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Gagesch M, Wieczorek M, Vellas B, Kressig RW, Rizzoli R, Kanis J, Willett WC, Egli A, Lang W, Orav EJ, Bischoff-Ferrari HA. Effects of Vitamin D, Omega-3 Fatty Acids and a Home Exercise Program on Prevention of Pre-Frailty in Older Adults: The DO-HEALTH Randomized Clinical Trial. J Frailty Aging 2022; 12:71-77. [PMID: 36629088 DOI: 10.14283/jfa.2022.48] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The benefits of supplemental vitamin D3, marine omega-3 fatty acids, and a simple home exercise program (SHEP) on frailty prevention in generally healthy community-dwelling older adults are unclear. OBJECTIVE To test the effect of vitamin D3, omega-3s, and a SHEP, alone or in combination on incident pre-frailty and frailty in robust older adults over a follow-up of 36 months. METHODS DO-HEALTH is a multi-center, double-blind, placebo-controlled, 2x2x2 factorial randomized clinical trial among generally healthy European adults aged 70 years or older, who had no major health events in the 5 years prior to enrollment, sufficient mobility and intact cognitive function. As a secondary outcome of the DO-HEALTH trial, among the subset of participants who were robust at baseline, we tested the individual and combined benefits of supplemental 2,000 IU/day of vitamin D3, 1 g/day of marine omega-3s, and a SHEP on the odds of being pre-frail and frail over 3 years of follow-up. RESULTS At baseline, 1,137 out of 2,157 participants were robust (mean age 74.3 years, 56.5% women, mean gait speed 1.18 m/s). Over a median follow-up time of 2.9 years, 696 (61.2%) became pre-frail and 29 (2.6%) frail. Odds ratios for becoming pre-frail were not significantly lower for vitamin D3, or omega 3-s, or SHEP, individually, compared to control (placebo for the supplements and control exercise). However, the three treatments combined showed significantly decreased odds (OR 0.61 [95% CI 0.38-0.98; p=0.04) of becoming pre-frail compared to control. None of the individual treatments or their combination significantly reduced the odds of becoming frail. CONCLUSION Robust, generally healthy and active older adults without major comorbidities, may benefit from a combination of high-dose, supplemental vitamin D3, marine omega-3s, and SHEP with regard to the risk of becoming pre-frail over 3 years.
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Affiliation(s)
- M Gagesch
- Michael Gagesch, MD, Department of Aging Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland,
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Reginster J, Cooper C, Kanis J, Schneider M, Bruyère O, Rizzoli R. CAPTURE THE FRACTURE: INTEGRATED CARE PREVENTS THE DECREASE IN INTRINSIC CAPACITY IN ELDERLY SUBJECTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J. Reginster
- ESCEO ASBL, Liège, Liège, Belgium,
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Liège, Belgium,
| | - C. Cooper
- ESCEO ASBL, Liège, Liège, Belgium,
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom,
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, United Kingdom,
| | - J. Kanis
- ESCEO ASBL, Liège, Liège, Belgium,
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom,
| | - M. Schneider
- Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom,
| | - O. Bruyère
- ESCEO ASBL, Liège, Liège, Belgium,
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Liège, Belgium,
| | - R. Rizzoli
- ESCEO ASBL, Liège, Liège, Belgium,
- Service of Bone Diseases, Faculty of Medicine, Geneva, University Hospitals, Geneva, Switzerland
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McCloskey E, Kanis J, Reginster J, Cooper C, Rizzoli R, Cruz Jentoft A, Landi F. DETERMINING THE ROLE OF SARCOPENIA IN THE DECLINE OF INTRINSIC CAPACITY IN ELDERLY SUBJECTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E. McCloskey
- Centre for Integrated Research in Musculosksletal Ageing, University of Sheffield, Sheffield, United Kingdom,
| | - J. Kanis
- Centre for Integrated Research in Musculosksletal Ageing, University of Sheffield, Sheffield, United Kingdom,
| | | | - C. Cooper
- University of Southampton, Southampton, United Kingdom,
| | - R. Rizzoli
- University Hospitals Geneva, Geneva, Switzerland,
| | | | - F. Landi
- Universita Cattolica del Sacro Cuore, Rome, Italy
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Vala CH, Odén A, Lorentzon M, Sundh V, Johansson H, Karlsson M, Rosengren B, Ohlsson C, Johansson B, Kanis J, Mellström D. Increased risk of hip fracture among spouses-evidence of a homogamy effect. Osteoporos Int 2017; 28:95-102. [PMID: 27585578 PMCID: PMC5206252 DOI: 10.1007/s00198-016-3738-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 08/10/2016] [Indexed: 12/22/2022]
Abstract
UNLABELLED Spouses tend to share habits and therefore have an increased risk of same diseases. We followed all married couples in Sweden, born 1902 to 1942, in hospital records from 1987 to 2002, and found that individuals whose spouse had a hip fracture had an increased risk of hip fracture. INTRODUCTION The purpose of this study was to determine whether spouses of hip fracture patients have an elevated risk of hip fracture. METHODS We performed a retrospective cohort study of all couples married for at least 5 years in Sweden and born between 1902 and 1942 (n = 904,451) and all patients registered with a hip fracture (n = 218,285) in the National Inpatients Register in Sweden from 1987 to 2002. RESULTS During the period 1987 to 2002 hip fractures occurred among spouses in 4212 married couples. The hazard ratio (HR) for hip fracture in a married woman following hip fracture in the husband was 1.11 (95 % confidence interval 1.07 to 1.16) compared to a woman whose husband did not have hip fracture. The corresponding HR for a married man was 1.20 (1.15 to 1.26) compared to a man whose wife did not have hip fracture. The risk was significantly elevated over the age range 60 to 90 years. The increased risk for hip fracture among spouses remained after adjustments for income, education, geographical latitude and urbanisation. In a common model with spouses and their siblings, the HR for spousal effect were 1.63 (1.01 to 2.64) and for sibling effect 2.18 (1.55 to 3.06) compared to married with spouse and sibling respectively without hip fracture. CONCLUSION The novel finding of an increased risk for hip fracture among spouses provides evidence indicating that there is a homogamy effect due to common social and lifestyle factors but could also be due to assortative mating.
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Affiliation(s)
- C H Vala
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 431 80, Mölndal, Sweden
| | - A Odén
- Department of Biostatics, Chalmers University, 412 58, Gothenburg, Sweden
| | - M Lorentzon
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 431 80, Mölndal, Sweden
- Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - V Sundh
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 431 80, Mölndal, Sweden
| | - H Johansson
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 431 80, Mölndal, Sweden
| | - M Karlsson
- Department of Orthopedics and Clinical Sciences, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - B Rosengren
- Department of Orthopedics and Clinical Sciences, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - C Ohlsson
- Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - B Johansson
- Department of Psychology, University of Gothenburg, 405 30, Gothenburg, Sweden
| | - J Kanis
- Centre for Metabolic Bone Disease, Medical School, University of Sheffield, Sheffield, S10 2RX, UK
| | - D Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 431 80, Mölndal, Sweden.
- Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
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Kanis J, Link V, Dippon C, Becker N, Kübler A. Schlaf, Kindlein, schlaf? Somnologie 2016. [DOI: 10.1007/s11818-016-0092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jürisson M, Pisarev H, Kanis J, Borgström F, Svedbom A, Kallikorm R, Lember M, Uusküla A. Quality of life, resource use, and costs related to hip fracture in Estonia. Osteoporos Int 2016; 27:2555-66. [PMID: 26905271 DOI: 10.1007/s00198-016-3544-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 09/27/2015] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED We assessed the impact of hip fracture on health-related quality of life (HRQoL) and costs in Estonia. The mean 18-month HRQoL loss in quality adjusted life years (QALY) was estimated at 0.31, and the average cumulative cost from a societal perspective was 8146 euros per hip fracture patient. INTRODUCTION The aim of this study is to estimate the impact of hip fracture on HRQoL, resource consumption, and cost over 18 months after the fracture among individuals aged over 50 in Estonia. METHODS A cohort of 205 hip fracture patients ≥50 years was followed up for 18 months. HRQoL was estimated before fracture (recall), after fracture, and at 4, 12, and 18 months using the EQ-5D instrument. Health care utilization and costs were obtained from a public health insurance fund database; social, informal, and indirect costs were estimated using patient-reported data. RESULTS Hip fracture resulted in the mean 18-month HRQoL loss of 0.31 QALYs. The mean 18-months cumulative cost of hip fracture from a societal perspective was estimated at 8146 (95 % CI 6236-10717) euros per patient. Most of the cost was related to health care (56 %) and informal care (33 %), while social care contributed only 5 %. Utilization of outpatient rehabilitation and nursing care was low (8 % of patients). CONCLUSIONS The impact of hip fracture on HRQoL and cost was substantial. Despite appropriate inpatient care, utilization of rehabilitation, nursing care, and social care were low and potentially insufficient to meet the needs of patients with low HRQoL. The shortfall may partially explain a remarkably high use of informal care.
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Affiliation(s)
- M Jürisson
- Department of Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia.
| | - H Pisarev
- Department of Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - J Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - F Borgström
- Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - A Svedbom
- Mapigroup, Klarabergsviadukten 90, Hus D, 111 64, Stockholm, Sweden
- Unit of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Karolinska Universitetssjukhuset, 171 76, Stockholm, Sweden
| | - R Kallikorm
- Department of Internal Medicine, University of Tartu and Tartu University Hospital, L. Puusepa st 8, 51014, Tartu, Estonia
| | - M Lember
- Department of Internal Medicine, University of Tartu and Tartu University Hospital, L. Puusepa st 8, 51014, Tartu, Estonia
| | - A Uusküla
- Department of Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
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Reginster JY, Reiter-Niesert S, Bruyère O, Berenbaum F, Brandi ML, Branco J, Devogelaer JP, Herrero-Beaumont G, Kanis J, Maggi S, Maheu E, Richette P, Rizzoli R, Cooper C. Recommendations for an update of the 2010 European regulatory guideline on clinical investigation of medicinal products used in the treatment of osteoarthritis and reflections about related clinically relevant outcomes: expert consensus statement. Osteoarthritis Cartilage 2015; 23:2086-2093. [PMID: 26187570 DOI: 10.1016/j.joca.2015.07.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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: 01/05/2015] [Revised: 07/01/2015] [Accepted: 07/07/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The European Society on Clinical and Economic aspects of Osteoporosis and Osteoarthritis (ESCEO) organised a working group to evaluate the need for updating the current European guideline on clinical investigation of drugs used in the treatment of osteoarthritis (OA). DESIGN Areas of potential attention were identified and the need for modifications, update or clarification was examined. Proposals were then developed based on literature reviews and through a consensus process. RESULTS It was agreed that the current guideline overall still reflects the current knowledge in OA, although two possible modifications were identified. The first relates to the number and timing of measurements required as primary endpoints during clinical trials of symptom-relieving drugs, either drugs with rapid onset of action or slow acting drugs. The suggested modifications are intended to take into consideration the time related clinical need and expected time response to these drugs - i.e., a more early effect for the first category in addition to the maintenance of effect, a more continuous benefit over the long-term for the latter - in the timing of assessments. Secondly, values above which a benefit over placebo should be considered clinically relevant were considered. Based on literature reviews, the most consensual values were determined for primary endpoints of both symptom-relieving drugs (i.e., pain intensity on a visual analogue scale (VAS)) and disease-modifying drugs (i.e., radiographic joint-space narrowing). CONCLUSIONS This working document might be considered by the European regulatory authorities in a future update of the guideline for the registration of drugs in OA.
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Affiliation(s)
- J-Y Reginster
- Department of Public Health Sciences, University of Liège and CHU Centre Ville, Liège, Belgium.
| | - S Reiter-Niesert
- Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| | - O Bruyère
- Department of Public Health Sciences, University of Liège and CHU Centre Ville, Liège, Belgium
| | - F Berenbaum
- Department of Rheumatology, University Pierre and Marie Curie AP-HP, Hôpital Saint-Antoine, Paris, France; University of Paris06, INSERM, UMR-S938, Paris, France
| | - M-L Brandi
- Department of Internal Medicine, University of Florence, Florence, Italy
| | - J Branco
- CEDOC - Department of Rheumatology, Faculdade de Ciências Médicas, Universidade Novade Lisboa, Lisbon, Portugal; CHLO, EPE-Hospital Egas Moniz, Lisbon, Portugal
| | - J-P Devogelaer
- Department of Rheumatology, Saint-Luc University Hospital, Catholic University, Louvain, Belgium
| | | | - J Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - S Maggi
- Aging Program, National Research Council, Padova, Italy
| | - E Maheu
- Rheumatology Department, AP-HP, St-Antoine Hospital, Paris, France
| | - P Richette
- Paris Diderot University, UFR médicale, Paris, France; AP-HP, Hôpital Lariboisière, fédération de Rhumatologie, Paris, France
| | - R Rizzoli
- Service of Bone Diseases, Department of Rehabilitation and Geriatrics, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - C Cooper
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK; MRC Epidemiology Resource Centre, University of Southampton, Southampton, UK
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Kanis J, Orourke N, McCloskey E. Consequences of neoplasia induced bone-resorption and the use of clodronate (review). Int J Oncol 2012; 5:713-31. [PMID: 21559634 DOI: 10.3892/ijo.5.4.713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
There are several mechanisms whereby the skeleton loses bone tissue in patients with malignant diseases. They include an increase in skeletal turnover, imbalances between bone formation and resorption, and uncoupled bone resorption. Additionally, bone loss may be focal and confined to sites of metastatic disease or generalised due to endocrine consequences of malignancy. Irrespective of the mechanism and pattern of bone loss, this is largely if not exclusively mediated by activation of the bone resorbing cells (osteoclasts) rather than due to direct effects of tumour tissue or their products on bone. The bisphosphonates are potent and specific inhibitors of osteoclast mediated bone resorption. They accumulate at skeletal sites, particularly at sites of disease activity and are not metabolised in vivo. Of the several bisphosphonates tested in man, clodronate is of particular interest since it can be given both intravenously and by mouth, and unlike etidronate does not impair the mineralisation of bone. It has been shown to be highly effective in the management of hypercalcaemia of malignancy, and in some patients, for the acute management of bone pain. Well designed long-term studies indicate that its long-term use decreases the development of skeletal complications of malignancy including the incidence of hypercalcaemia, severe bone pain, fractures and retards the development or extension of osteolytic foci. For these reasons clodronate affords a useful adjunctive role in the management of osteolytic bone disease.
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Goldhahn J, Féron JM, Kanis J, Papapoulos S, Reginster JY, Rizzoli R, Dere W, Mitlak B, Tsouderos Y, Boonen S. Implications for fracture healing of current and new osteoporosis treatments: an ESCEO consensus paper. Calcif Tissue Int 2012; 90:343-53. [PMID: 22451221 DOI: 10.1007/s00223-012-9587-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [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: 11/29/2011] [Accepted: 02/15/2012] [Indexed: 12/27/2022]
Abstract
Osteoporotic fracture healing is critical to clinical outcome in terms of functional recovery, morbidity, and quality of life. Osteoporosis treatments may affect bone repair, so insights into their impact on fracture healing are important. We reviewed the current evidence for an impact of osteoporosis treatments on bone repair. Treatment with bisphosphonate in experimental models is associated with increased callus size and mineralization, reduced callus remodeling, and improved mechanical strength. Local and systemic bisphosphonate treatment may improve implant fixation. No negative impact on fracture healing has been observed, even after major surgery or when administered immediately after fracture. Experimental data for denosumab and raloxifene suggest no negative implications for bone repair. The extensive experimental results for teriparatide indicate increased callus formation, improved biomechanical strength, and greater external callus volume and total bone mineral content and density. Case reports and a randomized trial have produced mixed results but are consistent with a positive impact of teriparatide on clinical fracture healing. Studies with strontium ranelate in models of fracture healing indicate that it is associated with improved bone microstructure, callus volume, and biomechanical properties. Finally, there is experimental evidence for a beneficial effect of some of the agents currently being developed for osteoporosis, notably sclerostin antibody and DKK1 antibody. There is currently no evidence that osteoporosis treatments are detrimental for bone repair and some promising experimental evidence for positive effects on healing, notably for agents with a bone-forming mode of action, which may translate into therapeutic applications.
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Affiliation(s)
- J Goldhahn
- AO Clinical Priority Program "Fracture Fixation in Osteoporotic Bone", Institute for Biomechanics of ETH, Zurich, Switzerland.
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Johansson H, Odén A, Kanis J, McCloskey E, Lorentzon M, Ljunggren Ö, Karlsson MK, Thorsby PM, Tivesten Å, Barrett-Connor E, Ohlsson C, Mellström D. Low serum vitamin D is associated with increased mortality in elderly men: MrOS Sweden. Osteoporos Int 2012; 23:991-9. [PMID: 22008880 DOI: 10.1007/s00198-011-1809-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [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: 03/22/2011] [Accepted: 08/04/2011] [Indexed: 12/31/2022]
Abstract
UNLABELLED In elderly man, low serum 25-hydroxyvitamin D (25(OH)D) was associated with a substantial excess risk of death compared to 25(OH)D values greater than 50-70 nmol/l, but the association attenuated with time. INTRODUCTION The aim of the present study was to determine whether poor vitamin D status was associated with an increase in the risk of death in elderly men. METHODS We studied the relationship between serum 25(OH)D and the risk of death in 2,878 elderly men drawn from the population and recruited to the MrOS study in Sweden. Baseline data included general health and lifestyle measures and serum 25(OH)D measured by competitive RIA. Men were followed for up to 8.2 years (average 6.0 years). RESULTS Mortality adjusted for comorbidities decreased by 5% for each SD increase in 25(OH)D overall (gradient of risk 1.05; 95% confidence interval 0.96-1.14). The predictive value of 25(OH)D for death was greatest below a threshold value of 50-70 nmol/l, was greatest at approximately 3 years after baseline and thereafter decreased with time. CONCLUSIONS Low serum 25(OH)D is associated with a substantial excess risk of death compared to 25(OH)D values greater than 50-70 nmol/l, but the association attenuates with time. These findings, if causally related, have important implications for intervention in elderly men.
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Affiliation(s)
- H Johansson
- Centre for Bone and Arthritis Research, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gibraltargatan 1 C, 411 32 Gothenburg, Sweden.
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Johansson H, Odén A, Kanis J, McCloskey E, Lorentzon M, Ljunggren Ö, Karlsson MK, Orwoll E, Tivesten Å, Ohlsson C, Mellström D. Low bone mineral density is associated with increased mortality in elderly men: MrOS Sweden. Osteoporos Int 2011; 22:1411-8. [PMID: 20585938 DOI: 10.1007/s00198-010-1331-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [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: 03/02/2010] [Accepted: 06/04/2010] [Indexed: 11/24/2022]
Abstract
SUMMARY We studied the nature of the relationship between bone mineral density (BMD) and the risk of death among elderly men. BMD was associated with mortality risk and was independent of adjustments for other co-morbidities. A piecewise linear function described the relationship more accurately than assuming the same gradient of risk over the whole range of BMD (p = 0.020). Low BMD was associated with a substantial excess risk of death, whilst a higher than average BMD had little impact on mortality. INTRODUCTION Previous studies have demonstrated an association between low BMD and an increased risk of death among men and women. The aim of the present study was to examine the pattern of the risk in men and its relation to co-morbidities. METHODS We studied the nature of the relationship between BMD and death among 3,014 elderly men drawn from the population and recruited to the MrOS study in Sweden. Baseline data included general health questionnaires, life style questionnaires and BMD measured using DXA. Men were followed for up to 6.5 years (average 4.5 years). Poisson regression was used to investigate the relationship between BMD, co-morbidities and the hazard function of death. RESULTS During follow-up, 382 men died (all-cause mortality). Low BMD at all measured skeletal sites was associated with increased mortality. In multivariate analyses, the relationship between BMD and mortality was non-linear, and a piecewise linear function described the relationship more accurately than assuming the same gradient of risk over the whole range of BMD (p = 0.020). CONCLUSIONS Low BMD is associated with a substantial excess risk of death compared to an average BMD, whereas a higher than average BMD has a more modest effect on mortality. These findings, if confirmed elsewhere, have implications for the constructing of probability-based fracture risk assessment tools.
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Affiliation(s)
- H Johansson
- Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gibraltargatan 1C, 411 32 Gothenburg, Sweden.
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Ivergård M, Ström O, Borgström F, Burge RT, Tosteson ANA, Kanis J. Identifying cost-effective treatment with raloxifene in postmenopausal women using risk algorithms for fractures and invasive breast cancer. Bone 2010; 47:966-74. [PMID: 20691296 DOI: 10.1016/j.bone.2010.07.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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: 05/05/2010] [Revised: 07/27/2010] [Accepted: 07/27/2010] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The National Osteoporosis Foundation (NOF) recommends considering treatment in women with a 20% or higher 10-year probability of a major fracture. However, raloxifene reduces both the risk of vertebral fractures and invasive breast cancer so that raloxifene treatment may be clinically appropriate and cost-effective in women who do not meet a 20% threshold risk. The aim of this study was to identify cost-effective scenarios of raloxifene treatment compared to no treatment in younger postmenopausal women at increased risk of invasive breast cancer and fracture risks below 20%. METHOD A micro-simulation model populated with data specific to American Caucasian women was used to quantify the costs and benefits of 5-year raloxifene treatment. The population evaluated was selected based on 10-year major fracture probability as estimated with FRAX® being below 20% and 5-year invasive breast cancer risk as estimated with the Gail risk model ranging from 1% to 5%. RESULTS The cost per QALY gained ranged from US $22,000 in women age 55 with 5% invasive breast cancer risk and 15-19.9% fracture probability, to $110,000 in women age 55 with 1% invasive breast cancer risk and 5-9.9% fracture probability. Raloxifene was progressively cost-effective with increasing fracture risk and invasive breast cancer risk for a given age cohort. At lower fracture risk in combination with lower invasive breast cancer risk or when no preventive raloxifene effect on invasive breast cancer was assumed, the cost-effectiveness of raloxifene worsened markedly and was not cost-effective given a willingness-to-pay of US $50,000. At fracture risk of 15-19.9% raloxifene was cost-effective also in women at lower invasive breast cancer risk. CONCLUSIONS Raloxifene is potentially cost-effective in cohorts of young postmenopausal women, who do not meet the suggested NOF 10-year fracture risk threshold. The cost-effectiveness is contingent on their 5-year invasive breast cancer risk. The result highlights the importance of considering a woman's full risk profile when considering anti-osteoporosis treatment.
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Johansson H, Oden A, McCloskey E, Kanis J. Estimates of fracture probability in Denmark. Osteoporos Int 2007; 18:1141-3; author reply 1145-6. [PMID: 17308955 DOI: 10.1007/s00198-007-0346-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 01/22/2007] [Indexed: 11/26/2022]
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Abstract
INTRODUCTION Epidemiological observations suggest that sunlight exposure is an important determinant of hip fracture risk. The aim of this ecological study was to examine the relationship between latitude and hip fracture probability. METHODS Hip fracture incidence and mortality were obtained from literature searches and 10-year hip fracture probability computed from fracture and death hazards. RESULTS There was a significant association between latitude and 10-year hip fracture probability. For each 10 degrees change in latitude from the equator (e.g., from Paris to Stockholm), fracture probability increased by 0.3% in men, by 0.8% in women and by 0.6% in men and women combined. There was also a significant association between economic prosperity and hip fracture risk as judged by gross domestic product (GDP)/capita or the use of mobile phones/capita. A US $10,000 higher GDP/capita was associated with a 1.3% increase in hip fracture probability. The association between latitude and hip fracture probability persisted after adjusting for indices of economic prosperity. CONCLUSIONS These findings provide support for an important role of sunlight exposure in the global variation of hip fracture risk. In addition, there is a need to identify the factors related to socioeconomic prosperity that may provide mechanisms for the variation in hip fracture probability worldwide.
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Affiliation(s)
- O Johnell
- Department of Orthopaedics, Malmo University Hospital, Malmo, Sweden.
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16
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Powles T, Paterson A, McCloskey E, Kanis J. P106 A Number-Needed-to-Treat(NNT) analysis of bonerelapse and mortality in a randomized trial of oral clodronate as supplementary adjuvant therapy for operable breast cancer. Breast 2005. [DOI: 10.1016/s0960-9776(05)80142-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Affiliation(s)
- E Seeman
- Austin Hospital, Heidelberg, 3084, Melbourne, Victoria, Australia.
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18
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Powles T, Paterson A, McCloskey E, Kurkilahti M, Kanis J. Oral clodronate for adjuvant treatment of operable breast cancer: Results of a randomized, double-blind, placebo-controlled multicenter trial. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- T. Powles
- Parkside Oncology Clinic, Wimbleton, United Kingdom; University of Sheffield, Metabolic Bone Centre, Sheffield, United Kingdom; Schering OY, Helsinki, Finland
| | - A. Paterson
- Parkside Oncology Clinic, Wimbleton, United Kingdom; University of Sheffield, Metabolic Bone Centre, Sheffield, United Kingdom; Schering OY, Helsinki, Finland
| | - E. McCloskey
- Parkside Oncology Clinic, Wimbleton, United Kingdom; University of Sheffield, Metabolic Bone Centre, Sheffield, United Kingdom; Schering OY, Helsinki, Finland
| | - M. Kurkilahti
- Parkside Oncology Clinic, Wimbleton, United Kingdom; University of Sheffield, Metabolic Bone Centre, Sheffield, United Kingdom; Schering OY, Helsinki, Finland
| | - J. Kanis
- Parkside Oncology Clinic, Wimbleton, United Kingdom; University of Sheffield, Metabolic Bone Centre, Sheffield, United Kingdom; Schering OY, Helsinki, Finland
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19
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Abstract
Several studies show that for most clinical fractures the mortality is higher in men than in women, also compared with the general population. However, there are still uncertainties whether this is true for the vertebral deformities. There are few studies comparing men and women but there does not seem to be any difference in morbidity between men and women even though data here are scarce. Several of the risk factors that have been identified in women are also important in men. However, there are problems comparing men and women, such as recreational activity, where men have more strenuous activities. The same for alcohol intake and for BMD. Larger studies in men are needed. At present there are no diagnosis or intervention thresholds for men. Indication thresholds should be determined for those who have a high risk of fractures and should be based on a combination of risk factors in which bone mineral density (BMD) is the most important. This review of papers has dealt with women and men within the same study to compare differences or similarities.
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Affiliation(s)
- O Johnell
- Department of Orthopaedics, Malmö University Hospital, Sweden
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20
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Abstract
BACKGROUND AND PURPOSE The aims of this study were to determine the magnitude of the increase in fracture risk after hospitalization for stroke, and in particular to determine the time course of this risk. METHODS The records of the Swedish register of patients admitted during 1987-1996 were examined to identify all patients who were admitted to the hospital for stroke. Patients were followed for subsequent hospitalizations for hip and all fractures combined. We analyzed 16.3 million hospitalizations, from which 273 288 individuals with stroke were identified. A Poisson model was used to determine the absolute risk of subsequent fractures and the risk compared with that of the general population. RESULTS After hospitalization for stroke, there was a >7-fold increase in fracture risk, including that for hip fracture within the first year after hospitalization for stroke. Thereafter, fracture risk declined toward, but did not attain, the baseline risk except in men and women aged >/=80 years. CONCLUSIONS The high incidence of new fractures within the first year of hospitalization for stroke suggests that such patients should be preferentially targeted for treatment. It is possible that short courses of treatment at the time of stroke would provide important therapeutic dividends.
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Affiliation(s)
- J Kanis
- Center for Metabolic Bone Diseases (World Health Organization Collaborating Center), University of Sheffield Medical School (UK).
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Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J. Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 2000; 15:1384-92. [PMID: 10893688 DOI: 10.1359/jbmr.2000.15.7.1384] [Citation(s) in RCA: 331] [Impact Index Per Article: 13.8] [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] [Indexed: 12/26/2022]
Abstract
Fractures and subsequent morbidity determine the impact of established postmenopausal osteoporosis. Health-related quality of life (HRQOL) has become an important outcome criterion in the assessment and follow-up of osteoporotic patients. As part of the baseline measurements of the Multiple Outcomes of Raloxifene Evaluation (MORE) study, HRQOL was assessed in 751 osteoporotic (bone mineral density [BMD] T score > or = -2.5) women from Europe with or without vertebral fractures (VFX). This was done using the quality of life questionnaire of the European Foundation for Osteoporosis (QUALEFFO), Nottingham Health Profile (NHP) and the EQ-5D (former EuroQol). QUALEFFO contains questions in five domains: pain, physical function, social function, general health perception, and mental function. Each domain score and QUALEFFO total scores are expressed on a 100-point scale, with 0 corresponding to the best HRQOL. In comparison with patients without VFX, those with VFX were older (66.2 +/- 5.9 years vs. 68.8 +/- 6.3 years; p < 0.001), had higher prevalence of nonvertebral fractures (25% vs. 36%; p = 0.002), and higher QUALEFFO scores (worse HRQOL; total score, 26 +/- 14 vs. 36 +/- 17; p < 0.001). QUALEFFO scores increased progressively with increasing number of VFX, especially lumbar fractures (p < 0.001). Patients with a single VFX already had a significant increase in QUALEFFO scores (p < 0.05). Similar, though weaker, associations were seen for NHP and EQ-5D scores. This study confirms decreased HRQOL for patients with prevalent VFX. In osteoporotic patients, QUALEFFO scores change in relation to the number of VFX. QUALEFFO is suitable for clinical studies in patients with postmenopausal osteoporosis.
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Affiliation(s)
- A Oleksik
- Department of Endocrinology, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands
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22
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Coleman RE, Purohit OP, Black C, Vinholes JJ, Schlosser K, Huss H, Quinn KJ, Kanis J. Double-blind, randomised, placebo-controlled, dose-finding study of oral ibandronate in patients with metastatic bone disease. Ann Oncol 1999; 10:311-6. [PMID: 10355575 DOI: 10.1023/a:1008386501738] [Citation(s) in RCA: 74] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Bisphosphonates are an important component of the treatment of metastatic bone disease but more potent, oral formulations are required to improve the effectiveness and convenience of treatment. An oral formulation of the new bisphosphonate, ibandronate (BM 21.0955) has recently been developed. PATIENTS AND METHODS One hundred ten patients with bone metastases (77 breast, 16, prostate, 3 myeloma, 14 others) were recruited from a single institution to this double blind placebo-controlled evaluation of four oral dose levels (5, 10, 20 and 50 mg) of ibandronate. No changes in systemic anti-cancer treatment were allowed in the month before commencing treatment or during the study period. After an initial four-week tolerability phase, patients could continue on treatment for a further three months without unblinding; patients initially allocated to placebo received ibandronate 50 mg. The primary endpoint was urinary calcium excretion (UCCR). Bone resorption was also assessed by measurement of pyridinoline (Pyr), deoxypyridinoline (Dpd), and the N-terminal (NTX) and C-terminal (Crosslaps) portions of the collagen crosslinking molecules. RESULTS Two patients did not receive any trial medication thus, 108 patients were evaluable for safety. Ninety-two patients were evaluable for efficacy. A dose dependent reduction was observed in both UCCR and collagen crosslink excretion. At the 50 mg dose level, the percentage reductions from baseline in UCCR, Pyr, Dpd, Crosslaps and NTX were 71%, 28%, 39%, 80% and 74% respectively. One or more gastrointestinal (GI) adverse events occurring in the first month of treatment were reported by six (30%), seven (33%), nine (39%), nine (41%) and eleven (50%) patients at the placebo, 5, 10, 20 and 50 mg dose levels respectively. One patient (20 mg dose) developed radiographically confirmed oesophageal ulceration. GI tolerability may have been adversely affected by concomitant administration of non-steroidal anti-inflammatory agents. Nine (8%) patients stopped treatment within the first month due to GI intolerability but these patients were evenly distributed across the five treatment groups. There was no difference in non-GI adverse events between groups. CONCLUSIONS Oral ibandronate has potent effects on the rate of bone resorption at doses which are generally well tolerated. Further development is appropriate to evaluate the effects of long-term administration in the prevention of metastatic bone disease and the management of established skeletal metastases.
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Affiliation(s)
- R E Coleman
- Yorkshire Cancer Research Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
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23
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Kanis J. Strategies for osteoporosis treatment. Bull World Health Organ 1999; 77:431-2. [PMID: 10361766 PMCID: PMC2557668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Affiliation(s)
- J Kanis
- Department of Human Metabolism and Clinical Biochemistry, University of Sheffield Medical School, England
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Abstract
We investigated the cost-effectiveness of treatments that reduce the risk of hip fracture using a computer simulation model. Cost-effectiveness was measured as cost per quality-adjusted life-year (QALY) gained using a threshold value for cost-effectiveness of $30,000/QALY gained. The baseline simulations assumed a 5-year intervention that reduced the risk of hip fracture by 50% during the intervention period, and an effect which reversed to the pretreatment risk during the next 5 years. Sensitivity analyses included the effects of age, different fracture risks, and different treatment costs and duration of therapeutic effect once treatment was stopped. Cost-effectiveness was critically dependent upon absolute risk determined by the age and the relative risk of hip fracture at any given age. Reasonable cost-effectiveness was shown even with relatively high intervention costs for women with a risk about twice the average at the age of 70 or more years. Cost-effectiveness was critically dependent upon the assumptions made concerning offset of effect of intervention after the end of treatment. Where no residual effect was assumed, it was difficult to show cost-effectiveness from any intervention except for the most effective and least expensive. Conversely, cost-effectiveness improved considerably where effectiveness persisted for a longer time. These studies support the view that intervention in the elderly with agents affecting skeletal metabolism alone may be preferred to such interventions at the time of the menopause, and that offset time, hitherto poorly characterized, is a critical component of cost-effectiveness, particularly in younger women.
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Affiliation(s)
- B Jonsson
- Department of Economics, Stockholm School of Economics, Stockholm, Sweden
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25
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Kanis J, Johnell O, Gullberg B, Allander E, Elffors L, Ranstam J, Dequeker J, Dilsen G, Gennari C, Vaz AL, Lyritis G, Mazzuoli G, Miravet L, Passeri M, Perez Cano R, Rapado A, Ribot C. Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean Osteoporosis Study. Osteoporos Int 1999; 9:45-54. [PMID: 10367029 DOI: 10.1007/s001980050115] [Citation(s) in RCA: 216] [Impact Index Per Article: 8.6] [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] [Indexed: 10/28/2022]
Abstract
The aims of this study were to identify risk factors for hip fracture in men aged 50 years or more. We identified 730 men with hip fracture from 14 centers from Portugal, Spain, France, Italy, Greece and Turkey during the course of a prospective study of hip fracture incidence and 1132 age-stratified controls selected from the neighborhood or population registers. The questionnaire examined aspects of work, physical activity past and present, diseases and drugs, height, weight, indices of co-morbidity and consumption of tobacco, alcohol, calcium, coffee and tea. Significant risk factors identified by univariate analysis included low body mass index (BMI), low sunlight exposure, a low degree of recreational physical activity, low consumption of milk and cheese, and a poor mental score. Co-morbidity including sleep disturbances, loss of weight, impaired mental status and poor appetite were also significant risk factors. Previous stroke with hemiplegia, prior fragility fractures, senile dementia, alcoholism and gastrectomy were associated with significant risk, whereas osteoarthrosis, nephrolithiasis and myocardial infarction were associated with lower risks. Taking medications was not associated with a difference in risk apart from a protective effect with the use of analgesics independent of co-existing osteoarthrosis and an increased risk with the use of anti-epileptic agents. Of the potentially 'reversible' risk factors, BMI, leisure exercise, exposure to sunlight and consumption of tea and alcohol and tobacco remained independent risk factors after multivariate analysis, accounting for 54% of hip fractures. Excluding BMI, 46% of fractures could be explained on the basis of the risk factors sought. Of the remaining factors low exposure to sunlight and decreased physical activity accounted for the highest attributable risks (14% and 9% respectively). The use of risk factors to predict hip fractures had relatively low sensitivity and specificity (59.6% and 61.0% respectively). We conclude that lifestyle factors are associated with significant differences in the risk of hip fracture. Potentially remediable factors including a low degree of physical exercise and a low BMI account for a large component of the total risk.
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Affiliation(s)
- J Kanis
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, UK
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26
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Genant HK, Cooper C, Poor G, Reid I, Ehrlich G, Kanis J, Nordin BE, Barrett-Connor E, Black D, Bonjour JP, Dawson-Hughes B, Delmas PD, Dequeker J, Ragi Eis S, Gennari C, Johnell O, Johnston CC, Lau EM, Liberman UA, Lindsay R, Martin TJ, Masri B, Mautalen CA, Meunier PJ, Khaltaev N. Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis. Osteoporos Int 1999; 10:259-64. [PMID: 10692972 DOI: 10.1007/s001980050224] [Citation(s) in RCA: 457] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- H K Genant
- Department of Radiology, University of California San Francisco 94143-0628, USA.
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27
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Powles TJ, McCloskey E, Paterson AH, Ashley S, Tidy VA, Nevantaus A, Rosenqvist K, Kanis J. Oral clodronate and reduction in loss of bone mineral density in women with operable primary breast cancer. J Natl Cancer Inst 1998; 90:704-8. [PMID: 9586668 DOI: 10.1093/jnci/90.9.704] [Citation(s) in RCA: 123] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Women with primary breast cancer who receive systemic therapy may experience ovarian failure or early menopause, leading to a loss of bone mineral density (BMD). Loss of BMD may be reduced by use of bisphosphonates, compounds that inhibit the action of osteoclasts (cells that absorb or remove bone tissue). We have conducted a double-blind, randomized, two-center trial to evaluate BMD in women with primary breast cancer who were given the bisphosphonate clodronate (1600 mg/day orally) or placebo for 2 years. METHODS From August 31, 1990, through March 31, 1996, more than 300 eligible patients had been accrued, randomly assigned to study treatment, given the appropriate primary surgical care and systemic (chemotherapy and/or tamoxifen) therapy, and had completed follow-up for at least 1 year. BMD in the lumbar spine and in the hip, including the trochanteric area, was measured by use of dual-energy x-ray absorptiometry at the beginning of treatment and after 1 and 2 years of treatment. Changes in BMD were calculated as percent changes from the initial readings. Treatment effects for clodronate versus placebo (i.e., mean percent changes in BMD with clodronate minus mean percent changes in BMD with placebo) at 1 and 2 years for individual sites were calculated. RESULTS After 1 year, the treatment effects for clodronate versus placebo in the lumbar spine, the total hip, and the trochanter, respectively, were as follows: +2.38% (95% confidence interval [CI] = 1.36-3.41), +0.74% (95% CI = -0.13 - 1.60), and +1.29% (95% CI = 0.24-2.34). After 2 years, the corresponding treatment effects were +1.72% (95% CI = 0.12-3.34), +1.85% (95% CI = 0.51-3.20), and +2.30% (95% CI = 0.66-3.94), respectively. CONCLUSIONS Oral clodronate appears to reduce the loss of BMD in patients who receive treatment for primary breast cancer.
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Affiliation(s)
- T J Powles
- Royal Marsden Hospital, Sutton, Surrey, UK
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Johnell O, O'Neill T, Felsenberg D, Kanis J, Cooper C, Silman AJ. Anthropometric measurements and vertebral deformities. European Vertebral Osteoporosis Study (EVOS) Group. Am J Epidemiol 1997; 146:287-93. [PMID: 9270407 DOI: 10.1093/oxfordjournals.aje.a009269] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To investigate the association between anthropometric indices and morphometrically determined vertebral deformity, the authors carried out a cross-sectional study using data from the European Vertebral Osteoporosis Study (EVOS), a population-based study of vertebral osteoporosis in 36 European centers from 19 countries. A total of 16,047 EVOS subjects were included in this analysis, of whom 1,973 subjects (915 males, 1,058 females) (12.3%) aged 50 years or over had one or more vertebral deformities ("cases"). The cases were compared with the 14,074 subjects (6,539 males, 7,535 females) with morphometrically normal spines ("controls"). Data were collected on self-reported height at age 25 years and minimum weight after age 25 years, as well as on current measured height and weight. Body mass index (BMI) and height and weight change were calculated from these data. The relations between these variables and vertebral deformity were examined separately by sex with logistic regression adjusting for age, smoking, and physical activity. In females, there was a significant trend of decreasing risk with increasing quintile of current weight, current BMI, and weight gain since age 25 years. In males, subjects in the lightest quintile for these measures were at increased risk but there was no evidence of a trend. An ecologic analysis by country revealed a negative correlation between mean BMI and the prevalence of deformity in females but not in males. The authors conclude that low body weight is associated with presence of vertebral deformity.
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Affiliation(s)
- O Johnell
- ARC Epidemiology Research Unit, University of Manchester, England
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Silman AJ, O'Neill TW, Cooper C, Kanis J, Felsenberg D. Influence of physical activity on vertebral deformity in men and women: results from the European Vertebral Osteoporosis Study. J Bone Miner Res 1997; 12:813-9. [PMID: 9144348 DOI: 10.1359/jbmr.1997.12.5.813] [Citation(s) in RCA: 80] [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] [Indexed: 02/04/2023]
Abstract
Physical activity is associated with an increased bone mass and a reduced risk of hip fracture. There are, however, no data from population samples of men and women concerning the effect of regular levels of physical activity on the risk of vertebral deformity. The aim of this study was to determine the relationship between regular physical activity and vertebral deformity in European men and women. A population survey method was used. Thirty-six centers from 19 European countries participated. Each center recruited a population sample of men and women aged 50 years and over. Those who took part received an interviewer-administered questionnaire and lateral thoracolumbar radiographs. Subjects were asked about two dimensions of physical activity: (1) the level of physical activity undertaken either at work or at home on a daily basis at three different age periods: 15-25 years, 25-50 years, and 50+ years; and (2) the amount of time spent walking or cycling out of doors each day. Spinal radiographs were evaluated morphometrically and the presence of vertebral deformity was defined according to the McCloskey method. In total, 14,261 subjects, aged 50-79 years, from 30 centers were studied, of whom 809 (12.0%) men and 884 (11.7%) women had one or more deformities. After adjusting for age, center, smoking, and body mass index, very heavy levels of activity in all three age groups were associated with an increased risk of vertebral deformity in men (odds ratios, age adjusted [OR], 1.5-1.7; with all 95% confidence intervals [CI] excluding unity). No increased risk was observed in women. Current walking or cycling more than 1/2 h/day was associated with a reduced risk of vertebral deformity in women (OR 0.8; 95% CI 0.7-1.0). We conclude that regular walking in middle-aged and elderly women is associated with a reduced risk of vertebral deformity. By contrast, heavy levels of physical activity in early and middle adult life are associated with an increased risk in men. These differences are of relevance in understanding the epidemiology of vertebral deformity and planning programs of prevention.
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Affiliation(s)
- A J Silman
- ARC Epidemiology Research Unit, University of Manchester, United Kingdom
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30
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O'Neill TW, Silman AJ, Naves Diaz M, Cooper C, Kanis J, Felsenberg D. Influence of hormonal and reproductive factors on the risk of vertebral deformity in European women. European Vertebral Osteoporosis Study Group. Osteoporos Int 1997; 7:72-8. [PMID: 9102068 DOI: 10.1007/bf01623464] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [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] [Indexed: 02/04/2023]
Abstract
The aim of this study was to determine whether variation in the level of selected hormonal and reproductive variables might explain variation in the occurrence of vertebral deformity across Europe. A population-based cross-sectional survey method was used. A total of 7530 women aged 50-79 years and over were recruited from 30 European centres. Subjects were invited to attend for an interviewer-administered questionnaire and lateral spinal radiographs which were taken according to a standard protocol. After adjusting for age, centre, body mass index and smoking, those in the highest quintile of menarche (age > or = 16 years) had an increased risk of vertebral deformity (odds ratio [OR] = 1.48; 95% confidence interval [CI] 1.16, 1.88). Increased menopausal age (> 52.5 years) was associated with a reduced risk of deformity (OR = 0.78; 95% CI 0.60, 1.00), while use of the oral contraceptive pill was also protective (OR = 0.76; 95% CI 0.58, 0.99). There was a smaller protective effect associated with one or more years use of hormone replacement therapy, though the confidence limits clearly embraced unity. There was no apparent effect of parity or breast-feeding on the risk of deformity. We conclude that oestrogen status is an important determinant of vertebral deformity. Ever use of the oral contraceptive pill was associated with a 25% reduction in risk of deformity though the effect may be a result of the higher-dosage oestrogen pills used in the past. Parity and breast-feeding do not appear to be important and would appear to have little potential for identification of women at high risk of vertebral deformity.
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Affiliation(s)
- T W O'Neill
- ARC Epidemiology Research Unit, Manchester University, UK
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31
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Lips P, Agnusdei D, Caulin F, Cooper C, Johnell O, Kanis J, Liberman U, Minne H, Reeve J, Reginster JY, de Vernejoul MC, Wiklund I. The development of a European questionnaire for quality of life in patients with vertebral osteoporosis. Scand J Rheumatol Suppl 1996; 103:84-5; discussion 86-8. [PMID: 8966496 DOI: 10.3109/03009749609103757] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The complaints of vertebral osteoporosis usually result from wedge or crush fractures and biconcave deformities. These are caused by a decrease of bone mass and deterioration of bone structure leading to loss of strength. Treatment of osteoporosis should result in an increase of bone mass, and the incidence of new vertebral fractures should diminish. However, new vertebral fractures are not always accompanied by pain, and disability does not well correlate with the number of vertebral fractures. Patients with osteoporosis often have other problems e.g. with taking a shower, preparing meals, gardening, walking stairs, visiting friends and attending social activities. In addition, pain and disability may influence mood and lead to depression. The assessment of quality of life should be a primary endpoint in clinical trials in patients with osteoporosis and in individual patients care. Recently, the European Foundation for Osteoporosis (EFFO) has decided a develop a questionnaire for patients with vertebral osteoporosis, i.e. patients with vertebral deformities. The questionnaire is meant for use in clinical trials. A questionnaire was made including 48 questions and 6 visual analogue scales. The questions concern the following domains: pain, activities of daily living, jobs around the house, moving, leisure and social activities, general health perception and mood. The questionnaire ("Qualeffo") has now entered the validation phase. The first study in 8 centres concerns the within-subject reproducibility, the internal coherence, and the specificity by comparing osteoporotic patients with a control group not suffering from osteoporosis or backpain.
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Affiliation(s)
- P Lips
- Department of Endocrinology, Free University Hospital, Amsterdam, The Netherlands
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32
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Compston J, Cooper C, Kanis J. Authors' reply. West J Med 1995. [DOI: 10.1136/bmj.311.7015.1301a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kanis J, Ritz E. Editorial. Nephrol Dial Transplant 1995. [DOI: 10.1093/ndt/10.supp4.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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O'Neill TW, Varlow J, Felsenberg D, Johnell O, Weber K, Marchant F, Delmas PD, Cooper C, Kanis J, Silman AJ. Variation in vertebral height ratios in population studies. European Vertebral Osteoporosis Study Group. J Bone Miner Res 1994; 9:1895-907. [PMID: 7872055 DOI: 10.1002/jbmr.5650091209] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.8] [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] [Indexed: 01/27/2023]
Abstract
Vertebral height ratios are used to define vertebral deformity in clinical and epidemiologic studies of vertebral osteoporosis. However, few data have been obtained on the variation in these ratios in different populations using standard methods. We examined vertebral morphometric measurements obtained in a population survey from three centers: Malmö (Sweden), Montceau-les-Mines (France), and Graz (Austria), to study the influence of sex and the population center on vertebral height ratios. Radiographs were obtained according to a standardized protocol, and morphometric measurements, anterior height Ha, central height Hc, and posterior height Hp, made in Berlin. The height ratios anterior, Ha/Hp, central, Hc/Hp, posterior I, Hp/Hp', and posterior II, Hp/Hp" (Hp' = posterior height of vertebrae above, Hp" = posterior height of vertebrae below) were calculated for each vertebra from T4 to L4. The mean and standard deviation of these ratios for each sex and each center were derived using a statistical trimming procedure to normalize the distribution. Threshold values for defining grade 1 and grade 2 deformities, wedge, biconcavity, and compression, were calculated using these parameters. Anterior and central vertebral height ratios were smaller in males than females (p < 0.01). There were significant differences between the three centers (p < 0.01) both in the trimmed mean values for anterior and central vertebral height ratios and in the thresholds derived using standard criteria for defining wedge and biconcavity deformity. The data confirm the impression from single-center studies that vertebral height ratios vary between populations and suggest that reference values for vertebral height ratios should be derived separately for males and females within individual populations whenever possible.
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Affiliation(s)
- T W O'Neill
- ARC Epidemiology Unit, University of Manchester, England
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Kanis J. Osteoporosis--the silent epidemic. Health Visit 1989; 62:14-5. [PMID: 2914766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Osteoporosis is a very common disorder which receives much less attention than it deserves, both from the general public and from a large section of the medical community. This article describes osteoporosis, the problems it causes and their scale, and looks at the prospects for prevention and treatment.
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Heynen G, Cecchettin M, Gaspar S, Kanis J, Franchimont P. The effect of beta-blockade on ethanol-induced secretion of calcitonin in chronic renal failure. Calcif Tissue Res 1977; 22 Suppl:137-41. [PMID: 562224 DOI: 10.1007/bf02064054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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