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Orford NR, Bone A, Kotowicz MA, Bailey M, Pasco JA, Maiden M, Kakho N, Cattigan C, Nichonghaile M, Jones C, Hodgson C, Nair P, Center J, Bellomo R. A pilot feasibility randomised controlled trial of bone antiresorptive agents on bone turnover markers in critically ill women. Sci Rep 2024; 14:2071. [PMID: 38267490 PMCID: PMC10810087 DOI: 10.1038/s41598-024-52607-1] [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] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/21/2024] [Indexed: 01/26/2024] Open
Abstract
Critical illness is associated with increased bone turnover, loss of bone density, and increased risk of fragility fractures. The impact of bone antiresorptive agents in this population is not established. This trial examined the efficacy, feasibility, and safety of antiresorptive agents administered to critically ill women aged fifty years or greater. Women aged 50 years or greater admitted to an intensive care unit for at least 24 h were randomised to receive an antiresorptive agent (zoledronic acid or denosumab) or placebo, during critical illness and six months later (denosumab only). Bone turnover markers and bone mineral density (BMD) were monitored for 1 year. We studied 18 patients over 35 months before stopping the study due to the COVID-19 pandemic. Antiresorptive medications decreased the bone turnover marker type 1 cross-linked c-telopeptide (CTX) from day 0 to 28 by 43% (± 40%), compared to an increase of 26% (± 55%) observed with placebo (absolute difference - 69%, 95% CI - 127% to - 11%), p = 0.03). Mixed linear modelling revealed differences in the month after trial drug administration between the groups in serum CTX, alkaline phosphatase, parathyroid hormone, and phosphate. Change in BMD between antiresorptive and placebo groups was not statistically analysed due to small numbers. No serious adverse events were recorded. In critically ill women aged 50-years and over, antiresorptive agents suppressed bone resorption markers without serious adverse events. However, recruitment was slow. Further phase 2 trials examining the efficacy of these agents are warranted and should address barriers to enrolment.Trial registration: ACTRN12617000545369, registered 18th April 2017.
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Affiliation(s)
- Neil R Orford
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Australia.
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine (SPPHPM), Monash University, Melbourne, Australia.
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia.
- Department of Critical Care, University of Melbourne, Melbourne, Australia.
| | - Allison Bone
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine (SPPHPM), Monash University, Melbourne, Australia
| | - Mark A Kotowicz
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine (SPPHPM), Monash University, Melbourne, Australia
| | - Julie A Pasco
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, Australia
| | - Matthew Maiden
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Nima Kakho
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Claire Cattigan
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Martina Nichonghaile
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Claire Jones
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine (SPPHPM), Monash University, Melbourne, Australia
| | - Priya Nair
- Intensive Care Unit, St Vincent's Hospital Sydney, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
| | - Jacqueline Center
- Intensive Care Unit, St Vincent's Hospital Sydney, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine (SPPHPM), Monash University, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
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Zanker J, Scott D, Szoeke C, Vogrin S, Patel S, Blackwell T, Bird S, Kirk B, Center J, Alajlouni DA, Gill T, Jones G, Pasco JA, Waters DL, Cawthon PM, Duque G. Predicting Slow Walking Speed From a Pooled Cohort Analysis: Sarcopenia Definitions, Agreement, and Prevalence in Australia and New Zealand. J Gerontol A Biol Sci Med Sci 2023; 78:2415-2425. [PMID: 37428864 PMCID: PMC10692428 DOI: 10.1093/gerona/glad165] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Recent operational definitions of sarcopenia have not been replicated and compared in Australia and New Zealand (ANZ) populations. We aimed to identify sarcopenia measures that discriminate ANZ adults with slow walking speed (<0.8 m/s) and determine the agreement between the Sarcopenia Definitions and Outcomes Consortium (SDOC) and revised European Working Group for Sarcopenia in Older People (EWGSOP2) operational definitions of sarcopenia. METHODS Eight studies comprising 8 100 ANZ community-dwelling adults (mean age ± standard deviation, 62.0 ± 14.4 years) with walking speed, grip strength (GR), and lean mass data were combined. Replicating the SDOC methodology, 15 candidate variables were included in sex-stratified classification and regression tree models and receiver operating characteristic curves on a pooled cohort with complete data to identify variables and cut points discriminating slow walking speed (<0.8 m/s). Agreement and prevalence estimates were compared using Cohen's Kappa (CK). RESULTS Receiver operating characteristic curves identified GR as the strongest variable for discriminating slow from normal walking speed in women (GR <20.50 kg, area under curve [AUC] = 0.68) and men (GR <31.05 kg, AUC = 0.64). Near-perfect agreement was found between the derived ANZ cut points and SDOC cut points (CK 0.8-1.0). Sarcopenia prevalence ranged from 1.5% (EWGSOP2) to 37.2% (SDOC) in women and 1.0% (EWGSOP2) to 9.1% (SDOC) in men, with no agreement (CK <0.2) between EWGSOP2 and SDOC. CONCLUSIONS Grip strength is the primary discriminating characteristic for slow walking speed in ANZ women and men, consistent with findings from the SDOC. Sarcopenia Definitions and Outcomes Consortium and EWGSOP2 definitions showed no agreement suggesting these proposed definitions measure different characteristics and identify people with sarcopenia differently.
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Affiliation(s)
- Jesse Zanker
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - David Scott
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Cassandra Szoeke
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - Sheena Patel
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Terri Blackwell
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Stefanie Bird
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Ben Kirk
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - Jacqueline Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Dima A Alajlouni
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Tiffany Gill
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Julie A Pasco
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, Barwon HealthDeakin University, Geelong, Victoria, Australia
| | - Debra L Waters
- Department of Medicine, School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
- Department of Internal Medicine/Geriatrics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Moles RJ, Perry L, Naylor JM, Center J, Ebeling P, Duque G, Major G, White C, Yates C, Jennings M, Kotowicz M, Tran T, Bliuc D, Si L, Gibson K, Basger BJ, Bolton P, Barnett S, Hassett G, Kelly A, Bazarnik B, Ezz W, Luckie K, Carter SR. Safer medicines To reduce falls and refractures for OsteoPorosis (#STOP): a study protocol for a randomised controlled trial of medical specialist-initiated pharmacist-led medication management reviews in primary care. BMJ Open 2023; 13:e072050. [PMID: 37620274 PMCID: PMC10450068 DOI: 10.1136/bmjopen-2023-072050] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Minimal trauma fractures (MTFs) often occur in older patients with osteoporosis and may be precipitated by falls risk-increasing drugs. One category of falls risk-increasing drugs of concern are those with sedative/anticholinergic properties. Collaborative medication management services such as Australia's Home Medicine Review (HMR) can reduce patients' intake of sedative/anticholinergics and improve continuity of care. This paper describes a protocol for an randomised controlled trial to determine the efficacy of an HMR service for patients who have sustained MTF. METHOD AND ANALYSIS Eligible participants are as follows: ≥65 years of age, using ≥5 medicines including at least one falls risk-increasing drug, who have sustained an MTF and under treatment in one of eight Osteoporosis Refracture Prevention clinics in Australia. Consenting participants will be randomised to control (standard care) or intervention groups. For the intervention group, medical specialists will refer to a pharmacist for HMR focused on reducing falls risk predominately through making recommendations to reduce falls risk medicines, and adherence to antiosteoporosis medicines. Twelve months from treatment allocation, comparisons between groups will be made. The main outcome measure is participants' cumulative exposure to sedative and anticholinergics, using the Drug Burden Index. Secondary outcomes include medication adherence, emergency department visits, hospitalisations, falls and mortality. Economic evaluation will compare the intervention strategy with standard care. ETHICS AND DISSEMINATION Approval was obtained via the New South Wales Research Ethics and Governance Information System (approval number: 2021/ETH12003) with site-specific approvals granted through Human Research Ethics Committees for each research site. Study outcomes will be published in peer-reviewed journals. It will provide robust insight into effectiveness of a pharmacist-based intervention on medicine-related falls risk for patients with osteoporosis. We anticipate that this study will take 2 years to fully accrue including follow-up. TRIAL REGISTRATION NUMBER ACTRN12622000261718.
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Affiliation(s)
- Rebekah Jane Moles
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lin Perry
- School of Nursing and Midwifery, University of Technology Sydney Faculty of Health, Sydney, New South Wales, Australia
| | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Southwestern Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jacqueline Center
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Peter Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor Major
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle Faculty of Health and Medicine, Callaghan, New South Wales, Australia
| | - Christopher White
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Christopher Yates
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Matthew Jennings
- Physiotherapy, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Mark Kotowicz
- Epi-Centre for Healthy Ageing, Deakin University - Geelong Campus at Waurn Ponds, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
| | - Thach Tran
- Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Dana Bliuc
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Lei Si
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Kathryn Gibson
- Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute, Liverpool, New South Wales, Australia
| | - Benjamin Joseph Basger
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patrick Bolton
- Public Health and Community Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Stephen Barnett
- GP Academic Unit, University of Wollongong, Wollongong, New South Wales, Australia
| | - Geraldine Hassett
- Ingham Institute, Liverpool, New South Wales, Australia
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Ayano Kelly
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Barbara Bazarnik
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Wafaa Ezz
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kate Luckie
- Musculoskeletal Clinical Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Ross Carter
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Elder M, Moonen A, Crowther S, Aleksova J, Center J, Elder GJ. Chronic kidney disease-related sarcopenia as a prognostic indicator in elderly haemodialysis patients. BMC Nephrol 2023; 24:138. [PMID: 37208625 DOI: 10.1186/s12882-023-03175-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/18/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND The mortality of dialysis patients greatly exceeds that of the general population and identifying predictive factors for mortality may provide opportunities for earlier intervention. This study assessed the influence of sarcopenia on mortality in patients on haemodialysis. METHODS This prospective, observational study enrolled 77 haemodialysis patients aged 60 years and over, of whom 33 (43%) were female, from two community dialysis centres. Baseline demographic and laboratory data were collected, and sarcopenia was diagnosed using grip strength, muscle mass by bioimpedance analysis (BIA) and muscle function by timed up-and-go according to European Working Group on Sarcopenia in Older People criteria. Nutritional status was assessed using a subjective nutritional assessment score, comprising functional changes in weight, appetite, gastrointestinal symptoms and energy.. A comorbidity score (maximum 7 points) was derived from the presence or absence of hypertension, ischaemic heart disease, vascular disease (cerebrovascular disease, peripheral vascular disease, and abdominal aortic aneurysm), diabetes mellitus, respiratory disease, a history of malignancy and psychiatric disease. Outcomes over six years were linked to the Australian and New Zealand Dialysis and Transplant Registry. RESULTS The median participant age was 71 years (range 60-87). Probable and confirmed sarcopenia was present in 55.9% and severe sarcopenia with reduced functional testing in 11.7%. Over 6 years, overall mortality was 50 of the 77 patients (65%), principally from cardiovascular events, dialysis withdrawal and infection. There were no significant survival differences between patients with no, probable, confirmed, or severe sarcopenia, or between tertiles of the nutritional assessment score. After adjustment for age, dialysis vintage, mean arterial pressure (MAP) and the total comorbidity score, no sarcopenia category predicted mortality. However, the total comorbidity score [Hazard Ratio (HR) 1.27, Confidence Intervals (CI) 1.02, 1.58, p = 0.03] and MAP (HR 0.96, CI 0.94, 0.99, P = < 0.01) predicted mortality. CONCLUSION Sarcopenia is highly prevalent in elderly haemodialysis patients but is not an independent predictor of mortality. Haemodialysis patients have multiple competing risks for mortality which, in this study, was predicted by a lower MAP and a higher total comorbidity score. TRIAL REGISTRATION Recruitment commenced December 2011. The study was registered 10.01.2012 with the Australian New Zealand Clinical Trials Registry (ACTRN12612000048886).
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Affiliation(s)
- Madeleine Elder
- School of Medicine, The University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | | | - Sjorjina Crowther
- School of Medicine, The University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | - Jasna Aleksova
- Hudson Institute of Medical Research, Clayton, Vic, Australia
- Department of Endocrinology, Monash Health, Clayton, Vic, Australia
- Monash University, Clayton Vic, Australia
| | - Jacqueline Center
- Skeletal Biology Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Grahame J Elder
- School of Medicine, The University of Notre Dame Australia, Darlinghurst, NSW, Australia.
- University of Sydney, Sydney, NSW, Australia.
- Skeletal Biology Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.
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Bliuc D, Tran T, Alarkawi D, Chen W, Blank RD, Ensrud KE, Blith F, March L, Center J. Multimorbidity Increases Risk of Osteoporosis Under-Diagnosis and Under-Treatment in Patients at High Fracture Risk: 45 and up a Prospective Population Based-Study. J Endocr Soc 2021. [PMCID: PMC8090391 DOI: 10.1210/jendso/bvab048.505] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Management of osteoporosis following fracture is suboptimal. Multimorbidity adds to clinical management complexity in the elderly but its contribution to the osteoporosis treatment gap has never been investigated. Objectives: To determine the impact of multimorbidity on fracture risk and on osteoporosis investigation and treatment in patients at high fracture risk. Design and Setting: The 45 and Up Study is a prospective population-based cohort study in NSW, Australia with questionnaire data linked to hospital records by the Centre for Health Record Linkage (CHeReL) and the Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Scheme (MBS) data provided by Department of Human Services. Fractures identified from hospital records, comorbidities from questionnaires, hospital and PBS records. Bone mineral density (BMD) investigation obtained from MBS and treatment for osteoporosis from PBS. Participants: 16191 women and 9089 men with incident low-trauma fracture (2000 - 2017) classified in a high and low-risk group based on 10-year fracture risk threshold of 20% from the Garvan Fracture Risk Calculator (age, gender, prior fracture and falls). Main Outcome Measurements: Association of Charlson comorbidity index (CCI) with fracture. Likelihood of BMD investigation and treatment initiation. Outcomes ascertained by logistic regression and re-fracture risk by Cox models. Results: Individuals at high fracture risk were significantly older [women (mean age ±SD) 77 ± 10 vs 57 ±4 for high- vs low risk and men 86±5 vs 65±8 for high vs low risk] and had a higher morbidity burden [women, CCI ≥ 2 40% vs 12% for high- vs low-risk and men 53% vs 26% for high vs low risk]. Being in the high-risk group as well as a higher CCI were independently associated with > 2-fold higher risk of re-fracture. However, in the high-risk group, only 28% (48% women and 17% men) had a BMD investigation and 31% (24% women and 14% men) received anti-osteoporosis medication post-fracture. A higher CCI was associated with a lower probability of both BMD investigation [CCI 2–3 vs 0–1, RR 0.73 (0.65–0.82) for women, and 0.50 (0.40–0.64) for men and CCI ≥4 vs 0–1, RR 0.50 (0.41- 0.62) for women and 0.36 (0.25–0.52) for men] and treatment initiation [CCI 2–3 vs 0–1, RR 0.88 (0.77–0.98) for women and 0.75 (0.60–0.95) for men and CCI ≥4 vs 0–1, RR 0.75 (0.59- 0.95) for women and 0.35 (0.23–0.53) for men]. Conclusion: Multimorbidity, despite being associated with the highest fracture risk, significantly lowers the likelihood of osteoporosis investigation and treatment. These findings suggest that fracture risk is either under-estimated or under-prioritized in the context of multimorbidity. Our findings highlight the need for improved delivery of fracture preventive care in this setting. More generally, they also point out the need for a better understanding of how problems are prioritized in complex clinical situations.
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Affiliation(s)
- Dana Bliuc
- Garvan Institute of Medical Research, DARLINGHURST, Australia
| | - Thach Tran
- Garvan Institute of Medical Research, DARLINGHURST, Australia
| | - Dunia Alarkawi
- Garvan Institute of Medical Research, DARLINGHURST, Australia
| | - Weiwen Chen
- Garvan Institute of Medical Research, DARLINGHURST, Australia
| | - Robert D Blank
- Garvan Institute of Medical Research, DARLINGHURST, Australia
| | | | | | - Lyn March
- University of Sydney, Sydney, Australia
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Zamerli J, Mohanty S, Xiao Y, Kim A, Center J, Girgis C, Croucher P, Mcdonald M. Sequential dosing with zoledronate following OPG:Fc treatment protects against rebound bone loss. Bone Rep 2021. [DOI: 10.1016/j.bonr.2021.101016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tran T, Bliuc D, O’Donoghue S, Hansen L, Abrahamsen B, Bergh JVD, Geel TV, Geusens P, Vestergaard P, Nguyen TV, Eisman JA, Center J. OR13-03 Understanding Why Older People with Low Trauma Fractures Die Prematurely. J Endocr Soc 2020. [PMCID: PMC7209211 DOI: 10.1210/jendso/bvaa046.1579] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There is increasing evidence that all proximal and not just hip fractures are associated with increased mortality risk. However, the cause of this increased mortality is unknown. We sought to determine the post-fracture trajectories of subsequent hospital admissions and mortality to develop an understanding of why patients with non-hip fractures die prematurely. This nationwide Danish population-based study included all individuals aged 50+ years who sustained an incident fragility fracture between 2001 and 2014. High-trauma fractures or individuals with fracture prior to 2001 were excluded. Fracture patients were matched 1:4 by sex, age and comorbidity status with non-fracture subjects alive at the time of fracture. Comorbidities included 33 unique medical conditions of the Charlson or Elixhauser comorbidity index. We modelled the contribution of specific fractures on the risk of subsequent admissions or death within the following 2 years. There were 212,498 women and 95,372 men with fracture followed by 30,677 and 19,519 deaths, respectively over 163,482 and 384,995 person-years of follow up. Mean age at fracture was 72± 11 for women and 75± 11 for men. Proximal fractures including hip, femur, pelvis, rib, clavicle and humerus had increased mortality compared with their matched non-fracture counterparts with HRs ranging from 1.5-4.0, while distal fractures such as ankle, forearm, hand or foot fractures had similar or lower mortality risk. Almost 75% of men and 60% of women had ≥1 comorbidity. For every additional comorbidity, risk of mortality increased for all fracture types. However, only for proximal fractures did the fracture itself independently increase mortality risk over and above co-morbidity status. The 2-yr post fracture admission and mortality patterns differed between proximal and distal fractures. Proximal, but not distal fracture subjects had greater risk of any major hospital admission (including cardiovascular disease, cancer, stroke, diabetes, pneumonia and pulmonary disease) within 2 years compared with their non-fracture counterparts. Distal fractures in general had similar admission patterns as their non-fractured matched counterparts. Furthermore, 2 year mortality risk was increased for proximal fractures whether or not they were admitted to hospital post fracture. By contrast, mortality risk was similar or reduced for distal fractures compared with non-fracture controls. This study has not only confirmed the increased mortality following proximal fractures but has demonstrated differing clinical trajectories between proximal and distal fractures that contribute to this increased mortality. These findings provide important insights as to why proximal fracture subjects die prematurely that may lead to specific avenues for intervention.
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Affiliation(s)
- Thach Tran
- Garvan Inst of Med Research, Sydney, Australia
| | - Dana Bliuc
- Garvan Inst of Med Research, Sydney, Australia
| | | | | | - Bo Abrahamsen
- Holbk Hospital and University of Southern Denmark, Holbk, Denmark
| | | | - Tineke van Geel
- Maastricht University Medical Center, Maastricht, Netherlands
| | - Piet Geusens
- Maastricht University Medical Center, Maastricht, Netherlands
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Yeap BB, Alfonso H, Chubb P, Center J, Beilin J, Hankey G, Almeida O, Golledge J, Norman P, Flicker L. SAT-033 U-Shaped Association of Plasma Testosterone, and No Association of Plasma Estradiol, with Incidence of Any Fracture and Hip Fracture in Older Men. J Endocr Soc 2020. [PMCID: PMC7209445 DOI: 10.1210/jendso/bvaa046.985] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Osteoporosis resulting in bone fractures is a major cause of morbidity in older men. Previous studies implicated reduced exposure to estradiol (E2) with increased fracture risk in men. The extent to which circulating androgens contribute to maintenance of bone health is uncertain. We examined associations of different sex hormones with incidence of any bone fracture or hip fracture in older men. We analysed 3,307 community-dwelling men aged 76.8±3.5 years, median follow-up period of 10.6 years. Medical information was collected by questionnaire. Frailty was assessed using the FRAIL scale (1). Early morning plasma testosterone (T), dihydrotestosterone (DHT) and E2 were assayed by mass spectrometry, sex hormone-binding globulin (SHBG) and luteinising hormone (LH) by immunoassay. Incidence of any fracture and hip fracture were determined via data linkage to emergency department presentations and hospital admissions. Risk of fracture according to sex hormone concentrations was analysed. Hazard ratio of fracture according to sex hormone quartiles (Q1-4) was assessed using Cox regression models adjusted for age, medical comorbidities and frailty. In 30,355 participant-years of follow-up, the incidence of any fracture was 1.1% and hip fracture 0.5% per participant per year. Incident fractures occurred in 330 men, including 144 hip fractures. Probability plots suggested non-linear relationships between hormones and risk of any fracture and hip fracture, with higher risk at lower and higher concentrations of plasma T, lower E2, higher SHBG and higher LH. In fully-adjusted models, there was a U-shaped association of plasma T with incidence of any fracture (Q1: reference group, Q2: fully-adjusted hazard ratio [HR]=0.69, 95% confidence interval [CI]=0.51-0.94, p=0.020; Q3: HR=0.59, CI=0.42-0.83, p=0.002; Q4: 0.85, CI=0.62-1.18, p=0.335). A similar U-shaped association of T was found with incidence of hip fracture (Q1: HR=1.0; Q2: HR=0.60, CI=0.37-0.93, p=0.043; Q3: HR=0.52, CI=0.31-0.88, p=0.015; Q4: HR=1.04, CI=0.65-1.68, p=0.866). DHT, E2 and LH were not associated with incidence of any fracture or hip fracture (all p>0.050). SHBG was not associated with incidence of any fracture, but was associated with hip fracture (Q4 vs Q1: HR=1.76, CI=1.05-2.96, p=0.033). In conclusion, we found a non-linear or U-shaped association of T with fracture risk, with no association of E2. Mid-range plasma T was associated with lower incidence of any fracture and hip fracture, and higher SHBG with increased risk of hip fracture. Circulating androgen rather than estrogen may be a biomarker for hormone effects on bone driving fracture risk. A randomised controlled trial of T therapy powered for the outcome of fracture may be warranted and should recruit men with baseline T in the lowest quartile of values. Reference: (1) Hyde Z, et al. J Clin Endocrinol Metab 2010; 95: 3165-3172.
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Affiliation(s)
- Bu Beng Yeap
- University of Western Australia, Perth, Australia
| | | | - Paul Chubb
- Fiona Stanley Hospital, Perth, Australia
| | | | | | | | | | | | - Paul Norman
- University of Western Australia, Perth, Australia
| | - Leon Flicker
- University of Western Australia, Perth, Australia
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9
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Abstract
Abstract
Fracture liaison services (FLS) address the treatment gap for those with osteoporosis (OP) who fracture and are not treated. Given the limited human resources in FLS, screening high volumes of radiology reports for fractures with Natural Language Processing (NLP) could identify patients that have not been recognized or treated. This study is an analytical and clinical validation of X-Ray Artificial Intelligence Tool software (XRAIT) at its development site (a tertiary hospital) and external validation in an adjudicated cohort from the Dubbo Osteoporosis Epidemiology Study (DOES).Methods: XRAIT uses NLP to perform a Boolean search of radiology reports for fracture and related terms. It can be trained for site-specific reporting styles and use rules to refine identification (e.g. age>50y; bone involved; etc). At the development site, XRAIT was used to search the emergency patient presentations of people over 50 years of age and compared to referrals to FLS (usual care) during the same 3-month period. XRAIT analyzed all plain radiographs and CT scans (n = 5089) while n = 224 were referred to FLS for usual care. External validation: XRAIT was used to analyze digitally readable radiology reports in an untrained cohort from DOES (n = 327) to calculate sensitivity and specificity.Results: XRAIT identified a 5-fold higher number of potential significant fractures (349/5089) compared to manual case finding (70/224). 339/349 were confirmed fractures (97.1%). Only 29% of those eligible were started or recommended anti-resorptive therapy, including those seen by the fracture liaison service. XRAIT unadjusted for the local radiology reporting styles in DOES had a sensitivity of 69.6% and specificity of 95%. Conclusion: XRAIT identifies clinically significant fractures efficiently with minimal additional human resources. Its high specificity in an untrained cohort suggests it could be used at other sites. Automated methods of patient identification may assist fracture liaison services to identify fractures that still remain largely untreated.
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Affiliation(s)
- Nithin Kolanu
- Garvan Institute of Medical Research, Sydney NSW, Australia
| | | | - Amanda Beech
- Prince of Wales Hospital, Randwick NSW, Australia
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10
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Frost SA, Kelly A, Gaudin J, Evoy LM, Wilson C, Marov L, El Haddad C, Center J, Eisman JA, Nguyen TV, Hassett G. Establishing baseline absolute risk of subsequent fracture among adults presenting to hospital with a minimal-trauma-fracture. BMC Musculoskelet Disord 2020; 21:133. [PMID: 32111200 PMCID: PMC7049191 DOI: 10.1186/s12891-020-3161-4] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background One in three women and one in five men are expected to experience a minimal-trauma-fracture after the age of 50-years, which increases the risk of subsequent fracture. Importantly, timely diagnosis and optimal treatment in the form of a fracture liaison service (FLS), has been shown to reduce this risk of a subsequent fracture. However, baseline risk of subsequent fracture among this group of FLS patients has not been well described. Therefore, this study aims to estimate absolute risk of subsequent fracture, among women and men aged 50-years or more, presenting to hospital with a minimal-trauma-fracture. Methods Women and men aged 50-years or more with a minimal-trauma-fracture, presenting to hospitals across the South Western Sydney Local Health District between January 2003 and December 2017 were followed to identify subsequent fracture presentations to hospital. Absolute risk of subsequent fracture was estimated, by taking into account the competing risk of death. Results Between January 2003 and December 2017–15,088 patients presented to the emergency departments of the five hospitals in the SWSLHD (11,149, women [74%]), with minimal-trauma-fractures. Subsequent fractures identified during the follow-up period (median = 4.5 years [IQR, 1.6–8.2]), occurred in 2024 (13%) patients. Death during the initial hospital stay, or during a subsequent hospital visit was recorded among 1646 patients (11%). Women were observed to have 7.1% risk of subsequent fracture after 1-year, following an initial fracture; and, the risk of subsequent fracture after 1-year was 6.2% for men. After 5-years the rate among women was 13.7, and 11.3% for men, respectively. Cumulative risk of subsequent fracture when initial fractures were classified as being at proximal or distal sites are also presented. Conclusion This study has estimated the baseline risk of subsequent fracture among women and men presenting to hospital with minimal trauma fractures. Importantly, this information can be used to communicate risk to patients deciding to attend an osteoporosis refracture prevention clinic, and highlight the need for screening, and initial of treatment when indicated, once a minimal-trauma-fracture has occurred.
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Affiliation(s)
- Steven A Frost
- SPHERE MSK Clinical Academic Group, Sydney, Australia. .,South Western Sydney Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia. .,Western Sydney University, Sydney, Australia. .,Faculty of Medicine, UNSW Sydney, Sydney, Australia. .,Garvan Institute of Medical Research, Darlinghurst, Australia. .,Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, South Western Sydney Local Health District (SWSLHD), Sydney, Australia.
| | - Ayano Kelly
- SPHERE MSK Clinical Academic Group, Sydney, Australia.,Liverpool Hospital, Sydney, Australia
| | - Julia Gaudin
- SPHERE MSK Clinical Academic Group, Sydney, Australia.,Liverpool Hospital, Sydney, Australia
| | | | | | | | - Carlos El Haddad
- Western Sydney University, Sydney, Australia.,Liverpool Hospital, Sydney, Australia.,Campbelltown Hospital, Sydney, Australia
| | - Jacqueline Center
- SPHERE MSK Clinical Academic Group, Sydney, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Garvan Institute of Medical Research, Darlinghurst, Australia
| | - John A Eisman
- SPHERE MSK Clinical Academic Group, Sydney, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Garvan Institute of Medical Research, Darlinghurst, Australia.,St Vincent's Hospital, Sydney, Australia.,School of Medicine, University of Notre Dame Australia, Sydney, Australia.,Visiting Professor, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Tuan V Nguyen
- SPHERE MSK Clinical Academic Group, Sydney, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Garvan Institute of Medical Research, Darlinghurst, Australia.,University of Technology Sydney, Sydney, NSW, Australia
| | - Geraldine Hassett
- SPHERE MSK Clinical Academic Group, Sydney, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Liverpool Hospital, Sydney, Australia
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11
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Muir C, Dwight T, Center J, Greenfield J, Clifton-Bligh R, Lee P. MON-378 Somatic HIF2α Mutation and Pheochromocytoma in a Patient with Cyanotic Congenital Heart Disease. J Endocr Soc 2019. [PMCID: PMC6550643 DOI: 10.1210/js.2019-mon-378] [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: 11/19/2022] Open
Abstract
Background: Pheochromocytoma and paraganglioma (PPGL) prevalence is increased in cyanotic congenital heart disease relative to the unaffected population. Chronic hypoxemia promotes stabilization of hypoxia inducible factors (HIFs), which activate downstream hypoxia responsive genes. Somatic mutations in EPAS1 (HIF2α) distort the conformational properties of HIF2α, allowing for avoidance of normally rapid oxygen-dependent enzymatic degradation. EPAS1 mutations have been implicated in PPGL and have recently been proposed to mediate the increased rates of PPGL observed in patients with cyanotic congenital heart disease. Clinical Case: A 48 year old woman with Eisenmenger’s syndrome secondary to congenital ventricular septal defect was admitted to hospital for combined heart and bilateral lung transplantation. Severe pulmonary hypertension with hypoxic respiratory failure had been present for >15 years pre-transplant, and during the 12 months directly preceding admission oxygen saturations routinely measured below 80%. Surgery was complicated by major bleeding and prolonged intraoperative hypotension necessitating initiation of extracorporeal membranous oxygenation to achieve hemodynamic stability. The patient was admitted to the intensive care unit for post-surgical management and within hours of arrival developed paroxysms of pronounced hypertension during which the systolic blood pressure repeatedly exceeded 230 mmHg. On each occasion the hypertensive episode was self-limiting and followed by a period of marked hypotension requiring maximal inotropic support. Plasma metanephrine and normetanephrine concentrations were elevated at 1.00 nmol/L (NR <0.4) and 8.00 nmol/L (NR <0.9) respectively. Computed tomography demonstrated adrenal lesions measuring 18x22x21 mm on the right and 39x38x42 mm on the left. Both adrenal masses were gallium-68 DOTATATE PET-CT avid and pathologic extra-adrenal DOTATATE avidity was not present. The left adrenal tumour was histologically confirmed as PPGL. Histology of the right adrenal gland was unremarkable, but pathologic examination of an extra-adrenal mass identified during surgery was consistent with PPGL. Immunohistochemistry was positive for synaptophysin, chromogranin, CD56 and SDHB in both tumours. Germline mutation screening was negative for pathologic variants in the known PPGL susceptibility genes, but tumour DNA isolated from formalin-fixed paraffin embedded sections identified a pathogenic HIF2α mutation (c.1589C>T, p.Ala530Val) in the left phaeochromocytoma. This variant was not observed in the right PPGL and both PPGL were negative for other known PPGL gene mutations. Conclusions: Chronic hypoxia associated with cyanotic heart conditions may be a risk factor for development of PPGL. Increased risk appears to be mediated, at least in part, through somatic gain of function mutations in the HIF2α gene.
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Affiliation(s)
| | | | - Jacqueline Center
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, , Australia
| | - Jerry Greenfield
- DIABETES & OBESITY RES PROGRAM, Garvan Institute of Medical Research, Sydney, , Australia
| | | | - Paul Lee
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, , Australia
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12
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Affiliation(s)
- Grahame J Elder
- Department of Renal Medicine; Westmead Hospital; Westmead Australia
- Osteoporosis and Bone Biology Division; Garvan Institute of Medical Research; Darlinghurst Australia
| | - Jacqueline Center
- Osteoporosis and Bone Biology Division; Garvan Institute of Medical Research; Darlinghurst Australia
- Department of Endocrinology; St Vincent's Hospital; Darlinghurst Australia
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13
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Chen W, Slattery A, Center J, Pocock N. The Effect of Changing Scan Mode on Trabecular Bone Score Using Lunar Prodigy. J Clin Densitom 2016; 19:502-506. [PMID: 26896337 DOI: 10.1016/j.jocd.2016.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 08/07/2015] [Revised: 12/27/2015] [Accepted: 01/06/2016] [Indexed: 11/27/2022]
Abstract
Trabecular bone score (TBS) is a measure of gray scale homogeneity that correlates with trabecular microarchitecture and is an independent predictor of fracture risk. TBS is being increasingly used in the assessment of patients at risk of osteoporosis and has recently been incorporated into FRAX®. GE Lunar machines acquire spine scans using 1 of 3 acquisition modes depending on abdominal tissue thickness (thin, standard, and thick). From a database review, 30 patients (mean body mass index: 30.8, range 26.2-34.1) were identified who had undergone lumbar spine DXA scans (GE Lunar Prodigy, software 14.10; Lunar Radiation Corporation, Madison, WI) in both standard mode and thick mode, on the same day with no repositioning. Lumbar spine bone mineral density (L1-L4) and TBS were derived from the 30 paired spine scans. There was no significant difference in lumbar spine bone mineral density between the 2 scanning modes. There were, however, significant higher TBS values from the spine scans acquired in thick mode compared to the TBS values derived from spine acquisitions in standard mode (mean TBS difference: 0.24 [20%], standard deviation ±0.10). In conclusion, these preliminary data suggest that TBS values acquired in the GE Lunar Prodigy are dependent on the scanning mode used. Further evaluation is required to confirm the cause and develop appropriate protocols.
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Affiliation(s)
- Weiwen Chen
- Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, Australia
| | - Anthony Slattery
- Department of Nuclear Medicine, St Vincent's Hospital, Sydney, Australia
| | - Jacqueline Center
- Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, Australia
| | - Nicholas Pocock
- Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, Australia.
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14
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Omsland TK, Emaus N, Tell GS, Magnus JH, Ahmed LA, Holvik K, Center J, Forsmo S, Gjesdal CG, Schei B, Vestergaard P, Eisman JA, Falch JA, Tverdal A, Søgaard AJ, Meyer HE. Mortality following the first hip fracture in Norwegian women and men (1999-2008). A NOREPOS study. Bone 2014; 63:81-6. [PMID: 24607943 DOI: 10.1016/j.bone.2014.02.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [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: 11/08/2013] [Revised: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Abstract
Hip fractures are associated with increased mortality and their incidence in Norway is one of the highest worldwide. The aim of this nationwide study was to examine short- and long-term mortality after hip fractures, burden of disease (attributable fraction and potential years of life lost), and time trends in mortality compared to the total Norwegian population. Information on incident hip fractures between 1999 and 2008 in all persons aged 50 years and older was collected from Norwegian hospitals. Death and emigration dates of the hip fracture patients were obtained through 31 December 2010. Standardized mortality ratios (SMRs) were calculated and Poisson regression analyses were used for the estimation of time trends in SMRs. Among the 81,867 patients with a first hip fracture, the 1-year excess mortality was 4.6-fold higher in men, and 2.8-fold higher in women compared to the general population. Although the highest excess mortality was observed during the first two weeks post fracture, the excess risk persisted for twelve years. Mortality rates post hip fracture were higher in men compared to women in all age groups studied. In both genders aged 50 years and older, approximately 5% of the total mortality in the population was related to hip fractures. The largest proportion of the potential life-years lost was in the relatively young-old, i.e. less than 80 years. In men, the 1-year absolute mortality rates post hip fracture declined significantly between 1999 and 2008, by contrast, the mortality in women increased significantly relatively to the population mortality.
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Affiliation(s)
- Tone K Omsland
- Department of Global Public Health and Primary Care, University of Bergen, Norway; Institute of Health and Society, Department of Community Medicine, University of Oslo, Norway; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
| | - Nina Emaus
- Department of Health and Care Sciences, University of Tromsø, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Jeanette H Magnus
- Institute of Health and Society, Department of Community Medicine, University of Oslo, Norway
| | - Luai Awad Ahmed
- Department of Health and Care Sciences, University of Tromsø, Norway
| | - Kristin Holvik
- Department of Global Public Health and Primary Care, University of Bergen, Norway; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Jacqueline Center
- Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Siri Forsmo
- Institute of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Clara G Gjesdal
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Berit Schei
- Institute of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Obstetrics and Gynecology, St. Olav's University Hospital, Trondheim, Norway
| | | | - John A Eisman
- Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, Sydney, NSW, Australia; Clinical Translation and Advanced Education, Garvan Institute of Medical Research, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Jan A Falch
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Aage Tverdal
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Haakon E Meyer
- Institute of Health and Society, Department of Community Medicine, University of Oslo, Norway; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
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15
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Geusens P, van Geel T, Bours S, Eisman J, Center J, van den Bergh J. THU0398 Most Patients with a Recent Fracture after the Age of 50 Years are not Predicted to be at High Risk: The Fracture Prevention Paradox. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.926] [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: 11/04/2022]
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16
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Kuo I, Ong C, Simmons L, Bliuc D, Eisman J, Center J. Successful direct intervention for osteoporosis in patients with minimal trauma fractures. Osteoporos Int 2007; 18:1633-9. [PMID: 17603741 DOI: 10.1007/s00198-007-0418-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [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: 02/14/2007] [Accepted: 05/30/2007] [Indexed: 10/23/2022]
Abstract
UNLABELLED In this study, we offered osteoporosis investigation and treatment directly to patients at out-patient fracture clinics shortly after they sustained minimal trauma fractures. We achieved long-term compliance to the recommended investigation and treatment in 80% of patients. This approach is much more successful than previous interventions. INTRODUCTION Osteoporosis remains under-treated in minimal-trauma fracture subjects. The aim of this study was to determine if direct intervention at orthopaedic fracture clinics would improve post-fracture management in these subjects. METHODS From March 2004 to March 2006, 155 consecutive minimal-trauma fracture subjects (mean age 64.0 +/- 17.6) attending fracture clinics at St. Vincent's Hospital, Sydney, had a specific medical assessment, following which they were recommended BMD and laboratory testing. Treatment recommendations were given after review of investigations with further follow-up at a median of 8.6 months following therapy. Comparison of outcomes was made with a similar group of patients given written information 2 years prior. RESULTS At baseline, 47% of patients had prior fractures, but only 26% had had BMD screening. Twenty-one percent were on anti-resorptive therapy, and 15% were on calcium/vitamin D. Following intervention, 83% had a BMD and of these, 68% had a T-score < -1.0. Of treatment naïve patients, 44% were recommended anti-resorptive therapy and 56% were recommended calcium/vitamin D. Compliance was 80% for anti-resorptive and 76% for calcium/vitamin D. Female gender and lower BMD were predictors of compliance. CONCLUSION Compared with information-based intervention, direct intervention improved management two to fivefold, maintaining long-term treatment in 90% of osteoporotic and 73% of osteopenic subjects requiring therapy.
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Affiliation(s)
- I Kuo
- Bone and Mineral Research Program, Garvan Institute of Medical Research, Sydney, NSW, Australia.
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17
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Port L, Center J, Briffa NK, Nguyen T, Cumming R, Eisman J. Osteoporotic fracture: missed opportunity for intervention. Osteoporos Int 2003; 14:780-4. [PMID: 12904835 DOI: 10.1007/s00198-003-1452-x] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.4] [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: 12/10/2002] [Accepted: 05/23/2003] [Indexed: 11/26/2022]
Abstract
As prior fracture is consistently associated with increased risk of subsequent fracture, subjects with a history of prior fracture represent a high risk group which should be targeted for intervention to reduce future fracture rates. The aim of this study was to investigate whether prior osteoporotic fracture affected treatment patterns among subjects admitted with hip fractures. All hip fracture admissions to two major teaching hospitals of the University of New South Wales, Sydney, Australia, over the 12-month period between July 1997 and June 1998 were identified retrospectively from medical records. Patient demographics, frequency and location of prior fractures, and treatment status on admission were recorded. There were a total of 348 atraumatic hip fracture admissions over this 12-month period. Forty five percent of 251 women and 30% of 97 men with an osteoporotic hip fracture had a known prior fracture, including prior hip fracture in 19% of the women and 8% of the men. Among subjects with prior fractures, only 18% of women and 7% of men were on any specific anti-osteoporosis therapy. Even among those with a prior hip fracture, only 21% of women and none of the men were taking optimal appropriate therapy. A high proportion of individuals suffering hip fractures had sustained prior "signal" fractures. Although more subjects with prior fracture received treatment than those without prior fracture, total treatment levels were low, and the majority of high-risk subjects did not receive therapy shown to reduce the risk of further fractures.
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Affiliation(s)
- Leah Port
- Bone and Mineral Research Program, Garvan Institute of Medical Research, St Vincent's Hospital, 384 Victoria Street, 2010 Sydney, NSW, Australia
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18
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Abstract
Prevalence of and risk factors for osteoporosis in a community population of 94 young adults with mental retardation was examined. Results show lower bone mineral density in this group than in an age-matched reference population. Factors associated with low bone mineral density included small body size, hypogonadism, and Down syndrome in both genders and a high phosphate level in females. Low vitamin D levels were common in both genders, despite high levels of exposure to sunshine. A history of fracture was also common. Low bone mineral density and fracture were associated in females but not males. Because morbidity following fracture is likely to be more serious in this population, further investigation of osteoporosis and prevention strategies for both osteoporosis and fractures are important.
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Affiliation(s)
- J Center
- Royal North Shore Hospital, St Leonards, Australia
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19
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Abstract
Osteoporosis is an increasing health care concern as populations age throughout the developed and developing world. The social and economic costs of osteoporosis are due to its clinical outcome of fracture which increases exponentially with age. This review will highlight some of the key epidemiological aspects of osteoporosis incorporating areas of more recent interest. These include the definition; the magnitude of the problem encompassing differing incidence and prevalence patterns of both low bone mass and fracture in different cultural groups; the social consequences of fracture, including economic costs, morbidity and mortality; the evaluation of fracture risk, including the role of bone density, bone quality and the risk of falling; as well as an overview of some of the factors involved in determining low bone mass. Bone mineral density (BMD) is the most easily measured and accurate predictor of fracture risk. For any individual, BMD is the combination of their peak bone density and subsequent bone loss, both of which are influenced by genetic, hormonal and environmental factors. An understanding of key issues relating to this important disease may lead to earlier detection of the individual at high risk for fracture and rational approach to prevention and management.
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Affiliation(s)
- J Center
- University of New South Wales, Sydney, Australia
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