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Gastens V, Chiolero A, Anker D, Feller M, Bauer DC, Rodondi N, Del Giovane C. Life expectancy in multimorbid older adults: Why it matters for preventive care. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Multimorbidity is highly prevalent among older adults and associated with a shorter life expectancy. Many guidelines recommend tailoring preventive care of multimorbid people according to life expectancy. Indeed, there is a time lag between a preventive care intervention and the expected potential benefit, and patients with a relatively short life expectancy might not have the time to benefit from the preventive care intervention. Further, both patients and health care providers tend to overestimate benefits and underestimate risks of interventions. It is therefore necessary to have a valid index for mortality prediction in multimorbid patients, but there is no life expectancy estimator designed and recommended for this population. The paper describes the development and internal validation of a new life expectancy estimator. In this presentation, we focus on the importance of life expectancy estimation in multimorbid older adults: Why does it matter in this population? What is the time lag to benefit of a preventive intervention, e.g., cancer screening? What is the state in this field, in research and clinical practice? How could tailoring preventive care to life expectancy improve patient outcomes?
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Affiliation(s)
- V Gastens
- Institute of Primary Health Care, University of Bern , Bern, Switzerland
- Department of Community Health, University of Fribourg , Fribourg, Switzerland
- Department of General Internal Medicine, University of Bern , Bern, Switzerland
| | - A Chiolero
- Institute of Primary Health Care, University of Bern , Bern, Switzerland
- Department of Community Health, University of Fribourg , Fribourg, Switzerland
- School of Population and Global Health, McGill University , Montreal, Canada
| | - D Anker
- Department of Community Health, University of Fribourg , Fribourg, Switzerland
| | - M Feller
- Institute of Primary Health Care, University of Bern , Bern, Switzerland
- Department of General Internal Medicine, University of Bern , Bern, Switzerland
| | - DC Bauer
- Departments of Medicine and Epidemiology, University of California , San Francisco, USA
| | - N Rodondi
- Institute of Primary Health Care, University of Bern , Bern, Switzerland
- Department of General Internal Medicine, University of Bern , Bern, Switzerland
| | - C Del Giovane
- Institute of Primary Health Care, University of Bern , Bern, Switzerland
- Department of Community Health, University of Fribourg , Fribourg, Switzerland
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Trabert B, Geczik AM, Bauer DC, Buist DSM, Cauley JA, Falk RT, Gierach GL, Hue TF, Lacey JV, LaCroix AZ, Michels KA, Tice JA, Xu X, Brinton LA, Dallal CM. Association of Endogenous Pregnenolone, Progesterone, and Related Metabolites with Risk of Endometrial and Ovarian Cancers in Postmenopausal Women: The B ∼FIT Cohort. Cancer Epidemiol Biomarkers Prev 2021; 30:2030-2037. [PMID: 34465588 DOI: 10.1158/1055-9965.epi-21-0669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/19/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Postmenopausal pregnenolone and/or progesterone levels in relation to endometrial and ovarian cancer risks have been infrequently evaluated. To address this, we utilized a sensitive and reliable assay to quantify prediagnostic levels of seven markers related to endogenous hormone metabolism. METHODS Hormones were quantified in baseline serum collected from postmenopausal women in a cohort study nested within the Breast and Bone Follow-up to the Fracture Intervention Trial (B∼FIT). Women using exogenous hormones at baseline (1992-1993) were excluded. Incident endometrial (n = 65) and ovarian (n = 67) cancers were diagnosed during 12 follow-up years and compared with a subcohort of 345 women (no hysterectomy) and 413 women (no oophorectomy), respectively. Cox models with robust variance were used to estimate cancer risk. RESULTS Circulating progesterone levels were not associated with endometrial [tertile (T)3 vs. T1 HR (95% confidence interval): 1.87 (0.85-4.11); P trend = 0.17] or ovarian cancer risk [1.16 (0.58-2.33); 0.73]. Increasing levels of the progesterone-to-estradiol ratio were inversely associated with endometrial cancer risk [T3 vs. T1: 0.29 (0.09-0.95); 0.03]. Increasing levels of 17-hydroxypregnenolone were inversely associated with endometrial cancer risk [0.40 (0.18-0.91); 0.03] and positively associated with ovarian cancer risk [3.11 (1.39-6.93); 0.01]. CONCLUSIONS Using sensitive and reliable assays, this study provides novel data that endogenous progesterone levels are not strongly associated with incident endometrial or ovarian cancer risks. 17-hydroxypregnenolone was positively associated with ovarian cancer and inversely associated with endometrial cancer. IMPACT While our results require replication in large studies, they provide further support of the hormonal etiology of endometrial and ovarian cancers.
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Affiliation(s)
- Britton Trabert
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland. .,Department of Obstetrics and Gynecology, University of Utah, and Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Ashley M Geczik
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Doug C Bauer
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Department of Medicine, University of California San Francisco, San Francisco, California
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | | | - Trisha F Hue
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - James V Lacey
- Division of Health Analytics, Department of Computational and Quantitative Medicine, City of Hope, Duarte, California
| | - Andrea Z LaCroix
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California San Diego, San Diego, California
| | - Kara A Michels
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Jeffrey A Tice
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Xia Xu
- Leidos Biomedical Research, Inc., Frederick, Maryland
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Cher M Dallal
- School of Public Health, University of Maryland, College Park, Maryland
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Lyles KW, Bauer DC, Colon-Emeric CS, Pieper CF, Cummings SR, Black DM. Zoledronic acid reduces the rate of clinical fractures after surgical repair of a hip fracture regardless of the Pretreatment bone mineral density. Osteoporos Int 2021; 32:1217-1219. [PMID: 33903925 DOI: 10.1007/s00198-021-05923-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED In patients with surgical repair of a low-trauma hip fracture, zoledronic acid (ZA) reduced the risk of subsequent fractures regardless of pretreatment femoral neck and total hip bone mineral density (BMD). INTRODUCTION Zoledronic acid reduces the risk of subsequent fractures after repair of a hip fracture. It is still unclear whether the benefits in fracture reduction with ZA depend upon hip bone mineral density at the time of fracture. METHODS We preformed additional post hoc analyses of data from the HORIZON Recurrent Fracture Trial to determine if ZA treatment reduced the risk of new clinical fractures regardless of pretreatment BMD. We modeled femoral neck and total hip BMD as both continuous and dichotomous variables (BMD T-score above and below -2.5). RESULTS There are no evidence that baseline femoral neck and total hip BMD modified the anti-fracture efficacy of ZA when pretreatment BMD was analyzed as a continuous or a dichotomous variable (interaction p-values > 0.20). The clinical fracture efficacy of ZA was similar among patients with pretreatment femoral neck BMD values above and below -2.5 (relative hazards = 0.60 and 0.67, respectively, interaction p-value = 0.95). A similar result was obtained using pretreatment total hip BMD values (relative hazards = 0.72 and 0.57, respectively, interaction p-value = 0.41). CONCLUSION There data should provide more comfort in prescribing ZA after surgical repair of a hip fracture, regardless of pretreatment BMD.
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Affiliation(s)
- K W Lyles
- Duke University School of Medicine, Durham, NC, USA.
- GRECC, VA Medical Center, Durham, NC, USA.
| | - D C Bauer
- University of California, San Francisco, San Francisco, CA, USA
- California Pacific Medical Center, San Francisco, CA, USA
| | - C S Colon-Emeric
- Duke University School of Medicine, Durham, NC, USA
- GRECC, VA Medical Center, Durham, NC, USA
| | - C F Pieper
- Duke University School of Medicine, Durham, NC, USA
| | - S R Cummings
- University of California, San Francisco, San Francisco, CA, USA
- California Pacific Medical Center, San Francisco, CA, USA
| | - D M Black
- University of California, San Francisco, San Francisco, CA, USA
- California Pacific Medical Center, San Francisco, CA, USA
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Michels KA, Geczik AM, Bauer DC, Brinton LA, Buist DSM, Cauley JA, Dallal CM, Falk RT, Hue TF, Lacey JV, LaCroix AZ, Tice JA, Xu X, Trabert B. Endogenous Progestogens and Colorectal Cancer Risk among Postmenopausal Women. Cancer Epidemiol Biomarkers Prev 2021; 30:1100-1105. [PMID: 33827983 DOI: 10.1158/1055-9965.epi-20-1568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/03/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The role of progestogens in colorectal cancer development is poorly characterized. To address this, our group developed a highly sensitive assay to measure concentrations of seven markers of endogenous progestogen metabolism among postmenopausal women. METHODS The markers were measured in baseline serum collected from postmenopausal women in a case-cohort study within the breast and bone follow-up to the fracture intervention trial (B∼FIT). We followed women not using exogenous hormones at baseline (1992-1993) for up to 12 years: 187 women with incident colorectal cancer diagnosed during follow-up and a subcohort of 495 women selected on strata of age and clinical center. We used adjusted Cox regression models with robust variance to estimate risk for colorectal cancer [hazard ratios (HR), 95% confidence intervals (CI)]. RESULTS High concentrations of pregnenolone and progesterone were not associated with colorectal cancer [quintile(Q)5 versus Q1: pregnenolone HR, 0.71, 95% CI, 0.40-1.25; progesterone HR, 1.25; 95% CI, 0.71-2.22]. A trend of increasing risk was suggested, but statistically imprecise across quintiles of 17-hydroxypregnenolone (Q2 to Q5 HRs, 0.75-1.44; P trend, 0.06). CONCLUSIONS We used sensitive and reliable assays to measure multiple circulating markers of progestogen metabolism. Progestogens were generally unassociated with colorectal cancer risk in postmenopausal women. IMPACT Our findings are consistent with most prior research on circulating endogenous sex hormones, which taken together suggest that sex hormones may not be major drivers of colorectal carcinogenesis in postmenopausal women.
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Affiliation(s)
- Kara A Michels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
| | - Ashley M Geczik
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Doug C Bauer
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cher M Dallal
- School of Public Health, University of Maryland, College Park, Maryland
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Trisha F Hue
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - James V Lacey
- Department of Computational and Quantitative Medicine, Division of Health Analytics, City of Hope, Duarte, California
| | - Andrea Z LaCroix
- Department of Family and Preventive Medicine, Division of Epidemiology, University of California San Diego, San Diego, California
| | - Jeffrey A Tice
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Xia Xu
- Leidos Biomedical Research, Inc., Frederick, Maryland
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Swanson CM, Blatchford PJ, Stone KL, Cauley JA, Lane NE, Rogers-Soeder TS, Redline S, Bauer DC, Wright KP, Wierman ME, Kohrt WM, Orwoll ES. Sleep duration and bone health measures in older men. Osteoporos Int 2021; 32:515-527. [PMID: 32930851 PMCID: PMC7933119 DOI: 10.1007/s00198-020-05619-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/01/2020] [Indexed: 01/11/2023]
Abstract
UNLABELLED The associations between objective measures of sleep duration and bone outcomes in older men are unknown. No consistent, significant association was identified between sleep duration and bone mineral density (BMD) in the current analysis. However, future research should determine if vitamin D status modifies this relationship. INTRODUCTION Prior studies, predominantly in women, reported that long and short self-reported sleep duration are associated with lower BMD. Associations between actigraphy-determined sleep duration and BMD or bone turnover markers (BTMs) in older men are unknown. METHODS Men in The Osteoporotic Fractures in Men (MrOS) Study with wrist actigraphy and concurrent BMD assessment but without comorbidities affecting bone health were included. Sleep duration was considered as a continuous (N = 1926) and dichotomized variable where men were classified as getting the recommended (7-8 h/night; N = 478) or short (< 6 h/night; N = 577) sleep. The cross-sectional association between BMD, BTMs, and sleep duration was examined using a t test or linear regression, where appropriate, in unadjusted and adjusted models. RESULTS There were no clinically or statistically significant differences in BMD at the L-spine, total hip, or femoral neck between men getting the recommended vs. short sleep duration, using actigraphy or self-reported sleep duration (all p ≥ 0.07). When sleep duration was considered as a continuous variable, femoral neck BMD was higher in men with longer self-reported sleep duration (β = 0.006 ±0.003, p = 0.02), but this was not significant after further adjustment. In men with low 25OHD (< 20 ng/mL), longer actigraphy-determined sleep duration was associated with higher total hip BMD (β = 0.016 ± 0.008; p = 0.04). Sleep duration and BTMs were not associated. CONCLUSION Sleep duration was not associated with hip or L-spine BMD or BTMs in older men. Future research should determine if vitamin D status or other factors modify this relationship.
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Affiliation(s)
- C M Swanson
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E. 17th Ave. Mail Stop 8106, Aurora, CO, 80045, USA.
| | - P J Blatchford
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - K L Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- San Francisco Coordinating Center, University of California San Francisco, San Francisco, CA, USA
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - N E Lane
- Center for Musculoskeletal Health, University of California, Davis Health, Davis, CA, USA
| | | | - S Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Pulmonary Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - D C Bauer
- San Francisco Coordinating Center, University of California San Francisco, San Francisco, CA, USA
- University of California San Francisco Medical Center, San Francisco, CO, USA
| | - K P Wright
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E. 17th Ave. Mail Stop 8106, Aurora, CO, 80045, USA
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - M E Wierman
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E. 17th Ave. Mail Stop 8106, Aurora, CO, 80045, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - W M Kohrt
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado VA Geriatric, Research, Education, and Clinical Center (GRECC), Aurora, CO, USA
| | - E S Orwoll
- Division of Endocrinology and Bone & Mineral Unit, Oregon Health & Science University, Portland, OR, USA
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Michels KA, Falk RT, Geczik AM, Bauer DC, Buist DS, Cauley JA, Dallal CM, Hue TF, Lacey JV, LaCroix AZ, Tice JA, Xu X, Brinton LA, Trabert B. Abstract 2359: Endogenous progestogens and colorectal cancer risk among postmenopausal women. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-2359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Progestogens are sex steroid hormones that serve as precursors to androgens, estrogens, and corticosteroids. While known to influence breast and endometrial cancer risk, the exact roles progestogens play in cancer development are poorly characterized–especially for colorectal cancer. Nor have we been able to determine the utility of measuring circulating progestogens for cancer risk prediction in epidemiologic studies and clinical settings. These gaps in knowledge are largely attributable to the difficulty in measuring hormones among postmenopausal women, when concentrations are low. To address this problem, we developed a highly sensitive and reliable liquid chromatography-tandem mass spectrometry assay to measure concentrations of seven markers of endogenous progestogen metabolism: pregnenolone (a progestogen precursor), progesterone, the two 17-alpha-hydroxy (17OH) forms of these hormones (which are androgen precursors), and three progesterone metabolites. These markers were measured in prediagnostic serum collected from women in a case-cohort study within the Breast and Bone Follow-up to the Fracture Intervention Trial (B~FIT). From the 15,595 postmenopausal women in B~FIT, we followed women not using exogenous hormones at baseline (1992-1993) for up to twelve years: 187 women with incident colorectal cancer diagnosed during follow-up and a subcohort of 495 women selected on strata of age (10-year windows) and clinical center. We used Cox regression models to estimate risk for colorectal cancer (hazard ratios [HR], 95% confidence intervals [CI]); models were adjusted for age, body mass index, clinic site, and enrollment arm from the original clinical trial. High concentrations of progestogens were not associated with colorectal cancer risk (quintile(Q)5 vs. Q1: pregnenolone HR 0.71, CI 0.40-1.25; progesterone HR 1.25, CI 0.71, 2.22). A trend of increasing risk was suggested, but imprecise across quintiles of 17OH-pregnenolone (Q2 to Q5 HRs 0.75 to 1.44, p-trend 0.06), but no association was noted with 17OH-progesterone. Using 5-knot splines, we identified non-linear risk relationships with several of the progestogens–indicating that biologic mechanisms unique to each hormone may exist. However, circulating progestogens were generally unrelated to colorectal cancer risk in postmenopausal women, which is in line with prior work indicating that circulating estrogen metabolites are also not associated with risk.
Citation Format: Kara A. Michels, Roni T. Falk, Ashley M. Geczik, Doug C. Bauer, Diana S. Buist, Jane A. Cauley, Cher M. Dallal, Trisha F. Hue, James V. Lacey, Andrea Z. LaCroix, Jeffrey A. Tice, Xia Xu, Louise A. Brinton, Britton Trabert. Endogenous progestogens and colorectal cancer risk among postmenopausal women [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2359.
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Affiliation(s)
| | | | | | - Doug C. Bauer
- 2University of California San Francisco, San Francisco, CA
| | - Diana S. Buist
- 3Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | | | - Trisha F. Hue
- 2University of California San Francisco, San Francisco, CA
| | | | | | | | - Xia Xu
- 8Leidos Biomedical Research, Frederick, MD
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Trabert B, Bauer DC, Buist DSM, Cauley JA, Falk RT, Geczik AM, Gierach GL, Hada M, Hue TF, Lacey JV, LaCroix AZ, Tice JA, Xu X, Dallal CM, Brinton LA. Association of Circulating Progesterone With Breast Cancer Risk Among Postmenopausal Women. JAMA Netw Open 2020; 3:e203645. [PMID: 32329771 PMCID: PMC7182797 DOI: 10.1001/jamanetworkopen.2020.3645] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE The role of endogenous progesterone in the development of breast cancer remains largely unexplored to date, primarily owing to assay sensitivity limitations and low progesterone concentrations in postmenopausal women. Recently identified progesterone metabolites may provide insights as experimental data suggest that 5α-dihydroprogesterone (5αP) concentrations reflect cancer-promoting properties and 3α-dihydroprogesterone (3αHP) concentrations reflect cancer-inhibiting properties. OBJECTIVE To evaluate the association between circulating progesterone and progesterone metabolite levels and breast cancer risk. DESIGN, SETTING, AND PARTICIPANTS Using a sensitive liquid chromatography-tandem mass spectrometry assay, prediagnostic serum levels of progesterone and progesterone metabolites were quantified in a case-cohort study nested within the Breast and Bone Follow-up to the Fracture Intervention Trial (n = 15 595). Participation was limited to women not receiving exogenous hormone therapy at the time of blood sampling (1992-1993). Incident breast cancer cases (n = 405) were diagnosed during 12 follow-up years and a subcohort of 495 postmenopausal women were randomly selected within 10-year age and clinical center strata. Progesterone assays were completed in July 2017; subsequent data analyses were conducted between July 15, 2017, and December 20, 2018. EXPOSURES Circulating concentrations of pregnenolone, progesterone, and their major metabolites. MAIN OUTCOMES AND MEASURES Development of breast cancer, with hazard ratios (HRs) and 95% CIs was estimated using Cox proportional hazards regression adjusted for key confounders, including estradiol. Evaluation of hormone ratios and effect modification were planned a priori. RESULTS The present study included 405 incident breast cancer cases and a subcohort of 495 postmenopausal women; the mean (SD) age at the time of the blood draw was 67.2 (6.2) years. Progesterone concentrations were a mean (SD) of 4.6 (1.7) ng/dL. Women with higher circulating progesterone levels were at an increased risk for breast cancer per SD increase in progesterone levels (HR, 1.16; 95% CI, 1.00-1.35; P = .048). The association with progesterone was linear in a 5-knot spline and stronger for invasive breast cancers (n = 267) (HR, 1.24; 95% CI, 1.07-1.43; P = .004). Among women in the lowest quintile (Q1) of circulating estradiol (<6.30 pg/mL) elevated progesterone concentrations were associated with reduced breast cancer risk per SD increase in progesterone levels (HR, 0.38; 95% CI, 0.15-0.95; P = .04) and increased risk among women in higher quintiles of estradiol (Q2-Q5; ≥6.30 pg/mL) (HR, 1.18; 95% CI, 1.04-1.35; P = .01; P = .04 for interaction). CONCLUSIONS AND RELEVANCE In this case-cohort study of postmenopausal women, elevated circulating progesterone levels were associated with a 16% increase in the risk of breast cancer. Additional research should be undertaken to assess how postmenopausal breast cancer risk is associated with both endogenous progesterone and progesterone metabolites and their interactions with estradiol.
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Affiliation(s)
- Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Doug C. Bauer
- Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Diana S. M. Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jane A. Cauley
- Graduate School of Public Health Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roni T. Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Ashley M. Geczik
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Gretchen L. Gierach
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Manila Hada
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Trisha F. Hue
- Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - James V. Lacey
- Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, California
| | - Andrea Z. LaCroix
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego
| | - Jeffrey A. Tice
- Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Xia Xu
- Leidos Biomedical Research Inc, Frederick, Maryland
| | - Cher M. Dallal
- School of Public Health, University of Maryland College Park
| | - Louise A. Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Gencer B, Moutzouri E, Blum MR, Feller M, Collet TH, Buffle E, Monney P, Gabus V, Muller H, Kearney P, Gussekloo J, Westendorp R, Scott DJ, Bauer DC, Rodondi N. P755The impact of levothyroxine on cardiac function in older adults with subclinical hypothyroidism: a randomized clinical trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Importance
Subclinical hypothyroidism has been associated with heart failure, but no conclusive clinical trial assessed whether treating subclinical hypothyroidism with levothyroxine has an impact on cardiac function.
Objective
To assess the impact of levothyroxine treatment on cardiac function in subclinical hypothyroidism.
Design
This is a randomized, double-blind placebo-controlled, multicenter Swiss substudy within the TRUST trial.
Participants
Participants aged ≥65 years with subclinical hypothyroidism.
Intervention
Levothyroxine to achieve TSH normalization, or placebo including mock titrations.
Main outcome measures
Primary outcomes, assessed by echocardiography at the end of the trial were the left ventricular ejection fraction (LVEF, normal defined as >50%) for systolic function and the ratio between mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (e' (E/e' ratio) for diastolic function. Secondary outcomes included transmitral E and A waves, e' lateral/septal, left atrial (LA) volume index and systolic pulmonary artery pressure.
Results
Of 217 randomized Swiss participants of the TRUST trial, 185 (mean age 74.1 years, 47% women, mean TSH at baseline 6.35 ± SD 1.95 mIU/L) underwent echocardiography. After a median treatment duration of 18.4 months, the mean TSH among participants randomized to levothyroxine (n=95) decreased to 3.55 mIU/L, whereas it remained elevated in the placebo group (n=89; 5.29 mIU/L). The mean LVEF was similar in both arms (adjusted between-group difference 0.4%, 95% CI −1.8% to 2.5%, P=0.72) and no significant differences were found for the E/e' ratio (adjusted between-group difference 0.4, 95% CI −0.7 to 1.4, P=0.47). In intention-to-treat and per-protocol analyses, no clinically significant differences were found for secondary diastolic function parameters: e' lateral 8 vs. 8 cm/s, P=0.54; e' septal 6 vs. 6 cm/s, P=0.75; LA volume index 34 vs. 33 ml/m2, P=0.57; E/A ratio 0.8 vs. 0.8, P=0.94; E deceleration time 225 vs. 216 ms, P=0.27, except for systolic pulmonary artery pressure (37 mm Hg in the levothyoxine group vs. 33 mm Hg in the placebo group, P=0.02 intention-to-treat and P=0.06 per protocol)
Conclusion
Treatment of subclinical hypothyroidism with levothyroxine was not associated with benefits regarding systolic and diastolic heart function in older adults with subclinical hypothyroidism.
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Affiliation(s)
- B Gencer
- Geneva University Hospitals, Cardiology Division, Geneva, Switzerland
| | - E Moutzouri
- University of Bern, Institute of Primary Health Care (BIHAM), Bern, Switzerland
| | - M R Blum
- Bern University Hospital, Department of General Internal Medicine, Bern, Switzerland
| | - M Feller
- University of Bern, Institute of Primary Health Care (BIHAM), Bern, Switzerland
| | - T H Collet
- University Hospital Centre Vaudois (CHUV), 5Service of Endocrinology, Diabetes and Metabolism, Lausanne, Switzerland
| | - E Buffle
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - P Monney
- University Hospital Centre Vaudois (CHUV), Service of Cardiology, Department of Heart and Vessels, Lausanne, Switzerland
| | - V Gabus
- University Hospital Centre Vaudois (CHUV), Service of Cardiology, Department of Heart and Vessels, Lausanne, Switzerland
| | - H Muller
- Geneva University Hospitals, Cardiology Division, Geneva, Switzerland
| | - P Kearney
- University College Cork, Cork, Ireland
| | - J Gussekloo
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - R Westendorp
- University of Copenhagen, Center for Healthy Aging, Copenhagen, Denmark
| | - D J Scott
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom
| | - D C Bauer
- University of California San Francisco, San Francisco, United States of America
| | - N Rodondi
- Bern University Hospital, Department of General Internal Medicine, Bern, Switzerland
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Trabert B, Bauer DC, Brinton LA, Buist DS, Cauley JA, Dallal CM, Gierach GL, Falk RT, Hue TF, Lacey JV, LaCroix AZ, Tice JA, Xu X. Abstract 589: Circulating progesterone is associated with increased postmenopausal breast cancer risk: B~FIT cohort. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Epidemiologic data provide compelling evidence of the association between elevated endogenous estrogens and androgens and increased postmenopausal breast cancer risk. However, the role of progesterone remains largely unexplored, primarily due to limitations in assay sensitivity and precision of progesterone measurements at low concentrations in postmenopausal women. Recently identified progesterone metabolites may provide etiologic insights as experimental data suggest that relative changes in concentrations of 5-α dihydroprogesterone (5αP) and 3-α dihydroprogesterone (3αHP) reflect cancer promoting and cancer inhibiting properties, respectively.
METHODS: We developed a sensitive and reliable liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay and quantified prediagnostic levels of progesterone/progesterone metabolites in a case-cohort study within the Breast and Bone Follow-up to the Fracture Intervention Trial (B~FIT) including 405 breast cancer cases diagnosed during follow-up and a subcohort of 495 postmenopausal women not using exogenous hormones at blood draw. Multivariable adjusted hazard ratios (HR) and 95% confidence intervals (CIs) were estimated using Cox regression and linearity was assessed using splines.
RESULTS: Hormone concentrations among women in the subcohort were on average 4.6 pg/mL (range 2.3-21.6) for progesterone; all measured values were above the assay detection limit. Women with higher circulating progesterone levels had an elevated postmenopausal breast cancer risk [HR (95% CI) per 10 pg/mL increase in progesterone: 1.18 (0.99-1.41)]. This association was linear in a 5-knot spline and strengthened [1.24 (1.03-1.49)] in models excluding women who reported current use of tamoxifen/raloxifene. Higher levels of 5αP relative to 3αHP were associated with a 4% increased postmenopausal breast cancer risk [per unit increase in ratio: 1.04 (1.00-1.07)]. For the individual metabolites, higher levels of both 5αP [per 10 pg/mL increase: 1.04 (0.93-1.18) and 3αHP [per 3 pg/mL increase: 1.11 (0.999-1.24)] were associated with elevated risk. All associations remained after adjustment for circulating estrogen levels.
CONCLUSIONS: Our prospective data suggest that postmenopausal women with increased serum progesterone concentrations, measured using a highly sensitive LC-MS/MS assay, are at increased risk of breast cancer. Consistent with experimental studies, higher levels of 5αP relative to 3αHP were indicative of increased breast cancer risk. Unlike experimental studies, our data do not suggest that endogenous concentrations of 3αHP are associated with reduced breast cancer risk; instead both metabolites were associated with elevated risk. The identification of these risk-related progesterone metabolites supports the need for additional research regarding their role in the etiology of breast cancer.
Citation Format: Britton Trabert, Doug C. Bauer, Louise A. Brinton, Diane S. Buist, Jane A. Cauley, Cher M. Dallal, Gretchen L. Gierach, Roni T. Falk, Trisha F. Hue, James V. Lacey, Andrea Z. LaCroix, Jeffrey A. Tice, Xia Xu. Circulating progesterone is associated with increased postmenopausal breast cancer risk: B~FIT cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 589.
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Affiliation(s)
| | - Doug C. Bauer
- 2University of California San Francisco, San Francisco, CA
| | | | - Diane S. Buist
- 3Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | | | | | | | - Trisha F. Hue
- 2University of California San Francisco, San Francisco, CA
| | | | | | | | - Xia Xu
- 8Leidos Biomedical Research, Inc., Frederick, MD
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10
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LeBlanc ES, Rosales AG, Genant HK, Dell RM, Friess DM, Boardman DL, Santora AC, Bauer DC, de Papp AE, Black DM, Orwoll ES. Radiological criteria for atypical features of femur fractures: what we can learn when applied in a clinical study setting. Osteoporos Int 2019; 30:1287-1295. [PMID: 30809724 DOI: 10.1007/s00198-019-04869-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
UNLABELLED The paper focuses on the identification of atypical fractures (AFFs). This paper examines the concordance between objective classification and expert subjective review. We believe the paper adds critical information about how to apply the American Society of Bone and Mineral Research (ASBMR) criteria to diagnose AFFs and is of high interest to the field. INTRODUCTION Assess American Society of Bone and Mineral Research (ASBMR) criteria for identifying atypical femoral fractures (AFFs). METHODS Two orthopedic surgeons independently evaluated radiographs of 372 fractures, applying ASBMR criteria. We assessed ease of applying ASBMR criteria and whether criteria-based assessment matched qualitative expert assessment. RESULTS There was up to 27% uncertainty about how to classify specific features. 84% of films were classified similarly for the presence of AFF according to ASBMR criteria; agreement increased to 94% after consensus meeting. Of 37 fractures categorized as AFFs based on ASBMR criteria, 23 (62.2%) were considered AFFs according to expert assessment (not relying on criteria). Only one (0.5%) femoral shaft fracture that did not meet ASBMR criteria was considered an AFF per expert assessment. The number of major ASBMR features present (four vs five) and whether there was periosteal or endosteal thickening ("beaking" or "flaring") played major roles in the discrepancies between ASBMR criteria-based and expert-based determinations. CONCLUSIONS ASBMR AFF criteria were useful for reviewers but several features were difficult to interpret. Expert assessments did not agree with the ASBMR classification in almost one-third of cases, but rarely identified an AFF when a femoral shaft fracture did not meet ASBMR AFF criteria. Experts identified lateral cortical transverse fracture line and associated new-bone formation along with no or minimal comminution as crucial features necessary for the definition of atypical femoral fractures.
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Affiliation(s)
- E S LeBlanc
- Kaiser Permanente Center for Health Research NW, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
| | - A G Rosales
- Kaiser Permanente Center for Health Research NW, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - H K Genant
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - R M Dell
- Kaiser Permanente Southern California, Cypress, CA, USA
| | - D M Friess
- Oregon Health & Science University (OHSU), Portland, OR, USA
| | | | - A C Santora
- Merck & Co., Inc, Kenilworth, NJ, Kenilworth, NJ, USA
| | - D C Bauer
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - A E de Papp
- Merck & Co., Inc, Kenilworth, NJ, Kenilworth, NJ, USA
| | - D M Black
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - E S Orwoll
- Oregon Health & Science University (OHSU), Portland, OR, USA
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11
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Trabert B, Bauer DC, Brinton LA, Buist DS, Cauley JA, Dallal CM, Gierach GL, Falk RT, Hue TF, Lacey JV, LaCroix AZ, Tice JA, Xu X. Abstract P1-08-04: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-08-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
Citation Format: Trabert B, Bauer DC, Brinton LA, Buist DS, Cauley JA, Dallal CM, Gierach GL, Falk RT, Hue TF, Lacey, Jr. JV, LaCroix AZ, Tice JA, Xu X. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-04.
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Affiliation(s)
- B Trabert
- National Cancer Institute, Bethesda, MD; University of California San Francisco, San Francisco, CA; Kaiser Permanente Washington Health Research Institute, Seattle, WA; University of Pittsburgh, Pittsburgh, PA; University of Maryland, College Park, MD; City of Hope, Duarte, CA; University of Washington, Seattle, WA; Leidos Biomedical Research, Inc., Frederick, MD
| | - DC Bauer
- National Cancer Institute, Bethesda, MD; University of California San Francisco, San Francisco, CA; Kaiser Permanente Washington Health Research Institute, Seattle, WA; University of Pittsburgh, Pittsburgh, PA; University of Maryland, College Park, MD; City of Hope, Duarte, CA; University of Washington, Seattle, WA; Leidos Biomedical Research, Inc., Frederick, MD
| | - LA Brinton
- National Cancer Institute, Bethesda, MD; University of California San Francisco, San Francisco, CA; Kaiser Permanente Washington Health Research Institute, Seattle, WA; University of Pittsburgh, Pittsburgh, PA; University of Maryland, College Park, MD; City of Hope, Duarte, CA; University of Washington, Seattle, WA; Leidos Biomedical Research, Inc., Frederick, MD
| | - DS Buist
- National Cancer Institute, Bethesda, MD; University of California San Francisco, San Francisco, CA; Kaiser Permanente Washington Health Research Institute, Seattle, WA; University of Pittsburgh, Pittsburgh, PA; University of Maryland, College Park, MD; City of Hope, Duarte, CA; University of Washington, Seattle, WA; Leidos Biomedical Research, Inc., Frederick, MD
| | - JA Cauley
- National Cancer Institute, Bethesda, MD; University of California San Francisco, San Francisco, CA; Kaiser Permanente Washington Health Research Institute, Seattle, WA; University of Pittsburgh, Pittsburgh, PA; University of Maryland, College Park, MD; City of Hope, Duarte, CA; University of Washington, Seattle, WA; Leidos Biomedical Research, Inc., Frederick, MD
| | - CM Dallal
- National Cancer Institute, Bethesda, MD; University of California San Francisco, San Francisco, CA; Kaiser Permanente Washington Health Research Institute, Seattle, WA; University of Pittsburgh, Pittsburgh, PA; University of Maryland, College Park, MD; City of Hope, Duarte, CA; University of Washington, Seattle, WA; Leidos Biomedical Research, Inc., Frederick, MD
| | - GL Gierach
- National Cancer Institute, Bethesda, MD; University of California San Francisco, San Francisco, CA; Kaiser Permanente Washington Health Research Institute, Seattle, WA; University of Pittsburgh, Pittsburgh, PA; University of Maryland, College Park, MD; City of Hope, Duarte, CA; University of Washington, Seattle, WA; Leidos Biomedical Research, Inc., Frederick, MD
| | - RT Falk
- National Cancer Institute, Bethesda, MD; University of California San Francisco, San Francisco, CA; Kaiser Permanente Washington Health Research Institute, Seattle, WA; University of Pittsburgh, Pittsburgh, PA; University of Maryland, College Park, MD; City of Hope, Duarte, CA; University of Washington, Seattle, WA; Leidos Biomedical Research, Inc., Frederick, MD
| | - TF Hue
- National Cancer Institute, Bethesda, MD; University of California San Francisco, San Francisco, CA; Kaiser Permanente Washington Health Research Institute, Seattle, WA; University of Pittsburgh, Pittsburgh, PA; University of Maryland, College Park, MD; City of Hope, Duarte, CA; University of Washington, Seattle, WA; Leidos Biomedical Research, Inc., Frederick, MD
| | - JV Lacey
- National Cancer Institute, Bethesda, MD; University of California San Francisco, San Francisco, CA; Kaiser Permanente Washington Health Research Institute, Seattle, WA; University of Pittsburgh, Pittsburgh, PA; University of Maryland, College Park, MD; City of Hope, Duarte, CA; University of Washington, Seattle, WA; Leidos Biomedical Research, Inc., Frederick, MD
| | - AZ LaCroix
- National Cancer Institute, Bethesda, MD; University of California San Francisco, San Francisco, CA; Kaiser Permanente Washington Health Research Institute, Seattle, WA; University of Pittsburgh, Pittsburgh, PA; University of Maryland, College Park, MD; City of Hope, Duarte, CA; University of Washington, Seattle, WA; Leidos Biomedical Research, Inc., Frederick, MD
| | - JA Tice
- National Cancer Institute, Bethesda, MD; University of California San Francisco, San Francisco, CA; Kaiser Permanente Washington Health Research Institute, Seattle, WA; University of Pittsburgh, Pittsburgh, PA; University of Maryland, College Park, MD; City of Hope, Duarte, CA; University of Washington, Seattle, WA; Leidos Biomedical Research, Inc., Frederick, MD
| | - X Xu
- National Cancer Institute, Bethesda, MD; University of California San Francisco, San Francisco, CA; Kaiser Permanente Washington Health Research Institute, Seattle, WA; University of Pittsburgh, Pittsburgh, PA; University of Maryland, College Park, MD; City of Hope, Duarte, CA; University of Washington, Seattle, WA; Leidos Biomedical Research, Inc., Frederick, MD
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Boskey AL, Spevak L, Ma Y, Wang H, Bauer DC, Black DM, Schwartz AV. Insights into the bisphosphonate holiday: a preliminary FTIRI study. Osteoporos Int 2018; 29:699-705. [PMID: 29204959 DOI: 10.1007/s00198-017-4324-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 11/21/2017] [Indexed: 12/23/2022]
Abstract
UNLABELLED Bone composition evaluated by FTIRI analysis of iliac crest biopsies from post-menopausal women treated with alendronate for 10 years, continuously or alendronate for 5 years, followed by a 5-year alendronate-holiday, only differed with the discontinued biopsies having increased cortical crystallinity and heterogeneity of acid phosphate substitution and decreased trabecular crystallinity heterogeneity. INTRODUCTION Bisphosphonates (BP) are the most commonly used and effective drugs to prevent fragility fractures; however, concerns exist that prolonged use may lead to adverse events. Recent recommendations suggest consideration of a BP "holiday" in individuals taking long-term BP therapy not at high risk of fracture. Data supporting or refuting this recommendation based on bone quality are limited. We hypothesized that a "holiday" of 5 years would cause no major bone compositional changes. METHODS We analyzed the 31 available biopsies from the FLEX-Long-term Extension of FIT (Fracture Intervention Trial) using Fourier transform infrared imaging (FTIRI). Biopsies from two groups of post-menopausal women, a "Continuously treated group" (N = 16) receiving alendronate for ~ 10 years and a "Discontinued group" (N = 15), alendronate treated for 5 years taking no antiresorptive medication during the following 5 years. Iliac crest bone biopsies were provided at 10 years. RESULTS Key FTIRI parameters, mineral-to-matrix ratio, carbonate-to-phosphate ratio, acid phosphate substitution, and collagen cross-link ratio as well as heterogeneity of these parameters were similar for Continuously treated and Discontinued groups in age-adjusted models. The Discontinued group had 2% greater cortical crystallinity (p = 0.01), 31% greater cortical acid phosphate heterogeneity (p = 0.02), and 24% lower trabecular crystallinity heterogeneity (p = 0.02). CONCLUSIONS Discontinuation of alendronate for 5 years did not affect key FTIRI parameters, supporting the hypothesis that discontinuation would have little impact on bone composition. Modest differences were observed in three parameters that are not likely to affect bone mechanical properties. These preliminary data suggest that a 5-year BP holiday is not harmful to bone composition.
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Affiliation(s)
- A L Boskey
- Hospital for Special Surgery, New York, NY, USA
| | - L Spevak
- Hospital for Special Surgery, New York, NY, USA
| | - Y Ma
- The George Washington University, Washington, DC, USA
| | - H Wang
- The George Washington University, Washington, DC, USA
| | - D C Bauer
- University of California San Francisco, San Francisco, CA, USA
| | - D M Black
- University of California San Francisco, San Francisco, CA, USA
| | - A V Schwartz
- University of California San Francisco, San Francisco, CA, USA.
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13
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Schousboe JT, Vo TN, Langsetmo L, Taylor BC, Kats AM, Schwartz AV, Bauer DC, Cauley JA, Ensrud KE. Predictors of change of trabecular bone score (TBS) in older men: results from the Osteoporotic Fractures in Men (MrOS) Study. Osteoporos Int 2018; 29:49-59. [PMID: 29090329 PMCID: PMC5777142 DOI: 10.1007/s00198-017-4273-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/12/2017] [Indexed: 02/08/2023]
Abstract
UNLABELLED Among older men, characteristics that predict longitudinal changes in trabecular bone score (TBS) are different from characteristics that predict changes in bone mineral density (BMD). Most notably, weight loss is strongly associated with concomitant loss in BMD but with concomitant increases in TBS, when measured on Hologic densitometers. INTRODUCTION Our objective was to compare and contrast predictors of changes in TBS, total hip BMD, and lumbar spine BMD. METHODS Our study population was 3969 Osteoporotic Fractures in Men (MrOS) cohort participants (mean age 72.8 years) with repeat measures of TBS, lumbar spine and total hip BMD, body mass index (BMI) less than 37 kg/m2, and no use of bisphosphonate or glucocorticoid medications. TBS was scored (Med-Imaps Software version 2.1) and BMD measured on Hologic densitometers. RESULTS One thousand four hundred forty-four men had a TBS decrease > 0.04 units (estimated least significant change for TBS), 795 men had a TBS increase > 0.04 units, and 1730 men had TBS change ≤ 0.04 units over mean follow-up of 4.6 years. Older age was not associated with TBS change, but was associated with greater decline in lumbar spine and total hip BMD. Compared to stable weight, > 10% weight loss was strongly associated with an increase in TBS [effect size = 1.24 (95% CI 1.12, 1.36)] and strongly associated with a decrease in total hip BMD [- 1.16 (95% CI - 1.19, - 1.03)]. Other predictors discordant for longitudinal changes of TBS and BMD included baseline BMI, walk speed, and ACE inhibitor use. CONCLUSIONS Predictors of changes in TBS are different from predictors of changes in lumbar spine and total hip BMD. At least when assessed on Hologic densitometers, weight loss is associated with subsequent declines in spine and total hip BMD but subsequent increase in TBS. Faster walk speed may protect against loss of hip BMD, but is not associated with longitudinal changes of TBS.
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Affiliation(s)
- J T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, 3800 Park Nicollet Blvd., Minneapolis, MN, 55416, USA.
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
| | - T N Vo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - L Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - B C Taylor
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Diseases Outcomes Research, VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - A M Kats
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Diseases Outcomes Research, VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - A V Schwartz
- Department of Biostatistics and Epidemiology, University of California, San Francisco, CA, USA
| | - D C Bauer
- Department of Biostatistics and Epidemiology, University of California, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
| | - J A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - K E Ensrud
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Diseases Outcomes Research, VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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14
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Langsetmo L, Shikany JM, Burghardt AJ, Cawthon PM, Orwoll ES, Cauley JA, Taylor BC, Schousboe JT, Bauer DC, Vo TN, Ensrud KE. High dairy protein intake is associated with greater bone strength parameters at the distal radius and tibia in older men: a cross-sectional study. Osteoporos Int 2018; 29:69-77. [PMID: 29063213 PMCID: PMC5772967 DOI: 10.1007/s00198-017-4261-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/09/2017] [Indexed: 12/17/2022]
Abstract
UNLABELLED Dairy protein but not plant protein was associated with bone strength of the radius and tibia in older men. These results are consistent with previous results in women and support similar findings related to fracture outcomes. Bone strength differences were largely due to thickness and area of the bone cortex. INTRODUCTION Our objective was to determine the association of protein intake by source (dairy, non-dairy animal, plant) with bone strength and bone microarchitecture among older men. METHODS We used data from 1016 men (mean 84.3 years) who attended the Year 14 exam of the Osteoporotic Fractures in Men (MrOS) study, completed a food frequency questionnaire (500-5000 kcal/day), were not taking androgen or androgen agonists, and had high-resolution peripheral quantitative computed tomography (HR-pQCT) scans of the distal radius and distal or diaphyseal tibia. Protein was expressed as percentage of total energy intake (TEI); mean ± SD for TEI = 1548 ± 607 kcal/day and for total protein = 16.2 ± 2.9%TEI. We used linear regression with standardized HR-pQCT parameters as dependent variables and adjusted for age, limb length, center, education, race/ethnicity, marital status, smoking, alcohol intake, physical activity level, corticosteroids use, supplement use (calcium and vitamin D), and osteoporosis medications. RESULTS Higher dairy protein intake was associated with higher estimated failure load at the distal radius and distal tibia [radius effect size = 0.17 (95% CI 0.07, 0.27), tibia effect size = 0.13 (95% CI 0.03, 0.23)], while higher non-dairy animal protein was associated with higher failure load at only the distal radius. Plant protein intake was not associated with failure load at any site. CONCLUSION The association between protein intake and bone strength varied by source of protein. These results support a link between dairy protein intake and skeletal health, but an intervention study is needed to evaluate causality.
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Affiliation(s)
- L Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, 55454, USA.
| | - J M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - P M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - E S Orwoll
- Bone and Mineral Unit, Oregon Health Sciences University, Portland, OR, USA
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - B C Taylor
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, 55454, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - J T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, Bloomington, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - D C Bauer
- Departments of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - T N Vo
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, 55454, USA
| | - K E Ensrud
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, 55454, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
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Cauley JA, Danielson ME, Jammy GR, Bauer DC, Jackson R, Wactawski-Wende J, Chlebowski RT, Ensrud KE, Boudreau R. Sex Steroid Hormones and Fracture in a Multiethnic Cohort of Women: The Women's Health Initiative Study (WHI). J Clin Endocrinol Metab 2017; 102:1538-1547. [PMID: 28324031 PMCID: PMC5443326 DOI: 10.1210/jc.2016-3589] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/20/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT We hypothesize that endogenous sex steroids are associated with fracture risk independent of race/ethnicity. DESIGN AND SETTING We performed a nested case-control study within the prospective Women's Health Initiative Observational Study. Incident nonspine fractures were identified in 381 black, 192 Hispanic, 112 Asian, and 46 Native American women over an average of 8.6 years. A random sample of 400 white women who experienced an incident fracture was chosen. One control was selected per case and matched on age, race/ethnicity, and blood draw date. Bioavailable estradiol (BioE2), bioavailable testosterone (BioT), and sex hormone-binding globulin (SHBG) were measured using baseline fasting serum. Conditional logistic regression models calculated the odds ratio (OR) and 95% confidence interval (CI) of fracture across tertiles of hormone. RESULTS In multivariable and race/ethnicity-adjusted models, higher BioE2 (>8.25 pg/mL) and higher BioT (>13.3 ng/dL) were associated with decreased risk of fracture (OR, 0.65; 95% CI, 0.50 to 0.85; P trend = 0.001 and OR, 0.76; 95% CI, 0.60 to 0.96; P trend = 0.02, respectively). The interaction term between race/ethnicity and either BioE2 or BioT was not significant. There was no association between SHBG and fracture risk. In models stratifying by race/ethnicity, higher BioE2 was associated with a lower risk of fracture in both white women (OR, 0.56; 95% CI, 0.36 to 0.87) and black women (OR, 0.61; 95% CI, 0.39 to 0.96). Higher BioT was associated with a significantly lower fracture risk in only black women (OR, 0.65; 95% CI, 0.43 to 1.00), P trend = 0.03. CONCLUSIONS Serum BioE2 and BioT are associated with fracture risk in older women irrespective of race/ethnicity and independent of established risk factors for fracture.
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Affiliation(s)
- Jane A. Cauley
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
| | - Michelle E. Danielson
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
| | - Guru Rajesh Jammy
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
| | - Doug C. Bauer
- University of California at San Francisco, San Francisco, California 94143
| | - Rebecca Jackson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University, Columbus, Ohio 43210
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, New York 14260
| | - Rowan T. Chlebowski
- Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, California 90502
| | - Kristine E. Ensrud
- Department of Medicine and Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota 55455
- Department of Medicine, Minneapolis Veteran's Administration Health System, Minneapolis, Minnesota 55417
- Center for Chronic Disease Outcomes Research, Veteran's Administration Health Care System, Minneapolis, Minnesota 55417
| | - Robert Boudreau
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
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Hanlon JT, Perera S, Newman AB, Thorpe JM, Donohue JM, Simonsick EM, Shorr RI, Bauer DC, Marcum ZA. Potential drug-drug and drug-disease interactions in well-functioning community-dwelling older adults. J Clin Pharm Ther 2017; 42:228-233. [PMID: 28111765 DOI: 10.1111/jcpt.12502] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/20/2016] [Indexed: 12/17/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE There are few studies examining both drug-drug and drug-disease interactions in older adults. Therefore, the objective of this study was to describe the prevalence of potential drug-drug and drug-disease interactions and associated factors in community-dwelling older adults. METHODS This cross-sectional study included 3055 adults aged 70-79 without mobility limitations at their baseline visit in the Health Aging and Body Composition Study conducted in the communities of Pittsburgh PA and Memphis TN, USA. The outcome factors were potential drug-drug and drug-disease interactions as per the application of explicit criteria drawn from a number of sources to self-reported prescription and non-prescription medication use. RESULTS Over one-third of participants had at least one type of interaction. Approximately one quarter (25·1%) had evidence of had one or more drug-drug interactions. Nearly 10·7% of the participants had a drug-drug interaction that involved a non-prescription medication. % The most common drug-drug interaction was non-steroidal anti-inflammatory drugs (NSAIDs) affecting antihypertensives. Additionally, 16·0% had a potential drug-disease interaction with 3·7% participants having one involving non-prescription medications. The most common drug-disease interaction was aspirin/NSAID use in those with history of peptic ulcer disease without gastroprotection. Over one-third (34·0%) had at least one type of drug interaction. Each prescription medication increased the odds of having at least one type of drug interaction by 35-40% [drug-drug interaction adjusted odds ratio (AOR) = 1·35, 95% confidence interval (CI) = 1·27-1·42; drug-disease interaction AOR = 1·30; CI = 1·21-1·40; and both AOR = 1·45; CI = 1·34-1·57]. A prior hospitalization increased the odds of having at least one type of drug interaction by 49-84% compared with those not hospitalized (drug-drug interaction AOR = 1·49, 95% CI = 1·11-2·01; drug-disease interaction AOR = 1·69, CI = 1·15-2·49; and both AOR = 1·84, CI = 1·20-2·84). WHAT IS NEW AND CONCLUSION Drug interactions are common among community-dwelling older adults and are associated with the number of medications and hospitalization in the previous year. Longitudinal studies are needed to evaluate the impact of drug interactions on health-related outcomes.
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Affiliation(s)
- J T Hanlon
- Division of Geriatrics, Department of Medicine, School of Medicine, Pittsburgh, PA, USA.,Department of Pharmacy and Therapeutics, School of Pharmacy, Pittsburgh, PA, USA.,Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Health Equity Research and Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - S Perera
- Division of Geriatrics, Department of Medicine, School of Medicine, Pittsburgh, PA, USA.,Department of Biostatistics, Pittsburgh, PA, USA
| | - A B Newman
- Division of Geriatrics, Department of Medicine, School of Medicine, Pittsburgh, PA, USA.,Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - J M Thorpe
- Department of Pharmacy and Therapeutics, School of Pharmacy, Pittsburgh, PA, USA.,Center for Health Equity Research and Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - J M Donohue
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - E M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - R I Shorr
- Geriatric Research, Education and Clinical Center, Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL, USA
| | - D C Bauer
- University of California at San Francisco, San Francisco, CA, USA
| | - Z A Marcum
- Division of Geriatrics, Department of Medicine, School of Medicine, Pittsburgh, PA, USA
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17
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Fink HA, Litwack-Harrison S, Taylor BC, Bauer DC, Orwoll ES, Lee CG, Barrett-Connor E, Schousboe JT, Kado DM, Garimella PS, Ensrud KE. Erratum to: Clinical utility of routine laboratory testing to identify possible secondary causes in older men with osteoporosis: the osteoporotic fractures in men (MrOS) study. Osteoporos Int 2017; 28:419-420. [PMID: 27766366 PMCID: PMC5262150 DOI: 10.1007/s00198-016-3805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- H A Fink
- Geriatric Research Education & Clinical Center, Minneapolis VA, Health Care System, One Veterans Drive, 11-G, Minneapolis, MN, 55417, USA.
| | - S Litwack-Harrison
- Department of Epidemiology & Statistics, University of California, San Francisco, San Francisco Coordinating Center, Mission Hall: Global Health & Clinical Sciences Building, 550 16th Street, 2nd, floor, Box, San Francisco, CA, #0560, USA
| | - B C Taylor
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Mail code 152, Building 9, Minneapolis, MN, 55417, USA
| | - D C Bauer
- Department of Medicine, University of California, San Francisco, 1545 Divisadero St, 3rd Floor, San Francisco, CA, USA
| | - E S Orwoll
- Bone & Mineral Unit, Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR113, Portland, OR, 97239, USA
| | - C G Lee
- Portland Veterans Affairs HealthCareSystem, 3710SWUSVeterans Hospital Rd, R&D45, Portland, OR, 97239, USA
| | - E Barrett-Connor
- Department of Family Medicine & Public Health, University of California, San Diego 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - J T Schousboe
- Health Research Center, Park Nicollet Institute for Research and Education, 3800 Park Nicollet Boulevard, Minneapolis, MN, 55416, USA
| | - D M Kado
- Department of Family Medicine & Public Health, University of California, San Diego 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - P S Garimella
- Division of Nephrology, Tufts Medical Center, 800 Washington, Street, Box 391, Boston, MA, 02111, USA
| | - K E Ensrud
- Division of General Internal Medicine, Minneapolis VA Health Care System, One Veterans Drive, 111-0, Minneapolis, MN, 55417, USA
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Kendler DL, Bauer DC, Davison KS, Dian L, Hanley DA, Harris ST, McClung MR, Miller PD, Schousboe JT, Yuen CK, Lewiecki EM. Vertebral Fractures: Clinical Importance and Management. Am J Med 2016; 129:221.e1-10. [PMID: 26524708 DOI: 10.1016/j.amjmed.2015.09.020] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 11/19/2022]
Abstract
Vertebral fractures are common and can result in acute and chronic pain, decreases in quality of life, and diminished lifespan. The identification of vertebral fractures is important because they are robust predictors of future fractures. The majority of vertebral fractures do not come to clinical attention. Numerous modalities exist for visualizing suspected vertebral fracture. Although differing definitions of vertebral fracture may present challenges in comparing data between different investigations, at least 1 in 5 men and women aged >50 years have one or more vertebral fractures. There is clinical guidance to target spine imaging to individuals with a high probability of vertebral fracture. Radiology reports of vertebral fracture need to clearly state that the patient has a "fracture," with further pertinent details such as the number, recency, and severity of vertebral fracture, each of which is associated with risk of future fractures. Patients with vertebral fracture should be considered for antifracture therapy. Physical and pharmacologic modalities of pain control and exercises or physiotherapy to maintain spinal movement and strength are important components in the care of vertebral fracture patients.
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Affiliation(s)
- D L Kendler
- Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - D C Bauer
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco
| | | | - L Dian
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - D A Hanley
- Departments of Medicine, Oncology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - S T Harris
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco
| | | | - P D Miller
- Colorado Center for Bone Research, Lakewood
| | - J T Schousboe
- Park Nicollet Health Services, Park Nicollet Osteoporosis Center, Minneapolis, Minn; Division of Health Policy and Management, University of Minnesota, Minneapolis
| | - C K Yuen
- Prohealth Clinical Research, University of British Columbia, Vancouver, Canada
| | - E M Lewiecki
- New Mexico Clinical Research and Osteoporosis Center, Albuquerque
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19
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Fink HA, Litwack-Harrison S, Taylor BC, Bauer DC, Orwoll ES, Lee CG, Barrett-Connor E, Schousboe JT, Kado DM, Garimella PS, Ensrud KE. Clinical utility of routine laboratory testing to identify possible secondary causes in older men with osteoporosis: the Osteoporotic Fractures in Men (MrOS) Study. Osteoporos Int 2016; 27:331-8. [PMID: 26458388 PMCID: PMC4719570 DOI: 10.1007/s00198-015-3356-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/29/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED We investigated the value of routine laboratory testing for identifying underlying causes in older men diagnosed with osteoporosis. Most osteoporotic and nonosteoporotic men had ≥1 laboratory abnormality. Few individual laboratory abnormalities were more common in osteoporotic men. The benefit of routine laboratory testing in older osteoporotic men may be low. INTRODUCTION To evaluate the utility of recommended laboratory testing to identify secondary causes in older men with osteoporosis, we examined prevalence of laboratory abnormalities in older men with and without osteoporosis. METHODS One thousand five hundred seventy-two men aged ≥65 years in the Osteoporotic Fractures in Men study completed bone mineral density (BMD) testing and a battery of laboratory measures, including serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), thyroid-stimulating hormone (TSH), 25-OH vitamin D, total testosterone, spot urine calcium/creatinine ratio, spot urine albumin/creatinine ratio, creatinine-derived estimated glomerular filtration rate, 24-h urine calcium, and 24-h urine free cortisol. Using cross-sectional analyses, we calculated prevalence ratios (PRs) and 95 % confidence intervals (CI) for the association of any and specific laboratory abnormalities with osteoporosis and the number of men with osteoporosis needed to test to identify one additional laboratory abnormality compared to testing men without osteoporosis. RESULTS Approximately 60 % of men had ≥1 laboratory abnormality in both men with and without osteoporosis. Among individual tests, only vitamin D insufficiency (PR, 1.13; 95 % CI, 1.05-1.22) and high alkaline phosphatase (PR, 3.05; 95 % CI, 1.52-6.11) were more likely in men with osteoporosis. Hypercortisolism and hyperthyroidism were uncommon and not significantly more frequent in men with osteoporosis. No osteoporotic men had hypercalciuria. CONCLUSIONS Though most of these older men had ≥1 laboratory abnormality, few routinely recommended individual tests were more common in men with osteoporosis than in those without osteoporosis. Possibly excepting vitamin D and alkaline phosphatase, benefit of routine laboratory testing to identify possible secondary causes in older osteoporotic men appears low. Results may not be generalizable to younger men or to older men in whom history and exam findings raise clinical suspicion for a secondary cause of osteoporosis.
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Affiliation(s)
- H A Fink
- Geriatric Research Education & Clinical Center, Minneapolis VA Health Care System, One Veterans Drive, 11-G, Minneapolis, MN, 55417, USA.
| | - S Litwack-Harrison
- Department of Epidemiology & Statistics, University of California, San Francisco, San Francisco Coordinating Center, Mission Hall: Global Health & Clinical Sciences Building, 550 16th Street, 2nd floor, Box #0560, San Francisco, CA, USA
| | - B C Taylor
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Mail code 152, Building 9, Minneapolis, MN, 55417, USA
| | - D C Bauer
- Department of Medicine, University of California, San Francisco, 1545, Divisadero St, 3rd Floor, San Francisco, CA, USA
| | - E S Orwoll
- Bone & Mineral Unit, Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR113, Portland, OR, 97239, USA
| | - C G Lee
- Portland Veterans Affairs Health Care System, 3710 SW US Veterans Hospital Rd, R&D45, Portland, OR, 97239, USA
| | - E Barrett-Connor
- Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - J T Schousboe
- Health Research Center, Park Nicollet Institute for Research and Education, 3800 Park Nicollet Boulevard, Minneapolis, MN, 55416, USA
| | - D M Kado
- Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - P S Garimella
- Division of Nephrology, Tufts Medical Center, 800 Washington Street, Box 391, Boston, MA, 02111, USA
| | - K E Ensrud
- Division of General Internal Medicine, Minneapolis VA Health Care System, One Veterans Drive, 111-0, Minneapolis, MN, 55417, USA
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Abrahamsen B, Jørgensen HL, Laulund AS, Nybo M, Bauer DC, Brix TH, Hegedüs L. The excess risk of major osteoporotic fractures in hypothyroidism is driven by cumulative hyperthyroid as opposed to hypothyroid time: an observational register-based time-resolved cohort analysis. J Bone Miner Res 2015; 30:898-905. [PMID: 25431028 DOI: 10.1002/jbmr.2416] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 11/11/2014] [Accepted: 11/27/2014] [Indexed: 11/10/2022]
Abstract
The long-term relationship between hypothyroidism and fracture risk is challenging to dissect because of the modifying influence of subsequent thyroxine replacement with the potential for excessive replacement doses. We studied changes in serum thyrotropin concentration (TSH) over time and association with fracture risk in real-world patients presenting with elevated TSH. All TSH determinations were done in the same laboratory, which served all hospitals and general practices. The study population consisted of all adults with a first measurement of TSH >4.0 mIU/L (n = 8414) or normal TSH (n = 222,138; comparator). We used a Cox proportional hazards analysis incorporating additional time-dependent covariates to represent initiation of thyroxine replacement and cumulative number of periods with high versus low TSH after index date with a mean follow-up of 7.2 years. Elevated baseline TSH was not associated with an increased risk of hip fracture (HR 0.90; 95% CI, 0.80 to 1.02) or major osteoporotic fractures (HR 0.97; 95% CI, 0.90 to 1.05), nor was subsequent thyroxine prescription predictive of increased risk of fractures. The number of subsequent 6-month periods with low TSH-suggesting excessive thyroxine dosing-was significantly associated with increased risk of both hip fracture (HR 1.09; 95% CI, 1.04 to 1.15) and major osteoporotic fracture (HR 1.10; 95% CI, 1.06 to 1.14). When gender- and age-stratified analyses for major osteoporotic fractures were undertaken, hyperthyroid time was identified as a predictor of fracture risk in postmenopausal women whereas hypothyroid time predicted increased fracture risk in men below age 75 years. In conclusion, among patients who present with an elevated TSH, the long-term risk of hip and other osteoporotic fractures is strongly related to the cumulative duration of periods with low TSH-likely from excessive replacement. An independent effect of elevated TSH could only be observed in young and middle-aged men, suggesting gender-discrepant consequences on risk.
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Affiliation(s)
- Bo Abrahamsen
- Odense Patient data Explorative Network (OPEN), Institute of Clinical Research University of Southern Denmark, Odense, Denmark; Department of Medicine M, Research Centre for Ageing and Osteoporosis, Glostrup Hospital, Glostrup, Denmark
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21
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Tabatabai LS, Cummings SR, Tylavsky FA, Bauer DC, Cauley JA, Kritchevsky SB, Newman A, Simonsick EM, Harris TB, Sebastian A, Sellmeyer DE. Arterialized venous bicarbonate is associated with lower bone mineral density and an increased rate of bone loss in older men and women. J Clin Endocrinol Metab 2015; 100:1343-9. [PMID: 25642590 PMCID: PMC4399281 DOI: 10.1210/jc.2014-4166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Higher dietary net acid loads have been associated with increased bone resorption, reduced bone mineral density (BMD), and increased fracture risk. OBJECTIVE The objective was to compare bicarbonate (HCO3) measured in arterialized venous blood samples to skeletal outcomes. DESIGN Arterialized venous samples collected from participants in the Health, Aging and Body Composition (Health ABC) Study were compared to BMD and rate of bone loss. SETTING The setting was a community-based observational cohort. PARTICIPANTS A total of 2287 men and women age 74 ± 3 years participated. INTERVENTION Arterialized venous blood was obtained at the year 3 study visit and analyzed for pH and pCO2. HCO3 was determined using the Henderson-Hasselbalch equation. MAIN OUTCOME MEASURE BMD was measured at the hip by dual-energy x-ray absorptiometry at the year 1 (baseline) and year 3 study visits. RESULTS Plasma HCO3 was positively associated with BMD at both year 1 (P = .001) and year 3 (P = .001) in models adjusted for age, race, sex, clinic site, smoking, weight, and estimated glomerular filtration rate. Plasma HCO3 was inversely associated with rate of bone loss at the total hip over the 2.1 ± 0.3 (mean ± SD) years between the two bone density measurements (P < .001). Across quartiles of plasma HCO3, the rate of change in BMD over the 2.1 years ranged from a loss of 0.72%/y in the lowest quartile to a gain of 0.15%/y in the highest quartile of HCO3. CONCLUSIONS Arterialized plasma HCO3 was associated positively with cross-sectional BMD and inversely with the rate of bone loss, implying that systemic acid-base status is an important determinant of skeletal health during aging. Ongoing bone loss was linearly related to arterialized HCO3, even after adjustment for age and renal function. Further research in this area may have major public health implications because reducing dietary net acid load is possible through dietary intervention or through supplementation with alkaline potassium compounds.
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Affiliation(s)
- L S Tabatabai
- Division of Endocrinology (L.S.T., D.E.S.), Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland 21224; California Pacific Medical Center Research Institute (S.R.C.), San Francisco, California 94118; Department of Preventive Medicine (F.A.T.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; Department of Medicine (D.C.B., A.S.), School of Medicine, University of California, San Francisco, San Francisco, California 94143; Department of Epidemiology (J.A.C., A.N.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15260; Department of Internal Medicine (S.B.K.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157; Translational Gerontology Branch (E.M.S.), National Institute on Aging, Baltimore, Maryland 21224; and Laboratory of Epidemiology and Population Science (T.B.H.), National Institute on Aging, Bethesda, Maryland 20892
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22
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Yende S, Alvarez K, Loehr L, Folsom AR, Newman AB, Weissfeld LA, Wunderink RG, Kritchevsky SB, Mukamal KJ, London SJ, Harris TB, Bauer DC, Angus DC. Epidemiology and long-term clinical and biologic risk factors for pneumonia in community-dwelling older Americans: analysis of three cohorts. Chest 2013; 144:1008-1017. [PMID: 23744106 PMCID: PMC3760741 DOI: 10.1378/chest.12-2818] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 04/15/2013] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Preventing pneumonia requires better understanding of incidence, mortality, and long-term clinical and biologic risk factors, particularly in younger individuals. METHODS This was a cohort study in three population-based cohorts of community-dwelling individuals. A derivation cohort (n = 16,260) was used to determine incidence and survival and develop a risk prediction model. The prediction model was validated in two cohorts (n = 8,495). The primary outcome was 10-year risk of pneumonia hospitalization. RESULTS The crude and age-adjusted incidences of pneumonia were 6.71 and 9.43 cases/1,000 person-years (10-year risk was 6.15%). The 30-day and 1-year mortality were 16.5% and 31.5%. Although age was the most important risk factor (range of crude incidence rates, 1.69-39.13 cases/1,000 person-years for each 5-year increment from 45-85 years), 38% of pneumonia cases occurred in adults < 65 years of age. The 30-day and 1-year mortality were 12.5% and 25.7% in those < 65 years of age. Although most comorbidities were associated with higher risk of pneumonia, reduced lung function was the most important risk factor (relative risk = 6.61 for severe reduction based on FEV1 by spirometry). A clinical risk prediction model based on age, smoking, and lung function predicted 10-year risk (area under curve [AUC] = 0.77 and Hosmer-Lemeshow [HL] C statistic = 0.12). Model discrimination and calibration were similar in the internal validation cohort (AUC = 0.77; HL C statistic, 0.65) but lower in the external validation cohort (AUC = 0.62; HL C statistic, 0.45). The model also calibrated well in blacks and younger adults. C-reactive protein and IL-6 were associated with higher pneumonia risk but did not improve model performance. CONCLUSIONS Pneumonia hospitalization is common and associated with high mortality, even in younger healthy adults. Long-term risk of pneumonia can be predicted in community-dwelling adults with a simple clinical risk prediction model.
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Affiliation(s)
- Sachin Yende
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
| | - Karina Alvarez
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Laura Loehr
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Aaron R Folsom
- School of Public Health, University of Minnesota, Minneapolis, MN
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Lisa A Weissfeld
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Stephanie J London
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Tamara B Harris
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD
| | - Doug C Bauer
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Derek C Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
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Houston DK, Tooze JA, Neiberg RH, Hausman DB, Johnson MA, Cauley JA, Bauer DC, Cawthon PM, Shea MK, Schwartz GG, Williamson JD, Tylavsky FA, Visser M, Simonsick EM, Harris TB, Kritchevsky SB. 25-hydroxyvitamin D status and change in physical performance and strength in older adults: the Health, Aging, and Body Composition Study. Am J Epidemiol 2012; 176:1025-34. [PMID: 23118104 DOI: 10.1093/aje/kws147] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Low 25-hydroxyvitamin D (25(OH)D) concentrations are common among older adults and are associated with poorer physical performance and strength, but results from longitudinal studies have been inconsistent. The 25(OH)D threshold for physical performance and strength was determined, and both cross-sectional and longitudinal associations between 25(OH)D and physical performance and strength were examined, in men and women aged 71-80 years from the Health, Aging, and Body Composition Study (n = 2,641). Baseline serum 25(OH)D was measured in 1998-1999, and physical performance and strength were measured at baseline and at 2- and 4-year follow-up. Piecewise regression models were used to determine 25(OH)D thresholds. Linear regression and mixed models were used to examine cross-sectional and longitudinal associations. The 25(OH)D thresholds were 70-80 nmol/L for physical performance and 55-70 nmol/L for strength. Participants with 25(OH)D <50 nmol/L had poorer physical performance at baseline and at 2- and 4-year follow-up than participants with 25(OH)D ≥75 nmol/L (P < 0.01). Although physical performance and strength declined over 4 years of follow-up (P < 0.0001), in general, the rate of decline was not associated with baseline 25(OH)D. Older adults with low 25(OH)D concentrations had poorer physical performance over 4 years of follow-up, but low 25(OH)D concentrations were not associated with a faster rate of decline in physical performance or strength.
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Affiliation(s)
- Denise K Houston
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157-1207, USA.
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Cawthon PM, Ewing SK, Mackey DC, Fink HA, Cummings SR, Ensrud KE, Stefanick ML, Bauer DC, Cauley JA, Orwoll ES. Change in hip bone mineral density and risk of subsequent fractures in older men. J Bone Miner Res 2012; 27:2179-88. [PMID: 22648990 PMCID: PMC3447117 DOI: 10.1002/jbmr.1671] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Low bone mineral density (BMD) increases fracture risk; how changes in BMD influence fracture risk in older men is uncertain. BMD was assessed at two to three time points over 4.6 years using dual-energy X-ray absorptiometry (DXA) for 4470 men aged ≥65 years in the Osteoporotic Fractures in Men (MrOS) Study. Change in femoral neck BMD was estimated using mixed effects linear regression models. BMD change was categorized as "accelerated" (≤-0.034 g/cm(2) ), "expected" (between 0 and -0.034 g/cm(2) ), or "maintained" (≥0 g/cm(2) ). Fractures were adjudicated by central medical record review. Multivariate proportional hazards models estimated the risk of hip, nonspine/nonhip, and nonspine fracture over 4.5 years after the final BMD measure, during which time 371 (8.3%) men experienced at least one nonspine fracture, including 78 (1.7%) hip fractures. Men with accelerated femoral neck BMD loss had an increased risk of nonspine (hazard ratio [HR] = 2.0; 95% confidence interval [CI] 1.4-2.8); nonspine/nonhip (HR = 1.6; 95% CI 1.1-2.3); and hip fracture (HR = 6.3; 95% CI 2.7-14.8) compared with men who maintained BMD over time. No difference in risk was seen for men with expected loss. Adjustment for the initial BMD measure did not alter the results. Adjustment for the final BMD measure attenuated the change in BMD-nonspine fracture and the change in BMD-nonspine/nonhip relationships such that they were no longer significant, whereas the change in the BMD-hip fracture relationship was attenuated (HR = 2.6; 95% CI 1.1-6.4). Total hip BMD change produced similar results. Accelerated decrease in BMD is a strong, independent risk factor for hip and other nonspine fractures in men.
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Affiliation(s)
- Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA.
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Houston DK, Neiberg RH, Tooze JA, Hausman DB, Johnson MA, Cauley JA, Bauer DC, Shea MK, Schwartz GG, Williamson JD, Harris TB, Kritchevsky SB. Low 25-hydroxyvitamin D predicts the onset of mobility limitation and disability in community-dwelling older adults: the Health ABC Study. J Gerontol A Biol Sci Med Sci 2012; 68:181-7. [PMID: 22573914 DOI: 10.1093/gerona/gls136] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although low 25-hydroxyvitamin D (25(OH)D) is prevalent among older adults and is associated with poor physical function, longitudinal studies examining vitamin D status and physical function are lacking. We examined the association between 25(OH)D, parathyroid hormone (PTH), and the onset of mobility limitation and disability over 6 years of follow-up in community-dwelling, initially well-functioning older adults participating in the Health, Aging and Body Composition study (n = 2,099). METHODS Serum 25(OH)D and PTH were measured at the 12-month follow-up visit (1998-1999). Mobility limitation and disability (any/severe difficulty walking 1/4 mile or climbing 10 steps) was assessed semiannually over 6 years of follow-up. The association between 25(OH)D, PTH, and mobility limitation and disability was examined using Cox proportional hazard regression models adjusted for demographics, season, behavioral characteristics, and chronic conditions. RESULTS At baseline, 28.9% of the participants had 25(OH)D <50 nmol/L and 36.1% had 25(OH)D of 50 to <75 nmol/L. Participants with 25(OH)D <50 and 50 to <75 nmol/L were at greater risk of developing mobility limitation (HR (95% CI): 1.29 (1.04-1.61) and 1.27 (1.05-1.53), respectively) and mobility disability (HR (95% CI): 1.93 (1.32-2.81) and 1.30 (0.92-1.83), respectively) over 6 years of follow-up compared with participants with 25(OH)D ≥75 nmol/L. Elevated PTH, however, was not significantly associated with developing mobility limitation or disability. CONCLUSIONS Low 25(OH)D was associated with an increased risk of mobility limitation and disability in community-dwelling, initially well-functioning black and white older adults. Prevention or treatment of low 25(OH)D may provide a pathway for reducing the burden of mobility disability in older adults.
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Affiliation(s)
- Denise K Houston
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157-1207, USA.
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Ensrud KE, Barbour K, Canales MT, Danielson ME, Boudreau RM, Bauer DC, Lacroix AZ, Ishani A, Jackson RD, Robbins JA, Cauley JA. Renal function and nonvertebral fracture risk in multiethnic women: the Women's Health Initiative (WHI). Osteoporos Int 2012; 23:887-99. [PMID: 21625880 PMCID: PMC3643305 DOI: 10.1007/s00198-011-1667-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 04/14/2011] [Indexed: 01/22/2023]
Abstract
UNLABELLED To examine the association between renal function and fracture in multiethnic women, we studied postmenopausal women enrolled in the Women's Health Initiative. Postmenopausal White women with mild renal dysfunction were at increased risk of nonvertebral fracture; this association was at least partially explained by effects of renal dysfunction on chronic inflammation. Reduced renal function appeared to increase fracture risk among Black women, but there was little evidence to support this association among other racial/ethnic groups. INTRODUCTION The purpose of this study was to determine whether renal function is associated with fracture risk within racial/ethnic groups. METHODS A nested case-control study was conducted among 93,673 postmenopausal women; incident nonvertebral fractures were identified in 362 Black, 183 Hispanic, 110 Asian, and 45 American-Indian women. A random sample of 395 White women with incident nonvertebral fracture was chosen. One nonfracture control for each case was selected (matched on age, race/ethnicity, and blood draw date). Cystatin C levels were measured using baseline serum, and estimated glomerular filtration rate calculated (eGFR(cys-c)). RESULTS Each 1 SD increase in cystatin C was associated with a 1.2-fold increased risk of fracture among White women (adjusted odds ratios [OR], 1.23; 95% confidence intervals [CI], 1.04-1.46). The OR of fracture was 1.16 (95% CI, 0.85-1.58) among women with eGFR(cys-c) 60-90 mL/min/1.73 m(2) and 2.46 (95% CI, 1.16-5.21) among those with eGFR(cys-c) <60 mL/min/1.73 m(2) compared to the reference group (eGFR(cys-c) >90 mL/min/1.73 m(2)) (p trend = 0.05). The association was reduced after adjustment for cytokine TNFα soluble receptors (OR, 1.62; 95% CI, 0.59-4.46 for eGFR(cys-c) <60 mL/min/1.73 m(2)). Among Blacks, there was an association between cystatin C and fracture risk (OR per 1 SD increase, 1.15; 95% CI, 1.00-1.32); after adjustment, this association was only modestly attenuated, but no longer statistically significant. There was no evidence of significant associations among Hispanic, Asian, or American-Indian women. CONCLUSION Postmenopausal White women with mild renal dysfunction are at increased risk of nonvertebral fracture. Effects of renal function on chronic inflammation may mediate this association. Reduced renal function may increase fracture risk among Black women, but there was little evidence to support this association among other racial/ethnic groups.
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Affiliation(s)
- K E Ensrud
- Department of Medicine, University of Minnesota, One Veterans Drive 111-0, Minneapolis, MN 55417, USA.
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Marcum ZA, Perera S, Donohue JM, Boudreau RM, Newman AB, Ruby CM, Studenski SA, Kwoh CK, Simonsick EM, Bauer DC, Satterfield S, Hanlon JT. Analgesic use for knee and hip osteoarthritis in community-dwelling elders. Pain Med 2011; 12:1628-36. [PMID: 21992521 DOI: 10.1111/j.1526-4637.2011.01249.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the prevalence and correlates of non-opioid and opioid analgesic use and descriptively evaluate potential undertreatment in a sample of community-dwelling elders with symptomatic knee and/or hip osteoarthritis (OA). DESIGN Cross-sectional. SETTING Health, Aging, and Body Composition Study. PATIENTS Six hundred and fifty-two participants attending the year 6 visit (2002-03) with symptomatic knee and/or hip OA. OUTCOME MEASURES Analgesic use was defined as taking ≥1 non-opioid and/or ≥1 opioid receptor agonist. Non-opioid and opioid doses were standardized across all agents by dividing the daily dose used by the minimum effective analgesic daily dose. Inadequate pain control was defined as severe/extreme OA pain in the past 30 days from a modified Western Ontario and McMaster Universities Osteoarthritis Index. RESULTS Just over half (51.4%) reported taking at least one non-opioid analgesic and approximately 10% was taking an opioid, most (88.5%) of whom also took a non-opioid. One in five participants (19.3%) had inadequate pain control, 39% of whom were using <1 standardized daily dose of either a non-opioid or opioid analgesic. In adjusted analyses, severe/extreme OA pain was significantly associated with both non-opioid (adjusted odds ratio [AOR] = 2.44; 95% confidence interval [95% CI] = 1.49-3.99) and opioid (AOR = 2.64; 95% CI = 1.26-5.53) use. CONCLUSIONS Although older adults with severe/extreme knee and/or hip OA pain are more likely to take analgesics than those with less severe pain, a sizable proportion takes less than therapeutic doses and thus may be undertreated. Further research is needed to examine barriers to optimal analgesic use.
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Affiliation(s)
- Zachary A Marcum
- Department of Medicine (Geriatrics), School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Manini TM, Patel KV, Bauer DC, Ziv E, Schoeller DA, Mackey DC, Li R, Newman AB, Nalls M, Zmuda JM, Harris TB. European ancestry and resting metabolic rate in older African Americans. Eur J Clin Nutr 2011; 65:663-7. [PMID: 21468093 DOI: 10.1038/ejcn.2011.22] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Resting metabolic rate (RMR) contributes 60-80% of total energy expenditure and is consistently lower in populations of African descent compared with populations of European populations. Determination of European ancestry (EA) through single nucleotide polymorphism (SNP) analysis would provide an initial step for identifying genetic associations that contribute to low RMR. We sought to evaluate the association between RMR and EA in African Americans. SUBJECTS/METHODS RMR was measured by indirect calorimetry in 141 African American men and women (aged 74.7±3.0 years) enrolled in a substudy of the Health, Aging and Body Composition Study. Ancestry informative markers were used to estimate individual percent EA. Multivariate regression was used to assess the association between RMR and EA after adjustments for soft tissue fat-free mass (STFFM), fat mass, age, study site, physical activity level and sex. RESULTS Mean EA was 23.8±16% (range: 0.1-70.7%) and there were no differences by sex. Following adjustments, each percent EA was associated with a 1.6 kcal/day (95% Confidence interval: 0.42, 2.7 kcal/day) higher RMR (P=0.008). This equates to a 160 kcal/day lower RMR in a population of completely African ancestry, with one of completely European ancestry. Additional adjustment for trunk STFFM that partially accounts for high-metabolic rate organs did not affect this association. CONCLUSIONS EA in African Americans is strongly associated with higher RMR. The data suggest that population differences in RMR may be due to genetic variants.
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Affiliation(s)
- T M Manini
- Department of Aging and Geriatric Research, University of Florida, Institute on Aging, Gainesville, USA.
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Lee JS, Buzková P, Fink HA, Vu J, Carbone L, Chen Z, Cauley J, Bauer DC, Cappola AR, Robbins J. Subclinical thyroid dysfunction and incident hip fracture in older adults. ACTA ACUST UNITED AC 2010; 170:1876-83. [PMID: 21098345 DOI: 10.1001/archinternmed.2010.424] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Subclinical thyroid dysfunction is common in older adults and affects bone metabolism, but its effects on fracture risk have not been reported. We sought to determine prospectively whether older men and women with subclinical hyperthyroidism or hypothyroidism have an increased risk of hip fracture. METHODS Prospective cohort of 3567 US community-dwelling adults, 65 years or older, with biochemically defined subclinical thyroid dysfunction or euthyroidism was enrolled from June 10, 1989, through May 30, 1990, and followed up through 2004. Main outcome measures included incidence and hazard ratios (HRs), with 95% confidence intervals (CIs), of confirmed incident hip fractures for groups with subclinical hypothyroidism, subclinical hyperthyroidism, and euthyroidism as defined at baseline. RESULTS During 39 952 person-years (median follow-up, 13 years), hip fracture incidence (per 1000 men-years) was 13.65 in men with subclinical hyperthyroidism (n = 29) and 10.27 in men with subclinical hypothyroidism (n = 184), both greater than 5.0 in men with euthyroidism (n = 1159). Men with subclinical hypothyroidism had a multivariable-adjusted HR of 2.31 (95% CI, 1.25-4.27); those with subclinical hyperthyroidism, 3.27 (0.99-11.30). After excluding those with baseline use of thyroid-altering medications, men with endogenous subclinical hyperthyroidism had a higher HR of 4.91 (95% CI, 1.13-21.27), as did men with endogenous subclinical hypothyroidism (2.45, 1.27-4.73). Hip fracture incidence (per 1000 women-years) was 8.93 in women with subclinical hypothyroidism (n = 359) and 10.90 in women with subclinical hyperthyroidism (n = 142) compared with 10.18 in women with euthyroidism (n = 1694). No clear association between subclinical dysfunction and fracture was observed in women. CONCLUSIONS Older men with subclinical hyperthyroidism or hypothyroidism are at increased risk for hip fracture. Whether treatment of the subclinical syndrome reduces this risk is unknown.
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Affiliation(s)
- Jennifer S Lee
- Department of Internal Medicine, University of California, Davis, Sacramento, 95817, USA.
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Schafer AL, Vittinghoff E, Ramachandran R, Mahmoudi N, Bauer DC. Laboratory reproducibility of biochemical markers of bone turnover in clinical practice. Osteoporos Int 2010; 21:439-45. [PMID: 19506793 PMCID: PMC2817087 DOI: 10.1007/s00198-009-0974-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 04/01/2009] [Accepted: 04/06/2009] [Indexed: 11/03/2022]
Abstract
SUMMARY To determine the laboratory reproducibility of urine N-telopeptide and serum bone-specific alkaline phosphatase measurements, we sent identical specimens to six US commercial labs over an 8-month period. Longitudinal and within-run laboratory reproducibility varied substantially. Efforts to improve the reproducibility of these tests are needed. INTRODUCTION We assessed the laboratory reproducibility of urine N-telopeptide (NTX) and serum bone-specific alkaline phosphatase (BAP). METHODS Serum and urine were collected from five postmenopausal women, pooled, divided into identical aliquots, and frozen. To evaluate longitudinal reproducibility, identical specimens were sent to six US commercial labs on five dates over an 8-month period. To evaluate within-run reproducibility, on the fifth date, each lab was sent five identical specimens. Labs were unaware of the investigation. RESULTS Longitudinal coefficients of variation (CVs) ranged from 5.4% to 37.6% for NTX and from 3.1% to 23.6% for BAP. Within-run CVs ranged from 1.5% to 17.2% for NTX. Compared to the Osteomark NTX assay, the Vitros ECi NTX assay had significantly higher longitudinal reproducibility (mean CV 7.2% vs. 30.3%, p < 0.0005) and within-run reproducibility (mean CV 3.5% vs. 12.7%, p < 0.0005). CONCLUSIONS Reproducibility of urine NTX and serum BAP varies substantially across US labs.
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Affiliation(s)
- A L Schafer
- Department of Medicine, University of California, San Francisco, CA, USA.
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Cauley JA, LaCroix AZ, Robbins JA, Larson J, Wallace R, Wactawski-Wende J, Chen Z, Bauer DC, Cummings SR, Jackson R. Baseline serum estradiol and fracture reduction during treatment with hormone therapy: the Women's Health Initiative randomized trial. Osteoporos Int 2010; 21:167-77. [PMID: 19436934 PMCID: PMC2787820 DOI: 10.1007/s00198-009-0953-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 03/27/2009] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The purpose of the study was to test the hypothesis that the reduction in fractures with hormone therapy (HT) is greater in women with lower estradiol levels. METHODS We conducted a nested case-control study within the Women's Health Initiative HT Trials. The sample included 231 hip fracture case-control pairs and a random sample of 519 all fracture case-control pairs. Cases and controls were matched for age, ethnicity, randomization date, fracture history, and hysterectomy status. Hormones were measured prior to randomization. Incident cases of fracture were identified over an average follow-up of 6.53 years. RESULTS There was no evidence that the effect of HT on fracture differed by baseline estradiol (E2) or sex hormone binding globulin (SHBG). Across all quartiles of E2 and SHBG, women randomized to HT had about a 50% lower risk of fracture, including hip fracture, compared to placebo. CONCLUSION The effect of HT on fracture reduction is independent of estradiol and SHBG levels.
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Affiliation(s)
- J A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Cesari M, Kritchevsky SB, Newman AB, Simonsick EM, Harris TB, Penninx BW, Brach JS, Tylavsky FA, Satterfield S, Bauer DC, Rubin SM, Visser M, Pahor M. Added value of physical performance measures in predicting adverse health-related events: results from the Health, Aging And Body Composition Study. J Am Geriatr Soc 2009; 57:251-9. [PMID: 19207142 DOI: 10.1111/j.1532-5415.2008.02126.x] [Citation(s) in RCA: 429] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To determine how three different physical performance measures (PPMs) combine for added utility in predicting adverse health events in elders. DESIGN Prospective cohort study. SETTING Health, Aging and Body Composition Study. PARTICIPANTS Three thousand twenty-four well-functioning older persons (mean age 73.6). MEASUREMENTS Timed gait, repeated chair stands, and balance (semi- and full-tandem, and single leg stands each held for 30 seconds) tests were administered at baseline. Usual gait speed was categorized to distinguish high- and low-risk participants using the previously established 1-m/s cutpoint. The same population-percentile (21.3%) was used to identify cutpoints for the repeated chair stands (17.1 seconds) and balance (53.0 seconds) tests. Cox proportional hazard analyses were performed to evaluate the added value of PPMs in predicting mortality, hospitalization, and (severe) mobility limitation events over 6.9 years of follow-up. RESULTS Risk estimates for developing adverse health-related events were similarly large for each of the three high-risk groups considered separately. Having more PPM scores at the high-risk level was associated with a greater risk of developing adverse health-related events. When all three PPMs were considered, having only one poor performance was sufficient to indicate a highly significantly higher risk of (severe) lower extremity and mortality events. CONCLUSION Although gait speed is considered to be the most important predictor of adverse health events, these findings demonstrate that poor performance on other tests of lower extremity function are equally prognostic. This suggests that chair stand and standing balance performance may be adequate substitutes when gait speed is unavailable.
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Affiliation(s)
- Matteo Cesari
- Department of Aging and Geriatric Reseach, Institute on Aging, University of Florida, Gainesville, 32611, USA.
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Cauley JA, Lacroix AZ, Wu L, Horwitz M, Danielson ME, Bauer DC, Lee JS, Jackson RD, Robbins JA, Wu C, Stanczyk FZ, LeBoff MS, Wactawski-Wende J, Sarto G, Ockene J, Cummings SR. Serum 25-hydroxyvitamin D concentrations and risk for hip fractures. Ann Intern Med 2008; 149:242-50. [PMID: 18711154 PMCID: PMC2743412 DOI: 10.7326/0003-4819-149-4-200808190-00005] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The relationship between serum 25-hydroxyvitamin D [25(OH) vitamin D] concentration and hip fractures is unclear. OBJECTIVE To see whether low serum 25(OH) vitamin D concentrations are associated with hip fractures in community-dwelling women. DESIGN Nested case-control study. SETTING 40 clinical centers in the United States. PARTICIPANTS 400 case-patients with incident hip fracture and 400 control participants matched on the basis of age, race or ethnicity, and date of blood draw. Both groups were selected from 39 795 postmenopausal women who were not using estrogens or other bone-active therapies and who had not had a previous hip fracture. MEASUREMENTS Serum 25(OH) vitamin D was measured and patients were followed for a median of 7.1 years (range, 0.7 to 9.3 years) to assess fractures. RESULTS Mean serum 25(OH) vitamin D concentrations were lower in case-patients than in control participants (55.95 nmol/L [SD, 20.28] vs. 59.60 nmol/L [SD, 18.05]; P = 0.007), and lower serum 25(OH) vitamin D concentrations increased hip fracture risk (adjusted odds ratio for each 25-nmol/L decrease, 1.33 [95% CI, 1.06 to 1.68]). Women with the lowest 25(OH) vitamin D concentrations (< or =47.5 nmol/L) had a higher fracture risk than did those with the highest concentrations (> or =70.7 nmol/L) (adjusted odds ratio, 1.71 [CI, 1.05 to 2.79]), and the risk increased statistically significantly across quartiles of serum 25(OH) vitamin D concentration (P for trend = 0.016). This association was independent of number of falls, physical function, frailty, renal function, and sex-steroid hormone levels and seemed to be partially mediated by bone resorption. LIMITATIONS Few case-patients were nonwhite women. Bone mineral density and parathyroid hormone levels were not accounted for in the analysis. CONCLUSION Low serum 25(OH) vitamin D concentrations are associated with a higher risk for hip fracture.
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Affiliation(s)
- Jane A Cauley
- University of Pittsburgh, Department of Epidemiology, 130 DeSoto Street, Crabtree A524, Pittsburgh, PA 15261, USA.
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Freitas SS, Barrett-Connor E, Ensrud KE, Fink HA, Bauer DC, Cawthon PM, Lambert LC, Orwoll ES. Rate and circumstances of clinical vertebral fractures in older men. Osteoporos Int 2008; 19:615-23. [PMID: 18038109 PMCID: PMC2492834 DOI: 10.1007/s00198-007-0510-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Accepted: 09/21/2007] [Indexed: 10/22/2022]
Abstract
UNLABELLED We examined the rate of clinical vertebral fractures, and the circumstances associated with the fractures, in a cohort of 5,995 US older men. Fractures were more common in the most elderly men, and were usually associated with falls and other low-energy trauma. INTRODUCTION Little is known about clinical vertebral fractures in older men. We postulated that clinical vertebral fractures occur with falls, affect men with osteoporosis, and are more common as age increases. METHODS Five thousand nine hundred and ninety-five men aged > or =65 years were followed prospectively for an average of 4.7 years. Men with incident clinical vertebral fractures were compared to controls. RESULTS One percent (n = 61) sustained incident clinical vertebral fractures (2.2/1,000 person-years). The rate of fracture rose with age (0.7% in men 65-69 years and 5% > or =85 years). Fractured men were more likely frail (8.2% vs. 2.2%), more often fell (36.1% vs. 21%) and had lower total hip and lumbar spine BMD (all p values < or =0.002). In 73.8% of cases fractures were precipitated by no known trauma or by low-energy trauma, including falls in 57.3% Fractures were thoracic in 33% and lumbar in 56%. Men with an incident vertebral fracture were more likely to be osteoporotic (13% vs. 2%, p < 0.0001), but most men with incident fractures did not have osteoporosis. CONCLUSIONS Incident clinical vertebral fractures were relatively common in older men and the rate increased after age 80 years. Fractures were usually associated with minimal trauma, most commonly a fall.
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Affiliation(s)
- S S Freitas
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
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Hunter DJ, Li J, LaValley M, Bauer DC, Nevitt M, DeGroot J, Poole R, Eyre D, Guermazi A, Gale D, Felson DT. Cartilage markers and their association with cartilage loss on magnetic resonance imaging in knee osteoarthritis: the Boston Osteoarthritis Knee Study. Arthritis Res Ther 2008; 9:R108. [PMID: 17958892 PMCID: PMC2212578 DOI: 10.1186/ar2314] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 09/12/2007] [Accepted: 10/24/2007] [Indexed: 11/24/2022] Open
Abstract
We used data from a longitudinal observation study to determine whether markers of cartilage turnover could serve as predictors of cartilage loss on magnetic resonance imaging (MRI). We conducted a study of data from the Boston Osteoarthritis of the Knee Study (BOKS), a completed natural history study of knee osteoarthritis (OA). All subjects in the study met American College of Rheumatology criteria for knee OA. Baseline and follow-up knee magnetic resonance images were scored for cartilage loss by means of the WORMS (Whole Organ Magnetic Resonance Imaging Score) semiquantitative grading scheme. Within the BOKS population, 80 subjects who experienced cartilage loss and 80 subjects who did not were selected for the purposes of this nested case control study. We assessed the baseline levels of cartilage degradation and synthesis products by means of assays for type I and II cleavage by collagenases (Col2:3/4Cshort or C1,2C), type II cleavage only with Col2:3/4Clongmono (C2C), type II synthesis (C-propeptide), the C-telopeptide of type II (Col2CTx), aggrecan 846 epitope, and cartilage oligomeric matrix protein (COMP). We performed a logistic regression to examine the relation of levels of each biomarker to the risk of cartilage loss in any knee. All analyses were adjusted for gender, age, and body mass index (BMI); results stratified by gender gave similar results. One hundred thirty-seven patients with symptomatic knee OA were assessed. At baseline, the mean (standard deviation) age was 67 (9) years and 54% were male. Seventy-six percent of the subjects had radiographic tibiofemoral OA (Kellgren & Lawrence grade of greater than or equal to 2) and the remainder had patellofemoral OA. With the exception of COMP, none of the other biomarkers was a statistically significant predictor of cartilage loss. For a 1-unit increase in COMP, the odds of cartilage loss increased 6.09 times (95% confidence interval [CI] 1.34 to 27.67). After the analysis of COMP was adjusted for age, gender, and BMI, the risk for cartilage loss was 6.35 (95% CI 1.36 to 29.65). Among subjects with symptomatic knee OA, a single measurement of increased COMP predicted subsequent cartilage loss on MRI. The other biochemical markers of cartilage synthesis and degradation do not facilitate prediction of cartilage loss. With the exception of COMP, if changes in cartilage turnover in patients with symptomatic knee OA are associated with cartilage loss, they do not appear to affect systemic biomarker levels.
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Affiliation(s)
- David J Hunter
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA.
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Shaffer JR, Kammerer CM, Reich D, McDonald G, Patterson N, Goodpaster B, Bauer DC, Li J, Newman AB, Cauley JA, Harris TB, Tylavsky F, Ferrell RE, Zmuda JM. Genetic markers for ancestry are correlated with body composition traits in older African Americans. Osteoporos Int 2007; 18:733-41. [PMID: 17235662 DOI: 10.1007/s00198-006-0316-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Accepted: 12/07/2006] [Indexed: 12/25/2022]
Abstract
UNLABELLED Individual-specific percent European ancestry was assessed in 1,277 African Americans. We found significant correlations between proportion of European ancestry and several musculoskeletal traits, indicating that admixture mapping may be a useful strategy for locating genes affecting these traits. INTRODUCTION Genotype data for admixed populations can be used to detect chromosomal regions influencing disease risk if allele frequencies at disease-related loci differ between parental populations. We assessed evidence for differentially distributed alleles affecting bone and body composition traits in African Americans. METHODS Bone mineral density (BMD) and body composition data were collected for 1,277 African and 1,790 European Americans (aged 70-79). Maximum likelihood methods were used to estimate individual-specific percent European ancestry for African Americans genotyped at 37 ancestry-informative genetic markers. Partial correlations between body composition traits and percent European ancestry were calculated while simultaneously adjusting for the effects of covariates. RESULTS Percent European ancestry (median = 18.7%) in African Americans was correlated with femoral neck BMD in women (r = -0.18, p < 10(-5)) and trabecular spine BMD in both sexes (r = -0.18, p < 10(-5)) independently of body size, fat, lean mass, and other covariates. Significant associations of European ancestry with appendicular lean mass (r = -0.19, p < 10(-10)), total lean mass (r = -0.12, p < 10(-4)), and total body fat (r = 0.09, p < 0.002) were also observed for both sexes. CONCLUSIONS These results indicate that some population differences in body composition may be due to population-specific allele frequencies, suggesting the utility of admixture mapping for identifying susceptibility genes for osteoporosis, sarcopenia, and obesity.
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Affiliation(s)
- J R Shaffer
- Graduate School of Public Health, University of Pittsburgh, PA 15261, USA.
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Bauer DC, Ewing SK, Cauley JA, Ensrud KE, Cummings SR, Orwoll ES. Quantitative ultrasound predicts hip and non-spine fracture in men: the MrOS study. Osteoporos Int 2007; 18:771-7. [PMID: 17273893 DOI: 10.1007/s00198-006-0317-5] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Accepted: 12/07/2006] [Indexed: 11/26/2022]
Abstract
UNLABELLED Quantitative ultrasound (QUS) is associated with fracture risk in women, but there are few data in men. We studied 5,607 older men and found that QUS predicts hip and any non-spine fracture risk nearly as well as BMD. Combined measurements of QUS and BMD are not superior to either measurement alone. INTRODUCTION Quantitative ultrasound (QUS) predicts fracture risk among older women, but there are few prospective studies among older men. We studied the ability of QUS and BMD measurements to predict hip and other non-spine fractures in a population-based study of older men. METHODS Calcaneal QUS and hip BMD were measured in 5,607 men aged > or =65 years recruited from six US centers. At baseline duplicate QUS measurements with repositioning were obtained, and subsequent hip and other non-spine fractures were documented by review of x-rays or x-ray reports. The relationships between QUS and fractures were examined with proportional hazard models adjusted for age and clinic. We used receiver operating characteristic curves and predicted fracture risk models to determine the utility of QUS alone, BMD alone or the combination of QUS+BMD. RESULTS During a mean follow-up of 4.2 years with 99% complete follow-up, 239 men suffered a non-spine fracture, including 49 hip fractures. Each standard deviation reduction in broadband ultrasonic attenuation (BUA) was associated with an increased risk of hip (relative hazard=2.0, CI: 1.5, 2.8) and any non-spine fracture (relative hazard=1.6, CI: 1.4, 1.8). The area under the receiver operating characteristic curve and the predicted probability of fracture were similar for BUA alone, BMD alone and the combination of BUA+BMD, indicating that once BUA or BMD is known, the other measurement does not add useful information. Other QUS parameters gave similar results. CONCLUSIONS QUS measurements predict the risk of hip and any non-spine fracture in older men, and do so nearly as well as hip BMD measurements. Combined measurements of QUS and BMD are not superior to either measurement alone.
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Li R, Nicklas B, Pahor M, Newman A, Sutton-Tyrrell K, Harris T, Lakatta E, Bauer DC, Ding J, Satterfield S, Kritchevsky SB. Polymorphisms of angiotensinogen and angiotensin-converting enzyme associated with lower extremity arterial disease in the Health, Aging and Body Composition study. J Hum Hypertens 2007; 21:673-82. [PMID: 17429448 DOI: 10.1038/sj.jhh.1002198] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The role of renin-angiotensin system (RAS) genes on the risk of lower extremity arterial disease (LEAD) in elderly people remains unclear. We assessed the relationship of genetic polymorphisms in RAS: G-6A, T174M and M235T of the angiotensinogen (AGT) gene, and the angiotensin-converting enzyme insertion/deletion (ACE_I/D) variant to the risk of LEAD in the Health, Aging and Body Composition (Health ABC) Study. This analysis included 1228 black and 1306 white men and women whose age ranged between 70 and 79 years at the study enrollment. LEAD was defined as ankle-arm index (AAI) <0.9. Genotype-phenotype associations were estimated by regression analyses with and without adjustment for established cardiovascular disease (CVD) risk factors. The proportion of LEAD was significantly higher in black (21.1%) than that in white elderly people (10.1%, P<0.0001). The distribution of AGT polymorphisms was also significantly different between black and white participants. There was no statistically significant association between the selected RAS genetic variants and LEAD after adjustment for age, antihypertensive medications, lipid-lowering medication, pack-year smoking, body mass index, low-density lipoprotein cholesterol, and prevalent diabetes and coronary heart disease. However, A-T haplotype of G-6A and M235T interacting with homozygous ACE_II (beta=-1.07, P=0.006) and with ACE inhibitors (beta=-1.03, P=0.01) significantly decreased the risk of LEAD in white but not in black participants after adjustment for the selected CVD risk factors. In conclusion, the study observed a gene-gene and gene-drug interaction for LEAD in the white elderly.
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Affiliation(s)
- R Li
- Department of Preventive Medicine, Center for Genomics and Bioinformatics, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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Rodondi N, Taylor BC, Bauer DC, Lui LY, Vogt MT, Fink HA, Browner WS, Cummings SR, Ensrud KE. Association between aortic calcification and total and cardiovascular mortality in older women. J Intern Med 2007; 261:238-44. [PMID: 17305646 DOI: 10.1111/j.1365-2796.2007.01769.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine whether older women with abdominal aortic calcification had a greater cardiovascular and all-cause mortality, as such data are limited in older adults. DESIGN Prospective cohort study with a mean follow-up of 13 years. SETTING Community-based sample with four US clinical centres. SUBJECTS A total of 2056 women aged > or =65 years with abdominal aortic calcification assessed on baseline radiographs. MAIN OUTCOME MEASURE Mortality rate (all, cardiovascular, cancer or other cause) adjudicated from death certificates and hospital records. RESULTS The prevalence of abdominal aortic calcification increased with age, ranging from 60% at age 65-69 years to 96% at 85 years and older. Participants with aortic calcification were more likely to die during follow-up of any cause (47% vs. 27%) or a cardiovascular-specific cause (18% vs. 11%, both P < 0.001) than those without aortic calcification. In age-adjusted analyses, aortic calcification was associated with a greater rate of all-cause and cause-specific mortality (cardiovascular, cancer, and other, all P < or = 0.01). In analyses adjusted for age and cardiovascular risk factors, aortic calcification was associated with an increased rate of all-cause mortality (HR: 1.37, 95% CI: 1.15-1.64), and noncardiovascular noncancer mortality (HR: 1.57, 95% CI: 1.17-2.11). The associations between aortic calcification and cancer mortality (HR: 1.44, 95% CI: 1.00-2.08) or cardiovascular mortality (HR: 1.18, 95% CI: 0.88-1.57) showed a similar pattern without reaching statistical significance, but was slightly stronger for mortality from coronary heart disease (HR: 1.53, 95% CI: 0.91-2.56). CONCLUSIONS Abdominal aortic calcification in older women is associated with increased mortality. Future research should examine potential mechanisms for this association.
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Affiliation(s)
- N Rodondi
- Cardiovascular Prevention Clinic, University Outpatient Clinic, Department of Community Medicine and Public Health, University of Lausanne, Lausanne, Switzerland.
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Schousboe JT, Bauer DC, Nyman JA, Kane RL, Melton LJ, Ensrud KE. Potential for bone turnover markers to cost-effectively identify and select post-menopausal osteopenic women at high risk of fracture for bisphosphonate therapy. Osteoporos Int 2007; 18:201-10. [PMID: 17019515 DOI: 10.1007/s00198-006-0218-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 08/07/2006] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Over half of all fractures among post-menopausal women occur in those who do not have osteoporosis by bone density criteria. Measurement of bone turnover may cost-effectively identify a subset of women with T-score >-2.5 for whom anti-resorptive drug therapy is cost-effective. METHODS Using a Markov model, we estimated the cost per quality adjusted life year (QALY) for five years of oral bisphosphonate compared to no drug therapy for osteopenic post-menopausal women aged 60 to 80 years with a high (top quartile) or low (bottom 3 quartiles) level of a bone turnover marker. RESULTS For women with high bone turnover, the cost per QALY gained with alendronate compared to no drug therapy among women aged 70 years with T-scores of -2.0 or -1.5 were $58,000 and $80,000 (U.S. 2004 dollars), respectively. If bisphosphonates therapy also reduced the risk of non-vertebral fractures by 20% among osteopenic women with high bone turnover, then the costs per QALY gained were $34,000 and $50,000 for women age 70 with high bone turnover and T-scores of -2.0 and -1.5, respectively. CONCLUSION Measurement of bone turnover markers has the potential to identify a subset of post-menopausal women without osteoporosis by bone density criteria for whom bisphosphonate therapy to prevent fracture is cost-effective. The size of that subset highly depends on the assumed efficacy of bisphosphonates for fracture risk reduction among women with both a T-score >-2.5 and high bone turnover and the cost of bisphosphonate treatment.
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Affiliation(s)
- J T Schousboe
- Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
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Hillier TA, Stone KL, Bauer DC, Rizzo JH, Pedula KL, Cauley JA, Ensrud KE, Hochberg MC, Cummings SR. Evaluating the Value of Repeat Bone Mineral Density Measurement and Prediction of Fractures in Older Women. ACTA ACUST UNITED AC 2007; 167:155-60. [PMID: 17242316 DOI: 10.1001/archinte.167.2.155] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Whether repeat bone mineral density (BMD) measurement adds benefit beyond the initial BMD measurement in predicting fractures in older women is unknown. METHODS We prospectively measured total hip BMD in 4124 older women (mean +/- SD age, 72 +/- 4 years) from 1989 to 1990 and again 8 years later. Incident nontraumatic hip and nonspine fractures were validated by radiology reports (>95% follow-up). In addition, spine fractures were defined morphometrically in 2129 of these women by lateral spine x-ray films from 1991 to 1992 and then again 11.4 years later. Prediction of fracture risk was assessed with proportional hazards models and receiver operating characteristic curves for BMD measures. RESULTS Over a mean of 5 years after the repeat BMD measure, 877 women experienced an incident nontraumatic nonspine fracture (275 hip fractures). In addition, 340 women developed a spine fracture. After adjustment for age and weight change, initial and repeat BMD measurements were similarly associated with fracture risk (per unit standard deviation lower in BMD) for nonspine (hazard ratio, 1.6), spine (odds ratio, 1.8-1.9), and hip (hazard ratio, 2.0-2.2) fractures (P<.001 for all models). Areas under the receiver operating characteristic curves (AUC) revealed no significant differences to discriminate nonspine (AUC, 0.65), spine (AUC, 0.67-0.68), or hip (AUC, 0.73-0.74) fractures between models with initial BMD, repeat BMD, or initial BMD plus change in BMD. Stratification by initial BMD t scores (normal, osteopenic, or osteoporotic), high bone loss, or hormone therapy did not alter results. CONCLUSION In healthy, older, postmenopausal women, repeating a measurement of BMD up to 8 years later provides little additional value besides the initial BMD measurement for predicting incident fractures.
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Affiliation(s)
- Teresa A Hillier
- Center for Health Research, Kaiser Permanente Northwest/Hawaii, Portland, OR 97227, USA.
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Abstract
Differential effectiveness of treatments across subgroups defined by pretreatment variables are of increasing interest, particularly in the expanding research field of pharmacogenomics. When the pretreatment variable is difficult to obtain or expensive to measure, but can be assessed at the end of the study using stored samples, nested case-control and case-cohort methods can be used to reduce costs in large efficacy trials with rare outcomes. Case-only methods are even more efficient, and reliable under a range of circumstances.
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Affiliation(s)
- E Vittinghoff
- Department of Epidemiology and Biostatistics, Division of Biostatistics, University of California, San Francisco, California 94143, USA.
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Bauer DC, Hunter DJ, Abramson SB, Attur M, Corr M, Felson D, Heinegård D, Jordan JM, Kepler TB, Lane NE, Saxne T, Tyree B, Kraus VB. Classification of osteoarthritis biomarkers: a proposed approach. Osteoarthritis Cartilage 2006; 14:723-7. [PMID: 16733093 DOI: 10.1016/j.joca.2006.04.001] [Citation(s) in RCA: 279] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Accepted: 04/04/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) biomarkers are needed by researchers and clinicians to assist in disease diagnosis and assessment of disease severity, risk of onset, and progression. As effective agents for OA are developed and tested in clinical studies, biomarkers that reliably mirror or predict the progression or amelioration of OA will also be needed. METHODS The NIH-funded OA Biomarkers Network is a multidisciplinary group interested in the development and validation of OA biomarkers. This review summarizes our efforts to characterize and classify OA biomarkers. RESULTS We propose the "BIPED" biomarker classification (which stands for Burden of Disease, Investigative, Prognostic, Efficacy of Intervention and Diagnostic), and offer suggestions on optimal study design and analytic methods for use in OA investigations. CONCLUSION The BIPED classification provides specific biomarker definitions with the goal of improving our ability to develop and analyze OA biomarkers, and to communicate these advances within a common framework.
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Affiliation(s)
- D C Bauer
- Department of Medicine, University of California, San Francisco, CA 94107, USA.
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Farhat GN, Strotmeyer ES, Newman AB, Sutton-Tyrrell K, Bauer DC, Harris T, Johnson KC, Taaffe DR, Cauley JA. Volumetric and areal bone mineral density measures are associated with cardiovascular disease in older men and women: the health, aging, and body composition study. Calcif Tissue Int 2006; 79:102-11. [PMID: 16927045 DOI: 10.1007/s00223-006-0052-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2006] [Accepted: 05/23/2006] [Indexed: 10/24/2022]
Abstract
The associations of volumetric (vBMD) and areal (aBMD) bone mineral density measures with prevalent cardiovascular disease (CVD) and subclinical peripheral arterial disease (PAD) were investigated in a cohort of older men and women enrolled in the Health, Aging, and Body Composition Study. Participants were 3,075 well-functioning white and black men and women (42% black, 51% women), aged 68-80 years. Total hip, femoral neck, and trochanter aBMD were measured using dual-energy X-ray absorptiometry. Quantitative computed tomography was used to evaluate spine trabecular, integral, and cortical vBMD measures in a subgroup (n = 1,489). Logistic regression was performed to examine associations of BMD measures with CVD and PAD. The prevalence of CVD (defined by coronary heart disease, PAD, cerebrovascular disease, or congestive heart failure) was 29.8%. Among participants without CVD, 10% had subclinical PAD (defined as ankle-arm index <0.9). Spine vBMD measures were inversely associated with CVD in men (odds ratio of integral [OR(integral)] = 1.34, 95% confidence interval [CI] 1.10-1.63; OR(trabecular )= 1.25, 95% CI 1.02-1.53; OR(cortical )= 1.36, 95% CI 1.11-1.65). In women, for each standard deviation decrease in integral vBMD, cortical vBMD, or trochanter aBMD, the odds of CVD were significantly increased by 28%, 27%, and 22%, respectively. Total hip aBMD was associated with subclinical PAD in men (OR = 1.39, 95% CI 1.03-1.84) but not in women. All associations were independent of age and shared risk factors between BMD and CVD and were not influenced by inflammatory cytokines (interleukin-6 and tumor necrosis factors-alpha). In conclusion, our results provide further evidence for an inverse association between BMD and CVD in men and women. Future research should investigate common pathophysiological links for osteoporosis and CVD.
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Affiliation(s)
- G N Farhat
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, 127 Parran Hall, PA 15261, USA.
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Bauer DC, Stavitsky AB. ON THE DIFFERENT MOLECULAR FORMS OF ANTIBODY SYNTHESIZED BY RABBITS DURING THE EARLY RESPONSE TO A SINGLE INJECTION OF PROTEIN AND CELLULAR ANTIGENS. Proc Natl Acad Sci U S A 2006; 47:1667-80. [PMID: 16590890 PMCID: PMC223190 DOI: 10.1073/pnas.47.10.1667] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- D C Bauer
- DEPARTMENT OF MICROBIOLOGY, WESTERN RESERVE UNIVERSITY SCHOOL OF MEDICINE
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Bauer DC, Garnero P, Bilezikian JP, Greenspan SL, Ensrud KE, Rosen CJ, Palermo L, Black DM. Short-term changes in bone turnover markers and bone mineral density response to parathyroid hormone in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 2006; 91:1370-5. [PMID: 16449339 DOI: 10.1210/jc.2005-1712] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT Treatment of osteoporotic women with PTH increases biochemical markers of bone turnover, increases axial bone mineral density (BMD), and reduces fracture risk. OBJECTIVE Our objective was to determine the relationship between levels of baseline turnover before PTH therapy and short-term changes in turnover during PTH therapy and subsequent changes in areal and volumetric BMD. DESIGN AND SETTING We conducted a randomized, placebo-controlled trial at four academic centers. PATIENTS Patients included 238 postmenopausal women with low hip or spine BMD. INTERVENTION Subjects were randomized to sc PTH (1-84), 100 mug/d (119 women), for 1 yr. MAIN OUTCOME MEASURE Bone turnover markers were measured in fasting blood samples collected before therapy and after 1 and 3 months. Areal and volumetric BMD at the spine and hip were assessed by dual-energy x-ray absorptiometry and quantitative computed tomography (QCT) after 1 yr of therapy. RESULTS Among women treated with PTH alone, the relationships between baseline turnover and 1-yr changes in dual-energy x-ray absorptiometry and QCT BMD were inconsistent. Greater 1- and 3-month increases in turnover, particularly the formation marker N-propeptide of type I collagen, were associated with greater increases in areal BMD. When volumetric hip and spine BMD were assessed by QCT, greater short-term increases in turnover were even more positively associated with 1-yr increases in BMD. Each sd increase in the 3-month change of N-propeptide of type I collagen was associated with an a 21% greater increase in QCT spine trabecular BMD. CONCLUSIONS Greater short-term changes in turnover with PTH therapy are associated with greater 1-yr increases in spine and hip BMD among postmenopausal osteoporotic women.
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Affiliation(s)
- D C Bauer
- Department of Medicine, University of California-San Francisco Coordinating Center, 185 Berry 5700, San Francisco, CA 94107, USA.
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Jamal SA, Leiter RE, Jassal V, Hamilton CJ, Bauer DC. Impaired muscle strength is associated with fractures in hemodialysis patients. Osteoporos Int 2006; 17:1390-7. [PMID: 16799753 DOI: 10.1007/s00198-006-0133-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Accepted: 03/29/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Fractures are extremely common among hemodialysis (HD) patients. METHODS To assess if bone mineral density (BMD) and/or tests of muscle strength were associated with fractures, we studied 37 men and 15 women, 50 years and older, on HD for at least 1 year. We excluded subjects with prior renal transplants and women taking hormone replacement therapy. We inquired about low-trauma fractures since starting dialysis. Subjects underwent BMD testing with a Lunar DPX-L densitometer. Tests of muscle strength included: timed up and go (TUG), 6-min walk, functional reach, and grip strength. Lateral and thoracic radiographs of the spine were obtained and reviewed for prevalent vertebral fractures. We used logistic regression to examine associations between fracture (prevalent vertebral, self-reported low trauma since starting dialysis and/or both) and BMD, and fracture and muscle-strength tests. Analyses were adjusted for age, weight, and gender. RESULTS Mean age was 66+/-9.0 years, mean weight was 72.9+/-15.2 kg, and most (35 of 52) participants were Caucasian. Average duration of dialysis was 40.2 (interquartile range: 24-61.2) months. The most common cause of renal failure was diabetes (16 subjects). There were no differences by gender or fracture. Of the 52 subjects, 27 had either a vertebral fracture or low trauma fracture. There was no association between fractures, hip or spine BMD, or grip strength. In contrast, greater functional reach [odds ratio (OR) per standard deviation (SD) increase: 0.29; 95% CI: 0.13-0.69), quicker TUG (OR per SD decrease: 0.14; 95% CI: 0.11-0.23), and a greater distance walked in 6 min (OR per SD increase: 0.10; 95% CI: 0.03-0.36) were all associated with a reduced risk of fracture. CONCLUSIONS Impaired neuromuscular function is associated with fracture in hemodialysis patients.
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Affiliation(s)
- S A Jamal
- Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
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Yende S, Waterer GW, Tolley EA, Newman AB, Bauer DC, Taaffe DR, Jensen R, Crapo R, Rubin S, Nevitt M, Simonsick EM, Satterfield S, Harris T, Kritchevsky SB. Inflammatory markers are associated with ventilatory limitation and muscle dysfunction in obstructive lung disease in well functioning elderly subjects. Thorax 2005; 61:10-6. [PMID: 16284220 PMCID: PMC2080698 DOI: 10.1136/thx.2004.034181] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Inflammatory markers are increased in chronic obstructive pulmonary disease (COPD) and are hypothesised to play an important part in muscle dysfunction and exercise intolerance. METHODS The Health Aging and Body Composition (Health ABC) study is a prospective observational cohort of well functioning individuals aged 70-79 years. A cross sectional analysis of the baseline data was conducted to examine the association between inflammatory markers and ventilatory limitation, muscle strength, and exercise capacity. These associations were compared in participants with and without obstructive lung disease (OLD). RESULTS Of the 3075 participants enrolled in the Health ABC cohort, OLD was identified by spirometric testing in 268 participants and 2005 participants had normal spirometric results. Of the participants with OLD, 35%, 38%, and 27% participants had mild, moderate, and severe OLD, respectively. Participants with OLD had lower quadriceps strength (102.5 Nm v 108.9 Nm, p = 0.02), lower maximum inspiratory pressure (64.7 cm H(2)O v 74.2 cm H(2)O, p<0.0001), higher systemic interleukin (IL)-6 levels (2.6 pg/ml v 2.2 pg/ml, p<0.0001), and higher C-reactive protein (CRP) levels (3.5 mg/l v 2.5 mg/l, p<0.0001) than those with normal spirometry. In participants with OLD and those with normal spirometry, forced expiratory volume in 1 second (FEV(1)) was associated with IL-6 (adjusted regression coefficients (beta) = -5.3 (95% CI -9.1 to-1.5) and -3.1 (95% CI -4.3 to -1.9), respectively). IL-6 and TNF were also associated with quadriceps strength among participants with OLD and those with normal spirometry (beta = -6.4 (95% CI -12.8 to -0.03) and -3.4 (95% CI -5.4 to -1.3), respectively, for IL-6 and beta = -10.1 (95% CI -18.7 to -1.5) and -3.8 (95% CI -7 to -0.6), respectively, for TNF). IL-6, quadriceps strength, and maximum inspiratory pressures were independent predictors of reduced exercise capacity in both groups. CONCLUSIONS In well functioning elderly subjects with or without OLD, IL-6 is associated with reduced FEV(1), quadriceps strength, and exercise capacity.
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Affiliation(s)
- S Yende
- CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, PA 15238, USA.
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Abstract
BACKGROUND Fractures and atherosclerosis are common in patients with renal failure; this may be due to hyperhomocysteinemia. AIM To examine the relationships between fractures, vascular calcification and homocysteine levels in haemodialysis patients. DESIGN Cross-sectional survey. METHODS We enrolled 37 men and 15 women who had been on haemodialysis for at least 1 year. We identified prevalent spine fractures by radiographs. Non-spine fractures were identified by self-report and confirmed by review of radiographs or radiology reports. We classified the presence and severity of lumbar aortic calcifications with lateral lumbar radiographs. We measured serum homocysteine in all subjects within 30 days of study entry. RESULTS After adjusting for age and weight, increased levels of homocysteine were associated with an increased risk fracture (OR per mmol/l increase in homocysteine 1.6, 95%CI 1.2-2.0), as was the presence of aortic calcification (OR 1.6, 95%CI 1.2-2.1). Homocysteine and lumbar aortic calcification were highly correlated (r = 0.86). DISCUSSION Hyperhomocysteinaemia may explain the relationship between fractures and atherosclerosis in patients with renal failure.
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Affiliation(s)
- S A Jamal
- Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Canada.
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Duboeuf F, Bauer DC, Chapurlat RD, Dinten JMP, Delmas P. Assessment of vertebral fracture using densitometric morphometry. J Clin Densitom 2005; 8:362-8. [PMID: 16055969 DOI: 10.1385/jcd:8:3:362] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2004] [Revised: 01/14/2005] [Accepted: 03/28/2005] [Indexed: 11/11/2022]
Abstract
Diagnosis of vertebral fracture is critical for management of osteoporosis, as existence of such deformities substantially increases the risk of subsequent fracture. Thus, accurate and precise techniques allowing detection of such deformities are essential to clinicians. So far, this detection has been performed by spinal lateral X-rays. More advanced techniques have recently been developed, based on dual energy X-ray absorptiometry (DXA). This review describes these different techniques and discusses the effectiveness of the DXA technique to assess vertebral deformities compared to X-ray. The use of DXA detection of vertebral fracture for clinical practice and clinical trials is discussed. Specifically, vertebral morphometry using DXA provides an excellent specificity, with moderate sensitivity. The major limitation of the DXA vertebral assessment is the poor quality of images of thoracic vertebrae. The clinical utility of vertebral morphometry using densitometry may help screening patients with vertebral fracture, but technological improvements are necessary to improve image quality.
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Affiliation(s)
- F Duboeuf
- INSERM U403, Hôpital Edouard Herriot, Lyon cedex, France, and Prevention Sciences Group, University of California at San Francisco, USA.
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