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Mou X, Sun M, Chen X. Causal effect of education on bone mineral density: A Mendelian randomization study. Medicine (Baltimore) 2024; 103:e37435. [PMID: 38489681 PMCID: PMC10939692 DOI: 10.1097/md.0000000000037435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 03/17/2024] Open
Abstract
Education level may have some association with the incidence of osteoporosis, but it is elusive if this association is causal. This two-sample Mendelian randomization analysis focused on the causal effect of education level on femoral neck bone mineral density (FN-BMD), forearm BMD, lumbar spine BMD, and heel BMD. Twelve single nucleotide polymorphisms were used as instrumental variables. The results suggested that high education level was associated with improved FN-BMD (beta-estimate: 0.406, 95% confidence interval: 0.061 to 0.751, standard error: 0.176, P-value = .021). There were null association between education and other sites of bone mineral density. Our results found the causal effect of high education level on improved FN-BMD, and improved educational attainment may be beneficial to prevent osteoporosis.
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Affiliation(s)
- Xiaoqing Mou
- Department of Radiology, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Mingqi Sun
- Department of Orthopaedic Trauma, The Second Affiliated Hospital of Inner Mongolia Medical University, Huhhot, Inner Mongolia, China
| | - Xiaojun Chen
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China
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Indicators of Improvement in Performing Activities of Daily Living Among Older Patients Undergoing Rehabilitation Following Hip Fractures. J Aging Phys Act 2023; 31:75-80. [PMID: 35894998 DOI: 10.1123/japa.2021-0490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/25/2022] [Accepted: 05/04/2022] [Indexed: 02/03/2023]
Abstract
This study aimed to evaluate the relationship between improvement in activities of daily living (ADL) and cognitive status during rehabilitation and assess factors associated with ADL improvement among older patients undergoing rehabilitation after hip fractures. This retrospective cohort study comprised 306 patients aged ≥80 years who underwent hip fracture rehabilitation. The functional independence measure gain during rehabilitation was significantly lower in the group with abnormal cognition than in the group with normal cognition. Mini-Mental State Examination, Charlson Comorbidity Index, daily duration of rehabilitation, and length of hospitalization for rehabilitation were independent factors associated with functional independence measure gain during rehabilitation in the multivariate regression analysis. Although older patients with cognitive impairment had lower ADL improvements during hip fracture rehabilitation, such patients may be able to improve their ADL by undergoing intensive and long rehabilitation programs. They should not refrain from such rehabilitation programs due to older age, fracture, and cognitive impairment.
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Gough Courtney M, Roberts J, Godde K. Structural Inequity and Socioeconomic Status Link to Osteoporosis Diagnosis in a Population-Based Cohort of Middle-Older-Age Americans. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231155719. [PMID: 36789725 PMCID: PMC9932766 DOI: 10.1177/00469580231155719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
Socioeconomic status (SES) is an important social determinant of health inequities that has been linked to chronic conditions, including osteoporosis, but research tends to focus on socioeconomic disadvantage rather than how socioeconomic advantage may facilitate these inequities. This study accounts for structural inequities and assesses the relationship between early-life and later-life SES, and risk of osteoporosis diagnosis. Data come from the nationally representative, population-based cohort Health and Retirement Study and include individuals ages 50 to 90. The outcome variable is osteoporosis diagnosis. Logistic regression models of the relationship between SES and osteoporosis diagnosis are estimated, accounting for demographic, health, and childhood variables. Higher levels of childhood and adult SES link to lower odds of osteoporosis diagnosis. Structural inequities in income and underdiagnosis of osteoporosis among persons identifying as Black/African American were detected. Accounting for bone density scan access, inequities in osteoporosis diagnosis appear to stem from barriers to accessing health care due to financial constraints. The important role of SES and evidence of structural inequities leading to underdiagnosis suggest the critical importance of clinicians receiving Diversity, Equity, and Inclusion training to reduce health inequities.
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Pluskiewicz W, Adamczyk P, Drozdzowska B. Impaired Functional Status Increases Fracture Incidence in 10-year Follow-Up: The Results from RAC-OST-POL Study. J Clin Densitom 2023; 26:104-108. [PMID: 36567159 DOI: 10.1016/j.jocd.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/11/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The aim of study was to establish the influence of baseline functional status on fracture incidence. METHODOLOGY In a prospective 10-years observation in epidemiological sample of postmenopausal women from RAC-OST-POL Study a thesis that affected functional status enhance fracture incidence was verified. At baseline, data were collected in 978 women at mean age 66.48±7.6 years and after 10 years of follow-up 640 subjects at mean age 75.04±6.95 years remained in the study. Functional status at baseline was established using Stand up and Go test (SAG) and Activity of Daily Living (IADL). Afterwards, annually data on fracture incidence were collected by phone interviews. RESULTS In the period of observation 190 low-energy fractures in 129 women were noted. The whole group was divided into subgroups: without fracture (n=511), with one fracture (n=91) and those ones who had more than one fracture (n=38). In fractured and unfractured subgroup mean SAG results were 11.36±4.28 and 10.36±2.76, respectively and differed significantly (p<0.01). With increasing number of fractures the SAG time was longer - it was 11.15±4.49 in one fracture subgroup and 11.87±3.73 in multiple fractures subgroup, with both values significantly higher than in no fracture subjects. The mean value of IADL was 23.56±1.60. In 576 (90%) women IADL reached maximal value of 24 points. In the rest of them (n=64) IADL score was between 11 and 23 points. Mean value of IADL in fractured and unfractured subgroup were 23.27±1.97 and 23.64±1.47, respectively and differed significantly (p<0.01). CONCLUSION The measures of functional status predict fractures in a prospective observation of representative epidemiological female sample.
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Affiliation(s)
- Wojciech Pluskiewicz
- Department and Clinic of Internal Diseases, Diabetology, and Nephrology, Metabolic Bone Diseases Unit, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 3-Maja 13/15 street, Zabrze 41-800, Poland.
| | - Piotr Adamczyk
- Department of Paediatrcs, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Poland
| | - Bogna Drozdzowska
- Department of Pathomorfology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
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Osteoporosis among Postmenopausal Women in Jordan: A National Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148803. [PMID: 35886655 PMCID: PMC9315755 DOI: 10.3390/ijerph19148803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 11/17/2022]
Abstract
Osteoporosis is considered a widespread health problem that affects senior citizens, particularly older women, after the menopause. This national study aimed to estimate the prevalence of osteoporosis among Jordanian postmenopausal women and to determine the association of demographic and nutritional factors, such as calcium and vitamin D supplement intake, with osteoporosis in postmenopausal women. A cross-sectional study was conducted among 884 postmenopausal women aged ≥50 years. A multistage sampling technique was used to select participants from three geographic regions of Jordan (north, middle, and south). The data were collected from the participants by a team of field researchers comprising men and women through a standard questionnaire. The prevalence of osteoporosis was 19.8% among postmenopausal Jordanian women. The study results showed that age (p ˂ 0.001), geographic region (p = 0.019), occupation (p = 0.002), and educational level (p = 0.001) were significantly associated with osteoporosis. Moreover, osteoporosis was significantly associated with calcium and vitamin D supplement intake (p < 0.05). There is a high prevalence of osteoporosis among postmenopausal Jordanian women. Therefore, there is a need to educate women at this age, and probably at an earlier age, to prevent or reduce the development of osteoporosis.
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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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Long H, Cao R, Zhang H, Qiu Y, Yin H, Yu H, Ma L, Diao N, Yu F, Guo A. Incidence of hip fracture among middle-aged and older Chinese from 2013 to 2015: results from a nationally representative study. Arch Osteoporos 2022; 17:48. [PMID: 35277743 DOI: 10.1007/s11657-022-01082-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/15/2022] [Indexed: 02/03/2023]
Abstract
China is experiencing remarkable changes in people aging and migration. Therefore, the incidence and associated factors for hip fracture might differ from previous results. A nationally representative study of hip fracture enables policymakers to formulate preventive strategies and provide information on resource allocation. PURPOSE To estimate the incidence of hip fracture, between 2013 and 2015, among the middle-aged and older Chinese population. METHODS Individuals with hip fractures between 2013 and 2015 were identified from the China Health and Retirement Longitudinal Study. The sex-specific incidence and the associated factors of hip fracture were assessed. RESULTS Among 19,112 individuals (51.4% women; mean age 60.5 years) included in the analysis, 408 (2.13%) had a hip fracture between 2013 and 2015. Moreover, the annual incidence of hip fracture for men and women were 1065 and 1069 per 100,000, respectively. The incidence of hip fracture increased with age (p < 0.001). A history of chronic disease, being unmarried, and individuals without insurance were associated with a higher incidence of hip fracture. Interestingly, the incidence of hip fracture was higher among individuals with fewer years of education (p = 0.002). The North-East regions of China had the lowest incidence of hip fracture (1022 per 100,000) between 2013 and 2015, followed by the North (1602 per 100,000), South-Central (2055 per 100,000), East (2173 per 100,000), and South-West (2537 per 100,000) regions. Finally, the incidence was highest among participants living in the North-West region (3244 per 100,000). CONCLUSION Between 2013 and 2015, the incidence of hip fracture is high among the middle-aged and older Chinese population. Furthermore, it varied significantly according to sociodemographic and geographic factors. Therefore, the support of targeted health policies and cost-effective preventive strategies are warranted in China.
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Affiliation(s)
- Huibin Long
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, 100050, Beijing, China
| | - Ruiqi Cao
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, 100050, Beijing, China
| | - Hongrui Zhang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, 100050, Beijing, China
| | - Yudian Qiu
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Heyong Yin
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, 100050, Beijing, China
| | - Haomian Yu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, 100050, Beijing, China
| | - Lifeng Ma
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, 100050, Beijing, China
| | - Naicheng Diao
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, 100050, Beijing, China
| | - Fei Yu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, 100050, Beijing, China.
| | - Ai Guo
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, 100050, Beijing, China.
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Bento R, Gaddam A, Ferreira JMF. Sol-Gel Synthesis and Characterization of a Quaternary Bioglass for Bone Regeneration and Tissue Engineering. MATERIALS (BASEL, SWITZERLAND) 2021; 14:4515. [PMID: 34443039 PMCID: PMC8398804 DOI: 10.3390/ma14164515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 12/27/2022]
Abstract
Sol-gel synthesis using inorganic and/or organic precursors that undergo hydrolysis and condensation at room temperature is a very attractive and less energetic method for preparing bioactive glass (BG) compositions, as an alternative to the melt-quenching process. When properly conducted, sol-gel synthesis might result in amorphous structures, with all of the components intimately mixed at the atomic scale. Moreover, developing new and better performing materials for bone tissue engineering is a growing concern, as the aging of the world's population leads to lower bone density and osteoporosis. This work describes the sol-gel synthesis of a novel quaternary silicate-based BG with the composition 60 SiO2-34 CaO-4 MgO-2 P2O5 (mol%), which was prepared using acidified distilled water as a single solvent. By controlling the kinetics of the hydrolysis and condensation steps, an amorphous glass structure could be obtained. The XRD results of samples calcined within the temperature range of 600-900 °C demonstrated that the amorphous nature was maintained until 800 °C, followed by partial crystallization at 900 °C. The specific surface area-an important factor in osteoconduction-was also evaluated over different temperatures, ranging from 160.6 ± 0.8 m2/g at 600 °C to 2.2 ± 0.1 m2/g at 900 °C, accompanied by consistent changes in average pore size and pore size distribution. The immersion of the BG particles in simulated body fluid (SBF) led to the formation of an extensive apatite layer on its surface. These overall results indicate that the proposed material is very promising for biomedical applications in bone regeneration and tissue engineering.
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Affiliation(s)
- Ricardo Bento
- CICECO—Aveiro Institute of Materials, Department of Materials and Ceramic Engineering, University of Aveiro, Santiago University Campus, 3810-193 Aveiro, Portugal; (R.B.); (A.G.)
| | - Anuraag Gaddam
- CICECO—Aveiro Institute of Materials, Department of Materials and Ceramic Engineering, University of Aveiro, Santiago University Campus, 3810-193 Aveiro, Portugal; (R.B.); (A.G.)
- Instituto de Física de São Carlos, Universidade de São Paulo, São Carlos 13566-590, SP, Brazil
| | - José M. F. Ferreira
- CICECO—Aveiro Institute of Materials, Department of Materials and Ceramic Engineering, University of Aveiro, Santiago University Campus, 3810-193 Aveiro, Portugal; (R.B.); (A.G.)
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Daniolou S, Rapp A, Haase C, Ruppert A, Wittwer M, Scoccia Pappagallo A, Pandis N, Kressig RW, Ienca M. Digital Predictors of Morbidity, Hospitalization, and Mortality Among Older Adults: A Systematic Review and Meta-Analysis. Front Digit Health 2021; 2:602093. [PMID: 34713066 PMCID: PMC8521803 DOI: 10.3389/fdgth.2020.602093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/17/2020] [Indexed: 12/17/2022] Open
Abstract
The widespread adoption of digital health technologies such as smartphone-based mobile applications, wearable activity trackers and Internet of Things systems has rapidly enabled new opportunities for predictive health monitoring. Leveraging digital health tools to track parameters relevant to human health is particularly important for the older segments of the population as old age is associated with multimorbidity and higher care needs. In order to assess the potential of these digital health technologies to improve health outcomes, it is paramount to investigate which digitally measurable parameters can effectively improve health outcomes among the elderly population. Currently, there is a lack of systematic evidence on this topic due to the inherent heterogeneity of the digital health domain and the lack of clinical validation of both novel prototypes and marketed devices. For this reason, the aim of the current study is to synthesize and systematically analyse which digitally measurable data may be effectively collected through digital health devices to improve health outcomes for older people. Using a modified PICO process and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework, we provide the results of a systematic review and subsequent meta-analysis of digitally measurable predictors of morbidity, hospitalization, and mortality among older adults aged 65 or older. These findings can inform both technology developers and clinicians involved in the design, development and clinical implementation of digital health technologies for elderly citizens.
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Affiliation(s)
- Sofia Daniolou
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | | | | | | | | | | | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, School of Dentistry, University of Bern, Bern, Switzerland
| | - Reto W. Kressig
- University Department of Geriatric Medicine FELIX PLATTER, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Marcello Ienca
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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Predictors of Loss to Follow-up in Hip Fracture Trials: A Secondary Analysis of the FAITH and HEALTH Trials. J Orthop Trauma 2020; 34 Suppl 3:S22-S28. [PMID: 33027162 DOI: 10.1097/bot.0000000000001928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip fracture trials often suffer substantial loss to follow-up due to difficulties locating and communicating with participants or when participants, or their family members, withdraw their consent. We aimed to determine which factors were associated with being unable to contact FAITH and HEALTH participants for their 24-month follow-up and to also determine which factors were associated with their withdrawal of consent. METHODS We conducted 2 multivariable logistic regression analyses to determine which factors were predictive of being unable to contact participants at 24 months postfracture and withdrawal of consent within 24 months of their fracture. Results were reported as odds ratios, 95% confidence intervals, and associated P-values. All tests were 2-tailed with alpha = 0.05. RESULTS We were unable to contact 123 of 2520 participants (4.9%) for their 24-month follow-up visits and 124 (4.9%) withdrew their consent from the trial. Being non-White (P = 0.003), enrolled from a non-European hospital (P < 0.001), and treated with arthroplasty (P < 0.001) were associated with an increased odds of not completing the 24-month follow-up visit. Being enrolled from a hospital in the United States (P = 0.02), from a hospital in Oceania, India, or South Africa (P < 0.001) as compared to a European hospital, and treated with arthroplasty (P < 0.001) were associated with an increased odds of consent withdrawal. DISCUSSION Certain factors may be predictive of loss to follow-up in hip fracture trials. We suggest that the identification of such factors may be used to inform and improve retention strategies in future orthopaedic hip fracture trials. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Zanjani F, Gruber-Baldini AL, Resnick B, Orwig D, Hochberg M, Magaziner J. The Relationship Between Alcohol Consumption and Hip Fracture Recovery Among Older Adults. J Appl Gerontol 2020; 39:1046-1051. [PMID: 31027444 PMCID: PMC7041881 DOI: 10.1177/0733464819845802] [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] [Indexed: 11/16/2022] Open
Abstract
Background: We examined the relationship between alcohol consumption and hip fracture recovery. Methods: Repeated measures analysis was used to analyze Baltimore Hip Studies (BHS) seventh cohort 12-month prospective data of hip fracture patients. The analytical sample was limited to individuals with baseline and follow-up alcohol data, representing n = 278 sample size, 49% male, and mean age 81 years. Results: In the year prior to fracture, sample reporting indicated 45% nondrinking, 48% one to seven drinks per week, and 7% eight or more drinks per week alcohol levels. There were some changes in alcohol status during the study period (p < .001); 42% remained nondrinkers and 47% remained alcohol consumers, but 8% stopped alcohol use, and 3% reported alcohol consumption after nondrinking at baseline. Alcohol was a predictor (p < .05) of disability and physical function, not showing worse recovery for drinkers. Conclusion: Almost half of the sample consumed alcohol throughout the study period, with no clear indication of negative effects on hip fracture recovery.
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Affiliation(s)
| | | | | | - Denise Orwig
- University of Maryland School of Medicine, Baltimore, USA
| | - Marc Hochberg
- University of Maryland School of Medicine, Baltimore, USA
| | - Jay Magaziner
- University of Maryland School of Medicine, Baltimore, USA
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Morales-Contreras MF, Chana-Valero P, Suárez-Barraza MF, Saldaña Díaz A, García García E. Applying Lean in Process Innovation in Healthcare: The Case of Hip Fracture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155273. [PMID: 32707826 PMCID: PMC7432005 DOI: 10.3390/ijerph17155273] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
Academic literature and practitioners acknowledge that there is a need to improve efficiency and service quality in the healthcare industry. In Spain, osteoporotic fractures represent a great cost in socio-economic and morbi-mortality terms, hip fracture being the surgical pathology with the second highest consumption of resources. The research questions that govern this study concern the use of Lean principles to identify waste, and an evaluation of the application of an innovative approach in the hip fracture surgery process. A research design based on a case study and action research was developed. Findings relate to (i) the identification of the main types of waste or muda (being the most frequent delay, transportation, over-processing and defects); (ii) the analysis of existing processes based on a Lean approach (identifying opportunities for improvement as a reduction of the number of steps and participants, improving communication, automation, standardization, etc.); and (iii) the application of an innovative process based on the Lean approach and action research in the healthcare industry. This research provides insights for academia, practitioners, management, and society: waste identification and process redesign helps to continue the improvement of operations, increase efficiency, reduce costs, and enhance services, providing benefits to patients, families, hospital employees, and the healthcare system.
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Affiliation(s)
- Manuel Francisco Morales-Contreras
- Department of Management, ICADE, Universidad Pontificia Comillas, ICADE, 28015 Madrid, Spain
- Correspondence: ; Tel.: +34-91-5422800 (ext. 2461)
| | - Pedro Chana-Valero
- Fundación San Juan de Dios, Centro de CC de la Salud San Rafael, Universidad Nebrija, 28036 Madrid, Spain; (P.C.-V.); (E.G.G.)
| | - Manuel F. Suárez-Barraza
- International Business Department, School of Business and Economy, Universidad de las Américas Puebla (UDLAP), Puebla 72810, Mexico;
| | | | - Elena García García
- Fundación San Juan de Dios, Centro de CC de la Salud San Rafael, Universidad Nebrija, 28036 Madrid, Spain; (P.C.-V.); (E.G.G.)
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Follis SL, Bea J, Klimentidis Y, Hu C, Crandall CJ, Garcia DO, Shadyab AH, Nassir R, Chen Z. Psychosocial stress and bone loss among postmenopausal women: results from the Women’s Health Initiative. J Epidemiol Community Health 2019; 73:888-892. [DOI: 10.1136/jech-2019-212516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/28/2019] [Accepted: 06/01/2019] [Indexed: 12/29/2022]
Abstract
BackgroundBone loss is a major public health concern with large proportions of older women experiencing osteoporotic fractures. Previous research has established a relationship between psychosocial stressors and fractures. However, few studies have investigated bone loss as an intermediary in this relationship. This study investigates whether social stress is associated with bone loss during a 6-year period in postmenopausal women.MethodsData from 11 020 postmenopausal women from the USA was used to examine self-reported psychosocial stress in relation to change in bone mineral density (BMD) measured at the femoral neck, lumbar spine and total hip. Linear regression models were used to examine associations between social measures of psychosocial stress (social strain, social functioning and social support) and per cent change in BMD over 6 years.ResultsHigh social stress was associated with decreased BMD over 6 years. After adjustment for confounders, each point higher in social strain was associated with 0.082% greater loss of femoral neck BMD, 0.108% greater loss of total hip BMD and 0.069% greater loss of lumbar spine BMD (p<0.05). Low social functioning and low social support were associated with greater decreases in femoral neck BMD, and low social functioning was associated with greater decreases in total hip BMD.ConclusionThe findings provide evidence for an association between high social stress and greater bone loss over 6 years of follow-up. In agreement with the prior literature, the findings for social strain and social functioning suggest that poor quality of social relationships may be associated with bone loss in postmenopausal women.
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Pierrie SN, Wally MK, Churchill C, Patt JC, Seymour RB, Karunakar MA. Pre-Hip Fracture Falls: A Missed Opportunity for Intervention. Geriatr Orthop Surg Rehabil 2019; 10:2151459319856230. [PMID: 31218094 PMCID: PMC6558529 DOI: 10.1177/2151459319856230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction The purpose of this study is to examine utilization of acute care services in the year prior to hip fracture to inform development and implementation of an intervention to prevent subsequent falls and hip fracture that targets high-risk patients. Methods Elderly patients (age >55) with hip fractures managed at a level one trauma center during 1 year (n = 134) were included. All "preadmissions," defined as an emergency department (ED) visit or inpatient admission within our hospital system in the year before fall with fracture, were documented. Proportion of patients with a "preadmission," reason for "preadmission," demographic characteristics, medical comorbidities, history of falls with fracture, cause of fracture, and time between preadmission and fracture were documented and described. Results Of all, 45.5% of patients (n = 61) had a preadmission. Falls was the reason for presentation in 27.5% of the preadmission encounters, and the median interval between preadmission and fracture was 217 days. Only 8% of the patients presenting for falls in the ED received falls counseling. Patients who experienced preadmission were younger, had a higher Charlson Comorbidity Index, and were more likely to be male. Seventy-nine percent were community dwelling at the time of preadmission, and 68% were discharged home. Discussion Nearly half of hip fracture patients were seen in a high acuity care environment in the year prior to fracture. A quarter presented for falls, supporting previous findings that history of falls is an important risk factor for future falls and injury. However, very few received falls counseling, documenting a major missed opportunity to address falls prevention in the acute care setting. Conclusions Preventing subsequent falls and hip fractures in a targeted, high-risk population in the year prior to potential hip fracture has important implications for improving individual morbidity and mortality and population health. Community-based falls prevention programs are a viable option for this high-risk, community-dwelling population. Collaborative interventions are needed to actively link patients to evidence-based community resources.
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Affiliation(s)
- Sarah N Pierrie
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Meghan K Wally
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Christine Churchill
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Joshua C Patt
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Rachel B Seymour
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Madhav A Karunakar
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
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Tsai AJ. Disparities in osteoporosis by race/ethnicity, education, work status, immigrant status, and economic status in the United States. Eur J Intern Med 2019; 64:85-89. [PMID: 31030967 DOI: 10.1016/j.ejim.2019.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/05/2019] [Accepted: 04/20/2019] [Indexed: 12/15/2022]
Abstract
AIMS Osteoporosis is one of the most common bone health diseases affecting older adults in US. Addressing disparities in osteoporosis will help to enhance the quality of bone care in the nation's bone health programs. MATERIALS & METHODS We used the data of adult participants of the National Health and Nutrition Examination Survey with reported bone mineral density measured during the periods of 2005-2010 and 2013-2014 to examine disparities in osteoporosis based on race/ethnicity, educational attainment, work status, immigrant status, and economic status in US. RESULTS Based on educational attainment, the age- and sex-standardized osteoporosis prevalence (SOP) was highest among those with less than a high school education (HSE) (5.1%, 95% CI (CI): 4.3%-5.9%), whereas it was lowest among those with more than HSE (3.2%, CI: 2.7%-3.6%). Based on work status, SOP was highest among unemployed participants (5.4%, CI: 1.9%-8.9%), whereas it was lowest among working participants (2%, CI: 1.6%-2.4%). Based on immigrant status, SOP was highest among non-citizens (6.4%, CI: 5%-7.8%), whereas it was lowest among those born in US (3.4%, CI: 3.1%-3.7%). Based on economic status, SOP was highest among those with poverty-to-income ratio (PIR) <1 (5.5%, CI: 4.4%-6.5%), whereas it was lowest among those with PIR ≥ 4 (2.4%, CI: 1.9%-2.9%). CONCLUSIONS Osteoporosis was more prevalent among US adults who were non-citizens, less educated, unemployed, and had lower income. The observed disparities suggest a need for interventions to promote better quality bone care among the socioeconomically disadvantaged groups.
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Affiliation(s)
- Allen J Tsai
- College of Medicine, Northeast Ohio Medical University, 4209 St. Rt. 44, Rootstown, OH, USA.
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Ren Y, Hu J, Lu B, Zhou W, Tan B. Prevalence and risk factors of hip fracture in a middle-aged and older Chinese population. Bone 2019; 122:143-149. [PMID: 30797059 DOI: 10.1016/j.bone.2019.02.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/10/2019] [Accepted: 02/19/2019] [Indexed: 02/05/2023]
Abstract
UNLABELLED The prevalence of hip fracture and associated risk factors in China were evaluated in a Health and Retirement Longitudinal Study. There is an apparent geographic variation in the prevalence of hip fracture in China. Advanced age, West region, lower education, under-weight, having self-reported history of chronic lung diseases, heart diseases, stroke, and arthritis appear to be associated with risk of hip fracture. INTRODUCTION The aim of this study is to estimate the prevalence of hip fracture and to identify its risk factors in China. METHODS Using the national survey data collected from the China Health and Retirement Longitudinal Study (CHARLS), we estimated the prevalence of hip fracture, considering the complex survey design and response rate. We applied the weighted logistic regression analysis to identify risk factors associated with hip fracture employing cross-sectional study designs. RESULTS Among 20,110 respondents included in the analysis, there were 431 hip fractures. The overall prevalence of hip fracture among middle-aged and older Chinese adults was 2.36%. From those aged<50 years to 60-69 years, the prevalence of hip fracture did not increase with age, but significantly increased after the age of 70; 1.62% for those aged <50 years and 5.42% for those aged ≥70 years. East, South-Central, South-West, and North-West region had a higher prevalence of hip fracture than North and North-East region. Compared with underweight, obesity (OR 0.37 [95% CI 0.20-0.69]) was associated with a lower likelihood of hip fracture. A self-reported history of chronic lung diseases (OR 2.11 [95% CI 1.51-2.96]), heart diseases (OR 1.36 [95% CI 1.00-1.85]), stroke (OR 2.30 [95% CI 1.08-4.92]), and arthritis (OR 2.30 [95% CI 1.08-4.92]) were significantly correlated with hip fracture. CONCLUSIONS There is an apparent geographic variation in the prevalence of hip fracture in China. Advanced age, West region, lower education, under-weight, having self-reported history of chronic lung diseases, heart diseases, stroke, and arthritis appear to be associated with risk of hip fracture. Understanding the geographic variations in hip fracture prevalence is important for allocation of healthcare resources. Knowing the reasons for hip fracture is necessary to implement a comprehensive policy for hip fracture prevention in China.
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Affiliation(s)
- Yan Ren
- Chinese Evidence-based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, Sichuan 610044, China
| | - Jiang Hu
- Department of Orthopedics, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, China
| | - Bing Lu
- Department of Orthopedics, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, China
| | - Weijun Zhou
- Department of Orthopedics, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, China
| | - Bo Tan
- Department of Orthopedics, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, China.
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Gardea-Reséndez MA, Kawas-Valle O, Peña-Martínez VM, Barragán-Rodríguez AG. Perfil psicosocial de adultos mayores mexicanos hospitalizados por fractura de cadera secundaria a caída. Rev Salud Publica (Bogota) 2019; 21:181-186. [DOI: 10.15446/rsap.v21n2.79382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/16/2019] [Indexed: 11/09/2022] Open
Abstract
Objetivo Definir el perfil psicosocial de adultos mayores de 65 años hospitalizados por fractura de cadera secundaria a caída.Métodos Se realizó un estudio de prevalencia, descriptivo, cuantitativo; reclutándose 55 sujetos mayores de 65 años hospitalizados de marzo 2017 a febrero 2018. Los datos fueron recolectados a través de un cuestionario socioeconómico y el índice de Barthel para Actividades de la Vida Diaria.Resultados El promedio de edad fue de 80,8 años, de los cuales 76,36% eran mujeres. El 58,2% de pacientes eran viudos; 61,8% habían cursado solo la educación primaria y 29,1% no contaban con estudios. El 69,1% de la muestra se encontraba desempleada y 56,36% subsistía con un ingreso mensual menor a US$101,77, dependiendo de programas de apoyo social gubernamental como fuente de ingreso. Los hallazgos en las condiciones de vivienda fueron homogéneos entre la población estudiada. El 67.3% de la muestra presentaba un grado variable de dependencia en las actividades cotidianas.Discusión Los resultados permiten generar la hipótesis de que el riesgo de complicaciones médicas y socioeconómicas durante el periodo de recuperación puede ser mayor en nuestra población debido a las condiciones premórbidas descritas.
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Gough M, Godde K. Accelerated Aging: The Role of Socioeconomic, Social, Demographic, and Biological Factors on Bone Mineral Density. Res Aging 2018; 41:443-466. [DOI: 10.1177/0164027518816516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We investigate socioeconomic, social, demographic, and biological variables that are associated with chronic stress in the body to assess whether they have an effect on bone mineral density (BMD) as an indicator of accelerated aging. Multiple regression models were derived from data in the Midlife in the United States: A National Longitudinal Study of Health and Well-Being, Waves 1 (1995–1996) and 2 (2004–2006). Three BMD variables were used as outcomes: femoral, femoral neck, and spine T scores. The sample included 333 men and women aged 34–80. Poverty and C-reactive protein were related to BMD for spine T scores, partially consistent with hypotheses. But, marital status, perceived support of a partner, and education were not associated. Friend strain was discovered to have a relationship with BMD. More variables, and from a broader context, need to be examined together to understand what affects reduced BMD, given the high costs of accelerated aging.
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Affiliation(s)
- Margaret Gough
- Sociology and Anthropology Department, University of La Verne, La Verne, CA, USA
| | - Kanya Godde
- Sociology and Anthropology Department, University of La Verne, La Verne, CA, USA
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Lindéus M, Englund M, Kiadaliri AA. Educational inequalities in fracture-related mortality using multiple cause of death data in the Skåne region, Sweden. Scand J Public Health 2018; 48:72-79. [PMID: 30345871 DOI: 10.1177/1403494818807831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: To assess the absolute and relative educational inequalities in mortality from hip and non-hip fractures in Skåne region, Sweden. Methods: We conducted a population-based open cohort study. People aged 30-99 years, resident in the region during 1998-2013 (n = 999, 148) were followed until death, their 100th birthday, relocation outside Skåne, or the end of 2014. We obtained individual-level data from the Statistics Sweden and the Swedish National Board of Health and Welfare's Cause of Death Register. Death certificates coded with any fracture diagnosis were defined as fracture-related deaths. Educational inequalities were assessed by slope and relative indices of inequality (SII and RII). Cox regression and additive hazard models were used to estimates these indices. Results: During a mean follow-up of 12.2 years, there were 5,121 fracture-related deaths, of which 3,110 were associated with hip fracture. Age-standardized, hip fracture-related mortality rates per 100,000 person-years were 31, 95% confidence interval (CI) (30, 32) and 23 (20, 26) in people with low and high levels of education, respectively (rate ratio 1.4, 95% CI (1.2, 1.5)). Corresponding mortality rates for non-hip-fracture related deaths were 20 (18, 21) and 16 (14, 19) (rate ratio 1.2, 95% CI (1.0, 1.4)). SII and RII revealed educational inequalities in hip fracture-related mortality in favour of highly educated people. For non hip fracture-related mortality, there were statistically significant educational inequalities in people aged <70 years. Conclusions: We found higher fracture-related mortality with lower education suggesting preventative and therapeutic interventions for fractures should pay special attention to people with low-level education.
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Affiliation(s)
- Maria Lindéus
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Sweden
| | - Martin Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Sweden
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, USA
| | - Aliasghar A Kiadaliri
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Sweden
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20
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Hansen L, Judge A, Javaid MK, Cooper C, Vestergaard P, Abrahamsen B, Harvey NC. Social inequality and fractures-secular trends in the Danish population: a case-control study. Osteoporos Int 2018; 29:2243-2250. [PMID: 29946757 PMCID: PMC6140998 DOI: 10.1007/s00198-018-4603-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/06/2018] [Indexed: 12/21/2022]
Abstract
UNLABELLED We examined links between markers of social inequality and fracture risk in the Danish population, demonstrating that high income and being married are associated with a significantly lower risk. INTRODUCTION We explored whether the risk of hip, humerus, and wrist fracture was associated with markers of inequality using data from Danish health registries. METHODS All patients 50 years or older with a primary hip (ICD10 S720, S721, S722, and S729) humerus (ICD10 S422, S423, S424, S425, S426, and S427), or wrist (ICD10: S52) fracture were identified from 1/1/1995 to 31/12/2011. Fracture patients were matched 1:1 by age, sex, and year of fracture, to a non-fracture control. Markers of inequality were as follows: income (fifths); marital status (married, divorced, widowed, or unmarried); area of residence (remote, rural, intermediate, or urban). Conditional logistic regression was used to investigate associations between these exposures, and risk of fracture, adjusting for covariates (smoking, alcohol, and Charlson co-morbidity). Interactions were fitted between exposure and covariates where appropriate. RESULTS A total of 189,838 fracture patients (37,500 hip, 45,602 humerus, and 106,736 wrist) and 189,838 controls were included. Mean age was 73.9 years (hip), 67.5 years (humerus), and 65.3 years (wrist). High income (5th quintile) was significantly associated with a lower odds ratio of all three fractures, compared to average income (3rd quintile). Married subjects had a significantly decreased odds ratio across all three fractures. However, no overall secular difference was observed regarding the influence of the markers of inequality. CONCLUSION In conclusion, we have demonstrated important, stable associations between social inequality, assessed using income, marital status, and area of residence, and fracture at the population level. These findings can inform approaches to healthcare, and suggest that much thought should be given to novel interventions aimed especially at those living alone, and ideally societal measures to reduce social inequality.
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Affiliation(s)
- L Hansen
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg, Denmark
| | - A Judge
- University of Bristol, Bristol, England
| | - M K Javaid
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - C Cooper
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - P Vestergaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - B Abrahamsen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
- Odense Exploratory Patient Network (OPEN), University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK.
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21
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Housing conditions and non-communicable diseases among older adults in Ireland. QUALITY IN AGEING AND OLDER ADULTS 2018. [DOI: 10.1108/qaoa-03-2018-0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Housing quality across the life course is an important health determinant. The purpose of this paper is to profile the current housing conditions of older adults in Ireland, and to investigate the association between housing conditions and heating problems and two types of non-communicable diseases: respiratory health problems and bone and joint conditions.
Design/methodology/approach
Data are from the Healthy and Positive Ageing Initiative Age-friendly Cities and Counties Survey, a random-sample, population representative survey of 10,540 adults aged 55 and older collected in 2015–2016. Mixed-effects logistic regression analysis was used to investigate the association between poor housing (leaks, rot and damp) and poor heating (unable to keep the home adequately warm) and the likelihood of having a respiratory health problem or a bone or joint condition. Results are reported as odds ratios with 95% confidence intervals.
Findings
Overall, 10.2 per cent had poor housing and 10.4 per cent had poor heating. Poor housing and poor heating were strongly associated with respiratory health problems and there was a strong association between poor housing and bone and joint conditions. These associations were not explained by health behaviours or socio-demographic characteristics.
Originality/value
Despite a number of publicly funded schemes available to assist in upgrading and maintaining housing, a considerable number of adults aged 55 years and older continue to report problems which are associated with an increased likelihood of respiratory health problem and bone and joint conditions and present a considerable threat to healthy ageing in place.
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Rocha VM, Gaspar HA, Oliveira CFD. Fracture risk assessment in home care patients using the FRAX® tool. ACTA ACUST UNITED AC 2018; 16:eAO4236. [PMID: 30208152 PMCID: PMC6122886 DOI: 10.1590/s1679-45082018ao4236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 02/12/2018] [Indexed: 02/04/2023]
Abstract
Objective To assess the ten-year risk of hip and osteoporotic fracture in home care patients using the FRAX® tool. Methods A retrospective, cross-sectional observational study including patients aged ≥ 40 and ≤ 90 years and receiving home care from a private provider. The risk of fracture was calculated using an online calculator. High risk was defined as risk of hip fracture greater than 3% or risk of osteoporotic fracture greater than 20%. Data were expressed as absolute number (n), relative frequency (%), mean, standard deviation (±) and probability value (p). Results Eighty-three (37.7%) out of 222 patients were at high risk of fracture. Of these, 81 (36.7%) were at high risk of hip fracture, as follows: 18 patients aged 70-80 years (17 female) and 63 patients aged 80-90 years (51 female). High risk of osteoporotic fracture was limited to two female patients (0.1%) aged over 80 years. Conclusion FRAX® analysis revealed similar fracture risks in the sample and the older adult population overall. Prospective investigation of fracture rates in home care patients, identification of true risk factors and construction of a home care patient-specific clinical score are warranted.
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Yuma-Guerrero P, Orsi R, Lee PT, Cubbin C. A systematic review of socioeconomic status measurement in 13 years of U.S. injury research. JOURNAL OF SAFETY RESEARCH 2018; 64:55-72. [PMID: 29636170 PMCID: PMC10372816 DOI: 10.1016/j.jsr.2017.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/09/2017] [Accepted: 12/05/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of this review was to assess the impact of socioeconomic status (SES) on injury and to evaluate how U.S. injury researchers have measured SES over the past 13years in observational research studies. DESIGN & METHODS This systematic review included 119 US injury studies indexed in PubMed between January 1, 2002 and August 31, 2015 that used one or more individual and/or area-level measures of SES as independent variables. Study findings were compared to the results of a previous review published in 2002. RESULTS Findings indicate SES remains an important predictor of injury. SES was inversely related to injury in 78 (66%) of the studies; inverse relationships were more consistently found in studies of fatal injury (77.4%) than in studies of non-fatal injury (58%). Approximately two-thirds of the studies (n=73, 61%) measured SES along a gradient and 59% used more than one measure of SES (n=70). Studies that used a gradient measure of SES and/or more than one measure of SES identified significant relationships more often. These findings were essentially equivalent to those of a similar 2002 review (Cubbin & Smith, 2002). CONCLUSIONS There remains a need to improve measurement of SES in injury research. Public health training programs should include best practices for measurement of SES, which include: measuring SES along a gradient, selecting SES indicators based on the injury mechanism, using the smallest geographic region possible for area-level measures, using multiple indicators when possible, and using both individual and area-level measures as both contribute independently to injury risk. Area-level indicators of SES are not accurate estimates of individual-level SES. PRACTICAL APPLICATIONS Injury researchers should measure SES along a gradient and incorporate individual and area-level SES measures that are appropriate to the injury outcome under study.
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Affiliation(s)
- Paula Yuma-Guerrero
- Colorado State University, College of Health and Human Sciences, School of Social Work, 127 Education, 1586 Campus Delivery, Fort Collins, CO 80523-1586, United States.
| | - Rebecca Orsi
- Colorado State University, College of Health and Human Sciences, School of Social Work, 127 Education, 1586 Campus Delivery, Fort Collins, CO 80523-1586, United States
| | - Ping-Tzu Lee
- Colorado State University, College of Health and Human Sciences, School of Social Work, 127 Education, 1586 Campus Delivery, Fort Collins, CO 80523-1586, United States
| | - Catherine Cubbin
- The University of Texas at Austin, School of Social Work, Austin, TX, United States
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Lobo E, Marcos G, Santabárbara J, Lobo-Escolar L, Salvador-Rosés H, De la Cámara C, Lopez-Anton R, Gracia-García P, Lobo-Escolar A. Gender differences in the association of cognitive impairment with the risk of hip fracture in the older population. Maturitas 2017; 109:39-44. [PMID: 29452780 DOI: 10.1016/j.maturitas.2017.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/17/2017] [Accepted: 12/06/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To test the hypothesis that differences by gender will be observed in the association of hip fracture risk with stages of cognitive impairment; and to explore the association between Petersen's "mild cognitive impairment" (MCI) and DSM-5 "mild neurocognitive disorder" (MND). STUDY DESIGN A community sample of 4803 individuals aged 55+ years was assessed in a two-phase case-finding enquiry in Zaragoza, Spain, and was followed up for 16 years. Medical and psychiatric history was collected with standardized instruments, including the Mini-Mental Status Examination (MMSE), Geriatric Mental State (GMS), History and Aetiology Schedule, and a Risk Factors Questionnaire. The statistical analysis included calculations of Hazard Ratios (HR) in multivariate Cox proportional hazards regression models. MAIN OUTCOME MEASURES Identified cases of hip fracture, validated by blind researchers. RESULTS In men, hip fracture risk was increased at the "mild" (HR=4.99 (1.39-17.91)) and at the "severe" (HR=9.31 (1.35-64.06)) stages of cognitive impairment, indicated by MMSE performance. In contrast, in women no association could be documented at the "mild stage" (power=89%), and the association disappeared altogether at the "severe stage" in the final multivariate statistical model (power 100%). No association observed between hip fracture and mild cognitive impairment in both men (power=28% for P-MCI) and women (power=44% and 19% for Petersen's MCI and DSM-5 MND, respectively). CONCLUSIONS Increased hip fracture risk was associated with "mild" stages of cognitive impairment in men, but not in women. To explore the potential association with the construct MCI or MND, studies with greater statistical power would be required.
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Affiliation(s)
- Elena Lobo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain.
| | - Guillermo Marcos
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain; Servicio de Archivos, Hospital Clínico Universitario, Avda. San Juan Bosco 15, 50009 Zaragoza, Spain
| | - Javier Santabárbara
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
| | - Luis Lobo-Escolar
- Servicio de Ortopedia y Traumatología, Asepeyo Sant Cugat Hospital, Av. Alcalde Barnils, 54-60, 08174 Sant Cugat del Vallés, Barcelona, Spain
| | - Helena Salvador-Rosés
- Servicio de Cirugía Digestiva, Dr. Josep Trueta University Hospital, Avda. de França s/n, 17007 Girona, Spain
| | - Concepción De la Cámara
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain; Servicio de Psiquiatría, Hospital Clínico Universitario, Avda. San Juan Bosco 15, 50009 Zaragoza, Spain; Departamento de Psiquiatría, Universidad de Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Raul Lopez-Anton
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain; Departamento de Psicología y Sociología, Universidad de Zaragoza, C/Doctor Cerrada 1-5, 50009 Zaragoza, Spain
| | - Patricia Gracia-García
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain; Servicio de Psiquiatría, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - Antonio Lobo-Escolar
- Servicio de Cirugía Ortopédica y Traumatológica, Hospital San Jorge, Avda. Martínez de Velasco 36, 22004 Huesca, Spain
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Kristensen PK, Thillemann TM, Pedersen AB, Søballe K, Johnsen SP. Socioeconomic inequality in clinical outcome among hip fracture patients: a nationwide cohort study. Osteoporos Int 2017; 28:1233-1243. [PMID: 27909785 DOI: 10.1007/s00198-016-3853-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
Abstract
UNLABELLED The evidence is limited regarding the association between socioeconomic status and the clinical outcome among patients with hip fracture. In this nationwide, population-based cohort study, higher education and higher family income were associated with a substantially lower 30-day mortality and risk of unplanned readmission after hip fracture. INTRODUCTION We examined the association between socioeconomic status and 30-day mortality, acute readmission, quality of in-hospital care, time to surgery and length of hospital stay among patients with hip fracture. METHODS This is a nationwide, population-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry. We identified 25,354 patients ≥65 years admitted with a hip fracture between 2010 and 2013 at Danish hospitals. Individual-level socioeconomic status included highest obtained education, family mean income, cohabiting status and migrant status. We performed multilevel regression analysis, controlling for potential confounders. RESULTS Hip fracture patients with higher education had a lower 30-day mortality risk compared to patients with low education (7.3 vs 10.0% adjusted odds ratio (OR) = 0.74 (95% confidence interval (CI) (0.63-0.88)). The highest level of family income was also associated with lower 30-day mortality (11.9 vs 13.0% adjusted OR = 0.77, 95% CI 0.69-0.85). Cohabiting status and migrant status were not associated with 30-day mortality in the adjusted analysis. Furthermore, patients with both high education and high income had a lower risk of acute readmission (14.5 vs 16.9% adjusted OR = 0.94, 95% CI 0.91-0.97). Socioeconomic status was, however, not associated with quality of in-hospital care, time to surgery and length of hospital stay. CONCLUSIONS Higher education and higher family income were associated with substantially lower 30-day mortality and risk of readmission after hip fracture.
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Affiliation(s)
- P K Kristensen
- Department of Orthopedic Surgery, Horsens Hospital, Sundvej 30, 8700, Horsens, Denmark.
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - T M Thillemann
- Department of Orthopedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, 8200, Aarhus, Denmark
| | - A B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - K Søballe
- Department of Orthopedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, 8200, Aarhus, Denmark
| | - S P Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
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Huang YF, Liang J, Shyu YIL. Number of Comorbidities Negatively Influence Psychological Outcomes of the Elderly Following Hip Fracture in Taiwan. J Aging Health 2016; 28:1343-1361. [PMID: 26786859 DOI: 10.1177/0898264315618922] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Hip fracture usually affects psychological functions of the elderly, and comorbidities often interfere with their recovery. However, little is known about the influence of number of comorbidities on their psychological outcomes. METHOD Data from a previous study of 461 hip-fractured elders treated at a medical center in northern Taiwan were analyzed by the generalized estimating equation approach. Outcomes were assessed at 1, 3, 6, 12 months following discharge by the Geriatric Depression Scale (GDS), Mini-Mental State Examination, and two subscales of the Medical Outcomes Study Short Form 36: role limitations due to emotional problems, and Mental Health (MH). RESULTS Hip-fractured elders with more comorbidities were more likely to have cognitive impairment (β = 0.224, p = .004), higher GDS scores (β = 0.328, p = .001), and worse MH (β = -1.784, p = .009) during the first year following discharge. DISCUSSION Having more comorbidities negatively influenced the psychological outcomes of elderly patients with hip fracture.
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Affiliation(s)
- Yueh-Fang Huang
- 1 Chang Gung University of Science and Technology, Taoyuan, Taiwan
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Sarvi MN, Luo Y. A two-level subject-specific biomechanical model for improving prediction of hip fracture risk. Clin Biomech (Bristol, Avon) 2015; 30:881-7. [PMID: 26126498 DOI: 10.1016/j.clinbiomech.2015.05.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/23/2015] [Accepted: 05/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sideways fall-induced hip fracture is a major worldwide health problem among the elderly population. However, all existing biomechanical models for predicting hip fracture mainly consider the femur related parameters. Their accuracy is limited as hip fracture is significantly affected by loading conditions as well. The objective of this study was to develop a biomechanical model for improving assessment of hip fracture risk by subject-specific prediction of fall-induced loading conditions. METHOD All information required to construct the models was extracted from the subject's whole-body and hip medical image in order to make the models subject-specific. Fall-induced hip fracture risk for eighty clinical cases was calculated under two sets of loading conditions: subject-specific determined by the proposed model, and non-subject-specific obtained from empirical functions. The predicted hip fracture risk indices were then compared with clinical observations. FINDINGS It was found that the subject-specific prediction of fall-induced loading conditions significantly improves the hip fracture risk assessment. Consistent to the clinical observations, the fracture risk predicted by the proposed model suggested that obesity is a protective factor for hip fracture and underweight subjects are more likely to experience a hip fracture. INTERPRETATIONS This study shows that hip fracture risk is affected by a number of factors, including body weight, body height, impact force, body mass index, hip soft tissue thickness, and bone quality. The proposed model provides a comprehensive, fast, accurate, and non-expensive method for prediction of hip fracture risk which should lead to more effective prevention of hip fractures.
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Affiliation(s)
- Masoud Nasiri Sarvi
- Department of Mechanical Engineering, Faculty of Engineering, University of Manitoba, 75A Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada
| | - Yunhua Luo
- Department of Mechanical Engineering, Faculty of Engineering, University of Manitoba, 75A Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada.
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Probiotics (Bifidobacterium longum) Increase Bone Mass Density and Upregulate Sparc and Bmp-2 Genes in Rats with Bone Loss Resulting from Ovariectomy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:897639. [PMID: 26366421 PMCID: PMC4558422 DOI: 10.1155/2015/897639] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/10/2015] [Accepted: 07/14/2015] [Indexed: 12/11/2022]
Abstract
Probiotics are live microorganisms that exert beneficial effects on the host, when administered in adequate amounts. Mostly, probiotics affect the gastrointestinal (GI) tract of the host and alter the composition of gut microbiota. Nowadays, the incidence of hip fractures due to osteoporosis is increasing worldwide. Ovariectomized (OVX) rats have fragile bone due to estrogen deficiency and mimic the menopausal conditions in women. Therefore, this study aimed to examine the effects of Bifidobacterium longum (B. longum) on bone mass density (BMD), bone mineral content (BMC), bone remodeling, bone structure, and gene expression in OVX rats. The rats were randomly assigned into 3 groups (sham, OVX, and the OVX group supplemented with 1 mL of B. longum 108–109 colony forming units (CFU)/mL). B. longum was given once daily for 16 weeks, starting from 2 weeks after the surgery. The B. longum supplementation increased (p < 0.05) serum osteocalcin (OC) and osteoblasts, bone formation parameters, and decreased serum C-terminal telopeptide (CTX) and osteoclasts, bone resorption parameters. It also altered the microstructure of the femur. Consequently, it increased BMD by increasing (p < 0.05) the expression of Sparc and Bmp-2 genes. B. longum alleviated bone loss in OVX rats and enhanced BMD by decreasing bone resorption and increasing bone formation.
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Benetou V, Orfanos P, Feskanich D, Michaëlsson K, Pettersson-Kymmer U, Ahmed LA, Peasey A, Wolk A, Brenner H, Bobak M, Wilsgaard T, Schöttker B, Saum KU, Bellavia A, Grodstein F, Klinaki E, Valanou E, Papatesta EM, Boffetta P, Trichopoulou A. Education, marital status, and risk of hip fractures in older men and women: the CHANCES project. Osteoporos Int 2015; 26:1733-46. [PMID: 25820745 DOI: 10.1007/s00198-015-3054-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/28/2015] [Indexed: 01/12/2023]
Abstract
UNLABELLED The role of socioeconomic status in hip fracture incidence is unclear. In a diverse population of elderly, higher education was found to be associated with lower, whereas living alone, compared to being married/cohabiting, with higher hip fracture risk. Educational level and marital status may contribute to hip fracture risk. INTRODUCTION The evidence on the association between socioeconomic status and hip fracture incidence is limited and inconsistent. We investigated the potential association of education and marital status with hip fracture incidence in older individuals from Europe and USA. METHODS A total of 155,940 participants (79 % women) aged 60 years and older from seven cohorts were followed up accumulating 6456 incident hip fractures. Information on education and marital status was harmonized across cohorts. Hip fractures were ascertained through telephone interviews/questionnaires or through record linkage with registries. Associations were assessed through Cox proportional hazard regression adjusting for several factors. Summary estimates were derived using random effects models. RESULTS Individuals with higher education, compared to those with low education, had lower hip fracture risk [hazard ratio (HR) = 0.84, 95 % confidence interval (CI) 0.72-0.95]. Respective HRs were 0.97 (95 % CI 0.82-1.13) for men and 0.75 (95 % CI 0.65-0.85) for women. Overall, individuals living alone, especially those aged 60-69 years, compared to those being married/cohabiting, tended to have a higher hip fracture risk (HR = 1.12, 95 % CI 1.02-1.22). There was no suggestion for heterogeneity across cohorts (P heterogeneity > 0.05). CONCLUSIONS The combined data from >150,000 individuals 60 years and older suggest that higher education may contribute to lower hip fracture risk. Furthermore, this risk may be higher among individuals living alone, especially among the age group 60-69 years, when compared to those being married/cohabiting.
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Affiliation(s)
- V Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece.
- Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece.
| | - P Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece
- Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece
| | - D Feskanich
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - K Michaëlsson
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - U Pettersson-Kymmer
- Department of Pharmacology and Clinical Neurosciences and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - L A Ahmed
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - A Peasey
- Department of Epidemiology and Public Health, University College London, London, UK
| | - A Wolk
- Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - M Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
| | - T Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - B Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - K-U Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - A Bellavia
- Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - F Grodstein
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - E Klinaki
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece
| | - E Valanou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece
| | - E-M Papatesta
- Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece
| | - P Boffetta
- Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece
- Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - A Trichopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece
- Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece
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Reyes C, García-Gil M, Elorza JM, Fina-Avilés F, Mendez-Boo L, Hermosilla E, Coma E, Carbonell C, Medina-Peralta M, Ramos R, Bolibar B, Díez-Pérez A, Prieto-Alhambra D. Socioeconomic status and its association with the risk of developing hip fractures: a region-wide ecological study. Bone 2015; 73:127-31. [PMID: 25542156 DOI: 10.1016/j.bone.2014.12.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 12/15/2014] [Accepted: 12/18/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the association between socioeconomic deprivation (SES) and hip fracture risk. METHODS Retrospective cohort study using a population-based database (primary care records) of over 5 million people. Eligibility: all living subjects registered during the period 2009-2012 and resident in an urban area. MEASURES a validated SES composite index (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) estimated for each area based on census data. OUTCOME incident hip fracture rates as coded in medical records using ICD-10 codes. STATISTICS zero-inflated Poisson models fitted to study the association between SES quintiles and hip fracture risk, adjusted for age, sex, obesity, smoking and alcohol consumption. RESULTS Compared to the most deprived, wealthy areas had a higher hip fracture incidence (age- and sex-adjusted incidence 38.57 (37.14-40.00) compared to 34.33 (32.90-35.76) per 10,000 person-years). Similarly, most deprived areas had a crude and age- and sex-adjusted lower risk of hip fracture, RR of 0.71 (0.65-0.78) and RR of 0.90 (0.85-0.95), respectively, compared to wealthiest areas. The association was attenuated and no longer significant after adjustment for obesity: RR 0.96 (0.90-1.01). Further adjustment for smoking and high alcohol consumption did not make a difference. CONCLUSION Wealthiest areas have an almost 30% increased risk of hip fracture compared to the most deprived. Differences in age-sex composition and a higher prevalence of obesity in deprived areas could explain this higher risk.
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Affiliation(s)
- Carlen Reyes
- Primary Health Care Center Eap Sardenya, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya 466, Barcelona 08025, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Maria García-Gil
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Research Unit, Family Medicine, Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Maluquer Salvador 11, Girona 17002, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Emili Grahit 77, Girona 17003, Spain
| | - Josep Maria Elorza
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Francesc Fina-Avilés
- Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain
| | - Leonardo Mendez-Boo
- Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain
| | - Eduardo Hermosilla
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Ermengol Coma
- Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain
| | - Cristina Carbonell
- Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain
| | - Manuel Medina-Peralta
- Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain
| | - Rafel Ramos
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Research Unit, Family Medicine, Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Maluquer Salvador 11, Girona 17002, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Emili Grahit 77, Girona 17003, Spain; Primary Care Services, Girona, Catalan Institute of Health (ICS), Maluquer Salvador 11, Girona 17003, Spain
| | - Bonaventura Bolibar
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Adolfo Díez-Pérez
- Musculoskeletal Research Unit and RETICEF, IMIM Research Foundation, Parc de Salut Mar and Instituto de Salud Carlos III, Doctor Aiguader 88, Barcelona 08003, Spain
| | - Daniel Prieto-Alhambra
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Musculoskeletal Research Unit and RETICEF, IMIM Research Foundation, Parc de Salut Mar and Instituto de Salud Carlos III, Doctor Aiguader 88, Barcelona 08003, Spain; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, United Kingdom; Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7HE, United Kingdom
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Oliveira CM, Economou T, Bailey T, Mendonça D, Pina MF. The interactions between municipal socioeconomic status and age on hip fracture risk. Osteoporos Int 2015; 26:489-98. [PMID: 25344400 DOI: 10.1007/s00198-014-2869-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 08/20/2014] [Indexed: 11/28/2022]
Abstract
SUMMARY Age modifies the effect of area-level socioeconomic status (SES) in the risk of fragility hip fractures (HF). For older individuals, the risk of HF increases as SES increases. For younger individuals, risk of HF increases as SES decreases. Our study may help decision-makers to better direct the implementation of political decisions. INTRODUCTION The effect of socioeconomic status (SES) on hip fracture (HF) incidence remains unclear. The objective of this study is to evaluate the association between HF incidence and municipality-level SES as well as interactions between age and SES. METHODS From the Portuguese Hospital Discharge Database, we selected hospitalizations (2000-2010) of patients aged 50+, with HF diagnosis (codes 820.x, ICD9-CM), caused by traumas of low/moderate energy, excluding bone cancer cases and readmissions for aftercare. Municipalities were classified according to SES (deprived to affluent) using 2001 Census data. A spatial Bayesian hierarchical regression model (controlling for data heterogeneity and spatial autocorrelation), using the Poisson distribution, was used to quantify the relative risk (RR) of HF, 95% credible interval (95%CrI), and analyze the interaction between age and SES after adjusting for rural conditions. RESULTS There were 96,905 HF, 77.3% of which were on women who, on average, were older than men (mean age 81.2±8.5 vs 78.2±10.1 years) at admission (p<0.001). In women, there was a lower risk associated with better SES: RR=0.83 (95%CrI 0.65-1.00) for affluent versus deprived. There was an inverse association between SES and HF incidence rate in the youngest and a direct association in the oldest, for both sexes, but significant only between deprived and affluent in older ages (≥75 years). CONCLUSIONS Interaction between SES and age may be due to inequalities in lifestyles, access to health systems, and preventive actions. These results may help decision-makers to better understand the epidemiology of hip fractures and to better direct the available funding.
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Affiliation(s)
- C M Oliveira
- INEB, Instituto de Engenharia Biomédica, Rua do Campo Alegre, 823, 4150-180, Porto, Portugal,
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Brennan SL, Yan L, Lix LM, Morin SN, Majumdar SR, Leslie WD. Sex- and age-specific associations between income and incident major osteoporotic fractures in Canadian men and women: a population-based analysis. Osteoporos Int 2015; 26:59-65. [PMID: 25278299 DOI: 10.1007/s00198-014-2914-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED We investigated sex- and age-specific associations between income and fractures at the hip, humerus, spine, and forearm in adults aged ≥50 years. Compared to men with the highest income, men with the lowest income had an increased fracture risk at all skeletal sites. These associations were attenuated in women. INTRODUCTION Associations between income and hip fractures are contested, even less is known about other fracture sites. We investigated sex- and age-specific associations between income and major osteoporotic fractures (MOF) at the hip, humerus, spine, and forearm. METHODS Incident fractures were identified from administrative health data for adults aged ≥50 years in Manitoba, Canada, 2000-2007. Mean neighborhood (postal code area) annual household incomes were extracted from 2006 census files and categorized into quintiles. We calculated age-adjusted and age-specific sex-stratified fracture incidence across income quintiles. We estimated relative risks (RR) and 95% CI for income quintile 1 (Q1, lowest income) vs. income quintile 5 (Q5) and tested the linear trend across quintiles. RESULTS We identified 15,094 incident fractures (4736 hip, 3012 humerus, 1979 spine, and 5367 forearm) in 2718 men and 6786 women. For males, the RR of fracture for the lowest vs. highest income quintile was 1.63 (95% CI 1.42-1.87) and the negative trend was statistically significant (p < 0.0001); individual skeletal sites showed similar associations. For females, the RR of fracture for the lowest vs. highest income quintile was 1.14 (95% CI 1.01-1.28), with a statistically significant negative trend (p = 0.0291); however, the only skeletal site associated with income in women was the forearm (Q1 vs. Q5 RR 1.09, 95% CI 1.01-1.28). CONCLUSIONS Compared to men with the highest income, men with the lowest income had an increased fracture risk at all skeletal sites. These associations were attenuated in women. For men, these effect sizes seem large enough to warrant public health concern.
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Affiliation(s)
- S L Brennan
- School of Medicine, Deakin University, Geelong, Australia
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Araujo AB, Yang M, Suarez EA, Dagincourt N, Abraham JR, Chiu G, Holick MF, Bouxsein ML, Zmuda JM. Racial/ethnic and socioeconomic differences in bone loss among men. J Bone Miner Res 2014; 29:2552-60. [PMID: 24984683 DOI: 10.1002/jbmr.2305] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 05/22/2014] [Accepted: 05/29/2014] [Indexed: 11/10/2022]
Abstract
As men age, they lose bone and are susceptible to fracture. Despite having lower fracture rates than women, men have worse fractures than women do. Racial/ethnic and socioeconomic status (SES) disparities in fracture rates exist, yet data on rates of bone loss by race/ethnicity and SES among men are limited. We examined annualized percentage change in bone mineral density (%ΔBMD) at the hip (N = 681), spine (N = 663), and forearm (N = 636) during 7 years of follow-up among men aged 30-79 years at baseline. Multivariable models tested whether race/ethnicity, income, or genetic ancestry predicted annualized %ΔBMD after controlling for an extensive set of covariates. Annualized %ΔBMD ranged from -0.65(0.04)% (femoral neck) to +0.26(0.03)% (1/3 distal radius), and changes were consistent across age groups with the exception of the ultradistal radius, where annualized declines increased with age. Neither self-identified race/ethnicity nor genetic ancestry were associated with annualized %ΔBMD. In contrast, income was strongly associated (dose-response) with annualized %ΔBMD at total hip (independent of confounders, self-identified race/ethnicity, and genetic ancestry). Fully adjusted least-square mean change in annualized %ΔBMD at the total hip were -0.24(0.12)% and -0.16(0.06)% steeper among men with low and moderate incomes, respectively, than among men with higher incomes (overall p = 0.0293). Results show a linear decline in bone that begins relatively early in life among men, that rates of bone loss do not vary with race/ethnicity (self-identified or "objectively" measured), and that income plays an important role in relation to bone loss at the hip. These data suggest that fracture risk in men may be driven in part by income-related differences in bone loss, but also, that the known higher fracture risk among white men is not the result of racial/ethnic differences in bone loss, but rather, early life exposures that lead to attainment of higher peak bone mass among minorities.
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Affiliation(s)
- Andre B Araujo
- Department of Epidemiology, New England Research Institutes, Inc., Watertown, MA, USA; Eli Lilly and Company, Indianapolis, IN, USA
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Liu Y, Chan JSY, Yan JH. Neuropsychological mechanisms of falls in older adults. Front Aging Neurosci 2014; 6:64. [PMID: 24782761 PMCID: PMC3988382 DOI: 10.3389/fnagi.2014.00064] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 03/23/2014] [Indexed: 11/13/2022] Open
Abstract
Falls, a common cause of injury among older adults, have become increasingly prevalent. As the world's population ages, the increase in-and the prevalence of-falls among older people makes this a serious and compelling societal and healthcare issue. Physical weakness is a critical predictor in falling. While considerable research has examined this relationship, comprehensive reviews of neuropsychological predictors of falls have been lacking. In this paper, we examine and discuss current studies of the neuropsychological predictors of falls in older adults, as related to sporting and non-sporting contexts. By integrating the existing evidence, we propose that brain aging is an important precursor of the increased risk of falls in older adults. Brain aging disrupts the neural integrity of motor outputs and reduces neuropsychological abilities. Older adults may shift from unconscious movement control to more conscious or attentive motor control. Increased understanding of the causes of falls will afford opportunities to reduce their incidence, reduce consequent injuries, improve overall well-being and quality of life, and possibly to prolong life.
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Affiliation(s)
- Yu Liu
- Department of Psychology, Peking University Beijing, China
| | - John S Y Chan
- Department of Psychology, The Chinese University of Hong Kong Hong Kong SAR, China
| | - Jin H Yan
- Institute of Affective and Social Neuroscience, Shenzhen University Nanshan District, Shenzhen, Guangdong, China ; Department of Psychology, Tsinghua University Beijing, China
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Crandall CJ, Han W, Greendale GA, Seeman T, Tepper P, Thurston R, Karvonen-Gutierrez C, Karlamangla AS. Socioeconomic status in relation to incident fracture risk in the Study of Women's Health Across the Nation. Osteoporos Int 2014; 25:1379-88. [PMID: 24504101 PMCID: PMC4004589 DOI: 10.1007/s00198-013-2616-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 11/20/2013] [Indexed: 10/25/2022]
Abstract
UNLABELLED We examined baseline and annual follow-up data (through annual follow-up visit 9) from a cohort of 2,234 women aged 42 to 52 years at baseline. Independent of financial status, higher educational level was associated with lower fracture incidence among non-Caucasian women but not among Caucasian women. INTRODUCTION This study was conducted to determine the associations of education and income with fracture incidence among midlife women over 9 years of follow-up. METHODS We examined baseline and annual follow-up data (through annual follow-up visit 9) from 2,234 participants of the Study of Women's Health Across the Nation, a cohort of women aged 42 to 52 years at baseline. We used Cox proportional hazards regression models to examine the associations of socioeconomic predictors (education, family-adjusted poverty-to-income ratio, and difficulty paying for basics) with time to first incident nontraumatic, nondigital, noncraniofacial fracture. RESULTS Independent of family-adjusted poverty-to-income ratio, higher educational level was associated with decreased time to first incident fracture among non-Caucasian women but not among Caucasian women (p(interaction) 0.02). Compared with non-Caucasian women who completed no more than high school education, non-Caucasian women who attained at least some postgraduate education had 87% lower rates of incident nontraumatic fracture (adjusted hazard ratio 0.13, 95% confidence interval [CI] 0.03-0.60). Among non-Caucasian women, each additional year of education was associated with a 16% lower odds of nontraumatic fracture (adjusted odds ratio 0.84, 95% CI 0.73-0.97). Income, family-adjusted poverty-to-income ratio, and degree of difficulty paying for basic needs were not associated with time to first fracture in Caucasian or non-Caucasian women. CONCLUSIONS Among non-Caucasian midlife women, higher education, but not higher income, was associated with lower fracture incidence. Elucidation of the mechanisms underlying the possible protective effects of higher educational level on nontraumatic fracture incidence may allow us to better target individuals at risk of future fracture.
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Affiliation(s)
- C. J. Crandall
- Division of General Internal Medicine, David Geffen School of Medicine at University of California, 911 Broxton Ave., 1st floor, Los Angeles, CA 90024, USA
| | - W. Han
- Division of Geriatrics, David Geffen School of Medicine at University of California, Los Angeles, USA,
| | - G. A. Greendale
- Division of Geriatrics, David Geffen School of Medicine at University of California, Los Angeles, USA,
| | - T. Seeman
- Division of Geriatrics, David Geffen School of Medicine at University of California, Los Angeles, USA,
| | - P. Tepper
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - R. Thurston
- University of Pittsburgh School of Medicine & Graduate School of Public Health, Pittsburgh, PA 15213, USA
| | | | - A. S. Karlamangla
- Division of Geriatrics, David Geffen School of Medicine at University of California, Los Angeles, USA,
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Garin N, Olaya B, Miret M, Ayuso-Mateos JL, Power M, Bucciarelli P, Haro JM. Built environment and elderly population health: a comprehensive literature review. Clin Pract Epidemiol Ment Health 2014; 10:103-15. [PMID: 25356084 PMCID: PMC4211137 DOI: 10.2174/1745017901410010103] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 07/17/2014] [Accepted: 08/02/2014] [Indexed: 04/15/2023]
Abstract
Global population aging over recent years has been linked to poorer health outcomes and higher healthcare expenditure. Policies focusing on healthy aging are currently being developed but a complete understanding of health determinants is needed to guide these efforts. The built environment and other external factors have been added to the International Classification of Functioning as important determinants of health and disability. Although the relationship between the built environment and health has been widely examined in working age adults, research focusing on elderly people is relatively recent. In this review, we provide a comprehensive synthesis of the evidence on the built environment and health in the elderly.
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Affiliation(s)
- Noe Garin
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona. Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Bar-celona, Spain
- Fundació Sant Joan de Déu. Santa Rosa, 39-57, 08950. Esplugues de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM. Monforte de Lemos 3-5. Pabellón 11. 28029 Madrid, Spain
| | - Beatriz Olaya
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona. Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Bar-celona, Spain
- Fundació Sant Joan de Déu. Santa Rosa, 39-57, 08950. Esplugues de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM. Monforte de Lemos 3-5. Pabellón 11. 28029 Madrid, Spain
| | - Marta Miret
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM. Monforte de Lemos 3-5. Pabellón 11. 28029 Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid. Arzobispo Morcillo s/n 28029 Madrid, Spain
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP). Diego de León, 62, 28006. Madrid, Spain
| | - Jose Luis Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM. Monforte de Lemos 3-5. Pabellón 11. 28029 Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid. Arzobispo Morcillo s/n 28029 Madrid, Spain
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP). Diego de León, 62, 28006. Madrid, Spain
| | - Michael Power
- Instituto de Salud Carlos III; Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Paola Bucciarelli
- Scientific Directorate, Neurological Institute Carlo Besta, Milan, Via Celoria 11, Italy
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona. Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Bar-celona, Spain
- Fundació Sant Joan de Déu. Santa Rosa, 39-57, 08950. Esplugues de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM. Monforte de Lemos 3-5. Pabellón 11. 28029 Madrid, Spain
- Address correspondence to this author at the Parc Sanitari Sant Joan de Déu, Universitat de Barcelona. Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain; Tel: +34 936406350; Fax: +34 935569674;
E-mail:
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Brennan SL, Leslie WD, Lix LM. Is lower income associated with an increased likelihood of qualification for treatment for osteoporosis in Canadian women? Osteoporos Int 2014; 25:273-9. [PMID: 23907573 DOI: 10.1007/s00198-013-2467-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED We examined whether low income was associated with an increased likelihood of treatment qualification for osteoporotic fracture probability determined by Canada FRAX in women aged ≥50 years. A significant negative linear association was observed between income and treatment qualification when FRAX included bone mineral density (BMD), which may have implications for clinical practice. INTRODUCTION Lower income has been associated with increased fracture risk. We examined whether lower income in women was associated with an increased likelihood of treatment qualification determined by Canada FRAX®. METHODS We calculated 10-year FRAX probabilities in 51,327 Canadian women aged ≥50 years undergoing baseline BMD measured by dual energy x-ray absorptiometry 1996-2001. FRAX probabilities for hip fracture ≥3% or major osteoporotic fracture (MOF) ≥20 % were used to define treatment qualification. Mean household income from Canada Census 2006 public use files was used to categorize the population into quintiles. Logistic regression analyses were used to model the association between income and treatment qualification. RESULTS Percentages of women who qualified for treatment based upon high hip fracture probability increased linearly with declining income quintile (all p trend <0.001), but this was partially explained by older age among lower income quintiles (p trend <0.001). Compared to the highest income quintile, women in the lowest income quintile had a greater likelihood of treatment qualification based upon high hip fracture probability determined with BMD (age-adjusted odds ratio [OR], 1.34; 95% confidence intervals (CI), 1.23-1.47) or high MOF fracture probability determined with BMD (age-adjusted OR, 1.31; 95% CI, 1.18-1.46). Differences were nonsignificant when FRAX was determined without BMD, implying that BMD differences may be the primary explanatory factor. CONCLUSIONS FRAX determined with BMD identifies a larger proportion of lower income women as qualifying for treatment than higher income women.
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Affiliation(s)
- S L Brennan
- NorthWest Academic Centre, The University of Melbourne, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, VIC, Australia, 3021,
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Karlamangla AS, Mori T, Merkin SS, Seeman TE, Greendale GA, Binkley N, Crandall CJ. Childhood socioeconomic status and adult femoral neck bone strength: findings from the Midlife in the United States Study. Bone 2013; 56:320-6. [PMID: 23810840 PMCID: PMC3784306 DOI: 10.1016/j.bone.2013.06.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 05/16/2013] [Accepted: 06/18/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE Bone acquisition in childhood impacts adult bone mass, and can be influenced by childhood socioeconomic conditions. Socioeconomic status is also associated with body weight which affects the load that bone is exposed to in a fall. We hypothesized that socioeconomic advantage in childhood is associated with greater bone strength relative to load in adulthood. METHODS Hip dual x-ray absorptiometry scans from 722 participants in the Midlife in the United States Study were used to measure femoral neck size and bone mineral density, and combined with body weight and height to create composite indices of femoral neck strength relative to load in different failure modes: compression, bending, and impact. A childhood socioeconomic advantage score was created for the same participants from parental education, self-rated financial status relative to others, and not being on welfare. Multiple linear regression was used to determine the association of childhood socioeconomic advantage with femoral neck composite strength indices, stratified by gender and race (white/non-white), and adjusted for study site, age, menopause status in women, education, and current financial advantage. RESULTS Childhood socioeconomic advantage was independently associated with higher indices of all three composite strength indices in white men (adjusted standardized effect sizes, 0.19 to 0.27, all p values<0.01), but not in the other three race/gender groups. Additional adjustment for adult obesity, physical activity in different life stages, smoking, and heavy drinking over the life-course significantly attenuated the associations in white men. CONCLUSIONS Socioeconomic disadvantage in childhood is associated with lower hip strength relative to load in white men, and these influences are dampened by healthy lifestyle choices.
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Affiliation(s)
- Arun S Karlamangla
- Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave., Suite 2339, Los Angeles, CA 90095, USA.
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Lai JKC, Lucas RM, Armstrong M, Banks E. Prospective observational study of physical functioning, physical activity, and time outdoors and the risk of hip fracture: a population-based cohort study of 158,057 older adults in the 45 and up study. J Bone Miner Res 2013; 28:2222-31. [PMID: 23609238 DOI: 10.1002/jbmr.1963] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 03/19/2013] [Accepted: 03/26/2013] [Indexed: 02/06/2023]
Abstract
Low levels of physical activity or sun exposure and limitations to physical functioning (or disability) have been identified as possible risk factors for hip fracture. However, these factors are closely related, and data on their independent and joint association with risk of hip fracture are limited. A total of 158,057 individuals aged ≥45 years sampled from the general population of New South Wales, Australia, from the prospective 45 and Up Study completed a baseline postal questionnaire in 2006 to 2009 including data on physical activity (Active Australia questionnaire); sun exposure (usual time outdoors); and physical functioning (Medical Outcomes Score-Physical Functioning; scored 0 to 100). Incident first hip fractures were ascertained by linkage to administrative hospital data (n = 293; average follow-up 2.3 years). The relative risk (RR) of hip fracture was estimated using Cox proportional hazards. Poorer physical functioning, lower physical activity, and less time outdoors were positively related to each other at baseline and individually associated with significantly increased hip fracture risk. However, physical activity and time outdoors were not significantly related to hip fracture risk after adjustment for baseline physical functioning or when analysis was restricted to those with no or mild baseline physical limitation. In contrast, physical functioning remained strongly related to hip fracture risk after adjustment for the other two factors; compared with the group without limitation (100), the RR of hip fracture among those with mild (75-95), moderate (50-70), severe (25-45), and greatest (0-20) level of physical limitation was 1.38 (95% confidence interval [CI] 0.88-2.14), 2.14 (1.29-3.53), 3.87 (2.31-6.44), and 5.61 (3.33-9.42), respectively. The findings suggest that limitation in physical functioning, but not physical activity or time outdoors, is strongly related to hip fracture risk. The apparent increased risk of hip fracture previously described for low physical activity or sun exposure may be, at least in part due to uncontrolled confounding.
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Affiliation(s)
- Jeffrey K C Lai
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
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Kubo JT, Stefanick ML, Robbins J, Wactawski-Wende J, Cullen MR, Freiberg M, Desai M. Preference for wine is associated with lower hip fracture incidence in post-menopausal women. BMC Womens Health 2013; 13:36. [PMID: 24053784 PMCID: PMC3848688 DOI: 10.1186/1472-6874-13-36] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 09/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Past studies of relationships between alcohol and hip fracture have generally focused on total alcohol consumed and not type of alcohol. Different types of alcohol consist of varying components which may affect risk of hip fracture differentially. This study seeks to examine the relationship between alcohol consumption, with a focus on type of alcohol consumed (e.g. beer, wine, or hard liquor) and hip fracture risk in post-menopausal women. METHODS The longitudinal cohort consisted of U.S. post-menopausal women aged 50-79 years enrolled between 1993-1998 in the Women's Health Initiative Clinical Trials and Observational Study (N=115,655). RESULTS Women were categorized as non-drinkers, past drinkers, infrequent drinkers and drinkers by preference of alcohol type (i.e. those who preferred wine, beer, hard liquor, or who had no strong preference). Mean alcohol consumption among current drinkers was 3.3 servings per week; this was similar among those who preferred wine, beer and liquor. After adjustment for potential confounders, alcohol preference was strongly correlated with hip fracture risk (p = 0.0167); in particular, women who preferred wine were at lower risk than non-drinkers (OR=0.78; 95% CI 0.64-0.95), past drinkers (OR=0.85; 95% CI 0.72-1.00), infrequent drinkers (OR=0.73; 95% CI 0.61-0.88), hard liquor drinkers (OR=0.87; 95% CI 0.71-1.06), beer drinkers (OR=0.72; 95% CI 0.55-0.95) and those with no strong preference (OR=0.89; 95% CI 0.89; 95% CI 0.73-1.10). CONCLUSIONS Preference of alcohol type was associated with hip fracture; women who preferentially consumed wine had a lower risk of hip fracture compared to non-drinkers, past drinkers, and those with other alcohol preferences.
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Affiliation(s)
- Jessica T Kubo
- Quantitative Sciences Unit, Stanford University School of Medicine, 1070 Arastradero Road, Palo Alto, Stanford, CA 94304, USA
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - John Robbins
- Department of Internal Medicine, University of California-Davis, Davis, CA, USA
| | - Jean Wactawski-Wende
- Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Mark R Cullen
- Department of Medicine, Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew Freiberg
- Division of General Internal Medicine and Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University School of Medicine, 1070 Arastradero Road, Palo Alto, Stanford, CA 94304, USA
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Brennan SL, Leslie WD, Lix LM. Associations between adverse social position and bone mineral density in women aged 50 years or older: data from the Manitoba Bone Density Program. Osteoporos Int 2013; 24:2405-12. [PMID: 23430105 DOI: 10.1007/s00198-013-2311-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
Abstract
UNLABELLED We examined the independent contribution of income to low bone mineral density in women aged 50 years and older. A significant dose-response association was observed between low income and low (bone mineral density) BMD, which was not explained by clinical risk factors or osteoporotic treatment in the year prior. INTRODUCTION The association between social disadvantage and osteoporosis is attracting increased attention; however, little is known of the role played by income. We examined associations between income and bone mineral density (BMD) in 51,327 women aged ≥50 years from Manitoba, Canada. METHODS Low BMD was defined as a T-score ≥2.5SD (femoral neck or minimum) measured by dual energy X-ray absorptiometry (DXA) 1996-2001. Mean household income was extracted from Canada Census 2006 public use files and categorized into quintiles. Age, weight and height were recorded at time of DXA. Parental hip fracture was self-reported. Diagnosed comorbidities, including osteoporotic fracture and rheumatoid arthritis, were ascertained from hospital records and physician billing claims. Chronic obstructive pulmonary disease was used as a proxy for smoking and alcohol abuse as a proxy for high alcohol intake. Corticosteroid use was obtained from the comprehensive provincial pharmacy system. Logistic regression was used to assess relationships between income (highest income quintile held as referent) and BMD, accounting for clinical risk factors. RESULTS Compared to quintile 5, the adjusted odds ratio (OR) for low BMD at femoral neck for quintiles 1 through 4 were, respectively, OR1.41 (95%CI 1.29-1.55), OR1.32 (95%CI 1.20-1.45), OR1.19 (95%CI 1.08-1.30) and OR1.10 (95%CI 1.00-1.21). Similar associations were observed when further adjustment was made for osteoporotic drug treatment 12 months prior and when low BMD was defined by minimum T-score. CONCLUSIONS Lower income was associated with lower BMD, independent of clinical risk factors. Further work should examine whether lower income increases the likelihood of treatment qualification.
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Affiliation(s)
- S L Brennan
- NorthWest Academic Centre, The University of Melbourne, Sunshine Hospital, 176 Furlong Road, St Albans, Victoria, 3021, Australia.
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Richardson KK, Cram P, Vaughan-Sarrazin M, Kaboli PJ. Fee-based care is important for access to prompt treatment of hip fractures among veterans. Clin Orthop Relat Res 2013; 471:1047-53. [PMID: 23322188 PMCID: PMC3563825 DOI: 10.1007/s11999-013-2783-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 01/02/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip fracture is a medical emergency for which delayed treatment increases risk of disability and death. In emergencies, veterans without access to a Veterans Administration (VA) hospital may be admitted to non-VA hospitals under fee-based (NVA-FB) care paid by the VA. The affect of NVA-FB care for treatment and outcomes of hip fractures is unknown. QUESTIONS/PURPOSES This research seeks to answer three questions: (1) What patient characteristics determine use of VA versus NVA-FB hospitals for hip fracture? (2) Does time between admission and surgery differ by hospital (VA versus NVA-FB)? (3) Does mortality differ by hospital? METHODS Veterans admitted for hip fractures to VA (n = 9308) and NVA-FB (n = 1881) hospitals from 2003 to 2008 were identified. Primary outcomes were time to surgery and death. Logistic regression identified patient characteristics associated with NVA-FB hospital admissions; differences in time to surgery and death were evaluated using Cox proportional hazards regression, controlling for patient covariates. RESULTS Patients admitted to NVA-FB hospitals were more likely to be younger, have service-connected disabilities, and live more than 50 miles from a VA hospital. Median days to surgery were less for NVA-FB admissions compared with VA admissions (1 versus 3 days, respectively). NVA-FB admissions were associated with 21% lower relative risk of death within 1 year compared with VA hospital admissions. CONCLUSIONS For veterans with hip fractures, NVA-FB hospital admission was associated with shorter time to surgery and lower 1-year mortality. These findings suggest fee-based care, especially for veterans living greater distances from VA hospitals, may improve access to care and health outcomes. LEVEL OF EVIDENCE Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kelly K. Richardson
- Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246 USA ,Veterans Rural Health Resource Center - Central Region, Iowa City VA Healthcare System, Iowa City, IA USA
| | - Peter Cram
- Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246 USA ,Veterans Rural Health Resource Center - Central Region, Iowa City VA Healthcare System, Iowa City, IA USA ,University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Mary Vaughan-Sarrazin
- Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246 USA ,Veterans Rural Health Resource Center - Central Region, Iowa City VA Healthcare System, Iowa City, IA USA ,University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Peter J. Kaboli
- Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246 USA ,Veterans Rural Health Resource Center - Central Region, Iowa City VA Healthcare System, Iowa City, IA USA ,University of Iowa Carver College of Medicine, Iowa City, IA USA
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Sanfélix-Gimeno G, Sanfelix-Genovés J, Hurtado I, Reig-Molla B, Peiró S. Vertebral fracture risk factors in postmenopausal women over 50 in Valencia, Spain. A population-based cross-sectional study. Bone 2013; 52:393-9. [PMID: 23103928 DOI: 10.1016/j.bone.2012.10.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 10/22/2012] [Accepted: 10/22/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aims to estimate the prevalence of risk factors for osteoporotic vertebral fracture and analyze the possible associations between these factors and the presence of densitometric osteoporosis and prevalent morphometric vertebral fracture. METHODS Data from a population-based cross-sectional sample of 804 postmenopausal women over the age of 50 years old living in the city of Valencia (Spain) were used. The women were interviewed to identify the prevalence of osteoporotic fracture risk factors and underwent a densitometry and a dorsolumbar spine X-ray. RESULTS The most prevalent risk factors were densitometric osteoporosis (31.7%), history of parental hip fracture (19.4%), hypoestrogenism (19%), and body mass index (BMI) ≥ 30 kg/m(2) (35.2%). After adjusting for all covariables, densitometric osteoporosis was associated with increased age [odds ratio (OR)(65-69 years): 2.84, 95% confidence interval (CI): 1.75-4.61; OR(70-74 years): 4.01, 95% CI: 2.47-6.52; OR(75+years): 5.96, 95% CI: 3.27-10.87] and inversely associated with high BMI (OR(25.0-29.9): 0.51, 95% CI: 0.34-0.76; OR(≥ 30): 0.30, 95% CI: 0.19-0.46). Morphometric vertebral fracture was associated with age (OR(65-69 years): 2.04, 95% CI: 1.03-4.05; OR(70-74 years): 4.05, 95% CI: 2.11-7.77; OR(75+years): 8.43, 95% CI: 3.97-17.93), poor educational level (OR: 1.70, 95% CI: 1.06-2.72) and with densitometric osteoporosis and BMI ≥ 30 kg/m(2) (OR: 3.35, 95% CI: 1.85-6.07). CONCLUSIONS The most prevalent osteoporotic fracture risk factors were having a high BMI and the presence of densitometric osteoporosis. A higher risk of morphometric vertebral fracture in women with both low bone mineral density and high BMI was found. This association, if confirmed, has important implications for clinical practice and fracture risk tools. We also found a higher risk in women with a poor educational level. More attention should be addressed to these populations in order to control modifiable risk factors.
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Affiliation(s)
- Gabriel Sanfélix-Gimeno
- Centro Superior de Investigación en Salud Pública (CSISP), Avda. Cataluña 21, 46020 Valencia, Spain.
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Huang YF, Shyu YIL, Liang J, Chen MC, Cheng HS, Wu CC. Diabetes and Health Outcomes Among Older Taiwanese with Hip Fracture. Rejuvenation Res 2012; 15:476-82. [DOI: 10.1089/rej.2011.1308] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yueh-Fang Huang
- School of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Graduate Institute of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Yea-Ing L. Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Institute of Gerontology, University of Michigan, Ann Arbor, Michigan
| | - Min-Chi Chen
- Department of Public Health & Biostatistics Consulting Center, Chang Gung University, Taoyuan, Taiwan
| | - Huey-Shinn Cheng
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Chuan Wu
- Traumatological Division, Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Hill KD, Wee R. Psychotropic drug-induced falls in older people: a review of interventions aimed at reducing the problem. Drugs Aging 2012; 29:15-30. [PMID: 22191720 DOI: 10.2165/11598420-000000000-00000] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Falls are a common health problem for older people, and psychotropic medications have been identified as an important independent fall risk factor. The objective of this paper was to review the literature relating to the effect of psychotropic medications on falls in older people, with a particular focus on evidence supporting minimization of their use to reduce risk of falls. A literature search identified 18 randomized trials meeting the inclusion criteria for the review of effectiveness of psychotropic medication withdrawal studies, including four with falls outcomes. One of these, which targeted reduced psychotropic medication use in the community, reported a 66% reduction in falls, while the other studies demonstrated some success in reducing psychotropic medication use but with mixed effects on falls. Other randomized trials evaluated various approaches to reducing psychotropic medications generally or specific classes of psychotropic medications (e.g. benzodiazepines), but did not report fall-related outcomes. Overall, these studies reported moderate success in reducing psychotropic medication use, and a number reported no or limited worsening of key outcomes such as sleep quality or behavioural difficulties associated with withdrawal of psychotropic medication use. Reduced prescription of psychotropic medications (e.g. seeking non-pharmacological alternatives to their use in place of prescription in the first place or, for those patients for whom these medications are deemed necessary, regular monitoring and efforts to cease use or wean off use over time) needs to be a strong focus in clinical practice for three reasons. Firstly, psychotropic medications are commonly prescribed for older people, both in the community and especially in the residential care setting, and their effectiveness in a number of clinical groups has been questioned. Secondly, there is strong evidence of an association between substantially increased risk of falls and use of a number of psychotropic medications, including benzodiazepines (particularly, the long-acting agents), antidepressants and antipsychotic drugs. Finally, the largest effect of any randomized trial of falls prevention to date was achieved with a single intervention consisting of weaning psychotropic drug users off their medications.
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Affiliation(s)
- Keith D Hill
- Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora, VIC, Australia.
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Myong JP, Kim HR, Choi SE, Koo JW. The effect of socioeconomic position on bone health among Koreans by gender and menopausal status. Calcif Tissue Int 2012; 90:488-95. [PMID: 22527203 DOI: 10.1007/s00223-012-9597-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 03/25/2012] [Indexed: 11/25/2022]
Abstract
While studies suggest that socioeconomic position (SEP) influences bone health and risk of osteoporotic fracture in postmenopausal women, few studies have simultaneously examined gender and menopause differences as they relate to SEP and bone health. Here, we investigated the relationship between SEP and bone mineral density (BMD) among Korean men, premenopausal women, and postmenopausal women using the BMD data set (n = 9,995) of the Korean National Health and Nutrition Examination Survey IV. The relationship between SEP and BMD was estimated using analysis of covariance (ANCOVA); adjustments were made for age and body mass index (BMI) in the multivariate models. The relationship between SEP and osteoporosis prevalence was estimated using logistic regression. Relative index of inequality (RII) in osteoporosis was estimated using log-binomial regression. ANCOVA (adjusted for age and for age plus BMI) showed a significant positive association between SEP and BMD among men and postmenopausal women. Logistic regression showed a significant negative association between SEP and osteoporosis prevalence among men and postmenopausal women but not in premenopausal women. The RII, estimated by log-binomial regression, showed the impact of SEP on osteoporosis to be significant in men and postmenopausal women (p < 0.05) but not in premenopausal women. Overall, low SEP was associated with both low BMD and high risk of osteoporosis among men and postmenopausal women. Efforts to reduce the economic burden of morbidity and mortality from osteoporosis should target men and postmenopausal women with low SEP.
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Affiliation(s)
- Jun-Pyo Myong
- Department of Preventive Medicine and Catholic Industrial Medical Center, College of Medicine, The Catholic University of Korea, 505 BanPo-dong Seocho-gu, Seoul, 137-701, Republic of Korea
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Syddall HE, Evandrou M, Dennison EM, Cooper C, Sayer AA. Social inequalities in osteoporosis and fracture among community-dwelling older men and women: findings from the Hertfordshire Cohort Study. Arch Osteoporos 2012; 7:37-48. [PMID: 23225280 PMCID: PMC3636494 DOI: 10.1007/s11657-012-0069-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 01/25/2012] [Indexed: 02/03/2023]
Abstract
UNLABELLED It is unknown whether osteoporosis is socially patterned. Using data from the Hertfordshire Cohort Study we found no consistent evidence for social inequalities in prevalent or incident fracture, bone mineral density or loss rates, or bone strength. Public health strategies for prevention of osteoporosis should focus on the whole population. INTRODUCTION Osteoporosis and osteoporotic fracture are major public health issues for society; the burden for the affected individual is also high. It is unclear whether osteoporosis and osteoporotic fracture are socially patterned. OBJECTIVE This study aims to analyse social inequalities in osteoporosis and osteoporotic fracture among the 3,225 community-dwelling men and women, aged 59-73 years, who participated in the Hertfordshire Cohort Study (HCS), UK. METHODS A panel of markers of bone health (fracture since 45 years of age; DXA bone mineral density and loss rate at the total femur; pQCT strength strain indices for the radius and tibia; and incident fracture) were analysed in relation to the social circumstances of the HCS participants (characterised at the individual level by: age left full time education; current social class; housing tenure and car availability). RESULTS We found little strong or consistent evidence among men, or women, for social inequalities in prevalent or incident fracture, DXA bone mineral density, bone loss rates, or pQCT bone strength, with or without adjustment for age, anthropometry, lifestyle and clinical characteristics. Reduced car availability at baseline was associated with lower pQCT radius and tibia strength strain indices at follow-up among men only (p = 0.02 radius and p < 0.01 tibia unadjusted; p = 0.05 radius and p = 0.01 tibia, adjusted for age, anthropometry, lifestyle and clinical characteristics). CONCLUSIONS Our results suggest that fracture and osteoporosis do not have a strong direct social gradient and that public health strategies for prevention and treatment of osteoporosis should continue to focus on the whole population.
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Affiliation(s)
- Holly E Syddall
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK.
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Ma CC, Burchfiel CM, Grove J, Fekedulegn D, Lu Y, Andrew ME, Willcox B, Masaki KH, Curb JD, Rodriguez BL. Risk factors for fractures among Japanese-American men: The Honolulu Heart Program and Honolulu-Asia Aging Study. Arch Osteoporos 2011; 6:197-207. [PMID: 22886106 PMCID: PMC3565433 DOI: 10.1007/s11657-011-0068-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 09/26/2011] [Indexed: 02/03/2023]
Abstract
UNLABELLED Baseline risk factors were associated with fractures that developed after 29-31 years among Japanese-American men. Hip fracture risk increased with increasing BMI (28% increase for 1 U increase), physical activity (7% increase for 1 U increase), and was decreased with increasing arm girth (27% decrease for 1 U increase). PURPOSE The objective of this study was to identify risk factors among Japanese-American men aged 45-68 years at baseline that were associated with prevalence and incidence of fractures at advanced age. METHODS We used baseline information from Honolulu Heart Program (HHP) and Honolulu-Asia Aging Study (HAAS). The HHP was a prospective study with primary focus on risk factors for cardiovascular disease. A cohort of 8,006 men of Japanese ancestry aged 45-68 years residing on Oahu was recruited in 1965 and followed for 31 years. The HAAS started in 1991 in conjunction with the HHP with a focus on age-related health conditions. Self-reported hip, spine, and forearm fracture prevalence was ascertained in 1991-1993 among 3,845 men aged 71-93 years. Incidence was obtained during the period (1994-1999) among 2,737 men aged 74-98 years. Poisson regression models were used to determine multi-variable adjusted prevalence and incidence ratios for fracture. RESULTS Incident hip fracture was directly associated with baseline body mass index (BMI) and physical activity, and inversely associated with left upper arm girth. Incident spine fracture was directly associated with baseline age. Prevalent hip fracture was directly associated with baseline pack-years of smoking. Prevalent spine fracture was inversely associated with baseline education, and directly associated with standing height and use of medication for diabetes. Prevalent forearm fracture was inversely associated with baseline age, and directly associated with education. CONCLUSIONS Results indicated that multiple baseline demographic lifestyle and anthropometric characteristics predict fracture risk at advanced age. In addition, associations varied by fracture location.
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Affiliation(s)
- Claudia C Ma
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26505-2888, USA.
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Wilson RT, Roff AN, Dai PJ, Fortugno T, Douds J, Chen G, Grove GL, Nikiforova SO, Barnholtz-Sloan J, Frudakis T, Chinchilli VM, Hartman TJ, Demers LM, Shriver MD, Canfield VA, Cheng KC. Genetic Ancestry, Skin Reflectance and Pigmentation Genotypes in Association with Serum Vitamin D Metabolite Balance. Horm Mol Biol Clin Investig 2011; 7:279-293. [PMID: 23525585 DOI: 10.1515/hmbci.2011.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Lower serum vitamin D (25(OH)D) among individuals with African ancestry is attributed primarily to skin pigmentation. However, the influence of genetic polymorphisms controlling for skin melanin content has not been investigated. Therefore, we investigated differences in non-summer serum vitamin D metabolites according to self-reported race, genetic ancestry, skin reflectance and key pigmentation genes (SLC45A2 and SLC24A5). MATERIALS AND METHODS Healthy individuals reporting at least half African American or half European American heritage were frequency matched to one another on age (+/- 2 years) and sex. 176 autosomal ancestry informative markers were used to estimate genetic ancestry. Melanin index was measured by reflectance spectrometry. Serum vitamin D metabolites (25(OH)D3, 25(OH)D 2 and 24,25(OH)2D3) were determined by high performance liquid chromatography (HPLC) tandem mass spectrometry. Percent 24,25(OH)2D3 was calculated as a percent of the parent metabolite (25(OH)D3). Stepwise and backward selection regression models were used to identify leading covariates. RESULTS Fifty African Americans and 50 European Americans participated in the study. Compared with SLC24A5 111Thr homozygotes, individuals with the SLC24A5 111Thr/Ala and 111Ala/Ala genotypes had respectively lower levels of 25(OH)D3 (23.0 and 23.8 nmol/L lower, p-dominant=0.007), and percent 24,25(OH)2D3 (4.1 and 5.2 percent lower, p-dominant=0.003), controlling for tanning bed use, vitamin D/fish oil supplement intake, race/ethnicity, and genetic ancestry. Results were similar with melanin index adjustment, and were not confounded by glucocorticoid, oral contraceptive, or statin use. CONCLUSIONS The SLC24A5 111Ala allele was associated with lower serum vitamin 25(OH)D3 and lower percent 24,25(OH)2D3, independently from melanin index and West African genetic ancestry.
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Affiliation(s)
- Robin Taylor Wilson
- Penn State Hershey College of Medicine, and Penn State Hershey Cancer Institute, The Pennsylvania State University, Hershey, Pennsylvania, U.S.A
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