medicines, Programs for Assessment of Technology in Health (PATH) Research Institute, McMaster University, Hamilton, ON, Canada
| | - Yanling Jin
- Department of Health Research Methods, Impact and Evidence, McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Impact and Evidence, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | - Lisa Dolovich
- Department of Health Research Methods, Impact and Evidence, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Jonathan D Adachi
- St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mitchell AH Levine
- Department of Health Research Methods, Impact and Evidence, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
- Centre for Evaluation of Medicines, Programs for Assessment of Technology in Health (PATH) Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Deborah Cook
- Department of Health Research Methods, Impact and Evidence, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Health Research Methods, Impact and Evidence, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Impact and Evidence, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
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14
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Miller MG, Thangthaeng N, Shukitt-Hale B. A Clinically Relevant Frailty Index for Aging Rats. J Gerontol A Biol Sci Med Sci 2017; 72:892-896. [PMID: 28329224 DOI: 10.1093/gerona/glw338] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/04/2017] [Indexed: 11/12/2022] Open
Abstract
Frailty is a clinical syndrome that is increasingly prevalent during aging. Frailty involves the confluence of reduced strength, speed, physical activity, and endurance and is associated with adverse health outcomes. The present study adapts existing clinical and preclinical indices of frailty to the Fischer (F344) rat. Male F344 rats (n = 133; 17 mo) completed a battery of behavioral tasks, including forelimb wire suspension (strength), rotarod (speed), open field (physical activity), and inclined screen (endurance). Rats that performed poorly (lowest quintile) on two tasks were considered mildly frail (17.29%, n = 23), and rats that performed poorly on 3-4 tasks were considered frail (2.26%, n = 3). Logistic regression of 100-day survival revealed that mildly frail rats were 3.8 times and frail rats were 27.5 times more likely to die during that period than nonfrail rats (p = .038; 95% confidence interval: 2.030, 372.564). The selected criterion tests, cutoff points, and index provide a potential tool for identifying frailty in aged F344 rats, which is consistent with existing frailty indices for humans and mice.
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Affiliation(s)
- Marshall G Miller
- USDA-ARS, Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Nopporn Thangthaeng
- USDA-ARS, Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Barbara Shukitt-Hale
- USDA-ARS, Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
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15
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Li G, Thabane L, Papaioannou A, Ioannidis G, Levine MAH, Adachi JD. An overview of osteoporosis and frailty in the elderly. BMC Musculoskelet Disord 2017; 18:46. [PMID: 28125982 PMCID: PMC5270357 DOI: 10.1186/s12891-017-1403-x] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/14/2017] [Indexed: 12/20/2022] Open
Abstract
Osteoporosis and osteoporotic fractures remain significant public health challenges worldwide. Recently the concept of frailty in relation to osteoporosis in the elderly has been increasingly accepted, with emerging studies measuring frailty as a predictor of osteoporotic fractures. In this overview, we reviewed the relationship between frailty and osteoporosis, described the approaches to measuring the grades of frailty, and presented current studies and future research directions investigating osteoporosis and frailty in the elderly. It is concluded that measuring the grades of frailty in the elderly could assist in the assessment, management and decision-making for osteoporosis and osteoporotic fractures at a clinical research level and at a health care policy level.
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Affiliation(s)
- Guowei Li
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,St. Joseph's Healthcare Hamilton, McMaster University, 25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada. .,Programs for Assessment of Technology in Health, Centre for Evaluation of Medicines, Hamilton, ON, L8N 1Y3, Canada.
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,St. Joseph's Healthcare Hamilton, McMaster University, 25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - George Ioannidis
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Mitchell A H Levine
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,St. Joseph's Healthcare Hamilton, McMaster University, 25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada.,Programs for Assessment of Technology in Health, Centre for Evaluation of Medicines, Hamilton, ON, L8N 1Y3, Canada
| | - Jonathan D Adachi
- St. Joseph's Healthcare Hamilton, McMaster University, 25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada. .,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,St. Joseph's Healthcare Hamilton, McMaster University, 25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada.
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16
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Kojima G. Frailty as a predictor of fractures among community-dwelling older people: A systematic review and meta-analysis. Bone 2016; 90:116-22. [PMID: 27321894 DOI: 10.1016/j.bone.2016.06.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 04/28/2016] [Accepted: 06/13/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE To identify prospective studies examining associations between frailty and fractures and to combine the risk measures to synthesize pooled evidence on frailty as a predictor of fractures among community-dwelling older people. METHODS A systematic literature search was conducted using five databases: Embase, MEDLINE, CINAHL Plus, PsycINFO, and the Cochrane Library for prospective studies on associations between frailty and fracture risk published from 2000 to August 2015 without language restriction. Odds ratios (OR) and hazard ratios (HR) extracted from the studies or calculated from available data were combined to synthesize pooled effect measures using random-effects or fixed-effects models. Heterogeneity, methodological quality, and publication bias were assessed. Meta-regression analyses were performed to explore the cause of high heterogeneity. RESULTS Of 1305 studies identified, six studies involving 96,564 older people in the community were included in this review. Frailty and prefrailty were significantly associated with future fractures among five studies with OR (pooled OR=1.70, 95% confidence interval (95% CI)=1.34-2.15, p<0.0001; pooled OR=1.31, 95% CI=1.18-1.46, p<0.00001, respectively) and four studies with HR (pooled HR=1.57, 95% CI=1.31-1.89, p<0.00001; pooled HR=1.30, 95% CI=1.12-1.51, p=0.0006, respectively). High heterogeneity was observed among five studies with OR of frailty (I(2)=66%). The studies from the United States were found to have a higher fracture risk than from those from other countries in a meta-regression model (regression coefficient=0.39, p=0.04). No evidence of publication bias was identified. CONCLUSIONS This systematic review and meta-analysis showed evidence that frailty and prefrailty are significant predictors of fractures among community-dwelling older people. Treating frailty may potentially lead to lowering fracture risks.
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Affiliation(s)
- Gotaro Kojima
- Japan Green Medical Centre, 10 Throgmorton Avenue, London EC2N 2DL, United Kingdom.
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Blodgett JM, Theou O, Howlett SE, Wu FCW, Rockwood K. A frailty index based on laboratory deficits in community-dwelling men predicted their risk of adverse health outcomes. Age Ageing 2016; 45:463-8. [PMID: 27076524 DOI: 10.1093/ageing/afw054] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/25/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND abnormal laboratory test results accumulate with age and can be common in people with few clinically detectable health deficits. A frailty index (FI) based entirely on common physiological and laboratory tests (FI-Lab) might offer pragmatic and scientific advantages compared with a clinical FI (FI-Clin). OBJECTIVES to compare the FI-Lab with the FI-Clin and to assess their individual and combined relationships with mortality and other adverse health outcomes. DESIGN AND SUBJECTS secondary analysis of the eight-centre, longitudinal European Male Ageing Study (EMAS) of community-dwelling men aged 40-79 at baseline. Follow-up assessment occurred 4.4 ± 0.3 (mean ± SD) years later. METHODS we constructed a 23-item FI using common laboratory tests, blood pressure and pulse (FI-Lab), compared it with a previously validated 39-item FI using self-report and performance-based measures (FI-Clin) and finally combined both FIs to create a 62-item FI-Combined. Outcomes were all-cause mortality, institutionalisation, doctor visits, medication use, self-reported health, falls and fractures. RESULTS the mean FI-Lab score was 0.28 ± 0.11, the FI-Clin was 0.13 ± 0.11 and FI-Combined was 0.19 ± 0.09. Age-adjusted models demonstrated that each FI was associated with mortality [HR (CI) FI-Lab: 1.04 (1.03-1.06); FI-Clin: 1.05 (1.04-1.06); FI-Combined: 1.07 (1.06-1.09)], institutionalisation, doctor visits, medication use, self-reported health and falls. Combined in a model with FI-Clin, the FI-Lab remained independently associated with mortality, institutionalisation, doctor visits, medication use and self-reported health. CONCLUSIONS the FI-Lab detected an increased risk of adverse health outcomes alone and in combination with a clinical FI; further evaluation of the feasibility of the FI-Lab as a frailty screening tool within hospital care settings is needed.
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Affiliation(s)
- Joanna M Blodgett
- Andrology Research Unit, University of Manchester, Manchester, UK Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Frederick C W Wu
- Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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18
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Li G, Papaioannou A, Thabane L, Cheng J, Adachi JD. Frailty Change and Major Osteoporotic Fracture in the Elderly: Data from the Global Longitudinal Study of Osteoporosis in Women 3-Year Hamilton Cohort. J Bone Miner Res 2016; 31:718-24. [PMID: 26547825 PMCID: PMC5104549 DOI: 10.1002/jbmr.2739] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 10/30/2015] [Accepted: 11/05/2015] [Indexed: 11/05/2022]
Abstract
Investigating the cumulative rate of deficits and the change of a frailty index (FI) chronologically is helpful in clinical and research settings in the elderly. However, limited evidence for the change of frailty before and after some nonfatal adverse health event such as a major osteoporotic fracture (MOF) is available. Data from the Global Longitudinal Study of Osteoporosis in Women 3-Year Hamilton cohort were used in this study. The changes of FI before and after onset of MOF were compared between the women with and without incident MOF. We also evaluated the relationship between risk of MOF, falls, and death and the change of FI and the absolute FI measures. There were 3985 women included in this study (mean age 69.4 years). The change of FI was significantly larger in the women with MOF than those without MOF at year 1 (0.085 versus 0.067, p = 0.036) and year 2 (0.080 versus 0.052, p = 0.042) post-baseline. The FI change was not significantly related with risk of MOF independently of age. However, the absolute FI measures were significantly associated with increased risk of MOF, falls, and death independently of age. In summary, the increase of the FI is significantly larger in the elderly women experiencing a MOF than their peer controls, indicating their worsening frailty and greater deficit accumulation after a MOF. Measures of the FI change may aid in the understanding of cumulative aging nature in the elderly and serve as an instrument for intervention planning and assessment.
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Affiliation(s)
- Guowei Li
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, Hamilton, Canada.,St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.,St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Canada
| | - Ji Cheng
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.,St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Canada
| | - Jonathan D Adachi
- Department of Medicine, McMaster University, Hamilton, Canada.,St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Canada
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